@Article{info:doi/10.2196/66436,
author="Omole, Daniel Toluwa
and Mrkva, Andrew
and Ferry, Danielle
and Shepherd, Erin
and Caratelli, Jessica
and Davis, Noah
and Akatue, Richmond
and Bickmore, Timothy
and Paasche-Orlow, K. Michael
and Magnani, W. Jared",
title="Augmenting Engagement in Decentralized Clinical Trials for Atrial Fibrillation: Development and Implementation of a Programmatic Architecture",
journal="JMIR Cardio",
year="2025",
month="May",
day="12",
volume="9",
pages="e66436",
keywords="atrial fibrillation",
keywords="rurality",
keywords="diversity",
keywords="mobile health intervention",
keywords="mobile health",
keywords="mhealth",
keywords="chronic cardiovascular condition",
keywords="cardiovascular",
keywords="cardio",
keywords="heart",
keywords="vascular",
keywords="medication",
keywords="self-monitoring",
keywords="digital health",
keywords="programmatic architecture",
keywords="effectiveness",
keywords="smartphone-based",
keywords="smartphone",
keywords="telehealth",
keywords="telemedicine",
keywords="digital technology",
keywords="application",
keywords="digital literacy",
keywords="clinical trial",
keywords="cardiovascular trials",
abstract="Background: Atrial fibrillation (AF) is a chronic cardiovascular condition that requires long-term adherence to medications and self-monitoring. Clinical trials for AF have had limited diversity by sex, race and ethnicity, and rural residence, thereby compromising the integrity and generalizability of trial findings. Digital technology coupled with remote strategies has the potential to increase recruitment of individuals from underrepresented demographic and geographic populations, resulting in increased trial diversity, and improvement in the generalizability of interventions for complex diseases such as AF. Objective: This study aimed to summarize the architecture of a research program using remote methods to enhance geographic and demographic diversity in mobile health trials to improve medication adherence. Methods: We developed a programmatic architecture to conduct remote recruitment and assessments of individuals with AF in 2 complementary randomized clinical trials, funded by the National Institutes of Health, to test the effectiveness of a smartphone-based relational agent on adherence to oral anticoagulation. The study team engaged individuals with either rural or metropolitan residences receiving care for AF at health care settings who then provided consent, and underwent baseline assessments and randomization during a remotely conducted telephone visit. Participants were randomized to receive the relational agent intervention or control and subsequently received a study smartphone with installed apps by mail. Participants received a telephone-based training session on device and app usage accompanied by a booklet with pictures and instructions accessible for any level of health or digital literacy. The program included remote methods by mail and telephone to promote retention at 4-, 8-, and 12-month visits and incentivized return of the smartphone following study participation. The program demonstrated excellent participant engagement and retention throughout the duration of the clinical trials. Results: The trials enrolled 513 participants, surpassing recruitment goals for the rural (n=270; target n=264) and metropolitan (n=243; target n=240) studies. A total of 62\% (319/513) were women; 31\% (75/243) of participants in the metropolitan study were African American, Asian, American Indian or Alaskan native or other races or ethnicities, in contrast to 5\% (12/270) in the rural study. Among all participants, 56\% (286/513) had less than an associate's degree and 44\% (225/513) were characterized as having limited health literacy. Intervention recipients receiving the relational agent used the agent median of 95?98 (IQR, 56?109) days across both studies. Retention exceeded 89\% (457/513) at 12 months with study phones used for median 3.3 (IQR, 1?5) participants. Conclusions: We report here the development and implementation of a programmatic architecture for the remote conduct of clinical trials. Our program successfully enhanced trial diversity and composition while providing an innovative mobile health intervention for medication adherence in AF. Our methods provide a model for enhanced recruitment and engagement of diverse participants in cardiovascular trials. Trial Registration: Clinicaltrials.gov NCT04076020; https://clinicaltrials.gov/study/NCT04076020 and Clinicaltrials.gov NCT04075994; https://clinicaltrials.gov/study/NCT04075994 ",
doi="10.2196/66436",
url="https://cardio.jmir.org/2025/1/e66436"
}


@Article{info:doi/10.2196/58577,
author="Tijani, Bosun
and Igbokwe, Uchenna
and Filani, Temi
and Adewemimo, Adefemi
and Ameyan, Lola
and Iyekekpolor, Martins
and Karera, Steven
and Oluyide, Olatunji
and Ezike, Emmanuela
and Akinreni, Temidayo
and Ogefere, Obruche
and Adetimilehin, Victor
and Amasiatu, Valentine
and Nwaokorie, Chukwunonso
and Kangkum, Naanma
and Fasawe, Olufunke
and Aigbogun Jr, Eric",
title="Improving Access to and Delivery of Maternal Health Care Services to Prevent Postpartum Hemorrhage in Selected States in Nigeria: Human-Centered Design Study",
journal="JMIR Hum Factors",
year="2025",
month="May",
day="7",
volume="12",
pages="e58577",
keywords="human-centered design",
keywords="postpartum hemorrhage",
keywords="maternal health",
keywords="health care services",
keywords="maternal",
keywords="health care",
keywords="service",
keywords="postpartum",
keywords="facility",
keywords="uterotonic",
keywords="supply chain",
keywords="Nigeria",
keywords="interview",
keywords="focus group",
keywords="pregnant",
keywords="female",
keywords="health care workers",
keywords="stakeholder",
keywords="participatory",
keywords="prevention",
keywords="treatment",
keywords="hospital setting",
keywords="community",
abstract="Background: A significant cause of postpartum hemorrhage (PPH) is access to and delivery of maternal health care services. Several multisectoral strategies have been deployed to address the challenges with little success, thereby necessitating the use of human-centered design (HCD) to enhance health care delivery, particularly in PPH management. Objective: This study aims to develop facility-level solutions for optimizing uterotonic supply chain systems and health service delivery in PPH management through an HCD approach in selected Nigerian states. Methods: The research used a four-phase HCD methodology: (1) co-research, (2) co-design, (3) co-refinement, and (4) implementation. However, this paper focused on the first 3 phases. In the co-research phase, 203 interviews were conducted, involving 80 pregnant women and nursing mothers, 97 health care workers, and 26 key stakeholders. Additionally, 33 sites were observed across a 3-level continuum of care. Interviews and focus group discussions revealed insights into the distribution of health workers and observed PPH cases, alongside knowledge and administration of uterotonics. Data analysis was carried out using three key steps: (1) identifying key themes from the collected data, (2) developing insight statements that encapsulate these themes, and (3) translating each insight statement into actionable design opportunities. Results: About 150 ideas were produced and translated into 12 solution prototypes in the co-design phase. Progressive refinement following feedback from 140 stakeholders led to the selection of three final solutions: (1) implementing a referral linkage system to improve the transportation of pregnant women to nearby health facilities, (2) increasing demand for antenatal care services among pregnant women and their families, and (3) delivering a comprehensive uterotonic logistics management program for streamlined uterotonic storage and management. Conclusions: This approach aligns with global health trends advocating for HCD integration in health care programming and aims to empower local champions to drive sustainable improvements in maternal health outcomes. Judicious implementation of the developed prototypes across the states can strengthen clinical care and potentially reduce maternal health service delivery gaps. ",
doi="10.2196/58577",
url="https://humanfactors.jmir.org/2025/1/e58577"
}


@Article{info:doi/10.2196/68434,
author="Lamas, Almeida Celina de
and Santana Alves, Gabriela Patr{\'i}cia
and Nader de Ara{\'u}jo, Luciano
and de Souza Paes, Beatriz Ana
and Cielo, Claudia Ana
and Maciel de Almeida Lopes, Luciana
and Longo Ara{\'u}jo de Melo, Andr{\'e}
and Yokoyama, Thais
and Pagani Savastano, Clarice
and Gobi Scudeller, Paula
and Carvalho, Carlos
and ",
title="Telehealth Initiative to Enhance Primary Care Access in Brazil (UBS+Digital Project): Multicenter Prospective Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="29",
volume="27",
pages="e68434",
keywords="telehealth",
keywords="public health service",
keywords="innovation",
keywords="primary health care",
keywords="digital health",
abstract="Background: Brazil faces significant inequities in health care access, particularly in remote communities. The Brazilian Unified Health System is struggling to deliver adequate health care to its vast population. Telehealth, regulated in Brazil starting in 2022, emerged as a solution to improve access and quality of care. Thus, the Hospital das Cl{\'i}nicas da Faculdade de Medicina da Universidade de S{\~a}o Paulo, in partnership with the Ag{\^e}ncia Brasileira de Apoio {\`a} Gest{\~a}o do Sistema {\'U}nico de Sa{\'u}de, created the Unidade B{\'a}sica de Sa{\'u}de (UBS)+Digital project, which aimed to mitigate the lack of medical care in remote areas of Brazil by providing teleconsultation in primary health units (PHUs) across the country. Through teletraining and digital health strategies, the initiative enabled health care professionals to provide remote assistance, improving access to medical care. Objective: To describe the implementation and results of the UBS+Digital project, a telehealth initiative focused on training health care professionals, providing teleconsultations, and monitoring key performance indicators among PHUs in Brazil. Methods: The study examined 15 Brazilian PHUs using a multicenter, prospective design. Data were collected through anonymous surveys of patients and physicians, which were recorded in the REDCap (Research Electronic Data Capture) database. PHUs were selected based on criteria such as the absence of an on-site physician and existing technological infrastructure. Synchronous and asynchronous training was provided, focusing on digital health and teleconsultation skills. In loco training included workshops and community events to share experiences and foster local engagement. A community of practice facilitated ongoing knowledge exchange. Teleconsultations followed the person-centered clinical method and Calgary-Cambridge methodology. Key performance indicators were monitored by a dashboard to guide continuous improvement. The transition of operations was managed based on physician availability and project duration. Microcosting analysis assessed the project's economic impact using Brazilian guidelines, with statistical analysis performed using Jamovi software. Results: From March to November 2023, the project conducted 6312 telehealth sessions. A total of 342 professionals were trained, including participants from all three training modalities that were implemented. The Net Promoter Score for teleconsultations was 97, indicating excellent service quality. Of the teleconsultations, 65.3\% (4009/6140) were prescheduled, and 34.7\% (2130/6140) were on demand, depending on the family health team organization. Teleconsultations resolved 85\% (5219/6140) of cases, with 15\% (921/6140) requiring in-person referrals or emergency care. The average absenteeism rate was 15\% (1083/7223), and consultation durations were between 15 and 20 minutes, suggesting potential adjustments in scheduling. Conclusions: The results highlight the effectiveness of telehealth programs in primary care settings with limited medical professionals. The UBS+Digital project demonstrated that telehealth can enhance health care access, presenting a pioneering model within the Brazilian Unified Health System for digital primary care. ",
doi="10.2196/68434",
url="https://www.jmir.org/2025/1/e68434"
}


@Article{info:doi/10.2196/49363,
author="Goh, Huat Kim
and Yeow, Kwang Adrian Yong
and Wang, Le
and Poh, Hermione
and Ng, Hui Hannah Jia
and Tan, Gamaliel
and Wee, Khai Soon
and Lim, Luen Er
and D'Souza, Andre Jared Louis",
title="The Benefits of Integrating Electronic Medical Record Systems Between Primary and Specialist Care Institutions: Mixed Methods Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="22",
volume="27",
pages="e49363",
keywords="EMR integration",
keywords="primary care",
keywords="specialist care",
keywords="medical neighborhood",
keywords="efficiency",
abstract="Background: The benefits of a fully integrated electronic medical record (EMR) system across primary and specialist care institutions have yet to be formally established. Integrating the EMR systems between primary and specialist care is the first step in building a medical neighborhood. A medical neighborhood is a set of policies and procedures implemented through integrated systems and processes that support the joint management of patient care across primary care physicians, specialist physicians, and other health care providers. Objective: This study aims to quantify the impacts of integrating the EMR systems of primary and specialist care institutions in the process of developing a medical neighborhood. The impacts are operationalized in both quantitative and qualitative measures, measuring the benefits of such an integration in 3 specific areas, namely, patient diagnosis tracking, patient care management, and patient coordination. Methods: A comprehensive, mixed methods examination was conducted using 3 different data sources (EMR consultation data, clinician survey data, and in-depth interviews). The EMR data consist of patient encounters referred to a specialist clinic from 6 primary care providers before and after integrating the EMR system into the primary and specialist care institutions. We analyzed 25,404 specialist consultation referrals to the specialist clinics by the primary care partners for a 12-month period, during which the integration of the EMR system was conducted. A cohort empirical investigation was used to identify the quantitative impacts of the EMR integration, and a follow-up survey was conducted with the clinicians 18 months post integration. The clinicians' perceptions of the integration were measured to triangulate the empirical observation from the patient encounters, and the postimplementation perception survey was analyzed to triangulate the empirical investigation of consultation instances of the earlier cohort. Concurrently, a total of 30 interviews were conducted between March 16, 2021, and July 28, 2021, with clinicians and operations staff to gather on-the-ground sentiments engendered by this integration, which further informed our quantitative findings. Results: The integration of EMR systems between primary and specialist care institutions was associated with benefits in patient diagnosis tracking, patient care management, and patient coordination. Specifically, it was found that the integration resulted in a decrease in wait time for specialist appointments of an average of 16.5 days (P<.001). Patients were also subjected to fewer repeated procedures and tests; the number of procedures (P=.006), radiographies (P=.02), and overall bill sizes (P=.004) all decreased by between 4.08\% and 39.7\%, resulting in reduced health care resource wastage while maintaining similar medical outcomes (P=.37). Conclusions: Our study's results are among the first instances of empirical evidence to show that the integration and sharing of data between primary and specialist care institutions promote continuity in health care delivery and joint patient management in a medical neighborhood. The findings go beyond the traditional benefits of improved referral communication, as shown in prior literature. ",
doi="10.2196/49363",
url="https://www.jmir.org/2025/1/e49363"
}


@Article{info:doi/10.2196/71777,
author="Li, Haoran
and Zhang, Jingya
and Zhang, Ning
and Zhu, Bin",
title="Advancing Emergency Care With Digital Twins",
journal="JMIR Aging",
year="2025",
month="Apr",
day="21",
volume="8",
pages="e71777",
keywords="emergency care",
keywords="digital twin",
keywords="prehospital emergency care",
keywords="in-hospital emergency care",
keywords="recovery",
doi="10.2196/71777",
url="https://aging.jmir.org/2025/1/e71777"
}


@Article{info:doi/10.2196/68757,
author="McCabe, Catherine
and Connolly, Leona
and Quintana, Yuri
and Weir, Arielle
and Moen, Anne
and Ingvar, Martin
and McCann, Margaret
and Doyle, Carmel
and Hughes, Mary
and Brenner, Maria",
title="How to Refine and Prioritize Key Performance Indicators for Digital Health Interventions: Tutorial on Using Consensus Methodology to Enable Meaningful Evaluation of Novel Digital Health Interventions",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="16",
volume="27",
pages="e68757",
keywords="digital health interventions",
keywords="key performance indicators",
keywords="Delphi technique",
keywords="consensus methodology",
keywords="drug-related side effects and adverse reactions",
keywords="referral",
keywords="consultation",
doi="10.2196/68757",
url="https://www.jmir.org/2025/1/e68757"
}


@Article{info:doi/10.2196/58264,
author="Elg, Mattias
and Kabel, Daan
and Gremyr, Ida
and Olsson, Jesper
and Martin, Jason
and Smith, Frida",
title="Identification and Categorization of the Distinct Purposes Underpinning the Use of Digital Health Care Self-Monitoring: Qualitative Study of Stakeholders in the Health Care Ecosystem",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="3",
volume="27",
pages="e58264",
keywords="self-monitoring",
keywords="healthcare provider",
keywords="medtech provider",
keywords="digital health",
keywords="healthcare ecosystem",
keywords="qualitative study",
keywords="technology",
keywords="semi structured interview",
keywords="macro perspective",
keywords="telehealth",
keywords="telemonitoring",
abstract="Background: Digital health care self-monitoring has gained prominence as a tool to address various challenges in health care, including patient autonomy, data-informed decision-making, and organizational improvements. However, integrating self-monitoring solutions across a diverse ecosystem of stakeholders---patients, health care providers, policy makers, and industry---can be complicated by differing priorities and needs. Objective: This study aimed to identify and categorize the distinct purposes underpinning the use of digital health care self-monitoring. By mapping these purposes, the research seeks to clarify how technology design and implementation can be better aligned with stakeholder expectations, thereby enhancing adoption and impact. Methods: A qualitative design was used, drawing on 31 in-depth, semistructured interviews conducted with stakeholders in the Swedish health care ecosystem. Participants included patients, advocacy groups, health care professionals, policy makers, pharmaceutical representatives, and technology developers. Data were analyzed thematically using an inductive coding approach supported by NVivo 12 (Lumivero). Emerging themes were refined through iterative discussion among the research team and validated by presentation to health care practitioners. Results: A total of 8 distinct purposes of digital health care self-monitoring emerged: (1) emancipate (enhance patient autonomy), (2) learn (understand health behaviors), (3) improve (enhance patient health), (4) engage (bolster patient involvement), (5) control (manage adherence and symptoms), (6) evaluate (assess health parameters), (7) innovate (advance interventions and processes), and (8) generate (drive new initiatives). These purposes form three categories of value creation: (1) improving the patient-provider link, (2) leveraging big data analytics for knowledge creation, and (3) using digital infrastructure to develop new care processes. Conclusions: Our findings demonstrate that digital health care self-monitoring serves multifaceted aims, ranging from individual patient empowerment to ecosystem-wide innovation. Designing and implementing these tools with an explicit understanding of all stakeholders' ``why'' can help address potential conflicts (eg, balancing patient autonomy with clinical control) and facilitate more holistic adoption. Ultimately, this study underscores the importance of clear, purpose-driven approaches to promote better health outcomes, knowledge generation, and care process improvements. ",
doi="10.2196/58264",
url="https://www.jmir.org/2025/1/e58264"
}


@Article{info:doi/10.2196/54143,
author="Gray, Kathleen
and Butler-Henderson, Kerryn
and Day, Karen",
title="A Digitally Capable Aged Care Workforce: Demands and Directions for Workforce Education and Development",
journal="JMIR Aging",
year="2025",
month="Apr",
day="2",
volume="8",
pages="e54143",
keywords="aged care",
keywords="digital health",
keywords="digital literacy",
keywords="education",
keywords="older adults",
keywords="professional development",
keywords="digital transformation",
keywords="digital resources",
keywords="users",
keywords="community",
keywords="learning",
keywords="support",
keywords="safe",
keywords="ethical",
keywords="satisfaction",
doi="10.2196/54143",
url="https://aging.jmir.org/2025/1/e54143"
}


@Article{info:doi/10.2196/70789,
author="Chen, Jun
and Liu, Yu
and Liu, Peng
and Zhao, Yiming
and Zuo, Yan
and Duan, Hui",
title="Adoption of Large Language Model AI Tools in Everyday Tasks: Multisite Cross-Sectional Qualitative Study of Chinese Hospital Administrators",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="1",
volume="27",
pages="e70789",
keywords="large language model",
keywords="artificial intelligence",
keywords="health care administration",
keywords="technology adoption",
keywords="hospital administrator",
keywords="qualitative study",
keywords="barriers to adoption",
abstract="Background: Large language model (LLM) artificial intelligence (AI) tools have the potential to streamline health care administration by enhancing efficiency in document drafting, resource allocation, and communication tasks. Despite this potential, the adoption of such tools among hospital administrators remains understudied, particularly at the individual level. Objective: This study aims to explore factors influencing the adoption and use of LLM AI tools among hospital administrators in China, focusing on enablers, barriers, and practical applications in daily administrative tasks. Methods: A multicenter, cross-sectional, descriptive qualitative design was used. Data were collected through semistructured face-to-face interviews with 31 hospital administrators across 3 tertiary hospitals in Beijing, Shenzhen, and Chengdu from June 2024 to August 2024. The Colaizzi method was used for thematic analysis to identify patterns in participants' experiences and perspectives. Results: Adoption of LLM AI tools was generally low, with significant site-specific variations. Participants with higher technological familiarity and positive early experiences reported more frequent use, while barriers such as mistrust in tool accuracy, limited prompting skills, and insufficient training hindered broader adoption. Tools were primarily used for document drafting, with limited exploration of advanced functionalities. Participants strongly emphasized the need for structured training programs and institutional support to enhance usability and confidence. Conclusions: Familiarity with technology, positive early experiences, and openness to innovation may facilitate adoption, while barriers such as limited knowledge, mistrust in tool accuracy, and insufficient prompting skills can hinder broader use. LLM AI tools are now primarily used for basic tasks such as document drafting, with limited application to more advanced functionalities due to a lack of training and confidence. Structured tutorials and institutional support are needed to enhance usability and integration. Targeted training programs, combined with organizational strategies to build trust and improve accessibility, could enhance adoption rates and broaden tool use. Future quantitative investigations should validate the adoption rate and influencing factors. ",
doi="10.2196/70789",
url="https://www.jmir.org/2025/1/e70789"
}


@Article{info:doi/10.2196/70404,
author="Mackwood, Matthew
and Fisher, Elliott
and Schmidt, O. Rachel
and O'Malley, James A.
and Rodriguez, P. Hector
and Shortell, Stephen
and Akr{\'e}, Ellesse-Roselee
and Berube, Alena
and Schifferdecker, E. Karen",
title="Primary Care Practice Factors Associated With Telehealth Adoption in the United States: Cross-Sectional Survey Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e70404",
keywords="telehealth",
keywords="telemedicine",
keywords="remote consultation",
keywords="primary health care",
keywords="general practice",
keywords="internet access",
keywords="health policy",
keywords="health care economics and organizations",
keywords="access to primary care",
keywords="digital divide",
keywords="vulnerable populations",
keywords="medically underserved area",
doi="10.2196/70404",
url="https://www.jmir.org/2025/1/e70404"
}


@Article{info:doi/10.2196/65863,
author="Hagiwara, Yuta
and Adachi, Takuji
and Kanai, Masashi
and Shimizu, Kotoe
and Ishida, Shinpei
and Miki, Takahiro",
title="Interactive Effects of Weight Recording Frequency and the Volume of Chat Communication With Health Care Professionals on Weight Loss in mHealth Interventions for Noncommunicable Diseases: Retrospective Observational Study",
journal="Interact J Med Res",
year="2025",
month="Mar",
day="27",
volume="14",
pages="e65863",
keywords="weight change",
keywords="behavior modification",
keywords="health care communication",
keywords="weight recording",
keywords="chat communication",
keywords="text communication",
keywords="health care professionals",
keywords="weight loss",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="digital health",
keywords="smartphone",
keywords="mobile health intervention",
keywords="noncommunicable disease",
keywords="NCD",
keywords="weight loss outcome",
keywords="obesity",
keywords="overweight",
keywords="retrospective study",
keywords="observational study",
keywords="cerebrovascular disease",
keywords="cardiovascular disease",
keywords="lifestyle modification",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps are increasingly used for health promotion, particularly for managing noncommunicable diseases (NCDs) through behavior modification. Understanding the factors associated with successful weight loss in such interventions can improve program effectiveness. Objective: This study examined factors influencing weight change and the relationship between weight recording frequency and chat volume with health care professionals on weight loss in individuals with obesity and NCDs. Methods: The participants had obesity (BMI ?25 kg/m{\texttwosuperior}) and were diagnosed with NCDs (eg, hypertension, diabetes, dyslipidemia). The program included 12 telephone consultations with health care professionals. Only participants who completed the full 6-month program, including all 12 telephone consultations, and provided an end-of-study weight were included in the analysis. The primary outcome was the rate of weight change, defined as the percentage change in weight from the initial period (first 14 days) to the final period (2 weeks before the last consultation), relative to the initial weight. The key independent variables were proportion of days with weight recording and chat communication volume (total messages exchanged). An interaction term between these variables was included to assess moderation effects in the regression analysis. The volume of communication was measured as the total number of messages exchanged, with each message, regardless of who sent it, being counted as 1 interaction. Health care staffs were instructed to send a single scheduled chat message per week following each biweekly phone consultation. These scheduled messages primarily included personalized feedback, reminders, and motivational support. In addition, providers responded to participant-initiated messages at any time during the program. Furthermore, 1 professional responded to each participant. Hierarchical multiple regression and simple slope analyses were conducted to identify relationships and interactions among these variables. Results: The final analysis of this study included 2423 participants. Significant negative associations were found between the rate of weight change and baseline BMI ($\beta$=?.10; P<.001), proportion of days with weight recording ($\beta$=?.017; P<.001), and communication volume ($\beta$=?.193; P<.001). The interaction between proportion of days with weight recording and chat frequency also showed a significantly negative effect on weight change ($\beta$=?.01; P<.001). Simple slope analysis showed that when the proportion of days with weight recording was +1 SD above the mean, frequent chats were associated with greater weight reduction (slope=?0.60; P<.001), whereas no significant effect was observed at ?1 SD (slope=?0.01; P=.94) Conclusions: The findings suggest that both the proportion of days with weight recording and communication volume independently and interactively influence weight change in individuals with obesity and NCDs. ",
doi="10.2196/65863",
url="https://www.i-jmr.org/2025/1/e65863"
}


@Article{info:doi/10.2196/63079,
author="Zakaria, Hala
and Jabri, Hadoun
and Alshehhi, Sheikha
and Caccelli, Milena
and Debs, Joelle
and Said, Yousef
and Kattan, Joudy
and Almarzooqi, Noah
and Hashemi, Ali
and Almarzooqi, Ihsan",
title="Glucagon-Like Peptide-1 Receptor Agonists Combined With Personalized Digital Health Care for the Treatment of Metabolic Syndrome in Adults With Obesity: Retrospective Observational Study",
journal="Interact J Med Res",
year="2025",
month="Mar",
day="27",
volume="14",
pages="e63079",
keywords="metabolic syndrome",
keywords="obesity",
keywords="GLP-1 medications",
keywords="hybrid model of care",
keywords="digital health",
keywords="effectiveness",
keywords="digital engagement",
keywords="hybrid care",
keywords="adult",
keywords="cardiovascular disease",
keywords="type 2 diabetes",
keywords="insulin resistance",
keywords="efficacy",
keywords="behavioral change",
keywords="obese",
keywords="zone health",
keywords="weight loss",
keywords="monitoring",
keywords="tirzepatide",
keywords="semaglutide",
keywords="treatment",
keywords="medication",
keywords="telehealth",
keywords="health informatics",
keywords="glucagon-like peptide-1",
abstract="Background: Metabolic syndrome (MetS) represents a complex and multifaceted health condition characterized by a clustering of interconnected metabolic abnormalities, including central obesity, insulin resistance, dyslipidemia, and hypertension. Effective management of MetS is crucial for reducing the risk of cardiovascular diseases and type 2 diabetes. Objective: This study aimed to assess the effectiveness of combining glucagon-like peptide-1 (GLP-1) and dual gastric inhibitory polypeptide (GIP)/GLP-1 agonists with a continuous, digitally delivered behavioral change model by an integrated care team, in treating MetS among individuals with obesity. Methods: The 6-month Zone.Health (meta[bolic]) weight loss program involved 51 participants (mean age 45, SD 10 years; mean BMI 35, SD 5 kg/m{\texttwosuperior}), categorized by gender, and treated with either tirzepatide or semaglutide. Participants received continuous support via a digital health platform, which facilitated real time monitoring and personalized feedback from an integrated care team. Engagement levels with the digital platform, measured by the frequency of inbound interactions, were tracked and analyzed in relation to health outcomes. Results: Tirzepatide reduced waist circumference (WC) by ?18.08 cm, compared with ?13.04 cm with semaglutide (P<.001). Triglycerides decreased significantly with both drugs, with tirzepatide showing a reduction of ?64.42 mg/dL and semaglutide ?70.70 mg/dL (P<.001). Tirzepatide generally showed more pronounced improvements in fasting glucose, blood pressure (BP), low-density lipoprotein, and total cholesterol compared with semaglutide. Higher engagement with the digital health platform showed significant difference among the 3 groups; the group with the highest level of app-based interactions (?25 interactions) had the greatest WC reduction (mean ?19.04, SD 7.40 cm) compared with those with ?15 interactions (mean ?9.60, SD 5.10 cm; P=.002). Similarly, triglycerides showed the greatest reduction in the group with ?25 interactions (mean ?108.56, SD 77.06 mg/dL) compared with those with ?15 interactions (mean ?44.49, SD 50.85 mg/dL; P=.02). This group also exhibited the largest reduction in diastolic BP (mean ?10.33, SD 7.40 mm Hg) compared with those with ?15 interactions (mean ?0.83, SD 7.83 mm Hg; P=.004), and the most substantial decrease in fasting glucose levels (mean ?18.60, SD 10.82 mg/dL) compared with those with ?15 interactions (mean ?2.49, SD 27.54 mg/dL; P=.02). Participants in the highest quartile of digital engagement had a 60\% greater likelihood of MetS reversal compared with those in the lowest quartile. Conclusions: This study shows that combining GLP-1 and dual GIP/GLP-1 agonists with a digital behavioral change model significantly improves MetS markers in individuals with obesity. Tirzepatide proved more effective than semaglutide, leading to greater reductions in WC and triglyceride levels, along with better improvements in fasting glucose, BP, and lipid profiles. Higher app-based engagement was linked to better health outcomes, with participants in the highest engagement group having a 60\% greater likelihood of treating MetS compared with those with the lowest engagement. ",
doi="10.2196/63079",
url="https://www.i-jmr.org/2025/1/e63079"
}


@Article{info:doi/10.2196/59738,
author="Dima, Lelia Alexandra
and Nabergoj Makovec, Urska
and Ribaut, Janette
and Haupenthal, Frederik
and Barnestein-Fonseca, Pilar
and Goetzinger, Catherine
and Grant, Sean
and J{\'a}come, Cristina
and Smits, Dins
and Tadic, Ivana
and van Boven, Job
and Tsiligianni, Ioanna
and Herdeiro, Teresa Maria
and Roque, F{\'a}tima
and ",
title="Stakeholder Consensus on an Interdisciplinary Terminology to Enable the Development and Uptake of Medication Adherence Technologies Across Health Systems: Web-Based Real-Time Delphi Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="25",
volume="27",
pages="e59738",
keywords="health technology",
keywords="medication adherence",
keywords="Delphi study",
keywords="stakeholder engagement",
keywords="digital health",
keywords="behavioral science",
keywords="implementation science",
abstract="Background: Technology-mediated medication adherence interventions have proven useful, yet implementation in clinical practice is low. The European Network to Advance Best Practices and Technology on Medication Adherence (ENABLE) European Cooperation in Science and Technology Action (CA19132) online repository of medication adherence technologies (MATechs) aims to provide an open access, searchable knowledge management platform to facilitate innovation and support medication adherence management across health systems. To provide a solid foundation for optimal use and collaboration, the repository requires a shared interdisciplinary terminology. Objective: We consulted stakeholders on their views and level of agreement with the terminology proposed to inform the ENABLE repository structure. Methods: A real-time web-based Delphi study was conducted with stakeholders from 39 countries active in research, clinical practice, patient representation, policy making, and technology development. Participants rated terms and definitions of MATech and of 21 attribute clusters on product and provider information, medication adherence descriptors, and evaluation and implementation. Relevance, clarity, and completeness criteria were rated on 9-point scales, and free-text comments were provided interactively. Participants could reconsider their ratings based on real-time aggregated feedback and revisit the survey throughout the study period. We quantified agreement and process indicators for the complete sample and per stakeholder group and performed content analysis on comments. Consensus was considered reached for ratings with a disagreement index of <1. Median ratings guided decisions on whether attributes were considered mandatory, optional, or not relevant. We used the results to improve the terminology and repository structure. Results: Of 250 stakeholders invited, 117 (46.8\%) rated the MATech definition, of whom 83 (70.9\%) rated all attributes. Consensus was reached for all items. The definition was considered appropriate and clear (median ratings 7.02, IPR 6.10-7.69, and 7.26, IPR 6.73-7.90, respectively). Most attributes were considered relevant, mandatory, and sufficiently clear to remain unchanged except for ISO certification (considered optional; median relevance rating 6.34, IPR 5.50-7.24) and medication adherence phase, medication adherence measurement, and medication adherence intervention (candidates for optional changes; median clarity ratings 6.07, IPR 4.86-7.17; 6.37, IPR 4.80-6.67; and 5.67, IPR 4.66-6.61, respectively). Subgroup analyses found several attribute clusters considered moderately clear by some stakeholder groups. Results were consistent across stakeholder groups and time, yet response variation was found within some stakeholder groups for selected clusters, suggesting targets for further discussion. Comments highlighted issues for further debate and provided suggestions informing modifications to improve comprehensiveness, relevance, and clarity. Conclusions: By reaching agreement on a comprehensive MATech terminology developed following state-of-the-art methodology, this study represents a key step in the ENABLE initiative to develop an information architecture capable of structuring and facilitating the development and implementation of MATech across Europe. The debates and challenges highlighted in stakeholders' comments outline a potential road map for further development of the terminology and the ENABLE repository. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-059674 ",
doi="10.2196/59738",
url="https://www.jmir.org/2025/1/e59738"
}


@Article{info:doi/10.2196/56836,
author="Reed, Julie
and Svedberg, Petra
and Nygren, Jens",
title="Enhancing the Innovation Ecosystem: Overcoming Challenges to Introducing Information-Driven Technologies in Health Care",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="24",
volume="27",
pages="e56836",
keywords="artificial intelligence",
keywords="ecosystem",
keywords="health care",
keywords="implementation",
keywords="technology adoption",
keywords="improvement",
keywords="complex-systems",
doi="10.2196/56836",
url="https://www.jmir.org/2025/1/e56836"
}


@Article{info:doi/10.2196/54560,
author="Murray, Aoife
and Conroy, Irial
and Kirrane, Frank
and Cullen, Leonie
and Worlikar, Hemendra
and O'Keeffe, T. Derek",
title="User Experience of a Bespoke Videoconferencing System for Web-Based Family Visitation for Patients in an Intensive Care Unit: 1-Year Cross-Sectional Survey of Nursing Staff",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="21",
volume="12",
pages="e54560",
keywords="telemedicine",
keywords="health",
keywords="telehealth",
keywords="videoconferencing",
keywords="web-based",
keywords="usability",
keywords="intensive care",
keywords="critical care",
keywords="communication",
keywords="COVID-19",
keywords="SARS-COV-2",
keywords="intensive care unit",
keywords="ICU",
keywords="cross-sectional survey",
keywords="nursing",
keywords="transmission",
keywords="transmission risk",
keywords="usability questionnaire",
keywords="questionnaire",
keywords="reliability",
keywords="satisfaction",
keywords="usefulness",
keywords="family",
abstract="Background: During the COVID-19 pandemic, in-person visitation within hospitals was restricted and sometimes eliminated to reduce the risk of transmission of SARS-CoV-2. Many health care professionals created novel strategies that were deployed to maintain a patient-centered approach. Although pandemic-related restrictions have eased, these systems, including videoconferencing or web-based bedside visits, remain relevant for visitors who cannot be present due to other reasons (lack of access to transport, socioeconomic restraints, geographical distance, etc). Objective: The aims of this study were (1) to report the experience of intensive care nursing staff using a bespoke videoconferencing system called ICU FamilyLink; (2) to examine the scenarios in which the nursing staff used the system; and (3) to assess the future use of videoconferencing systems to enhance communication with families. Methods: A modified Telehealth Usability questionnaire was administered to the nursing staff (N=22) of an intensive care unit in a model 4 tertiary hospital in Ireland 1 year after implementing the bespoke videoconferencing system. Results: In total, 22 nurses working in the intensive care department at University Hospital Galway, Ireland, responded to the survey. A total of 23\% (n=5) of participants were between the ages of 25 and 34 years, 54\% (n=12) were between 35 and 44 years, and 23\% (n=5) were between 45 and 54 years. Most (n=15, 68\%) of the participants reported never using videoconferencing in the intensive care setting to communicate with family members before March 2020. The modified Telehealth Usability Questionnaire showed overall satisfaction scores for each subcategory of ease of use and learnability, interface quality, interaction quality, reliability, satisfaction and future use, and usefulness. In total, 21 (95\%) participants agreed or strongly agreed with the statement, ``I would use the ICU FamilyLink system in future circumstances in which family members cannot be physically present (ie, pandemics, abroad, inability to travel, etc),'' and 1 participant responded neutrally. One participant highlighted a common scenario in intensive care settings in which a videoconferencing system can be used ``Even without COVID, web-based communication is important when patients become unexpectedly ill and when families are abroad.'' Conclusions: This study provides valuable insights into health care professionals' experience using a videoconferencing system to facilitate web-based visits for families. We conclude that videoconferencing systems when appropriately tailored to the environment with the users in mind can be an acceptable solution to maintain communication with family members who cannot be physically present at the bedside. The bespoke videoconferencing system had an overall positive response from 22 nursing staff who interacted with the system at varying frequency levels. ",
doi="10.2196/54560",
url="https://humanfactors.jmir.org/2025/1/e54560"
}


@Article{info:doi/10.2196/54516,
author="Kong, Menglei
and Wang, Yu
and Li, Meixuan
and Yao, Zhong",
title="Mechanism Assessment of Physician Discourse Strategies and Patient Consultation Behaviors on Online Health Platforms: Mixed Methods Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="19",
volume="27",
pages="e54516",
keywords="online health consultation",
keywords="physician discourse strategies",
keywords="online physician-patient trust",
keywords="shared decision-making",
keywords="patient consultation behavior",
abstract="Background: Online health platforms are currently experiencing significant growth. Patients can conveniently seek medical consulting services on such platforms. Against the backdrop of the thriving development of digital health care, the patterns of physician-patient communication are undergoing profound changes. It is imperative to focus on physician discourse strategies during online physician-patient interactions, which will improve the efficiency of physician-patient communication and achieve better management of the physician-patient relationship. Objective: This study aims to explore the influencing mechanism between physician discourse strategies and patient consultation behavior on online health platforms. Additionally, we explore the crucial mediating role of online physician-patient trust and the moderating role of shared decision-making in the online physician-patient communication process. Methods: We used a mixed research approach to explore the influencing mechanism. Data on physician basic attributes and physician-patient communication text records were collected from the Chunyu Doctor website using a web spider. The study obtained a total of 8628 interaction texts from January 2022 to July 2023. Physician discourse strategies (capacity-oriented strategy, quality-oriented strategy, and goodwill-oriented strategy), online physician-patient trust, and shared decision-making were captured through text mining and a random forest model. First, we employed text mining to extract the speech acts, modal resources, and special linguistic resources of each record. Then, using a well-trained random forest model, we captured the specific discourse strategy of each interaction text based on the learned features and patterns. The study generated 863 groups of physician samples with 17 data fields. The hypotheses were tested using an ``ordinary least squares'' model, and a stability test was conducted by replacing the dependent variable. Results: The capacity-oriented strategy, goodwill-oriented strategy, and quality-oriented strategy had significant effects on patient consultation behavior ($\beta$=.151, P=.007; $\beta$=.154, P<.001; and $\beta$=.17, P<.001, respectively). It should be noted that the anticipated strong effect of the capacity-oriented strategy on patient consultation behavior was not observed. Instead, the effects of the quality-oriented strategy and goodwill-oriented strategy were more prominent. Physician notification adequacy from shared decision-making moderated the effect between the goodwill-oriented strategy and patient consultation behavior ($\beta$=.172; P<.001). Additionally, patient expression adequacy from shared decision-making moderated the effect between the capacity-oriented strategy and patient consultation behavior ($\beta$=.124; P<.001), and between the goodwill-oriented strategy and patient consultation behavior ($\beta$=.104; P=.003). Online physician-patient trust played a significant mediating role between physician discourse strategies and patient consultation behavior. Conclusions: The study findings suggest significant implications for stimulating patient consultation behavior on online health platforms by providing guidance on effective discourse strategies for physicians, thus constructing a trustworthy physician image, improving the physician-patient relationship, and increasing platform traffic. ",
doi="10.2196/54516",
url="https://www.jmir.org/2025/1/e54516"
}


@Article{info:doi/10.2196/64325,
author="Trivedi, Ritu
and Shaw, Tim
and Sheahen, Brodie
and Chow, K. Clara
and Laranjo, Liliana",
title="Patient Perspectives on Conversational Artificial Intelligence for Atrial Fibrillation Self-Management: Qualitative Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="12",
volume="27",
pages="e64325",
keywords="atrial fibrillation",
keywords="conversational agents",
keywords="qualitative research",
keywords="self-management",
keywords="digital health",
keywords="patient perspective",
keywords="conversational artificial intelligence",
keywords="speech recognition",
abstract="Background: Conversational artificial intelligence (AI) allows for engaging interactions, however, its acceptability, barriers, and enablers to support patients with atrial fibrillation (AF) are unknown. Objective: This work stems from the Coordinating Health care with AI--supported Technology for patients with AF (CHAT-AF) trial and aims to explore patient perspectives on receiving support from a conversational AI support program. Methods: Patients with AF recruited for a randomized controlled trial who received the intervention were approached for semistructured interviews using purposive sampling. The 6-month intervention consisted of fully automated conversational AI phone calls (with speech recognition and natural language processing) that assessed patient health and provided self-management support and education. Interviews were recorded, transcribed, and thematically analyzed. Results: We conducted 30 interviews (mean age 65.4, SD 11.9 years; 21/30, 70\% male). Four themes were identified: (1) interaction with a voice-based conversational AI program (human-like interactions, restriction to prespecified responses, trustworthiness of hospital-delivered conversational AI); (2) engagement is influenced by the personalization of content, delivery mode, and frequency (tailoring to own health context, interest in novel information regarding health, overwhelmed with large volumes of information, flexibility provided by multichannel delivery); (3) improving access to AF care and information (continuity in support, enhancing access to health-related information); (4) empowering patients to better self-manage their AF (encouraging healthy habits through frequent reminders, reassurance from rhythm-monitoring devices). Conclusions: Although conversational AI was described as an engaging way to receive education and self-management support, improvements such as enhanced dialogue flexibility to allow for more naturally flowing conversations and tailoring to patient health context were also mentioned. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000174886; https://tinyurl.com/3nn7tk72 International Registered Report Identifier (IRRID): RR2-10.2196/34470 ",
doi="10.2196/64325",
url="https://www.jmir.org/2025/1/e64325"
}


@Article{info:doi/10.2196/57858,
author="Cresswell, Kathrin
and Jahn, Franziska
and Silsand, Line
and Woods, Leanna
and Postema, Tim
and Logan, Marion
and Malkic, Sevala
and Ammenwerth, Elske",
title="Assessing Digital Maturity of Hospitals: Viewpoint Comparing National Approaches in Five Countries",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="6",
volume="27",
pages="e57858",
keywords="digital maturity",
keywords="hospitals",
keywords="assessment",
keywords="decision making",
keywords="health systems",
keywords="infancy",
keywords="Australia",
keywords="Australian",
keywords="data collection",
keywords="data",
keywords="qualitative thematic analysis",
keywords="self-reporting",
keywords="practical feasibility",
keywords="long-term tracking",
keywords="local data",
keywords="monitoring",
doi="10.2196/57858",
url="https://www.jmir.org/2025/1/e57858",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053724"
}


@Article{info:doi/10.2196/65938,
author="Barclay, Jayne
and Sullivan, Clair
and Beckmann, Michael
and Mattison, Graeme
and Runciman, Rebecca
and Martin, Elizabeth",
title="Use of Remote Assessment Tools to Substitute Routine Outpatient Care: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e65938",
keywords="remote assessment",
keywords="remote patient monitoring",
keywords="telemedicine",
keywords="mHealth",
keywords="applications",
keywords="patient-reported outcome measures",
keywords="self-reported",
keywords="health care cost reduction",
keywords="hybrid care models",
abstract="Background: The increasing global demand for health care, driven by demographic shifts, the rise of personalized medicine, and technological innovations necessitate novel approaches to health care delivery. Digital remote assessment tools have emerged as a promising solution, enabling hybrid care models that combine traditional and remote patient management. These tools support the quadruple aim of health care by enhancing the monitoring and evaluation of patient-reported data, thereby improving patient care, boosting operational efficiency, reducing costs, and improving the experience of patients and clinicians. This review seeks to understand how remote assessment tools are used for routine consultation substitution in adult tertiary care centers. Objective: This scoping review aims to evaluate the implementation and health outcomes of digital remote assessment tools used for routine consultation substitutions in adult tertiary care centers. The objectives include assessing the extent of use, types, and effectiveness of these tools in substituting conventional outpatient care. Methods: A comprehensive scoping review was conducted, adhering to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The review focused on studies that used internet-dependent remote assessment technologies for patient data transfer in tertiary care settings. A detailed search strategy was used across multiple databases, with studies selected based on predefined inclusion and exclusion criteria. Data extraction and analysis were performed by independent reviewers, with a focus on the functionalities of the tools and their alignment with the Quadruple Aim of Healthcare. Results: The review included 12 studies, highlighting a growing interest in remote assessment technologies across diverse clinical settings. The interventions varied in length, from 4 weeks to 12 months, and demonstrated a range of functionalities, including symptom monitoring and postsurgical follow-ups. The use of these tools was associated with improved clinical outcomes, such as timely intervention for clinical deterioration and enhanced clinical protocol adherence. Additionally, a small number of studies identified potential cost savings in terms of reduced unplanned health care contacts and optimized clinical resource use. Patient and clinician experiences were generally positive, with high adherence to remote assessments and an appreciation for the personalized and timely care facilitated by these technologies. Barriers included high initial setup costs for digital technologies, leading to an inflated cost per patient in small sample studies. Conclusions: Digital remote assessment tools offer significant potential to enhance health care delivery by improving health outcomes, reducing costs, and enriching patient and clinician experiences. Their flexibility and adaptability make them suitable for various clinical contexts, supporting the personalization of care and operational efficiency. While digital remote assessment tools offer significant potential, careful consideration of implementation strategies, equity, cost, and clinician and patient experiences is crucial for successful clinical integration. ",
doi="10.2196/65938",
url="https://www.jmir.org/2025/1/e65938",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053751"
}


@Article{info:doi/10.2196/45367,
author="Valdes, Daniela
and Shanker, Ankit
and Hijazi, Ghofran
and Mensah, Opoku Daniel
and Bockarie, Tahir
and Lazar, Ioana
and Ibrahim, Aishah Siti
and Zolfagharinia, Hamid
and Procter, Rob
and Spencer, Rachel
and Dale, Jeremy
and Paule, Armina
and Medlin, Jonathon Liam
and Tharuvara Kallottil, Keerthana",
title="Global Evidence on the Sustainability of Telemedicine in Outpatient and Primary Care During the First 2 Years of the COVID-19 Pandemic: Scoping Review Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework",
journal="Interact J Med Res",
year="2025",
month="Feb",
day="28",
volume="14",
pages="e45367",
keywords="pandemic",
keywords="primary care",
keywords="outpatients",
keywords="telemedicine",
keywords="ambulatory care",
keywords="global health",
keywords="patient experience",
keywords="NASSS",
keywords="clinician-patient relationship",
keywords="health inequalities",
keywords="gray literature",
keywords="PRISMA",
abstract="Background: The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about the sustainability of this intervention at the global level. Objective: This research examines the patient experience, health inequalities, and clinician-patient relationship in telemedicine during the COVID-19 pandemic's first 2 years, aiming to identify sustainability factors. Methods: This study was based on a prepublished protocol using the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included academic and gray literature published between March 2020 and March 2022 according to these criteria: (1) population (any group); (2) concepts (patient experience, clinician-patient relationship, health inequalities); (3) context (telemedicine in primary and outpatient care); (4) excluding studies pertaining to surgery, oncology, and (inpatient) psychiatry. We searched Ovid Medline/PubMed (January 1, 2022), Web of Science (March 19, 2022), Google/Google Scholar (February and March 2022), and others. The risk of bias was not assessed as per guidance. We used an analysis table for the studies and color-coded tabular mapping against a health care technology adoption framework to identify sustainability (using double-blind extraction). Results: Of the 134 studies that met our criteria, 49.3\% (66/134) reported no specific population group. Regarding the concepts, 41.8\% (56/134) combined 2 of the concepts studied. The context analysis identified that 56.0\% (75/134) of the studies referred to, according to the definition in the United Kingdom, an outpatient (ambulatory care) setting, and 34.3\% (46/134) referred to primary care. The patient experience analysis reflected positive satisfaction and sustained access during lockdowns. The clinician-patient relationship impacts were nuanced, affecting interaction and encounter quality. When mapping to the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, 81.3\% (109/134) of the studies referenced the innovation's sustainability. Although positive overall, there were some concerns about sustainability based on quality, eHealth literacy, and access to health care for vulnerable migrants and the uninsured. Conclusions: We identified confusion between the concepts of patient experience and patient satisfaction; therefore, future research could focus on established frameworks to qualify the patient experience across the whole pathway and not just the remote encounter. As expected, our research found mainly descriptive analyses, so there is a need for more robust evidence methods identifying impacts of changes in treatment pathways. This study illustrates modern methods to decolonize academic research by using gray literature extracts in other languages. We acknowledge that the use of Google to identify gray literature at the global level and in other languages has implications on reproducibility. We did not consider synchronous text-based communication. Trial Registration: Open Science Framework 4z5ut; https://osf.io/4z5ut/ ",
doi="10.2196/45367",
url="https://www.i-jmr.org/2025/1/e45367",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053716"
}


@Article{info:doi/10.2196/59165,
author="De la Torre, Katherine
and Min, Sukhong
and Lee, Hyobin
and Kang, Daehee",
title="The Application of Preventive Medicine in the Future Digital Health Era",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="27",
volume="27",
pages="e59165",
keywords="preventive medicine",
keywords="personalized prevention",
keywords="digital health technology",
keywords="digital health",
keywords="artificial intelligence",
keywords="wearable devices",
keywords="telemedicine",
doi="10.2196/59165",
url="https://www.jmir.org/2025/1/e59165",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053712"
}


@Article{info:doi/10.2196/58543,
author="Chen, Yu-Ting
and Lehman, Michelle
and Van Denend, Toni
and Kish, Jacqueline
and Wu, Yue
and Preissner, Katharine
and Plow, Matthew
and Packer, L. Tanya",
title="Features of Structured, One-to-One Videoconference Interventions That Actively Engage People in the Management of Their Chronic Conditions: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="26",
volume="27",
pages="e58543",
keywords="videoconference",
keywords="chronic disease management",
keywords="active participation",
keywords="intervention program",
keywords="self-management",
keywords="scoping review",
keywords="Taxonomy of Every Day Self-Management Strategies",
keywords="TEDSS",
keywords="Behavior Change Technique Taxonomy version 1",
keywords="BCTTv1",
keywords="behavior change",
keywords="mobile phone",
abstract="Background: A dramatic increase in the use of videoconferencing occurred as a response to the COVID-19 pandemic, including delivery of chronic disease management programs. With this increase, clients' openness to and confidence in receiving any type of telehealth care has dramatically improved. However, the rapidity of the response was accomplished with little time to learn from existing knowledge and research. Objective: The purpose of this scoping review was to identify features, barriers, and facilitators of synchronous videoconference interventions that actively engage clients in the management of chronic conditions. Methods: Using scoping review methodology, MEDLINE, CINAHL, and 6 other databases were searched from 2003 onward. The included studies reported on structured, one-on-one, synchronous videoconferencing interventions that actively engaged adults in the management of their chronic conditions at home. Studies reporting assessment or routine care were excluded. Extracted text data were analyzed using thematic analysis and published taxonomies. Results: The 33 included articles reported on 25 distinct programs. Most programs targeted people with neurological conditions (10/25, 40\%) or cancer (7/25, 28\%). Analysis using the Taxonomy of Every Day Self-Management Strategies and the Behavior Change Technique Taxonomy version 1 identified common program content and behavior change strategies. However, distinct differences were evident based on whether program objectives were to improve physical activity or function (7/25, 28\%) or mental health (7/25, 28\%). Incorporating healthy behaviors was addressed in all programs designed to improve physical activity or function, whereas only 14\% (1/7) of the programs targeting mental health covered content about healthy lifestyles. Managing emotional distress and social interaction were commonly discussed in programs with objectives of improving mental health (6/25, 24\% and 4/25, 16\%, respectively) but not in programs aiming at physical function (2/25, 8\% and 0\%, respectively). In total, 13 types of behavior change strategies were identified in the 25 programs. The top 3 types of strategies applied in programs intent on improving physical activity or function were feedback and monitoring, goals and planning, and social support, in contrast to shaping knowledge, regulation, and identity in programs with the goal of improving mental health. The findings suggest that chronic condition interventions continue to neglect evidence that exercise and strong relationships improve both physical and mental health. Videoconference interventions were seen as feasible and acceptable to clients. Challenges were mostly technology related: clients' comfort, technology literacy, access to hardware and the internet, and technical breakdowns and issues. Only 15\% (5/33) of the studies explicitly described compliance with health information or privacy protection regulations. Conclusions: Videoconferencing is a feasible and acceptable delivery format to engage clients in managing their conditions at home. Future program development could reduce siloed approaches by adding less used content and behavior change strategies. Addressing client privacy and technology issues should be priorities. ",
doi="10.2196/58543",
url="https://www.jmir.org/2025/1/e58543"
}


@Article{info:doi/10.2196/46441,
author="Erasmus, Pieter
and Borrmann, Moritz
and Becker, Jule
and Kuchinke, Lars
and Meinlschmidt, Gunther",
title="Comparing Digital Versus Face-to-Face Delivery of Systemic Psychotherapy Interventions: Systematic Review and Meta-Analysis of Randomized Controlled Trials",
journal="Interact J Med Res",
year="2025",
month="Feb",
day="24",
volume="14",
pages="e46441",
keywords="systemic psychotherapy",
keywords="family therapy",
keywords="adolescent",
keywords="systematic review",
keywords="meta-analysis",
keywords="face to face",
keywords="digital",
keywords="remote",
keywords="distance",
keywords="telehealth",
keywords="delivery modality",
abstract="Background: As digital mental health delivery becomes increasingly prominent, a solid evidence base regarding its efficacy is needed. Objective: This study aims to synthesize evidence on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities. Methods: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for searching PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and PSYNDEX and conducting a systematic review and meta-analysis. We included randomized controlled trials comparing mental, behavioral, and somatic outcomes of systemic psychotherapy interventions using self- and therapist-guided digital versus face-to-face delivery modalities. The risk of bias was assessed with the revised Cochrane Risk of Bias tool for randomized trials. Where appropriate, we calculated standardized mean differences and risk ratios. We calculated separate mean differences for nonaggregated analysis. Results: We screened 3633 references and included 12 articles reporting on 4 trials (N=754). Participants were youths with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youths with anorexia nervosa. A total of 56 outcomes were identified. Two trials provided digital intervention delivery via videoconferencing: one via an interactive graphic interface and one via a web-based program. In total, 23\% (14/60) of risk of bias judgments were high risk, 42\% (25/60) were some concerns, and 35\% (21/60) were low risk. Due to heterogeneity in the data, meta-analysis was deemed inappropriate for 96\% (54/56) of outcomes, which were interpreted qualitatively instead. Nonaggregated analyses of mean differences and CIs between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 18\% (10/56) of outcomes, superiority of the face-to-face delivery modality for 5\% (3/56) of outcomes, equivalence between delivery modalities for 2\% (1/56) of outcomes, and neither superiority of one modality nor equivalence between modalities for 75\% (42/56) of outcomes. Consequently, for most outcome measures, no indication of superiority or equivalence regarding the relative efficacy of either delivery modality can be made at this stage. We further meta-analytically compared digital versus face-to-face delivery modalities for attrition (risk ratio 1.03, 95\% CI 0.52-2.03; P=.93) and number of sessions attended (standardized mean difference --0.11; 95\% CI --1.13 to --0.91; P=.83), finding no significant differences between modalities, while CIs falling outside the range of the minimal important difference indicate that equivalence cannot be determined at this stage. Conclusions: Evidence on digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous, limiting conclusions regarding the differential efficacy of digital and face-to-face delivery. Nonaggregated and meta-analytic analyses did not indicate the superiority of either delivery condition. More research is needed to conclude if digital and face-to-face delivery modalities are generally equivalent or if---and in which contexts---one modality is superior to another. Trial Registration: PROSPERO CRD42022335013; https://tinyurl.com/nprder8h ",
doi="10.2196/46441",
url="https://www.i-jmr.org/2025/1/e46441"
}


@Article{info:doi/10.2196/55007,
author="Agarwal, Payal
and Fletcher, George Glenn
and Ramamoorthi, Karishini
and Yao, Xiaomei
and Bhattacharyya, Onil",
title="Uses of Virtual Care in Primary Care: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="14",
volume="27",
pages="e55007",
keywords="primary care",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="remote consultation",
keywords="telephone consultation",
keywords="video consultations",
keywords="medical informatics",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="coronavirus infections",
keywords="PRISMA",
abstract="Background: The COVID-19 pandemic catalyzed an uptake in virtual care. However, the rapid shift left unanswered questions about the impact of virtual care on the quality of primary care and its appropriateness and effectiveness. Moving forward, health care providers require guidance on how best to use virtual care to support high-quality primary care. Objective: This study aims to identify and summarize clinical studies and systematic reviews comparing virtual care and in-person care in primary care, with a focus on how virtual care can support key clinical functions such as triage, medical assessment and treatment, counseling, and rehabilitation in addition to the management of particular conditions. Methods: We conducted a scoping review following an established framework. Comprehensive searches were performed across the following databases: Embase, MEDLINE, PsycInfo, Emcare, and Cochrane Database of Systematic Reviews. Other well-known websites were also searched. PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Articles were selected by considering article type, language, care provided, intervention, mode of care delivery, and sample size. Results: A total of 13,667 articles were screened, and 219 (1.6\%) articles representing 170 studies were included in the review. Of the 170 studies included, 142 (83.5\%) were primary studies, and 28 (16.5\%) were systematic reviews. The studies were grouped by functions of primary care, including triage (16/170, 9.4\%), medical assessment and treatment of particular conditions (63/170, 37.1\%), rehabilitation (17/170, 10\%), and counseling (74/170, 43.5\%). The studies suggested that many primary care functions could appropriately be conducted virtually. Virtual rehabilitation was comparable to in-person care and virtual counseling was found to be equally effective as in-person counseling in several contexts. Some of the studies indicated that many general primary care issues could be resolved virtually without the need for any additional follow-up, but data on diagnostic accuracy were limited. Virtual triage is clinically appropriate and led to fewer in-person visits, but overall impact on efficiency was unclear. Many studies found that virtual care was more convenient for many patients and provided care equivalent to in-person care for a range of conditions. Studies comparing appropriate antibiotic prescription between virtual and in-person care found variable impact by clinical condition. Studies on virtual chronic disease management observed variability in impact on overall disease control and clinical outcomes. Conclusions: Virtual care can be safe and appropriate for triage and seems equivalent to in-person care for counseling and some rehabilitation services; however, further studies are needed to determine specific contexts or medical conditions where virtual care is appropriate for diagnosis, management outcomes, and other functions of primary care. Virtual care needs to be adapted to fit a new set of patient and provider workflows to demonstrate positive impacts on experience, outcomes, and costs of care. ",
doi="10.2196/55007",
url="https://www.jmir.org/2025/1/e55007"
}


@Article{info:doi/10.2196/66222,
author="Harari, E. Rayan
and Schulwolf, L. Sara
and Borges, Paulo
and Salmani, Hamid
and Hosseini, Farhang
and Bailey, T. Shannon K.
and Quach, Brian
and Nohelty, Eric
and Park, Sandra
and Verma, Yash
and Goralnick, Eric
and Goldberg, A. Scott
and Shokoohi, Hamid
and Dias, D. Roger
and Eyre, Andrew",
title="Applications of Augmented Reality for Prehospital Emergency Care: Systematic Review of Randomized Controlled Trials",
journal="JMIR XR Spatial Comput",
year="2025",
month="Feb",
day="11",
volume="2",
pages="e66222",
keywords="prehospital emergency care",
keywords="emergency medical services",
keywords="randomized controlled trials",
keywords="clinical decision support",
keywords="training",
keywords="augmented reality",
keywords="emergency",
keywords="care",
keywords="systematic review",
keywords="BLS",
keywords="procedures",
keywords="traumatic injury",
keywords="survival",
keywords="prehospital",
keywords="emergency care",
keywords="AR",
keywords="decision-making",
keywords="educational",
keywords="education",
keywords="EMS",
keywords="database",
keywords="technology",
keywords="critical care",
keywords="basic life support",
abstract="Background: Delivering high-quality prehospital emergency care remains challenging, especially in resource-limited settings where real-time clinical decision support is limited. Augmented reality (AR) has emerged as a promising health care technology, offering potential solutions to enhance decision-making, care processes, and emergency medical service (EMS) training. Objective: This systematic review assesses the effectiveness of AR in improving clinical decision-making, care delivery, and educational outcomes for EMS providers. Methods: We searched databases including PubMed, Cochrane CENTRAL, Web of Science, Institute of Electrical and Electronics Engineers (IEEE), Embase, PsycInfo, and Association for Computing Machinery (ACM). Studies were selected based on their focus on AR in prehospital care. A total of 14 randomized controlled trials were selected from an initial screening of 2081 manuscripts. Included studies focused on AR use by EMS personnel, examining clinical and educational impacts. Data such as study demographics, intervention type, outcomes, and methodologies were extracted using a standardized form. Primary outcomes assessed included clinical task accuracy, response times, and training efficacy. A narrative synthesis was conducted, and bias was evaluated using Cochrane's risk of bias tool. Improvements in AR-assisted interventions and their limitations were analyzed. Results: AR significantly improved clinical decision-making accuracy and EMS training outcomes, reducing response times in simulations and real-world applications. However, small sample sizes and challenges in integrating AR into workflows limit the generalizability of the findings. Conclusions: AR holds promise for transforming prehospital care by enhancing real-time decision-making and EMS training. Future research should address technological integration and scalability to fully realize AR's potential in EMS. ",
doi="10.2196/66222",
url="https://xr.jmir.org/2025/1/e66222"
}


@Article{info:doi/10.2196/46007,
author="Beqaj, Safedin
and Shrestha, Rojeet
and Hamill, Tim",
title="An Automated Clinical Laboratory Decision Support System for Test Utilization, Medical Necessity Verification, and Payment Processing",
journal="Interact J Med Res",
year="2025",
month="Feb",
day="11",
volume="14",
pages="e46007",
keywords="clinical decision system",
keywords="CDSS",
keywords="laboratory decision system",
keywords="laboratory testing",
keywords="test utilization",
keywords="test ordering",
keywords="lab test",
keywords="laboratory",
keywords="testing",
keywords="payment",
keywords="decision-making",
keywords="user",
keywords="utilization",
keywords="processing",
keywords="decision",
doi="10.2196/46007",
url="https://www.i-jmr.org/2025/1/e46007",
url="http://www.ncbi.nlm.nih.gov/pubmed/39808833"
}


@Article{info:doi/10.2196/64445,
author="Abdulazeem, Hebatullah
and Borges do Nascimento, J{\'u}nior Israel
and Weerasekara, Ishanka
and Sharifan, Amin
and Grandi Bianco, Victor
and Cunningham, Ciara
and Kularathne, Indunil
and Deeken, Genevieve
and de Barros, Jerome
and Sathian, Brijesh
and {\O}stengaard, Lasse
and Lamontagne-Godwin, Frederique
and van Hoof, Joost
and Lazeri, Ledia
and Redlich, Cassie
and Marston, R. Hannah
and Dos Santos, Alistair Ryan
and Azzopardi-Muscat, Natasha
and Yon, Yongjie
and Novillo-Ortiz, David",
title="Use of Digital Health Technologies for Dementia Care: Bibliometric Analysis and Report",
journal="JMIR Ment Health",
year="2025",
month="Feb",
day="10",
volume="12",
pages="e64445",
keywords="people living with dementia",
keywords="digital health technologies",
keywords="bibliometric analysis",
keywords="evidence-based medicine",
abstract="Background: Dementia is a syndrome that compromises neurocognitive functions of the individual and that is affecting 55 million individuals globally, as well as global health care systems, national economic systems, and family members. Objective: This study aimed to determine the status quo of scientific production on use of digital health technologies (DHTs) to support (older) people living with dementia, their families, and care partners. In addition, our study aimed to map the current landscape of global research initiatives on DHTs on the prevention, diagnosis, treatment, and support of people living with dementia and their caregivers. Methods: A bibliometric analysis was performed as part of a systematic review protocol using MEDLINE, Embase, Scopus, Epistemonikos, the Cochrane Database of Systematic Reviews, and Google Scholar for systematic and scoping reviews on DHTs and dementia up to February 21, 2024. Search terms included various forms of dementia and DHTs. Two independent reviewers conducted a 2-stage screening process with disagreements resolved by a third reviewer. Eligible reviews were then subjected to a bibliometric analysis using VOSviewer to evaluate document types, authorship, countries, institutions, journal sources, references, and keywords, creating social network maps to visualize emergent research trends. Results: A total of 704 records met the inclusion criteria for bibliometric analysis. Most reviews were systematic, with a substantial number covering mobile health, telehealth, and computer-based cognitive interventions. Bibliometric analysis revealed that the Journal of Medical Internet Research had the highest number of reviews and citations. Researchers from 66 countries contributed, with the United Kingdom and the United States as the most prolific. Overall, the number of publications covering the intersection of DHTs and dementia has increased steadily over time. However, the diversity of reviews conducted on a single topic has resulted in duplicated scientific efforts. Our assessment of contributions from countries, institutions, and key stakeholders reveals significant trends and knowledge gaps, particularly highlighting the dominance of high-income countries in this research domain. Furthermore, our findings emphasize the critical importance of interdisciplinary, collaborative teams and offer clear directions for future research, especially in underrepresented regions. Conclusions: Our study shows a steady increase in dementia- and DHT-related publications, particularly in areas such as mobile health, virtual reality, artificial intelligence, and sensor-based technologies interventions. This increase underscores the importance of systematic approaches and interdisciplinary collaborations, while identifying knowledge gaps, especially in lower-income regions. It is crucial that researchers worldwide adhere to evidence-based medicine principles to avoid duplication of efforts. This analysis offers a valuable foundation for policy makers and academics, emphasizing the need for an international collaborative task force to address knowledge gaps and advance dementia care globally. Trial Registration: PROSPERO CRD42024511241; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=511241 ",
doi="10.2196/64445",
url="https://mental.jmir.org/2025/1/e64445"
}


@Article{info:doi/10.2196/58956,
author="Bakker, P. Jessie
and McClenahan, J. Samantha
and Fromy, Piper
and Turner, Simon
and Peterson, T. Barry
and Vandendriessche, Benjamin
and Goldsack, C. Jennifer",
title="A Hierarchical Framework for Selecting Reference Measures for the Analytical Validation of Sensor-Based Digital Health Technologies",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="7",
volume="27",
pages="e58956",
keywords="digital health technologies",
keywords="analytical validation",
keywords="digital medicine",
keywords="reference measures",
keywords="fit-for-purpose digital clinical measures",
doi="10.2196/58956",
url="https://www.jmir.org/2025/1/e58956",
url="http://www.ncbi.nlm.nih.gov/pubmed/39918870"
}


@Article{info:doi/10.2196/53483,
author="Tran, Minh Duc
and Thanh Dung, Nguyen
and Minh Duc, Chau
and Ngoc Hon, Huynh
and Minh Khoi, Le
and Phuc Hau, Nguyen
and Thi Thu Huyen, Duong
and Thi Le Thu, Huynh
and Van Duc, Tran
and 
and Minh Yen, Lam
and Thwaites, Louise C.
and Paton, Chris",
title="Status of Digital Health Technology Adoption in 5 Vietnamese Hospitals: Cross-Sectional Assessment",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="6",
volume="9",
pages="e53483",
keywords="electronic health record",
keywords="electronic medical record",
keywords="digital maturity",
keywords="clinical decision support",
keywords="digital infrastructure",
keywords="Vietnam",
keywords="health information technology",
keywords="digital health technology",
keywords="low- and middle-income country",
abstract="Background: Digital health technologies (DHTs) have been recognized as a key solution to help countries, especially those in the low- and middle-income group, to achieve the Sustainable Development Goals (SDGs) and the World Health Organization's (WHO) Triple Billion Targets. In hospital settings, DHTs need to be designed and implemented, considering the local context, to achieve usability and sustainability. As projects such as the Vietnam ICU Translational Applications Laboratory are seeking to integrate new digital technologies in the Vietnamese critical care settings, it is important to understand the current status of DHT adoption in Vietnamese hospitals. Objective: We aimed to explore the current digital maturity in 5 Vietnamese public hospitals to understand their readiness in implementing new DHTs. Methods: We assessed the adoption of some key DHTs and infrastructure in 5 top-tier public hospitals in Vietnam using a questionnaire adapted from the Vietnam Health Information Technology (HIT) Maturity Model. The questionnaire was answered by the heads of the hospitals' IT departments, with follow-up for clarifications and verifications on some answers. Descriptive statistics demonstrated on radar plots and tile graphs were used to visualize the data collected. Results: Hospital information systems (HIS), laboratory information systems (LIS), and radiology information systems--picture archiving and communication systems (RIS-PACS) were implemented in all 5 hospitals, albeit at varied digital maturity levels. At least 50\% of the criteria for LIS in the Vietnam HIT Maturity Model were satisfied by the hospitals in the assessment. However, this threshold was only met by 80\% and 60\% of the hospitals with regard to HIS and RIS-PACS, respectively. Two hospitals were not using any electronic medical record (EMR) system or fulfilling any extra digital capability, such as implementing clinical data repositories (CDRs) and clinical decision support systems (CDSS). No hospital reported sharing clinical data with other organizations using Health Level Seven (HL7) standards, such as Continuity of Care Document (CCD) and Clinical Document Architecture (CDA), although 2 (40\%) reported their systems adopted these standards. Of the 5 hospitals, 4 (80\%) reported their RIS-PACS adopted the Digital Imaging and Communications in Medicine (DICOM) standard. Conclusions: The 5 major Vietnamese public hospitals in this assessment have widely adopted information systems, such as HIS, LIS, and RIS-PACS, to support administrative and clinical tasks. Although the adoption of EMR systems is less common, their implementation revolves around data collection, management, and access to clinical data. Secondary use of clinical data for decision support through the implementation of CDRs and CDSS is limited, posing a potential barrier to the integration of external DHTs into the existing systems. However, the wide adoption of international standards, such as HL7 and DICOM, is a facilitator for the adoption of new DHTs in these hospitals. ",
doi="10.2196/53483",
url="https://formative.jmir.org/2025/1/e53483"
}


@Article{info:doi/10.2196/53741,
author="Siira, Elin
and Johansson, Hanna
and Nygren, Jens",
title="Mapping and Summarizing the Research on AI Systems for Automating Medical History Taking and Triage: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="6",
volume="27",
pages="e53741",
keywords="scoping review",
keywords="artificial intelligence",
keywords="AI",
keywords="medical history taking",
keywords="triage",
keywords="health care",
keywords="automation",
abstract="Background: The integration of artificial intelligence (AI) systems for automating medical history taking and triage can significantly enhance patient flow in health care systems. Despite the promising performance of numerous AI studies, only a limited number of these systems have been successfully integrated into routine health care practice. To elucidate how AI systems can create value in this context, it is crucial to identify the current state of knowledge, including the readiness of these systems, the facilitators of and barriers to their implementation, and the perspectives of various stakeholders involved in their development and deployment. Objective: This study aims to map and summarize empirical research on AI systems designed for automating medical history taking and triage in health care settings. Methods: The study was conducted following the framework proposed by Arksey and O'Malley and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A comprehensive search of 5 databases---PubMed, CINAHL, PsycINFO, Scopus, and Web of Science---was performed. A detailed protocol was established before the review to ensure methodological rigor. Results: A total of 1248 research publications were identified and screened. Of these, 86 (6.89\%) met the eligibility criteria. Notably, most (n=63, 73\%) studies were published between 2020 and 2022, with a significant concentration on emergency care (n=32, 37\%). Other clinical contexts included radiology (n=12, 14\%) and primary care (n=6, 7\%). Many (n=15, 17\%) studies did not specify a clinical context. Most (n=31, 36\%) studies used retrospective designs, while others (n=34, 40\%) did not specify their methodologies. The predominant type of AI system identified was the hybrid model (n=68, 79\%), with forecasting (n=40, 47\%) and recognition (n=36, 42\%) being the most common tasks performed. While most (n=70, 81\%) studies included patient populations, only 1 (1\%) study investigated patients' views on AI-based medical history taking and triage, and 2 (2\%) studies considered health care professionals' perspectives. Furthermore, only 6 (7\%) studies validated or demonstrated AI systems in relevant clinical settings through real-time model testing, workflow implementation, clinical outcome evaluation, or integration into practice. Most (n=76, 88\%) studies were concerned with the prototyping, development, or validation of AI systems. In total, 4 (5\%) studies were reviews of several empirical studies conducted in different clinical settings. The facilitators and barriers to AI system implementation were categorized into 4 themes: technical aspects, contextual and cultural considerations, end-user engagement, and evaluation processes. Conclusions: This review highlights current trends, stakeholder perspectives, stages of innovation development, and key influencing factors related to implementing AI systems in health care. The identified literature gaps regarding stakeholder perspectives and the limited research on AI systems for automating medical history taking and triage indicate significant opportunities for further investigation and development in this evolving field. ",
doi="10.2196/53741",
url="https://www.jmir.org/2025/1/e53741"
}


@Article{info:doi/10.2196/65546,
author="Insani, Norma Widya
and Zakiyah, Neily
and Puspitasari, Melyani Irma
and Permana, Yorga Muhammad
and Parmikanti, Kankan
and Rusyaman, Endang
and Suwantika, Abdurrohim Auliya",
title="Digital Health Technology Interventions for Improving Medication Safety: Systematic Review of Economic Evaluations",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e65546",
keywords="digital health technology",
keywords="drug safety",
keywords="adverse drug events",
keywords="medication errors",
keywords="patient safety",
abstract="Background: Medication-related harm, including adverse drug events (ADEs) and medication errors, represents a significant iatrogenic burden in clinical care. Digital health technology (DHT) interventions can significantly enhance medication safety outcomes. Although the clinical effectiveness of DHT for medication safety has been relatively well studied, much less is known about the cost-effectiveness of these interventions. Objective: This study aimed to systematically review the economic impact of DHT interventions on medication safety and examine methodological challenges to inform future research directions. Methods: A systematic search was conducted across 3 major electronic databases (ie, PubMed, Scopus, and EBSCOhost). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed for this systematic review. Two independent investigators conducted a full-text review after screening preliminary titles and abstracts. We adopted recommendations from the Panel on Cost-Effectiveness in Health and Medicine for data extraction. A narrative analysis was conducted to synthesize clinical and economic outcomes. The quality of reporting for the included studies was assessed using the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) guidelines. Results: We included 13 studies that assessed the cost-effectiveness (n=9, 69.2\%), cost-benefit (n=3, 23.1\%), and cost-utility (n=1, 7.7\%) of DHT for medication safety. Of the included studies, more than half (n=7, 53.9\%) evaluated a clinical decision support system (CDSS)/computerized provider order entry (CPOE), 4 (30.8\%) examined automated medication-dispensing systems, and 2 (15.4\%) focused on pharmacist-led outreach programs targeting health care professionals. In 12 (92.3\% ) studies, DHT was either cost-effective or cost beneficial compared to standard care. On average, DHT interventions reduced ADEs by 37.12\% (range 8.2\%-66.5\%) and medication errors by 54.38\% (range 24\%-83\%). The key drivers of cost-effectiveness included reductions in outcomes, the proportion of errors resulting in ADEs, and implementation costs. Despite a significant upfront cost, DHT showed a return on investment within 3-4.25 years due to lower cost related with ADE treatment and improved workflow efficiency. In terms of reporting quality, the studies were classified as good (n=10, 76.9\%) and moderate (n=3, 23.1\%). Key methodological challenges included short follow-up periods, the absence of alert compliance tracking, the lack of ADE and error severity categorization, and omission of indirect costs. Conclusions: DHT interventions are economically viable to improve medication safety, with a substantial reduction in ADEs and medication errors. Future studies should prioritize incorporating alert compliance tracking, ADE and error severity classification, and evaluation of indirect costs, thereby increasing clinical benefits and economic viability. ",
doi="10.2196/65546",
url="https://www.jmir.org/2025/1/e65546"
}


@Article{info:doi/10.2196/60777,
author="de Ligt, M. Kelly
and Hommes, Saar
and Vromans, D. Ruben
and Boomstra, Eva
and van de Poll, V. Lonneke
and Krahmer, J. Emiel",
title="Improving the Implementation of Patient-Reported Outcome Measure in Clinical Practice: Tackling Current Challenges With Innovative Digital Communication Technologies",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="5",
volume="27",
pages="e60777",
keywords="patient reported outcome measures",
keywords="quality of life",
keywords="health communication",
keywords="delivery of health care",
keywords="digital sciences",
keywords="clinical practice: patient reported outcomes",
keywords="patient reported outcome",
keywords="digital communication",
keywords="communication",
keywords="health management",
keywords="digital technologies",
doi="10.2196/60777",
url="https://www.jmir.org/2025/1/e60777"
}


@Article{info:doi/10.2196/67929,
author="Sugawara, Yuka
and Hirakawa, Yosuke
and Iwagami, Masao
and Inokuchi, Ryota
and Wakimizu, Rie
and Nangaku, Masaomi",
title="Metrics for Evaluating Telemedicine in Randomized Controlled Trials: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e67929",
keywords="patient experience",
keywords="patient-reported outcome",
keywords="quality of life",
keywords="quality-adjusted life year",
keywords="telehealth",
keywords="eHealth",
keywords="mobile phone",
keywords="metrics",
keywords="telemedicine",
keywords="systematic review",
keywords="scoping review",
keywords="review",
keywords="telecommunications",
keywords="database",
keywords="health care",
keywords="patient-centeredness",
keywords="patient satisfaction",
keywords="patient outcome",
keywords="clinical parameter",
keywords="cost-effectiveness",
keywords="evaluation metrics",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Telemedicine involves medical, diagnostic, and treatment-related services using telecommunication technology. Not only does telemedicine contribute to improved patient quality of life and satisfaction by reducing travel time and allowing patients to be seen in their usual environment, but it also has the potential to improve disease management by making it easier for patients to see a doctor. Recently, owing to IT developments, research on telemedicine has been increasing; however, its usefulness and limitations in randomized controlled trials remain unclear because of the multifaceted effects of telemedicine. Furthermore, the specific metrics that can be used as cross-disciplinary indicators when comparing telemedicine and face-to-face care also remain undefined. Objective: This review aimed to provide an overview of the general and cross-disciplinarity metrics used to compare telemedicine with in-person care in randomized controlled trials. In addition, we identified previously unevaluated indicators and suggested those that should be prioritized in future clinical trials. Methods: MEDLINE and Embase databases were searched for publications that met the inclusion criteria according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews). Original, English-language articles on randomized controlled trials comparing some forms of telemedicine with face-to-face care from January 2019 to March 2024 were included, and the basic information and general metrics used in these studies were summarized. Results: Of the 2275 articles initially identified, 79 were included in the final analysis. The commonly used metrics that can be used across medical specialties were divided into the following 3 categories: (1) patient-centeredness (67/79, 85\%), including patient satisfaction, workload, and quality of life; (2) patient outcomes (57/79, 72\%), including general clinical parameters such as death, admission, and adverse events; and (3) cost-effectiveness (40/79, 51\%), including cost assessment and quality-adjusted life year. Notably, only 25 (32\%) of 79 studies evaluated all the 3 categories. Other metrics, such as staff convenience, system usability, and environmental impact, were extracted as indicators in different directions from the three categories above, although few previous reports have evaluated them (staff convenience: 8/79, 10\%; system usability: 3/79, 4\%; and environmental impact: 2/79, 3\%). Conclusions: A significant variation was observed in the metrics used across previous studies. Notably, general indicators should be used to enhance the understandability of the results for people in other areas, even if disease-specific indicators are used. In addition, indicators should be established to include all three commonly used categories of measures to ensure a comprehensive evaluation: patient-centeredness, patient outcomes, and cost-effectiveness. Staff convenience, system usability, and environmental impact are important indicators that should be used in future trials. Moreover, standardization of the evaluation metrics is desired for future clinical trials and studies. Trial Registration: Open Science Forum Registries YH5S7; https://doi.org/10.17605/OSF.IO/YH5S7 ",
doi="10.2196/67929",
url="https://www.jmir.org/2025/1/e67929"
}


@Article{info:doi/10.2196/51785,
author="Werder, Karl
and Cao, Lan
and Park, Hee Eun
and Ramesh, Balasubramaniam",
title="Why AI Monitoring Faces Resistance and What Healthcare Organizations Can Do About It: An Emotion-Based Perspective",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e51785",
keywords="artificial intelligence",
keywords="AI monitoring",
keywords="emotion",
keywords="resistance",
keywords="health care",
doi="10.2196/51785",
url="https://www.jmir.org/2025/1/e51785"
}


@Article{info:doi/10.2196/59946,
author="Tsai, Chuan-Ching
and Kim, Yong Jin
and Chen, Qiyuan
and Rowell, Brigid
and Yang, Jessie X.
and Kontar, Raed
and Whitaker, Megan
and Lester, Corey",
title="Effect of Artificial Intelligence Helpfulness and Uncertainty on Cognitive Interactions with Pharmacists: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="31",
volume="27",
pages="e59946",
keywords="CDSS",
keywords="eye-tracking",
keywords="medication verification",
keywords="uncertainty visualization",
keywords="AI helpfulness and accuracy",
keywords="artificial intelligence",
keywords="cognitive interactions",
keywords="clinical decision support system",
keywords="cognition",
keywords="pharmacists",
keywords="medication",
keywords="interaction",
keywords="decision-making",
keywords="cognitive processing",
abstract="Background: Clinical decision support systems leveraging artificial intelligence (AI) are increasingly integrated into health care practices, including pharmacy medication verification. Communicating uncertainty in an AI prediction is viewed as an important mechanism for boosting human collaboration and trust. Yet, little is known about the effects on human cognition as a result of interacting with such types of AI advice. Objective: This study aimed to evaluate the cognitive interaction patterns of pharmacists during medication product verification when using an AI prototype. Moreover, we examine the impact of AI's assistance, both helpful and unhelpful, and the communication of uncertainty of AI-generated results on pharmacists' cognitive interaction with the prototype. Methods: In a randomized controlled trial, 30 pharmacists from professional networks each performed 200 medication verification tasks while their eye movements were recorded using an online eye tracker. Participants completed 100 verifications without AI assistance and 100 with AI assistance (either with black box help without uncertainty information or uncertainty-aware help, which displays AI uncertainty). Fixation patterns (first and last areas fixated, number of fixations, fixation duration, and dwell times) were analyzed in relation to AI help type and helpfulness. Results: Pharmacists shifted 19\%-26\% of their total fixations to AI-generated regions when these were available, suggesting the integration of AI advice in decision-making. AI assistance did not reduce the number of fixations on fill images, which remained the primary focus area. Unhelpful AI advice led to longer dwell times on reference and fill images, indicating increased cognitive processing. Displaying AI uncertainty led to longer cognitive processing times as measured by dwell times in original images. Conclusions: Unhelpful AI increases cognitive processing time in the original images. Transparency in AI is needed in ``black box'' systems, but showing more information can add a cognitive burden. Therefore, the communication of uncertainty should be optimized and integrated into clinical workflows using user-centered design to avoid increasing cognitive load or impeding clinicians' original workflow. Trial Registration: ClinicalTrials.gov NCT06795477; https://clinicaltrials.gov/study/NCT06795477 ",
doi="10.2196/59946",
url="https://www.jmir.org/2025/1/e59946",
url="http://www.ncbi.nlm.nih.gov/pubmed/39888668"
}


@Article{info:doi/10.2196/63126,
author="Holmes, Glenn
and Tang, Biya
and Gupta, Sunil
and Venkatesh, Svetha
and Christensen, Helen
and Whitton, Alexis",
title="Applications of Large Language Models in the Field of Suicide Prevention: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="23",
volume="27",
pages="e63126",
keywords="suicide",
keywords="suicide prevention",
keywords="large language model",
keywords="self-harm",
keywords="artificial intelligence",
keywords="AI",
keywords="PRISMA",
abstract="Background: Prevention of suicide is a global health priority. Approximately 800,000 individuals die by suicide yearly, and for every suicide death, there are another 20 estimated suicide attempts. Large language models (LLMs) hold the potential to enhance scalable, accessible, and affordable digital services for suicide prevention and self-harm interventions. However, their use also raises clinical and ethical questions that require careful consideration. Objective: This scoping review aims to identify emergent trends in LLM applications in the field of suicide prevention and self-harm research. In addition, it summarizes key clinical and ethical considerations relevant to this nascent area of research. Methods: Searches were conducted in 4 databases (PsycINFO, Embase, PubMed, and IEEE Xplore) in February 2024. Eligible studies described the application of LLMs for suicide or self-harm prevention, detection, or management. English-language peer-reviewed articles and conference proceedings were included, without date restrictions. Narrative synthesis was used to synthesize study characteristics, objectives, models, data sources, proposed clinical applications, and ethical considerations. This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) standards. Results: Of the 533 studies identified, 36 (6.8\%) met the inclusion criteria. An additional 7 studies were identified through citation chaining, resulting in 43 studies for review. The studies showed a bifurcation of publication fields, with varying publication norms between computer science and mental health. While most of the studies (33/43, 77\%) focused on identifying suicide risk, newer applications leveraging generative functions (eg, support, education, and training) are emerging. Social media was the most common source of LLM training data. Bidirectional Encoder Representations from Transformers (BERT) was the predominant model used, although generative pretrained transformers (GPTs) featured prominently in generative applications. Clinical LLM applications were reported in 60\% (26/43) of the studies, often for suicide risk detection or as clinical assistance tools. Ethical considerations were reported in 33\% (14/43) of the studies, with privacy, confidentiality, and consent strongly represented. Conclusions: This evolving research area, bridging computer science and mental health, demands a multidisciplinary approach. While open access models and datasets will likely shape the field of suicide prevention, documenting their limitations and potential biases is crucial. High-quality training data are essential for refining these models and mitigating unwanted biases. Policies that address ethical concerns---particularly those related to privacy and security when using social media data---are imperative. Limitations include high variability across disciplines in how LLMs and study methodology are reported. The emergence of generative artificial intelligence signals a shift in approach, particularly in applications related to care, support, and education, such as improved crisis care and gatekeeper training methods, clinician copilot models, and improved educational practices. Ongoing human oversight---through human-in-the-loop testing or expert external validation---is essential for responsible development and use. Trial Registration: OSF Registries osf.io/nckq7; https://osf.io/nckq7 ",
doi="10.2196/63126",
url="https://www.jmir.org/2025/1/e63126",
url="http://www.ncbi.nlm.nih.gov/pubmed/39847414"
}


@Article{info:doi/10.2196/58177,
author="Kim, Hoon Ji
and Kim, Joung Min
and Kim, Chang Hyeon
and Kim, Yan Ha
and Sung, Min Ji
and Chang, Hyuk-Jae",
title="A Novel Artificial Intelligence--Enhanced Digital Network for Prehospital Emergency Support: Community Intervention Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="23",
volume="27",
pages="e58177",
keywords="emergency patient transport",
keywords="transport time",
keywords="artificial intelligence",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Efficient emergency patient transport systems, which are crucial for delivering timely medical care to individuals in critical situations, face certain challenges. To address this, CONNECT-AI (CONnected Network for EMS Comprehensive Technical-Support using Artificial Intelligence), a novel digital platform, was introduced. This artificial intelligence (AI)--based network provides comprehensive technical support for the real-time sharing of medical information at the prehospital stage. Objective: This study aimed to evaluate the effectiveness of this system in reducing patient transport delays. Methods: The CONNECT-AI system provided 3 key AI services to prehospital care providers by collecting real-time patient data from the scene and hospital resource information, such as bed occupancy and the availability of emergency surgeries or procedures, using 5G communication technology and internet of things devices. These services included guidance on first aid, prediction of critically ill patients, and recommendation of the optimal transfer hospital. In addition, the platform offered emergency department medical staff real-time clinical information, including live video of patients during transport to the hospital. This community-based, nonrandomized controlled intervention study was designed to evaluate the effectiveness of the CONNECT-AI system in 2 regions of South Korea, each of which operated an intervention and a control period, each lasting 16 weeks. The impact of the system was assessed based on the proportion of patients experiencing transfer delays. Results: A total of 14,853 patients transported by public ambulance were finally selected for analysis. Overall, the median transport time was 10 (IQR 7-14) minutes in the intervention group and 9 (IQR 6-13) minutes in the control group. When comparing the incidence of transport time outliers (>75\%), which was the primary outcome of this study, the rate was higher in the intervention group in region 1, but significantly reduced in region 2, with the overall outlier rate being higher in the intervention group (27.5\%-29.7\%, P=.04). However, for patients with fever or respiratory symptoms, the group using the system showed a statistically significant reduction in outlier cases (36.5\%-30.1\%, P=.01). For patients who received real-time acceptance signals from the hospital, the reduction in the percentage of 75\% outliers was statistically significant compared with those without the system (27.5\%-19.6\%, P=.02). As a result of emergency department treatment, 1.5\% of patients in the control group and 1.1\% in the intervention group died (P=.14). In the system-guided optimal hospital transfer group, the mortality rate was significantly lower than in the control group (1.54\%-0.64\%, P=.01). Conclusions: The present digital emergency medical system platform offers a novel approach to enhancing emergency patient transport by leveraging AI, real-time information sharing, and decision support. While the system demonstrated improvements for certain patient groups facing transfer challenges, further research and modifications are necessary to fully realize its benefits in diverse health care contexts. Trial Registration: ClinicalTrials.gov NCT04829279; https://clinicaltrials.gov/study/NCT04829279 ",
doi="10.2196/58177",
url="https://www.jmir.org/2025/1/e58177",
url="http://www.ncbi.nlm.nih.gov/pubmed/39847421"
}


@Article{info:doi/10.2196/57385,
author="Zhang, Lan
and Bullen, Christopher
and Chen, Jinsong",
title="Digital Health Innovations to Catalyze the Transition to Value-Based Health Care",
journal="JMIR Med Inform",
year="2025",
month="Jan",
day="20",
volume="13",
pages="e57385",
keywords="digital health",
keywords="value-based health care",
keywords="VBHC",
keywords="patient-reported outcome measures",
keywords="PROM",
keywords="digital transformation",
keywords="health care innovation",
keywords="patient-centric care",
keywords="health technology",
keywords="patient-reported outcome",
keywords="PRO",
keywords="outcome measure",
keywords="telehealth",
keywords="telemedicine",
keywords="eHealth",
keywords="personalized",
keywords="customized",
keywords="engagement",
keywords="patient-centered care",
keywords="standardization",
keywords="implementation",
doi="10.2196/57385",
url="https://medinform.jmir.org/2025/1/e57385"
}


@Article{info:doi/10.2196/69798,
author="Sugawara, Yuka
and Hirakawa, Yosuke
and Iwagami, Masao
and Kuroki, Haruo
and Mitani, Shuhei
and Inagaki, Ataru
and Ohashi, Hiroki
and Kubota, Mitsuru
and Koike, Soichi
and Wakimizu, Rie
and Nangaku, Masaomi",
title="Authors' Reply: Japan's Telepsychiatry Dissemination: Current Status and Challenges",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="20",
volume="27",
pages="e69798",
doi="10.2196/69798",
url="https://www.jmir.org/2025/1/e69798"
}


@Article{info:doi/10.2196/22849,
author="Kinoshita, Shotaro
and Kishimoto, Taishiro",
title="Japan's Telepsychiatry Dissemination: Current Status and Challenges",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="20",
volume="27",
pages="e22849",
doi="10.2196/22849",
url="https://www.jmir.org/2025/1/e22849"
}


@Article{info:doi/10.2196/59611,
author="Conen, Robin
and Mueller, Steffen
and Tibubos, Nanette Ana",
title="Integration of Conventional and Virtual Reality Approaches in Augmented Reality for Theory-Based Psychoeducational Intervention Design for Chronic Low Back Pain: Scoping Review",
journal="Interact J Med Res",
year="2025",
month="Jan",
day="20",
volume="14",
pages="e59611",
keywords="augmented reality",
keywords="virtual reality",
keywords="chronic low back pain",
keywords="education",
keywords="pain management",
keywords="intervention",
abstract="Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one's own body sensory perception and can combine conventional and VR approaches. Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP. Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories. Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended. Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed. ",
doi="10.2196/59611",
url="https://www.i-jmr.org/2025/1/e59611"
}


@Article{info:doi/10.2196/57614,
author="Romm, Lie Kristin
and Skoge, Mari
and Barrett, Ann Elizabeth
and Berentzen, Lars-Christian
and Bergsager, Dagfinn
and Fugelli, P{\aa}l
and Bjella, Thomas
and Gardsjord, Strand Erlend
and Kling, Kristine
and Kruse, Hembre Sindre
and Kv{\ae}rner, Jorunn Kari
and Melle, Ingrid
and Mork, Erlend
and Ihler, Myhre Henrik
and Rognli, Borger Eline
and Simonsen, Carmen
and V{\ae}rnes, Gunnar Tor
and Aminoff, Ragnhild Sofie",
title="A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="17",
volume="9",
pages="e57614",
keywords="eHealth",
keywords="shared decision-making",
keywords="user involvement",
keywords="user-centered design",
keywords="mental disorder",
keywords="mobile technology",
keywords="illness course",
keywords="recovery",
keywords="mobile apps",
keywords="mHealth",
abstract="Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. Objective: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. Methods: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. Results: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. Conclusions: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings---from development to implementation---and to conduct further research on early health technology assessments to guide these processes. ",
doi="10.2196/57614",
url="https://formative.jmir.org/2025/1/e57614"
}


@Article{info:doi/10.2196/60512,
author="Song, Mingming
and Elson, Joel
and Bastola, Dhundy",
title="Digital Age Transformation in Patient-Physician Communication: 25-Year Narrative Review (1999-2023)",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="16",
volume="27",
pages="e60512",
keywords="health communication",
keywords="health IT",
keywords="patient empowerment",
keywords="shared decision-making",
keywords="patient-physician relationship",
keywords="trust",
abstract="Background: The evolution of patient-physician communication has changed since the emergence of the World Wide Web. Health information technology (health IT) has become an influential tool, providing patients with access to a breadth of health information electronically. While such information has greatly facilitated communication between patients and physicians, it has also led to information overload and the potential for spreading misinformation. This could potentially result in suboptimal health care outcomes for patients. In the digital age, effectively integrating health IT with patient empowerment, strong patient-physician relationships, and shared decision-making could be increasingly important for health communication and reduce these risks. Objective: This review aims to identify key factors in health communication and demonstrate how essential elements in the communication model, such as health IT, patient empowerment, and shared decision-making, can be utilized to optimize patient-physician communication and, ultimately, improve patient outcomes in the digital age. Methods: Databases including PubMed, Web of Science, Scopus, PsycINFO, and IEEE Xplore were searched using keywords related to patient empowerment, health IT, shared decision-making, patient-physician relationship, and health communication for studies published between 1999 and 2023. The data were constrained by a modified query using a multidatabase search strategy. The screening process was supported by the web-based software tool Rayyan. The review methodology involved carefully designed steps to provide a comprehensive summary of existing research. Topic modeling, trend analysis, and synthesis were applied to analyze and evaluate topics, trends, and gaps in health communication. Results: From a total of 389 selected studies, topic modeling analysis identified 3 primary topics: (1) Patient-Physician Relationship and Shared Decision-Making, (2) Patient Empowerment and Education Strategies, and (3) Health Care Systems and Health IT Implementations. Trend analysis further indicated their frequency and prominence in health communication from 1999 to 2023. Detailed examinations were conducted using secondary terms, including trust, health IT, patient-physician relationship, and patient empowerment, derived from the main topics. These terms clarified the collective impact on improving health communication dynamics. The synthesis of the role of health IT in health communication models underscores its critical role in shaping patient-centered health care frameworks. Conclusions: This review highlights the significant contributions of key topics that should be thoroughly investigated and integrated into health communication models in the digital age. While health IT plays an essential role in promoting shared decision-making and patient empowerment, challenges such as usability, privacy concerns, and digital literacy remain significant barriers. Future research should prioritize evaluating these key themes and addressing the challenges associated with health IT in health communication models. Additionally, exploring how emerging technologies, such as artificial intelligence, can support these goals may provide valuable insights for enhancing health communication. ",
doi="10.2196/60512",
url="https://www.jmir.org/2025/1/e60512"
}


@Article{info:doi/10.2196/63015,
author="Laukka, Elina
and Tuunanen, Tuure
and Jansson, Miia
and Vanhanen, Minna
and Hirvonen, Nina
and Palukka, Jenni
and Vesinurm, M{\"a}rt
and Torkki, Paulus",
title="Value Cocreation and Codestruction in Digital Health Services: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="14",
volume="14",
pages="e63015",
keywords="value cocreation",
keywords="value codestruction",
keywords="telemedicine",
keywords="eHealth",
keywords="systematic review",
abstract="Background: To successfully design, develop, implement, and deliver digital health services that provide value, they should be cocreated with patients. However, occasionally, the value may also be codestructed. In the field of health care, the concepts of value cocreation and codestruction still need to be better established within emerging digital health services. Studying these concepts is essential for developing effective and sustainable patient-centered care. Objective: The aim of the study is (1) to understand the antecedents, decisions, and outcomes of value cocreation and codestruction in digital health services, (2) to define the dynamics between value cocreation and codestruction, and (3) to map future research areas of value cocreation and codestruction within digital health services. Methods: The systematic review will be conducted in accordance with the Joanna Briggs Institute methodology for mixed method systematic reviews and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The review considers scientific qualitative, quantitative, or mixed method studies published in English, Finnish, or Swedish that concern either value cocreation or codestruction in digital health services. Studies focusing on physical robotics and online health communities, as well as non--peer-reviewed and nonscientific papers, will be excluded. The searches were conducted using Scopus and MEDLINE during this protocol creation. Critical appraisal will be done using suitable checklists for qualitative, quantitative, and mixed method studies. The review will adhere to a convergent integrated approach as outlined in the Joanna Briggs Institute methodology for mixed methods systematic reviews. Results: The searches resulted in a total of 837 records. The antecedents, decisions, and outcomes of value cocreation and codestruction in the context of digital health services will be described in a finalized systematic review. In the outcomes, our main interest is the effect on patient outcomes and experiences and professional experiences. Conclusions: Since our study involves diverse scientific fields, there is a risk that our search does not capture all relevant papers. To mitigate this risk, we used 2 large databases for the searches. In addition, the value cocreation or codestruction terms may not have been used in all studies focusing on the collaborative roles of patients and providers, especially in the medical field, and that may be difficult to capture. The review reveals the current understanding of value cocreation and codestruction in digital health services and shapes the research agenda for these phenomena. Value cocreation can be used to both design and efficiently use digital health services trying to maximize the value for patients. International Registered Report Identifier (IRRID): DERR1-10.2196/63015 ",
doi="10.2196/63015",
url="https://www.researchprotocols.org/2025/1/e63015"
}


@Article{info:doi/10.2196/59261,
author="Tanaka, Hiroki
and Miyamoto, Kana
and Hamet Bagnou, Jennifer
and Prigent, Elise
and Clavel, C{\'e}line
and Martin, Jean-Claude
and Nakamura, Satoshi",
title="Analysis of Social Performance and Action Units During Social Skills Training: Focus Group Study of Adults With Autism Spectrum Disorder and Schizophrenia",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="10",
volume="9",
pages="e59261",
keywords="social performance rating scale",
keywords="social skills training",
keywords="autism spectrum disorder",
keywords="schizophrenia",
keywords="facial expressions",
keywords="social",
keywords="autism",
keywords="training",
keywords="communication",
keywords="trainers",
keywords="tool",
keywords="neurological",
abstract="Background: Social communication is a crucial factor influencing human social life. Quantifying the degree of difficulty faced in social communication is necessary for understanding developmental and neurological disorders and for creating systems used in automatic symptom screening and assistive methods such as social skills training (SST). SST by a human trainer is a well-established method. Previous SST used a modified roleplay test to evaluate human social communication skills. However, there are no widely accepted evaluation criteria or social behavioral markers to quantify social performance during SST. Objective: This paper has 2 objectives. First, we propose applying the Social Performance Rating Scale (SPRS) to SST data to measure social communication skills. We constructed a Japanese version of the SPRS already developed in English and French. Second, we attempt to quantify action units during SST for people with autism spectrum disorder (ASD) or schizophrenia. Methods: We used videos of interactions between trainers, adults with ASD (n=16) or schizophrenia (n=15), and control participants (n=19) during SST sessions. Two raters applied the proposed scale to annotate the collected data. We investigated the differences between roleplay tasks and participant groups (ASD, schizophrenia, and control). Furthermore, the intensity of action units on the OpenFace toolkit was measured in terms of mean and SD during SST roleplaying. Results: We found significantly greater gaze scores in adults with ASD than in adults with schizophrenia. Differences were also found between the ratings of different tasks in the adults with schizophrenia and the control participants. Action units numbered AU06 and AU12 were significantly deactivated in people with schizophrenia compared with the control group. Moreover, AU02 was significantly activated in people with ASD compared with the other groups. Conclusions: The results suggest that the SPRS can be a useful tool for assessing social communication skills in different cultures and different pathologies when used with the modified roleplay test. Furthermore, facial expressions could provide effective social and behavioral markers to characterize psychometric properties. Possible future directions include using the SPRS for assessing social behavior during interaction with a digital agent. ",
doi="10.2196/59261",
url="https://formative.jmir.org/2025/1/e59261"
}


@Article{info:doi/10.2196/68072,
author="Chen, Nai-Jung
and Chang, Ching-Hao
and Huang, Chiu-Mieh
and Lin, Fen-He
and Lu, Li-Ting
and Liu, Kuan-Yi
and Lai, Chih-Lin
and Lin, Chin-Yao
and Hou, Yi-Chou
and Guo, Jong-Long",
title="Assessing the Effectiveness of Interactive Robot-Assisted Virtual Health Coaching for Health Literacy and Disease Knowledge of Patients with Chronic Kidney Disease: Quasiexperimental Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e68072",
keywords="chronic kidney disease",
keywords="disease knowledge",
keywords="eHealth",
keywords="health coaching",
keywords="health education",
keywords="health literacy",
keywords="interactive robot",
abstract="Background: Chronic kidney disease (CKD) imposes a significant global health and economic burden, impacting millions globally. Despite its high prevalence, public awareness and understanding of CKD remain limited, leading to delayed diagnosis and suboptimal management. Traditional patient education methods, such as 1-on-1 verbal instruction or printed brochures, are often insufficient, especially considering the shortage of nursing staff. Technology-assisted education presents a promising and standardized solution, emphasizing the need for innovative and scalable approaches to improve CKD-specific knowledge and health literacy. Objective: This study aimed to develop and evaluate the effectiveness of an innovative 12-unit virtual health coaching program delivered through interactive robots that is intended to enhance disease knowledge and health literacy among patients with CKD. Methods: A quasiexperimental design was used, and 60 participants were evenly assigned to experimental and comparison groups. However, due to attrition, 14 participants in the experimental group and 16 participants in the comparison group completed the study. The intervention involved a 12-unit program, with each unit lasting approximately 20 minutes to 30 minutes and delivered across 3 to 4 learning sessions, and participants completed 3 to 4 units per session. The program addressed key aspects of CKD-specific health literacy including functional, communicative, and critical literacy and CKD-specific knowledge including basic knowledge, prevention, lifestyle, dietary intake, and medication. Data were collected through validated pre and postintervention questionnaires. All 30 participants completed the program and subsequent evaluations, with outcome measures assessing changes in CKD-specific knowledge and health literacy. Results: Postintervention analysis using generalized estimating equations, adjusted for age, revealed that the experimental group (n=14) had significantly greater improvements in health literacy (coefficient=2.51, Wald $\chi${\texttwosuperior}1=5.89; P=.02) and disease knowledge (coefficient=1.66, Wald $\chi${\texttwosuperior}1=11.75; P=.001) than the comparison group (n=16). Postintervention t tests revealed significant improvements in CKD-specific health literacy and disease knowledge (P<.001) between the experimental and comparison groups. Additional analyses identified significant group {\texttimes} time interactions, indicating improvements in communicative literacy (P=.01) and critical literacy (P=.02), while no significant changes were observed in functional literacy. Regarding disease knowledge, the experimental group demonstrated a significant improvement in medication (P<.001), whereas changes in basic knowledge, prevention, lifestyle, and dietary intake were not significant. Conclusions: This study demonstrated that interactive robot-assisted eHealth coaching effectively enhanced CKD-specific disease knowledge and health literacy. Despite the challenges posed by the COVID-19 pandemic, which constrained sample sizes, the findings indicate that this program is a promising patient education tool in clinical nephrology. Future research should involve larger sample sizes to enhance generalizability and examine additional factors influencing effectiveness. ",
doi="10.2196/68072",
url="https://www.jmir.org/2025/1/e68072"
}


@Article{info:doi/10.2196/59024,
author="Shen, Yun
and Yu, Jiamin
and Zhou, Jian
and Hu, Gang",
title="Twenty-Five Years of Evolution and Hurdles in Electronic Health Records and Interoperability in Medical Research: Comprehensive Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e59024",
keywords="electronic health record",
keywords="electronic medical record",
keywords="medical research",
keywords="interoperability",
keywords="eHealth",
keywords="systematic review",
keywords="real-world evidence",
keywords="artificial intelligence",
abstract="Background: Electronic health records (EHRs) facilitate the accessibility and sharing of patient data among various health care providers, contributing to more coordinated and efficient care. Objective: This study aimed to summarize the evolution of secondary use of EHRs and their interoperability in medical research over the past 25 years. Methods: We conducted an extensive literature search in the PubMed, Scopus, and Web of Science databases using the keywords Electronic health record and Electronic medical record in the title or abstract and Medical research in all fields from 2000 to 2024. Specific terms were applied to different time periods. Results: The review yielded 2212 studies, all of which were then screened and processed in a structured manner. Of these 2212 studies, 2102 (93.03\%) were included in the review analysis, of which 1079 (51.33\%) studies were from 2000 to 2009, 582 (27.69\%) were from 2010 to 2019, 251 (11.94\%) were from 2020 to 2023, and 190 (9.04\%) were from 2024. Conclusions: The evolution of EHRs marks an important milestone in health care's journey toward integrating technology and medicine. From early documentation practices to the sophisticated use of artificial intelligence and big data analytics today, EHRs have become central to improving patient care, enhancing public health surveillance, and advancing medical research. ",
doi="10.2196/59024",
url="https://www.jmir.org/2025/1/e59024"
}


@Article{info:doi/10.2196/55015,
author="Riahi, Vahid
and Diouf, Ibrahima
and Khanna, Sankalp
and Boyle, Justin
and Hassanzadeh, Hamed",
title="Digital Twins for Clinical and Operational Decision-Making: Scoping Review",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="8",
volume="27",
pages="e55015",
keywords="digital twin",
keywords="health care",
keywords="clinical decision-making",
keywords="CDM",
keywords="operational decision-making",
keywords="ODM",
keywords="scoping review",
abstract="Background: The health care industry must align with new digital technologies to respond to existing and new challenges. Digital twins (DTs) are an emerging technology for digital transformation and applied intelligence that is rapidly attracting attention. DTs are virtual representations of products, systems, or processes that interact bidirectionally in real time with their actual counterparts. Although DTs have diverse applications from personalized care to treatment optimization, misconceptions persist regarding their definition and the extent of their implementation within health systems. Objective: This study aimed to review DT applications in health care, particularly for clinical decision-making (CDM) and operational decision-making (ODM). It provides a definition and framework for DTs by exploring their unique elements and characteristics. Then, it assesses the current advances and extent of DT applications to support CDM and ODM using the defined DT characteristics. Methods: We conducted a scoping review following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol. We searched multiple databases, including PubMed, MEDLINE, and Scopus, for original research articles describing DT technologies applied to CDM and ODM in health systems. Papers proposing only ideas or frameworks or describing DT capabilities without experimental data were excluded. We collated several available types of information, for example, DT characteristics, the environment that DTs were tested within, and the main underlying method, and used descriptive statistics to analyze the synthesized data. Results: Out of 5537 relevant papers, 1.55\% (86/5537) met the predefined inclusion criteria, all published after 2017. The majority focused on CDM (75/86, 87\%). Mathematical modeling (24/86, 28\%) and simulation techniques (17/86, 20\%) were the most frequently used methods. Using International Classification of Diseases, 10th Revision coding, we identified 3 key areas of DT applications as follows: factors influencing diseases of the circulatory system (14/86, 16\%); health status and contact with health services (12/86, 14\%); and endocrine, nutritional, and metabolic diseases (10/86, 12\%). Only 16 (19\%) of 86 studies tested the developed system in a real environment, while the remainder were evaluated in simulated settings. Assessing the studies against defined DT characteristics reveals that the developed systems have yet to materialize the full capabilities of DTs. Conclusions: This study provides a comprehensive review of DT applications in health care, focusing on CDM and ODM. A key contribution is the development of a framework that defines important elements and characteristics of DTs in the context of related literature. The DT applications studied in this paper reveal encouraging results that allow us to envision that, in the near future, they will play an important role not only in the diagnosis and prevention of diseases but also in other areas, such as efficient clinical trial design, as well as personalized and optimized treatments. ",
doi="10.2196/55015",
url="https://www.jmir.org/2025/1/e55015"
}


@Article{info:doi/10.2196/65690,
author="Husain, Laiba
and Greenhalgh, Trisha",
title="Examining Intersectionality and Barriers to the Uptake of Video Consultations Among Older Adults From Disadvantaged Backgrounds With Limited English Proficiency: Qualitative Narrative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65690",
keywords="digital health disparities",
keywords="video consultations",
keywords="intersectionality",
keywords="health inequity",
keywords="digital capital",
keywords="mobile phone",
abstract="Background: The rapid shift to video consultation services during the COVID-19 pandemic has raised concerns about exacerbating existing health inequities, particularly for disadvantaged populations. Intersectionality theory provides a valuable framework for understanding how multiple dimensions of disadvantage interact to shape health experiences and outcomes. Objective: This study aims to explore how multiple dimensions of disadvantage---specifically older age, limited English proficiency, and low socioeconomic status---intersect to shape experiences with digital health services, focusing on video consultations. Methods: Following familiarization visits and interviews with service providers, 17 older people with multiple markers of disadvantage (older age, low socioeconomic status, and limited English proficiency) were recruited in the Redbridge borough of London. Data collection included narrative interviews and ethnographic observations during home visits. Field notes captured participants' living conditions, family dynamics, and technological arrangements. Guided by intersectionality theory and digital capital concepts, interviews explored participants' experiences accessing health care remotely. Intersectional narrative analysis was used to identify key themes and examine how different forms of disadvantage interact. We developed theoretically informed narrative portraits and user personas to synthesize findings. Results: Analysis revealed that the digitalization of health care can exacerbate existing inequities, erode trust, compound oppression, and reduce patient agency for multiply disadvantaged patient populations. Examining intersectionality illuminated how age, language proficiency, and socioeconomic status interact to create unique barriers and experiences. Key themes included the following: weakened presence in digital interactions, erosion of therapeutic relationships, shift from relational to distributed continuity, increased complexity leading to disorientation, engagement shaped by previous experiences of discrimination, and reduced patient agency. Conclusions: This study provides critical insights into how the digitalization of health care can deepen disparities for older patients with low income and limited English proficiency. By applying intersectionality theory to digital health disparities, our findings underscore the need for multifaceted approaches to digital health equity that address the complex interplay of disadvantage. Recommendations include co-designing inclusive digital services, strengthening relational continuity, and developing targeted support to preserve agency and trust for marginalized groups in an increasingly digital health care landscape. ",
doi="10.2196/65690",
url="https://www.jmir.org/2025/1/e65690"
}


@Article{info:doi/10.2196/54047,
author="Zhao, Ziwei
and Zhang, Weiyi
and Chen, Xiaolan
and Song, Fan
and Gunasegaram, James
and Huang, Wenyong
and Shi, Danli
and He, Mingguang
and Liu, Na",
title="Slit Lamp Report Generation and Question Answering: Development and Validation of a Multimodal Transformer Model with Large Language Model Integration",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="30",
volume="26",
pages="e54047",
keywords="large language model",
keywords="slit lamp",
keywords="medical report generation",
keywords="question answering",
abstract="Background: Large language models have shown remarkable efficacy in various medical research and clinical applications. However, their skills in medical image recognition and subsequent report generation or question answering (QA) remain limited. Objective: We aim to finetune a multimodal, transformer-based model for generating medical reports from slit lamp images and develop a QA system using Llama2. We term this entire process slit lamp--GPT. Methods: Our research used a dataset of 25,051 slit lamp images from 3409 participants, paired with their corresponding physician-created medical reports. We used these data, split into training, validation, and test sets, to finetune the Bootstrapping Language-Image Pre-training framework toward report generation. The generated text reports and human-posed questions were then input into Llama2 for subsequent QA. We evaluated performance using qualitative metrics (including BLEU [bilingual evaluation understudy], CIDEr [consensus-based image description evaluation], ROUGE-L [Recall-Oriented Understudy for Gisting Evaluation---Longest Common Subsequence], SPICE [Semantic Propositional Image Caption Evaluation], accuracy, sensitivity, specificity, precision, and F1-score) and the subjective assessments of two experienced ophthalmologists on a 1-3 scale (1 referring to high quality). Results: We identified 50 conditions related to diseases or postoperative complications through keyword matching in initial reports. The refined slit lamp--GPT model demonstrated BLEU scores (1-4) of 0.67, 0.66, 0.65, and 0.65, respectively, with a CIDEr score of 3.24, a ROUGE (Recall-Oriented Understudy for Gisting Evaluation) score of 0.61, and a Semantic Propositional Image Caption Evaluation score of 0.37. The most frequently identified conditions were cataracts (22.95\%), age-related cataracts (22.03\%), and conjunctival concretion (13.13\%). Disease classification metrics demonstrated an overall accuracy of 0.82 and an F1-score of 0.64, with high accuracies (?0.9) observed for intraocular lens, conjunctivitis, and chronic conjunctivitis, and high F1-scores (?0.9) observed for cataract and age-related cataract. For both report generation and QA components, the two evaluating ophthalmologists reached substantial agreement, with $\kappa$ scores between 0.71 and 0.84. In assessing 100 generated reports, they awarded scores of 1.36 for both completeness and correctness; 64\% (64/100) were considered ``entirely good,'' and 93\% (93/100) were ``acceptable.'' In the evaluation of 300 generated answers to questions, the scores were 1.33 for completeness, 1.14 for correctness, and 1.15 for possible harm, with 66.3\% (199/300) rated as ``entirely good'' and 91.3\% (274/300) as ``acceptable.'' Conclusions: This study introduces the slit lamp--GPT model for report generation and subsequent QA, highlighting the potential of large language models to assist ophthalmologists and patients. ",
doi="10.2196/54047",
url="https://www.jmir.org/2024/1/e54047"
}


@Article{info:doi/10.2196/60374,
author="Pearce, Nettleton Louise Michelle
and Pryor, Julie
and Redhead, Jason
and Sherrington, Catherine
and Hassett, Leanne",
title="Advanced Technology in a Real-World Rehabilitation Setting: Longitudinal Observational Study on Clinician Adoption and Implementation",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="30",
volume="26",
pages="e60374",
keywords="rehabilitation",
keywords="technology",
keywords="digital health",
keywords="virtual reality",
keywords="robotics",
keywords="exoskeleton device",
keywords="implementation science",
keywords="physiotherapy",
keywords="physical therapy",
keywords="occupational therapy",
keywords="mobile phone",
abstract="Background: Advanced technologies are becoming increasingly accessible in rehabilitation. Current research suggests technology can increase therapy dosage, provide multisensory feedback, and reduce manual handling for clinicians. While more high-quality evidence regarding the effectiveness of rehabilitation technologies is needed, understanding of how to effectively integrate technology into clinical practice is also limited. Current implementation of rehabilitation technology is inconsistent, with low uptake among clinicians and frequent reports of technology abandonment. An Australian rehabilitation provider opened a new technology therapy center in 2022, offering a unique opportunity to generate practice-based evidence to inform future technology implementation and research. Objective: This study aimed to investigate the implementation and adoption of advanced technology within a real-world rehabilitation setting. Methods: This study was a longitudinal observational study in a rehabilitation organization with inpatient, outpatient, and community settings. Allied health clinicians (n=119) within the organization had access to advanced technologies, with patients receiving neurological, spinal cord injury, brain injury, or general rehabilitation. Interventions included 21 advanced technologies, including robotic, virtual reality (VR), sensor-based, and functional electrical stimulation devices. Clinicians received training for devices in a staged approach by external and internal trainers. Data were collected from patient electronic medical records from July 1, 2022, to June 30, 2023. Outcomes included frequency of advanced technology use, patient demographics (age, gender, and primary health condition), clinician discipline, rehabilitation service (inpatient, outpatient, or community), goals of technology therapy sessions, and therapy dosage achieved (minutes active, number of repetitions, and meters walked). Results: Clinicians used advanced technology 4208 times with 269 patients over 12 months; specifically, physiotherapists (2716/4208, 65\%), occupational therapists (1396/4208, 33\%), and allied health assistants (96/4208, 2\%). The majority of patients had stroke, spinal cord injury, or brain injury diagnoses (188/269, 70\%). Devices were typically used to target impairment and activity limitation--related goals. Frequently used devices included gait training body-weight support (VR treadmill and overground), overground robotic exoskeletons, and upper limb robotic VR devices. Outpatient services were the dominant users of advanced technology (3940/4208, 94\%). Clinicians most commonly used devices for patients with stroke (1973/4208, 47\%) and the greatest variety of devices for patients with stroke and spinal cord injury. The relative use of lower limb robotic devices was greater in inpatient services (91/178, 51\%, vs outpatient services, 963/2335, 41\%) ($\chi$21=6.6, P=.01) and for patients with spinal cord injury (48/95, 51\%, vs all other conditions, between 24\%-31\%; $\chi$25=16.8, P=.005). Conclusions: The type and amount of advanced technology use differed between patient populations and rehabilitation settings. To support clinician use of advanced technology, devices should match the rehabilitation context. Tailored strategies are important, such as clinician training. Further practice-based research is required to provide guidance on implementation and to establish the effectiveness of advanced technology use. ",
doi="10.2196/60374",
url="https://www.jmir.org/2024/1/e60374"
}


@Article{info:doi/10.2196/65734,
author="Smiley, Aref
and Finkelstein, Joseph",
title="Home Automated Telemanagement System for Individualized Exercise Programs: Design and Usability Evaluation",
journal="JMIR Biomed Eng",
year="2024",
month="Dec",
day="27",
volume="9",
pages="e65734",
keywords="telemedicine",
keywords="home-based exercise",
keywords="telerehabilitation",
keywords="remote cycling",
keywords="usability",
keywords="physical rehabilitation",
keywords="exercise therapy",
abstract="Background: Exercise is essential for physical rehabilitation, helping to improve functional performance and manage chronic conditions. Telerehabilitation offers an innovative way to deliver personalized exercise programs remotely, enhancing patient adherence and clinical outcomes. The Home Automated Telemanagement (HAT) System, integrated with the interactive bike (iBikE) system, was designed to support home-based rehabilitation by providing patients with individualized exercise programs that can be monitored remotely by a clinical rehabilitation team. Objective: This study aims to evaluate the design, usability, and efficacy of the iBikE system within the HAT platform. We assessed the system's ability to enhance patient adherence to prescribed exercise regimens while minimizing patient and clinician burden in carrying out the rehabilitation program. Methods: We conducted a quasi-experimental study with 5 participants using a pre- and posttest design. Usability testing included 2 primary tasks that participants performed with the iBikE system. Task completion times, adherence to exercise protocols, and user satisfaction were measured. A System Usability Scale (SUS) was also used to evaluate participants' overall experience. After an initial introduction, users performed the tasks independently following a 1-week break to assess retention of the system's operation skills and its functionality. Results: Task completion times improved substantially from the pretest to the posttest: execution time for task 1 reduced from a mean of 8.6 (SD 4.7) seconds to a mean of 1.8 (SD 0.8) seconds, and the time for task 2 decreased from a mean of 315 (SD 6.9) seconds to a mean of 303.4 (SD 1.1) seconds. Adherence to the prescribed cycling speed also improved, with deviations from the prescribed speed reduced from a mean of 6.26 (SD 1.00) rpm (revolutions per minute) to a mean of 4.02 (SD 0.82) rpm (t=3.305, n=5, P=.03). SUS scores increased from a mean of 92 (SD 8.6) to a mean of 97 (SD 3.3), indicating high user satisfaction and confidence in system usability. All participants successfully completed both tasks without any additional assistance during the posttest phase, demonstrating the system's ease of use and effectiveness in supporting independent exercise. Conclusions: The iBikE system, integrated into the HAT platform, effectively supports home-based telerehabilitation by enabling patients to follow personalized exercise prescriptions with minimal need for further training or supervision. The significant improvements in task performance and exercise adherence suggest that the system is well-suited for use in home-based rehabilitation programs, promoting sustained patient engagement and adherence to exercise regimens. Further studies with larger sample sizes are recommended to validate these findings and explore the long-term benefits of the system in broader patient populations. ",
doi="10.2196/65734",
url="https://biomedeng.jmir.org/2024/1/e65734",
url="http://www.ncbi.nlm.nih.gov/pubmed/39658220"
}


@Article{info:doi/10.2196/66648,
author="Gong, Jeong Eun
and Bang, Seok Chang
and Lee, Jun Jae
and Park, Jonghyung
and Kim, Eunsil
and Kim, Subeen
and Kimm, Minjae
and Choi, Seoung-Ho",
title="Large Language Models in Gastroenterology: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="20",
volume="26",
pages="e66648",
keywords="large language model",
keywords="LLM",
keywords="deep learning",
keywords="artificial intelligence",
keywords="AI",
keywords="endoscopy",
keywords="gastroenterology",
keywords="clinical practice",
keywords="systematic review",
keywords="diagnostic",
keywords="accuracy",
keywords="patient engagement",
keywords="emotional support",
keywords="data privacy",
keywords="diagnosis",
keywords="clinical reasoning",
abstract="Background: As health care continues to evolve with technological advancements, the integration of artificial intelligence into clinical practices has shown promising potential to enhance patient care and operational efficiency. Among the forefront of these innovations are large language models (LLMs), a subset of artificial intelligence designed to understand, generate, and interact with human language at an unprecedented scale. Objective: This systematic review describes the role of LLMs in improving diagnostic accuracy, automating documentation, and advancing specialist education and patient engagement within the field of gastroenterology and gastrointestinal endoscopy. Methods: Core databases including MEDLINE through PubMed, Embase, and Cochrane Central registry were searched using keywords related to LLMs (from inception to April 2024). Studies were included if they satisfied the following criteria: (1) any type of studies that investigated the potential role of LLMs in the field of gastrointestinal endoscopy or gastroenterology, (2) studies published in English, and (3) studies in full-text format. The exclusion criteria were as follows: (1) studies that did not report the potential role of LLMs in the field of gastrointestinal endoscopy or gastroenterology, (2) case reports and review papers, (3) ineligible research objects (eg, animals or basic research), and (4) insufficient data regarding the potential role of LLMs. Risk of Bias in Non-Randomized Studies---of Interventions was used to evaluate the quality of the identified studies. Results: Overall, 21 studies on the potential role of LLMs in gastrointestinal disorders were included in the systematic review, and narrative synthesis was done because of heterogeneity in the specified aims and methodology in each included study. The overall risk of bias was low in 5 studies and moderate in 16 studies. The ability of LLMs to spread general medical information, offer advice for consultations, generate procedure reports automatically, or draw conclusions about the presumptive diagnosis of complex medical illnesses was demonstrated by the systematic review. Despite promising benefits, such as increased efficiency and improved patient outcomes, challenges related to data privacy, accuracy, and interdisciplinary collaboration remain. Conclusions: We highlight the importance of navigating these challenges to fully leverage LLMs in transforming gastrointestinal endoscopy practices. Trial Registration: PROSPERO 581772; https://www.crd.york.ac.uk/prospero/ ",
doi="10.2196/66648",
url="https://www.jmir.org/2024/1/e66648"
}


@Article{info:doi/10.2196/53873,
author="Lee, Kiseong
and Chung, Yoongi
and Kim, Ji-Su",
title="Research Trends on Metabolic Syndrome in Digital Health Care Using Topic Modeling: Systematic Search of Abstracts",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="12",
volume="26",
pages="e53873",
keywords="metabolic syndrome",
keywords="digital health care",
keywords="topic modeling",
keywords="text network analysis",
keywords="research trends",
keywords="prevention",
keywords="management",
keywords="telemedicine",
keywords="wearable",
keywords="devices",
keywords="apps",
keywords="applications",
keywords="methodological",
keywords="cardiovascular disease",
abstract="Background: Metabolic syndrome (MetS) is a prevalent health condition that affects 20\%-40\% of the global population. Lifestyle modification is essential for the prevention and management of MetS. Digital health care, which incorporates technologies like wearable devices, mobile apps, and telemedicine, is increasingly becoming integral to health care systems. By analyzing existing research trends in the application of digital health care for MetS management, this study identifies gaps in current knowledge and suggests avenues for future research. Objective: This study aimed to identify core keywords, topics, and research trends concerning the use of digital health care in the management of MetS. Methods: A systematic search of abstracts from peer-reviewed papers was conducted across 6 academic databases. Following eligibility screening, 162 abstracts were selected for further analysis. The methodological approach included text preprocessing, text network analysis, and topic modeling using the BERTopic algorithm. Results: Analysis of the 162 selected abstracts yielded a keyword network comprising 1047 nodes and 34,377 edges. The top 5 core keywords were identified as ``MetS,'' ``use,'' ``patient,'' ``health,'' and ``intervention.'' We identified 12 unique topics, with topic 1 focusing on the use of telehealth for self-management of diabetes. The diversity of the 12 topics reflected various aspects of digital health care, including telehealth for diabetes management, electronic health records for MetS complications, and wearable devices for monitoring metabolic status. Research trends showed an expanding field of precision medicine driven by the demand for tailored interventions and the significant impact of the COVID-19 pandemic. Conclusions: By analyzing past research trends and extracting data from scholarly databases, this study has provided valuable insights that can guide future investigations in the field of digital health care and MetS management. ",
doi="10.2196/53873",
url="https://www.jmir.org/2024/1/e53873",
url="http://www.ncbi.nlm.nih.gov/pubmed/39666378"
}


@Article{info:doi/10.2196/65730,
author="Kokorelias, M. Kristina
and Valentine, Dean
and Dove, M. Erica
and Brown, Paige
and McKinlay, Stuart
and Sheppard, L. Christine
and Singh, Hardeep
and Eaton, D. Andrew
and Jamieson, Laura
and Wasilewski, B. Marina
and Zhabokritsky, Alice
and Flanagan, Ashley
and Abdelhalim, Reham
and Zewude, Rahel
and Parpia, Rabea
and Walmsley, Sharon
and Sirisegaram, Luxey",
title="Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Dec",
day="4",
volume="7",
pages="e65730",
keywords="HIV",
keywords="human immunodeficiency virus",
keywords="perspective",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="qualitative",
keywords="gerontology",
keywords="geriatrics",
keywords="older adult",
keywords="older people",
keywords="aging",
abstract="Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV. Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care. Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes. Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access. Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities. ",
doi="10.2196/65730",
url="https://aging.jmir.org/2024/1/e65730"
}


@Article{info:doi/10.2196/60258,
author="Chen, You
and Lehmann, U. Christoph
and Malin, Bradley",
title="Digital Information Ecosystems in Modern Care Coordination and Patient Care Pathways and the Challenges and Opportunities for AI Solutions",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e60258",
keywords="patient care pathway",
keywords="care journey",
keywords="care coordination",
keywords="digital information ecosystem",
keywords="digital technologies",
keywords="artificial intelligence",
keywords="information interoperability",
keywords="information silos",
keywords="workload",
keywords="information retrieval",
keywords="care transitions",
keywords="patient-reported outcome measures",
keywords="clinical workflow",
keywords="usability",
keywords="user experience workflow",
keywords="health care information systems",
keywords="networks of health care professionals",
keywords="patient information flow",
doi="10.2196/60258",
url="https://www.jmir.org/2024/1/e60258"
}


@Article{info:doi/10.2196/53157,
author="Zhang, Zhan
and Bai, Enze
and Xu, Yincao
and Stepanian, Aram
and Kutzin, M. Jared
and Adelgais, Kathleen
and Ozkaynak, Mustafa",
title="A Smart Glass Telemedicine Application for Prehospital Communication: User-Centered Design Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="29",
volume="26",
pages="e53157",
keywords="smart glass",
keywords="telemedicine",
keywords="participatory design",
keywords="emergency medical service",
keywords="health care",
keywords="prehospital care",
keywords="mobile health",
keywords="mHealth",
keywords="augmented reality",
abstract="Background: Smart glasses have emerged as a promising solution for enhancing communication and care coordination among distributed medical teams. While prior research has explored the feasibility of using smart glasses to improve prehospital communication between emergency medical service (EMS) providers and remote physicians, a research gap remains in understanding the specific requirements and needs of EMS providers for smart glass implementation. Objective: This study aims to iteratively design and evaluate a smart glass application tailored for prehospital communication by actively involving prospective users in the system design process. Methods: Grounded in participatory design, the study consisted of 2 phases of design requirement gathering, rapid prototyping, usability testing, and prototype refinement. In total, 43 distinct EMS providers with diverse backgrounds participated in this 2-year long iterative design process. All qualitative data (eg, transcribed interviews and discussions) were iteratively coded and analyzed by at least 2 researchers using thematic analysis. Quantitative data, such as System Usability Scale (SUS) scores and feature ratings, were analyzed using statistical methods. Results: Our research identified challenges in 2 essential prehospital communication activities: contacting online medical control (OLMC) physicians for medical guidance and notifying receiving hospital teams of incoming patients. The iterative design process led to the identification of 5 key features that could potentially address the identified challenges: video call functionality with OLMC physicians, call priority indication for expedited OLMC contact, direct communication with receiving hospitals, multimedia patient information sharing, and touchless interaction methods for operating the smart glasses. The SUS score for our system design improved from a mean of 74.3 (SD 11.3) in the first phase (classified as good usability) to 80.3 (SD 13.1) in the second phase (classified as excellent usability). This improvement, along with consistently high ratings for other aspects (eg, willingness to use and feature design), demonstrated continuous enhancement of the system's design across the 2 phases. Additionally, significant differences in SUS scores were observed between EMS providers in urban areas (median 85, IQR 76-94) and rural areas (median 72.5, IQR 66-83; Mann-Whitney U=43; P=.17), as well as between paramedics (median 72.5, IQR 70-80) and emergency medical technicians (median 85, IQR: 74-98; Mann-Whitney U=44.5; P=.13), suggesting that EMS providers in urban settings and those with less training in treating patients in critical conditions perceived the smart glass application as more useful and user-friendly. Finally, the study also identified several concerns regarding the adoption of the smart glass application, including technical limitations, environmental constraints, and potential barriers to workflow integration. Conclusions: Using a participatory design approach, this study provided insights into designing user-friendly smart glasses that address the current challenges EMS providers face in dynamic prehospital settings. ",
doi="10.2196/53157",
url="https://www.jmir.org/2024/1/e53157"
}


@Article{info:doi/10.2196/65477,
author="Cerrito, Brianna
and Xiao, Jamie
and Fialk, Amanda
and Buono, D. Frank",
title="Therapy Mode Preference Scale: Preliminary Validation Methodological Design",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="29",
volume="8",
pages="e65477",
keywords="virtual teletherapy",
keywords="young adult mental health treatment",
keywords="in-person therapy",
keywords="virtual mental health care",
keywords="telehealth",
keywords="mental health treatment",
keywords="virtual care",
keywords="therapeutic",
keywords="virtual therapy",
keywords="in-person treatment",
keywords="exploratory factor analysis",
keywords="hierarchical linear regression",
keywords="standardized tool",
keywords="herapeutic impact",
abstract="Background: The use of tele--mental health care increased rapidly in 2020 as a critical response to the COVID-19 pandemic, serving as an effective contact-free alternative to treatment. Today, tele--mental health care remains a viable option for individuals with geographic and physical barriers to treatment. However, there are several potential therapeutic disadvantages to tele--mental health care (ie, missing nonverbal signals, handling crises, confidentiality, weakened social connection in group therapy) that should be evaluated. While published literature has explored client satisfaction within teletherapy and the effect of using technology for tele--mental health care demands, there is a need for published surveys that evaluate the therapeutic experience in teletherapy and in-person mediums of care. Objective: The authors of this study sought to develop and validate a survey that could evaluate the comparative impact of teletherapy and in-person care from a therapeutic perspective across key factors (ie, therapeutic alliance, engagement, rapport, and confidentiality). Methods: Participants were clients who experienced both tele--mental health care and in-person therapy at an intensive outpatient mental health treatment program for young adults from April 2020 through June 2022. Generated items on the survey were formulated based on input from experts in the field and existing validated scales. All individuals completed the survey on the internet, following informed consent (n=89). An exploratory factor analysis was conducted to understand factor structure, and Cronbach $\alpha$ was used to determine internal consistency. Incremental validity was demonstrated through a hierarchical linear regression. Results: The exploratory factor analysis revealed a 14-item, 3-factor structure. All 14 items correlated at a minimum of 0.30 with at least one other item. Kaiser-Meyer-Olkin measure of sampling adequacy was 0.75 and Bartlett's test of sphericity was significant ($\chi$291=528.41, P<.001). In total, 3 factors accounted for 61\% of the variance, and the preliminary Cronbach $\alpha$ ($\alpha$=0.71) indicates a satisfactory level of internal consistency. The Zoom Exhaustion and Fatigue Scale (ZEF) and Client Satisfaction Questionnaire (CSQ; ?0.29) were significantly correlated, as well as the ZEF and Therapy Mode Preference Scale (TMPS; ?0.31), and CSQ and TMPS (0.50; P<.001). Hierarchical linear regression revealed that the CSQ significantly accounted for additional variance in the TMPS (P<.001). With the ZEF entered into the model, no further variance was accounted for (P=.06). Conclusions: Continual research is warranted to expand the current findings by validating this standardized tool for assessing the therapeutic impact of teletherapy versus in-person care in a generalizable population. ",
doi="10.2196/65477",
url="https://formative.jmir.org/2024/1/e65477"
}


@Article{info:doi/10.2196/53320,
author="Smith, C. Lisa
and Johnson, George
and Jadhav, Snehal
and Kabayundo, Josiane
and Ahuja, Muskan
and Wang, Hongmei
and Ratnapradipa, L. Kendra",
title="Ever Use of Telehealth in Nebraska by March 2021: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e53320",
keywords="COVID-19",
keywords="digital divide",
keywords="health care access",
keywords="telehealth",
keywords="cross-sectional study",
keywords="Nevada",
keywords="United States",
keywords="adult",
keywords="medical care",
keywords="geographical area",
keywords="disparity",
keywords="accessibility",
keywords="utilization",
keywords="survey",
keywords="chi-square test",
keywords="regression model",
keywords="socioeconomic",
keywords="demographic",
keywords="health condition",
keywords="digital health",
abstract="Background: Nationally, COVID-19 spurred the uptake of telehealth to facilitate patients' access to medical care, especially among individuals living in geographically isolated areas. Despite the potential benefits of telehealth to address health care access barriers and enhance health outcomes, there are still disparities in the accessibility and utilization of telehealth services. Hence, identifying facilitators and barriers to telehealth should be prioritized to ensure that disparities are mitigated rather than exacerbated. Objective: This study aims to identify factors associated with ever use of telehealth in Nebraska, a primarily rural state with a significant portion of its population living in nonmetropolitan areas. Methods: A stratified random sample of Nebraska households (n=5300), with oversampling of census tracts with at least 30\% African American, Hispanic, or Native American populations, received a mailed survey (English and Spanish) with web-based response options about social determinants of health and health care access (October 2020-March 2021). Survey weights were used for all calculations. Chi-square tests were used to compare telehealth use (yes or no) by participant sociodemographic, health, and access variables. Robust Poisson regression models were used to compute prevalence odds ratios (POR) with 95\% CIs of telehealth use after controlling for socioeconomic, demographic, and health conditions. Results: The overall response rate was 20.8\% (1101/5300). About 25.5\% of Nebraska adults had ever used telehealth (urban 26.4\%, rural 20.8\%), despite 97\% of respondents reporting internet access (98.3\% urban, 90.5\% rural). In the chi-square analysis, telehealth use was statistically significantly more common (P<.05) among those who are aged <45 years (32.4\%), female (30.7\%), and non-Hispanic (25.9\%); with at least a bachelor's degree (32.6\%); who had a routine checkup (30.2\%) or health care visit other than a routine checkup (34.2\%); and with any chronic health conditions (29.6\%) but did not differ (P?.05) by race, marital status, income, insurance, having a primary care provider, or 1-way travel time for medical visits. In univariate models, internet access, age, sex, ethnicity, education, any health care visit in the past year, and no chronic health condition were significant (P<.05). When adjusted, education (POR 1.87, 95\% CI 0.33-10.63) and sex (1.38, 0.93-2.04) were not significant, but internet access (5.43, 1.62-18.16), age <45 (5.33, 2.22-12.81) and 45-64 years (9.05, 2.37-34.62), non-Hispanic ethnicity (7.40, 2.39-22.90), any health care visit (2.43, 1.23-4.79), and any chronic condition (1.73, 1.09-2.76) were significantly associated with having ever used telehealth. Conclusions: This study highlights disparities in telehealth use. Despite high coverage, internet access was a significant predictor of telehealth use, highlighting the role of the digital divide in telehealth access and use. Telehealth use was significantly less prevalent among older adults, people without chronic health conditions, and Hispanic individuals. Targeted interventions that address barriers to telehealth use and improve health care access are warranted. ",
doi="10.2196/53320",
url="https://www.jmir.org/2024/1/e53320"
}


@Article{info:doi/10.2196/63743,
author="M{\"u}nchenberg, Sarah Pauline
and Yessimova, Dinara
and Panteli, Dimitra
and Kurth, Tobias",
title="Digital Health Interventions for Informal Family Caregivers of People With First-Episode Psychosis: Systematic Review on User Experience and Effectiveness",
journal="JMIR Ment Health",
year="2024",
month="Nov",
day="28",
volume="11",
pages="e63743",
keywords="first-episode psychosis",
keywords="early psychosis",
keywords="digital health interventions",
keywords="telepsychiatry",
keywords="informal caregivers",
keywords="family caregivers",
keywords="telehealth",
keywords="severe mental disorders",
keywords="psychosis",
keywords="digital intervention",
keywords="digital health",
keywords="mental health",
keywords="psychoeducation",
keywords="mobile phone",
abstract="Background: First-episode psychosis (FEP) imposes a substantial burden not only on the individual affected but also on their families. Given that FEP usually occurs during adolescence, families overtake a big part of informal care. Early family interventions, especially psychoeducation, are crucial for informal family caregivers to best support the recovery of their loved one with FEP and to reduce the risk of a psychotic relapse as much as possible, but also to avoid chronic stress within the family due to the burden of care. Digital health interventions offer the possibility to access help quicker, use less resources, and improve informal family caregiver outcomes, for example, by reducing stress and improving caregiver quality of life. Objective: This study aimed to systematically identify studies on digital health interventions for informal family caregivers of people with FEP and to describe and synthesize the available literature on user experience, as well as the effectiveness of such digital applications on the clinical outcomes, consisting of (1) perceived caregiver stress, (2) expressed emotion, and (3) parental self-efficacy. Methods: A systematic search was carried out across 4 electronic databases. In addition, reference lists of relevant studies were hand-searched. This review aimed to include only primary studies on informal family caregivers, who had to care for a person with FEP between 15 years and 40 years of age and a diagnosis of FEP with onset of observed symptoms within the past 5 years. All types of digital interventions were included. This systematic review is aligned with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines. Results: The search identified 7 studies that reported on user experience or effectiveness of digital health interventions on perceived caregiver stress, expressed emotion, and parental self-efficacy, including 377 informal family FEP caregivers across trials. Digital health interventions--web-based, videoconferences, and mHealth--were well accepted and perceived as relevant, easy to use, and helpful by informal family FEP caregivers. Psychoeducational content was rated as the most important across studies. Perceived caregiver stress, expressed emotion, and parental self-efficacy improved in all studies that reported on these clinical outcomes. Conclusions: The results of this review suggest that digital health interventions aimed at informal family caregivers of individuals with FEP can improve relevant clinical outcomes, with participants reporting a positive user experience. However, for some interventions reviewed, specialized in-person family care outperformed the digital intervention and partially led to better results in perceived caregiver stress and parental self-efficacy. Therefore, while digital interventions present a promising approach to alleviate the burden of care and improve informal family FEP caregiver outcomes, more studies with well-powered experimental designs are needed to further investigate the effectiveness of such applications in this population. Trial Registration: PROSPERO CRD42024536715; https://tinyurl.com/bdd3u7v9 ",
doi="10.2196/63743",
url="https://mental.jmir.org/2024/1/e63743"
}


@Article{info:doi/10.2196/53932,
author="Tisdale, Lauren Rebecca
and Purmal, Colin
and Kalwani, Neil
and Sandhu, Alexander
and Heidenreich, Paul
and Zulman, Donna
and Hussain, Tanvir",
title="Opportunities to Address Specialty Care Deserts and the Digital Divide through the Veterans Health Administration's Telehealth Hub-and-Spoke Cardiology Clinic: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e53932",
keywords="telehealth",
keywords="specialty care",
keywords="cardiovascular disease",
keywords="telemedicine",
keywords="cardiology",
keywords="veterans",
keywords="low income",
keywords="digital divide",
keywords="access",
keywords="Veterans Health Administration",
keywords="VA",
keywords="VHA",
keywords="rural",
keywords="clinical resource hub",
keywords="CRH",
abstract="Background: To address geographic barriers to specialty care access for services such as cardiology, the Veterans Health Administration (VA) has implemented a novel, regionalized telehealth care hub. The Clinical Resource Hub (CRH) model extends care, including cardiology services, to individuals in low-access communities across the region. Little is known, however, about the reach of such programs. Objective: This study aimed to describe the initial CRH program implementation in terms of growth in users and clinical encounters, as well as the association between user characteristics and the use of CRH cardiology care, in VA's Sierra Pacific region (Northern California, Nevada, and the Pacific Islands). Methods: We compared patients who used CRH cardiology services (CRH users) to those using non-CRH cardiology services (CRH nonusers) in the Sierra Pacific region between July 15, 2021, and March 31, 2023. After characterizing changes in the numbers of CRH users and nonusers and clinical encounters over the study period, we used multivariable logistic regression to estimate the association between patient-level factors and the odds of being a CRH user. Results: There were 804 CRH users over the study period, with 1961 CRH encounters concentrated at 3 main CRH sites. The CRH program comprised a minority of cardiology users and encounters in the region, with 19,583 CRH nonusers with 83,489 encounters. The numbers of CRH patients and encounters both increased at a steady-to-increasing rate over the study period, with increases of 37\% (n=292 vs n=213) in users and 64\% (n=584 vs n=356) in encounters in the first quarter of 2023 compared with the last quarter of 2022. Among CRH users, 8.3\% (67/804) were female and 41.4\% (333/804) were aged ?75 years, compared with 4.3\% (840/19,583) and 49\% (9600/19,583), respectively, among CRH nonusers. The proportions of rural (users: 205/804, 25.5\%; nonusers: 4936/19,583, 25.2\%), highly disabled (users: 387/804, 48.1\%; nonusers: 9246/19,583, 47.2\%), and low-income (users: 165/804, 20.5\%; nonusers: 3941/19,583, 20.1\%) veterans in both groups were similar. In multivariable logistic models, adjusted odds ratios of using CRH were higher for female veterans (1.70, 95\% CI 1.29-2.24) and lower for older veterans (aged ?75 years; 0.33, 95\% CI 0.23-0.47). Rural veterans also had a higher adjusted odds ratio of using CRH (1.19, 95\% CI 1.00-1.42; P=.046). Conclusions: The VA's Sierra Pacific CRH cardiology program grew substantially in its first 2 years of operation, serving disproportionately more female and rural veterans and similar proportions of highly disabled and low-income veterans compared to conventional VA care. This model appears to be effective for overcoming specialty care access barriers for certain individuals, although targeted efforts may be required to reach older veterans. While this study focuses on a single region, specialty, and health care system, lessons from implementing regionalized telehealth hub models may be applicable to other settings. ",
doi="10.2196/53932",
url="https://www.jmir.org/2024/1/e53932"
}


@Article{info:doi/10.2196/49305,
author="Backman, Anna
and Roll-Pettersson, Lise
and Mellblom, Are
and Norman-Claesson, Elisabet
and Sundqvist, Emma
and Zander, Eric
and Vigerland, Sarah
and Hirvikoski, Tatja",
title="Internet-Delivered Psychoeducation (SCOPE) for Transition-Aged Autistic Youth: Pragmatic Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e49305",
keywords="autism",
keywords="internet based",
keywords="young adult",
keywords="intervention",
keywords="digital communication",
keywords="life satisfaction",
keywords="codeveloped",
keywords="ASD",
keywords="autism spectrum disorder",
keywords="autistic",
keywords="RCT",
keywords="randomized controlled trial",
keywords="randomized",
keywords="psychoeducation",
keywords="patient education",
abstract="Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention. Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants' understanding of autism and, in doing so, increase their quality of life (QoL). Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module's topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants' autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points. Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: --0.13, 95\% CI --1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression. Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation. Trial Registration: ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363 ",
doi="10.2196/49305",
url="https://www.jmir.org/2024/1/e49305"
}


@Article{info:doi/10.2196/55473,
author="Yan, Z. Allie
and Staab, M. Erin
and Nu{\~n}ez, Daisy
and Zhu, Mengqi
and Wan, Wen
and Schaefer, T. Cynthia
and Campbell, Amanda
and Quinn, T. Michael
and Baig, A. Arshiya",
title="Impact of a Text Messaging Intervention as an In-Between Support to Diabetes Group Visits in Federally Qualified Health Centers: Cluster Randomized Controlled Study",
journal="JMIR Diabetes",
year="2024",
month="Nov",
day="28",
volume="9",
pages="e55473",
keywords="diabetes",
keywords="diabetes mellitus",
keywords="type 2 diabetes",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="text messaging intervention",
keywords="text message",
keywords="text messaging",
keywords="texting",
keywords="federally qualified health center",
keywords="FQHC",
keywords="mobile phone",
abstract="Background: In the United States, 1 in 11 people receive primary care from a federally qualified health center (FQHC). Text messaging interventions (TMIs) are accessible ways to deliver health information, engage patients, and improve health outcomes in the health center setting. Objective: We aimed to evaluate the impact of a TMI implemented with a group visit (GV) intervention among patients with type 2 diabetes mellitus (T2DM) at FQHCs on patient-reported outcomes and clinical outcomes based on patient TMI engagement. Methods: A TMI was implemented for 11 health centers participating in a cluster randomized study of diabetes GVs in Midwestern FQHCs targeting adults with T2DM. FQHC patients participated in 6 monthly GVs either in person or online and a concurrent 25-week TMI. Outcome measures included clinical markers such as glycated hemoglobin A1c and patient-reported diabetes distress, diabetes self-care, diabetes self-efficacy, diabetes care knowledge, diabetes quality of life, diabetes social support, and TMI use and satisfaction. TMI response rate was calculated as responses to an SMS text message requesting a response divided by total messages requesting a response sent. Patients were grouped as high responders if their response rate was greater than or equal to the median response rate and low responders if their response rate was below the median. We conducted linear mixed models to compare high and low responders and within a group, adjusting for age, gender, GV attendance, and depression/anxiety at baseline. Results: In total, 101 of 124 GV patients (81.5\%) enrolled in the TMI. The average age of the population in the TMI was 53 years. Of the 101 respondents, 61 (60\%) were racial or ethnic minorities, while 42 of 82 respondents (51\%) had a high school diploma/General Education Development or less, and 56 of 80 respondents (71\%) reported an annual income less than US \$30,000. In addition, 70 of 81 respondents (86\%) owned a smartphone and 74 of 80 respondents (93\%) had an unlimited texting plan. The median response rate was 41\% and the mean response rate was 41.6\%. Adjusted models showed significantly improved diabetes knowledge (P<.001), foot care (P<.001), and exercise (P=.002) in high responders (n=34) compared to low responders (n=23) at 6 months. No group difference was found in glycated hemoglobin A1c. Within high responders, diabetes distress (P=.001), social support (P<.001), quality of life (P<.001), diabetes knowledge (P<.001), foot care (P<.001), and diet (P=.003) improved from baseline to 6 months. Low responders only improved in diabetes quality of life (P=.003) from baseline to 6 months. Conclusions: In a FQHC safety net population participating in a combined TMI and GV intervention, our study showed improved diabetes distress, social support, knowledge, self-care, self-efficacy, and quality of life among patients highly engaged in the SMS text messaging program. Trial Registration: ClinicalTrials.gov NCT03487692; https://clinicaltrials.gov/study/NCT03487692 ",
doi="10.2196/55473",
url="https://diabetes.jmir.org/2024/1/e55473"
}


@Article{info:doi/10.2196/54420,
author="Chiou, Piao-Yi
and Tsao, Wei-Wen
and Li, Chia-Lin
and Yu, Jheng-Min
and Su, Wen-Han
and Liu, Zhi-Hua
and He, Cheng-Ru
and Chang, Yu-Chun
and Tsai, Yi-Hsuan",
title="Recruitment for Voluntary Video and Mobile HIV Testing on Social Media Platforms During the COVID-19 Pandemic: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="28",
volume="26",
pages="e54420",
keywords="COVID-19",
keywords="HIV testing",
keywords="mobile health",
keywords="risk-taking behavior",
keywords="social media",
keywords="video",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic prompted social distancing policies and caused misinformation that hindered in-person HIV screening for high-risk groups. Social media platforms provide additional options for voluntary counseling and testing (VCT) for HIV, overcoming these limitations. However, there is a lack of data on HIV testing recruitment through social media platforms and its outcomes during the pandemic. Objective: This study aimed to measure the rate of face-to-face mobile and video VCT conducted after recruitment through social media platforms and friend referrals during the pandemic and compare the geographic distribution, risk feature targeting, testing outcome, and cost between the 2 models. Methods: Data were collected from March 3 to December 31, 2021, during the COVID-19 outbreak in Taiwan. Participants engaging in unprotected sex were recruited. After one-on-one message discussions through the platforms, the well-trained research assistants provided mobile or video VCT based on the participants' availability. Primary outcomes were completion rate, testing results, and CD4 count. Secondary outcomes included demographic and HIV risk-taking and protective features from a questionnaire. Selection bias was controlled by adjusting for the testing site (Taipei vs non-Taipei) using univariable multinomial logistic regression. Results: This study gathered 5142 responses on the social media platforms, recruiting 1187 participants. Video VCT had a completion rate of 31.8\% (207/651), higher than mobile VCT's 21.8\% (980/4491). Both rates were higher than those before the COVID-19 pandemic. Recruitment through friend referrals, instant messaging apps (eg, Line [LY Corporation]), and geosocial dating apps (eg, Hornet [Queer Networks Inc], Grindr [Grindr LLC], and Gsland [Tien-Hao Tsai]) resulted in higher acceptance and completion rates than social networks (eg, Facebook [Meta], X [formerly Twitter], and Instagram [Meta]). Mobile VCT had higher recruitment among urban residents and screening density, while video VCT reached a broader geographic area. The mobile group was more likely to have had more than 10 sexual partners (odds ratio [OR] 1.92, 95\% CI 1.05-3.50; P=.03), history of sex work (OR 4.19, 95\% CI 1.68-10.43; P=.002), and sexually transmitted diseases (OR 2.23, 95\% CI 1.18-4.23; P=.01) within the past 3 months. The video group was more likely to meet sexual partners through social media. The HIV-positive rate in the mobile group was 0.7\% (7/973) with an average CD4 count of 460/$\mu$L, while in the video group, it was 1\% (2/205) with an average CD4 count of 347/$\mu$L, indicating a later diagnosis. Both positivity rates were higher than those before the COVID-19 pandemic, with no significant difference between the groups. The video group cost US \$54.68 per participant, slightly higher than the US \$50.36 for the mobile group. Conclusions: Recruiting through social media platforms that facilitate one-on-one message discussions can effectively target high-risk groups for mobile and video VCT. This approach should be integrated into the current screening model to enhance HIV case finding. ",
doi="10.2196/54420",
url="https://www.jmir.org/2024/1/e54420",
url="http://www.ncbi.nlm.nih.gov/pubmed/39607762"
}


@Article{info:doi/10.2196/59442,
author="Kang, Aimei
and Wu, XiuLi",
title="Assessing Visitor Expectations of AI Nursing Robots in Hospital Settings: Cross-Sectional Study Using the Kano Model",
journal="JMIR Nursing",
year="2024",
month="Nov",
day="27",
volume="7",
pages="e59442",
keywords="nursing robot",
keywords="artificial intelligence",
keywords="Kano model",
keywords="demand survey",
keywords="nursing",
keywords="care robots",
keywords="nursing management",
abstract="Background: Globally, the rates at which the aging population and the prevalence of chronic diseases are increasing are substantial. With declining birth rates and a growing percentage of older individuals, the demand for nursing staff is steadily rising. However, the shortage of nursing personnel has been a long-standing issue. In recent years, numerous researchers have advocated for the implementation of nursing robots as a substitute for traditional human labor. Objective: This study analyzes hospital visitors' attitudes and priorities regarding the functional areas of artificial intelligence (AI) nursing robots based on the Kano model. Building on this analysis, recommendations are provided for the functional optimization of AI nursing robots, aiming to facilitate their adoption in the nursing field. Methods: Using a random sampling method, 457 hospital visitors were surveyed between December 2023 and March 2024 to compare the differences in demand for AI nursing robot functionalities among the visitors. Results: A comparative analysis of the Kano attribute quadrant diagrams showed that visitors seeking hospitalization prioritized functional aspects that enhance medical activities. In contrast, visitors attending outpatient examinations focused more on functional points that assist in medical treatment. Additionally, visitors whose purpose was companionship and care emphasized functional aspects that offer psychological and life support to patients. Conclusions: AI nursing robots serve various functional areas and cater to diverse audience groups. In the future, it is essential to thoroughly consider users' functional needs and implement targeted functional developments to maximize the effectiveness of AI nursing robots. ",
doi="10.2196/59442",
url="https://nursing.jmir.org/2024/1/e59442"
}


@Article{info:doi/10.2196/51056,
author="Ivanova, Julia
and Wilczewski, Hattie
and Klocksieben, Farina
and Cummins, Mollie
and Soni, Hiral
and Ong, Triton
and Barrera, Janelle
and Harvey, Jillian
and O'Connell, Nathaniel
and McElligott, James
and Welch, Brandon
and Bunnell, Brian",
title="Patient Preferences for Direct-to-Consumer Telemedicine Services: Replication and Extension of a Nationwide Survey",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="27",
volume="11",
pages="e51056",
keywords="telemedicine",
keywords="survey",
keywords="patient preferences",
keywords="direct-to-consumer telemedicine",
keywords="patient-provider relationship",
keywords="inequity",
keywords="consumer",
keywords="patient experience",
keywords="willingness",
keywords="income",
keywords="association",
keywords="satisfaction",
keywords="mobile phone",
abstract="Background: A 2017 survey of patient perspectives showed overall willingness and comfort to use telemedicine, but low actual use. Given recent growth and widespread exposure of patients to telemedicine, patient preferences are likely to have changed. Objective: This study aimed to (1) identify demographic trends in patient preferences and experiences; (2) measure ease of use and satisfaction of telemedicine; and (3) measure changes in telemedicine use, willingness, and comfort since 2017. Methods: We replicated a 2017 study with a nationwide survey of US adults. The survey, an extended version of the previous study, measured patient health care access as well as knowledge, experiences, and preferences regarding telemedicine encounters. We recruited participants using SurveyMonkey Audience in July 2022. We used descriptive statistics and generalized estimating equations to measure change and identify trends. Results: We accrued 4577 complete responses. Patient experience with telemedicine was substantially higher in 2022 than in 2017, with 61.1\% (vs 5.3\%) of participants aware that their primary care provider offered telemedicine and 34.5\% (vs 3.5\%) reporting use of telemedicine with their primary care provider. This study also reported ease of use and satisfaction rates to be similar to in-person visits, while overall willingness and comfort in using telemedicine increased from 2017. Individuals at the poverty line were significantly less likely to report satisfaction with telemedicine visits. We found increased interpersonal distance in a patient and health care professional relationship significantly reduced patient ease of use, willingness, and comfort in using telemedicine. Conclusions: This study identified an association between income and patient satisfaction, conveying the importance of understanding telemedicine in relation to health care access and equity. Telemedicine ease of use and satisfaction were comparable to in-person visits. Individuals reported greater use and higher positive perceptions of telemedicine willingness and comfort since 2017. ",
doi="10.2196/51056",
url="https://humanfactors.jmir.org/2024/1/e51056"
}


@Article{info:doi/10.2196/52552,
author="McCaffrey, Graham
and Wilson, Erin
and Zimmer, V. Lela
and Singh, Anurag
and Jonatansdottir, Steinunn
and Zimmer, Peter
and Snadden, David
and Graham, D. Ian
and MacLeod, Martha",
title="Effects of Virtual Care on Patient and Provider Experience of the Clinical Encounter: Qualitative Hermeneutic Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="26",
volume="26",
pages="e52552",
keywords="virtual medicine",
keywords="telehealth",
keywords="professional-patient relations",
keywords="hermeneutics",
keywords="kidney",
keywords="health care facility",
keywords="British Columbia",
keywords="Canada",
keywords="qualitative research",
keywords="eHealth",
keywords="health informatics",
keywords="physician",
keywords="COVID-19",
keywords="pandemic",
keywords="patient experience",
abstract="Background: Virtual health care has transformed health care delivery, with its use dramatically increasing since the COVID-19 pandemic. While it has been quickly adopted for its convenience and efficiency, there has been a relative lack of in-depth exploration of its human impact, specifically how both patients and providers experience clinical encounters. Objective: This analysis aims to identify and explore themes of change in how patients and providers in a geographically dispersed renal service described their experiences with virtual care, including those changes that occurred during the COVID-19 pandemic. Methods: Hermeneutics is an interpretive research methodology that treats human experience as inherently interpretive, generating meaning through interactions with others in specific, historically conditioned, social contexts. A total of 17 patients and 10 providers from various disciplines were interviewed by phone as part of a study on health care implementation in the context of a kidney care service in northern British Columbia, Canada. The interview data were analyzed using a hermeneutic approach, which emphasizes careful attention to reported experiences in relation to the relationships and contexts of care. Results: During analysis, the interdisciplinary team identified themes related to changes in the clinical encounter and how virtual care influenced perceptions of care among both providers and patients. We organized these themes into 2 categories: the structure and content of the encounter. The structure category included the convenience for patients, who no longer had to travel long distances for appointments, as well as changes in care networks. For example, communication between specialist services and local primary care providers became more crucial for ensuring continuity of care. The content category included issues related to trust-building and assessment. Providers expressed concerns about the difficulty in assessing and understanding their patients' physical and social well-being beyond laboratory results. Conclusions: Patients in the study appreciated the convenience of not needing to travel for appointments, while still having the option for in-person contact with local providers or specialists if their condition changed. Providers were more concerned about the loss of visual cues and sensory data for assessments, as well as the reduced opportunity to build relationships through conversation with patients. Providers also described changes in the locus of control and boundaries, as patients could join phone encounters from anywhere, bypassing traditional privacy and confidentiality boundaries. The study offers a nuanced view of the effects of virtual care on clinical encounters in one setting, seen through the experiences of both patients and providers. ",
doi="10.2196/52552",
url="https://www.jmir.org/2024/1/e52552"
}


@Article{info:doi/10.2196/49710,
author="Craig, William
and Ohlmann, Suzanne",
title="The Benefits of Using Active Remote Patient Management for Enhanced Heart Failure Outcomes in Rural Cardiology Practice: Single-Site Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="26",
volume="26",
pages="e49710",
keywords="rural",
keywords="remote patient monitoring",
keywords="heart failure",
keywords="heart failure hospitalizations",
keywords="office visits",
keywords="rural health inequalities",
keywords="telehealth",
abstract="Background: Rural populations have a disproportionate burden of heart failure (HF) morbidity and mortality, associated with socioeconomic and racial inequities. Multiple randomized controlled trials of remote patient monitoring (RPM) using both direct patient contact and device-based monitoring have been conducted to assess improvement in HF outcomes, with mixed results. Objective: We aimed to assess whether a novel digital health care platform designed to proactively assess and manage patients with HF improved patient outcomes by preventing HF re-exacerbations, thus reducing emergency room visits and HF hospitalizations. Methods: This was a single-site, retrospective cohort study using electronic medical record (EMR) data gathered from 2 years prior to RPM initiation and 2 years afterward. In January 2017, this single center began enrolling New York Heart Association (NYHA) class II and class III patients with HF prone to HF exacerbation into an RPM program using the Cordella HF system. By July 2022, 93 total patients had been enrolled in RPM. Of these patients, 87\% lived in rural areas. This retrospective review included 40 of the 93 patients enrolled in RPM. These 40 were selected because they had 2 years of established EMR data prior to initiation of RPM and 2 years of post-RPM data; each consented to this Sterling IRB--approved study. Results: We included 40 patients with at least 4 years of follow-up, including 2 years prior to RPM initiation and 2 years after RPM initiation. In the 2 years after RPM initiation, check-up calls increased 519\%, medication change calls increased 519\%, and total calls increased by 519\%. Emergency room visits for HF fell 93\%, heart failure hospitalizations fell 83\%, and all other cardiovascular hospitalizations fell 50\%. Additionally, the total number of office visits declined by 15\% after RPM, and unscheduled or urgent office visits declined by 73\%. Conclusions: Daily monitoring of trends in vital sign data between engaged patients and a collaborative team of clinicians, incorporated into daily clinical workflow, enhanced patient interactions and allowed timely response or intervention when HF decompensation occurred, resulting in a reduction of outpatient and inpatient clinical use over more than 2 years of follow-up. ",
doi="10.2196/49710",
url="https://www.jmir.org/2024/1/e49710",
url="http://www.ncbi.nlm.nih.gov/pubmed/39589775"
}


@Article{info:doi/10.2196/63661,
author="Tao, Youyou
and Vo, Ace
and Wu, Dezhi
and Lin, Junyuan
and Seal, Kala
and Mishra, Abhay
and Brahma, Arindam",
title="Impact of Telehealth on Health Disparities Associated With Travel Time to Hospital for Patients With Recurrent Admissions: 4-Year Panel Data Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="25",
volume="26",
pages="e63661",
keywords="telehealth",
keywords="health disparities",
keywords="travel time",
keywords="length of stay",
keywords="recurrent admissions",
keywords="health care access",
keywords="virtualization potential",
keywords="virtual care",
abstract="Background: Geographic, demographic, and socioeconomic differences in health outcomes persist despite the global focus on these issues by health organizations. Barriers to accessing care contribute significantly to these health disparities. Among these barriers, those related to travel time---the time required for patients to travel from their residences to health facilities---remain understudied compared with others. Objective: This study aimed to explore the impact of telehealth in addressing health disparities associated with travel time to hospitals for patients with recurrent hospital admissions. It specifically examined the role of telehealth in reducing in-hospital length of stay (LOS) for patients living farther from the hospital. Methods: We sourced the data from 4 datasets, and our final effective sample consisted of 1,600,699 admissions from 536,182 patients from 63 hospitals in New York and Florida in the United States from 2012 to 2015. We applied fixed-effect models to examine the direct effects and the interaction between telehealth and patients' travel time to hospitals on LOS. We further conducted a series of robustness checks to validate our main models and performed post hoc analyses to explore the different effects of telehealth across various patient groups. Results: Our summary statistics show that, on average, 22.08\% (353,396/1,600,699) of patients were admitted to a hospital with telehealth adopted, with an average LOS of 5.57 (SD 5.06) days and an average travel time of about 16.89 (SD 13.32) minutes. We found that telehealth adoption is associated with a reduced LOS (P<.001) and this effect is especially pronounced as the patients' drive time to the hospital increases. Specifically, the coefficient for drive time is --0.0079 (P<.001), indicating that for every additional minute of driving time, there is a decrease of 0.0079 days (approximately 11 minutes) in the expected LOS. We also found that telehealth adoption has a larger impact on patients frequently needing health services, patients living in high internet coverage areas, and patients who have high virtualization potential diseases. Conclusions: Our findings suggest that telehealth adoption can mitigate certain health disparities for patients living farther from hospitals. This study provides key insights for health care practitioners and policy makers on telehealth's role in addressing distance-related disparities and planning health care resources. It also has practical implications for hospitals in resource-limited countries that are in the early stages of implementing telehealth. ",
doi="10.2196/63661",
url="https://www.jmir.org/2024/1/e63661"
}


@Article{info:doi/10.2196/55897,
author="Preti, M. Luigi
and Ardito, Vittoria
and Compagni, Amelia
and Petracca, Francesco
and Cappellaro, Giulia",
title="Implementation of Machine Learning Applications in Health Care Organizations: Systematic Review of Empirical Studies",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="25",
volume="26",
pages="e55897",
keywords="artificial intelligence",
keywords="machine learning",
keywords="implementation",
keywords="health care organization",
keywords="barriers",
keywords="facilitators",
abstract="Background: There is a growing enthusiasm for machine learning (ML) among academics and health care practitioners. Despite the transformative potential of ML-based applications for patient care, their uptake and implementation in health care organizations are sporadic. Numerous challenges currently impede or delay the?widespread implementation of ML in clinical practice, and limited knowledge is available regarding how these challenges have been addressed. Objective: This work aimed to (1) examine the characteristics of ML-based applications and the implementation process in clinical practice, using the Consolidated Framework for Implementation Research (CFIR) for theoretical guidance and (2) synthesize the strategies adopted by health care organizations to foster successful implementation of ML. Methods: A systematic literature review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was conducted in PubMed, Scopus, and Web of Science over a 10-year period (2013-2023). The search strategy was built around 4 blocks of keywords (artificial intelligence, implementation, health care, and study type). Only empirical studies documenting the implementation of ML applications in clinical settings were considered. The implementation process was investigated using a thematic analysis and coding procedure. Results: Thirty-four studies were selected for data synthesis. Selected papers were relatively recent, with only 9\% (3/34) of records published before 2019. ML-based applications were implemented mostly within hospitals (29/34, 85\%). In terms of clinical workflow, ML-based applications supported mostly prognosis (20/34, 59\%) and diagnosis (10/34, 29\%). The implementation efforts were analyzed using CFIR domains. As for the inner setting domain, access to knowledge and information (12/34, 35\%), information technology infrastructure (11/34, 32\%), and organizational culture (9/34, 26\%) were among the most observed dimensions influencing the success of implementation. As for the ML innovation itself, factors deemed relevant were its design (15/34, 44\%), the relative advantage with respect to existing clinical practice (14/34, 41\%), and perceived complexity (14/34, 41\%). As for the other domains (ie, processes, roles, and outer setting), stakeholder engagement (12/34, 35\%), reflecting and evaluating practices (11/34, 32\%), and the presence of implementation leaders (9/34, 26\%) were the main factors identified as important. Conclusions: This review sheds some light on the factors that are relevant and that should be accounted for in the implementation process of ML-based applications in health care. While the relevance of ML-specific dimensions, like trust, emerges clearly across several implementation domains, the evidence from this review highlighted that relevant implementation factors are not necessarily specific for ML but rather transversal for digital health technologies. More research is needed to further clarify the factors that are relevant to implementing ML-based applications at the organizational level and to support their uptake within health care organizations. Trial Registration: PROSPERO 403873; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=403873 International Registered Report Identifier (IRRID): RR2-10.2196/47971 ",
doi="10.2196/55897",
url="https://www.jmir.org/2024/1/e55897"
}


@Article{info:doi/10.2196/60574,
author="Charles, Lesley
and Tang, Eileen
and Tian, Jaminal Peter George
and Chan, Karenn
and Br{\'e}mault-Phillips, Suzette
and Dobbs, Bonnie
and Vokey, Camelia
and Polard, Sharna
and Parmar, Jasneet",
title="Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="25",
volume="8",
pages="e60574",
keywords="decision making capacity",
keywords="mental competency",
keywords="aged",
keywords="mobile applications",
keywords="mobile phone",
keywords="Canada",
keywords="covid-19",
keywords="pandemics",
keywords="dementia",
keywords="survey",
keywords="virtual capacity assessment",
keywords="characteristics",
keywords="barriers",
keywords="facilitators",
keywords="virtual decision making",
keywords="assessment",
abstract="Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2\%, 14/31), occupational therapists (29\%, 9/31), and social workers (16.1\%, 5/31), with a majority (93.6\%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2\%, 16/29) being associated primarily with acute care services. Furthermore, 54.8\% (17/31) were interested in conducting DMCAs virtually; however, only 25.8\% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients' characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client's and assessor's sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors' ability to perform DMCA's virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. ",
doi="10.2196/60574",
url="https://formative.jmir.org/2024/1/e60574",
url="http://www.ncbi.nlm.nih.gov/pubmed/39585735"
}


@Article{info:doi/10.2196/65728,
author="Schmollinger, Martin
and Gerstner, Jessica
and Stricker, Eric
and Muench, Alexander
and Breckwoldt, Benjamin
and Sigle, Manuel
and Rosenberger, Peter
and Wunderlich, Robert",
title="Evaluation of an App-Based Mobile Triage System for Mass Casualty Incidents: Within-Subjects Experimental Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="21",
volume="26",
pages="e65728",
keywords="disaster medicine",
keywords="mass casualty incidents",
keywords="digitalization",
keywords="triage",
keywords="Germany",
keywords="mobile triage app",
abstract="Background: Digitalization in disaster medicine holds significant potential to accelerate rescue operations and ultimately save lives. Mass casualty incidents demand rapid and accurate information management to coordinate effective responses. Currently, first responders manually record triage results on patient cards, and brief information is communicated to the command post via radio communication. Although this process is widely used in practice, it involves several time-consuming and error-prone tasks. To address these issues, we designed, implemented, and evaluated an app-based mobile triage system. This system allows users to document responder details, triage categories, injury patterns, GPS locations, and other important information, which can then be transmitted automatically to the incident commanders. Objective: This study aims to design and evaluate an app-based mobile system as a triage and coordination tool for emergency and disaster medicine, comparing its effectiveness with the conventional paper-based system. Methods: A total of 38 emergency medicine personnel participated in a within-subject experimental study, completing 2 triage sessions with 30 patient cards each: one session using the app-based mobile system and the other using the paper-based tool. The accuracy of the triages and the time taken for each session were measured. Additionally, we implemented the User Experience Questionnaire along with other items to assess participants' subjective ratings of the 2 triage tools. Results: Our 2 (triage tool) {\texttimes} 2 (tool order) mixed multivariate analysis of variance revealed a significant main effect for the triage tool (P<.001). Post hoc analyses indicated that participants were significantly faster (P<.001) and more accurate (P=.005) in assigning patients to the correct triage category when using the app-based mobile system compared with the paper-based tool. Additionally, analyses showed significantly better subjective ratings for the app-based mobile system compared with the paper-based tool, in terms of both school grading (P<.001) and across all 6 scales of the User Experience Questionnaire (all P<.001). Of the 38 participants, 36 (95\%) preferred the app-based mobile system. There was no significant main effect for tool order (P=.24) or session order (P=.06) in our model. Conclusions: Our findings demonstrate that the app-based mobile system not only matches the performance of the conventional paper-based tool but may even surpass it in terms of efficiency and usability. This advancement could further enhance the potential of digitalization to optimize processes in disaster medicine, ultimately leading to the possibility of saving more lives. ",
doi="10.2196/65728",
url="https://www.jmir.org/2024/1/e65728",
url="http://www.ncbi.nlm.nih.gov/pubmed/39474975"
}


@Article{info:doi/10.2196/58329,
author="Seo, Junhyuk
and Choi, Dasol
and Kim, Taerim
and Cha, Chul Won
and Kim, Minha
and Yoo, Haanju
and Oh, Namkee
and Yi, YongJin
and Lee, Hwa Kye
and Choi, Edward",
title="Evaluation Framework of Large Language Models in Medical Documentation: Development and Usability Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e58329",
keywords="large language models",
keywords="health care documentation",
keywords="clinical evaluation",
keywords="emergency department",
keywords="artificial intelligence",
keywords="medical record accuracy",
abstract="Background: The advancement of large language models (LLMs) offers significant opportunities for health care, particularly in the generation of medical documentation. However, challenges related to ensuring the accuracy and reliability of LLM outputs, coupled with the absence of established quality standards, have raised concerns about their clinical application. Objective: This study aimed to develop and validate an evaluation framework for assessing the accuracy and clinical applicability of LLM-generated emergency department (ED) records, aiming to enhance artificial intelligence integration in health care documentation. Methods: We organized the Healthcare Prompt-a-thon, a competitive event designed to explore the capabilities of LLMs in generating accurate medical records. The event involved 52 participants who generated 33 initial ED records using HyperCLOVA X, a Korean-specialized LLM. We applied a dual evaluation approach. First, clinical evaluation: 4 medical professionals evaluated the records using a 5-point Likert scale across 5 criteria---appropriateness, accuracy, structure/format, conciseness, and clinical validity. Second, quantitative evaluation: We developed a framework to categorize and count errors in the LLM outputs, identifying 7 key error types. Statistical methods, including Pearson correlation and intraclass correlation coefficients (ICC), were used to assess consistency and agreement among evaluators. Results: The clinical evaluation demonstrated strong interrater reliability, with ICC values ranging from 0.653 to 0.887 (P<.001), and a test-retest reliability Pearson correlation coefficient of 0.776 (P<.001). Quantitative analysis revealed that invalid generation errors were the most common, constituting 35.38\% of total errors, while structural malformation errors had the most significant negative impact on the clinical evaluation score (Pearson r=--0.654; P<.001). A strong negative correlation was found between the number of quantitative errors and clinical evaluation scores (Pearson r=--0.633; P<.001), indicating that higher error rates corresponded to lower clinical acceptability. Conclusions: Our research provides robust support for the reliability and clinical acceptability of the proposed evaluation framework. It underscores the framework's potential to mitigate clinical burdens and foster the responsible integration of artificial intelligence technologies in health care, suggesting a promising direction for future research and practical applications in the field. ",
doi="10.2196/58329",
url="https://www.jmir.org/2024/1/e58329"
}


@Article{info:doi/10.2196/58933,
author="Piera-Jim{\'e}nez, Jordi
and Carot-Sans, Gerard
and Ramiro-Pareta, Marina
and Nogueras, Mercedes Maria
and Folguera-Profit{\'o}s, J{\'u}lia
and R{\'o}denas, Pepi
and Jim{\'e}nez-Rueda, Alba
and de Pando Navarro, Thais
and Mira Palacios, Antoni Josep
and Fajardo, Carles Joan
and Ustrell Campillo, Joan
and Vela, Emili
and Monterde, David
and Valero-Bover, Dami{\`a}
and Bonet, Tara
and Tarras{\'o}-Urios, Guillermo
and Cantenys-Sab{\`a}, Roser
and Fabregat-Fabregat, Pau
and G{\'o}mez Oliveros, Beatriz
and Berd{\'u}n, Jes{\'u}s
and Michelena, Xabier
and Cano, Isaac
and Gonz{\'a}lez-Colom, Rub{\`e}n
and Roca, Josep
and Solans, Oscar
and Pontes, Caridad
and P{\'e}rez-Sust, Pol",
title="A 25-Year Retrospective of Health IT Infrastructure Building: The Example of the Catalonia Region",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="18",
volume="26",
pages="e58933",
keywords="health ITs",
keywords="eHealth",
keywords="integrated care",
keywords="open platforms",
keywords="interoperability",
keywords="Catalonia",
keywords="digitalization",
keywords="health care structure",
keywords="health care delivery",
keywords="integrated pathway",
keywords="integrated treatment plan",
keywords="process management",
doi="10.2196/58933",
url="https://www.jmir.org/2024/1/e58933",
url="http://www.ncbi.nlm.nih.gov/pubmed/39556831"
}


@Article{info:doi/10.2196/60453,
author="Ding, Huitong
and Gifford, Katherine
and Shih, C. Ludy
and Ho, Kristi
and Rahman, Salman
and Igwe, Akwaugo
and Low, Spencer
and Popp, Zachary
and Searls, Edward
and Li, Zexu
and Madan, Sanskruti
and Burk, Alexa
and Hwang, H. Phillip
and Anda-Duran, De Ileana
and Kolachalama, B. Vijaya
and Au, Rhoda
and Lin, Honghuang",
title="Exploring the Perspectives of Older Adults on a Digital Brain Health Platform Using Natural Language Processing: Cohort Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="18",
volume="8",
pages="e60453",
keywords="digital brain health",
keywords="older adults",
keywords="perspectives",
keywords="semistructured interviews",
keywords="natural language processing",
keywords="mobile phone",
abstract="Background: Although digital technology represents a growing field aiming to revolutionize early Alzheimer disease risk prediction and monitoring, the perspectives of older adults on an integrated digital brain health platform have not been investigated. Objective: This study aims to understand the perspectives of older adults on a digital brain health platform by conducting semistructured interviews and analyzing their transcriptions by natural language processing. Methods: The study included 28 participants from the Boston University Alzheimer's Disease Research Center, all of whom engaged with a digital brain health platform over an initial assessment period of 14 days. Semistructured interviews were conducted to collect data on participants' experiences with the digital brain health platform. The transcripts generated from these interviews were analyzed using natural language processing techniques. The frequency of positive and negative terms was evaluated through word count analysis. A sentiment analysis was used to measure the emotional tone and subjective perceptions of the participants toward the digital platform. Results: Word count analysis revealed a generally positive sentiment toward the digital platform, with ``like,'' ``well,'' and ``good'' being the most frequently mentioned positive terms. However, terms such as ``problem'' and ``hard'' indicated certain challenges faced by participants. Sentiment analysis showed a slightly positive attitude with a median polarity score of 0.13 (IQR 0.08-0.15), ranging from --1 (completely negative) to 1 (completely positive), and a median subjectivity score of 0.51 (IQR 0.47-0.53), ranging from 0 (completely objective) to 1 (completely subjective). These results suggested an overall positive attitude among the study cohort. Conclusions: The study highlights the importance of understanding older adults' attitudes toward digital health platforms amid the comprehensive evolution of the digitalization era. Future research should focus on refining digital solutions to meet the specific needs of older adults, fostering a more personalized approach to brain health. ",
doi="10.2196/60453",
url="https://formative.jmir.org/2024/1/e60453"
}


@Article{info:doi/10.2196/55865,
author="Bogale, Binyam
and Vesinurm, M{\"a}rt
and Lillrank, Paul
and Celius, Gulowsen Elisabeth
and Halvorsrud, Ragnhild",
title="Visual Modeling Languages in Patient Pathways: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="15",
volume="13",
pages="e55865",
keywords="patient pathways",
keywords="visual modeling languages",
keywords="business process model and notation",
keywords="BPMN",
keywords="unified modeling language",
keywords="UML",
keywords="domain-specific modeling languages",
keywords="scoping review",
abstract="Background: Patient pathways (PPs) are presented as a panacea solution to enhance health system functions. It is a complex concept that needs to be described and communicated well. Modeling plays a crucial role in promoting communication, fostering a shared understanding, and streamlining processes. Only a few existing systematic reviews have focused on modeling methods and standardized modeling languages. There remains a gap in consolidated knowledge regarding the use of diverse visual modeling languages. Objective: This scoping review aimed to compile visual modeling languages used to represent PPs, including the justifications and the context in which a modeling language was adopted, adapted, combined, or developed. Methods: After initial experimentation with the keywords used to describe the concepts of PPs and visual modeling languages, we developed a search strategy that was further refined and customized to the major databases identified as topically relevant. In addition, we consulted gray literature and conducted hand searches of the referenced articles. Two reviewers independently screened the articles in 2 stages using preset inclusion criteria, and a third reviewer voted on the discordance. Data charting was done using an iteratively developed form in the Covidence software. Descriptive and thematic summaries were presented following rounds of discussion to produce the final report. Results: Of 1838 articles retrieved after deduplication, 22 satisfied our inclusion criteria. Clinical pathway is the most used phrase to represent the PP concept, and most papers discussed the concept without providing their operational definition. We categorized the visual modeling languages into five categories: (1) general purpose--modeling language (GPML) adopted without major extension or modification, (2) GPML used with formal extension recommendations, (3) combination of 2 or more modeling languages, (4) a developed domain-specific modeling language (DSML), and (5) ontological modeling languages. The justifications for adopting, adapting, combining, and developing visual modeling languages varied accordingly and ranged from versatility, expressiveness, tool support, and extensibility of a language to domain needs, integration, and simplification. Conclusions: Various visual modeling languages were used in PP modeling, each with varying levels of abstraction and granularity. The categorization we made could aid in a better understanding of the complex combination of PP and modeling languages. Standardized GPMLs were used with or without any modifications. The rationale to propose any modification to GPMLs evolved as more evidence was presented following requirement analyses to support domain constructs. DSMLs are infrequently used due to their resource-intensive development, often initiated at a project level. The justifications provided and the context where DSMLs were created are paramount. Future studies should assess the merits and demerits of using a visual modeling language to facilitate PP communications among stakeholders and use evaluation frameworks to identify, modify, or develop them, depending on the scope and goal of the modeling need. ",
doi="10.2196/55865",
url="https://www.i-jmr.org/2024/1/e55865"
}


@Article{info:doi/10.2196/52301,
author="Nebsbjerg, Amalie Mette
and Bomholt, Bj{\o}rnshave Katrine
and Vestergaard, H{\o}strup Claus
and Christensen, Bondo Morten
and Huibers, Linda",
title="The Added Value of Using Video in Out-of-Hours Primary Care Telephone Triage Among General Practitioners: Cross-Sectional Survey Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="15",
volume="11",
pages="e52301",
keywords="primary health care",
keywords="after-hours care",
keywords="referral and consultation",
keywords="general practitioners",
keywords="triage",
keywords="remote consultation",
keywords="telemedicine",
abstract="Background: Many countries have introduced video consultations in primary care both inside and outside of office hours. Despite some relational and technical limitations, general practitioners (GPs) have reported the benefits of video use in the daytime as it provides faster and more flexible access to health care. Studies have indicated that video may be specifically valuable in out-of-hours primary care (OOH-PC), but additional information on the added value of video use is needed. Objective: This study aimed to investigate triage GPs' perspectives on video use in GP-led telephone triage in OOH-PC by exploring their reasons for choosing video use and its effect on triage outcome, the decision-making process, communication, and invested time. Methods: We conducted a cross-sectional questionnaire study among GPs performing telephone triage in the OOH-PC service in the Central Denmark Region from September 5, 2022, until December 21, 2022. The questionnaire was integrated into the electronic patient registration system as a pop-up window appearing after every third video contact. This setup automatically linked background data on the contact, patient, and GP to the questionnaire data. We used descriptive analyses to describe reasons for and effects of video use and GP evaluation, stratified by patient age. Results: A total of 2456 questionnaires were completed. The most frequent reasons for video use were to assess the severity (n=1951, 79.4\%), to increase the probability of self-care (n=1279, 52.1\%), and to achieve greater certainty in decision-making (n=810, 33\%) (multiple answers were possible for reasons of video use). In 61.9\% (n=1516) of contacts, the triage GPs anticipated that the contact would have resulted in a different triage outcome if video had not been used. Use of video resulted in a downgrading of severity level in 88.3\% (n=1338) of cases. Triage GPs evaluated the use of video as positive in terms of their decision-making process (n=2358, 96\%), communication (n=2214, 90.1\%), and invested time (n=2391, 97.3\%). Conclusions: Triage GPs assessed that the use of video in telephone triage did affect their triage outcome, mostly by downgrading the level of care needed. The participating triage GPs found video in OOH-PC to be of added value, particularly in communication and the decision-making process. ",
doi="10.2196/52301",
url="https://humanfactors.jmir.org/2024/1/e52301"
}


@Article{info:doi/10.2196/58537,
author="Dumassais, Shirley
and Grewal, Singh Karl
and Aubin, Gabrielle
and O'Connell, Megan
and Phillips, A. Natalie
and Wittich, Walter",
title="Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="15",
volume="8",
pages="e58537",
keywords="neuropsychological tests",
keywords="telemedicine",
keywords="social inclusion",
keywords="telehealth",
keywords="remote",
keywords="qualitative",
keywords="neuropsychological",
keywords="cognitive",
keywords="screening",
keywords="assessment",
keywords="perception",
keywords="perspective",
keywords="telephone",
keywords="cross-sectional",
keywords="thematic",
keywords="mobile phone",
keywords="Montreal Cognitive Assessment",
keywords="MoCA",
abstract="Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities. Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener. Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session. Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension. Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability. ",
doi="10.2196/58537",
url="https://formative.jmir.org/2024/1/e58537"
}


@Article{info:doi/10.2196/58504,
author="Drummond, David
and Gonsard, Apolline",
title="Definitions and Characteristics of Patient Digital Twins Being Developed for Clinical Use: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="13",
volume="26",
pages="e58504",
keywords="patient simulation",
keywords="cyber-physical systems",
keywords="telemonitoring",
keywords="personalized medicine",
keywords="precision medicine",
keywords="digital twin",
abstract="Background: The concept of digital twins, widely adopted in industry, is entering health care. However, there is a lack of consensus on what constitutes the digital twin of a patient. Objective: The objective of this scoping review was to analyze definitions and characteristics of patient digital twins being developed for clinical use, as reported in the scientific literature. Methods: We searched PubMed, Scopus, Embase, IEEE, and Google Scholar for studies claiming digital twin development or evaluation until August 2023. Data on definitions, characteristics, and development phase were extracted. Unsupervised classification of claimed digital twins was performed. Results: We identified 86 papers representing 80 unique claimed digital twins, with 98\% (78/80) in preclinical phases. Among the 55 papers defining ``digital twin,'' 76\% (42/55) described a digital replica, 42\% (23/55) mentioned real-time updates, 24\% (13/55) emphasized patient specificity, and 15\% (8/55) included 2-way communication. Among claimed digital twins, 60\% (48/80) represented specific organs (primarily heart: 15/48, 31\%; bones or joints: 10/48, 21\%; lung: 6/48, 12\%; and arteries: 5/48, 10\%); 14\% (11/80) embodied biological systems such as the immune system; and 26\% (21/80) corresponded to other products (prediction models, etc). The patient data used to develop and run the claimed digital twins encompassed medical imaging examinations (35/80, 44\% of publications), clinical notes (15/80, 19\% of publications), laboratory test results (13/80, 16\% of publications), wearable device data (12/80, 15\% of publications), and other modalities (32/80, 40\% of publications). Regarding data flow between patients and their virtual counterparts, 16\% (13/80) claimed that digital twins involved no flow from patient to digital twin, 73\% (58/80) used 1-way flow from patient to digital twin, and 11\% (9/80) enabled 2-way data flow between patient and digital twin. Based on these characteristics, unsupervised classification revealed 3 clusters: simulation patient digital twins in 54\% (43/80) of publications, monitoring patient digital twins in 28\% (22/80) of publications, and research-oriented models unlinked to specific patients in 19\% (15/80) of publications. Simulation patient digital twins used computational modeling for personalized predictions and therapy evaluations, mostly for one-time assessments, and monitoring digital twins harnessed aggregated patient data for continuous risk or outcome forecasting and care optimization. Conclusions: We propose defining a patient digital twin as ``a viewable digital replica of a patient, organ, or biological system that contains multidimensional, patient-specific information and informs decisions'' and to distinguish simulation and monitoring digital twins. These proposed definitions and subtypes offer a framework to guide research into realizing the potential of these personalized, integrative technologies to advance clinical care. ",
doi="10.2196/58504",
url="https://www.jmir.org/2024/1/e58504"
}


@Article{info:doi/10.2196/60655,
author="Craamer, Casper
and Timmers, Thomas
and Siebelt, Michiel
and Kool, Bertijn Rudolf
and Diekerhof, Carel
and Caron, Jacob Jan
and Gosens, Taco
and van der Weegen, Walter",
title="Completion Rate and Satisfaction With Online Computer-Assisted History Taking Questionnaires in Orthopedics: Multicenter Implementation Report",
journal="JMIR Med Inform",
year="2024",
month="Nov",
day="13",
volume="12",
pages="e60655",
keywords="computer-assisted history taking",
keywords="history taking",
keywords="digital medical interview",
keywords="orthopedics",
keywords="digital health",
keywords="computer-assisted",
keywords="cohort study",
keywords="orthopedic",
keywords="outpatient",
keywords="satisfaction",
keywords="patient engagement",
keywords="medical record",
abstract="Background: Collecting the medical history during a first outpatient consultation plays an important role in making a diagnosis. However, it is a time-consuming process, and time is scarce in today's health care environment. The computer-assisted history taking (CAHT) systems allow patients to share their medical history electronically before their visit. Although multiple advantages of CAHT have been demonstrated, adoption in everyday medical practice remains low, which has been attributed to various barriers. Objective: This study aimed to implement a CAHT questionnaire for orthopedic patients in preparation for their first outpatient consultation and analyze its completion rate and added value. Methods: A multicenter implementation study was conducted in which all patients who were referred to the orthopedic department were invited to self-complete the CAHT questionnaire. The primary outcome of the study is the completion rate of the questionnaire. Secondary outcomes included patient and physician satisfaction. These were assessed via surveys and semistructured interviews. Implementation (Results): In total, 5321 patients were invited, and 4932 (92.7\%) fully completed the CAHT questionnaire between April 2022 and July 2022. On average, participants (n=224) rated the easiness of completing the questionnaire at 8.0 (SD 1.9; 0?10 scale) and the satisfaction of the consult at 8.0 (SD 1.7; 0?10 scale). Satisfaction with the outpatient consultation was higher in cases where the given answers were used by the orthopedic surgeon during this consultation (median 8.3, IQR 8.0?9.1 vs median 8.0, IQR 7.0?8.5; P<.001). Physicians (n=15) scored the average added value as 7.8 (SD 1.7; 0?10 scale) and unanimously recognized increased efficiency, better patient engagement, and better medical record completeness. Implementing the patient's answers into the electronic health record was deemed necessary. Conclusions: In this study, we have shown that previously recognized barriers to implementing and adapting CAHT can now be effectively overcome. We demonstrated that almost all patients completed the CAHT questionnaire. This results in reported improvements in both the efficiency and personalization of outpatient consultations. Given the pressing need for personalized health care delivery in today's time-constrained medical environment, we recommend implementing CAHT systems in routine medical practice. ",
doi="10.2196/60655",
url="https://medinform.jmir.org/2024/1/e60655"
}


@Article{info:doi/10.2196/51412,
author="Liao, Wenmin
and He, Rong
and He, Zhonglian
and Shi, Nan
and Li, Dan
and Zhuang, Aihua
and Gan, Feng
and Sun, Ying
and Li, Chaofeng",
title="Influence of Blood Sampling Service Process Reengineering on Medical Services Supply: Quasi-Experimental Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="12",
volume="26",
pages="e51412",
keywords="process reengineering",
keywords="blood sampling",
keywords="hospital administration",
keywords="medical informatics",
keywords="digital health",
keywords="patient experience",
abstract="Background: Tertiary hospitals in China are confronted with significant challenges due to limited spatial capacity and workforce constraints, leading to saturated allocation of medical resources and restricted growth in medical service provision. The incorporation of digital health into medical service process reengineering (MSPR) marks a pivotal transformation and restructuring of conventional health service delivery models. Specifically, the application of MSPR to blood sampling services processes reengineering (BSSPR) holds promise for substantially enhancing the efficiency and quality of medical services through streamlining and optimizing these procedures. However, the comprehensive impact of BSSPR has been infrequently quantified in existing research. Objective: This study aims to investigate the influence of BSSPR on the efficiency and quality of medical services and to elucidate the key informative technological support points underpinning BSSPR. Methods: Data were collected from both the new and old laboratory information systems from August 1, 2019, to December 31, 2021. A combination of statistical description, chi-square test, and t test was used to compare check-in time and waiting time of outpatients before and after the implementation of BSSPR. An interrupted time-series design was used to analyze the impact of BSSPR on medical service efficiency and quality, enabling the control of confounding variables, including changes in medical human resources and both long- and short-term temporal trends. Results: BSSPR had an impact on the efficiency and quality of medical services. Notably, there was a significant increase in the number of patients receiving blood sampling services, with a daily service volume increase of {\textasciitilde}150 individuals (P=.04). The average waiting time for patients decreased substantially from 29 (SD 36) to 11 (SD 11) minutes, indicating a marked improvement in patient experience. During the peak period, the number of patients receiving blood sampling services per working hour statistically increased from 9.56 to 16.77 (P<.001). The interrupted time-series model results demonstrated a reduction in patients' waiting time by an average of 26.1 (SD 3.8; 95\% CI --33.64 to --18.57) minutes. Although there was an initial decline in the number of outpatients admitted following BSSPR implementation, an upward trend was observed over time ($\beta$=1.13, 95\% CI 0.91-1.36). Conclusions: BSSPR implementation for outpatients not only reduced waiting time and improved patients' experience but also augmented the hospital's capacity to provide medical services. This study's findings offer valuable insights into the potential advantages of BSSPR and underscore the significance of harnessing digital technologies to optimize medical service processes. This research serves as a foundational basis and provides scientific support for the promotion and application of BSSPR in other health care contexts. By continuing to explore and refine the integration of digital technologies in health care, we can further enhance patient outcomes and elevate the overall quality of medical services. ",
doi="10.2196/51412",
url="https://www.jmir.org/2024/1/e51412"
}


@Article{info:doi/10.2196/54018,
author="Zhang, Guang-Wei
and Li, Bin
and Gu, Zheng-Min
and Yang, Wei-Feng
and Wang, Yi-Ran
and Li, Hui-Jun
and Zheng, Han-Bing
and Yue, Ying-Xu
and Wang, Kui-Zhong
and Gong, Mengchun
and Gong, Da-Xin",
title="In-Depth Examination of the Functionality and Performance of the Internet Hospital Information Platform: Development and Usability Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="8",
volume="26",
pages="e54018",
keywords="internet hospital",
keywords="smart hospital",
keywords="mobile applications",
keywords="operational data",
keywords="information system",
keywords="online service",
keywords="patient service",
keywords="management tool",
keywords="electronic prescriptions",
keywords="medical education",
keywords="integration",
abstract="Background: Internet hospitals (IHs) have rapidly developed as a promising strategy to address supply-demand imbalances in China's medical industry, with their capabilities directly dependent on information platform functionality. Furthermore, a novel theory of ``Trinity'' smart hospital has provided advanced guidelines on IH constructions. Objective: This study aimed to explore the construction experience, construction models, and development prospects based on operational data from IHs. Methods: Based on existing information systems and internet service functionalities, our hospital has built a ``Smart Hospital Internet Information Platform (SHIIP)'' for IH operations, actively to expand online services, digitalize traditional health care, and explore health care services modes throughout the entire process and lifecycle. This article encompasses the platform architecture design, technological applications, patient service content and processes, health care professional support features, administrative management tools, and associated operational data. Results: Our platform has presented a set of data, including 82,279,669 visits, 420,120 online medical consultations, 124,422 electronic prescriptions, 92,285 medication deliveries, 6,965,566 prediagnosis triages, 4,995,824 offline outpatient appointments, 2025 medical education articles with a total of 15,148,310 views, and so on. These data demonstrate the significant role of IH as an indispensable component of our physical hospital services, with deep integration between online and offline health care systems. Conclusions: The upward trends in various data metrics indicate that our IH has gained significant recognition and usage among both the public and healthcare workers, and may have promising development prospects. Additionally, the platform construction approach, which prioritizes comprehensive service digitization and the 'Trinity' of the public, healthcare workers, and managers, serves as an effective means of promoting the development of Internet Hospitals. Such insights may prove invaluable in guiding the development of IH and facilitating the continued evolution of the Internet healthcare sector. ",
doi="10.2196/54018",
url="https://www.jmir.org/2024/1/e54018",
url="http://www.ncbi.nlm.nih.gov/pubmed/39168813"
}


@Article{info:doi/10.2196/52557,
author="Reynaud, Danielle
and Bouscaren, Nicolas
and Cartron, Emmanuelle
and Marimoutou, Catherine",
title="Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island",
journal="JMIR Pediatr Parent",
year="2024",
month="Nov",
day="1",
volume="7",
pages="e52557",
keywords="sexual health",
keywords="adolescent",
keywords="young adults",
keywords="web application",
keywords="contraception prescription",
keywords="contraception",
keywords="teleconsultation",
keywords="telemedicine",
keywords="youth",
keywords="usage",
keywords="e-consultation",
keywords="web based",
abstract="Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36\%), receive an initial birth control prescription (12/22, 55\%), and inquire about condom prescriptions (2/22, 9\%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. ",
doi="10.2196/52557",
url="https://pediatrics.jmir.org/2024/1/e52557"
}


@Article{info:doi/10.2196/64159,
author="Sugawara, Yuka
and Hirakawa, Yosuke
and Iwagami, Masao
and Kuroki, Haruo
and Mitani, Shuhei
and Inagaki, Ataru
and Ohashi, Hiroki
and Kubota, Mitsuru
and Koike, Soichi
and Wakimizu, Rie
and Nangaku, Masaomi",
title="Issues in the Adoption of Online Medical Care: Cross-Sectional Questionnaire Survey",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="1",
volume="26",
pages="e64159",
keywords="telemedicine",
keywords="online medical care",
keywords="telehealth",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Telemedicine, or online medical care, has gained considerable attention worldwide. However, it has not been widely adopted in Japan, and the detailed status of received and provided online medical care and the reasons for its lack of popularity remain unknown. Objective: This study aims to investigate the current status of online medical care in Japan and the factors limiting its adoption from the perspective of both patients receiving and medical professionals providing online medical care. Methods: In total, 2 nationwide questionnaire surveys were conducted. The first survey, targeting both patients and healthy individuals, screened approximately 40,000 participants among 13 million people. The participants were selected to match the age distribution of the Japanese population based on government data, and their online medical care experience and medical visit status were recorded. To further investigate online medical care use and satisfaction, a web-based survey was conducted with 15\% (6000/40,000) of the screened participants. The second survey, targeting medical professionals, was administered to a physician, a nurse, and a member of the administrative staff in each of 4900 randomly selected medical facilities to inquire about their online medical care practices and impressions. In addition, both surveys investigated the factors limiting online medical care expansion in Japan. Results: The response rates among patients and healthy individuals targeted for the screening and main surveys were 92.5\% (36,998/40,000) and ?80\% (1312/1478, 88.77\%; 1281/1522, 84.17\%; 404/478, 84.5\%; and 2226/2522, 88.26\% in 4 survey groups), respectively. The survey of medical professionals yielded 1552 responses (n=618, 39.82\% physicians; n=428, 27.58\% nurses; n=506, 32.6\% administrative staff). Although the facility-level response rate was low (794/4900, 16.2\%), some facility categories had relatively high response rates. Only 5.29\% (1956/36,998) of the patients and healthy individuals had online medical care experience. When there were more hospitals nearby and they felt it was more work to see a physician in person, they were more likely to use online medical care (more nearby hospitals: adjusted odds ratio [aOR] 1.33, 95\% CI 1.18-1.50; more work: aOR 1.48, 95\% CI 1.35-1.63 per survey response point in the patient group). Similarly, these factors were substantially associated with satisfaction (more nearby hospitals: aOR 1.40, 95\% CI 1.14-1.73; more work: aOR 1.50, 95\% CI 1.27-1.76 per survey response point in the patient group). In both surveys, the most frequently selected factor preventing the widespread use of online medical care was patients' need to switch to face-to-face medical care for mandatory tests and procedures. Inadequate awareness of and education on online medical care were also frequently selected. Conclusions: Our nationwide surveys provided insights into the current status of online medical care in Japan and simultaneously identified several problems and issues related to it, which will be useful in promoting its wider adoption. ",
doi="10.2196/64159",
url="https://www.jmir.org/2024/1/e64159"
}


@Article{info:doi/10.2196/49065,
author="Bruera, Sebastian
and Staggers, Andrews Kristen
and Suarez-Almazor, Eugenia Maria
and Agarwal, Krishna Sandeep",
title="Telemedicine for Patients With Systemic Lupus Erythematosus in a Publicly Funded Hospital System: Retrospective Study",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="1",
volume="13",
pages="e49065",
keywords="lupus",
keywords="systemic lupus erythematosus",
keywords="telemedicine",
keywords="COVID-19",
keywords="access to care",
keywords="autoimmune disease",
keywords="no-show",
keywords="socioeconomic status",
keywords="adherence",
keywords="laboratory test",
keywords="management",
abstract="Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that requires frequent clinic and laboratory visits. However, patients with SLE, particularly those who are underresourced, have unacceptably high rates of no-shows. Objective: This study aims to determine no-show rates associated with telemedicine visits during the COVID-19 pandemic in comparison to no-show rates associated with contemporaneous and historic in-person visits. Methods: We performed a retrospective cohort study in a publicly funded county hospital system in Houston, Texas. We identified a cohort of established patients with SLE by the International Classification of Diseases codes that were independently confirmed as SLE by a review of medical records. We identified patients who were seen from March to December in 2018, 2019, and 2020 (to reflect the height of the COVID-19 pandemic and account for seasonal changes in disease activity). Our primary outcome was the percentage of no-shows for rheumatology clinic appointments. Our secondary outcome was laboratory use adherence, which was defined as lupus-specific blood and urine studies conducted within 30 days of the scheduled appointment. Covariates included age, sex, race, ethnicity, and SLE-related prescription drugs. Results: We included 156 patients with SLE in our analysis. Most were female (n=141, 90.4\%), were Hispanic (n=75, 49.3\%), and had a median age of 43 (range 19-80) years. In 2020, the no-show rate for telemedicine was 5.5\% (10/182) compared to a no-show rate of 16.2\% (31/191) for in-person visits (P=.002). After multivariable adjustment for covariates, the odds of no-show were lower for telemedicine visits (odds ratio 0.39, 95\% CI 0.20-0.77). There were no differences in adherence to laboratory testing. Conclusions: Telemedicine visits had decreased odds of no-shows without difference in laboratory testing adherence after adjustment for covariates. More research is needed to determine the clinical impact of telemedicine on patients with SLE. ",
doi="10.2196/49065",
url="https://www.i-jmr.org/2024/1/e49065",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078399"
}


@Article{info:doi/10.2196/51711,
author="Yang, Lingrui
and Pang, Jiali
and Zuo, Song
and Xu, Jian
and Jin, Wei
and Zuo, Feng
and Xue, Kui
and Xiao, Zhongzhou
and Peng, Xinwei
and Xu, Jie
and Zhang, Xiaofan
and Chen, Ruiyao
and Luo, Shuqing
and Zhang, Shaoting
and Sun, Xin",
title="Evolution of the ``Internet Plus Health Care'' Mode Enabled by Artificial Intelligence: Development and Application of an Outpatient Triage System",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="30",
volume="26",
pages="e51711",
keywords="artificial intelligence",
keywords="triage system",
keywords="all department recommendation",
keywords="subspecialty department recommendation",
keywords="``internet plus healthcare''",
keywords="``internet plus health care''",
abstract="Background: Although new technologies have increased the efficiency and convenience of medical care, patients still struggle to identify specialized outpatient departments in Chinese tertiary hospitals due to a lack of medical knowledge. Objective: The objective of our study was to develop a precise and subdividable outpatient triage system to improve the experiences and convenience of patient care. Methods: We collected 395,790 electronic medical records (EMRs) and 500 medical dialogue groups. The EMRs were divided into 3 data sets to design and train the triage model (n=387,876, 98\%) and test (n=3957, 1\%) and validate (n=3957, 1\%) it. The triage system was altered based on the current BERT (Bidirectional Encoder Representations from Transformers) framework and evaluated by recommendation accuracies in Xinhua Hospital using the cancellation rates in 2021 and 2022, from October 29 to December 5. Finally, a prospective observational study containing 306 samples was conducted to compare the system's performance with that of triage nurses, which was evaluated by calculating precision, accuracy, recall of the top 3 recommended departments (recall@3), and time consumption. Results: With 3957 (1\%) records each, the testing and validation data sets achieved an accuracy of 0.8945 and 0.8941, respectively. Implemented in Xinhua Hospital, our triage system could accurately recommend 79 subspecialty departments and reduce the number of registration cancellations from 16,037 (3.83\%) of the total 418,714 to 15,338 (3.53\%) of the total 434200 (P<.05). In comparison to the triage system, the performance of the triage nurses was more accurate (0.9803 vs 0.9153) and precise (0.9213 vs 0.9049) since the system could identify subspecialty departments, whereas triage nurses or even general physicians can only recommend main departments. In addition, our triage system significantly outperformed triage nurses in recall@3 (0.6230 vs 0.5266; P<.001) and time consumption (10.11 vs 14.33 seconds; P<.001). Conclusions: The triage system demonstrates high accuracy in outpatient triage of all departments and excels in subspecialty department recommendations, which could decrease the cancellation rate and time consumption. It also improves the efficiency and convenience of clinical care to fulfill better the usage of medical resources, expand hospital effectiveness, and improve patient satisfaction in Chinese tertiary hospitals. ",
doi="10.2196/51711",
url="https://www.jmir.org/2024/1/e51711"
}


@Article{info:doi/10.2196/59791,
author="Barker, Wesley
and Chang, Wei
and Everson, Jordan
and Gabriel, Meghan
and Patel, Vaishali
and Richwine, Chelsea
and Strawley, Catherine",
title="The Evolution of Health Information Technology for Enhanced Patient-Centric Care in the United States: Data-Driven Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="28",
volume="26",
pages="e59791",
keywords="interoperability",
keywords="e-prescribing",
keywords="electronic public health reporting",
keywords="patient access to health information",
keywords="electronic health records",
keywords="health IT",
abstract="Background: Health information technology (health IT) has revolutionized health care in the United States through interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and electronic patient access to health information. Objective: This study aims to examine progress in health IT adoption and its alignment with the Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health IT (ASTP's) mission to enhance health care through data access and exchange. Methods: This study leverages data on end users of health IT to capture trends in engagement in interoperable clinical care data exchange (ability to find, send, receive, and integrate information from outside organizations), e-prescribing, electronic public health reporting, and capabilities to enable patient access to electronic health information. Data were primarily sourced from the American Hospital Association Annual Survey IT Supplement (2008 to 2023), Surescripts e-prescribing use data (2008 to 2023), the National Cancer Institute's Health Information National Trends Survey (2014 to 2022), and the National Center for Health Statistics' National Electronic Health Records Survey (2009 to 2023). Results: Since 2009, there has been a 10-fold increase in electronic health record (EHR) use among hospitals and a 5-fold increase among physicians. This enabled the interoperable exchange of electronic health information, e- prescribing, electronic public health data exchange, and the means for patients and their caregivers to access crucial personal health information digitally. As of 2023, 70\% of hospitals are interoperable, with many providers integrated within EHR systems. Nearly all pharmacies and 92\% of prescribers possess e-prescribing capabilities, an 85\%-point increase since 2008. In 2013, 40\% of hospitals and one-third of physicians allowed patients to view their online medical records. Patient access has improved, with 97\% of hospitals and 65\% of physicians possessing EHRs that enable patients to access their online medical records. As of 2022, three-fourths of individuals report being offered access to patient portals, and over half (57\%) report engaging with their health information through their patient portal. Electronic public health reporting has also seen an increase, with most hospitals and physicians actively engaged in key reporting types. Conclusions: Federal incentives have contributed to the widespread adoption of EHRs and broad digitization in health care, while efforts to promote interoperability have encouraged collaboration across health care entities. As a result, interoperable clinical care data exchange, e-prescribing, electronic public health reporting, and patient access to health information have grown substantially over the past quarter century and have been shown to improve health care outcomes. However, interoperability hurdles, usability issues, data security concerns, and inequitable patient access persist. Addressing these issues will require collaborative efforts among stakeholders to promote data standardization, implement governance structures, and establish robust health information exchange networks. ",
doi="10.2196/59791",
url="https://www.jmir.org/2024/1/e59791",
url="http://www.ncbi.nlm.nih.gov/pubmed/39466303"
}


@Article{info:doi/10.2196/50730,
author="Kaafarani, Rima
and Ismail, Leila
and Zahwe, Oussama",
title="Automatic Recommender System of Development Platforms for Smart Contract--Based Health Care Insurance Fraud Detection Solutions: Taxonomy and Performance Evaluation",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="18",
volume="26",
pages="e50730",
keywords="blockchain",
keywords="blockchain development platform",
keywords="eHealth",
keywords="fraud detection",
keywords="fraud scenarios",
keywords="health care",
keywords="health care insurance",
keywords="health insurance",
keywords="machine learning",
keywords="medical informatics",
keywords="recommender system",
keywords="smart contract",
keywords="taxonomy",
abstract="Background: Health care insurance fraud is on the rise in many ways, such as falsifying information and hiding third-party liability. This can result in significant losses for the medical health insurance industry. Consequently, fraud detection is crucial. Currently, companies employ auditors who manually evaluate records and pinpoint fraud. However, an automated and effective method is needed to detect fraud with the continually increasing number of patients seeking health insurance. Blockchain is an emerging technology and is constantly evolving to meet business needs. With its characteristics of immutability, transparency, traceability, and smart contracts, it demonstrates its potential in the health care domain. In particular, self-executable smart contracts are essential to reduce the costs associated with traditional paradigms, which are mostly manual, while preserving privacy and building trust among health care stakeholders, including the patient and the health insurance networks. However, with the proliferation of blockchain development platform options, selecting the right one for health care insurance can be difficult. This study addressed this void and developed an automated decision map recommender system to select the most effective blockchain platform for insurance fraud detection. Objective: This study aims to develop smart contracts for detecting health care insurance fraud efficiently. Therefore, we provided a taxonomy of fraud scenarios and implemented their detection using a blockchain platform that was suitable for health care insurance fraud detection. To automatically and efficiently select the best platform, we proposed and implemented a decision map--based recommender system. For developing the decision-map, we proposed a taxonomy of 102 blockchain platforms. Methods: We developed smart contracts for 12 fraud scenarios that we identified in the literature. We used the top 2 blockchain platforms selected by our proposed decision-making map--based recommender system, which is tailored for health care insurance fraud. The map used our taxonomy of 102 blockchain platforms classified according to their application domains. Results: The recommender system demonstrated that Hyperledger Fabric was the best blockchain platform for identifying health care insurance fraud. We validated our recommender system by comparing the performance of the top 2 platforms selected by our system. The blockchain platform taxonomy that we created revealed that 59 blockchain platforms are suitable for all application domains, 25 are suitable for financial services, and 18 are suitable for various application domains. We implemented fraud detection based on smart contracts. Conclusions: Our decision map recommender system, which was based on our proposed taxonomy of 102 platforms, automatically selected the top 2 platforms, which were Hyperledger Fabric and Neo, for the implementation of health care insurance fraud detection. Our performance evaluation of the 2 platforms indicated that Fabric surpassed Neo in all performance metrics, as depicted by our recommender system. We provided an implementation of fraud detection based on smart contracts. ",
doi="10.2196/50730",
url="https://www.jmir.org/2024/1/e50730",
url="http://www.ncbi.nlm.nih.gov/pubmed/39423005"
}


@Article{info:doi/10.2196/53226,
author="Kuatsidzo, Ananda
and Wilson, Kumanan
and Ruller, Sydney
and Daly, Blake
and Halil, Roland
and Kobewka, Daniel",
title="Improving Vaccine Clinic Efficiency Through the CANImmunize Platform",
journal="Online J Public Health Inform",
year="2024",
month="Oct",
day="16",
volume="16",
pages="e53226",
keywords="digital solutions",
keywords="vaccine",
keywords="CANImmunize platform",
keywords="CANImmunize",
keywords="platform",
keywords="Canada",
keywords="Canadian",
keywords="workflow",
keywords="booking",
keywords="health care",
keywords="digital health",
keywords="hospital",
keywords="patient",
keywords="personnel",
doi="10.2196/53226",
url="https://ojphi.jmir.org/2024/1/e53226"
}


@Article{info:doi/10.2196/54083,
author="Hofstetter, Sebastian
and Zilezinski, Max
and Behr, Dominik
and Kraft, Bernhard
and Buhtz, Christian
and Paulicke, Denny
and Wolf, Anja
and Klus, Christina
and Stoevesandt, Dietrich
and Schwarz, Karsten
and Jahn, Patrick",
title="Integrating Digital Assistive Technologies Into Care Processes: Mixed Methods Study",
journal="JMIR Med Educ",
year="2024",
month="Oct",
day="9",
volume="10",
pages="e54083",
keywords="digital assistive technologies",
keywords="education concept",
keywords="intention to use",
keywords="learning effects",
keywords="digital transformation",
abstract="Background: Current challenges in patient care have increased research on technology use in nursing and health care. Digital assistive technologies (DATs) are one option that can be incorporated into care processes. However, how the application of DATs should be introduced to nurses and care professionals must be clarified. No structured and effective education concepts for the patient-oriented integration of DATs in the nursing sector are currently available. Objective: This study aims to examine how a structured and guided integration and education concept, herein termed the sensitization, evaluative introduction, qualification, and implementation (SEQI) education concept, can support the integration of DATs into nursing practices. Methods: This study used an explanatory, sequential study design with a mixed methods approach. The SEQI intervention was run in 26 long-term care facilities oriented toward older adults in Germany after a 5-day training course in each. The participating care professionals were asked to test 1 of 6 DATs in real-world practice over 3 days. Surveys (n=112) were then administered that recorded the intention to use DATs at 3 measurement points, and guided qualitative interviews with care professionals (n=12) were conducted to evaluate the learning concepts and effects of the intervention. Results: As this was a pilot study, no sample size calculation was carried out, and P values were not reported. The participating care professionals were generally willing to integrate DATs---as an additional resource---into nursing processes even before the 4-stage SEQI intervention was presented. However, the intervention provided additional background knowledge and sensitized care professionals to the digital transformation, enabling them to evaluate how DATs fit in the health care sector, what qualifies these technologies for correct application, and what promotes their use. The care professionals expressed specific ideas and requirements for both technology-related education concepts and nursing DATs. Conclusions: Actively matching technical support, physical limitations, and patients' needs is crucial when selecting DATs and integrating them into nursing processes. To this end, using a structured process such as SEQI that strengthens care professionals' ability to integrate DATs can help improve the benefits of such technology in the health care setting. Practical, application-oriented learning can promote the long-term implementation of DATs. ",
doi="10.2196/54083",
url="https://mededu.jmir.org/2024/1/e54083"
}


@Article{info:doi/10.2196/44294,
author="Oluokun, Oluwatosin Emmanuel
and Adedoyin, Fatai Festus
and Dogan, Huseyin
and Jiang, Nan",
title="Digital Interventions for Managing Medication and Health Care Service Delivery in West Africa: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="9",
volume="26",
pages="e44294",
keywords="digital interventions",
keywords="medications delivery",
keywords="phone-based intervention",
keywords="tele and e-based intervention",
keywords="West Africa",
keywords="management, technology",
keywords="intervention",
keywords="medication",
keywords="tool",
keywords="smartphone",
abstract="Background: As a result of the recent advancements in technology, the incorporation of digital interventions into the health care system has gained a lot of attention and adoption globally. However, these interventions have not been fully adopted, thereby limiting their impact on health care delivery in West Africa. Objective: This review primarily aims at evaluating the current digital interventions for medication and health care delivery in West Africa. Its secondary aim is to assess the impacts of digital interventions in managing medication and health care service delivery with the intent of providing vital recommendations that would contribute to an excellent adoption of digital intervention tools in the health care space in West Africa. Methods: In line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), a comprehensive search through various databases yielded 529 results. After a rigorous screening, 29 articles that provided information on 3 broad digital health intervention tools were found eligible for this review. Results: Out of 29 studies, 16 (55\%) studies examined phone-based interventions, 9 (31\%) studies focused on tele- and e-based interventions, and 4 (14\%) studies evaluated digital interventions. These interventions were used for diverse purposes, some of which are monitoring adverse drug reactions, general health, sexual and reproductive health, and training of health care practitioners. The phone-based intervention appears to be the most known and impactful of all the interventions, followed by tele- and e-based, while digital interventions were scarcely used. Conclusions: Digital interventions have had a considerable level of impact on medication and health care delivery across West Africa. However, the overall impact is limited. Therefore, strategies must be developed to address the challenges limiting the use of digital intervention tools so that these tools can be fully incorporated into the health care space in West Africa. ",
doi="10.2196/44294",
url="https://www.jmir.org/2024/1/e44294"
}


@Article{info:doi/10.2196/55472,
author="Trinkley, E. Katy
and Maw, M. Anna
and Torres, Huebner Cristina
and Huebschmann, G. Amy
and Glasgow, E. Russell",
title="Applying Implementation Science to Advance Electronic Health Record--Driven Learning Health Systems: Case Studies, Challenges, and Recommendations",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="7",
volume="26",
pages="e55472",
keywords="learning health systems",
keywords="implementation science",
keywords="chronic care",
keywords="electronic health record",
keywords="evidence-based medicine",
keywords="information technology",
keywords="research and technology",
doi="10.2196/55472",
url="https://www.jmir.org/2024/1/e55472",
url="http://www.ncbi.nlm.nih.gov/pubmed/39374069"
}


@Article{info:doi/10.2196/45122,
author="Peiffer-Smadja, Nathan
and Descousse, Sophie
and Courr{\`e}ges, Elsa
and Nganbou, Audrey
and Jeanmougin, Pauline
and Birgand, Gabriel
and L{\'e}naud, S{\'e}verin
and Beaumont, Anne-Lise
and Durand, Claire
and Delory, Tristan
and Le Bel, Josselin
and Bouvet, Elisabeth
and Lariven, Sylvie
and D'Ortenzio, Eric
and Konat{\'e}, Issa
and Bouyou-Akotet, Karine Marielle
and Ouedraogo, Abdoul-Salam
and Kouakou, Affoue Gis{\`e}le
and Poda, Armel
and Akpovo, Corinne
and Lescure, Fran{\c{c}}ois-Xavier
and Tanon, Aristophane",
title="Implementation of a Clinical Decision Support System for Antimicrobial Prescribing in Sub-Saharan Africa: Multisectoral Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="7",
volume="26",
pages="e45122",
keywords="antimicrobial resistance",
keywords="implementation research",
keywords="Consolidated Framework for Implementation Research",
keywords="CDSS",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Suboptimal use of antimicrobials is a driver of antimicrobial resistance in West Africa. Clinical decision support systems (CDSSs) can facilitate access to updated and reliable recommendations. Objective: This study aimed to assess contextual factors that could facilitate the implementation of a CDSS for antimicrobial prescribing in West Africa and Central Africa and to identify tailored implementation strategies. Methods: This qualitative study was conducted through 21 semistructured individual interviews via videoconference with health care professionals between September and December 2020. Participants were recruited using purposive sampling in a transnational capacity-building network for hospital preparedness in West Africa. The interview guide included multiple constructs derived from the Consolidated Framework for Implementation Research. Interviews were transcribed, and data were analyzed using thematic analysis. Results: The panel of participants included health practitioners (12/21, 57\%), health actors trained in engineering (2/21, 10\%), project managers (3/21, 14\%), antimicrobial resistance research experts (2/21, 10\%), a clinical microbiologist (1/21, 5\%), and an anthropologist (1/21, 5\%). Contextual factors influencing the implementation of eHealth tools existed at the individual, health care system, and national levels. At the individual level, the main challenge was to design a user-centered CDSS adapted to the prescriber's clinical routine and structural constraints. Most of the participants stated that the CDSS should not only target physicians in academic hospitals who can use their network to disseminate the tool but also general practitioners, primary care nurses, midwives, and other health care workers who are the main prescribers of antimicrobials in rural areas of West Africa. The heterogeneity in antimicrobial prescribing training among prescribers was a significant challenge to the use of a common CDSS. At the country level, weak pharmaceutical regulations, the lack of official guidelines for antimicrobial prescribing, limited access to clinical microbiology laboratories, self-medication, and disparity in health care coverage lead to inappropriate antimicrobial use and could limit the implementation and diffusion of CDSS for antimicrobial prescribing. Participants emphasized the importance of building a solid eHealth ecosystem in their countries by establishing academic partnerships, developing physician networks, and involving diverse stakeholders to address challenges. Additional implementation strategies included conducting a local needs assessment, identifying early adopters, promoting network weaving, using implementation advisers, and creating a learning collaborative. Participants noted that a CDSS for antimicrobial prescribing could be a powerful tool for the development and dissemination of official guidelines for infectious diseases in West Africa. Conclusions: These results suggest that a CDSS for antimicrobial prescribing adapted for nonspecialized prescribers could have a role in improving clinical decisions. They also confirm the relevance of adopting a cross-disciplinary approach with participants from different backgrounds to assess contextual factors, including social, political, and economic determinants. ",
doi="10.2196/45122",
url="https://www.jmir.org/2024/1/e45122",
url="http://www.ncbi.nlm.nih.gov/pubmed/39374065"
}


@Article{info:doi/10.2196/59098,
author="Bilbrey, Tim
and Martin, Jenny
and Zhou, Wen
and Bai, Changhao
and Vaswani, Nitin
and Shah, Rishab
and Chokshi, Sara
and Chen, Xi
and Bhusri, Satjit
and Niemi, Samantha
and Meng, Hongdao
and Lei, Zhen",
title="A Dual-Modality Home-Based Cardiac Rehabilitation Program for Adults With Cardiovascular Disease: Single-Arm Remote Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Oct",
day="1",
volume="12",
pages="e59098",
keywords="cardiac rehabilitation",
keywords="telehealth",
keywords="mHealth",
keywords="digital health",
keywords="exercise",
keywords="quality of life",
keywords="myocardial infarction",
keywords="app",
keywords="application",
keywords="physical fitness",
keywords="self-management",
keywords="disease management",
abstract="Background: Cardiac rehabilitation (CR) is a safe, effective intervention for individuals with cardiovascular disease (CVD). However, a majority of eligible patients do not complete CR. Growing evidence suggests that home-based cardiac rehabilitation (HBCR) programs are comparable in effectiveness and safety with traditional center-based programs. More research is needed to explore different ways to deliver HBCR programs to patients with CVD. Objective: We aimed to assess the feasibility and impact of a digital HBCR program (RecoveryPlus.Health) that integrates both telehealth and mHealth modalities on functional exercise capacity, resting heart rate, and quality of life among adults with CVD. Methods: This 12-week prospective, single-arm remote clinical trial used a within-subject design. We recruited adults with CVD (aged ?40 years) from the community with a CR-eligible diagnosis (stable angina pectoris, myocardial infarction, and heart failure) between May and August 2023. All enrolled patients referred to the RPH clinic in Roanoke, Texas, were included. The care team provided guideline-concordant CR services to study participants via two modalities: (1) a synchronous telehealth exercise training through videoconferencing; and (2) an asynchronous mobile health (mHealth) coaching app (RPH app). Baseline intake survey, electronic health record, and app log data were used to extract individual characteristics, care processes, and platform engagement data. Feasibility was measured by program completion rate and CR service use. Efficacy was measured by changes in the 6-minute walk test, resting heart rate, and quality of life (12-Item Short-Form Health Survey) before and after the 12-week program. Paired t tests were used to examine pre- and postintervention changes in the outcome variables. Results: In total, 162 met the inclusion criteria and 75 (46.3\%) consented and were enrolled (mean age 64, SD 10.30 years; male: n=37, 49\%; White: n=46, 61\%). Heart failure was the most common diagnosis (37/75, 49\%). In total, 62/75 (83\%) participants completed the 12-week study and used the telehealth modality with 9.63 (SD 3.33) sessions completed, and 59/75 (79\%) used the mHealth modality with 10.97 (SD 11.70) sessions completed. Post intervention, 50/62 (81\%) participants' performance in the 6-minute walk test had improved, with an average improvement of 40 (SD 63.39) m (95\% CI 25.6-57.1). The average 12-Item Short-Form Health Survey's physical and mental summary scores improved by 2.7 (SD 6.47) points (95\% CI 1.1-4.3) and 2.2 (SD 9.09) points (95\% CI 0.1-4.5), respectively. There were no changes in resting heart rate and no exercise-related adverse events were reported. Conclusions: The RecoveryPlus.Health digital HBCR program showed feasibility and efficacy in a group of nationally recruited patients with CVD. The findings add to the evidence that a telehealth and mHealth dual-modality HBCR program may be a promising approach to overcome some of the main barriers to improving CR access in the United States. Trial Registration: ClinicalTrials.gov NCT05804500; https://clinicaltrials.gov/search?cond=NCT05804500 ",
doi="10.2196/59098",
url="https://mhealth.jmir.org/2024/1/e59098",
url="http://www.ncbi.nlm.nih.gov/pubmed/39150858"
}


@Article{info:doi/10.2196/55576,
author="Wang, Hao-Nan
and Luo, Pei
and Liu, Shuyue
and Liu, Yunyi
and Zhang, Xiao
and Li, Jian",
title="Effectiveness of Internet-Based Telehealth Programs in Patients With Hip or Knee Osteoarthritis: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="30",
volume="26",
pages="e55576",
keywords="osteoarthritis",
keywords="knee",
keywords="hip",
keywords="telehealth",
keywords="telemedicine",
keywords="telerehabilitation",
keywords="eHealth",
keywords="exercise",
keywords="PRISMA",
abstract="Background: Osteoarthritis (OA) is a chronic musculoskeletal disease that causes pain, functional disability, and an economic burden. Nonpharmacological treatments are at the core of OA management. However, limited access to these services due to uneven regional local availability has been highlighted. Internet-based telehealth (IBTH) programs, providing digital access to abundant health care resources, offer advantages, such as convenience and cost-effectiveness. These characteristics make them promising strategies for the management of patients with OA. Objective: This study aimed to evaluate the effectiveness of IBTH programs in the management of patients with hip or knee OA. Methods: We systematically searched 6 electronic databases to identify trials comparing IBTH programs with conventional interventions for hip and knee OA. Studies were selected based on inclusion and exclusion criteria, focusing on outcomes related to function, pain, and self-efficacy. Standardized mean differences (SMDs) with 95\% CIs were calculated to compare outcome measures. Heterogeneity was assessed using I{\texttwosuperior} and $\chi${\texttwosuperior} tests. The methodological quality of the selected studies and the quality of evidence were also evaluated. Results: A total of 21 studies with low-to-high risk of bias were included in this meta-analysis. The pooled results showed that IBTH has a superior effect on increasing function (SMD 0.30, 95\% CI 0.23-0.37, P<.001), relieving pain (SMD --0.27, 95\% CI --0.34 to --0.19, P<.001), and improving self-efficacy for pain (SMD 0.21, 95\% CI 0.08-0.34, P<.001) compared to the conventional intervention group. Subgroup analysis revealed that IBTH with exercise can significantly alleviate pain and improve function and self-efficacy, but IBTH with cognitive-behavioral therapy only had the effect of reducing pain. Conclusions: The meta-analysis provides moderate-quality evidence that IBTH programs have a beneficial effect on improving function, relieving pain, and improving self-efficacy compared to conventional interventions in patients with hip or knee OA. Limited evidence suggests that the inclusion of exercise regimens in IBTH programs is recommended. Trial Registration: PROSPERO CRD42024541111; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=541111 ",
doi="10.2196/55576",
url="https://www.jmir.org/2024/1/e55576"
}


@Article{info:doi/10.2196/52785,
author="Egger, Jan
and Gsaxner, Christina
and Luijten, Gijs
and Chen, Jianxu
and Chen, Xiaojun
and Bian, Jiang
and Kleesiek, Jens
and Puladi, Behrus",
title="Is the Apple Vision Pro the Ultimate Display? A First Perspective and Survey on Entering the Wonderland of Precision Medicine",
journal="JMIR Serious Games",
year="2024",
month="Sep",
day="18",
volume="12",
pages="e52785",
keywords="Apple Vision Pro",
keywords="mixed reality",
keywords="augmented reality",
keywords="virtual reality",
keywords="health care",
keywords="mobile phone",
doi="10.2196/52785",
url="https://games.jmir.org/2024/1/e52785",
url="http://www.ncbi.nlm.nih.gov/pubmed/39292499"
}


@Article{info:doi/10.2196/52293,
author="Dimeff, A. Linda
and Koerner, Kelly
and Heard, Kandi
and Ruork, K. Allison
and Kelley-Brimer, Angela
and Witterholt, T. Suzanne
and Lardizabal, Beth Mary
and Clubb, R. Joseph
and McComish, Julie
and Waghray, Arpan
and Dowdy, Roger
and Asad-Pursley, Sara
and Ilac, Maria
and Lawrence, Hannah
and Zhou, Frank
and Beadnell, Blair",
title="A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="16",
volume="8",
pages="e52293",
keywords="suicide",
keywords="emergency department",
keywords="ED",
keywords="digital technology",
keywords="suicide prevention best practices",
keywords="individual",
keywords="particular",
keywords="suicide prevention",
keywords="evidence-based intervention",
keywords="hospital",
keywords="vulnerable population",
keywords="Jaspr Health",
keywords="psychiatric",
keywords="psychiatrist",
keywords="care",
keywords="safety",
abstract="Background: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. Objective: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr's use would be associated with improved patient agitation and distress. Methods: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. Results: The most frequent modules assigned were Comfort and Skills (98\% of users; n=942) and lethal means assessment (90\% of patient users; n=870). Patient task completion rates for all modules ranged from 51\% to 79\%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8\% (n=325) and 84\% (n=90) of patients recommending the app to others. Conclusions: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments. ",
doi="10.2196/52293",
url="https://formative.jmir.org/2024/1/e52293"
}


@Article{info:doi/10.2196/56729,
author="Raff, Daniel
and Stewart, Kurtis
and Yang, Christie Michelle
and Shang, Jessie
and Cressman, Sonya
and Tam, Roger
and Wong, Jessica
and Tammem{\"a}gi, C. Martin
and Ho, Kendall",
title="Improving Triage Accuracy in Prehospital Emergency Telemedicine: Scoping Review of Machine Learning--Enhanced Approaches",
journal="Interact J Med Res",
year="2024",
month="Sep",
day="11",
volume="13",
pages="e56729",
keywords="telemedicine",
keywords="machine learning",
keywords="emergency medicine",
keywords="artificial intelligence",
keywords="chatbot",
keywords="triage",
keywords="scoping review",
keywords="prehospital",
abstract="Background: Prehospital telemedicine triage systems combined with machine learning (ML) methods have the potential to improve triage accuracy and safely redirect low-acuity patients from attending the emergency department. However, research in prehospital settings is limited but needed; emergency department overcrowding and adverse patient outcomes are increasingly common. Objective: In this scoping review, we sought to characterize the existing methods for ML-enhanced telemedicine emergency triage. In order to support future research, we aimed to delineate what data sources, predictors, labels, ML models, and performance metrics were used, and in which telemedicine triage systems these methods were applied. Methods: A scoping review was conducted, querying multiple databases (MEDLINE, PubMed, Scopus, and IEEE Xplore) through February 24, 2023, to identify potential ML-enhanced methods, and for those eligible, relevant study characteristics were extracted, including prehospital triage setting, types of predictors, ground truth labeling method, ML models used, and performance metrics. Inclusion criteria were restricted to the triage of emergency telemedicine services using ML methods on an undifferentiated (disease nonspecific) population. Only primary research studies in English were considered. Furthermore, only those studies using data collected remotely (as opposed to derived from physical assessments) were included. In order to limit bias, we exclusively included articles identified through our predefined search criteria and had 3 researchers (DR, JS, and KS) independently screen the resulting studies. We conducted a narrative synthesis of findings to establish a knowledge base in this domain and identify potential gaps to be addressed in forthcoming ML-enhanced methods. Results: A total of 165 unique records were screened for eligibility and 15 were included in the review. Most studies applied ML methods during emergency medical dispatch (7/15, 47\%) or used chatbot applications (5/15, 33\%). Patient demographics and health status variables were the most common predictors, with a notable absence of social variables. Frequently used ML models included support vector machines and tree-based methods. ML-enhanced models typically outperformed conventional triage algorithms, and we found a wide range of methods used to establish ground truth labels. Conclusions: This scoping review observed heterogeneity in dataset size, predictors, clinical setting (triage process), and reported performance metrics. Standard structured predictors, including age, sex, and comorbidities, across articles suggest the importance of these inputs; however, there was a notable absence of other potentially useful data, including medications, social variables, and health system exposure. Ground truth labeling practices should be reported in a standard fashion as the true model performance hinges on these labels. This review calls for future work to form a standardized framework, thereby supporting consistent reporting and performance comparisons across ML-enhanced prehospital triage systems. ",
doi="10.2196/56729",
url="https://www.i-jmr.org/2024/1/e56729"
}


@Article{info:doi/10.2196/57435,
author="Luke, J. Michael
and Craig, Sansanee
and Pak-Gorstein, Suzinne
and Arellano, Marl{\'i}se
and Zhang, Jessica
and Wright, Margaret S.
and Chuo, John
and Scribano, V. Philip",
title="Narrowing the Digital Divide: Framework for Creating Telehealth Equity Dashboards",
journal="Interact J Med Res",
year="2024",
month="Sep",
day="4",
volume="13",
pages="e57435",
keywords="telehealth",
keywords="equity",
keywords="dashboard",
keywords="data",
keywords="framework",
keywords="televisit",
keywords="healthcare",
keywords="disparity",
keywords="disparities",
keywords="clinician",
keywords="clinicians",
keywords="informaticist",
keywords="informaticists",
keywords="researcher",
keywords="researchers",
keywords="pediatric",
keywords="pediatrics",
keywords="health system",
keywords="health systems",
keywords="dashboards",
keywords="access to care",
keywords="data source mapping",
doi="10.2196/57435",
url="https://www.i-jmr.org/2024/1/e57435"
}


@Article{info:doi/10.2196/57860,
author="Kraft, Bernhard
and Kuscher, Thomas
and Zawatzki, Susann
and Hofstetter, Sebastian
and Jahn, Patrick",
title="Evaluation of the Continuing Education Training ``Beratende f{\"u}r Digitale Gesundheitsversorgung'' (``Consultant for Digital Healthcare''): Protocol for an Effectiveness Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="4",
volume="13",
pages="e57860",
keywords="digitization",
keywords="digital-assistive technologies",
keywords="nursing and health care professionals",
keywords="further training program",
keywords="digital competence",
keywords="digital healthcare",
keywords="digital health",
keywords="effectiveness study",
keywords="training program",
keywords="nursing",
keywords="nursings",
keywords="health professional",
keywords="health professionals",
keywords="transfer of learning",
keywords="satisfaction",
keywords="mixed-method",
keywords="self-assessment",
keywords="Teaching Analysis Poll",
keywords="technology",
keywords="technologies",
keywords="innovation",
keywords="exploratory",
keywords="intervention",
abstract="Background: The digital transformation in health care requires training nursing and health professionals in the digitally competent use of digital assistive technologies (DAT). The continuing education training ``Beratende f{\"u}r digitale Gesundheitsversorgung'' (``Consultant for Digital Healthcare'') was developed to fill this gap. The effectiveness of the training program will be assessed in this study. Objective: The primary objective is to record and measure the participants' learning success. We will assess whether the previously defined teaching intentions, learning objectives, competencies, and participants' expectations have been achieved and whether a transfer of learning occurred. The secondary objective is participant satisfaction and feasibility of the training. The tertiary objective is the successful transfer of DAT by participants in their institutions. Methods: Approximately 65 nursing and health care professionals will participate in the pilot phase of the further training and evaluation process, which is planned in a mixed methods design in a nonsequential manner. The different methods will be combined in the interpretation of the results to achieve a synaptic view of the training program. We plan to conduct pre-post surveys in the form of participant self-assessments about dealing with DAT and content-related knowledge levels. Exploratory individual interviews will also be conducted to build theory, to examine whether and to what extent competence (cognition) has increased, and whether dealing (affect) with DAT has changed. Furthermore, an interim evaluation within the framework of the Teaching Analysis Poll (TAP) will occur. The knowledge thereby gained will be used to revise and adapt the modules for future courses. To assess the transfer success, the participants create a practical project, which is carried out within the training framework, observed by the lecturers, and subsequently evaluated and adapted. Results: We expect that the learning objectives for the continuing education training will be met. The attendees are expected to increase their level of digital competence in different skills areas: (1) theoretical knowledge, (2) hands-on skills for planning the application and practical use of DAT, (3) reflective skills and applying ethical and legal considerations in their use, (4) applying all that in a structured process of technology implementation within their practical sphere of work. Conclusions: The aim of this study and appropriate further training program are to educate nursing and health care professionals in the use of DAT, thereby empowering them for a structured change process toward digitally aided care. This focus gives rise to the following research questions: First, how should further training programs be developed, and which focus is appropriate for addressee-appropriate learning goals, course structure, and general curriculum? Second, how should a training program with this specific content and area be evaluated? Third, what are the conditions to offer a continued program? International Registered Report Identifier (IRRID): PRR1-10.2196/57860 ",
doi="10.2196/57860",
url="https://www.researchprotocols.org/2024/1/e57860"
}


@Article{info:doi/10.2196/59168,
author="Knotnerus, R. Hanna
and Ngo, N. H{\`a} T.
and Maarsingh, R. Otto
and van Vugt, A. Vincent",
title="Understanding Older Adults' Experiences With a Digital Health Platform in General Practice: Qualitative Interview Study",
journal="JMIR Aging",
year="2024",
month="Aug",
day="30",
volume="7",
pages="e59168",
keywords="digital health care",
keywords="digital health platform",
keywords="general practice",
keywords="qualitative research",
keywords="older adults",
keywords="primary care",
keywords="mobile phone",
abstract="Background: In our aging population, primary care is under pressure to remain accessible to all. Effective use of digital health care could potentially lower general practitioners' (GPs) workload. Some general practices are already implementing a digital health platform as a primary method to contact their patients. However, it is unknown how older people experience this novel way to communicate with their GP. Objective: The aim of this study was to study the experiences of patients aged 65 years and older in general practices who use digital health as a primary communication tool. The secondary aims were to identify barriers and facilitators for the use of digital health care and whether a practice focus on digital health influences older patients' choice to enlist. Methods: We invited all patients aged 65 years and older at 2 general practices in Amsterdam that work with a novel digital health platform. We used purposive sampling to select a heterogeneous group of patients in terms of age, sex, level of education, digital literacy, and experiences with the digital app of their general practice. We conducted 18 semistructured interviews from May through July 2023. All interviews were audio-recorded, transcribed, coded, and thematically analyzed. Results: We generated three themes: (1) experiences of older people with digital health care in general practice, (2) impact of individual factors on digital health experiences, and (3) reasons for choosing a digitally oriented general practice. Participants reported both positive and negative experiences. The main perceived advantages of the digital health platform were increased accessibility, direct GP contact without an intermediary, and saving time through asynchronous communication. The disadvantages mentioned were log-in difficulties and problems with the automated explanatory questionnaire. Individual factors such as age, digital literacy, and expectations of general practice care seemed to impact people's experiences and could act as barriers or facilitators for using digital health. Reasons for older patients to enlist at a general practice were mainly practical. The digital orientation of the practice hardly played a role in this choice. Conclusions: Older patients in general practice see benefits to using a digital health platform that offers 2-way chat-based communication between the patient and GP. We found that individual factors such as skills, norms and values, attitudes toward digitalization, and expectations of general practice care impacted older patients' experiences with digital health care. For many older participants, the digital profile of the general practice did not play a role in their choice to enlist. Further improvement of digital health platforms will be necessary to ensure digital health for all in general practice. ",
doi="10.2196/59168",
url="https://aging.jmir.org/2024/1/e59168"
}


@Article{info:doi/10.2196/40801,
author="Feng, Hanlin
and Kurata, Karin
and Cao, Jianfei
and Itsuki, Kageyama
and Niwa, Makoto
and Aoyama, Atsushi
and Kodama, Kota",
title="Telemedicine Research Trends in 2001-2022 and Research Cooperation Between China and Other Countries Before and After the COVID-19 Pandemic: Bibliometric Analysis",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="30",
volume="13",
pages="e40801",
keywords="telemedicine",
keywords="telehealth",
keywords="coauthorship analysis",
keywords="network analysis",
keywords="bibliometric analysis",
keywords="co-occurrence analysis",
abstract="Background: Advancements in technology have overcome geographical barriers, making telemedicine, which offers remote emergency services, healthcare, and medication guidance, increasingly popular. COVID-19 restrictions amplified its global importance by bridging distances. Objective: This study aimed to analyze Chinese and global literature data, present new global telemedicine research trends, and clarify the development potential, collaborations, and deficiencies in China's telemedicine research. Methods: We conducted bibliometrics and network analyses on relevant documents from the Web of Science database from 2001 to 2022. Data collection was completed on October 30, 2023. Considering COVID-19's impact, 2020 was used as a baseline, dividing the data into 2 periods: 2001-2019 and 2020-2022. The development potential was determined based on publication trends. An international coauthorship network analysis identified collaboration statuses and potential. Co-occurrence analysis was conducted for China and the world. Results: We identified 25,333 telemedicine-related research papers published between 2001 and 2022, with a substantial increase during the COVID-19 period (2020-2022), particularly in China (1.93-fold increase), moving its global publication rank from tenth to sixth. The United States, the United Kingdom, and Australia contributed 62.96\% of the literature, far ahead of China's 3.90\%. Globally, telemedicine research increased significantly post-2020. Between 2001 and 2019, the United States and Australia were central in coauthor networks; post-2020, the United States remained the largest node. Network hubs included the United States, the United Kingdom, Australia, and Canada. Keyword co-occurrence analysis revealed 5 global clusters from 2001 to 2019 (system technology, health care applications, mobile health, mental health, and electronic health) and 2020 to 2022 (COVID-19, children's mental health, artificial intelligence, digital health, and rehabilitation of middle-aged and older adults). In China, the research trends aligned with global patterns, with rapid growth post-2020. From 2001 to 2019, China cooperated closely with Indonesia, India, Japan, Taiwan, and South Korea. From 2020 to 2022, cooperation expanded to Japan, Singapore, Malaysia, and South Korea, as well as Saudi Arabia, Egypt, South Africa, Ghana, Lebanon, and other African and Middle Eastern countries. Chinese keyword co-occurrence analysis showed focus areas in system technology, health care applications, mobile health, big data analysis, and electronic health (2001-2019) and COVID-19, artificial intelligence, digital health, and mental health (2020-2022). Although psychology research increased, studies on children's mental health and middle-aged and older adults' rehabilitation were limited. Conclusions: We identified the latest trends in telemedicine research, demonstrating its significant potential in China and providing directions for future development and collaborations in telemedicine research. ",
doi="10.2196/40801",
url="https://www.i-jmr.org/2024/1/e40801"
}


@Article{info:doi/10.2196/56170,
author="Alexander, L. Gregory
and Poghosyan, Lusine
and Zhao, Yihong
and Hobensack, Mollie
and Kisselev, Sergey
and Norful, A. Allison
and McHugh, John
and Wise, Keely
and Schrimpf, Brooke M.
and Kolanowski, Ann
and Bhatia, Tamanna
and Tasnova, Sabrina",
title="Optimizing Response Rates to Examine Health IT Maturity and Nurse Practitioner Care Environments in US Nursing Homes: Mixed Mode Survey Recruitment Protocol",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="29",
volume="13",
pages="e56170",
keywords="surveys and questionnaires",
keywords="survey methods",
keywords="health care surveys",
keywords="survey",
keywords="survey design",
keywords="mixed-mMode survey",
keywords="nursing homes",
keywords="nursing home",
keywords="clinical informatics research",
keywords="electronic health records",
keywords="electronic health record",
keywords="clinicians",
keywords="HIT Maturity",
keywords="Care Environments",
keywords="United States",
abstract="Background: Survey-driven research is a reliable method for large-scale data collection. Investigators incorporating mixed-mode survey designs report benefits for survey research including greater engagement, improved survey access, and higher response rate. Mix-mode survey designs combine 2 or more modes for data collection including web, phone, face-to-face, and mail. Types of mixed-mode survey designs include simultaneous (ie, concurrent), sequential, delayed concurrent, and adaptive. This paper describes a research protocol using mixed-mode survey designs to explore health IT (HIT) maturity and care environments reported by administrators and nurse practitioners (NPs), respectively, in US nursing homes (NHs). Objective: The aim of this study is to describe a research protocol using mixed-mode survey designs in research using 2 survey tools to explore HIT maturity and NP care environments in US NHs. Methods: We are conducting a national survey of 1400 NH administrators and NPs. Two data sets (ie, Care Compare and IQVIA) were used to identify eligible facilities at random. The protocol incorporates 2 surveys to explore how HIT maturity (survey 1 collected by administrators) impacts care environments where NPs work (survey 2 collected by NPs). Higher HIT maturity collected by administrators indicates greater IT capabilities, use, and integration in resident care, clinical support, and administrative activities. The NP care environment survey measures relationships, independent practice, resource availability, and visibility. The research team conducted 3 iterative focus groups, including 14 clinicians (NP and NH experts) and recruiters from 2 national survey teams experienced with these populations to achieve consensus on which mixed-mode designs to use. During focus groups we identified the pros and cons of using mixed-mode designs in these settings. We determined that 2 mixed-mode designs with regular follow-up calls (Delayed Concurrent Mode and Sequential Mode) is effective for recruiting NH administrators while a concurrent mixed-mode design is best to recruit NPs. Results: Participant recruitment for the project began in June 2023. As of April 22, 2024, a total of 98 HIT maturity surveys and 81 NP surveys have been returned. Recruitment of NH administrators and NPs is anticipated through July 2025. About 71\% of the HIT maturity surveys have been submitted using the electronic link and 23\% were submitted after a QR code was sent to the administrator. Approximately 95\% of the NP surveys were returned with electronic survey links. Conclusions: Pros of mixed-mode designs for NH research identified by the team were that delayed concurrent, concurrent, and sequential mixed-mode methods of delivering surveys to potential participants save on recruitment time compared to single mode delivery methods. One disadvantage of single-mode strategies is decreased versatility and adaptability to different organizational capabilities (eg, access to email and firewalls), which could reduce response rates. International Registered Report Identifier (IRRID): DERR1-10.2196/56170 ",
doi="10.2196/56170",
url="https://www.researchprotocols.org/2024/1/e56170"
}


@Article{info:doi/10.2196/50251,
author="Rauwerdink, Anneloek
and Spinazze, Pier
and Gijsbers, Harm
and Molendijk, Juul
and Zwolsman, Sandra
and Schijven, P. Marlies
and Chavannes, H. Niels
and Kasteleyn, J. Marise",
title="Approaches to Evaluating Digital Health Technologies: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="28",
volume="26",
pages="e50251",
keywords="ehealth",
keywords="digital health",
keywords="telemedicine",
keywords="methods",
keywords="evaluation",
keywords="literature review",
keywords="DHI",
keywords="health technology",
keywords="health technologies",
keywords="telehealth",
keywords="e-health",
keywords="scoping review",
keywords="digital health intervention",
abstract="Background: Profound scientific evaluation of novel digital health technologies (DHTs) is key to enhance successful development and implementation. As such, we previously developed the eHealth evaluation cycle. The eHealth evaluation cycle contains 5 consecutive study phases: conceptual, development, feasibility, effectiveness, and implementation. Objective: The aim of this study is to develop a better understanding of the daily practice of the eHealth evaluation cycle. Therefore, the objectives are to conduct a structured analysis of literature data to analyze the practice of the evaluation study phases and to determine which evaluation approaches are used in which study phase of the eHealth evaluation cycle. Methods: We conducted a systematic literature search in PubMed including the MeSH term ``telemedicine'' in combination with a wide variety of evaluation approaches. Original peer-reviewed studies published in the year 2019 (pre-COVID-19 cohort) were included. Nonpatient-focused studies were excluded. Data on the following variables were extracted and systematically analyzed: journal, country, publication date, medical specialty, primary user, functionality, evaluation study phases, and evaluation approach. RStudio software was used to summarize the descriptive data and to perform statistical analyses. Results: We included 824 studies after 1583 titles and abstracts were screened. The majority of the evaluation studies focused on the effectiveness (impact; 304/824, 36.9\%) study phase, whereas uptake (implementation; 70/824, 8.5\%) received the least focus. Randomized controlled trials (RCTs; 170/899, 18.9\%) were the most commonly used DHT evaluation method. Within the effectiveness (impact) study phase, RCTs were used in one-half of the studies. In the conceptual and planning phases, survey research (27/78, 35\%) and interview studies (27/78, 35\%) were most frequently used. The United States published the largest amount of DHT evaluation studies (304/824, 36.9\%). Psychiatry and mental health (89/840, 10.6\%) and cardiology (75/840, 8.9\%) had the majority of studies published within the field. Conclusions: We composed the first comprehensive overview of the actual practice of implementing consecutive DHT evaluation study phases. We found that the study phases of the eHealth evaluation cycle are unequally studied and most attention is paid to the effectiveness study phase. In addition, the majority of the studies used an RCT design. However, in order to successfully develop and implement novel DHTs, stimulating equal evaluation of the sequential study phases of DHTs and selecting the right evaluation approach that fits the iterative nature of technology might be of the utmost importance. ",
doi="10.2196/50251",
url="https://www.jmir.org/2024/1/e50251",
url="http://www.ncbi.nlm.nih.gov/pubmed/39196643"
}


@Article{info:doi/10.2196/49868,
author="van Tilburg, Leendert Mark
and Spin, Ivar
and Pisters, F. Martijn
and Staal, Bart J.
and Ostelo, WJG Raymond
and van der Velde, Miriam
and Veenhof, Cindy
and Kloek, JJ Corelien",
title="Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e49868",
keywords="eHealth",
keywords="primary health care",
keywords="musculoskeletal problems",
keywords="implementation science",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Objective: This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. Methods: PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. Results: Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (--) of and facilitators (+) to implementation were identified in all 5 CFIR domains: ``digital health characteristics'' (ie, commercial neutral [+], privacy and safety [--], specificity [+], and good usability [+]), ``outer setting'' (ie, acceptance by stakeholders [+], lack of health care guidelines [--], and external financial incentives [--]), ``inner setting'' (ie, change of treatment routines [+ and --], information incongruence (--), and support from colleagues [+]), ``characteristics of the healthcare professionals'' (ie, health care professionals' acceptance [+ and --] and job satisfaction [+ and --]), and the ``implementation process'' (involvement [+] and justification and delegation [--]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. Conclusions: Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context. ",
doi="10.2196/49868",
url="https://www.jmir.org/2024/1/e49868",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190440"
}


@Article{info:doi/10.2196/55476,
author="Lee, Haedeun
and Oh, Bumjo
and Kim, Seung-Chan",
title="Recognition of Forward Head Posture Through 3D Human Pose Estimation With a Graph Convolutional Network: Development and Feasibility Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="26",
volume="8",
pages="e55476",
keywords="posture correction",
keywords="injury prediction",
keywords="human pose estimation",
keywords="forward head posture",
keywords="machine learning",
keywords="graph convolutional networks",
keywords="posture",
keywords="graph neural network",
keywords="graph",
keywords="pose",
keywords="postural",
keywords="deep learning",
keywords="neural network",
keywords="neural networks",
keywords="upper",
keywords="algorithms",
abstract="Background: Prolonged improper posture can lead to forward head posture (FHP), causing headaches, impaired respiratory function, and fatigue. This is especially relevant in sedentary scenarios, where individuals often maintain static postures for extended periods---a significant part of daily life for many. The development of a system capable of detecting FHP is crucial, as it would not only alert users to correct their posture but also serve the broader goal of contributing to public health by preventing the progression of chronic injuries associated with this condition. However, despite significant advancements in estimating human poses from standard 2D images, most computational pose models do not include measurements of the craniovertebral angle, which involves the C7 vertebra, crucial for diagnosing FHP. Objective: Accurate diagnosis of FHP typically requires dedicated devices, such as clinical postural assessments or specialized imaging equipment, but their use is impractical for continuous, real-time monitoring in everyday settings. Therefore, developing an accessible, efficient method for regular posture assessment that can be easily integrated into daily activities, providing real-time feedback, and promoting corrective action, is necessary. Methods: The system sequentially estimates 2D and 3D human anatomical key points from a provided 2D image, using the Detectron2D and VideoPose3D algorithms, respectively. It then uses a graph convolutional network (GCN), explicitly crafted to analyze the spatial configuration and alignment of the upper body's anatomical key points in 3D space. This GCN aims to implicitly learn the intricate relationship between the estimated 3D key points and the correct posture, specifically to identify FHP. Results: The test accuracy was 78.27\% when inputs included all joints corresponding to the upper body key points. The GCN model demonstrated slightly superior balanced performance across classes with an F1-score (macro) of 77.54\%, compared to the baseline feedforward neural network (FFNN) model's 75.88\%. Specifically, the GCN model showed a more balanced precision and recall between the classes, suggesting its potential for better generalization in FHP detection across diverse postures. Meanwhile, the baseline FFNN model demonstrates a higher precision for FHP cases but at the cost of lower recall, indicating that while it is more accurate in confirming FHP when detected, it misses a significant number of actual FHP instances. This assertion is further substantiated by the examination of the latent feature space using t-distributed stochastic neighbor embedding, where the GCN model presented an isotropic distribution, unlike the FFNN model, which showed an anisotropic distribution. Conclusions: Based on 2D image input using 3D human pose estimation joint inputs, it was found that it is possible to learn FHP-related features using the proposed GCN-based network to develop a posture correction system. We conclude the paper by addressing the limitations of our current system and proposing potential avenues for future work in this area. ",
doi="10.2196/55476",
url="https://formative.jmir.org/2024/1/e55476"
}


@Article{info:doi/10.2196/54616,
author="Zou, Xuan
and He, Weijie
and Huang, Yu
and Ouyang, Yi
and Zhang, Zhen
and Wu, Yu
and Wu, Yongsheng
and Feng, Lili
and Wu, Sheng
and Yang, Mengqi
and Chen, Xuyan
and Zheng, Yefeng
and Jiang, Rui
and Chen, Ting",
title="AI-Driven Diagnostic Assistance in Medical Inquiry: Reinforcement Learning Algorithm Development and Validation",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="23",
volume="26",
pages="e54616",
keywords="inquiry and diagnosis",
keywords="electronic health record",
keywords="reinforcement learning",
keywords="natural language processing",
keywords="artificial intelligence",
abstract="Background: For medical diagnosis, clinicians typically begin with a patient's chief concerns, followed by questions about symptoms and medical history, physical examinations, and requests for necessary auxiliary examinations to gather comprehensive medical information. This complex medical investigation process has yet to be modeled by existing artificial intelligence (AI) methodologies. Objective: The aim of this study was to develop an AI-driven medical inquiry assistant for clinical diagnosis that provides inquiry recommendations by simulating clinicians' medical investigating logic via reinforcement learning. Methods: We compiled multicenter, deidentified outpatient electronic health records from 76 hospitals in Shenzhen, China, spanning the period from July to November 2021. These records consisted of both unstructured textual information and structured laboratory test results. We first performed feature extraction and standardization using natural language processing techniques and then used a reinforcement learning actor-critic framework to explore the rational and effective inquiry logic. To align the inquiry process with actual clinical practice, we segmented the inquiry into 4 stages: inquiring about symptoms and medical history, conducting physical examinations, requesting auxiliary examinations, and terminating the inquiry with a diagnosis. External validation was conducted to validate the inquiry logic of the AI model. Results: This study focused on 2 retrospective inquiry-and-diagnosis tasks in the emergency and pediatrics departments. The emergency departments provided records of 339,020 consultations including mainly children (median age 5.2, IQR 2.6-26.1 years) with various types of upper respiratory tract infections (250,638/339,020, 73.93\%). The pediatrics department provided records of 561,659 consultations, mainly of children (median age 3.8, IQR 2.0-5.7 years) with various types of upper respiratory tract infections (498,408/561,659, 88.73\%). When conducting its own inquiries in both scenarios, the AI model demonstrated high diagnostic performance, with areas under the receiver operating characteristic curve of 0.955 (95\% CI 0.953-0.956) and 0.943 (95\% CI 0.941-0.944), respectively. When the AI model was used in a simulated collaboration with physicians, it notably reduced the average number of physicians' inquiries to 46\% (6.037/13.26; 95\% CI 6.009-6.064) and 43\% (6.245/14.364; 95\% CI 6.225-6.269) while achieving areas under the receiver operating characteristic curve of 0.972 (95\% CI 0.970-0.973) and 0.968 (95\% CI 0.967-0.969) in the scenarios. External validation revealed a normalized Kendall $\tau$ distance of 0.323 (95\% CI 0.301-0.346), indicating the inquiry consistency of the AI model with physicians. Conclusions: This retrospective analysis of predominantly respiratory pediatric presentations in emergency and pediatrics departments demonstrated that an AI-driven diagnostic assistant had high diagnostic performance both in stand-alone use and in simulated collaboration with clinicians. Its investigation process was found to be consistent with the clinicians' medical investigation logic. These findings highlight the diagnostic assistant's promise in assisting the decision-making processes of health care professionals. ",
doi="10.2196/54616",
url="https://www.jmir.org/2024/1/e54616"
}


@Article{info:doi/10.2196/46946,
author="Rahman, Jessica
and Brankovic, Aida
and Tracy, Mark
and Khanna, Sankalp",
title="Exploring Computational Techniques in Preprocessing Neonatal Physiological Signals for Detecting Adverse Outcomes: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="20",
volume="13",
pages="e46946",
keywords="physiological signals",
keywords="preterm",
keywords="neonatal intensive care unit",
keywords="morbidity",
keywords="signal processing",
keywords="signal analysis",
keywords="adverse outcomes",
keywords="predictive and diagnostic models",
abstract="Background: Computational signal preprocessing is a prerequisite for developing data-driven predictive models for clinical decision support. Thus, identifying the best practices that adhere to clinical principles is critical to ensure transparency and reproducibility to drive clinical adoption. It further fosters reproducible, ethical, and reliable conduct of studies. This procedure is also crucial for setting up a software quality management system to ensure regulatory compliance in developing software as a medical device aimed at early preclinical detection of clinical deterioration. Objective: This scoping review focuses on the neonatal intensive care unit setting and summarizes the state-of-the-art computational methods used for preprocessing neonatal clinical physiological signals; these signals are used for the development of machine learning models to predict the risk of adverse outcomes. Methods: Five databases (PubMed, Web of Science, Scopus, IEEE, and ACM Digital Library) were searched using a combination of keywords and MeSH (Medical Subject Headings) terms. A total of 3585 papers from 2013 to January 2023 were identified based on the defined search terms and inclusion criteria. After removing duplicates, 2994 (83.51\%) papers were screened by title and abstract, and 81 (0.03\%) were selected for full-text review. Of these, 52 (64\%) were eligible for inclusion in the detailed analysis. Results: Of the 52 articles reviewed, 24 (46\%) studies focused on diagnostic models, while the remainder (n=28, 54\%) focused on prognostic models. The analysis conducted in these studies involved various physiological signals, with electrocardiograms being the most prevalent. Different programming languages were used, with MATLAB and Python being notable. The monitoring and capturing of physiological data used diverse systems, impacting data quality and introducing study heterogeneity. Outcomes of interest included sepsis, apnea, bradycardia, mortality, necrotizing enterocolitis, and hypoxic-ischemic encephalopathy, with some studies analyzing combinations of adverse outcomes. We found a partial or complete lack of transparency in reporting the setting and the methods used for signal preprocessing. This includes reporting methods to handle missing data, segment size for considered analysis, and details regarding the modification of the state-of-the-art methods for physiological signal processing to align with the clinical principles for neonates. Only 7 (13\%) of the 52 reviewed studies reported all the recommended preprocessing steps, which could have impacts on the downstream analysis. Conclusions: The review found heterogeneity in the techniques used and inconsistent reporting of parameters and procedures used for preprocessing neonatal physiological signals, which is necessary to confirm adherence to clinical and software quality management system practices, usefulness, and choice of best practices. Enhancing transparency in reporting and standardizing procedures will boost study interpretation and reproducibility and expedite clinical adoption, instilling confidence in the research findings and streamlining the translation of research outcomes into clinical practice, ultimately contributing to the advancement of neonatal care and patient outcomes. ",
doi="10.2196/46946",
url="https://www.i-jmr.org/2024/1/e46946"
}


@Article{info:doi/10.2196/53821,
author="Tanaka, L. Hideaki
and Rees, R. Judy
and Zhang, Ziyin
and Ptak, A. Judy
and Hannigan, M. Pamela
and Silverman, M. Elaine
and Peacock, L. Janet
and Buckey, C. Jay
and ",
title="Emerging Indications for Hyperbaric Oxygen Treatment: Registry Cohort Study",
journal="Interact J Med Res",
year="2024",
month="Aug",
day="20",
volume="13",
pages="e53821",
keywords="hyperbaric oxygen",
keywords="inflammatory bowel disease",
keywords="calciphylaxis",
keywords="post--COVID-19 condition",
keywords="PCC",
keywords="postacute sequelae of COVID-19",
keywords="PASC",
keywords="infected implanted hardware",
keywords="hypospadias",
keywords="frostbite",
keywords="facial filler",
keywords="pyoderma gangrenosum",
abstract="Background: Hyperbaric oxygen (HBO2) treatment is used across a range of medical specialties for a variety of applications, particularly where hypoxia and inflammation are important contributors. Because of its hypoxia-relieving and anti-inflammatory effects HBO2 may be useful for new indications not currently approved by the Undersea and Hyperbaric Medical Society. Identifying these new applications for HBO2 is difficult because individual centers may only treat a few cases and not track the outcomes consistently. The web-based International Multicenter Registry for Hyperbaric Oxygen Therapy captures prospective outcome data for patients treated with HBO2 therapy. These data can then be used to identify new potential applications for HBO2, which has relevance for a range of medical specialties. Objective: Although hyperbaric medicine has established indications, new ones continue to emerge. One objective of this registry study was to identify cases where HBO2 has been used for conditions falling outside of current Undersea and Hyperbaric Medical Society--approved indications and present outcome data for them. Methods: This descriptive study used data from a web-based, multicenter, international registry of patients treated with HBO2. Participating centers agree to collect data on all patients treated using standard outcome measures, and individual centers send deidentified data to the central registry. HBO2 treatment programs in the United States, the United Kingdom, and Australia participate. Demographic, outcome, complication, and treatment data, including pre- and posttreatment quality of life questionnaires (EQ-5D-5L) were collected for individuals referred for HBO2 treatment. Results: Out of 9726 patient entries, 378 (3.89\%) individuals were treated for 45 emerging indications. Post--COVID-19 condition (PCC; also known as postacute sequelae of COVID-19; 149/378, 39.4\%), ulcerative colitis (47/378, 12.4\%), and Crohn disease (40/378, 10.6\%) accounted for 62.4\% (n=236) of the total cases. Calciphylaxis (20/378, 5.3\%), frostbite (18/378, 4.8\%), and peripheral vascular disease--related wounds (12/378, 3.2\%) accounted for a further 13.2\% (n=50). Patients with PCC reported significant improvement on the Neurobehavioral Symptom Inventory (NSI score: pretreatment=30.6; posttreatment=14.4; P<.001). Patients with Crohn disease reported significantly improved quality of life (EQ-5D score: pretreatment=53.8; posttreatment=68.8), and 5 (13\%) reported closing a fistula. Patients with ulcerative colitis and complete pre- and post-HBO2 data reported improved quality of life and lower scores on a bowel questionnaire examining frequency, blood, pain, and urgency. A subset of patients with calciphylaxis and arterial ulcers also reported improvement. Conclusions: HBO2 is being used for a wide range of possible applications across various medical specialties for its hypoxia-relieving and anti-inflammatory effects. Results show statistically significant improvements in patient-reported outcomes for inflammatory bowel disease and PCC. HBO2 is also being used for frostbite, pyoderma gangrenosum, pterygium, hypospadias repair, and facial filler procedures. Other indications show evidence for improvement, and the case series for all indications is growing in the registry. International Registered Report Identifier (IRRID): RR2-10.2196/18857 ",
doi="10.2196/53821",
url="https://www.i-jmr.org/2024/1/e53821",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078624"
}


@Article{info:doi/10.2196/53258,
author="Kleib, Manal
and Arnaert, Antonia
and Nagle, M. Lynn
and Sugars, Rebecca
and da Costa, Daniel",
title="Newly Qualified Canadian Nurses' Experiences With Digital Health in the Workplace: Comparative Qualitative Analysis",
journal="JMIR Med Educ",
year="2024",
month="Aug",
day="19",
volume="10",
pages="e53258",
keywords="digital health",
keywords="new graduate nurses",
keywords="nursing practice",
keywords="workplace",
keywords="informatics",
abstract="Background: Clinical practice settings have increasingly become dependent on the use of digital or eHealth technologies such as electronic health records. It is vitally important to support nurses in adapting to digitalized health care systems; however, little is known about nursing graduates' experiences as they transition to the workplace. Objective: This study aims to (1) describe newly qualified nurses' experiences with digital health in the workplace, and (2) identify strategies that could help support new graduates' transition and practice with digital health. Methods: An exploratory descriptive qualitative design was used. A total of 14 nurses from Eastern and Western Canada participated in semistructured interviews and data were analyzed using inductive content analysis. Results: Three themes were identified: (1) experiences before becoming a registered nurse, (2) experiences upon joining the workplace, and (3) suggestions for bridging the gap in transition to digital health practice. Findings revealed more similarities than differences between participants with respect to gaps in digital health education, technology-related challenges, and their influence on nursing practice. Conclusions: Digital health is the foundation of contemporary health care; therefore, comprehensive education during nursing school and throughout professional nursing practice, as well as organizational support and policy, are critical pillars. Health systems investing in digital health technologies must create supportive work environments for nurses to thrive in technologically rich environments and increase their capacity to deliver the digital health future. ",
doi="10.2196/53258",
url="https://mededu.jmir.org/2024/1/e53258"
}


@Article{info:doi/10.2196/47733,
author="Muehlensiepen, Felix
and Petit, Pascal
and Knitza, Johannes
and Welcker, Martin
and Vuillerme, Nicolas",
title="Identification of Motivational Determinants for Telemedicine Use Among Patients With Rheumatoid Arthritis in Germany: Secondary Analysis of Data From a Nationwide Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="19",
volume="26",
pages="e47733",
keywords="telemedicine",
keywords="rheumatoid arthritis",
keywords="rheumatology",
keywords="primary care",
keywords="health services research",
keywords="eHealth",
keywords="data analysis",
keywords="survey",
keywords="Germany",
keywords="tool",
keywords="care",
keywords="willingness",
keywords="sociodemographic",
keywords="age",
keywords="telehealth",
keywords="digital transition",
abstract="Background: Previous studies have demonstrated telemedicine to be an effective tool to complement rheumatology care and address workforce shortage. With the COVID-19 outbreak, telemedicine experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases to use telemedicine is closely connected to their disease. It remains unclear which factors are associated with patients' motivation to use telemedicine in certain rheumatic and musculoskeletal diseases groups, such as rheumatoid arthritis (RA). Objective: This study aims to identify factors that determine the willingness to try telemedicine among patients diagnosed with RA. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data to determine which factors were associated with willingness to try telemedicine. Predictor variables (covariates) studied individually included sociodemographic factors (eg, age, sex) and health characteristics (eg, health status). All the variables positively and negatively associated with willingness to try telemedicine in the univariate analyses were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (? 2.5) to identify determinants of willingness to try telemedicine. Results: Among 438 surveyed patients in the initial study, 210 were diagnosed with RA (47.9\%). Among them, 146 (69.5\%) answered either yes or no regarding willingness to try telemedicine and were included in the analysis. A total of 22 variables (22/55, 40\%) were associated with willingness to try telemedicine (region of practical equivalence \%?5). A total of 9 determinant factors were identified using Bayesian model averaging analysis. Positive determinants included desiring telemedicine services provided by a rheumatologist (odds ratio [OR] 13.7, 95\% CI 5.55-38.3), having prior knowledge of telemedicine (OR 2.91, 95\% CI 1.46-6.28), residing in a town (OR 2.91, 95\% CI 1.21-7.79) or city (OR 0.56, 95\% CI 0.23-1.27), and perceiving one's health status as moderate (OR 1.87, 95\% CI 0.94-3.63). Negative determinants included the lack of an electronic device (OR 0.1, 95\% CI 0.01-0.62), absence of home internet access (OR 0.1, 95\% CI 0.02-0.39), self-assessment of health status as bad (OR 0.44, 95\% CI 0.21-0.89) or very bad (OR 0.47, 95\% CI 0.06-2.06), and being aged between 60 and 69 years (OR 0.48, 95\% CI 0.22-1.04) or older than 70 years (OR 0.38, 95\% CI 0.16-0.85). Conclusions: The results suggest that some patients with RA will not have access to telemedicine without further support. Older patients, those not living in towns, those without adequate internet access, reporting a bad health status, and those not owning electronic devices might be excluded from the digital transformation in rheumatology and might not have access to adequate RA care. These patient groups certainly require support for the use of digital rheumatology care. ",
doi="10.2196/47733",
url="https://www.jmir.org/2024/1/e47733"
}


@Article{info:doi/10.2196/54556,
author="Sriharan, Abi
and Sekercioglu, Nigar
and Mitchell, Cheryl
and Senkaiahliyan, Senthujan
and Hertelendy, Attila
and Porter, Tracy
and Banaszak-Holl, Jane",
title="Leadership for AI Transformation in Health Care Organization: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="14",
volume="26",
pages="e54556",
keywords="AI implementation",
keywords="innovation",
keywords="health care",
keywords="leadership",
keywords="AI",
keywords="artificial intelligence",
keywords="management",
keywords="organization",
keywords="health care organization",
keywords="strategy",
abstract="Background: The leaders of health care organizations are grappling with rising expenses and surging demands for health services. In response, they are increasingly embracing artificial intelligence (AI) technologies to improve patient care delivery, alleviate operational burdens, and efficiently improve health care safety and quality. Objective: In this paper, we map the current literature and synthesize insights on the role of leadership in driving AI transformation within health care organizations. Methods: We conducted a comprehensive search across several databases, including MEDLINE (via Ovid), PsycINFO (via Ovid), CINAHL (via EBSCO), Business Source Premier (via EBSCO), and Canadian Business \& Current Affairs (via ProQuest), spanning articles published from 2015 to June 2023 discussing AI transformation within the health care sector. Specifically, we focused on empirical studies with a particular emphasis on leadership. We used an inductive, thematic analysis approach to qualitatively map the evidence. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. Results: A comprehensive review of 2813 unique abstracts led to the retrieval of 97 full-text articles, with 22 included for detailed assessment. Our literature mapping reveals that successful AI integration within healthcare organizations requires leadership engagement across technological, strategic, operational, and organizational domains. Leaders must demonstrate a blend of technical expertise, adaptive strategies, and strong interpersonal skills to navigate the dynamic healthcare landscape shaped by complex regulatory, technological, and organizational factors. Conclusions: In conclusion, leading AI transformation in healthcare requires a multidimensional approach, with leadership across technological, strategic, operational, and organizational domains. Organizations should implement a comprehensive leadership development strategy, including targeted training and cross-functional collaboration, to equip leaders with the skills needed for AI integration. Additionally, when upskilling or recruiting AI talent, priority should be given to individuals with a strong mix of technical expertise, adaptive capacity, and interpersonal acumen, enabling them to navigate the unique complexities of the healthcare environment. ",
doi="10.2196/54556",
url="https://www.jmir.org/2024/1/e54556",
url="http://www.ncbi.nlm.nih.gov/pubmed/39009038"
}


@Article{info:doi/10.2196/53254,
author="Kleib, Manal
and Arnaert, Antonia
and Nagle, M. Lynn
and Darko, Mirekuwaa Elizabeth
and Idrees, Sobia
and da Costa, Daniel
and Ali, Shamsa",
title="Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan",
journal="JMIR Med Educ",
year="2024",
month="Aug",
day="13",
volume="10",
pages="e53254",
keywords="virtual care",
keywords="digital health",
keywords="nursing practice",
keywords="environmental scan",
keywords="telehealth",
keywords="nurses",
keywords="Canada",
keywords="health care",
abstract="Background: Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges. Objective: This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations. Methods: An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process. Results: Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted. Conclusions: The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses. ",
doi="10.2196/53254",
url="https://mededu.jmir.org/2024/1/e53254",
url="http://www.ncbi.nlm.nih.gov/pubmed/39137026"
}


@Article{info:doi/10.2196/47848,
author="Sibanda, Khulekani
and Ndayizigamiye, Patrick
and Twinomurinzi, Hossana",
title="Industry 4.0 Technologies in Maternal Health Care: Bibliometric Analysis and Research Agenda",
journal="JMIR Pediatr Parent",
year="2024",
month="Aug",
day="8",
volume="7",
pages="e47848",
keywords="Industry 4.0",
keywords="Fourth Industrial Revolution",
keywords="bibliometrics",
keywords="maternal health care",
keywords="antenatal care",
keywords="postnatal care",
keywords="lean operations",
keywords="maternal",
keywords="pregnancy monitoring",
keywords="pregnancy",
keywords="maternal care",
keywords="monitoring",
keywords="thematic analysis",
keywords="data mining",
keywords="machine learning",
keywords="IoT",
keywords="Internet of Things",
keywords="artificial intelligence",
keywords="deep learning",
keywords="digital health",
keywords="wearable",
keywords="mobile phone",
abstract="Background: Industry 4.0 (I4.0) technologies have improved operations in health care facilities by optimizing processes, leading to efficient systems and tools to assist health care personnel and patients. Objective: This study investigates the current implementation and impact of I4.0 technologies within maternal health care, explicitly focusing on transforming care processes, treatment methods, and automated pregnancy monitoring. Additionally, it conducts a thematic landscape mapping, offering a nuanced understanding of this emerging field. Building on this analysis, a future research agenda is proposed, highlighting critical areas for future investigations. Methods: A bibliometric analysis of publications retrieved from the Scopus database was conducted to examine how the research into I4.0 technologies in maternal health care evolved from 1985 to 2022. A search strategy was used to screen the eligible publications using the abstract and full-text reading. The most productive and influential journals; authors', institutions', and countries' influence on maternal health care; and current trends and thematic evolution were computed using the Bibliometrix R package (R Core Team). Results: A total of 1003 unique papers in English were retrieved using the search string, and 136 papers were retained after the inclusion and exclusion criteria were implemented, covering 37 years from 1985 to 2022. The annual growth rate of publications was 9.53\%, with 88.9\% (n=121) of the publications observed in 2016-2022. In the thematic analysis, 4 clusters were identified---artificial neural networks, data mining, machine learning, and the Internet of Things. Artificial intelligence, deep learning, risk prediction, digital health, telemedicine, wearable devices, mobile health care, and cloud computing remained the dominant research themes in 2016-2022. Conclusions: This bibliometric analysis reviews the state of the art in the evolution and structure of I4.0 technologies in maternal health care and how they may be used to optimize the operational processes. A conceptual framework with 4 performance factors---risk prediction, hospital care, health record management, and self-care---is suggested for process improvement. a research agenda is also proposed for governance, adoption, infrastructure, privacy, and security. ",
doi="10.2196/47848",
url="https://pediatrics.jmir.org/2024/1/e47848"
}


@Article{info:doi/10.2196/46407,
author="Cresswell, Kathrin
and de Keizer, Nicolette
and Magrabi, Farah
and Williams, Robin
and Rigby, Michael
and Prgomet, Mirela
and Kukhareva, Polina
and Wong, Shui-Yee Zoie
and Scott, Philip
and Craven, K. Catherine
and Georgiou, Andrew
and Medlock, Stephanie
and Brender McNair, Jytte
and Ammenwerth, Elske",
title="Evaluating Artificial Intelligence in Clinical Settings---Let Us Not Reinvent the Wheel",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e46407",
keywords="artificial intelligence",
keywords="evaluation",
keywords="theory",
keywords="patient safety",
keywords="optimisation",
keywords="health care",
keywords="optimization",
doi="10.2196/46407",
url="https://www.jmir.org/2024/1/e46407",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110494"
}


@Article{info:doi/10.2196/51878,
author="Wasilewski, B. Marina
and Vijayakumar, Abirami
and Szigeti, Zara
and Mayo, Amanda
and Desveaux, Laura
and Shaw, James
and Hitzig, L. Sander
and Simpson, Robert",
title="Patient and Provider Experiences With Compassionate Care in Virtual Physiatry: Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="6",
volume="26",
pages="e51878",
keywords="compassionate care",
keywords="rehabilitation",
keywords="physiatry",
keywords="telemedicine",
keywords="burnout",
keywords="care",
keywords="qualitative study",
keywords="patient experience",
keywords="compassion",
keywords="compassionate",
keywords="patient centered",
keywords="virtual care",
keywords="communication",
keywords="health care delivery",
keywords="patient engagement",
keywords="physiatrist",
keywords="physiatrists",
keywords="Canada",
keywords="social media",
keywords="physical medicine",
keywords="technology",
keywords="communication technology",
keywords="ICT",
keywords="experience",
abstract="Background: Telemedicine in the realm of rehabilitation includes the remote delivery of rehabilitation services using communication technologies (eg, telephone, emails, and video). The widespread application of virtual care grants a suitable time to explore the intersection of compassion and telemedicine, especially due to the impact of COVID-19 and how it greatly influenced the delivery of health care universally. Objective: The purpose of this study was to explore how compassionate care is understood and experienced by physiatrists and patients engaged in telemedicine. Methods: We used a qualitative descriptive approach to conduct interviews with patients and physiatrists between June 2021 and March 2022. Patients were recruited across Canada from social media and from a single hospital network in Toronto, Ontario. Physiatrists were recruited across Canada through social media and the Canadian Association for Physical Medicine and Rehabilitation (CAPM\&R) email listserve. Interviews were recorded and transcribed. Data were analyzed thematically. Results: A total of 19 participants were interviewed---8 physiatrists and 11 patients. Two themes capturing physiatrists' and patients' experiences with delivering and receiving compassionate care, especially in the context of virtual care were identified: (1) compassionate care is inherently rooted in health care providers' inner intentions and are, therefore, expressed as caring behaviors and (2) virtual elements impact the delivery and receipt of compassionate care. Conclusions: Compassionate care stemmed from physiatrists' caring attitudes which then manifest as caring behaviors. In turn, these caring attitudes and behaviors enable individualized care and the establishment of a safe space for patients. Moreover, the virtual care modality both positively and negatively influenced how compassion is enacted by physiatrists and received by patients. Notably, there was large ambiguity around the norms and etiquette surrounding virtual care. Nonetheless, the flexibility and person-centeredness of virtual care cause it to be useful in health care settings. ",
doi="10.2196/51878",
url="https://www.jmir.org/2024/1/e51878",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106094"
}


@Article{info:doi/10.2196/54942,
author="Oppelaar, C. Martinus
and Emond, Yvette
and Bannier, E. Michiel A. G.
and Reijers, E. Monique H.
and van der Vaart, Hester
and van der Meer, Renske
and Altenburg, Josje
and Conemans, Lennart
and Rottier, L. Bart
and Nuijsink, Marianne
and van den Wijngaart, S. Lara
and Merkus, M. Peter J. F.
and Heinen, Maud
and Roukema, Jolt",
title="Potential, Pitfalls, and Future Directions for Remote Monitoring of Chronic Respiratory Diseases: Multicenter Mixed Methods Study in Routine Cystic Fibrosis Care",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="6",
volume="26",
pages="e54942",
keywords="telemonitoring",
keywords="digital health",
keywords="chronic respiratory diseases",
keywords="telespirometry",
keywords="interviews",
keywords="mixed methods",
keywords="qualitative study",
keywords="remote monitoring",
keywords="evaluation",
keywords="cystic fibrosis",
keywords="pediatrics",
keywords="mixed method",
keywords="observational study",
keywords="health care professionals",
keywords="semistructured interview",
keywords="psychosocial",
keywords="clinicians",
keywords="researchers",
keywords="policy makers",
keywords="telehealth",
abstract="Background: The current literature inadequately addresses the extent to which remote monitoring should be integrated into care models for chronic respiratory diseases (CRDs). Objective: This study examined a remote monitoring program (RMP) in cystic fibrosis (CF) by exploring experiences, future perspectives, and use behavior over 3 years, with the aim of developing future directions for remote monitoring in CRDs. Methods: This was a mixed methods, multicenter, observational study in 5 Dutch CF centers following a sequential explanatory design. Self-designed questionnaires using the technology acceptance model were sent out to people with CF who had a minimum of 12 months of experience with the RMP and local health care professionals (HCPs). Questionnaire outcomes were used to inform semistructured interviews with HCPs and people with CF. Qualitative findings were reported following the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Anonymous data on use frequency of all people with CF were analyzed. Results: Between the second quarter of 2020 and the end of 2022, a total of 608 people with CF were enrolled in the program, and a total of 9418 lung function tests and 2631 symptom surveys were conducted. In total, 65\% (24/37) of HCPs and 89\% (72/81) of people with CF responded to the questionnaire, and 7 HCPs and 12 people with CF participated in semistructured interviews. Both people with CF and HCPs were positive about remote monitoring in CF care and found the RMP a good addition to daily care (people with CF: 44/72, 61\%; HCPs: 21/24, 88\%). Benefits ranged from supporting individual patients to reducing health care consumption. The most valued monitoring tool was home spirometry by both people with CF (66/72, 92\%) and HCPs (22/24, 92\%). Downsides included the potential to lose sight of patients and negative psychosocial effects, as 17\% (12/72) of people with CF experienced some form of stress due to the RMP. A large majority of people with CF (59/72, 82\%) and HCPs (22/24, 92\%) wanted to keep using the RMP in future, with 79\% (19/24) of HCPs and 75\% (54/72) of people with CF looking forward to more replacement of in-person care with digital care during periods of well-being. Future perspectives for the RMP were centered on creating hybrid care models, personalizing remote care, and balancing individual benefits with monitoring burden. Conclusions: Remote monitoring has considerable potential in supporting people with CF and HCPs within the CF care model. We identified 4 practice-based future directions for remote monitoring in CF and CRD care. The strategies, ranging from patient driven to prediction driven, can help clinicians, researchers, and policy makers navigate the rapidly changing digital health field, integrate remote monitoring into local care models, and align remote care with patient and clinician needs. ",
doi="10.2196/54942",
url="https://www.jmir.org/2024/1/e54942",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106098"
}


@Article{info:doi/10.2196/50749,
author="Koenig, R. Leah
and Ko, Jennifer
and Upadhyay, D. Ushma",
title="Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="5",
volume="26",
pages="e50749",
keywords="medication abortion",
keywords="telehealth",
keywords="virtual clinics",
keywords="abortion",
keywords="access",
keywords="policy",
keywords="health equity",
abstract="Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women's Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic's policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US \$259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. ",
doi="10.2196/50749",
url="https://www.jmir.org/2024/1/e50749"
}


@Article{info:doi/10.2196/58928,
author="Larrabee Sonderlund, Anders
and Quirina Bang Van Sas, Tessa
and Wehberg, Sonja
and Huibers, Linda
and Nielsen, Bo Jesper
and S{\o}ndergaard, Jens
and Assing Hvidt, Elisabeth",
title="Development of a Video Consultation Patient-Satisfaction Questionnaire (vCare-PSQ): A Cross-Sectional Explorative Study",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="2",
volume="8",
pages="e58928",
keywords="video consultation",
keywords="patient satisfaction",
keywords="patient-physician relationship",
keywords="telehealth",
keywords="general practice",
keywords="pilot-testing",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="pandemic",
keywords="primary care",
keywords="healthcare",
keywords="health professional",
keywords="health professionals",
keywords="Danish",
keywords="adult",
keywords="adults",
keywords="IT-literacy",
keywords="methodological",
keywords="vCare-PSQ",
keywords="COSMIN",
abstract="Background: Since the COVID-19 pandemic, the use of video consultation (VC) in primary care has expanded considerably in many countries. VC and other telehealth formats are often touted as a solution to improved health care access, with numerous studies showing high satisfaction with this care format among health professionals and patients. However, operationalization and measurement of patient satisfaction with VC varies across studies and often lacks consideration of dynamic contextual factors (eg, convenience, ease-of-use, or privacy) and doctor-patient relational variables that may influence patient satisfaction. Objective: We aim to develop a comprehensive and evidence-based questionnaire for assessing patient satisfaction with VC in general practice. Methods: The vCare Patient-Satisfaction Questionnaire (the vCare-PSQ) was developed according to the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. To achieve our overall objective, we pursued three aims: (1) a validation analysis of an existing patient-satisfaction scale (the PS-14), (2) an assessment of extrinsic contextual factors that may impact patient satisfaction, and (3) an assessment of pertinent intrinsic and relational satisfaction correlates (eg, health anxiety, information technology literacy, trust in the general practitioner, or convenience). For validation purposes, the questionnaire was filled out by a convenience sample of 188 Danish adults who had attended at least 1 VC. Results: Our validation analysis of the PS-14 in a Danish population produced reliable results, indicating that the PS-14 is an appropriate measure of patient satisfaction with VC in Danish patient populations. Regressing situational and doctor-patient relational factors onto patient satisfaction further suggested that patient satisfaction is contingent on several factors not measured by the PS-14. These include information technology literacy and patient trust in the general practitioner, as well as several contextual pros and cons. Conclusions: Supplementing the PS-14 with dynamic measures of situational and doctor-patient relational factors may provide a more comprehensive understanding of patient satisfaction with VC. The vCare-PSQ may thus contribute to an enhanced methodological approach to assessing patient satisfaction with VC. We hope that the vCare-PSQ format may be useful for future research and implementation efforts regarding VC in a general practice setting. ",
doi="10.2196/58928",
url="https://formative.jmir.org/2024/1/e58928"
}


@Article{info:doi/10.2196/46073,
author="Jiang, Hongxun
and Mi, Ziyue
and Xu, Wei",
title="Online Medical Consultation Service--Oriented Recommendations: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="30",
volume="26",
pages="e46073",
keywords="online health community",
keywords="online medical consultation",
keywords="personalized recommendations",
keywords="2-sided matching",
keywords="load balancing",
abstract="Background: Online health communities have given rise to a new e-service known as online medical consultations (OMCs), enabling remote interactions between physicians and patients. To address challenges, such as patient information overload and uneven distribution of physician visits, online health communities should develop OMC-oriented recommenders. Objective: We aimed to comprehensively investigate what paradigms lead to the success of OMC-oriented recommendations. Methods: A literature search was conducted through e-databases, including PubMed, ACM Digital Library, Springer, and ScienceDirect, from January 2011 to December 2023. This review included all papers directly and indirectly related to the topic of health care--related recommendations for online services. Results: The search identified 611 articles, of which 26 (4.3\%) met the inclusion criteria. Despite the growing academic interest in OMC recommendations, there remains a lack of consensus among researchers on the definition of e-service--oriented recommenders. The discussion highlighted 3 key factors influencing recommender success: features, algorithms, and metrics. It advocated for moving beyond traditional e-commerce--oriented recommenders to establish an innovative theoretical framework for e-service--oriented recommenders and addresses critical technical issues regarding 2-sided personalized recommendations. Conclusions: This review underscores the essence of e-services, particularly in knowledge- and labor-intensive domains such as OMCs, where patients seek interpretable recommendations due to their lack of domain knowledge and physicians must balance their energy levels to avoid overworking. Our study's findings shed light on the importance of customizing e-service--oriented personalized recommendations to meet the distinct expectations of 2-sided users considering their cognitive abilities, decision-making perspectives, and preferences. To achieve this, a paradigm shift is essential to develop unique attributes and explore distinct content tailored for both parties involved. ",
doi="10.2196/46073",
url="https://www.jmir.org/2024/1/e46073",
url="http://www.ncbi.nlm.nih.gov/pubmed/38777810"
}


@Article{info:doi/10.2196/56715,
author="Lowe, Cabella
and Sephton, Ruth
and Marsh, William
and Morrissey, Dylan",
title="Evaluation of a Musculoskeletal Digital Assessment Routing Tool (DART): Crossover Noninferiority Randomized Pilot Trial",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="30",
volume="8",
pages="e56715",
keywords="mHealth",
keywords="eHealth",
keywords="digital health",
keywords="digital technology",
keywords="digital triage",
keywords="musculoskeletal",
keywords="triage",
keywords="physiotherapy triage",
keywords="validation",
keywords="acceptability",
keywords="physiotherapy",
keywords="primary care",
keywords="randomized controlled trial",
keywords="usability",
keywords="assess",
keywords="assessment",
keywords="triaging",
keywords="referrals",
keywords="crossover",
abstract="Background: Musculoskeletal conditions account for 16\% of global disability, resulting in a negative effect on patients and increasing demand for health care use. Triage directing patients to appropriate level intervention improving health outcomes and efficiency has been prioritized. We developed a musculoskeletal digital assessment routing tool (DART) mobile health (mHealth) system, which requires evaluation prior to implementation. Such innovations are rarely rigorously tested in clinical trials---considered the gold standard for evaluating safety and efficacy. This pilot study is a precursor to a trial assessing DART performance with a physiotherapist-led triage assessment. Objective: The study aims to evaluate trial design, assess procedures, and collect exploratory data to establish the feasibility of delivering an adequately powered, definitive randomized trial, assessing DART safety and efficacy in an NHS primary care setting. Methods: A crossover, noninferiority pilot trial using an integrated knowledge translation approach within a National Health Service England primary care setting. Participants were patients seeking assessment for a musculoskeletal condition, completing a DART assessment and the history-taking element of a face-to-face physiotherapist-led triage in a randomized order. The primary outcome was agreement between DART and physiotherapist triage recommendation. Data allowed analysis of participant recruitment and retention, randomization, blinding, study burden, and potential barriers to intervention delivery. Participant satisfaction was measured using the System Usability Scale. Results: Over 8 weeks, 129 patients were invited to participate. Of these, 92\% (119/129) proceeded to eligibility assessment, with 60\% (78/129) meeting the inclusion criteria and being randomized into each intervention arm (39/39). There were no dropouts and data were analyzed for all 78 participants. Agreement between physiotherapist and DART across all participants and all primary triage outcomes was 41\% (32/78; 95\% CI 22-45), intraclass correlation coefficient 0.37 (95\% CI 0.16-0.55), indicating that the reliability of DART was poor to moderate. Feedback from the clinical service team led to an adjusted analysis yielding of 78\% (61/78; 95\% CI 47-78) and an intraclass correlation coefficient of 0.57 (95\% CI 0.40-0.70). Participant satisfaction was measured quantitively using amalgamated System Usability Scale scores (n=78; mean score 84.0; 90\% CI +2.94 to --2.94), equating to an ``excellent'' system. There were no study incidents, and the trial burden was acceptable. Conclusions: Physiotherapist-DART agreement of 78\%, with no adverse triage decisions and high patient satisfaction, was sufficient to conclude DART had the potential to improve the musculoskeletal pathway. Study validity was enhanced by the recruitment of real-world patients and using an integrated knowledge translation approach. Completion of a context-specific consensus process is recommended to provide definitive definitions of safety criteria, range of appropriateness, noninferiority margin, and sample size. This pilot demonstrated an adequately powered definitive trial is feasible, which would provide evidence of DART safety and efficacy, ultimately informing potential for DART implementation. Trial Registration: ClinicalTrials.gov NCT04904029; http://clinicaltrials.gov/ct2/show/NCT04904029 International Registered Report Identifier (IRRID): RR2-10.2196/31541 ",
doi="10.2196/56715",
url="https://formative.jmir.org/2024/1/e56715",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078682"
}


@Article{info:doi/10.2196/53015,
author="Kirkpatrick, Suriya
and Davey, Zoe
and Wright, Richard Peter
and Henshall, Catherine",
title="Supportive eHealth Technologies and Their Effects on Physical Functioning and Quality of Life for People With Lung Cancer: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="26",
volume="26",
pages="e53015",
keywords="lung cancer",
keywords="physical activity",
keywords="exercise",
keywords="physical functioning",
keywords="mobile technology",
keywords="smartphone apps",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Despite advancements in treatment and early diagnosis, people with lung cancer are not living as long as those with other cancers. The more common symptoms of lung cancer, such as breathlessness, fatigue, and depression, can be alleviated by improving patients' physical functioning. Therefore, good symptom management and improved health-related quality of life (HRQoL) are priorities in this patient group. However, current health care services have limited capacity to provide this support. One way to address this issue of health care resources is to empower patients to self-manage their condition using eHealth technologies. Objective: The purpose of this review was to identify and assess available research on technologies that support persons with lung cancer to improve or maintain their physical functioning, HRQoL, or both. Methods: Six databases---PubMed, Web of Science, CINAHL, MEDLINE, SPORTDiscus, and PsycINFO---were searched from January 1, 1990, to April 30, 2023. Studies were suitable for inclusion if the participants included people with lung cancer aged >18 years who had been exposed to a physical activity, exercise, or training intervention that was delivered via an electronic or web-based application with or without a comparator. Furthermore, the study had to report on the impact of the intervention on physical functioning and HRQoL. Studies that focused on telemedicine without a digital intervention were excluded. The Grading of Recommendations Assessment, Development, and Evaluation system was used to assess the quality of the included papers. Due to the heterogeneity of the studies, a narrative synthesis was undertaken. Results: This review is reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 794 papers were initially identified through our search, of which, after screening, 8 (1\%) were confirmed suitable for inclusion in the review. As 2 (25\%) of the 8 papers reported on different stages of the same study, we included only 7 studies in our analysis. The studies were undertaken between 2010 and 2018 across multiple countries and aimed to develop a technology and test its feasibility or acceptance. The 7 technologies identified included web-based applications, mobile apps, and gaming consoles. The studies demonstrated impact on walking distance, muscle strength, balance, dyspnea symptoms, and cancer-related fatigue. HRQoL scores also showed improvement. Conclusions: The findings indicate that eHealth technologies can positively impact physical functioning and well-being for people with lung cancer, but there are limited studies that demonstrate the impact of these digital interventions over longer periods. None of the studies reported on the implementation or adoption of a mobile health or eHealth intervention in routine clinical practice, highlighting the need for further research in this area. Trial Registration: PROSPERO CRD42023414094; https://tinyurl.com/39hhbwyx ",
doi="10.2196/53015",
url="https://www.jmir.org/2024/1/e53015"
}


@Article{info:doi/10.2196/51272,
author="Ge, Xiaochen
and Chappell, Paul
and Ledger, Jean
and Bakhai, Minal
and Clarke, M. Geraldine",
title="The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="26",
volume="26",
pages="e51272",
keywords="general practice",
keywords="online consultation",
keywords="patient experience",
keywords="modern general practice",
keywords="sociodemographic health inequalities",
keywords="General Practice Patient Survey",
keywords="cross-sectional study",
abstract="Background: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients' primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. Objective: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). Methods: We categorized practices as ``low-use'' or ``high-use'' according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models---shorter ``free text'' input with an embedded single workflow OC system (FT practices) and longer ``mixed text'' input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience---overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. Results: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8\% (odds ratio [OR] 0.802, 95\% CI 0.782-0.823) less likely to report a good overall experience; 24.5\% (OR 0.755, 95\% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9\% (OR 0.811, 95\% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8\% (OR 1.278, 95\% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups---patients from urban and deprived areas, younger patients, and non-White patients. Conclusions: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients. ",
doi="10.2196/51272",
url="https://www.jmir.org/2024/1/e51272"
}


@Article{info:doi/10.2196/43119,
author="Unlu, Ozan
and Pikcilingis, Aaron
and Letourneau, Jonathan
and Landman, Adam
and Patel, Rajesh
and Shenoy, S. Erica
and Hashimoto, Dean
and Kim, Marvel
and Pellecer, Johnny
and Zhang, Haipeng",
title="Implementation of a Web-Based Chatbot to Guide Hospital Employees in Returning to Work During the COVID-19 Pandemic: Development and Before-and-After Evaluation",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="25",
volume="8",
pages="e43119",
keywords="chatbot",
keywords="return to work",
keywords="employee",
keywords="health care personnel",
keywords="COVID-19",
keywords="conversational agent",
keywords="occupational health",
keywords="support service",
keywords="health care delivery",
keywords="agile methodology",
keywords="digital intervention",
keywords="digital support",
keywords="work policy",
keywords="hospital staff",
abstract="Background: Throughout the COVID-19 pandemic, multiple policies and guidelines were issued and updated for health care personnel (HCP) for COVID-19 testing and returning to work after reporting symptoms, exposures, or infection. The high frequency of changes and complexity of the policies made it difficult for HCP to understand when they needed testing and were eligible to return to work (RTW), which increased calls to Occupational Health Services (OHS), creating a need for other tools to guide HCP. Chatbots have been used as novel tools to facilitate immediate responses to patients' and employees' queries about COVID-19, assess symptoms, and guide individuals to appropriate care resources. Objective: This study aims to describe the development of an RTW chatbot and report its impact on demand for OHS support services during the first Omicron variant surge. Methods: This study was conducted at Mass General Brigham, an integrated health care system with over 80,000 employees. The RTW chatbot was developed using an agile design methodology. We mapped the RTW policy into a unified flow diagram that included all required questions and recommendations, then built and tested the chatbot using the Microsoft Azure Healthbot Framework. Using chatbot data and OHS call data from December 10, 2021, to February 17, 2022, we compared OHS resource use before and after the deployment of the RTW chatbot, including the number of calls to the OHS hotline, wait times, call length, and time OHS hotline staff spent on the phone. We also assessed Centers for Disease Control and Prevention data for COVID-19 case trends during the study period. Results: In the 5 weeks post deployment, 5575 users used the RTW chatbot with a mean interaction time of 1 minute and 17 seconds. The highest engagement was on January 25, 2022, with 368 users, which was 2 weeks after the peak of the first Omicron surge in Massachusetts. Among users who completed all the chatbot questions, 461 (71.6\%) met the RTW criteria. During the 10 weeks, the median (IQR) number of daily calls that OHS received before and after deployment of the chatbot were 633 (251-934) and 115 (62-167), respectively (U=163; P<.001). The median time from dialing the OHS phone number to hanging up decreased from 28 minutes and 22 seconds (IQR 25:14-31:05) to 6 minutes and 25 seconds (IQR 5:32-7:08) after chatbot deployment (U=169; P<.001). Over the 10 weeks, the median time OHS hotline staff spent on the phone declined from 3 hours and 11 minutes (IQR 2:32-4:15) per day to 47 (IQR 42-54) minutes (U=193; P<.001), saving approximately 16.8 hours per OHS staff member per week. Conclusions: Using the agile methodology, a chatbot can be rapidly designed and deployed for employees to efficiently receive guidance regarding RTW that complies with the complex and shifting RTW policies, which may reduce use of OHS resources. ",
doi="10.2196/43119",
url="https://formative.jmir.org/2024/1/e43119"
}


@Article{info:doi/10.2196/57541,
author="Subramani, Yamini
and Querney, Jill
and Singh, Priyanka
and Zhang, Yifan
and Fochesato, Lee-Anne
and Fatima, Nida
and Wood, Natasha
and Nagappa, Mahesh",
title="Preoperative Anesthesia Virtual Video Consultations in a Preadmission Clinic: Quality Improvement Study",
journal="JMIR Perioper Med",
year="2024",
month="Jul",
day="25",
volume="7",
pages="e57541",
keywords="preoperative evaluation",
keywords="preadmission clinic",
keywords="telemedicine",
keywords="remote",
keywords="virtual care",
keywords="remote consultation",
keywords="video consultation",
keywords="telehealth",
keywords="online health",
keywords="digital health",
keywords="perioperative medicine",
keywords="preoperative",
keywords="eMedicine",
keywords="surgery",
keywords="consultation",
keywords="safety",
keywords="assessment",
keywords="workflow",
keywords="implementation",
keywords="integration",
keywords="hospital",
abstract="Background: The preadmission clinic (PAC) is crucial in perioperative care, offering evaluations, education, and patient optimization before surgical procedures. During the COVID-19 pandemic, the PAC adapted by implementing telephone visits due to a lack of infrastructure for video consultations. While the pandemic significantly increased the use of virtual care, including video appointments as an alternative to in-person consultations, our PAC had not used video consultations for preoperative assessments. Objective: This study aimed to develop, implement, and integrate preoperative video consultations into the PAC workflow. Methods: A prospective quality improvement project was undertaken using the Plan-Do-Study-Act (PDSA) methodology. The project focused on developing, implementing, and integrating virtual video consultations at London Health Sciences Centre and St. Joseph Health Care (London, Ontario, Canada) in the PAC. Data were systematically collected to monitor the number of patients undergoing video consultations, address patient flow concerns, and increase the percentage of video consultations. Communication between the PAC, surgeon offices, and patients was analyzed for continuous improvement. Technological challenges were addressed, and procedures were streamlined to facilitate video calls on appointment days. Results: The PAC team, which includes professionals from medicine, anesthesia, nursing, pharmacy, occupational therapy, and physiotherapy, offers preoperative evaluation and education to surgical patients, conducting approximately 8000 consultations annually across 3 hospital locations. Following the initial PDSA cycles, the interventions consistently improved the video consultation utilization rate to 17\%, indicating positive progress. With the onset of PDSA cycle 3, there was a notable surge to a 29\% utilization rate in the early phase. This upward trend continued, culminating in a 38\% utilization rate of virtual video consultations in the later stages of the cycle. This heightened level was consistently maintained throughout 2023, highlighting the sustained success of our interventions. Conclusions: The quality improvement process significantly enhanced the institution's preoperative video consultation workflow. By understanding the complexities within the PAC, strategic interventions were made to integrate video consultations without compromising efficiency, morale, or safety. This project highlights the potential for transformative improvements in health care delivery through the thoughtful integration of virtual care technologies. ",
doi="10.2196/57541",
url="https://periop.jmir.org/2024/1/e57541"
}


@Article{info:doi/10.2196/60116,
author="Chindamorragot, Naruemol
and Suitthimeathegorn, Orawan
and Garg, Amit",
title="Centralized Pump Monitoring System: Perception on Utility and Workflows by Nurses in a Tertiary Hospital",
journal="Asian Pac Isl Nurs J",
year="2024",
month="Jul",
day="24",
volume="8",
pages="e60116",
keywords="infusion management",
keywords="nurse efficiency",
keywords="pump monitoring system",
keywords="nurse attrition",
doi="10.2196/60116",
url="https://apinj.jmir.org/2024/1/e60116"
}


@Article{info:doi/10.2196/52020,
author="Hu, Zhiyuan
and Qin, Xiaoping
and Chen, Kaiyan
and Huang, Yu-Ni
and Wang, Szewei Richard
and Tung, Tao-Hsin
and Chuang, Yen-Ching
and Wang, Bing-Long",
title="Chinese Health Insurance in the Digital Era: Bibliometric Study",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="23",
volume="13",
pages="e52020",
keywords="telemedicine",
keywords="health insurance",
keywords="internet plus healthcare",
keywords="bibliometric",
keywords="VOSviewer",
abstract="Background: China has entered the era of digital health care after years of reforms in the health care system. The use of digital technologies in healthcare services is rapidly increasing, indicating the onset of a new period. The reform of health insurance has also entered a new phase. Objective: This study aims to investigate the evolution of health care insurance within the context of telemedicine and Internet Plus Healthcare (IPHC) during the digital health care era by using scientometric methods to analyze publication patterns, influential keywords, and research hot spots. It seeks to understand how health care insurance has adapted to the growing integration of IPHC and telemedicine in health care services and the implications for policy and practice. Methods: A total of 411 high-quality studies were curated from the China National Knowledge Infrastructure (CNKI) database in the Chinese language, scientometric analysis was conducted, and VOSviewer software was used to conduct a visualized analysis of keywords and hot spots in the literature. Results: The number of articles in this field has increased notably from 2000 to 2022 and has increased annually based on a curve of y=0.332exp (0.4002x) with R2=0.6788. In total, 62 institutions and 811 authors have published research articles in the Chinese language in this field. This study included 290 keywords and formulated a total of 5 hot-topic clusters of ``telemedicine,'' ``IPHC,'' ``internet hospital,'' ``health insurance payments,'' and ``health insurance system.'' Conclusions: Studies on the application of digital technologies in health care insurance has evolved from foundational studies to a broader scope. The emergence of internet hospitals has showcased the potential for integrating IPHC services into insurance payment systems. However, this development also highlights the necessity for enhanced interregional coordination mechanisms. The reform of health insurance payment is contingent upon ongoing advancements in digital technology and increased investment in electronic medical records and primary health care services. Future efforts should focus on integrating technology with administrative systems, advancing mobile health care solutions, and ensuring interoperability among various payment systems to improve efficiency and standardize health care services. ",
doi="10.2196/52020",
url="https://www.i-jmr.org/2024/1/e52020"
}


@Article{info:doi/10.2196/56312,
author="Meltzer, Ellen
and Wilshusen, Laurie
and Abdulwadood, Isra
and Yee, Claire
and Sherman, Amy
and Strader, Kelli
and Thomley, Barbara
and Millstine, Denise
and Tilburt, Jon
and Fields, Heather
and Bergstrom, Larry
and Patchett, David
and Camoriano, John
and Bauer, Brent",
title="Telemedicine and Patient Experience Ratings at an Academic Integrative Medicine Practice: Retrospective Examination",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="22",
volume="8",
pages="e56312",
keywords="telemedicine",
keywords="TELE",
keywords="patient experience",
keywords="communication skills",
keywords="integrative medicine",
keywords="face-to-face",
keywords="F2F",
keywords="encounters",
abstract="Background: The use of telemedicine (TELE) increased exponentially during the COVID-19 pandemic. While patient experience with TELE has been studied in other medical disciplines, its impact and applicability to integrative medicine practices remain unknown. Objective: The aim of this study is to assess the impact of visit modality, TELE versus face-to-face (F2F) encounters, on patient experience at an integrative medicine practice at a single academic medical center. Given the significant role of the patient-physician relationship, therapeutic presence, and touch in integrative medicine, we hypothesized that TELE would result in reduced patient experience compared to traditional F2F encounters. Methods: A retrospective examination of Press Ganey surveys at an academic, consultative, and integrative medicine practice was conducted. Anonymous surveys completed by patients, older than 18 years of age, who had TELE or F2F appointments from April 1, 2020, to March 31, 2023, were included. At our medical center, patients commonly travel in from out of state for complex care. We examined percentage ``top box'' scores (ie, the percentage of respondents who selected the most positive response category on the survey, ``very good''), across a variety of experience metrics. ANOVA and chi-square analyses were completed, with a significance threshold of P<.05. Results: Over the 36 months, a total of 1066 surveys were completed and returned (TELE: n=333; F2F: n=733). Overall, 73\% (n=778) of respondents were female with an average age of 57.6 (SD 13.84) years. Most patients were English-speaking (n=728, 99.3\%), White (n=1059, 92.7\%), and not Hispanic or Latino (n=985, 92.4\%). There was significantly higher satisfaction with access to care for TELE visits compared to F2F visits. There were no differences in satisfaction with the care provider or in overall experience. When examining the specific aspects of using technology during TELE visits, there were no differences in audio quality, visual quality, or ease of talking to the care provider based on sex. There was, however, a difference in video quality based on age, where those 80 years and older rated significantly lower video quality compared to all other age groups. Conclusions: Top-level patient experience can be attained with TELE integrative medicine visits. Additional studies, particularly those correlating positive experience findings with specific behaviors used during TELE visits, would further our understanding of the integrative medicine patient experience. In the meantime, efforts should be made to ensure a policy that promotes the ongoing provision of TELE in integrative medicine. ",
doi="10.2196/56312",
url="https://formative.jmir.org/2024/1/e56312",
url="http://www.ncbi.nlm.nih.gov/pubmed/39037767"
}


@Article{info:doi/10.2196/56585,
author="Obigbesan, Oyinda
and Graham, Kristen
and Benzies, M. Karen",
title="Software Testing of eHealth Interventions: Existing Practices and the Future of an Iterative Strategy",
journal="JMIR Nursing",
year="2024",
month="Jul",
day="19",
volume="7",
pages="e56585",
keywords="eHealth",
keywords="health system",
keywords="digital health",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="software testing",
keywords="alpha testing",
keywords="beta testing",
keywords="usability testing",
keywords="agile development",
keywords="health applications",
keywords="software",
keywords="usability",
keywords="literature review",
keywords="narrative review",
keywords="testing",
keywords="ICT",
keywords="information and communication technology",
keywords="reliability",
keywords="safety",
doi="10.2196/56585",
url="https://nursing.jmir.org/2024/1/e56585",
url="http://www.ncbi.nlm.nih.gov/pubmed/39028552"
}


@Article{info:doi/10.2196/53497,
author="Lin, Yulan
and Xu, Xiaonan
and Liu, Yiyang
and Alias, Haridah
and Hu, Zhijian
and Wong, Ping Li",
title="Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="16",
volume="26",
pages="e53497",
keywords="telemedicine",
keywords="acceptance",
keywords="China",
keywords="general public",
keywords="COVID-19",
keywords="pandemic",
keywords="health care",
keywords="public health",
keywords="health care delivery",
keywords="health care services",
keywords="survey",
keywords="cross-sectional survey",
keywords="consultation",
keywords="teleconsultation",
keywords="health care system",
abstract="Background: The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services. Objective: This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine. Methods: An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated. Results: In total, 1006 participants completed the survey. A total of 44.3\% (n=446) reported being very likely and 49.3\% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness ($\beta$=0.322; P<.001) and perceived ease of use ($\beta$=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8\%), skin (n=316, 31.4\%), and musculoskeletal issues (n=316, 31.4\%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4\%) and cancer (n=64, 6.4\%). The majority preferred video chat (n=443, 44\%) and text chat (n=317, 31.5\%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2\%) and email (n=53, 5.3\%). Conclusions: Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation. ",
doi="10.2196/53497",
url="https://www.jmir.org/2024/1/e53497",
url="http://www.ncbi.nlm.nih.gov/pubmed/39012687"
}


@Article{info:doi/10.2196/49570,
author="Avnat, Eden
and Samin, Michael
and Ben Joya, Daniel
and Schneider, Eyal
and Yanko, Elia
and Eshel, Dafna
and Ovadia, Shahar
and Lev, Yossi
and Souroujon, Daniel",
title="The Potential of Evidence-Based Clinical Intake Tools to Discover or Ground Prevalence of Symptoms Using Real-Life Digital Health Encounters: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="16",
volume="26",
pages="e49570",
keywords="clinical intake tool",
keywords="evidence-based medicine",
keywords="big data",
keywords="digital health",
keywords="symptoms",
keywords="prevalence",
abstract="Background: Evidence-based clinical intake tools (EBCITs) are structured assessment tools used to gather information about patients and help health care providers make informed decisions. The growing demand for personalized medicine, along with the big data revolution, has rendered EBCITs a promising solution. EBCITs have the potential to provide comprehensive and individualized assessments of symptoms, enabling accurate diagnosis, while contributing to the grounding of medical care. Objective: This work aims to examine whether EBCITs cover data concerning disorders and symptoms to a similar extent as physicians, and thus can reliably address medical conditions in clinical settings. We also explore the potential of EBCITs to discover and ground the real prevalence of symptoms in different disorders thereby expanding medical knowledge and further supporting medical diagnoses made by physicians. Methods: Between August 1, 2022, and January 15, 2023, patients who used the services of a digital health care (DH) provider in the United States were first assessed by the Kahun EBCIT. Kahun platform gathered and analyzed the information from the sessions. This study estimated the prevalence of patients' symptoms in medical disorders using 2 data sets. The first data set analyzed symptom prevalence, as determined by Kahun's knowledge engine. The second data set analyzed symptom prevalence, relying solely on data from the DH patients gathered by Kahun. The variance difference between these 2 prevalence data sets helped us assess Kahun's ability to incorporate new data while integrating existing knowledge. To analyze the comprehensiveness of Kahun's knowledge engine, we compared how well it covers weighted data for the symptoms and disorders found in the 2019 National Ambulatory Medical Care Survey (NMCAS). To assess Kahun's diagnosis accuracy, physicians independently diagnosed 250 of Kahun-DH's sessions. Their diagnoses were compared with Kahun's diagnoses. Results: In this study, 2550 patients used Kahun to complete a full assessment. Kahun proposed 108,523 suggestions related to symptoms during the intake process. At the end of the intake process, 6496 conditions were presented to the caregiver. Kahun covered 94\% (526,157,569/562,150,572) of the weighted symptoms and 91\% (1,582,637,476/173,4783,244) of the weighted disorders in the 2019 NMCAS. In 90\% (224/250) of the sessions, both physicians and Kahun suggested at least one identical disorder, with a 72\% (367/507) total accuracy rate. Kahun's engine yielded 519 prevalences while the Kahun-DH cohort yielded 599; 156 prevalences were unique to the latter and 443 prevalences were shared by both data sets. Conclusions: ECBITs, such as Kahun, encompass extensive amounts of knowledge and could serve as a reliable database for inferring medical insights and diagnoses. Using this credible database, the potential prevalence of symptoms in different disorders was discovered or grounded. This highlights the ability of ECBITs to refine the understanding of relationships between disorders and symptoms, which further supports physicians in medical diagnosis. ",
doi="10.2196/49570",
url="https://www.jmir.org/2024/1/e49570",
url="http://www.ncbi.nlm.nih.gov/pubmed/39012659"
}


@Article{info:doi/10.2196/48259,
author="Gu, Wenjun
and Wang, Jinhua
and Zhang, Yunqi
and Liang, Shaolin
and Ai, Zisheng
and Li, Jiyu",
title="Evolution of Digital Health and Exploration of Patented Technologies (2017-2021): Bibliometric Analysis",
journal="Interact J Med Res",
year="2024",
month="Jul",
day="11",
volume="13",
pages="e48259",
keywords="technology trends",
keywords="digital health",
keywords="patent",
keywords="bibliometric analysis",
keywords="CiteSpace5.1R8",
abstract="Background: The significant impact of digital health emerged prominently during the COVID-19 pandemic. Despite this, there is a paucity of bibliometric analyses focusing on technologies within the field of digital health patents. Patents offer a wealth of insights into technologies, commercial prospects, and competitive landscapes, often undisclosed in other publications. Given the rapid evolution of the digital health industry, safeguarding algorithms, software, and advanced surgical devices through patent systems is imperative. The patent system simultaneously acts as a valuable repository of technological knowledge, accessible to researchers. This accessibility facilitates the enhancement of existing technologies and the advancement of medical equipment, ultimately contributing to public health improvement and meeting public demands. Objective: The primary objective of this study is to gain a more profound understanding of technology hotspots and development trends within the field of digital health. Methods: Using a bibliometric analysis methodology, we assessed the global technological output reflected in patents on digital health published between 2017 and 2021. Using Citespace5.1R8 and Excel 2016, we conducted bibliometric visualization and comparative analyses of key metrics, including national contributions, institutional affiliations, inventor profiles, and technology topics. Results: A total of 15,763 digital health patents were identified as published between 2017 and 2021. The China National Intellectual Property Administration secured the top position with 7253 published patents, whereas Koninklijke Philips emerged as the leading institution with 329 patents. Notably, Assaf Govari emerged as the most prolific inventor. Technology hot spots encompassed categories such as ``Medical Equipment and Information Systems,'' ``Image Analysis,'' and ``Electrical Diagnosis,'' classified by Derwent Manual Code. A patent related to the technique of receiving and transmitting data through microchips garnered the highest citation, attributed to the patentee Covidien LP. Conclusions: The trajectory of digital health patents has been growing since 2017, primarily propelled by China, the United States, and Japan. Applications in health interventions and enhancements in surgical devices represent the predominant scenarios for digital health technology. Algorithms emerged as the pivotal technologies protected by patents, whereas techniques related to data transfer, storage, and exchange in the digital health domain are anticipated to be focal points in forthcoming basic research. ",
doi="10.2196/48259",
url="https://www.i-jmr.org/2024/1/e48259"
}


@Article{info:doi/10.2196/51538,
author="Zhang, Kun
and Huang, Qiyuan
and Wang, Qiaosong
and Li, Chengyang
and Zheng, Qirong
and Li, Zhuoyue
and Xu, Dan
and Xie, Cuiling
and Zhang, Mingqi
and Lin, Rongjin",
title="Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="9",
volume="26",
pages="e51538",
keywords="telemedicine",
keywords="digital health",
keywords="web-based",
keywords="type 1 diabetes mellitus",
keywords="children",
keywords="adolescents",
keywords="glycemic control",
keywords="chronic disease management",
keywords="randomized controlled trials",
keywords="meta-analysis",
keywords="mobile phone",
abstract="Background: Type 1 diabetes mellitus (T1DM) is the most common chronic autoimmune disease among children and adolescents. Telemedicine has been widely used in the field of chronic disease management and can benefit patients with T1DM. However, existing studies lack high-level evidence related to the effectiveness of telemedicine for glycemic control in children and adolescents with T1DM. Objective: This study aims to systematically review the evidence on the effectiveness of telemedicine interventions compared with usual care on glycemic control among children and adolescents with T1DM. Methods: In this systematic review and meta-analysis, we searched PubMed, Cochrane Library, Embase, Web of Science (all databases), and CINAHL Complete from database inception to May 2023. We included randomized controlled trials (RCTs) that evaluated the effectiveness of a telemedicine intervention on glycemic control in children and adolescents with T1DM. In total, 2 independent reviewers performed the study selection and data extraction. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Our primary outcome was glycated hemoglobin (HbA1c) levels. Secondary outcomes were quality of life, self-monitoring of blood glucose, the incidence of hypoglycemia, and cost-effectiveness. A random-effects model was used for this meta-analysis. Results: Overall, 20 RCTs (1704 participants from 12 countries) were included in the meta-analysis. Only 5\% (1/20) of the studies were at high risk of bias. Compared to usual care, telemedicine was found to reduce HbA1c levels by 0.22 (95\% CI --0.33 to --0.10; P<.001; I2=35\%). There was an improvement in self-monitoring of blood glucose (mean difference [MD] 0.54, 95\% CI --0.72 to 1.80; P=.40; I2=67.8\%) and the incidence of hypoglycemia (MD --0.15, 95\% CI --0.57 to 0.27; P=.49; I2=70.7\%), although this was not statistically significant. Moreover, telemedicine had no convincing effect on the Diabetes Quality of Life for Youth score (impact of diabetes: P=.59; worries about diabetes: P=.71; satisfaction with diabetes: P=.68), but there was a statistically significant improvement in non--youth-specific quality of life (MD --0.24, 95\% CI --0.45 to --0.02; P=.04; I2=0\%). Subgroup analyses revealed that the effect of telemedicine on HbA1c levels appeared to be greater in studies involving children (MD --0.41, 95\% CI --0.62 to --0.20; P<.001), studies that lasted <6 months (MD --0.32, 95\% CI --0.48 to --0.17; P<.001), studies where providers used smartphone apps to communicate with patients (MD --0.37, 95\% CI --0.53 to --0.21; P<.001), and studies with medication dose adjustment (MD --0.25, 95\% CI --0.37 to --0.12; P<.001). Conclusions: Telemedicine can reduce HbA1c levels and improve quality of life in children and adolescents with T1DM. Telemedicine should be regarded as a useful supplement to usual care to control HbA1c levels and a potentially cost-effective mode. Meanwhile, researchers should develop higher-quality RCTs using large samples that focus on hard clinical outcomes, cost-effectiveness, and quality of life. ",
doi="10.2196/51538",
url="https://www.jmir.org/2024/1/e51538"
}


@Article{info:doi/10.2196/44906,
author="Schmalstieg-Bahr, Katharina
and Colombo, Giovanna Miriam
and Koch, Roland
and Szecsenyi, Joachim
and V{\"o}lker, Friedrich
and Blozik, Elisabeth Eva
and Scherer, Martin",
title="Intramural Health Care Through Video Consultations and the Need for Referrals and Hospital Admissions: Retrospective Quantitative Subanalysis of an Evaluation Study",
journal="Interact J Med Res",
year="2024",
month="Jun",
day="28",
volume="13",
pages="e44906",
keywords="intramural health care",
keywords="prison",
keywords="telemedicine",
keywords="primary care",
keywords="family medicine",
keywords="referral",
keywords="hospital admission",
keywords="admission rate",
keywords="intramural",
keywords="penal",
keywords="video consult",
keywords="e-consult",
keywords="remote care",
keywords="virtual care",
keywords="health care delivery",
keywords="service delivery",
keywords="health care system",
abstract="Background: In comparison to the general population, prison inmates are at a higher risk for drug abuse and psychiatric, as well as infectious, diseases. Although intramural health care has to be equivalent to extramural services, prison inmates have less access to primary and secondary care. Furthermore, not every prison is constantly staffed with a physician. Since transportation to the nearest extramural medical facility is often resource-intensive, video consultations may offer cost-effective health care for prison inmates. Objective: This study aims to quantify the need for referrals to secondary care services and hospital admissions when video consultations with family physicians and psychiatrists are offered in prison. Methods: In 5 German prisons, a mixed methods evaluation study was conducted to assess feasibility, acceptance, and reasons for conducting video consultations with family physicians and psychiatrists. This analysis uses quantitative data from these consultations (June 2018 to February 2019) in addition to data from a sixth prison added in January 2019 focusing on referral and admission rates, as well as reasons for encounters. Results: At the initiation of the project, 2499 prisoners were detained in the 6 prisons. A total of 435 video consultations were conducted by 12 physicians (3 female and 7 male family physicians, and 2 male psychiatrists during the study period). The majority were scheduled consultations (341/435, 78\%). In 68\% (n=294) of all encounters, the patient was asked to consult a physician again if symptoms persisted or got worse. In 26\% (n=115), a follow-up appointment with either the video consultant or prison physician was scheduled. A referral to other specialties, most often psychiatry, was necessary in 4\% (n=17) of the cases. Only in 2\% (n=8) of the consultations, a hospital admission was needed. Usually, hospital admissions were the result of unscheduled consultations, and the videoconferencing system was the method of communication in 88\% (n=7) of these cases, while 12\% (n=1) were carried out over the phone. Reasons for admissions were severe abdominal pain, hypotension, unstable angina or suspected myocardial infarction, or a suspected schizophrenic episode. Conclusions: Most scheduled and unscheduled consultations did not require subsequent patient transport to external health care providers. Using telemedicine services allowed a prompt patient-physician encounter with the possibility to refer patients to other specialties or to admit them to a hospital if necessary. ",
doi="10.2196/44906",
url="https://www.i-jmr.org/2024/1/e44906"
}


@Article{info:doi/10.2196/54607,
author="Zhu, Lingxuan
and Mou, Weiming
and Wu, Keren
and Lai, Yancheng
and Lin, Anqi
and Yang, Tao
and Zhang, Jian
and Luo, Peng",
title="Multimodal ChatGPT-4V for Electrocardiogram Interpretation: Promise and Limitations",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="26",
volume="26",
pages="e54607",
keywords="ChatGPT",
keywords="ECG",
keywords="electrocardiogram",
keywords="multimodal",
keywords="artificial intelligence",
keywords="AI",
keywords="large language model",
keywords="diagnostic",
keywords="quantitative analysis",
keywords="clinical",
keywords="clinicians",
keywords="ECG interpretation",
keywords="cardiovascular care",
keywords="cardiovascular",
doi="10.2196/54607",
url="https://www.jmir.org/2024/1/e54607",
url="http://www.ncbi.nlm.nih.gov/pubmed/38764297"
}


@Article{info:doi/10.2196/56241,
author="O'Driscoll, Fiona
and O'Brien, Niki
and Guo, Chaohui
and Prime, Matthew
and Darzi, Ara
and Ghafur, Saira",
title="Clinical Simulation in the Regulation of Software as a Medical Device: An eDelphi Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="25",
volume="8",
pages="e56241",
keywords="digital health technology",
keywords="software as a medical device",
keywords="clinical simulation",
keywords="Delphi study",
keywords="eDelphi study",
keywords="artificial intelligence",
keywords="digital health",
abstract="Background: Accelerated digitalization in the health sector requires the development of appropriate evaluation methods to ensure that digital health technologies (DHTs) are safe and effective. Software as a medical device (SaMD) is a commonly used DHT by clinicians to provide care to patients. Traditional research methods for evaluating health care products, such as randomized clinical trials, may not be suitable for DHTs, such as SaMD. However, evidence to show their safety and efficacy is needed by regulators before they can be used in practice. Clinical simulation can be used by researchers to test SaMD in an agile and low-cost way; yet, there is limited research on criteria to assess the robustness of simulations and, subsequently, their relevance for a regulatory decision. Objective: The objective of this study was to gain consensus on the criteria that should be used to assess clinical simulation from a regulatory perspective when it is used to generate evidence for SaMD. Methods: An eDelphi study approach was chosen to develop a set of criteria to assess clinical simulation when used to evaluate SaMD. Participants were recruited through purposive and snowball sampling based on their experience and knowledge in relevant sectors. They were guided through an initial scoping questionnaire with key themes identified from the literature to obtain a comprehensive list of criteria. Participants voted upon these criteria in 2 Delphi rounds, with criteria being excluded if consensus was not met. Participants were invited to add qualitative comments during rounds and qualitative analysis was performed on the comments gathered during the first round. Consensus was predefined by 2 criteria: if <10\% of the panelists deemed the criteria as ``not important'' or ``not important at all'' and >60\% ``important'' or ``very important.'' Results: In total, 33 international experts in the digital health field, including academics, regulators, policy makers, and industry representatives, completed both Delphi rounds, and 43 criteria gained consensus from the participants. The research team grouped these criteria into 7 domains---background and context, overall study design, study population, delivery of the simulation, fidelity, software and artificial intelligence, and study analysis. These 7 domains were formulated into the simulation for regulation of SaMD framework. There were key areas of concern identified by participants regarding the framework criteria, such as the importance of how simulation fidelity is achieved and reported and the avoidance of bias throughout all stages. Conclusions: This study proposes the simulation for regulation of SaMD framework, developed through an eDelphi consensus process, to evaluate clinical simulation when used to assess SaMD. Future research should prioritize the development of safe and effective SaMD, while implementing and refining the framework criteria to adapt to new challenges. ",
doi="10.2196/56241",
url="https://formative.jmir.org/2024/1/e56241"
}


@Article{info:doi/10.2196/55321,
author="Lukkahatai, Nada
and Han, Gyumin",
title="Perspectives on Artificial Intelligence in Nursing in Asia",
journal="Asian Pac Isl Nurs J",
year="2024",
month="Jun",
day="19",
volume="8",
pages="e55321",
keywords="machine learning",
keywords="ML",
keywords="artificial intelligence",
keywords="AI",
keywords="algorithm",
keywords="predictive model",
keywords="predictive analytics",
keywords="predictive system",
keywords="practical model",
keywords="deep learning",
keywords="ChatGPT",
keywords="chatbot",
keywords="nursing",
keywords="nurse",
keywords="nursing education",
keywords="personalized education",
keywords="Asia",
doi="10.2196/55321",
url="https://apinj.jmir.org/2024/1/e55321",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896473"
}


@Article{info:doi/10.2196/49581,
author="Wekenborg, Katharina Magdalena
and F{\"o}rster, Katharina
and Schweden, Florian
and Weidemann, Robin
and Bechtolsheim, von Felix
and Kirschbaum, Clemens
and Weitz, J{\"u}rgen
and Ditzen, Beate",
title="Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="17",
volume="26",
pages="e49581",
keywords="physicians",
keywords="digital transformation",
keywords="chronic stress",
keywords="hair cortisol concentration",
keywords="work stressors",
keywords="work resources",
abstract="Background: The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine. Objective: To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions. Methods: Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56\% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55\% women) submitted self-collected hair samples for cortisol analysis. Results: The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73\%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing. Conclusions: Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics. ",
doi="10.2196/49581",
url="https://www.jmir.org/2024/1/e49581",
url="http://www.ncbi.nlm.nih.gov/pubmed/38885014"
}


@Article{info:doi/10.2196/47631,
author="Tegenaw, Sahle Geletaw
and Sori, Amenu Demisew
and Teklemariam, Ketema Girum
and Verbeke, Frank
and Cornelis, Jan
and Jansen, Bart",
title="Evaluation of a Computer-Aided Clinical Decision Support System for Point-of-Care Use in Low-Resource Primary Care Settings: Acceptability Evaluation Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="11",
volume="11",
pages="e47631",
keywords="low-resource setting",
keywords="clinical decision support system",
keywords="point-of-care instrument",
keywords="evaluation",
keywords="user acceptance",
keywords="structural equation modeling",
keywords="partial least squares structural equation modeling",
keywords="decision-making",
keywords="decision making",
keywords="decision support",
keywords="caregiver",
keywords="users",
keywords="acceptance",
keywords="system quality",
abstract="Background: A clinical decision support system (CDSS) based on the logic and philosophy of clinical pathways is critical for managing the quality of health care and for standardizing care processes. Using such a system at a point-of-care setting is becoming more frequent these days. However, in a low-resource setting (LRS), such systems are frequently overlooked. Objective: The purpose of the study was to evaluate the user acceptance of a CDSS in LRSs. Methods: The CDSS evaluation was carried out at the Jimma Health Center and the Jimma Higher Two Health Center, Jimma, Ethiopia. The evaluation was based on 22 parameters organized into 6 categories: ease of use, system quality, information quality, decision changes, process changes, and user acceptance. A Mann-Whitney U test was used to investigate whether the difference between the 2 health centers was significant (2-tailed, 95\% CI; $\alpha$=.05). Pearson correlation and partial least squares structural equation modeling (PLS-SEM) was used to identify the relationship and factors influencing the overall acceptance of the CDSS in an LRS. Results: On the basis of 116 antenatal care, pregnant patient care, and postnatal care cases, 73 CDSS evaluation responses were recorded. We found that the 2 health centers did not differ significantly on 16 evaluation parameters. We did, however, detect a statistically significant difference in 6 parameters (P<.05). PLS-SEM results showed that the coefficient of determination, R2, of perceived user acceptance was 0.703. More precisely, the perceived ease of use ($\beta$=.015, P=.91) and information quality ($\beta$=.149, P=.25) had no positive effect on CDSS acceptance but, rather, on the system quality and perceived benefits of the CDSS, with P<.05 and $\beta$=.321 and $\beta$=.486, respectively. Furthermore, the perceived ease of use was influenced by information quality and system quality, with an R2 value of 0.479, indicating that the influence of information quality on the ease of use is significant but the influence of system quality on the ease of use is not, with $\beta$=.678 (P<.05) and $\beta$=.021(P=.89), respectively. Moreover, the influence of decision changes ($\beta$=.374, P<.05) and process changes ($\beta$=.749, P<.05) both was significant on perceived benefits (R2=0.983). Conclusions: This study concludes that users are more likely to accept and use a CDSS at the point of care when it is easy to grasp the perceived benefits and system quality in terms of health care professionals' needs. We believe that the CDSS acceptance model developed in this study reveals specific factors and variables that constitute a step toward the effective adoption and deployment of a CDSS in LRSs. ",
doi="10.2196/47631",
url="https://humanfactors.jmir.org/2024/1/e47631",
url="http://www.ncbi.nlm.nih.gov/pubmed/38861298"
}


@Article{info:doi/10.2196/47810,
author="Hawrysz, Liliana
and Kludacz-Alessandri, Magdalena
and Walczak, Renata",
title="Predictive Factors of Physicians' Satisfaction and Quality of Work Under Teleconsultation Conditions: Structural Equation Analysis",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="10",
volume="11",
pages="e47810",
keywords="perceived ease of use",
keywords="perceived usefulness",
keywords="physicians' satisfaction",
keywords="behavioral intention to use telemedicine",
keywords="health care quality",
keywords="technology acceptance model",
keywords="TAM",
keywords="COVID-19: telemedicine",
abstract="Background: The COVID-19 pandemic contributed to an increase in teleconsultation adoption in the Polish primary health care system. It is expected that in the long run, teleconsultations will successfully replace a significant part of face-to-face visits. Therefore, a significant challenge facing primary health care facilities (PHCs) is the acceptance of teleconsultations by their users, especially physicians. Objective: This study aimed to explore physicians' acceptance of teleconsultations during the COVID-19 pandemic in Poland. Methods: A representative survey was conducted among 361 physicians of PHCs across Poland in 2021. For the purposes of the study, we developed a modified Technology Acceptance Model (TAM) model. Based on the modified TAM, we analyzed the impact of perceived usefulness (PU), perceived ease of use (PEU), and intention to use teleconsultation (INT) on physicians' satisfaction (SAT) and quality of work (Q). The psychometric properties of the research instrument were examined using exploratory factor analysis. Finally, structural equation modeling was used for data analysis. Results: The results indicated a generally high level of PU (mean 3.85-4.36, SD 0.87-1.18), PEU (mean 3.81-4.60, SD 0.60-1.42), INT (mean 3.87-4.22, SD 0.89-1.12), and SAT (mean 3.55-4.13, SD 0.88-1.16); the lowest rated dimension in TAM was Q (mean 3.28-3.73, SD 1.06-1.26). The most important independent variable was PU. The influence of PU on INT (estimate=0.63, critical ratio [CR]=15.84, P<.001) and of PU on SAT (estimate=0.44, CR= 9.53, P<.001) was strong. INT was also a key factor influencing SAT (estimate=0.4, CR=8.57, P<.001). A weaker relationship was noted in the effect of PEU on INT (estimate=0.17, CR=4.31, P<.001). In turn, Q was positively influenced by INT (estimate=0.179, CR=3.64, P<.001), PU (estimate=0.246, CR=4.79, P<.001), PEU (estimate=0.18, CR=4.93, P<.001), and SAT (estimate=0.357, CR=6.97, P<.001). All paths between the constructs (PU, PEU, INT, SAT, and Q) were statistically significant, which highlights the multifaceted nature of the adoption of teleconsultations among physicians. Conclusions: Our findings provide strong empirical support for the hypothesized relationships in TAM. The findings suggest that the PU and PEU of teleconsultation have a significant impact on the intention of physicians to adopt teleconsultation. This results in an improvement in the satisfaction of Polish physicians with the use of teleconsultation and an increase in Q. The study contributes to both theory and practice by identifying important prognostic factors affecting physicians' acceptance of teleconsultation systems. ",
doi="10.2196/47810",
url="https://humanfactors.jmir.org/2024/1/e47810",
url="http://www.ncbi.nlm.nih.gov/pubmed/38857081"
}


@Article{info:doi/10.2196/54642,
author="Wang, Panzhang
and Yu, Lei
and Li, Tao
and Zhou, Liang
and Ma, Xin",
title="Use of Mobile Technologies to Streamline Pretriage Patient Flow in the Emergency Department: Observational Usability Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="7",
volume="12",
pages="e54642",
keywords="overcrowding",
keywords="overcrowded",
keywords="crowding",
keywords="smartphone",
keywords="queueing",
keywords="pretriage",
keywords="self-service",
keywords="triage",
keywords="emergency",
keywords="urgent",
keywords="ambulatory",
keywords="mHealth",
keywords="mobile health",
keywords="workflow",
keywords="health care management",
keywords="hospital",
abstract="Background: In emergency departments (EDs), triage nurses are under tremendous daily pressure to rapidly assess the acuity level of patients and log the collected information into computers. With self-service technologies, patients could complete data entry on their own, allowing nurses to focus on higher-order tasks. Kiosks are a popular working example of such self-service technologies; however, placing a sufficient number of unwieldy and fixed machines demands a spatial change in the greeting area and affects pretriage flow. Mobile technologies could offer a solution to these issues. Objective: The aim of this study was to investigate the use of mobile technologies to improve pretriage flow in EDs. Methods: The proposed stack of mobile technologies includes patient-carried smartphones and QR technology. The web address of the self-registration app is encoded into a QR code, which was posted directly outside the walk-in entrance to be seen by every ambulatory arrival. Registration is initiated immediately after patients or their proxies scan the code using their smartphones. Patients could complete data entry at any site on the way to the triage area. Upon completion, the result is saved locally on smartphones. At the triage area, the result is automatically decoded by a portable code reader and then loaded into the triage computer. This system was implemented in three busy metropolitan EDs in Shanghai, China. Both kiosks and smartphones were evaluated randomly while being used to direct pretriage patient flow. Data were collected during a 20-day period in each center. Timeliness and usability of medical students simulating ED arrivals were assessed with the After-Scenario Questionnaire. Usability was assessed by triage nurses with the Net Promoter Score (NPS). Observations made during system implementation were subject to qualitative thematic analysis. Results: Overall, 5928 of 8575 patients performed self-registration on kiosks, and 7330 of 8532 patients checked in on their smartphones. Referring effort was significantly reduced (43.7\% vs 8.8\%; P<.001) and mean pretriage waiting times were significantly reduced (4.4, SD 1.7 vs 2.9, SD 1.0 minutes; P<.001) with the use of smartphones compared to kiosks. There was a significant difference in mean usability scores for ``ease of task completion'' (4.4, SD 1.5 vs 6.7, SD 0.7; P<.001), ``satisfaction with completion time'' (4.5, SD 1.4 vs 6.8, SD 0.6; P<.001), and ``satisfaction with support'' (4.9, SD 1.9 vs 6.6, SD 1.2; P<.001). Triage nurses provided a higher NPS after implementation of mobile self-registration compared to the use of kiosks (13.3\% vs 93.3\%; P<.001). A modified queueing model was identified and qualitative findings were grouped by sequential steps. Conclusions: This study suggests patient-carried smartphones as a useful tool for ED self-registration. With increased usability and a tailored queueing model, the proposed system is expected to minimize pretriage waiting for patients in the ED. ",
doi="10.2196/54642",
url="https://mhealth.jmir.org/2024/1/e54642",
url="http://www.ncbi.nlm.nih.gov/pubmed/38848554"
}


@Article{info:doi/10.2196/55471,
author="Martin, Tobias
and Veldeman, Sarah
and Gro{\ss}mann, Heidrun
and Fuchs-Frohnhofen, Paul
and Czaplik, Michael
and Follmann, Andreas",
title="Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study",
journal="JMIR Aging",
year="2024",
month="Jun",
day="6",
volume="7",
pages="e55471",
keywords="telemedicine",
keywords="televisits",
keywords="telehealth",
keywords="eHealth",
keywords="electronic health",
keywords="older adult care",
keywords="nursing homes",
keywords="change management",
keywords="implementation science",
keywords="technology transfer",
keywords="innovation transfer",
keywords="long-term adoption",
keywords="COVID-19 crisis",
keywords="postpandemic",
keywords="coronavirus",
keywords="digitalization",
abstract="Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses' workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. ",
doi="10.2196/55471",
url="https://aging.jmir.org/2024/1/e55471",
url="http://www.ncbi.nlm.nih.gov/pubmed/38842915"
}


@Article{info:doi/10.2196/54428,
author="Bittmann, A. Janina
and Scherkl, Camilo
and Meid, D. Andreas
and Haefeli, E. Walter
and Seidling, M. Hanna",
title="Event Analysis for Automated Estimation of Absent and Persistent Medication Alerts: Novel Methodology",
journal="JMIR Med Inform",
year="2024",
month="Jun",
day="4",
volume="12",
pages="e54428",
keywords="clinical decision support system",
keywords="CDSS",
keywords="medication alert system",
keywords="alerting",
keywords="alert acceptance",
keywords="event analysis",
abstract="Background: Event analysis is a promising approach to estimate the acceptance of medication alerts issued by computerized physician order entry (CPOE) systems with an integrated clinical decision support system (CDSS), particularly when alerts cannot be interactively confirmed in the CPOE-CDSS due to its system architecture. Medication documentation is then reviewed for documented evidence of alert acceptance, which can be a time-consuming process, especially when performed manually. Objective: We present a new automated event analysis approach, which was applied to a large data set generated in a CPOE-CDSS with passive, noninterruptive alerts. Methods: Medication and alert data generated over 3.5 months within the CPOE-CDSS at Heidelberg University Hospital were divided into 24-hour time intervals in which the alert display was correlated with associated prescription changes. Alerts were considered ``persistent'' if they were displayed in every consecutive 24-hour time interval due to a respective active prescription until patient discharge and were considered ``absent'' if they were no longer displayed during continuous prescriptions in the subsequent interval. Results: Overall, 1670 patient cases with 11,428 alerts were analyzed. Alerts were displayed for a median of 3 (IQR 1-7) consecutive 24-hour time intervals, with the shortest alerts displayed for drug-allergy interactions and the longest alerts displayed for potentially inappropriate medication for the elderly (PIM). Among the total 11,428 alerts, 56.1\% (n=6413) became absent, most commonly among alerts for drug-drug interactions (1915/2366, 80.9\%) and least commonly among PIM alerts (199/499, 39.9\%). Conclusions: This new approach to estimate alert acceptance based on event analysis can be flexibly adapted to the automated evaluation of passive, noninterruptive alerts. This enables large data sets of longitudinal patient cases to be processed, allows for the derivation of the ratios of persistent and absent alerts, and facilitates the comparison and prospective monitoring of these alerts. ",
doi="10.2196/54428",
url="https://medinform.jmir.org/2024/1/e54428"
}


@Article{info:doi/10.2196/46954,
author="Paatela, Satu
and Kyyts{\"o}nen, Maiju
and Saranto, Kaija
and Kinnunen, Ulla-Mari
and Vehko, Tuulikki",
title="Experiences of Electronic Health Records' and Client Information Systems' Use on a Mobile Device and Factors Associated With Work Time Savings Among Practical Nurses: Cross-Sectional Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="29",
volume="26",
pages="e46954",
keywords="practical nurse",
keywords="information and communication technology",
keywords="electronic health record",
keywords="client information system",
keywords="documentation",
keywords="mobile technology",
abstract="Background: The transmission of clinical information in nursing predominantly occurs through digital solutions, such as computers and mobile devices, in today's era. Various technological systems, including electronic health records (EHRs) and client information systems (CISs), can be seamlessly integrated with mobile devices. The use of mobile devices is anticipated to rise, particularly as long-term care is increasingly delivered in environments such as clients' homes, where computers are not readily accessible. However, there is a growing need for more user-centered data to ensure that mobile devices effectively support practical nurses in their daily activities. Objective: This study aims to analyze practical nurses' experiences of using EHRs or CISs on a mobile device in their daily practice. In addition, it aims to examine the factors associated with work time savings when using EHRs/CISs on a mobile device. Methods: A cross-sectional study using an electronic survey was conducted in spring 2022. A total of 3866 practical nurses participated in the survey based on self-assessment. The sample was limited to practical nurses who used EHRs or CISs on a mobile device and worked in home care or service housing within the social welfare or health care sector (n=1014). Logistic regression analysis was used to explore the factors associated with work time savings. Results: The likelihood of perceiving work time savings was higher among more experienced EHR/CIS users compared with those with less experience (odds ratio [OR] 1.59, 95\% CI 1.30-1.94). Participants with 0-5 years of work experience were more likely to experience work time savings compared with those who had worked 21 years or more (OR 2.41, 95\% CI 1.43-4.07). Practical nurses in home care were also more likely to experience work time savings compared with those working in service housing (OR 1.95, 95\% CI 1.23-3.07). A lower grade given for EHRs/CISs was associated with a reduced likelihood of experiencing work time savings (OR 0.76, 95\% CI 0.66-0.89). Participants who documented client data in a public area were more likely to experience work time savings compared with those who did so in the nurses' office (OR 2.33, 95\% CI 1.27-4.25). Practical nurses who found documentation of client data on a mobile device easy (OR 3.05, 95\% CI 2.14-4.34) were more likely to experience work time savings compared with those who did not. Similarly, participants who believed that documentation of client data on a mobile device reduced the need to memorize things (OR 4.10, 95\% CI 2.80-6.00) were more likely to experience work time savings compared with those who did not. Conclusions: To enhance the proportion of practical nurses experiencing work time savings, we recommend that organizations offer comprehensive orientation and regular education sessions tailored for mobile device users who have less experience using EHRs or CISs and find mobile devices less intuitive to use. ",
doi="10.2196/46954",
url="https://www.jmir.org/2024/1/e46954",
url="http://www.ncbi.nlm.nih.gov/pubmed/38809583"
}


@Article{info:doi/10.2196/50853,
author="Zondag, M. Anna G.
and Rozestraten, Raoul
and Grimmelikhuijsen, G. Stephan
and Jongsma, R. Karin
and van Solinge, W. Wouter
and Bots, L. Michiel
and Vernooij, M. Robin W.
and Haitjema, Saskia",
title="The Effect of Artificial Intelligence on Patient-Physician Trust: Cross-Sectional Vignette Study",
journal="J Med Internet Res",
year="2024",
month="May",
day="28",
volume="26",
pages="e50853",
keywords="patient-physician relationship",
keywords="trust",
keywords="clinical decision support",
keywords="artificial intelligence",
keywords="digital health",
keywords="decision support system",
abstract="Background: Clinical decision support systems (CDSSs) based on routine care data, using artificial intelligence (AI), are increasingly being developed. Previous studies focused largely on the technical aspects of using AI, but the acceptability of these technologies by patients remains unclear. Objective: We aimed to investigate whether patient-physician trust is affected when medical decision-making is supported by a CDSS. Methods: We conducted a vignette study among the patient panel (N=860) of the University Medical Center Utrecht, the Netherlands. Patients were randomly assigned into 4 groups---either the intervention or control groups of the high-risk or low-risk cases. In both the high-risk and low-risk case groups, a physician made a treatment decision with (intervention groups) or without (control groups) the support of a CDSS. Using a questionnaire with a 7-point Likert scale, with 1 indicating ``strongly disagree'' and 7 indicating ``strongly agree,'' we collected data on patient-physician trust in 3 dimensions: competence, integrity, and benevolence. We assessed differences in patient-physician trust between the control and intervention groups per case using Mann-Whitney U tests and potential effect modification by the participant's sex, age, education level, general trust in health care, and general trust in technology using multivariate analyses of (co)variance. Results: In total, 398 patients participated. In the high-risk case, median perceived competence and integrity were lower in the intervention group compared to the control group but not statistically significant (5.8 vs 5.6; P=.16 and 6.3 vs 6.0; P=.06, respectively). However, the effect of a CDSS application on the perceived competence of the physician depended on the participant's sex (P=.03). Although no between-group differences were found in men, in women, the perception of the physician's competence and integrity was significantly lower in the intervention compared to the control group (P=.009 and P=.01, respectively). In the low-risk case, no differences in trust between the groups were found. However, increased trust in technology positively influenced the perceived benevolence and integrity in the low-risk case (P=.009 and P=.04, respectively). Conclusions: We found that, in general, patient-physician trust was high. However, our findings indicate a potentially negative effect of AI applications on the patient-physician relationship, especially among women and in high-risk situations. Trust in technology, in general, might increase the likelihood of embracing the use of CDSSs by treating professionals. ",
doi="10.2196/50853",
url="https://www.jmir.org/2024/1/e50853",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805702"
}


@Article{info:doi/10.2196/53056,
author="Cermak, A. Carly
and Read, Heather
and Jeffs, Lianne",
title="Health Care Professionals' Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="28",
volume="8",
pages="e53056",
keywords="COVID-19",
keywords="information and communication technology",
keywords="health care provider experiences",
keywords="web-based care",
keywords="interview",
abstract="Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. ",
doi="10.2196/53056",
url="https://formative.jmir.org/2024/1/e53056",
url="http://www.ncbi.nlm.nih.gov/pubmed/38805250"
}


@Article{info:doi/10.2196/54095,
author="Li, Yun
and Wang, Min
and Wang, Lu
and Cao, Yuan
and Liu, Yuyan
and Zhao, Yan
and Yuan, Rui
and Yang, Mengmeng
and Lu, Siqian
and Sun, Zhichao
and Zhou, Feihu
and Qian, Zhirong
and Kang, Hongjun",
title="Advances in the Application of AI Robots in Critical Care: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="May",
day="27",
volume="26",
pages="e54095",
keywords="critical care medicine",
keywords="artificial intelligence",
keywords="AI",
keywords="robotics",
keywords="intensive care unit",
keywords="ICU",
abstract="Background: In recent epochs, the field of critical medicine has experienced significant advancements due to the integration of artificial intelligence (AI). Specifically, AI robots have evolved from theoretical concepts to being actively implemented in clinical trials and applications. The intensive care unit (ICU), known for its reliance on a vast amount of medical information, presents a promising avenue for the deployment of robotic AI, anticipated to bring substantial improvements to patient care. Objective: This review aims to comprehensively summarize the current state of AI robots in the field of critical care by searching for previous studies, developments, and applications of AI robots related to ICU wards. In addition, it seeks to address the ethical challenges arising from their use, including concerns related to safety, patient privacy, responsibility delineation, and cost-benefit analysis. Methods: Following the scoping review framework proposed by Arksey and O'Malley and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a scoping review to delineate the breadth of research in this field of AI robots in ICU and reported the findings. The literature search was carried out on May 1, 2023, across 3 databases: PubMed, Embase, and the IEEE Xplore Digital Library. Eligible publications were initially screened based on their titles and abstracts. Publications that passed the preliminary screening underwent a comprehensive review. Various research characteristics were extracted, summarized, and analyzed from the final publications. Results: Of the 5908 publications screened, 77 (1.3\%) underwent a full review. These studies collectively spanned 21 ICU robotics projects, encompassing their system development and testing, clinical trials, and approval processes. Upon an expert-reviewed classification framework, these were categorized into 5 main types: therapeutic assistance robots, nursing assistance robots, rehabilitation assistance robots, telepresence robots, and logistics and disinfection robots. Most of these are already widely deployed and commercialized in ICUs, although a select few remain under testing. All robotic systems and tools are engineered to deliver more personalized, convenient, and intelligent medical services to patients in the ICU, concurrently aiming to reduce the substantial workload on ICU medical staff and promote therapeutic and care procedures. This review further explored the prevailing challenges, particularly focusing on ethical and safety concerns, proposing viable solutions or methodologies, and illustrating the prospective capabilities and potential of AI-driven robotic technologies in the ICU environment. Ultimately, we foresee a pivotal role for robots in a future scenario of a fully automated continuum from admission to discharge within the ICU. Conclusions: This review highlights the potential of AI robots to transform ICU care by improving patient treatment, support, and rehabilitation processes. However, it also recognizes the ethical complexities and operational challenges that come with their implementation, offering possible solutions for future development and optimization. ",
doi="10.2196/54095",
url="https://www.jmir.org/2024/1/e54095",
url="http://www.ncbi.nlm.nih.gov/pubmed/38801765"
}


@Article{info:doi/10.2196/53129,
author="Elser, Alexander
and Lange, Marina
and Kopkow, Christian
and Sch{\"a}fer, Georg Axel",
title="Barriers and Facilitators to the Implementation of Virtual Reality Interventions for People With Chronic Pain: Scoping Review",
journal="JMIR XR Spatial Comput",
year="2024",
month="May",
day="15",
volume="1",
pages="e53129",
keywords="virtual reality",
keywords="VR",
keywords="chronic pain",
keywords="implementation science",
keywords="scoping review",
keywords="barriers",
keywords="facilitators",
abstract="Background: Chronic pain is a growing health problem worldwide with a significant impact on individuals and societies. In regard to treatment, there is a gap between guideline recommendations and common practice in health care, especially concerning cognitive and psychological interventions. Virtual reality (VR) may provide a way to improve this situation. A growing body of evidence indicates that VR therapy has positive effects on pain and physical function. However, there is limited knowledge about barriers and facilitators to the implementation of VR interventions for people with chronic pain in health care settings. Objective: The aim of this study was to identify and analyze the barriers and facilitators involved in implementing VR interventions for people with chronic pain. Methods: We conducted a scoping review of the German and English literature using the MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, PEDro, LILACS, and Web of Science (inception to November 2023) databases, including quantitative, qualitative, and mixed methods studies reporting barriers and facilitators to the implementation of VR interventions for people with chronic pain, as reported by patients or health care professionals. Two reviewers systematically screened the abstracts and full texts of retrieved articles according to the inclusion criteria. All mentioned barriers and facilitators were extracted and categorized according to the Theoretical Domains Framework (TDF). Results: The database search resulted in 1864 records after removal of duplicates. From the 14 included studies, 30 barriers and 33 facilitators from the patient perspective and 2 facilitators from the health care professional perspective were extracted. Barriers reported by people with chronic pain were most frequently assigned to the TDF domains environmental context (60\%) and skills (16.7\%). Most facilitators were found in three domains for both the patients and health care professionals: beliefs about consequences (30.3\%), emotions (18.2\%), and environmental context (18.2\%). Conclusions: The findings of this review can inform the development of strategies for future implementations of VR interventions for people with chronic pain. Additionally, further research should address knowledge gaps about the perspective of health care professionals regarding the implementation of VR interventions for people with chronic pain. ",
doi="10.2196/53129",
url="https://xr.jmir.org/2024/1/e53129"
}


@Article{info:doi/10.2196/50204,
author="Vall{\'e}e, Alexandre",
title="Envisioning the Future of Personalized Medicine: Role and Realities of Digital Twins",
journal="J Med Internet Res",
year="2024",
month="May",
day="13",
volume="26",
pages="e50204",
keywords="digital health",
keywords="digital twin",
keywords="personalized medicine",
keywords="prevention",
keywords="prediction",
keywords="health care system",
doi="10.2196/50204",
url="https://www.jmir.org/2024/1/e50204",
url="http://www.ncbi.nlm.nih.gov/pubmed/38739913"
}


@Article{info:doi/10.2196/53724,
author="Chiu, Keith Wan Hang
and Ko, Koel Wei Sum
and Cho, Shing William Chi
and Hui, Joanne Sin Yu
and Chan, Lawrence Wing Chi
and Kuo, D. Michael",
title="Evaluating the Diagnostic Performance of Large Language Models on Complex Multimodal Medical Cases",
journal="J Med Internet Res",
year="2024",
month="May",
day="13",
volume="26",
pages="e53724",
keywords="large language model",
keywords="hospital",
keywords="health center",
keywords="Massachusetts",
keywords="statistical analysis",
keywords="chi-square",
keywords="ANOVA",
keywords="clinician",
keywords="physician",
keywords="performance",
keywords="proficiency",
keywords="disease etiology",
doi="10.2196/53724",
url="https://www.jmir.org/2024/1/e53724",
url="http://www.ncbi.nlm.nih.gov/pubmed/38739441"
}


@Article{info:doi/10.2196/49769,
author="Iqbal, Mujtaba Fahad
and Aggarwal, Ravi
and Joshi, Meera
and King, Dominic
and Martin, Guy
and Khan, Sadia
and Wright, Mike
and Ashrafian, Hutan
and Darzi, Ara",
title="Barriers to and Facilitators of Key Stakeholders Influencing Successful Digital Implementation of Remote Monitoring Solutions: Mixed Methods Analysis",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="6",
volume="11",
pages="e49769",
keywords="implementation science",
keywords="health plan implementation",
keywords="mobile health",
keywords="health care industry",
keywords="stakeholder",
keywords="COVID-19",
keywords="remote monitoring",
keywords="digital tools",
keywords="digital health",
keywords="pandemic",
keywords="virtual wards",
keywords="virtual ward",
keywords="health care delivery",
keywords="telemedicine",
keywords="telehealth",
keywords="wearables",
keywords="wearable",
keywords="technology",
keywords="United Kingdom",
keywords="UK",
keywords="digital services",
abstract="Background: Implementation of remote monitoring solutions and digital alerting tools in health care has historically been challenging, despite the impetus provided by the COVID-19 pandemic. To date, a health systems--based approach to systematically describe barriers and facilitators across multiple domains has not been undertaken. Objective: We aimed to undertake a comprehensive mixed methods analysis of barriers and facilitators for successful implementation of remote monitoring and digital alerting tools in complex health organizations. Methods: A mixed methods approach using a modified Technology Acceptance Model questionnaire and semistructured interviews mapped to the validated fit among humans, organizations, and technology (HOT-fit) framework was undertaken. Likert frequency responses and deductive thematic analyses were performed. Results: A total of 11 participants responded to the questionnaire and 18 participants to the interviews. Key barriers and facilitators could be mapped onto 6 dimensions, which incorporated aspects of digitization: system use (human), user satisfaction (human), environment (organization), structure (organization), information and service quality (technology), and system quality (technology). Conclusions: The recommendations proposed can enhance the potential for future remote sensing solutions to be more successfully integrated in health care practice, resulting in more successful use of ``virtual wards.'' Trial Registration: ClinicalTrials.gov NCT05321004; https://www.clinicaltrials.gov/study/NCT05321004 ",
doi="10.2196/49769",
url="https://humanfactors.jmir.org/2024/1/e49769",
url="http://www.ncbi.nlm.nih.gov/pubmed/37338929"
}


@Article{info:doi/10.2196/54180,
author="Martin, Josh
and Rueda, Alice
and Lee, Hee Gyu
and Tassone, K. Vanessa
and Park, Haley
and Ivanov, Martin
and Darnell, C. Benjamin
and Beavers, Lindsay
and Campbell, M. Douglas
and Nguyen, Binh
and Torres, Andrei
and Jung, Hyejung
and Lou, Wendy
and Nazarov, Anthony
and Ashbaugh, Andrea
and Kapralos, Bill
and Litz, Brett
and Jetly, Rakesh
and Dubrowski, Adam
and Strudwick, Gillian
and Krishnan, Sridhar
and Bhat, Venkat",
title="Digital Interventions to Understand and Mitigate Stress Response: Protocol for Process and Content Evaluation of a Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="6",
volume="13",
pages="e54180",
keywords="web-based platform",
keywords="stress",
keywords="distress",
keywords="moral distress",
keywords="wearable",
keywords="oura ring",
keywords="virtual reality",
keywords="VR",
keywords="COVID-19",
keywords="nursing",
keywords="digital health implementation",
abstract="Background: Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions for moral distress and moral injury are limited. Objective: This study has the following aims: (1) to characterize and reduce stress and moral distress related to decision-making in morally complex situations using a virtual reality (VR) scenario and a didactic intervention; (2) to identify features contributing to mental health outcomes using wearable, physiological, and self-reported questionnaire data; and (3) to create a personal digital phenotype profile that characterizes stress and moral distress at the individual level. Methods: This will be a single cohort, pre- and posttest study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress, and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes, including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for 2 weeks before, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention, and machine learning will be used to create a personal digital phenotype profile for each participant using the physiological, wearable, and self-reported data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants' experiences. Results: The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing. Conclusions: It is expected that the VR scenario will elicit stress and moral distress. Additionally, the didactic intervention is anticipated to improve understanding of and decrease feelings of stress and moral distress. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment responses in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. Trial Registration: ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398 International Registered Report Identifier (IRRID): DERR1-10.2196/54180 ",
doi="10.2196/54180",
url="https://www.researchprotocols.org/2024/1/e54180",
url="http://www.ncbi.nlm.nih.gov/pubmed/38709554"
}


@Article{info:doi/10.2196/53122,
author="Avdagovska, Melita
and Kuziemsky, Craig
and Koosha, Helia
and Hadizadeh, Maliheh
and Pauly, P. Robert
and Graham, Timothy
and Stafinski, Tania
and Bigam, David
and Kassam, Narmin
and Menon, Devidas",
title="Exploring the Impact of In Basket Metrics on the Adoption of a New Electronic Health Record System Among Specialists in a Tertiary Hospital in Alberta: Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="29",
volume="26",
pages="e53122",
keywords="electronic health records",
keywords="In Basket",
keywords="metrics",
keywords="descriptive study",
keywords="inpatients",
abstract="Background: Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout. Objective: This study aims to document metrics related to the In Basket communication hub (time in In Basket per day, time in In Basket per appointment, In Basket messages received per day, and turnaround time) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities. Methods: A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into medical and surgical based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: medical FTE <0.5, medical FTE >0.5, and surgical (all of whom reported FTE >0.5). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities. Results: A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the time in In Basket per day metric and 1.84 minutes on average in the time in In Basket per appointment metric. The time for the providers to mark messages as done (turnaround time) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less connected time (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as done (turnaround time). Conclusions: We observed a range of patterns with no consistent direction. There does not seem to be evidence of a ``learning curve,'' which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers' satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area. ",
doi="10.2196/53122",
url="https://www.jmir.org/2024/1/e53122",
url="http://www.ncbi.nlm.nih.gov/pubmed/38684079"
}


@Article{info:doi/10.2196/50889,
author="Hellstrand Tang, Ulla
and Smith, Frida
and Karilampi, Leyla Ulla
and Gremyr, Andreas",
title="Exploring the Role of Complexity in Health Care Technology Bottom-Up Innovations: Multiple-Case Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Complexity Assessment Tool",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="26",
volume="11",
pages="e50889",
keywords="digital",
keywords="bottom-up innovation",
keywords="complexity",
keywords="eHealth",
keywords="health care",
keywords="nonadoption, abandonment, scale-up, spread, and sustainability complexity assessment tool",
keywords="NASSS-CAT",
keywords="mobile phone",
abstract="Background: New digital technology presents new challenges to health care on multiple levels. There are calls for further research that considers the complex factors related to digital innovations in complex health care settings to bridge the gap when moving from linear, logistic research to embracing and testing the concept of complexity. The nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework was developed to help study complexity in digital innovations. Objective: This study aims to investigate the role of complexity in the development and deployment of innovations by retrospectively assessing challenges to 4 digital health care innovations initiated from the bottom up. Methods: A multicase retrospective, deductive, and explorative analysis using the NASSS complexity assessment tool LONG was conducted. In total, 4 bottom-up innovations developed in Region V{\"a}stra G{\"o}taland in Sweden were explored and compared to identify unique and shared complexity-related challenges. Results: The analysis resulted in joint insights and individual learning. Overall, the complexity was mostly found outside the actual innovation; more specifically, it related to the organization's readiness to integrate new innovations, how to manage and maintain innovations, and how to finance them. The NASSS framework sheds light on various perspectives that can either facilitate or hinder the adoption, scale-up, and spread of technological innovations. In the domain of condition or diagnosis, a well-informed understanding of the complexity related to the condition or illness (diabetes, cancer, bipolar disorders, and schizophrenia disorders) is of great importance for the innovation. The value proposition needs to be clearly described early to enable an understanding of costs and outcomes. The questions in the NASSS complexity assessment tool LONG were sometimes difficult to comprehend, not only from a language perspective but also due to a lack of understanding of the surrounding organization's system and its setting. Conclusions: Even when bottom-up innovations arise within the same support organization, the complexity can vary based on the developmental phase and the unique characteristics of each project. Identifying, defining, and understanding complexity may not solve the issues but substantially improves the prospects for successful deployment. Successful innovation within complex organizations necessitates an adaptive leadership and structures to surmount cultural resistance and organizational impediments. A rigid, linear, and stepwise approach risks disregarding interconnected variables and dependencies, leading to suboptimal outcomes. Success lies in embracing the complexity with its uncertainty, nurturing creativity, and adopting a nonlinear methodology that accommodates the iterative nature of innovation processes within complex organizations. ",
doi="10.2196/50889",
url="https://humanfactors.jmir.org/2024/1/e50889",
url="http://www.ncbi.nlm.nih.gov/pubmed/38669076"
}


@Article{info:doi/10.2196/50938,
author="Neumann, Ariana
and K{\"o}nig, Hans-Helmut
and Hajek, Andr{\'e}",
title="Determinants of Telemedicine Service Use Among Middle-Aged and Older Adults in Germany During the COVID-19 Pandemic: Cross-Sectional Survey Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="23",
volume="7",
pages="e50938",
keywords="telemedicine",
keywords="telehealth",
keywords="digital health",
keywords="service use",
keywords="COVID-19",
abstract="Background: The occurrence of the COVID-19 pandemic demanded fast changes in the delivery of health care. As a result, significant growth in the use of telemedicine services occurred. Research, especially from nationally representative German samples, is needed to better understand determinants of telemedicine use. Objective: The purpose of this study was to identify determinants of telemedicine service use among middle-aged and older adults during the COVID-19 pandemic in Germany. Methods: Cross-sectional, nationally representative data were taken from the German sample of the Survey of Health, Ageing and Retirement in Europe (SHARE). The German Corona Survey 2 (n=2039), which was conducted between June and August 2021, was used for this study. Reporting experience with remote medical consultations during the COVID-19 pandemic served as the outcome measure. Associations with socioeconomic, psychological, social, health-related, and COVID-19--related determinants were examined using multiple Firth logistic regressions. Results: Psychological factors including feeling nervous, anxious, or on edge (odds ratio [OR] 1.61, 95\% CI 1.04-2.50; P=.03), feeling sad or depressed (OR 1.62, 95\% CI 1.05-2.51; P=.03) and feelings of loneliness (OR 1.66, 95\% CI 1.07-2.58; P=.02) were positively associated with telemedicine use. Moreover, forgoing medical treatment because of being afraid of being infected by SARS-CoV-2 (OR 1.81, 95\% CI 1.10-2.97; P=.02) and describing limitations because of a health problem as severe were positively associated with the outcome (OR 2.11, 95\% CI 1.12-4.00; P=.02). Socioeconomic and social factors were not significantly associated with telemedicine use in our sample. Conclusions: Middle-aged and older individuals in Germany seem to use telemedicine services according to psychological needs and health limitations. Especially when psychological symptoms are experienced, telemedicine seems to be a promising service option in this age group. Future research is needed to confirm these initial findings in postpandemic circumstances. ",
doi="10.2196/50938",
url="https://aging.jmir.org/2024/1/e50938"
}


@Article{info:doi/10.2196/54419,
author="Kernberg, Annessa
and Gold, A. Jeffrey
and Mohan, Vishnu",
title="Using ChatGPT-4 to Create Structured Medical Notes From Audio Recordings of Physician-Patient Encounters: Comparative Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="22",
volume="26",
pages="e54419",
keywords="generative AI",
keywords="generative artificial intelligence",
keywords="ChatGPT",
keywords="simulation",
keywords="large language model",
keywords="clinical documentation",
keywords="quality",
keywords="accuracy",
keywords="reproducibility",
keywords="publicly available",
keywords="medical note",
keywords="medical notes",
keywords="generation",
keywords="medical documentation",
keywords="documentation",
keywords="documentations",
keywords="AI",
keywords="artificial intelligence",
keywords="transcript",
keywords="transcripts",
keywords="ChatGPT-4",
abstract="Background: Medical documentation plays a crucial role in clinical practice, facilitating accurate patient management and communication among health care professionals. However, inaccuracies in medical notes can lead to miscommunication and diagnostic errors. Additionally, the demands of documentation contribute to physician burnout. Although intermediaries like medical scribes and speech recognition software have been used to ease this burden, they have limitations in terms of accuracy and addressing provider-specific metrics. The integration of ambient artificial intelligence (AI)--powered solutions offers a promising way to improve documentation while fitting seamlessly into existing workflows. Objective: This study aims to assess the accuracy and quality of Subjective, Objective, Assessment, and Plan (SOAP) notes generated by ChatGPT-4, an AI model, using established transcripts of History and Physical Examination as the gold standard. We seek to identify potential errors and evaluate the model's performance across different categories. Methods: We conducted simulated patient-provider encounters representing various ambulatory specialties and transcribed the audio files. Key reportable elements were identified, and ChatGPT-4 was used to generate SOAP notes based on these transcripts. Three versions of each note were created and compared to the gold standard via chart review; errors generated from the comparison were categorized as omissions, incorrect information, or additions. We compared the accuracy of data elements across versions, transcript length, and data categories. Additionally, we assessed note quality using the Physician Documentation Quality Instrument (PDQI) scoring system. Results: Although ChatGPT-4 consistently generated SOAP-style notes, there were, on average, 23.6 errors per clinical case, with errors of omission (86\%) being the most common, followed by addition errors (10.5\%) and inclusion of incorrect facts (3.2\%). There was significant variance between replicates of the same case, with only 52.9\% of data elements reported correctly across all 3 replicates. The accuracy of data elements varied across cases, with the highest accuracy observed in the ``Objective'' section. Consequently, the measure of note quality, assessed by PDQI, demonstrated intra- and intercase variance. Finally, the accuracy of ChatGPT-4 was inversely correlated to both the transcript length (P=.05) and the number of scorable data elements (P=.05). Conclusions: Our study reveals substantial variability in errors, accuracy, and note quality generated by ChatGPT-4. Errors were not limited to specific sections, and the inconsistency in error types across replicates complicated predictability. Transcript length and data complexity were inversely correlated with note accuracy, raising concerns about the model's effectiveness in handling complex medical cases. The quality and reliability of clinical notes produced by ChatGPT-4 do not meet the standards required for clinical use. Although AI holds promise in health care, caution should be exercised before widespread adoption. Further research is needed to address accuracy, variability, and potential errors. ChatGPT-4, while valuable in various applications, should not be considered a safe alternative to human-generated clinical documentation at this time. ",
doi="10.2196/54419",
url="https://www.jmir.org/2024/1/e54419",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648636"
}


@Article{info:doi/10.2196/50201,
author="Huguet, Nathalie
and Chen, Jinying
and Parikh, B. Ravi
and Marino, Miguel
and Flocke, A. Susan
and Likumahuwa-Ackman, Sonja
and Bekelman, Justin
and DeVoe, E. Jennifer",
title="Applying Machine Learning Techniques to Implementation Science",
journal="Online J Public Health Inform",
year="2024",
month="Apr",
day="22",
volume="16",
pages="e50201",
keywords="implementation science",
keywords="machine learning",
keywords="implementation strategies",
keywords="techniques",
keywords="implementation",
keywords="prediction",
keywords="adaptation",
keywords="acceptance",
keywords="challenges",
keywords="scientist",
doi="10.2196/50201",
url="https://ojphi.jmir.org/2024/1/e50201",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648094"
}


@Article{info:doi/10.2196/50475,
author="Shulha, Michael
and Hovdebo, Jordan
and D'Souza, Vinita
and Thibault, Francis
and Harmouche, Rola",
title="Integrating Explainable Machine Learning in Clinical Decision Support Systems: Study Involving a Modified Design Thinking Approach",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="16",
volume="8",
pages="e50475",
keywords="explainable machine learning",
keywords="XML",
keywords="design thinking approach",
keywords="NASSS framework",
keywords="clinical decision support",
keywords="clinician engagement",
keywords="clinician-facing interface",
keywords="clinician trust in machine learning",
keywords="COVID-19",
keywords="chest x-ray",
keywords="severity prediction",
abstract="Background: Though there has been considerable effort to implement machine learning (ML) methods for health care, clinical implementation has lagged. Incorporating explainable machine learning (XML) methods through the development of a decision support tool using a design thinking approach is expected to lead to greater uptake of such tools. Objective: This work aimed to explore how constant engagement of clinician end users can address the lack of adoption of ML tools in clinical contexts due to their lack of transparency and address challenges related to presenting explainability in a decision support interface. Methods: We used a design thinking approach augmented with additional theoretical frameworks to provide more robust approaches to different phases of design. In particular, in the problem definition phase, we incorporated the nonadoption, abandonment, scale-up, spread, and sustainability of technology in health care (NASSS) framework to assess these aspects in a health care network. This process helped focus on the development of a prognostic tool that predicted the likelihood of admission to an intensive care ward based on disease severity in chest x-ray images. In the ideate, prototype, and test phases, we incorporated a metric framework to assess physician trust in artificial intelligence (AI) tools. This allowed us to compare physicians' assessments of the domain representation, action ability, and consistency of the tool. Results: Physicians found the design of the prototype elegant, and domain appropriate representation of data was displayed in the tool. They appreciated the simplified explainability overlay, which only displayed the most predictive patches that cumulatively explained 90\% of the final admission risk score. Finally, in terms of consistency, physicians unanimously appreciated the capacity to compare multiple x-ray images in the same view. They also appreciated the ability to toggle the explainability overlay so that both options made it easier for them to assess how consistently the tool was identifying elements of the x-ray image they felt would contribute to overall disease severity. Conclusions: The adopted approach is situated in an evolving space concerned with incorporating XML or AI technologies into health care software. We addressed the alignment of AI as it relates to clinician trust, describing an approach to wire framing and prototyping, which incorporates the use of a theoretical framework for trust in the design process itself. Moreover, we proposed that alignment of AI is dependent upon integration of end users throughout the larger design process. Our work shows the importance and value of engaging end users prior to tool development. We believe that the described approach is a unique and valuable contribution that outlines a direction for ML experts, user experience designers, and clinician end users on how to collaborate in the creation of trustworthy and usable XML-based clinical decision support tools. ",
doi="10.2196/50475",
url="https://formative.jmir.org/2024/1/e50475",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625728"
}


@Article{info:doi/10.2196/52412,
author="Kawamoto, Shota
and Morikawa, Yoshihiko
and Yahagi, Naohisa",
title="Novel Approach for Detecting Respiratory Syncytial Virus in Pediatric Patients Using Machine Learning Models Based on Patient-Reported Symptoms: Model Development and Validation Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="12",
volume="8",
pages="e52412",
keywords="respiratory syncytial virus",
keywords="machine learning",
keywords="self-reported information",
keywords="clinical decision support system",
keywords="decision support",
keywords="decision-making",
keywords="artificial intelligence",
keywords="model development",
keywords="evaluation study",
keywords="detection",
keywords="respiratory",
keywords="respiratory virus",
keywords="virus",
keywords="machine learning model",
keywords="pediatric",
keywords="Japan",
keywords="detection model",
abstract="Background: Respiratory syncytial virus (RSV) affects children, causing serious infections, particularly in high-risk groups. Given the seasonality of RSV and the importance of rapid isolation of infected individuals, there is an urgent need for more efficient diagnostic methods to expedite this process. Objective: This study aimed to investigate the performance of a machine learning model that leverages the temporal diversity of symptom onset for detecting RSV infections and elucidate its discriminatory ability. Methods: The study was conducted in pediatric and emergency outpatient settings in Japan. We developed a detection model that remotely confirms RSV infection based on patient-reported symptom information obtained using a structured electronic template incorporating the differential points of skilled pediatricians. An extreme gradient boosting--based machine learning model was developed using the data of 4174 patients aged ?24 months who underwent RSV rapid antigen testing. These patients visited either the pediatric or emergency department of Yokohama City Municipal Hospital between January 1, 2009, and December 31, 2015. The primary outcome was the diagnostic accuracy of the machine learning model for RSV infection, as determined by rapid antigen testing, measured using the area under the receiver operating characteristic curve. The clinical efficacy was evaluated by calculating the discriminative performance based on the number of days elapsed since the onset of the first symptom and exclusion rates based on thresholds of reasonable sensitivity and specificity. Results: Our model demonstrated an area under the receiver operating characteristic curve of 0.811 (95\% CI 0.784-0.833) with good calibration and 0.746 (95\% CI 0.694-0.794) for patients within 3 days of onset. It accurately captured the temporal evolution of symptoms; based on adjusted thresholds equivalent to those of a rapid antigen test, our model predicted that 6.9\% (95\% CI 5.4\%-8.5\%) of patients in the entire cohort would be positive and 68.7\% (95\% CI 65.4\%-71.9\%) would be negative. Our model could eliminate the need for additional testing in approximately three-quarters of all patients. Conclusions: Our model may facilitate the immediate detection of RSV infection in outpatient settings and, potentially, in home environments. This approach could streamline the diagnostic process, reduce discomfort caused by invasive tests in children, and allow rapid implementation of appropriate treatments and isolation at home. The findings underscore the potential of machine learning in augmenting clinical decision-making in the early detection of RSV infection. ",
doi="10.2196/52412",
url="https://formative.jmir.org/2024/1/e52412",
url="http://www.ncbi.nlm.nih.gov/pubmed/38608268"
}


@Article{info:doi/10.2196/53726,
author="Louch, Gemma
and Berzins, Kathryn
and Walker, Lauren
and Wormald, Gemma
and Blackwell, Kirstin
and Stephens, Michael
and Brown, Mark
and Baker, John",
title="Promoting a Patient-Centered Understanding of Safety in Acute Mental Health Wards: A User-Centered Design Approach to Develop a Real-Time Digital Monitoring Tool",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="12",
volume="8",
pages="e53726",
keywords="patient safety",
keywords="mental health",
keywords="patient involvement",
keywords="qualitative",
keywords="digital innovation",
keywords="real time",
keywords="monitoring",
keywords="safety",
keywords="develop",
keywords="development",
keywords="design",
keywords="perception",
keywords="perceptions",
keywords="prototype",
keywords="evidence scan",
keywords="interview",
keywords="interviews",
keywords="logic model",
keywords="programme theory",
keywords="dashboard",
keywords="dashboards",
keywords="interface",
abstract="Background: Acute mental health services report high levels of safety incidents that involve both patients and staff. The potential for patients to be involved in interventions to improve safety within a mental health setting is acknowledged, and there is a need for interventions that proactively seek the patient perspective of safety. Digital technologies may offer opportunities to address this need. Objective: This research sought to design and develop a digital real-time monitoring tool (WardSonar) to collect and collate daily information from patients in acute mental health wards about their perceptions of safety. We present the design and development process and underpinning logic model and programme theory. Methods: The first stage involved a synthesis of the findings from a systematic review and evidence scan, interviews with patients (n=8) and health professionals (n=17), and stakeholder engagement. Cycles of design activities and discussion followed with patients, staff, and stakeholder groups, to design and develop the prototype tool. Results: We drew on patient safety theory and the concepts of contagion and milieu. The data synthesis, design, and development process resulted in three prototype components of the digital monitoring tool (WardSonar): (1) a patient recording interface that asks patients to input their perceptions into a tablet computer, to assess how the ward feels and whether the direction is changing, that is, ``getting worse'' or ``getting better''; (2) a staff dashboard and functionality to interrogate the data at different levels; and (3) a public-facing ward interface. The technology is available as open-source code. Conclusions: Recent patient safety policy and research priorities encourage innovative approaches to measuring and monitoring safety. We developed a digital real-time monitoring tool to collect information from patients in acute mental health wards about perceived safety, to support staff to respond and intervene to changes in the clinical environment more proactively. ",
doi="10.2196/53726",
url="https://formative.jmir.org/2024/1/e53726",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607663"
}


@Article{info:doi/10.2196/52612,
author="Ahmadzadeh, Bahareh
and Patey, Christopher
and Hurley, Oliver
and Knight, John
and Norman, Paul
and Farrell, Alison
and Czarnuch, Stephen
and Asghari, Shabnam",
title="Applications of Artificial Intelligence in Emergency Departments to Improve Wait Times: Protocol for an Integrative Living Review",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="12",
volume="13",
pages="e52612",
keywords="emergency department",
keywords="ED",
keywords="wait time",
keywords="artificial intelligence",
keywords="AI",
keywords="living systematic review",
keywords="LSR",
abstract="Background: Long wait times in the emergency department (ED) are a major issue for health care systems all over the world. The application of artificial intelligence (AI) is a novel strategy to reduce ED wait times when compared to the interventions included in previous research endeavors. To date, comprehensive systematic reviews that include studies involving AI applications in the context of EDs have covered a wide range of AI implementation issues. However, the lack of an iterative update strategy limits the use of these reviews. Since the subject of AI development is cutting edge and is continuously changing, reviews in this area must be frequently updated to remain relevant. Objective: This study aims to provide a summary of the evidence that is currently available regarding how AI can affect ED wait times; discuss the applications of AI in improving wait times; and periodically assess the depth, breadth, and quality of the evidence supporting the application of AI in reducing ED wait times. Methods: We plan to conduct a living systematic review (LSR). Our strategy involves conducting continuous monitoring of evidence, with biannual search updates and annual review updates. Upon completing the initial round of the review, we will refine the search strategy and establish clear schedules for updating the LSR. An interpretive synthesis using Whittemore and Knafl's framework will be performed to compile and summarize the findings. The review will be carried out using an integrated knowledge translation strategy, and knowledge users will be involved at all stages of the review to guarantee applicability, usability, and clarity of purpose. Results: The literature search was completed by September 22, 2023, and identified 17,569 articles. The title and abstract screening were completed by December 9, 2023. In total, 70 papers were eligible. The full-text screening is in progress. Conclusions: The review will summarize AI applications that improve ED wait time. The LSR enables researchers to maintain high methodological rigor while enhancing the timeliness, applicability, and value of the review. International Registered Report Identifier (IRRID): DERR1-10.2196/52612 ",
doi="10.2196/52612",
url="https://www.researchprotocols.org/2024/1/e52612",
url="http://www.ncbi.nlm.nih.gov/pubmed/38607662"
}


@Article{info:doi/10.2196/50410,
author="Choy, Ada Melinda
and O'Brien, Kathleen
and Barnes, Katelyn
and Sturgiss, Ann Elizabeth
and Rieger, Elizabeth
and Douglas, Kirsty",
title="Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="11",
volume="26",
pages="e50410",
keywords="digital health",
keywords="eHealth",
keywords="primary care",
keywords="general practice",
keywords="digital divide",
keywords="health inequities",
keywords="health inequality",
keywords="disparities",
keywords="digital cost",
keywords="financial cost",
keywords="health technology",
keywords="mixed methods",
keywords="barriers",
keywords="barrier",
abstract="Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access. Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide. Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices. Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31\% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7\% (52/487) were low- to medium-frequency users and 48.5\% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access. Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide. ",
doi="10.2196/50410",
url="https://www.jmir.org/2024/1/e50410",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602768"
}


@Article{info:doi/10.2196/50932,
author="Kleinschmidt, Lara
and Walendzik, Anke
and Wasem, J{\"u}rgen
and H{\"o}fer, Klemens
and Nauendorf, Beatrice
and Brittner, Matthias
and Brandenburg, Paul
and Aeustergerling, Andr{\'e}
and Schneider, Udo
and Wadeck, Anja
and Sehlen, Stephanie
and Liersch, Sebastian
and Schwarze, Katharina
and Schwenke, Carsten
and H{\"u}er, Theresa",
title="Preference-Based Implementation of Video Consultations in Urban and Rural Regions in Outpatient Care in Germany: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="11",
volume="13",
pages="e50932",
keywords="study protocol",
keywords="video consultation",
keywords="preference elicitation",
keywords="discrete choice experiment",
keywords="implementation",
keywords="telemedicine",
keywords="teleconsultation",
keywords="e-consultation",
keywords="outpatient",
keywords="rural area",
keywords="remote",
keywords="preferences",
keywords="strategy",
abstract="Background: Particularly in rural regions, factors such as lower physician density and long travel distances complicate adequate outpatient care. However, urban regions can also be affected by deficits in care, for example, long waiting times. One model of care intending to improve the situation is the implementation of video consultations. The study protocol presents the methodology of the research project titled ``Preference-based implementation of the video consultation in urban and rural regions'' funded by the German Federal Joint Committee (funding number 01VSF20011). Objective: This study aims to identify existing barriers to the use of video consultation and the preferences of insured individuals and physicians as well as psychotherapists in order to optimize its design and thus increase acceptance and use of video consultations in urban and rural regions. Methods: Built on a mixed methods approach, this study first assesses the status quo of video consultation use through claims data analysis and carries out a systematic literature review on barriers and promoting factors for the use of video consultations. Based on this preliminary work, focus groups are conducted in order to prepare surveys with insureds as well as physicians and psychotherapists in the second study phase. The central element of the survey is the implementation of discrete choice experiments to elicit relevant preferences of (potential) user groups and service providers. The summarized findings are discussed in a stakeholder workshop and translated into health policy recommendations. Results: The methodological approach used in this study is the focus of this paper. The study is still ongoing and will continue until March 2024. The first study phase has already been completed, in which preliminary work has been done on potential applications and hurdles for the use of video consultations. Currently, the survey is being conducted and analyses are being prepared. Conclusions: This study is intended to develop a targeted strategy for health policy makers based on actual preferences and perceived obstacles to the use of video consultations. The results of this study will contribute to further user-oriented development of the implementation of video consultations in German statutory health insurance. Furthermore, the iterative and mixed methods approach used in this study protocol is also suitable for a variety of other research projects. International Registered Report Identifier (IRRID): DERR1-10.2196/50932 ",
doi="10.2196/50932",
url="https://www.researchprotocols.org/2024/1/e50932",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602749"
}


@Article{info:doi/10.2196/52830,
author="Der-Martirosian, Claudia
and Hou, Cynthia
and Hovsepian, Sona
and Diarra Carter, Maia
and Heyworth, Leonie
and Dobalian, Aram
and Leung, Lucinda",
title="Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="9",
volume="8",
pages="e52830",
keywords="interdisciplinary primary care team members",
keywords="NASSS framework",
keywords="nonadoption, abandonment, scale-up, spread, and sustainability",
keywords="primary care",
keywords="telehealth",
keywords="video-based care",
abstract="Background: With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. Objective: The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. Methods: We applied a positive and negative deviance approach and selected the 6\% highest (n=8) and the 6\% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. Results: The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic---visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology---key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system---changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver's role (eg, participation of caregivers during video visits); (4) health care organization---leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time---capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). Conclusions: This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes. ",
doi="10.2196/52830",
url="https://formative.jmir.org/2024/1/e52830",
url="http://www.ncbi.nlm.nih.gov/pubmed/38592760"
}


@Article{info:doi/10.2196/54008,
author="Palakshappa, A. Jessica
and Hale, R. Erica
and Brown, D. Joshua
and Kittel, A. Carol
and Dressler, Emily
and Rosenthal, E. Gary
and Cutrona, L. Sarah
and Foley, L. Kristie
and Haines, R. Emily
and Houston II, K. Thomas",
title="Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="8",
volume="26",
pages="e54008",
keywords="telehealth",
keywords="telemedicine",
keywords="e-health",
keywords="eHealth",
keywords="video visits",
keywords="video",
keywords="ICT",
keywords="information and communication technology",
keywords="survey",
keywords="surveys",
keywords="adoption",
keywords="usability",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="COVID-19",
abstract="Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7\% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6\% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (``Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?'') was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5\% (156/511) selecting it as a challenge in 2020 and 37.1\% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3\% in 2020 and 137/615, 22.3\% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. ",
doi="10.2196/54008",
url="https://www.jmir.org/2024/1/e54008",
url="http://www.ncbi.nlm.nih.gov/pubmed/38587889"
}


@Article{info:doi/10.2196/53995,
author="Bendtsen, Gr{\o}nlund Magnus
and Sch{\"o}nwandt, Thuesen Bodil Marie
and Rub{\ae}k, Mette
and Hitz, Friberg Mette",
title="Evaluation of an mHealth App on Self-Management of Osteoporosis: Prospective Survey Study",
journal="Interact J Med Res",
year="2024",
month="Apr",
day="1",
volume="13",
pages="e53995",
keywords="eHealth literacy",
keywords="health literacy",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="mobile health apps",
keywords="self-management",
keywords="osteoporosis",
keywords="usability",
keywords="acceptability",
abstract="Background: Mobile health (mHealth) technologies can be used for disease-specific self-management, and these technologies are experiencing rapid growth in the health care industry. They use mobile devices, specifically smartphone apps, to enhance and support medical and public health practices. In chronic disease management, the use of apps in the realm of mHealth holds the potential to improve health outcomes. This is also true for mHealth apps on osteoporosis, but the usage and patients' experiences with these apps are underexplored. Objective: This prospective survey study aimed to investigate the eHealth literacy of Danish patients with osteoporosis, as well as the usability and acceptability of the app ``My Bones.'' Methods: Data on patient characteristics, disease knowledge, eHealth literacy, usability, and acceptability were collected using self-administered questionnaires at baseline, 2 months, and 6 months. The following validated questionnaires were used: eHealth Literacy Questionnaire, System Usability Scale, and Service User Technology Acceptability Questionnaire. Results: Mean scores for eHealth literacy ranged from 2.6 to 3.1, with SD ranging from 0.5 to 0.6 across the 7 domains. The mean (SD) System Usability Scale score was 74.7 (14.4), and the mean (SD) scores for domains 1, 2, and 6 of the Service User Technology Acceptability Questionnaire were 3.4 (1.2), 4.5 (1.1), 4.1 (1.2), respectively. Conclusions: Danish patients with osteoporosis are both motivated and capable of using digital health services. The app's usability was acceptable, and it has the potential to reduce visits to general practitioner clinics, enhance health outcomes, and serve as a valuable addition to regular health or social care services. ",
doi="10.2196/53995",
url="https://www.i-jmr.org/2024/1/e53995",
url="http://www.ncbi.nlm.nih.gov/pubmed/38557362"
}


@Article{info:doi/10.2196/51058,
author="Thomas, Amy
and Asnes, Andrea
and Libby, Kyle
and Hsiao, Allen
and Tiyyagura, Gunjan",
title="Developing and Testing the Usability of a Novel Child Abuse Clinical Decision Support System: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="29",
volume="26",
pages="e51058",
keywords="child abuse",
keywords="clinical decision support",
keywords="CDS",
keywords="pediatrics",
keywords="child",
keywords="children",
keywords="natural language processing",
keywords="usability",
keywords="clinical decision support system",
keywords="physical abuse",
abstract="Background: Despite the impact of physical abuse on children, it is often underdiagnosed, especially among children evaluated in emergency departments (EDs). Electronic clinical decision support (CDS) can improve the recognition of child physical abuse. Objective: We aimed to develop and test the usability of a natural language processing--based child abuse CDS system, known as the Child Abuse Clinical Decision Support (CA-CDS), to alert ED clinicians about high-risk injuries suggestive of abuse in infants' charts. Methods: Informed by available evidence, a multidisciplinary team, including an expert in user design, developed the CA-CDS prototype that provided evidence-based recommendations for the evaluation and management of suspected child abuse when triggered by documentation of a high-risk injury. Content was customized for medical versus nursing providers and initial versus subsequent exposure to the alert. To assess the usability of and refine the CA-CDS, we interviewed 24 clinicians from 4 EDs about their interactions with the prototype. Interview transcripts were coded and analyzed using conventional content analysis. Results: Overall, 5 main categories of themes emerged from the study. CA-CDS benefits included providing an extra layer of protection, providing evidence-based recommendations, and alerting the entire clinical ED team. The user-centered, workflow-compatible design included soft-stop alert configuration, editable and automatic documentation, and attention-grabbing formatting. Recommendations for improvement included consolidating content, clearer design elements, and adding a hyperlink with additional resources. Barriers to future implementation included alert fatigue, hesitancy to change, and concerns regarding documentation. Facilitators of future implementation included stakeholder buy-in, provider education, and sharing the test characteristics. On the basis of user feedback, iterative modifications were made to the prototype. Conclusions: With its user-centered design and evidence-based content, the CA-CDS can aid providers in the real-time recognition and evaluation of infant physical abuse and has the potential to reduce the number of missed cases. ",
doi="10.2196/51058",
url="https://www.jmir.org/2024/1/e51058",
url="http://www.ncbi.nlm.nih.gov/pubmed/38551639"
}


@Article{info:doi/10.2196/55039,
author="Shrier, A. Lydia
and O'Connell, M. Madison
and Torres, Alessandra
and Shone, P. Laura
and Fiks, G. Alexander
and Plumb, A. Julia
and Maturo, L. Jessica
and McCaskill, H. Nicholas
and Harris, Donna
and Burke, J. Pamela
and Felt, Thatcher
and Murphy, Lynd Marie
and Sherritt, Lon
and Harris, Kim Sion",
title="Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="26",
volume="13",
pages="e55039",
keywords="alcohol",
keywords="substance use",
keywords="adolescent",
keywords="primary care",
keywords="prevention",
keywords="intervention",
keywords="screening",
keywords="brief intervention",
keywords="computer-facilitated screening and brief intervention",
keywords="cSBI",
keywords="mobile phone",
abstract="Background: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. Objective: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. Methods: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use--associated health risks. During the visit, intervention clinicians access a computerized summary of the patient's screening results and a tailored counseling script to deliver a motivational interviewing--based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. Results: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. Conclusions: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. Trial Registration: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966 International Registered Report Identifier (IRRID): DERR1-10.2196/55039 ",
doi="10.2196/55039",
url="https://www.researchprotocols.org/2024/1/e55039",
url="http://www.ncbi.nlm.nih.gov/pubmed/38530346"
}


@Article{info:doi/10.2196/52071,
author="Ganeshan, Smitha
and Liu, W. Andrew
and Kroeger, Anne
and Anand, Prerna
and Seefeldt, Richard
and Regner, Alexis
and Vaughn, Diana
and Odisho, Y. Anobel
and Mourad, Michelle",
title="An Electronic Health Record--Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="19",
volume="26",
pages="e52071",
keywords="appointment",
keywords="consultation",
keywords="cost",
keywords="digital health",
keywords="digital tools",
keywords="electronic health record",
keywords="EHR",
keywords="informatics",
keywords="patient access",
keywords="retrospective review",
keywords="revenue",
keywords="self-rescheduling tool",
keywords="self-scheduling",
keywords="waiting time",
abstract="Background: In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician's schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. Objective: We evaluated an electronic health record (EHR)--based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. Methods: In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. Results: From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11\%) were accepted across all departments, and 5399 (8.9\%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95\% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95\% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95\% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95\% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US \$3 million. Conclusions: Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access. ",
doi="10.2196/52071",
url="https://www.jmir.org/2024/1/e52071",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502159"
}


@Article{info:doi/10.2196/53835,
author="Hofner, Michael
and Hurnaus, Patrick
and DiStefano, Dan
and Philip, Shaji
and Kim, Sarah
and Shaw, Julie
and Waring, Chander Avantika",
title="Outcomes of an Asynchronous Care Model for Chronic Conditions in a Diverse Population: 12-Month Retrospective Chart Review Study",
journal="JMIR Diabetes",
year="2024",
month="Mar",
day="13",
volume="9",
pages="e53835",
keywords="asynchronous",
keywords="blood pressure",
keywords="cardiology",
keywords="chronic disease",
keywords="cohort",
keywords="diabetes mellitus therapy",
keywords="diabetes",
keywords="diabetics",
keywords="eHealth",
keywords="e-health",
keywords="HbA1c",
keywords="health disparities",
keywords="heart",
keywords="hemoglobin A1c",
keywords="hypertension therapy",
keywords="hypertension",
keywords="hypertensive",
keywords="remote care",
keywords="retrospective",
keywords="telehealth",
keywords="telemedicine",
keywords="virtual care",
abstract="Background: Diabetes and hypertension are some of the most prevalent and costly chronic conditions in the United States. However, outcomes continue to lag behind targets, creating further risk of long-term complications, morbidity, and mortality for people living with these conditions. Furthermore, racial and ethnic disparities in glycemic and hypertension control persist. Flexible telehealth programs leveraging asynchronous care allow for increased provider access and more convenient follow-up, ultimately improving critical health outcomes across demographic groups. Objective: We aim to evaluate the 12-month clinical outcomes of participants in the 9amHealth web-based clinic for diabetes and hypertension. We hypothesized that participation in the 9amHealth program would be associated with significant improvements in glycemic and blood pressure (BP) control across a diverse group of individuals. Methods: We enrolled 95 patients in a completely web-based care clinic for diabetes and hypertension who received nutrition counseling, health coaching, and asynchronous physician consultations for medication prescribing. Patients received standard or cellular-connected glucose meters and BP cuffs in order to share data. Laboratory tests were completed either with at-home phlebotomy draws or a self-administered test kit. Patients' first and last hemoglobin A1c (HbA1c) and BP results over the 12-month period were compared, and analyses were repeated across race and ethnicity groups. Results: Among all 95 patients, the average HbA1c decreased by --1.0 (from 8.2\% to 7.2\%; P<.001) over 12 months of program participation. In those with a baseline HbA1c >8\%, the average HbA1c decreased by --2.1 (from 10.2\% to 8.1\%; P<.001), and in those with a baseline HbA1c >9\%, the average HbA1c decreased by --2.8 (from 11\% to 8.2\%; P<.001). Among participants who identified as a race or ethnicity other than White, the HbA1c decreased by --1.2 (from 8.6\% to 7.4\%, P=.001). Further examination of subgroups confirmed HbA1c lowering within each race or ethnicity group. In the overall population, the average systolic BP decreased by 17.7 mm Hg (P=.006) and the average diastolic BP decreased by 14.3 mm Hg (P=.002). Among participants self-identifying as a race or ethnicity other than White, the results similarly showed a decrease in BP (average reduction in systolic BP of 10 mm Hg and in diastolic BP of 9 mm Hg). Conclusions: A fully web-based model leveraging all-asynchronous physician review and prescribing, combined with synchronous and asynchronous coaching and nutrition support, was associated with clinically meaningful improvement in HbA1c and BP control over a 12-month period among a diverse group of individuals. Further studies should prospectively evaluate the effectiveness of such models among larger populations, assess the longer-term sustainability of these outcomes, and explore financial models to make these types of programs broadly accessible. ",
doi="10.2196/53835",
url="https://diabetes.jmir.org/2024/1/e53835",
url="http://www.ncbi.nlm.nih.gov/pubmed/38363585"
}


@Article{info:doi/10.2196/51311,
author="McCartney, Haruno
and Main, Ashleigh
and Ibrar, Maryam
and Rai, Kaur Harleen
and Weir, McFayden Natalie
and Maguire, Roma",
title="Professional-Facing Digital Health Solutions for the Care of Patients With Chronic Pain: Protocol for a Systematic Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="5",
volume="13",
pages="e51311",
keywords="burden",
keywords="chronic pain",
keywords="clinician",
keywords="digital health solution",
keywords="digital health",
keywords="digital solutions",
keywords="eHealth",
keywords="healthcare professional",
keywords="mHealth",
keywords="pain management",
keywords="patient-facing",
keywords="risk factor",
abstract="Background: Chronic pain is a highly prevalent condition and one of the most common reasons why people seek health care. As a result, chronic pain has a significant personal and economic burden. The COVID-19 pandemic has aggravated the situation for patients with chronic pain through increased risk factors (eg, anxiety or depression) as well as decreased access to health care. Digital health solutions to support people with chronic pain are becoming increasingly popular. Most of the research has focused on patient-facing digital health solutions, although it is clear that the involvement of health and care professionals is crucial in chronic pain care. Certainly, digital health solutions intended for the use of health and care professionals in the care of patients with chronic pain (ie, professional facing) exist, for example, for clinical decision support; however, no review has investigated the studies reporting these interventions. Objective: The overall aim of this scoping review is to identify the available professional-facing digital health solutions for the purpose of chronic pain management. The objectives of this review are to investigate the components, target populations, and user settings of the available professional-facing digital solutions; health and care professionals' perspectives on using digital health solutions (if reported); the methods in which the digital health solutions are developed; and the outcomes of using professional-facing digital health solutions. Methods: Databases including MEDLINE, Embase, CINAHL, PsycInfo, and Inspec will be searched for studies reporting professional-facing digital health solutions for chronic pain care, using a comprehensive search strategy developed for each of the specific databases. A total of 2 independent reviewers will screen the titles and abstracts for review inclusion and then conduct full-text screening. Any conflicts in study inclusion will be resolved by a third reviewer at each stage of the screening process. Following data extraction and quality assessment, a qualitative content analysis of the results will be conducted. This review will identify the available professional-facing digital health solutions for chronic pain management. The results of this review are likely to be heterogeneous in terms of content (ie, the digital solutions will serve a variety of purposes, settings, target populations, etc) and methods (ie, experimental and nonexperimental designs). Results: The review is expected to finish in March 2024 and published in the summer of 2024. Conclusions: This protocol outlines the need for a scoping review to identify professional-facing digital health solutions for the management of chronic pain. Results from this review will contribute to the growing field of research into the utility of digital health for chronic pain management. International Registered Report Identifier (IRRID): DERR1-10.2196/51311 ",
doi="10.2196/51311",
url="https://www.researchprotocols.org/2024/1/e51311",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441946"
}


@Article{info:doi/10.2196/50090,
author="Bargeri, Silvia
and Castellini, Greta
and Vitale, Antonino Jacopo
and Guida, Stefania
and Banfi, Giuseppe
and Gianola, Silvia
and Pennestr{\`i}, Federico",
title="Effectiveness of Telemedicine for Musculoskeletal Disorders: Umbrella Review",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="2",
volume="26",
pages="e50090",
keywords="telemedicine",
keywords="systematic review",
keywords="patient-reported outcomes measures",
keywords="PROMs",
keywords="patient-reported experience measures",
keywords="PREMs",
keywords="rehabilitation",
keywords="musculoskeletal disorder",
keywords="condition",
keywords="musculoskeletal",
keywords="patient-reported",
keywords="telerehabilitation",
keywords="orthopedics",
keywords="meta-analyses",
keywords="osteoarthritis",
keywords="accessibility",
keywords="health care",
abstract="Background: Several systematic reviews (SRs) assessing the use of telemedicine for musculoskeletal conditions have been published in recent years. However, the landscape of evidence on multiple clinical outcomes remains unclear. Objective: We aimed to summarize the available evidence from SRs on telemedicine for musculoskeletal disorders. Methods: We conducted an umbrella review of SRs with and without meta-analysis by searching PubMed and EMBASE up to July 25, 2022, for SRs of randomized controlled trials assessing telemedicine. We collected any kind of patient-reported outcome measures (PROMs), patient-reported experience measures (PREMs), and objective measures, including direct and indirect costs. We assessed the methodological quality with the AMSTAR 2 tool (A Measurement Tool to Assess systematic Reviews 2). Findings were reported qualitatively. Results: Overall, 35 SRs published between 2015 and 2022 were included. Most reviews (n=24, 69\%) were rated as critically low quality by AMSTAR 2. The majority of reviews assessed ``telerehabilitation'' (n=29) in patients with osteoarthritis (n=13) using PROMs (n=142 outcomes mapped with n=60 meta-analyses). A substantive body of evidence from meta-analyses found telemedicine to be beneficial or equal in terms of PROMs compared to conventional care (n=57 meta-analyses). Meta-analyses showed no differences between groups in PREMs (n=4), while objectives measures (ie, ``physical function'') were mainly in favor of telemedicine or showed no difference (9/13). All SRs showed notably lower costs for telemedicine compared to in-person visits. Conclusions: Telemedicine can provide more accessible health care with noninferior results for various clinical outcomes in comparison with conventional care. The assessment of telemedicine is largely represented by PROMs, with some gaps for PREMs, objective measures, and costs. Trial Registration: PROSPERO CRD42022347366; https://osf.io/pxedm/ ",
doi="10.2196/50090",
url="https://www.jmir.org/2024/1/e50090",
url="http://www.ncbi.nlm.nih.gov/pubmed/38306156"
}


@Article{info:doi/10.2196/45209,
author="Amar, Fouzia
and April, Alain
and Abran, Alain",
title="Electronic Health Record and Semantic Issues Using Fast Healthcare Interoperability Resources: Systematic Mapping Review",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="30",
volume="26",
pages="e45209",
keywords="electronic health record",
keywords="EHR",
keywords="Health Level Seven International Fast Healthcare Interoperability Resources",
keywords="HL7 FHIR",
keywords="interoperability, web ontology language",
keywords="OWL",
keywords="ontology",
keywords="semantic",
keywords="terminology",
keywords="resource description framework",
keywords="RDF",
keywords="machine learning",
keywords="ML",
keywords="natural language processing",
keywords="NLP",
abstract="Background: The increasing use of electronic health records and the Internet of Things has led to interoperability issues at different levels (structural and semantic). Standards are important not only for successfully exchanging data but also for appropriately interpreting them (semantic interoperability). Thus, to facilitate the semantic interoperability of data exchanged in health care, considerable resources have been deployed to improve the quality of shared clinical data by structuring and mapping them to the Fast Healthcare Interoperability Resources (FHIR) standard. Objective: The aims of this study are 2-fold: to inventory the studies on FHIR semantic interoperability resources and terminologies and to identify and classify the approaches and contributions proposed in these studies. Methods: A systematic mapping review (SMR) was conducted using 10 electronic databases as sources of information for inventory and review studies published during 2012 to 2022 on the development and improvement of semantic interoperability using the FHIR standard. Results: A total of 70 FHIR studies were selected and analyzed to identify FHIR resource types and terminologies from a semantic perspective. The proposed semantic approaches were classified into 6 categories, namely mapping (31/126, 24.6\%), terminology services (18/126, 14.3\%), resource description framework or web ontology language--based proposals (24/126, 19\%), annotation proposals (18/126, 14.3\%), machine learning (ML) and natural language processing (NLP) proposals (20/126, 15.9\%), and ontology-based proposals (15/126, 11.9\%). From 2012 to 2022, there has been continued research in 6 categories of approaches as well as in new and emerging annotations and ML and NLP proposals. This SMR also classifies the contributions of the selected studies into 5 categories: framework or architecture proposals, model proposals, technique proposals, comparison services, and tool proposals. The most frequent type of contribution is the proposal of a framework or architecture to enable semantic interoperability. Conclusions: This SMR provides a classification of the different solutions proposed to address semantic interoperability using FHIR at different levels: collecting, extracting and annotating data, modeling electronic health record data from legacy systems, and applying transformation and mapping to FHIR models and terminologies. The use of ML and NLP for unstructured data is promising and has been applied to specific use case scenarios. In addition, terminology services are needed to accelerate their use and adoption; furthermore, techniques and tools to automate annotation and ontology comparison should help reduce human interaction. ",
doi="10.2196/45209",
url="https://www.jmir.org/2024/1/e45209",
url="http://www.ncbi.nlm.nih.gov/pubmed/38289660"
}


@Article{info:doi/10.2196/50572,
author="Sharma, Pravesh
and Kamath, Celia
and Brockman, A. Tabetha
and Roche, Anne
and Sinicrope, Pamela
and Jiang, Ruoxiang
and Decker, A. Paul
and Pazdernik, Vanessa
and Patten, Christi",
title="Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="24",
volume="8",
pages="e50572",
keywords="digital health",
keywords="telemedicine",
keywords="telehealth",
keywords="video visits",
keywords="appointments",
keywords="SDoH, social determinants of health",
keywords="social determinants",
keywords="appointment",
keywords="users",
keywords="sociodemographic",
keywords="prevention",
keywords="discomfort",
keywords="video communication",
keywords="communication",
keywords="willingness",
keywords="mobile phone",
abstract="Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ?18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, ``Have you ever had a video appointment with a healthcare provider?'' ``Yes'' respondents were defined as ``users'' (adapted to video appointments), and ``no'' respondents were defined as ``persistent nonusers'' of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients' decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients' negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a ``digital health coordinator'' could be assigned to assist with various digital health solutions. ",
doi="10.2196/50572",
url="https://formative.jmir.org/2024/1/e50572",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265855"
}


@Article{info:doi/10.2196/53225,
author="Sezgin, Emre",
title="Redefining Virtual Assistants in Health Care: The Future With Large Language Models",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="19",
volume="26",
pages="e53225",
keywords="large language models",
keywords="voice assistants",
keywords="virtual assistants",
keywords="chatbots",
keywords="conversational agents",
keywords="health care",
doi="10.2196/53225",
url="https://www.jmir.org/2024/1/e53225",
url="http://www.ncbi.nlm.nih.gov/pubmed/38241074"
}


@Article{info:doi/10.2196/50962,
author="Khairat, Saif
and John, Roshan
and Pillai, Malvika
and McDaniel, Philip
and Edson, Barbara",
title="Patient Characteristics Associated With Phone and Video Visits at a Tele-Urgent Care Center During the Initial COVID-19 Response: Cross-Sectional Study",
journal="Online J Public Health Inform",
year="2024",
month="Jan",
day="19",
volume="16",
pages="e50962",
keywords="telehealth",
keywords="telemedicine",
keywords="tele-urgent care",
keywords="virtual urgent care",
keywords="nonemergency care",
keywords="televisit",
keywords="phone visit",
keywords="video visit",
keywords="urgent care",
keywords="health services research",
keywords="COVID-19",
keywords="health disparities",
keywords="insurance status",
keywords="cross-sectional study",
abstract="Background: Health systems rapidly adopted telemedicine as an alternative health care delivery modality in response to the COVID-19 pandemic. Demographic factors, such as age and gender, may play a role in patients' choice of a phone or video visit. However, it is unknown whether there are differences in utilization between phone and video visits. Objective: This study aimed to investigate patients' characteristics, patient utilization, and service characteristics of a tele-urgent care clinic during the initial response to the pandemic. Methods: We conducted a cross-sectional study of urgent care patients using a statewide, on-demand telemedicine clinic with board-certified physicians during the initial phases of the pandemic. The study data were collected from March 3, 2020, through May 3, 2020. Results: Of 1803 telemedicine visits, 1278 (70.9\%) patients were women, 730 (40.5\%) were aged 18 to 34 years, and 1423 (78.9\%) were uninsured. There were significant differences between telemedicine modalities and gender (P<.001), age (P<.001), insurance status (P<.001), prescriptions given (P<.001), and wait times (P<.001). Phone visits provided significantly more access to rural areas than video visits (P<.001). Conclusions: Our findings suggest that offering patients a combination of phone and video options provided additional flexibility for various patient subgroups, particularly patients living in rural regions with limited internet bandwidth. Differences in utilization were significant based on patient gender, age, and insurance status. We also found differences in prescription administration between phone and video visits that require additional investigation. ",
doi="10.2196/50962",
url="https://ojphi.jmir.org/2024/1/e50962",
url="http://www.ncbi.nlm.nih.gov/pubmed/38241073"
}


@Article{info:doi/10.2196/43583,
author="Bazzano, N. Alessandra
and Patel, Tejal
and Nauman, Elizabeth
and Cernigliaro, Dana
and Shi, Lizheng",
title="Optimizing Telehealth for Diabetes Management in the Deep South of the United States: Qualitative Study of Barriers and Facilitators on the Patient and Clinician Journey",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="1",
volume="26",
pages="e43583",
keywords="telemedicine",
keywords="diabetes mellitus",
keywords="chronic disease",
keywords="patient participation",
keywords="delivery of health care",
keywords="COVID-19",
keywords="mobile phone",
abstract="Background: The Deep South of the United States, and Louisiana in particular, bears a greater burden of obesity, diabetes, and heart disease compared with other regions in the United States. Throughout the COVID-19 pandemic, there has been a substantial increase in telehealth visits for diabetes management to protect the safety of patients. Although there have been significant advancements in telehealth and chronic disease management, little is known about patient and provider perspectives on the challenges and benefits of telehealth visits among people living with diabetes and providers who care for patients with diabetes in Louisiana. Objective: This study aimed to explore barriers, facilitators, challenges, and benefits to telehealth for patients with diabetes and health care providers as they transitioned from in-person to remote care during the early COVID-19 pandemic to understand potential optimization. Methods: A total of 24 semistructured qualitative interviews were conducted with 18 patients living with diabetes and 6 clinicians who served patients with diabetes to explore their experiences and perceptions of telehealth services for diabetes care. Approximately half of the participants identified as Black or African American, half as White, and 75\% as female. Interviews were recorded, transcribed, and coded by experienced qualitative researchers using inductive and deductive techniques. A narrative, descriptive approach to the patient and clinician journey framed the study, including the development of internal journey maps, and reflexive thematic analysis was applied to the transcripts, with special attention to barriers and facilitators. Results: In total, 5 themes illustrated barriers and facilitators for participants: convenience, safety, and comfort are the benefits of telehealth for patients and clinicians; yet telehealth and in-person visits are valued differently; the convenience of telehealth may have a downside; technology acts as a double-edged sword; and managing expectations and efficiency of the visit experience was an important factor. Individual experiences varied in relation to several factors, including comfort level and access to technology, health system protocols for providing telemedicine, and level of diabetes control among patients. Conclusions: Recommendations for optimization include providing support to help guide and inform patients about what to expect and how to prepare for telehealth visits as well as allowing clinicians to schedule telehealth and in-person visits during discrete blocks of time to improve efficiency. Further research should address how hybrid models of telehealth and in-person care may differentially impact health outcomes for patients with diabetes, particularly for people with multiple chronic conditions in settings where access to technology and connectivity is not optimal. ",
doi="10.2196/43583",
url="https://www.jmir.org/2024/1/e43583",
url="http://www.ncbi.nlm.nih.gov/pubmed/37976468"
}


@Article{info:doi/10.2196/50342,
author="He, Xin
and Zheng, Xi
and Ding, Huiyuan",
title="Existing Barriers Faced by and Future Design Recommendations for Direct-to-Consumer Health Care Artificial Intelligence Apps: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="18",
volume="25",
pages="e50342",
keywords="artificial intelligence",
keywords="medical",
keywords="health care",
keywords="consumer",
keywords="consumers",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="DTC",
keywords="direct to consumer",
keywords="barrier",
keywords="barriers",
keywords="implementation",
keywords="design",
keywords="scoping",
keywords="review methods",
keywords="review methodology",
abstract="Background: Direct-to-consumer (DTC) health care artificial intelligence (AI) apps hold the potential to bridge the spatial and temporal disparities in health care resources, but they also come with individual and societal risks due to AI errors. Furthermore, the manner in which consumers interact directly with health care AI is reshaping traditional physician-patient relationships. However, the academic community lacks a systematic comprehension of the research overview for such apps. Objective: This paper systematically delineated and analyzed the characteristics of included studies, identified existing barriers and design recommendations for DTC health care AI apps mentioned in the literature and also provided a reference for future design and development. Methods: This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines and was conducted according to Arksey and O'Malley's 5-stage framework. Peer-reviewed papers on DTC health care AI apps published until March 27, 2023, in Web of Science, Scopus, the ACM Digital Library, IEEE Xplore, PubMed, and Google Scholar were included. The papers were analyzed using Braun and Clarke's reflective thematic analysis approach. Results: Of the 2898 papers retrieved, 32 (1.1\%) covering this emerging field were included. The included papers were recently published (2018-2023), and most (23/32, 72\%) were from developed countries. The medical field was mostly general practice (8/32, 25\%). In terms of users and functionalities, some apps were designed solely for single-consumer groups (24/32, 75\%), offering disease diagnosis (14/32, 44\%), health self-management (8/32, 25\%), and health care information inquiry (4/32, 13\%). Other apps connected to physicians (5/32, 16\%), family members (1/32, 3\%), nursing staff (1/32, 3\%), and health care departments (2/32, 6\%), generally to alert these groups to abnormal conditions of consumer users. In addition, 8 barriers and 6 design recommendations related to DTC health care AI apps were identified. Some more subtle obstacles that are particularly worth noting and corresponding design recommendations in consumer-facing health care AI systems, including enhancing human-centered explainability, establishing calibrated trust and addressing overtrust, demonstrating empathy in AI, improving the specialization of consumer-grade products, and expanding the diversity of the test population, were further discussed. Conclusions: The booming DTC health care AI apps present both risks and opportunities, which highlights the need to explore their current status. This paper systematically summarized and sorted the characteristics of the included studies, identified existing barriers faced by, and made future design recommendations for such apps. To the best of our knowledge, this is the first study to systematically summarize and categorize academic research on these apps. Future studies conducting the design and development of such systems could refer to the results of this study, which is crucial to improve the health care services provided by DTC health care AI apps. ",
doi="10.2196/50342",
url="https://www.jmir.org/2023/1/e50342",
url="http://www.ncbi.nlm.nih.gov/pubmed/38109173"
}


@Article{info:doi/10.2196/49996,
author="Siqueira do Prado, Luiza
and Allemann, Samuel
and Viprey, Marie
and Schott, Anne-Marie
and Dediu, Dan
and Dima, Lelia Alexandra",
title="Toward an Interdisciplinary Approach to Constructing Care Delivery Pathways From Electronic Health Care Databases to Support Integrated Care in Chronic Conditions: Systematic Review of Quantification and Visualization Methods",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="14",
volume="25",
pages="e49996",
keywords="long-term care",
keywords="electronic health care databases",
keywords="patient pathway",
keywords="data visualization",
keywords="systematic review",
abstract="Background: Electronic health care databases are increasingly used for informing clinical decision-making. In long-term care, linking and accessing information on health care delivered by different providers could improve coordination and health outcomes. Several methods for quantifying and visualizing this information into data-driven care delivery pathways (CDPs) have been proposed. To be integrated effectively and sustainably into routine care, these methods need to meet a range of prerequisites covering 3 broad domains: clinical, technological, and behavioral. Although advances have been made, development to date lacks a comprehensive interdisciplinary approach. As the field expands, it would benefit from developing common standards of development and reporting that integrate clinical, technological, and behavioral aspects. Objective: We aimed to describe the content and development of long-term CDP quantification and visualization methods and to propose recommendations for future work. Methods: We conducted a systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations. We searched peer-reviewed publications in English and reported the CDP methods by using the following data in the included studies: long-term care data and extracted data on clinical information and aims, technological development and characteristics, and user behaviors. The data are summarized in tables and presented narratively. Results: Of the 2921 records identified, 14 studies were included, of which 13 (93\%) were descriptive reports and 1 (7\%) was a validation study. Clinical aims focused primarily on treatment decision-making (n=6, 43\%) and care coordination (n=7, 50\%). Technological development followed a similar process from scope definition to tool validation, with various levels of detail in reporting. User behaviors (n=3, 21\%) referred to accessing CDPs, planning care, adjusting treatment, or supporting adherence. Conclusions: The use of electronic health care databases for quantifying and visualizing CDPs in long-term care is an emerging field. Detailed and standardized reporting of clinical and technological aspects is needed. Early consideration of how CDPs would be used, validated, and implemented in clinical practice would likely facilitate further development and adoption. Trial Registration: PROSPERO CRD42019140494; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=140494 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033573 ",
doi="10.2196/49996",
url="https://www.jmir.org/2023/1/e49996",
url="http://www.ncbi.nlm.nih.gov/pubmed/38096009"
}


@Article{info:doi/10.2196/45364,
author="Pereira, Margarida Ana
and J{\'a}come, Cristina
and Jacinto, Tiago
and Amaral, Rita
and Pereira, Mariana
and S{\'a}-Sousa, Ana
and Couto, Mariana
and Vieira-Marques, Pedro
and Martinho, Diogo
and Vieira, Ana
and Almeida, Ana
and Martins, Constantino
and Marreiros, Goreti
and Freitas, Alberto
and Almeida, Rute
and Fonseca, A. Jo{\~a}o",
title="Multidisciplinary Development and Initial Validation of a Clinical Knowledge Base on Chronic Respiratory Diseases for mHealth Decision Support Systems",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="13",
volume="25",
pages="e45364",
keywords="knowledge base",
keywords="recommendations",
keywords="personalization",
keywords="clinical decision support system",
keywords="chronic obstructive respiratory diseases",
keywords="mobile phone",
doi="10.2196/45364",
url="https://www.jmir.org/2023/1/e45364",
url="http://www.ncbi.nlm.nih.gov/pubmed/38090790"
}


@Article{info:doi/10.2196/48981,
author="Ramjee, Serena
and Mohamedthani, Hanen
and Patel, Umeshkumar Aditya
and Goiriz, Rebeca
and Harwood, A. Catherine
and Osborne, H. Richard
and Cheng, Christina
and Hasan, Zeeshaan-ul",
title="The Effect of Remote Digital Services on Health Care Inequalities Among People Under Long-Term Dermatology Follow-Up: Cross-Sectional Questionnaire Study",
journal="JMIR Dermatol",
year="2023",
month="Dec",
day="8",
volume="6",
pages="e48981",
keywords="dermatology",
keywords="health literacy",
keywords="digital health literacy",
keywords="digital literacy",
keywords="skin",
keywords="chronic",
keywords="cluster analysis",
keywords="innovation",
keywords="eHealth literacy",
keywords="dermatologists",
keywords="telehealth",
keywords="dermatologist",
keywords="telemedicine",
keywords="remote care",
keywords="service",
keywords="services",
keywords="quality improvement",
abstract="Background: Given the expansion of remote digital dermatology services from the National Health Service, particularly during the COVID-19 pandemic, there is a need for methods that identify patients at risk of digital exclusion to guide equitable representation in service co-design processes and tailor remote services to the needs of their patient population. Objective: This quality improvement project aims to inform the redesign of remote services to optimally support the ongoing needs of patients with chronic skin diseases, ensuring that the services are tailored to patients' digital health literacy requirements. Methods: We profiled the digital health literacy of 123 people with chronic skin conditions who require long-term surveillance in 2 specialist clinics (London, United Kingdom) using the Multidimensional Readiness and Enablement Index for Health Technology (READHY) questionnaire alongside the Optimizing Health Literacy and Access (Ophelia) process for hierarchical cluster analysis. Results: The cluster analysis of READHY dimensions in responding participants (n=116) revealed 7 groups with distinct digital and health literacy characteristics. High READHY scores in groups 1 (n=22, 19\%) and 2 (n=20, 17.2\%) represent those who are confident with managing their health and using technology, whereas the lower-scoring groups, 6 (n=4, 3.4\%) and 7 (n=12, 10.3\%), depended on traditional services. Groups 3 (n=27, 23.3\%), 4 (n=23, 19.8\%), and 5 (n=8, 6.9\%) had varying digital skills, access, and engagement, highlighting a population that may benefit from a co-designed dermatology service. Conclusions: By identifying patient groups with distinguishable patterns of digital access and health literacy, our method demonstrates that 63.8\% (n=74) of people attending specialist clinics in our center require support in order to optimize remote follow-up or need an alternative approach. Future efforts should streamline the READHY question profile to improve its practicality and use focus groups to elicit strategies for engaging patients with digital services. ",
doi="10.2196/48981",
url="https://derma.jmir.org/2023/1/e48981",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064259"
}


@Article{info:doi/10.2196/49639,
author="Matthias, Katja
and Honekamp, Ivonne
and Heinrich, Monique
and De Santis, Karolina Karina",
title="Consideration of Sex, Gender, or Age on Outcomes of Digital Technologies for Treatment and Monitoring of Chronic Obstructive Pulmonary Disease: Overview of Systematic Reviews",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="29",
volume="25",
pages="e49639",
keywords="digital technologies",
keywords="digital intervention",
keywords="COPD",
keywords="AMSTAR 2",
keywords="chronic obstructive pulmonary disease",
keywords="gender",
keywords="sex",
keywords="age",
keywords="overview",
keywords="systematic review",
keywords="treatment",
keywords="monitoring",
keywords="chronic disease",
keywords="chronic illness",
keywords="outcome reporting",
keywords="review methodology",
keywords="critical appraisal",
abstract="Background: Several systematic reviews have addressed digital technology use for treatment and monitoring of chronic obstructive pulmonary disease (COPD). Objective: This study aimed to assess if systematic reviews considered the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD through an overview of such systematic reviews. The objectives of this overview were to (1) describe the definitions of sex or gender used in reviews; (2) determine whether the consideration of sex, gender, or age was planned in reviews; (3) determine whether sex, gender, or age was reported in review results; (4) determine whether sex, gender, or age was incorporated in implications for clinical practice in reviews; and (5) create an evidence map for development of individualized clinical recommendations for COPD based on sex, gender, or age diversity. Methods: MEDLINE, the Cochrane Library, Epistemonikos, Web of Science, and the bibliographies of the included systematic reviews were searched to June 2022. Inclusion was based on the PICOS framework: (1) population (COPD), (2) intervention (any digital technology), (3) comparison (any), (4) outcome (any), and (5) study type (systematic review). Studies were independently selected by 2 authors based on title and abstract and full-text screening. Data were extracted by 1 author and checked by another author. Data items included systematic review characteristics; PICOS criteria; and variables related to sex, gender, or age. Systematic reviews were appraised using A Measurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2). Data were synthesized using descriptive statistics. Results: Of 1439 records, 30 systematic reviews published between 2010 and 2022 were included in this overview. The confidence in the results of 25 of the 30 (83\%) reviews was critically low according to AMSTAR 2. The reviews focused on user outcomes that potentially depend on sex, gender, or age, such as efficacy or effectiveness (25/30, 83\%) and acceptance, satisfaction, or adherence (3/30, 10\%) to digital technologies for COPD. Reviews reported sex or gender (19/30 systematic reviews) or age (25/30 systematic reviews) among primary study characteristics. However, only 1 of 30 reviews included age in a subgroup analysis, and 3 of 30 reviews identified the effects of sex, gender, or age as evidence gaps. Conclusions: This overview shows that the effects of sex, gender, or age were rarely considered in 30 systematic reviews of digital technologies for COPD treatment and monitoring. Furthermore, systematic reviews did not incorporate sex, gender, nor age in their implications for clinical practice. We recommend that future systematic reviews should (1) evaluate the effects of sex, gender, or age on the outcomes of digital technologies for treatment and monitoring of COPD and (2) better adhere to reporting guidelines to improve the confidence in review results. Trial Registration: PROSPERO CRD42022322924; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=322924 International Registered Report Identifier (IRRID): RR2-10.2196/40538 ",
doi="10.2196/49639",
url="https://www.jmir.org/2023/1/e49639/"
}


@Article{info:doi/10.2196/50886,
author="Bibi, Igor
and Schaffert, Daniel
and Blauth, Mara
and Lull, Christian
and von Ahnen, Alwin Jan
and Gross, Georg
and Weigandt, Alexander Wanja
and Knitza, Johannes
and Kuhn, Sebastian
and Benecke, Johannes
and Leipe, Jan
and Schmieder, Astrid
and Olsavszky, Victor",
title="Automated Machine Learning Analysis of Patients With Chronic Skin Disease Using a Medical Smartphone App: Retrospective Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="28",
volume="25",
pages="e50886",
keywords="automated machine learning",
keywords="psoriasis",
keywords="hand and foot eczema",
keywords="medical smartphone app",
keywords="application",
keywords="smartphone",
keywords="machine learning",
keywords="digitalization",
keywords="skin",
keywords="skin disease",
keywords="use",
keywords="hand",
keywords="foot",
keywords="mobile phone",
abstract="Background: Rapid digitalization in health care has led to the adoption of digital technologies; however, limited trust in internet-based health decisions and the need for technical personnel hinder the use of smartphones and machine learning applications. To address this, automated machine learning (AutoML) is a promising tool that can empower health care professionals to enhance the effectiveness of mobile health apps. Objective: We used AutoML to analyze data from clinical studies involving patients with chronic hand and/or foot eczema or psoriasis vulgaris who used a smartphone monitoring app. The analysis focused on itching, pain, Dermatology Life Quality Index (DLQI) development, and app use. Methods: After extensive data set preparation, which consisted of combining 3 primary data sets by extracting common features and by computing new features, a new pseudonymized secondary data set with a total of 368 patients was created. Next, multiple machine learning classification models were built during AutoML processing, with the most accurate models ultimately selected for further data set analysis. Results: Itching development for 6 months was accurately modeled using the light gradient boosted trees classifier model (log loss: 0.9302 for validation, 1.0193 for cross-validation, and 0.9167 for holdout). Pain development for 6 months was assessed using the random forest classifier model (log loss: 1.1799 for validation, 1.1561 for cross-validation, and 1.0976 for holdout). Then, the random forest classifier model (log loss: 1.3670 for validation, 1.4354 for cross-validation, and 1.3974 for holdout) was used again to estimate the DLQI development for 6 months. Finally, app use was analyzed using an elastic net blender model (area under the curve: 0.6567 for validation, 0.6207 for cross-validation, and 0.7232 for holdout). Influential feature correlations were identified, including BMI, age, disease activity, DLQI, and Hospital Anxiety and Depression Scale-Anxiety scores at follow-up. App use increased with BMI >35, was less common in patients aged >47 years and those aged 23 to 31 years, and was more common in those with higher disease activity. A Hospital Anxiety and Depression Scale-Anxiety score >8 had a slightly positive effect on app use. Conclusions: This study provides valuable insights into the relationship between data characteristics and targeted outcomes in patients with chronic eczema or psoriasis, highlighting the potential of smartphone and AutoML techniques in improving chronic disease management and patient care. ",
doi="10.2196/50886",
url="https://www.jmir.org/2023/1/e50886",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015608"
}


@Article{info:doi/10.2196/43572,
author="Jeong, Hyunwoo
and Choi, Yonsu
and Kim, Heejung",
title="Nonface-to-Face Visitation to Restrict Patient Visits for Infection Control: Integrative Review",
journal="Interact J Med Res",
year="2023",
month="Nov",
day="28",
volume="12",
pages="e43572",
keywords="nonface-to-face visitation",
keywords="visit restriction",
keywords="infection control",
keywords="patient",
keywords="family",
abstract="Background: In the COVID-19 pandemic, a visit restriction policy for patients has been implemented in medical institutions worldwide and visits are being made using alternative communication technologies. This shift has also required the use of platforms to prevent negative consequences of these restrictions. Objective: The purpose of this review was to comprehensively explore nonface-to-face visits as an alternative during infection prevention and to synthesize the scientific evidence of their benefits and disadvantages. Methods: A comprehensive search was conducted via the PubMed, Embase, CINAHL, Cochrane, and Web of Science electronic databases; unpublished trials in the clinical trials register ClinicalTrials.gov; and Virginia Henderson International Nursing Library up to September 10, 2021. The search query was developed according to the guidelines of the Peer Review of Electronic Search Strategies and included keywords on the topics of telemedicine and visitation restrictions. The inclusion criteria were a nonface-to-face modality using telemedicine with family in a hospital setting, experimental and observational studies, and articles written in English. The exclusion criteria were inaccessible in full text, not related to patient or family involvement, mainly focused on the study protocol, or only discussing the pros and cons of telemedicine. Results: Overall, patients' families experienced emotional distress due to restrictions on face-to-face visits. Nonface-to-face virtual visits compensating for these restrictions had a positive effect on reducing the risk of infection to the patient and the family. This further encouraged psychological and physical recovery and decreased psychological distress. However, nonface-to-face virtual technology could not replace the existence of actual families, and technical problems with networks and devices are reported as limitations. Conclusions: Ensuring the availability of technology and educating on the same in alignment with the characteristics of patients and their families, nonface-to-face virtual visits need to show more potential as an effective patient-centered treatment strategy based on more research and advanced practice. ",
doi="10.2196/43572",
url="https://www.i-jmr.org/2023/1/e43572",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015595"
}


@Article{info:doi/10.2196/45215,
author="Braund, Heather
and Dalgarno, Nancy
and Chan-Nguyen, Sophy
and Digby, Genevi{\`e}ve
and Haji, Faizal
and O'Riordan, Anne
and Appireddy, Ramana",
title="Exploring Patient Advisors' Perceptions of Virtual Care Across Canada: Qualitative Phenomenological Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="23",
volume="25",
pages="e45215",
keywords="virtual care",
keywords="patient-oriented research",
keywords="patient advisor",
keywords="remote care",
keywords="telehealth",
keywords="telemedicine",
keywords="phenomenology",
keywords="phenomenological",
keywords="perception",
keywords="qualitative",
abstract="Background: While virtual care services existed prior to the emergence of COVID-19, the pandemic catalyzed a rapid transition from in-person to virtual care service delivery across the Canadian health care system. Virtual care includes synchronous or asynchronous delivery of health care services through video visits, telephone visits, or secure messaging. Patient advisors are people with patient and caregiving experiences who collaborate within the health care system to share insights and experiences in order to improve health care. Objective: This study aimed to understand patient advisors' perceptions related to virtual care and potential impacts on health care quality. Methods: We adopted a phenomenological approach, whereby we interviewed 20 participants who were patient advisors across Canada using a semistructured interview protocol. The protocol was developed by content experts and medical education researchers. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Data collection stopped once thematic saturation was reached. The study was conducted at Queen's University, Kingston, Ontario. We recruited 20 participants from 5 Canadian provinces (17 female participants and 3 male participants). Results: Six themes were identified: (1) characteristics of effective health care, (2) experiences with virtual care, (3) modality preferences, (4) involvement of others, (5) risks associated with virtual care encounters, and (6) vulnerable populations. Participants reported that high-quality health care included building relationships and treating patients holistically. In general, participants described positive experiences with virtual care during the pandemic, including greater efficiency, increased accessibility, and that virtual care was less stressful and more patient centered. Participants comparing virtual care with in-person care reported that time, scheduling, and content of interactions were similar across modalities. However, participants also shared the perception that certain modalities were more appropriate for specific clinical encounters (eg, prescription renewals and follow-up appointments). Perspectives related to the involvement of family members and medical trainees were positive. Potential risks included miscommunication, privacy concerns, and inaccurate patient assessments. All participants agreed that stakeholders should be proactive in applying strategies to support vulnerable patients. Participants also recommended education for patients and providers to improve virtual care delivery. Conclusions: Participant-reported experiences of virtual care encounters were relatively positive. Future work could focus on delivering training and resources for providers and patients. While initial experiences are positive, there is a need for ongoing stakeholder engagement and evaluation to improve patient and caregiver experiences with virtual care. ",
doi="10.2196/45215",
url="https://www.jmir.org/2023/1/e45215",
url="http://www.ncbi.nlm.nih.gov/pubmed/37995127"
}


@Article{info:doi/10.2196/49204,
author="Hirten, P. Robert
and Danieletto, Matteo
and Landell, Kyle
and Zweig, Micol
and Golden, Eddye
and Orlov, Georgy
and Rodrigues, Jovita
and Alleva, Eugenia
and Ensari, Ipek
and Bottinger, Erwin
and Nadkarni, N. Girish
and Fuchs, J. Thomas
and Fayad, A. Zahi",
title="Development of the ehive Digital Health App: Protocol for a Centralized Research Platform",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="16",
volume="12",
pages="e49204",
keywords="digital health",
keywords="wearable devices",
keywords="research platform",
keywords="eHive",
keywords="smartphone",
keywords="wearables",
keywords="digital technologies",
keywords="digital study",
keywords="multimodal data collection",
keywords="framework",
keywords="development",
keywords="centralized digital research platform",
keywords="ehive app",
keywords="mobile phone",
abstract="Background: The increasing use of smartphones, wearables, and connected devices has enabled the increasing application of digital technologies for research. Remote digital study platforms comprise a patient-interfacing digital application that enables multimodal data collection from a mobile app and connected sources. They offer an opportunity to recruit at scale, acquire data longitudinally at a high frequency, and engage study participants at any time of the day in any place. Few published descriptions of centralized digital research platforms provide a framework for their development. Objective: This study aims to serve as a road map for those seeking to develop a centralized digital research platform. We describe the technical and functional aspects of the ehive app, the centralized digital research platform of the Hasso Plattner Institute for Digital Health at Mount Sinai Hospital, New York, New York. We then provide information about ongoing studies hosted on ehive, including usership statistics and data infrastructure. Finally, we discuss our experience with ehive in the broader context of the current landscape of digital health research platforms. Methods: The ehive app is a multifaceted and patient-facing central digital research platform that permits the collection of e-consent for digital health studies. An overview of its development, its e-consent process, and the tools it uses for participant recruitment and retention are provided. Data integration with the platform and the infrastructure supporting its operations are discussed; furthermore, a description of its participant- and researcher-facing dashboard interfaces and the e-consent architecture is provided. Results: The ehive platform was launched in 2020 and has successfully hosted 8 studies, namely 6 observational studies and 2 clinical trials. Approximately 1484 participants downloaded the app across 36 states in the United States. The use of recruitment methods such as bulk messaging through the EPIC electronic health records and standard email portals enables broad recruitment. Light-touch engagement methods, used in an automated fashion through the platform, maintain high degrees of engagement and retention. The ehive platform demonstrates the successful deployment of a central digital research platform that can be modified across study designs. Conclusions: Centralized digital research platforms such as ehive provide a novel tool that allows investigators to expand their research beyond their institution, engage in large-scale longitudinal studies, and combine multimodal data streams. The ehive platform serves as a model for groups seeking to develop similar digital health research programs. International Registered Report Identifier (IRRID): DERR1-10.2196/49204 ",
doi="10.2196/49204",
url="https://www.researchprotocols.org/2023/1/e49204",
url="http://www.ncbi.nlm.nih.gov/pubmed/37971801"
}


@Article{info:doi/10.2196/50643,
author="Shin, Danielle Hwayeon
and Zaheer, Juveria
and Torous, John
and Strudwick, Gillian",
title="Designing Implementation Strategies for a Digital Suicide Safety Planning Intervention in a Psychiatric Emergency Department: Protocol for a Multimethod Research Project",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="9",
volume="12",
pages="e50643",
keywords="implementation science",
keywords="suicide prevention",
keywords="eHealth",
keywords="mental health",
keywords="health informatics",
keywords="integrated knowledge translation",
keywords="co-design",
keywords="research protocol",
keywords="mobile phone",
abstract="Background: Suicide prevention is currently a national health priority in Canada. Emergency departments (EDs) are critical settings for suicide prevention, and in our local psychiatric ED at the Centre for Addiction and Mental Health, we plan to embed an app-based tool called the Hope app to support suicide safety planning intervention. The app is free and available on app stores, and usability tests have been completed. As a next step to embed this new tool into the routine clinical workflow, research is needed to assess determinants of and design strategies for implementation with the end goal of routinization. Objective: The purpose of this 2-phased research is to implement the app in the routine clinical workflow in our local psychiatric ED. The specific objectives are as follows: (1) understanding ED clinicians' perceptions and experience of implementing the app in routine practice and identifying barriers to and facilitators of implementation (phase 1) and (2) using findings and outputs from phase 1 and collaborating with service users, families, and ED clinicians to co-design implementation strategies for the app (phase 2). Methods: We will use an integrated knowledge translation approach throughout this project. In phase 1, we will conduct interviews with ED clinicians to identify implementation determinants using a behavior change framework. In phase 2, a co-design team comprising clinicians, ED service users, and families will design implementation strategies that align with the determinants identified in phase 1. Results: This protocol presents detailed information about the entire structure of the 2-phased research project. Ethics approval for conducting the qualitative descriptive study (phase 1) has been obtained, and the recruitment and data collection processes will be completed no later than December 2023. Ethics approval for phase 2 is underway. Conclusions: Involving multiple knowledge user groups early in the research and decision-making process is crucial for successful implementation. Although co-designing is commonly practiced during innovation development, there is often a misconception that the responsibility for implementing what has been designed falls on others. This research aims to fill this methodological gap in the health informatics literature. By the end of this project, we will have developed theory-informed implementation strategies to support Centre for Addiction and Mental Health ED clinicians in adopting the Hope app to complete safety planning intervention. These strategies, guided by a behavior change framework, will target clinicians' behavior change and seamlessly integrate the app into the routine clinical workflow. In addition, this research project will provide recommendations on how to involve multiple knowledge user groups and offer insights into how the methodology used can be adapted to other areas within the health informatics literature. International Registered Report Identifier (IRRID): PRR1-10.2196/50643 ",
doi="10.2196/50643",
url="https://www.researchprotocols.org/2023/1/e50643",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943582"
}


@Article{info:doi/10.2196/51023,
author="Groot Bruinderink, L. Marije
and Boyd, Anders
and Coyer, Liza
and Boers, Sophie
and Blitz, Laura
and Brand, Jean-Marie
and G{\"o}tz, M. Hannelore
and Stip, Martijn
and Woudstra, Joey
and Yap, Kenneth
and Vermey, Koenraad
and Matser, Amy
and Feddes, R. Allard
and Jongen, W. Vita
and Prins, Maria
and Hoornenborg, Elske
and van Harreveld, Frenk
and Schim van der Loeff, F. Maarten
and Davidovich, Udi",
title="Online-Mediated HIV Pre-exposure Prophylaxis Care and Reduced Monitoring Frequency for Men Who Have Sex With Men: Protocol for a Randomized Controlled Noninferiority Trial (EZI-PrEP Study)",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="8",
volume="12",
pages="e51023",
keywords="pre-exposure prophylaxis",
keywords="randomized controlled trial",
keywords="telemedicine",
keywords="HIV prevention",
keywords="MSM",
keywords="men who have sex with men",
keywords="Netherlands",
keywords="adherence",
keywords="acceptability",
keywords="usability",
abstract="Background: Daily and event-driven HIV pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine is highly effective to prevent HIV in men who have sex with men (MSM). PrEP care generally consists of in-clinic monitoring every 3 months that includes PrEP dispensing, counseling, and screening for HIV and sexually transmitted infections (STIs). However, the optimal frequency for monitoring remains undetermined. Attending a clinic every 3 months for monitoring may be a barrier for PrEP. Online-mediated PrEP care and reduced frequency of monitoring may lower this barrier. Objective: The primary objective of this study is to establish the noninferiority of online PrEP care (vs in-clinic care) and monitoring every 6 months (vs every 3 months). The secondary objectives are to (1) examine differences between PrEP care modalities regarding incidences of STIs, HIV infection, and hepatitis C virus infection; retention in PrEP care; intracellular tenofovir-diphosphate concentration; and satisfaction, usability, and acceptability of PrEP care modalities; and (2) evaluate associations of these study outcomes with sociodemographic, behavioral, and psychological characteristics. Methods: This study is a 2{\texttimes}2 factorial, 4-arm, open-label, multi-center, randomized, controlled, noninferiority trial. The 4 arms are (1) in-clinic monitoring every 3 months, (2) in-clinic monitoring every 6 months, (3) online monitoring every 3 months, and (4) online monitoring every 6 months. The primary outcome is a condomless anal sex act with a casual partner not covered or insufficiently covered by PrEP (ie, ``unprotected act'') as a proxy for HIV infection risk. Eligible individuals are MSM, and transgender and gender diverse people aged ?18 years who are eligible for PrEP care at 1 of 4 participating sexual health centers in the Netherlands. The required sample size is 442 participants, and the planned observation time is 24 months. All study participants will receive access to a smartphone app, which contains a diary. Participants are requested to complete the diary on a daily basis during the first 18 months of participation. Participants will complete questionnaires at baseline and 6, 12, 18, and 24 months. Dried blood spots will be collected at 6 and 12 months for assessment of intracellular tenofovir-diphosphate concentration. Incidence rates of unprotected acts will be compared between the online and in-clinic arms, and between the 6-month and 3-month arms. Noninferiority will be concluded if the upper limit of the 2-sided 97.5\% CI of the incidence rate ratio is <1.8. Results: The results of the main analysis are expected in 2024. Conclusions: This trial will demonstrate whether online PrEP care and monitoring every 6 months is noninferior to standard PrEP care in terms of PrEP adherence. If noninferiority is established, these modalities may lower barriers for initiating and continuing PrEP use and potentially reduce the systemic burden for PrEP providers. Trial Registration: ClinicalTrials.gov NCT05093036; https://tinyurl.com/28b8ndvj International Registered Report Identifier (IRRID): DERR1-10.2196/51023 ",
doi="10.2196/51023",
url="https://www.researchprotocols.org/2023/1/e51023",
url="http://www.ncbi.nlm.nih.gov/pubmed/37938875"
}


@Article{info:doi/10.2196/49102,
author="C{\^a}mara Gradim, Carolina Luma
and Santana, Maciel Andr{\'e} Luiz
and Archanjo Jos{\'e}, Marcelo
and Zuffo, Kn{\"o}rich Marcelo
and Lopes, Deus Roseli de",
title="An Automated Electronic System in a Motorized Wheelchair for Telemonitoring: Mixed Methods Study Based on Internet of Things",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="8",
volume="7",
pages="e49102",
keywords="eHealth systems",
keywords="telemonitoring",
keywords="inertial measurement unit",
keywords="IMU",
keywords="sensors",
keywords="Internet of Things",
keywords="IoT",
keywords="pressure injury",
keywords="wheelchair",
keywords="mobile phone",
abstract="Background: Wheelchair positioning systems can prevent postural deficits and pressure injuries. However, a more effective professional follow-up is needed to assess and monitor positioning according to the specificities and clinical conditions of each user. Objective: This study aims to present the concept of an electronic system embedded in a motorized wheelchair, based on the Internet of Things (IoT), for automated positioning as part of a study on wheelchairs and telemonitoring. Methods: We conducted a mixed methods study with a user-centered design approach, interviews with 16 wheelchair users and 66 professionals for the development of system functions, and a formative assessment of 5 participants with descriptive analysis to design system concepts. Results: We presented a new wheelchair system with hardware and software components developed based on coparticipation with singular components in an IoT architecture. In an IoT solution, the incorporation of sensors from the inertial measurement unit was crucial. These sensors were vital for offering alternative methods to monitor and control the tilt and recline functions of a wheelchair. This monitoring and control could be achieved autonomously through a smartphone app. In addition, this capability addressed the requirements of real users. Conclusions: The technologies presented in this system can benefit telemonitoring and favor real feedback, allowing quality provision of health services to wheelchair users. User-centered development favored development with specific functions to meet the real demands of users. We emphasize the importance of future studies on the correlation between diagnoses and the use of the system in a real environment to help professionals in treatment. ",
doi="10.2196/49102",
url="https://formative.jmir.org/2023/1/e49102",
url="http://www.ncbi.nlm.nih.gov/pubmed/37776327"
}


@Article{info:doi/10.2196/47912,
author="Wang, Xinyi
and Su, Anping
and Liu, Feng
and Gong, Yanping
and Wei, Tao
and Gong, Rixiang
and Zhu, Jingqiang
and Li, Zhihui
and Lei, Jianyong",
title="Trends, Influence Factors, and Doctor-Patient Perspectives of Web-Based Visits for Thyroid Surgery Clinical Care: Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="7",
volume="25",
pages="e47912",
keywords="internet hospital",
keywords="outpatient",
keywords="telemedicine",
keywords="thyroid surgery",
keywords="web-based visit",
abstract="Background: In recent years, the new generation of telecommunication technologies has profoundly changed the traditional medical industry. To alleviate the medical difficulties faced by patients with thyroid diseases, hospitals have opened web-based visits and actively combined online-to-offline outpatient services. Objective: This study aims to explore differences between office and web-based outpatient services from doctors' and patients' perspectives, illustrate the effect of the COVID-19 pandemic on outpatient services, and provide clues for improving the online-to-offline mode of care for patients with thyroid diseases. Methods: We collected the complete web-based and office outpatient records of the Thyroid Surgery Center of West China Hospital. A total of 300,884 completed patient encounters occurred (201,840 office visits and 99,044 web-based visits) from January 1, 2019, to May 31, 2022. We performed logistic regression to evaluate the association between the chosen visit type and patients' sociodemographic characteristics. Results: The number of web-based visits rapidly increased since March 2020 and reached 45.1\% (4752/10,531) of all encounters in December 2021. The COVID-19 pandemic dramatically accelerated the development of web-based visits. Web-based visits were preferred by patients 18-45 years old (odds ratio [OR] 2.043, 95\% CI 1.635-2.552, P<.001), patients with relatively high-paying jobs (technical staff: OR 1.278, 95\% CI 1.088-1.479, P=.003; office clerk: OR 1.25, 95\% CI 1.07-1.461, P=.005; national public servant: OR:1.248, 95\% CI 1.042-1.494, P=.02), and patients living in Sichuan Province (excluding Chengdu; OR 1.167, 95\% CI 1.107-1.23, P<.001). The medicine cost (P<.001) and examination cost (P<.001) of office visits were significantly higher than those of web-based visits. Conclusions: Web-based outpatient visits have increased rapidly in recent years, and the COVID-19 pandemic has boosted their development. The preference for web-based visits was influenced by the socioeconomic and demographic characteristics of both patients and doctors. ",
doi="10.2196/47912",
url="https://www.jmir.org/2023/1/e47912",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796623"
}


@Article{info:doi/10.2196/50767,
author="Martinengo, Laura
and Lin, Xiaowen
and Jabir, Ishqi Ahmad
and Kowatsch, Tobias
and Atun, Rifat
and Car, Josip
and Tudor Car, Lorainne",
title="Conversational Agents in Health Care: Expert Interviews to Inform the Definition, Classification, and Conceptual Framework",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="1",
volume="25",
pages="e50767",
keywords="conceptual framework",
keywords="conversational agent",
keywords="chatbot",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="expert interview",
keywords="mobile phone",
abstract="Background: Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptual framework, designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER), consisting of 3 iterative stages of CA design, development, and evaluation and implementation, complemented by 2 cross-cutting themes (user-centered design and data privacy and security). Objective: This study aims to perform in-depth, semistructured interviews with multidisciplinary experts in health care CAs to share their views on the definition and classification of health care CAs and evaluate and validate the DISCOVER conceptual framework. Methods: We conducted one-on-one semistructured interviews via Zoom (Zoom Video Communications) with 12 multidisciplinary CA experts using an interview guide based on our framework. The interviews were audio recorded, transcribed by the research team, and analyzed using thematic analysis. Results: Following participants' input, we defined CAs as digital interfaces that use natural language to engage in a synchronous dialogue using ?1 communication modality, such as text, voice, images, or video. CAs were classified by 13 categories: response generation method, input and output modalities, CA purpose, deployment platform, CA development modality, appearance, length of interaction, type of CA-user interaction, dialogue initiation, communication style, CA personality, human support, and type of health care intervention. Experts considered that the conceptual framework could be adapted for artificial intelligence--based CAs. However, despite recent advances in artificial intelligence, including large language models, the technology is not able to ensure safety and reliability in health care settings. Finally, aligned with participants' feedback, we present an updated iteration of the conceptual framework for health care conversational agents (CHAT) with key considerations for CA design, development, and evaluation and implementation, complemented by 3 cross-cutting themes: ethics, user involvement, and data privacy and security. Conclusions: We present an expanded, validated CHAT and aim at guiding researchers from a variety of backgrounds and with different levels of expertise in the design, development, and evaluation and implementation of rule-based CAs in health care settings. ",
doi="10.2196/50767",
url="https://www.jmir.org/2023/1/e50767",
url="http://www.ncbi.nlm.nih.gov/pubmed/37910153"
}


@Article{info:doi/10.2196/46355,
author="Gauhe, Greta
and Cisneros, Kostic Rosemary E.
and Ward, Jade
and Hohenschurz-Schmidt, J. David",
title="Creatively Adapting Touch-Based Practices to the Web Format During the COVID-19 Pandemic: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="26",
volume="25",
pages="e46355",
keywords="digital health",
keywords="telehealth",
keywords="eHealth",
keywords="touch",
keywords="creative arts",
keywords="web",
keywords="digital therapeutics",
keywords="manual therapy",
keywords="psychotherapy",
keywords="arts therapy",
keywords="qualitative study",
keywords="web delivery",
keywords="implementation",
keywords="barrier",
keywords="physiotherapist",
keywords="psychotherapist",
abstract="Background: The COVID-19 pandemic forced numerous touch-based fields, including manual therapy, body psychotherapy, arts therapy, creative arts practices, and the fitness industry, to swiftly transition to web-based service delivery. These disciplines faced substantial challenges in adapting their traditionally in-person practices, which rely heavily on physical touch and close proximity, to a web format. Objective: This review intends to provide a systematically sourced overview of the literature concerning innovative approaches for adapting touch-based practices to the web format in response to the COVID-19 pandemic. Methods: A systematic search across 7 databases and gray literature sources identified studies presenting innovative web delivery methods, particularly those addressing the challenges arising from the absence of physical proximity and touch. The inclusion criteria were designed to encompass studies exploring the creative adaptation of touch-based practices to web formats in response to the COVID-19 pandemic irrespective of study methodology. The exclusion criteria applied to studies focusing solely on technical aspects of web delivery or nontouch or noninteractive practices. There were no geographical restrictions, but the selection was limited to publications from 2020 onward. As only qualitative studies were found, data synthesis was conducted thematically. Results: The review encompassed 17 studies revealing that touch-based fields successfully devised innovative and creative methods for web service delivery. These methods were categorized into five main themes: (1) adapted working methods (cross-field methods), (2) adapted working methods for sensorial experiences and nonphysical connections, (3) creative methods using materials or additional tools, (4) creative use of web-based platform tools or additional technologies, and (5) creative methods requiring previous preparation of practitioners or participants. These creative approaches allowed practitioners to address the challenges of web touch-based practices, fostering connections and offering unique sensory experiences, albeit with some concerns related to technology and preparation. Conclusions: These innovative methods demonstrate promise in circumventing the limitations imposed by the lack of physical touch and proximity in web settings during the COVID-19 pandemic. Furthermore, these insights hold potential for application in other fields in the future. This systematic search and thematic synthesis provide valuable guidance for practitioners and educators seeking to navigate the evolving landscape of web service delivery in touch-based disciplines, ensuring continuity of care even in challenging circumstances. Trial Registration: PROSPERO CRD42022379731; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=379731 ",
doi="10.2196/46355",
url="https://www.jmir.org/2023/1/e46355",
url="http://www.ncbi.nlm.nih.gov/pubmed/37883151"
}


@Article{info:doi/10.2196/49973,
author="Sant'Anna, Anita
and Nygren, Jens",
title="A Pragmatic Mapping of Perceptions and Use of Digital Information Systems in Primary Care in Sweden: Survey Study",
journal="Interact J Med Res",
year="2023",
month="Oct",
day="25",
volume="12",
pages="e49973",
keywords="digital information systems",
keywords="implementation",
keywords="primary care",
keywords="health care professionals",
keywords="information system",
keywords="information systems",
keywords="usability",
keywords="adoption",
keywords="perception",
keywords="perceptions",
keywords="technology use",
keywords="perspective",
keywords="perspectives",
abstract="Background: Electronic health records and IT infrastructure in primary care allow for digital documentation and access to information, which can be used to guide evidence-based care and monitor patient safety and quality of care. Quality indicators specified by regulatory authorities can be automatically computed and presented to primary care staff. However, the implementation of digital information systems (DIS) in health care can be challenging, and understanding factors such as relative advantage, compatibility, complexity, trialability, and observability is needed to improve the success and rate of adoption and diffusion. Objective: This study aims to explore how DIS are used and perceived by health care professionals in primary care. Methods: This study used quantitative assessment to gather survey data on the use and potential of DIS in health care in Sweden from the perspectives of primary care personnel in various roles. The digital questionnaire was designed to be short and contained 3 sections covering respondent characteristics, current use of platforms, and perceptions of decision support tools. Data were analyzed using descriptive statistics, nonparametric hypothesis testing, ordinal coefficient $\alpha$, and confirmatory factor analysis. Results: The study collected responses from participants across 10 regions of Sweden, comprising 31.9\% (n=22) from private clinics and 68.1\% (n=47) from public clinics. Participants included administrators (18/69, 26.1\%), a medical strategist (1/69, 1.4\%), and physicians (50/69, 72.5\%). Usage frequency varied as follows: 11.6\% (n=8) used DIS weekly, 24.6\% (n=17) monthly, 27.5\% (n=19) a few times a year, 26.1\% (n=18) very rarely, and 10.1\% (n=7) lacked access. Administrators used DIS more frequently than physicians (P=.005). DIS use centered on quality improvement and identifying high-risk patients, with differences by role. Physicians were more inclined to use DIS out of curiosity (P=.01). Participants desired DIS for patient follow-up, lifestyle guidance, treatment suggestions, reminders, and shared decision-making. Administrators favored predictive analysis (P<.001), while physicians resisted immediate patient identification (P=.03). The 5 innovation attributes showed high internal consistency ($\alpha$>.7). These factors explained 78.5\% of questionnaire variance, relating to complexity, competitive advantage, compatibility, trialability, and observability. Factors 2, 3, and 4 predicted intention to use DIS, with factor 2 alone achieving the best accuracy (root-mean-square=0.513). Conclusions: Administrators and physicians exhibited role-based DIS use patterns highlighting the need for tailored approaches to promote DIS adoption. The study reveals a link between positive perceptions and intention to use DIS, emphasizing the significance of considering all factors for successful health care integration. The results suggest various directions for future studies. These include refining the trialability and observability questions for increased reliability and validity, investigating a larger sample with more specific target groups to improve generalization, and exploring the relevance of different groups' perspectives and needs in relation to decisions about and use of DIS. ",
doi="10.2196/49973",
url="https://www.i-jmr.org/2023/1/e49973",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878357"
}


@Article{info:doi/10.2196/49804,
author="Buis, R. Lorraine
and Brown, K. Lindsay
and Plegue, A. Melissa
and Kadri, Reema
and Laurie, R. Anna
and Guetterman, C. Timothy
and Vydiswaran, Vinod V. G.
and Li, Jiazhao
and Veinot, C. Tiffany",
title="Identifying Inequities in Video and Audio Telehealth Services for Primary Care Encounters During COVID-19: Repeated Cross-Sectional, Observational Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="29",
volume="25",
pages="e49804",
keywords="COVID-19",
keywords="telemedicine",
keywords="health equity",
keywords="clinical encounters",
keywords="electronic health records",
abstract="Background: The COVID-19 pandemic resulted in rapid changes in how patient care was provided, particularly through the expansion of telehealth and audio-only phone-based care. Objective: The goal of this study was to evaluate inequities in video and audio-only care during various time points including the initial wave of the COVID-19 pandemic, later stages of the pandemic, and a historical control. We sought to understand the characteristics of care during this time for a variety of different groups of patients that may experience health care inequities. Methods: We conducted a retrospective analysis of electronic health record (EHR) data from encounters from 34 family medicine and internal medicine primary care clinics in a large, Midwestern health system, using a repeated cross-sectional, observational study design. These data included patient demographic data, as well as encounter, diagnosis, and procedure records. Data were obtained for all in-person and telehealth encounters (including audio-only phone-based care) that occurred during 3 separate time periods: an initial COVID-19 period (T2: March 16, 2020, to May 3, 2020), a later COVID-19 period (T3: May 4, 2020, to September 30, 2020), and a historical control period from the previous year (T1: March 16, 2019, to September 30, 2019). Primary analysis focused on the status of each encounter in terms of whether it was completed as scheduled, it was canceled, or the patient missed the appointment. A secondary analysis was performed to evaluate the likelihood of an encounter being completed based on visit modality (phone, video, in-person). Results: In total, there were 938,040 scheduled encounters during the 3 time periods, with 178,747 unique patients, that were included for analysis. Patients with completed encounters were more likely to be younger than 65 years old (71.8\%-74.1\%), be female (58.8\%-61.8\%), be White (75.6\%-76.7\%), and have no significant comorbidities (63.2\%-66.8\%) or disabilities (53.2\%-61.1\%) in all time periods than those who had only canceled or missed encounters. Effects on different subpopulations are discussed herein. Conclusions: Findings from this study demonstrate that primary care utilization across delivery modalities (in person, video, and phone) was not equivalent across all groups before and during the COVID-19 pandemic and different groups were differentially impacted at different points. Understanding how different groups of patients responded to these rapid changes and how health care inequities may have been affected is an important step in better understanding implementation strategies for digital solutions in the future. ",
doi="10.2196/49804",
url="https://www.jmir.org/2023/1/e49804",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773609"
}


@Article{info:doi/10.2196/49898,
author="Parab, Shubham
and Boster, Jerry
and Washington, Peter",
title="Parkinson Disease Recognition Using a Gamified Website: Machine Learning Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="29",
volume="7",
pages="e49898",
keywords="Parkinson disease",
keywords="digital health",
keywords="machine learning",
keywords="remote screening",
keywords="accessible screening",
abstract="Background: Parkinson disease (PD) affects millions globally, causing motor function impairments. Early detection is vital, and diverse data sources aid diagnosis. We focus on lower arm movements during keyboard and trackpad or touchscreen interactions, which serve as reliable indicators of PD. Previous works explore keyboard tapping and unstructured device monitoring; we attempt to further these works with structured tests taking into account 2D hand movement in addition to finger tapping. Our feasibility study uses keystroke and mouse movement data from a remotely conducted, structured, web-based test combined with self-reported PD status to create a predictive model for detecting the presence of PD. Objective: Analysis of finger tapping speed and accuracy through keyboard input and analysis of 2D hand movement through mouse input allowed differentiation between participants with and without PD. This comparative analysis enables us to establish clear distinctions between the two groups and explore the feasibility of using motor behavior to predict the presence of the disease. Methods: Participants were recruited via email by the Hawaii Parkinson Association (HPA) and directed to a web application for the tests. The 2023 HPA symposium was also used as a forum to recruit participants and spread information about our study. The application recorded participant demographics, including age, gender, and race, as well as PD status. We conducted a series of tests to assess finger tapping, using on-screen prompts to request key presses of constant and random keys. Response times, accuracy, and unintended movements resulting in accidental presses were recorded. Participants performed a hand movement test consisting of tracing straight and curved on-screen ribbons using a trackpad or mouse, allowing us to evaluate stability and precision of 2D hand movement. From this tracing, the test collected and stored insights concerning lower arm motor movement. Results: Our formative study included 31 participants, 18 without PD and 13 with PD, and analyzed their lower limb movement data collected from keyboards and computer mice. From the data set, we extracted 28 features and evaluated their significances using an extra tree classifier predictor. A random forest model was trained using the 6 most important features identified by the predictor. These selected features provided insights into precision and movement speed derived from keyboard tapping and mouse tracing tests. This final model achieved an average F1-score of 0.7311 (SD 0.1663) and an average accuracy of 0.7429 (SD 0.1400) over 20 runs for predicting the presence of PD. Conclusions: This preliminary feasibility study suggests the possibility of using technology-based limb movement data to predict the presence of PD, demonstrating the practicality of implementing this approach in a cost-effective and accessible manner. In addition, this study demonstrates that structured mouse movement tests can be used in combination with finger tapping to detect PD. ",
doi="10.2196/49898",
url="https://formative.jmir.org/2023/1/e49898",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773607"
}


@Article{info:doi/10.2196/47065,
author="Alqurashi, Heba
and Mohammed, Rafiuddin
and AlGhanmi, Shlyan Amany
and Alanazi, Farhan",
title="The Perception of Health Care Practitioners Regarding Telemedicine During COVID-19 in Saudi Arabia: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="28",
volume="7",
pages="e47065",
keywords="telemedicine",
keywords="health care practitioners",
keywords="COVID-19",
keywords="Saudi Arabia",
keywords="mobile phone",
abstract="Background: Telemedicine is a rapidly evolving field that uses information and communication technology to provide remote health care services, such as diagnosis, treatment, consultation, patient monitoring, and medication delivery. With advancements in technology, telemedicine has become increasingly popular during the COVID-19 lockdown and has expanded beyond remote consultations via telephone or video to include comprehensive and reliable services. The integration of telemedicine platforms can enable patients and health care providers to communicate more efficiently and effectively. Objective: This study aims to investigate the awareness, knowledge, requirements, and perceptions of health care practitioners in Saudi Arabia during the pandemic health crisis from the end-user perspective. The findings of this study will inform policy makers regarding the sustainability of telemedicine and how it affects the process of provision of health care and improves the patients' journey. Methods: This study adopted a mixed methods design with a quantitative-based cross-sectional design and qualitative interviews to assess the perceptions of various health care professionals working in outpatient departments that have a telemedicine system that was used during the COVID-19 pandemic. For both approaches, ethics approval was obtained, and informed consent forms were signed. In total, 81 completed questionnaires were used in this study. In the second phase, general interviews were conducted with managerial staff and health care professionals to obtain their view of telemedicine services in their hospitals. Results: The study revealed that most participants (67/81, 83\%) were familiar with telemedicine technology, and the study proved to be statistically significant at P<.05 with a proportion of the participants (52/81, 64\%) believing that continuous training was essential for its effective use. The study also found that consultations (55/153, 35.9\%) and monitoring patients (35/153, 22.9\%) were the major components of telemedicine used by health care professionals, with telephones being the most commonly used mode of interaction with patients (74/117, 63.2\%). In addition, 54\% (44/81) of the respondents expressed concerns about patient privacy and confidentiality, highlighting this as a major issue. Furthermore, the majority of participants (58/81, 72\%) reported the necessity of implementing national standards essential for telemedicine technology in Saudi Arabia. The interviews conducted as part of the study revealed 5 major themes: culture, barriers and difficulties, communication, implementation, and evaluation. These themes highlighted the importance of a culture of acceptance and flexibility, effective communication, and ongoing evaluation of telemedicine technologies in health care systems. Conclusions: This study provides a crucial message with insights into the perceptions and experiences of health care professionals with telemedicine during the COVID-19 pandemic in Saudi Arabia. ",
doi="10.2196/47065",
url="https://formative.jmir.org/2023/1/e47065",
url="http://www.ncbi.nlm.nih.gov/pubmed/37768720"
}


@Article{info:doi/10.2196/45433,
author="Napetschnig, Alina
and Brixius, Klara
and Deiters, Wolfgang",
title="Development of a Core Set of Quality Criteria for Virtual Reality Applications Designed for Older Adults: Multistep Qualitative Study",
journal="Interact J Med Res",
year="2023",
month="Sep",
day="27",
volume="12",
pages="e45433",
keywords="virtual reality",
keywords="older adults",
keywords="quality criteria",
keywords="user-centered",
abstract="Background: Virtual reality (VR) applications are gaining growing significance, particularly among older adults. These applications can provide valuable support to older adults by offering immersive VR content that positively influences various aspects of their daily lives, including activities of daily living. Furthermore, VR applications can contribute to the enhancement of cognitive and motor skills, ultimately leading to an improved quality of life for older individuals. Nevertheless, to ensure a positive impact, it is crucial to develop VR experiences that are tailored to the needs and preferences of the users. Objective: This study aims to develop a core set of quality criteria and guidelines for the development of user-centered VR applications specifically designed for older adults (target group). Methods: The multistep qualitative study design comprised several key stages, beginning with a systematic literature search. This was followed by a framework analysis aimed at identifying a core set of criteria. Subsequently, these criteria underwent validation through expert workshops. The outcomes achieved through this iterative process were organized and categorized into criteria, accompanied by explanations detailing the underlying categories or codes. Results: The quality criteria core set for older adults--friendly VR applications has been developed through an iterative process. It is divided into 2 distinct parts, each containing criteria categorized into specific areas. The first part includes the following categories: (1) quality assurance of medical/health content, (2) data protection provisions, (3) quality requirements, (4) consumer protection, and (5) interoperability. The second part includes the following categories: (1) graphic/quality, (2) 3D character/avatar, (3) providing in-game instructions and prompts, (4) interaction, (5) navigation, and (6) promotion of user motivation and loyalty to use. The results imply a differentiated scope as well as a differentiated granularity of the criteria. Conclusions: Considering the ongoing advancement of VR technology and the diverse needs within the older adult demographic, it is essential to assess the quality criteria core set results on an individual basis. ",
doi="10.2196/45433",
url="https://www.i-jmr.org/2023/1/e45433",
url="http://www.ncbi.nlm.nih.gov/pubmed/37756112"
}


@Article{info:doi/10.2196/49303,
author="Lammons, William
and Silkens, Milou
and Hunter, Jamie
and Shah, Sudhir
and Stavropoulou, Charitini",
title="Centering Public Perceptions on Translating AI Into Clinical Practice: Patient and Public Involvement and Engagement Consultation Focus Group Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="26",
volume="25",
pages="e49303",
keywords="acceptance",
keywords="AI in health care",
keywords="AI",
keywords="artificial intelligence",
keywords="health care research",
keywords="health care",
keywords="patient and public engagement and involvement",
keywords="patient engagement",
keywords="public engagement",
keywords="transition",
abstract="Background: Artificial intelligence (AI) is widely considered to be the new technical advancement capable of a large-scale modernization of health care. Considering AI's potential impact on the clinician-patient relationship, health care provision, and health care systems more widely, patients and the wider public should be a part of the development, implementation, and embedding of AI applications in health care. Failing to establish patient and public engagement and involvement (PPIE) can limit AI's impact. Objective: This study aims to (1) understand patients' and the public's perceived benefits and challenges for AI and (2) clarify how to best conduct PPIE in projects on translating AI into clinical practice, given public perceptions of AI. Methods: We conducted this qualitative PPIE focus-group consultation in the United Kingdom. A total of 17 public collaborators representing 7 National Institute of Health and Care Research Applied Research Collaborations across England participated in 1 of 3 web-based semistructured focus group discussions. We explored public collaborators' understandings, experiences, and perceptions of AI applications in health care. Transcripts were coanalyzed iteratively with 2 public coauthors using thematic analysis. Results: We identified 3 primary deductive themes with 7 corresponding inductive subthemes. Primary theme 1, advantages of implementing AI in health care, had 2 subthemes: system improvements and improve quality of patient care and shared decision-making. Primary theme 2, challenges of implementing AI in health care, had 3 subthemes: challenges with security, bias, and access; public misunderstanding of AI; and lack of human touch in care and decision-making. Primary theme 3, recommendations on PPIE for AI in health care, had 2 subthemes: experience, empowerment, and raising awareness; and acknowledging and supporting diversity in PPIE. Conclusions: Patients and the public can bring unique perspectives on the development, implementation, and embedding of AI in health care. Early PPIE is therefore crucial not only to safeguard patients but also to increase the chances of acceptance of AI by the public and the impact AI can make in terms of outcomes. ",
doi="10.2196/49303",
url="https://www.jmir.org/2023/1/e49303",
url="http://www.ncbi.nlm.nih.gov/pubmed/37751234"
}


@Article{info:doi/10.2196/45532,
author="Bannon, Sarah
and Brewer, Julie
and Ahmad, Nina
and Cornelius, Talea
and Jackson, Jonathan
and Parker, A. Robert
and Dams-O'Connor, Kristen
and Dickerson, C. Bradford
and Ritchie, Christine
and Vranceanu, Ana-Maria",
title="A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="20",
volume="12",
pages="e45532",
keywords="dyad",
keywords="dementia",
keywords="emotional distress",
keywords="intervention",
keywords="diagnosis",
keywords="telehealth",
abstract="Background: By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners---together called a ``dyad.'' Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms. Objective: This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures. Methods: All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses. Results: This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023. Conclusions: We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD. International Registered Report Identifier (IRRID): PRR1-10.2196/45532 ",
doi="10.2196/45532",
url="https://www.researchprotocols.org/2023/1/e45532",
url="http://www.ncbi.nlm.nih.gov/pubmed/37728979"
}


@Article{info:doi/10.2196/41409,
author="Noort, C. Bart A.
and Buijs, Paul
and Roemeling, Oskar",
title="Outsourcing the Management of Reusable Medical Devices in a Chain-Wide Care Setting: Mixed Methods Feasibility Study",
journal="Interact J Med Res",
year="2023",
month="Sep",
day="19",
volume="12",
pages="e41409",
keywords="health care logistics",
keywords="outsourcing",
keywords="web ordering portal",
keywords="medical devices",
keywords="feasibility study",
keywords="device management",
abstract="Background: Managing reusable medical devices incurs substantial health care costs and complexity, particularly in integrated care settings. This complexity hampers care quality, safety, and costs. Studying logistical innovations within integrated care can provide insights to medical devices use among staff effectively. Objective: This study aimed to establish the feasibility of a logistical intervention through outsourcing and a web portal. The goal was to provide insights into users' acceptability of the intervention, on whether the intervention was successfully implemented, and on the intervention's preliminary efficacy, thus benefiting practitioners and researchers. Methods: This paper presents a mixed methods feasibility study at a large chain-wide health care provider in the Netherlands. The intervention entailed outsourcing noncritical reusable medical devices and introducing a web portal for device management. A questionnaire gauged perceived ordering and delivery times, satisfaction with the ordering and delivery process, compliance with safety and hygiene certification, and effects on the care delivery process. Qualitative data in the form of observations, documentation, and interviews were used to identify implementing challenges. Using on-site stocktaking and data from information systems, we analyzed the utilization, costs, and rental time of medical devices before and after the intervention for wheelchairs and anti--pressure ulcer mattresses. Results: Looking at the acceptability of the intervention, a high user satisfaction with the ordering and delivery process was reported (rated on a 5-point Likert scale). With respect to preliminary efficacy, we noted a reduction in the utilization of wheelchairs (on average, 1106, SD 106 fewer utilization d/mo), and a halted increase in the utilization of anti--pressure ulcer mattresses. In addition, nurses who used the web portal reported shorter ordering times for wheelchairs (?2.7 min) and anti--pressure ulcer mattresses (?3.1 min), as well as shorter delivery times for wheelchairs (?0.5 d). Moreover, an increase in device certification was reported (average score of 1.9, SD 1.0), indicating higher levels of safety and hygiene standards. In theory, these improvements should translate into better outcomes in terms of costs and the quality of care. However, we were unable to establish a reduction in total care costs or a reduced rental time per device. Furthermore, respondents did not identify improvements in safety or the quality of care. Although implementation challenges related to the diverse supply base and complexities with different care financers were observed, the overall implementation of the intervention was considered successful. Conclusions: This study confirms the feasibility of our intervention, in terms of acceptability, implementation success, and preliminary efficacy. The integrated management of medical devices should enable a reduction in costs, required devices, and material waste, as well as higher quality care. However, several challenges remain related to the implementation of such interventions. ",
doi="10.2196/41409",
url="https://www.i-jmr.org/2023/1/e41409",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725420"
}


@Article{info:doi/10.2196/47047,
author="Ward, M. Marcia
and Ullrich, Fred
and Bhagianadh, Divya
and Nelson, Eve-Lynn
and Marcin, P. James
and Carter, D. Knute
and Law, Beth Kari
and McCord, Carly
and Neufeld, Jonathan
and Merchant, S. Kimberly A.",
title="Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study",
journal="JMIR Ment Health",
year="2023",
month="Sep",
day="18",
volume="10",
pages="e47047",
keywords="anxiety",
keywords="behavior",
keywords="behavioral health",
keywords="COVID-19",
keywords="depression",
keywords="digital health",
keywords="eHealth",
keywords="mental health",
keywords="mHealth",
keywords="pandemic",
keywords="rural health services",
keywords="rural",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. Objective: This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. Methods: We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. Results: The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30\% (698/2352) in the pre-PHE period to 35\% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11\% (468/4249) in the pre-PHE period to 18\% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1\% (22/2352) in the pre-PHE period to 11\% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0\% (0/4249) in the pre-PHE period to 16\% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8\% (190/2352) to 14\% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12\% (502/4249) to 4\% (739/17,047; P<.001). Conclusions: The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic. ",
doi="10.2196/47047",
url="https://mental.jmir.org/2023/1/e47047",
url="http://www.ncbi.nlm.nih.gov/pubmed/37721793"
}


@Article{info:doi/10.2196/47179,
author="Harrison, Conrad
and Trickett, Ryan
and Wormald, Justin
and Dobbs, Thomas
and Lis, Przemys?aw
and Popov, Vesselin
and Beard, J. David
and Rodrigues, Jeremy",
title="Remote Symptom Monitoring With Ecological Momentary Computerized Adaptive Testing: Pilot Cohort Study of a Platform for Frequent, Low-Burden, and Personalized Patient-Reported Outcome Measures",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="14",
volume="25",
pages="e47179",
keywords="patient-reported outcome measures",
keywords="ecological momentary assessment",
keywords="computerized adaptive testing",
keywords="EMCAT",
keywords="symptom monitoring",
keywords="monitoring",
keywords="assessment",
keywords="smartphone app",
keywords="trauma",
keywords="arthritis",
keywords="usability",
keywords="mobile phone",
abstract="Background: Remote patient-reported outcome measure (PROM) data capture can provide useful insights into research and clinical practice and deeper insights can be gained by administering assessments more frequently, for example, in ecological momentary assessment. However, frequent data collection can be limited by the burden of multiple, lengthy questionnaires. This burden can be reduced with computerized adaptive testing (CAT) algorithms that select only the most relevant items from a PROM for an individual respondent. In this paper, we propose ``ecological momentary computerized adaptive testing'' (EMCAT): the use of CAT algorithms to reduce PROM response burden and facilitate high-frequency data capture via a smartphone app. We develop and pilot a smartphone app for performing EMCAT using a popular hand surgery PROM. Objective: The aim of this study is to determine the feasibility of EMCAT as a system for remote PROM administration. Methods: We built the EMCAT web app using Concerto, an open-source CAT platform maintained by the Psychometrics Centre, University of Cambridge, and hosted it on an Amazon Web Service cloud server. The platform is compatible with any questionnaire that has been parameterized with item response theory or Rasch measurement theory. For this study, the PROM we chose was the patient evaluation measure, which is commonly used in hand surgery. CAT algorithms were built using item response theory models derived from UK Hand Registry data. In the pilot study, we enrolled 40 patients with hand trauma or thumb-base arthritis, across 2 sites, between July 13, 2022, and September 14, 2022. We monitored their symptoms with the patient evaluation measure, via EMCAT, over a 12-week period. Patients were assessed thrice weekly, once daily, or thrice daily. We additionally administered full-length PROM assessments at 0, 6, and 12 weeks, and the User Engagement Scale at 12 weeks. Results: The use of EMCAT significantly reduced the length of the PROM (median 2 vs 11 items) and the time taken to complete it (median 8.8 seconds vs 1 minute 14 seconds). Very similar scores were obtained when EMCAT was administered concurrently with the full-length PROM, with a mean error of <0.01 on a logit (z score) scale. The median response rate in the daily assessment group was 93\%. The median perceived usability score of the User Engagement Scale was 4.0 (maximum possible score 5.0). Conclusions: EMCAT reduces the burden of PROM assessments, enabling acceptable high-frequency, remote PROM data capture. This has potential applications in both research and clinical practice. In research, EMCAT could be used to study temporal variations in symptom severity, for example, recovery trajectories after surgery. In clinical practice, EMCAT could be used to monitor patients remotely, prompting early intervention if a patient's symptom trajectory causes clinical concern. Trial Registration: ISRCTN 19841416; https://www.isrctn.com/ISRCTN19841416 ",
doi="10.2196/47179",
url="https://www.jmir.org/2023/1/e47179",
url="http://www.ncbi.nlm.nih.gov/pubmed/37707947"
}


@Article{info:doi/10.2196/36808,
author="Hedbom, Towe
and Liljeroos, Maria
and Thyl{\'e}n, Ingela
and Orwelius, Lotti
and Jaarsma, Tiny
and Str{\"o}mberg, Anna",
title="Expectations of Tele-Yoga in Persons With Long-Term Illness: Qualitative Content Analysis",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="13",
volume="25",
pages="e36808",
keywords="yoga",
keywords="telerehabilitation",
keywords="eHealth",
keywords="chronic illness",
keywords="heart failure",
keywords="implantable cardioverter defibrillator",
keywords="postintensive care",
abstract="Background: Yoga is a mind-body exercise that has demonstrated its feasibility and safety even for individuals with severe long-term illness. Engaging in yoga has the potential to yield positive effects on both physical and mental well-being. Tele-yoga is a novel approach to rehabilitation in which participants practice group yoga with a live-streamed yoga instructor digitally via a tablet. This is especially beneficial for individuals who may find it difficult to leave their homes to participate in an exercise session. As part of our ongoing evaluation of the tele-yoga intervention in individuals with long-term illness, we have undertaken an exploration of participants' expectations regarding yoga in general and tele-yoga specifically. Understanding these expectations is crucial, as they can significantly impact their satisfaction with treatment and care and influence overall intervention outcomes. Objective: This study aims to explore the expectations of tele-yoga among individuals with long-term illness before starting a tele-yoga intervention. Methods: The study employed an inductive qualitative design and is part of a process evaluation within an ongoing randomized controlled trial. A total of 89 participants were interviewed before the start of the tele-yoga intervention. The interview guide encompassed questions about their general perceptions of yoga and the specific expectations they held for the upcoming tele-yoga sessions. The interviews were transcribed and analyzed using inductive qualitative content analysis. Results: Participants expressed their expectations for tele-yoga, focusing on the anticipated improvements in physical function and overall health. These expectations included hopes for reduced respiratory issues; relief from discomfort, aches, and pains; as well as increased physical flexibility, coordination, and overall well-being. Besides, they expected to achieve improved psychological well-being and performance; to acquire strategies to manage stress, anger, and anxiety; and to have their motivational drive strengthened and influence other activities. Participants described tele-yoga as a new and exciting technical solution that would facilitate the delivery of yoga. A few participants remained a little hesitant toward the use of technology, with some expectations based on previous experiences. When asked about expectations, some had no idea about what to expect. Participants also had varying perspectives on yoga, with some finding it mysterious and difficult to understand. Participants expressed thoughts that they found the idea of tele-yoga taking place in groups exciting and enjoyable. They also had expectations that being part of a group would provide opportunities for mutual inspiration and encouragement among the group members. Conclusions: Expectations before an intervention can provide valuable insights into understanding the factors influencing adherence to tele-yoga and its outcomes. Our findings provide a wide range of expectations for tele-yoga, spanning both physical and mental aspects. Moreover, the technology's potential to facilitate yoga delivery and the supportive nature of digital group interactions were evident from the results. Trial Registration: ClinicalTrials.gov NCT03703609; https://clinicaltrials.gov/ct2/show/NCT03703609 ",
doi="10.2196/36808",
url="https://www.jmir.org/2023/1/e36808",
url="http://www.ncbi.nlm.nih.gov/pubmed/37703082"
}


@Article{info:doi/10.2196/44759,
author="Sang, Ling
and Song, Li",
title="The Current Status of the Use of Internet Hospitals for Outpatients With Pain: Retrospective Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="11",
volume="25",
pages="e44759",
keywords="internet hospital",
keywords="internet +",
keywords="pain management",
keywords="online visit",
keywords="outpatient",
keywords="pain",
abstract="Background: The national ``Internet +'' policies and the emergence of internet hospitals have created a new direction for the management of pain outside of the hospital. Nevertheless, there are no consolidated studies conducted by pain physicians on the current state of internet hospital--based online medical services used by patients with pain outside of a hospital setting. Objective: In this retrospective study, we aimed to examine the status of the use of internet hospitals by patients who experience pain. Moreover, we identified the factors that influenced patients' decisions to make an online visit through the internet hospital. Methods: Detailed information was collected online and offline from outpatients with pain at the information technology center of West China Hospital of Sichuan University from February 2020 to April 2022. Binary logistic regression analysis was conducted to identify the determinants that influenced patients' decisions to make an online visit to the internet hospital. Results: Over a 2-year period, 85,266 pain-related clinic visits were recorded. Ultimately, 39,260 patients were enrolled for the analysis, with 12.9\% (5088/39,260) having online visits. Both online and offline clinics had a greater number of visits by women than men. The average age of patients attending the online clinic was 46.85 (SD 16.56) years, whereas the average age of patients attending the offline clinic was 51.48 (SD 16.12) years. The majority of online clinic visitors (3059/5088, 60.1\%) were employed, and one of the most common occupations was farming (721/5088, 14.2\%). In addition, 51.8\% (2635/5088) of patients who participated in the online clinics lived outside the hospital vicinity. Young (odds ratio [OR] 1.35, 95\% CI 1.01-1.81; P=.045) and middle-aged (OR 1.98, 95\% CI 1.81-2.16; P<.001) patients, employed patients (OR 1.11, 95\% CI 1.04-1.18; P=.002), nonlocal patients (OR 1.57, 95\% CI 1.48-1.67; P<.001), and the ordinary staff (OR 1.19, 95\%CI 1.01-1.39; P=.03) were more likely to have the intention to choose online visits through the internet hospitals. Conclusions: Internet hospitals are flourishing as a more efficient and promising method of pain management and follow-up for patients with pain outside the hospital. People with pain who are young, working, and not in the vicinity of hospitals are more likely to visit internet hospitals. ",
doi="10.2196/44759",
url="https://www.jmir.org/2023/1/e44759",
url="http://www.ncbi.nlm.nih.gov/pubmed/37695652"
}


@Article{info:doi/10.2196/44540,
author="Torres-Robles, Andrea
and Allison, Karen
and Poon, K. Simon
and Shaw, Miranda
and Hutchings, Owen
and Britton, J. Warwick
and Wilson, Andrew
and Baysari, Melissa",
title="Patient and Clinician Perceptions of the Pulse Oximeter in a Remote Monitoring Setting for COVID-19: Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="5",
volume="25",
pages="e44540",
keywords="remote monitoring",
keywords="patient experience",
keywords="user experience",
keywords="COVID-19",
keywords="pulse oximetry",
keywords="usability",
keywords="acceptability",
keywords="oximetry",
keywords="wearable device",
abstract="Background: As a response to the COVID-19 pandemic, the Sydney Local Health District in New South Wales, Australia, launched the rpavirtual program, the first full-scale virtual hospital in Australia, to remotely monitor and follow up stable patients with COVID-19. As part of the intervention, a pulse oximeter wearable device was delivered to patients to monitor their oxygen saturation levels, a critical indicator of COVID-19 patient deterioration. Understanding users' perceptions toward the device is fundamental to assessing its usability and acceptability and contributing to the effectiveness of the intervention, but no research to date has explored the user experience of the pulse oximeter for remote monitoring in this setting. Objective: This study aimed to explore the use, performance, and acceptability of the pulse oximeter by clinicians and patients in rpavirtual during COVID-19. Methods: Semistructured interviews and usability testing were conducted. Stable adult patients with COVID-19 (aged ?18 years) who used the pulse oximeter and were monitored by rpavirtual, and rpavirtual clinicians monitoring these patients were interviewed. Clinicians could be nurses, doctors, or staff who were part of the team that assisted patients with the use of the pulse oximeter. Usability testing was conducted with patients who had the pulse oximeter when they were contacted. Interviews were coded using the Theoretical Framework of Acceptability. Usability testing was conducted using a think-aloud protocol. Data were collected until saturation was reached. Results: Twenty-one patients (average age 51, SD 13 years) and 15 clinicians (average age 41, SD 11 years) completed the interview. Eight patients (average age 51, SD 13 years) completed the usability testing. All participants liked the device and thought it was easy to use. They also had a good understanding of how to use the device and the device's purpose. Patients' age and device use--related characteristics (eg, the warmth of hands and hand steadiness) were identified by users as factors negatively impacting the accurate use of the pulse oximeter. Conclusions: Patients and clinicians had very positive perceptions of the pulse oximeter for COVID-19 remote monitoring, indicating high acceptability and usability of the device. However, factors that may impact the accuracy of the device should be considered when delivering interventions using the pulse oximeter for remote monitoring. Targeted instructions about the use of the device may be necessary for specific populations (eg, older people and patients unfamiliar with technology). Further research should focus on the integration of the pulse oximeter data into electronic medical records for real-time and secure patient monitoring. ",
doi="10.2196/44540",
url="https://www.jmir.org/2023/1/e44540",
url="http://www.ncbi.nlm.nih.gov/pubmed/37535831"
}


@Article{info:doi/10.2196/48920,
author="Campbell, Kate
and Greenfield, Geva
and Li, Edmond
and O'Brien, Niki
and Hayhoe, Benedict
and Beaney, Thomas
and Majeed, Azeem
and Neves, Lu{\'i}sa Ana",
title="The Impact of Virtual Consultations on the Quality of Primary Care: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="30",
volume="25",
pages="e48920",
keywords="remote consultations",
keywords="primary care",
keywords="telemedicine",
keywords="systematic review",
keywords="teleconsult",
keywords="quality care",
keywords="efficiency",
keywords="socioeconomic status",
abstract="Background: The adoption of virtual consultations, catalyzed by the COVID-19 pandemic, has transformed the delivery of primary care services. Owing to their rapid global proliferation, there is a need to comprehensively evaluate the impact of virtual consultations on all aspects of care quality. Objective: This study aims to evaluate the impact of virtual consultations on the quality of primary care. Methods: A total of 6 databases were searched. Studies that evaluated the impact of virtual consultations, for any disease, were included. Title and abstract screening and full-text screening were performed by 2 pairs of investigators. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A narrative synthesis of the results was performed. Results: In total, 30 studies (5,469,333 participants) were included in this review. Our findings suggest that virtual consultations are equally effective to or more effective than face-to-face care for the management of certain conditions, including mental illness, excessive smoking, and alcohol consumption. Overall, 4 studies indicated positive impacts on some aspects of patient-centeredness; however, a negative impact was noted on patients' perceived autonomy support (ie, the degree to which people perceive those in positions of authority to be autonomy supportive). Virtual consultations may reduce waiting times, lower patient costs, and reduce rates of follow-up in secondary and tertiary care settings. Evidence for the impact on clinical safety is extremely limited. Evidence regarding equity was considerably mixed. Overall, it appears that virtual care is more likely to be used by younger, female patients, with disparities among other subgroups depending on contextual factors. Conclusions: Our systematic review demonstrated that virtual consultations may be as effective as face-to-face care and have a potentially positive impact on the efficiency and timeliness of care; however, there is a considerable lack of evidence on the impacts on patient safety, equity, and patient-centeredness, highlighting areas where future research efforts should be devoted. Capitalizing on real-world data, as well as clinical trials, is crucial to ensure that the use of virtual consultations is tailored according to patient needs and is inclusive of the intended end users. Data collection methods that are bespoke to the primary care context and account for patient characteristics are necessary to generate a stronger evidence base to inform future virtual care policies. ",
doi="10.2196/48920",
url="https://www.jmir.org/2023/1/e48920",
url="http://www.ncbi.nlm.nih.gov/pubmed/37647117"
}


@Article{info:doi/10.2196/46297,
author="Dalko, Katharina
and Kraft, Bernhard
and Jahn, Patrick
and Schildmann, Jan
and Hofstetter, Sebastian",
title="Cocreation of Assistive Technologies for Patients With Long COVID: Qualitative Analysis of a Literature Review on the Challenges of Patient Involvement in Health and Nursing Sciences",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="15",
volume="25",
pages="e46297",
keywords="cocreation",
keywords="participatory development",
keywords="transdisciplinary research",
keywords="technological development",
keywords="long COVID syndrome",
keywords="mobile phone",
abstract="Background: Digital assistive technologies have the potential to address the pressing need for adequate therapy options for patients with long COVID (also known as post--COVID-19 condition) by enabling the implementation of individual and independent rehabilitation programs. However, the involvement of the target patient group is necessary to develop digital devices that are closely aligned to the needs of this particular patient group. Objective: Participatory design approaches, such as cocreation, may be a solution for achieving usability and user acceptance. However, there are currently no set methods for implementing cocreative development processes incorporating patients. This study addresses the following research questions: what are the tasks and challenges associated with the involvement of patient groups? What lessons can be learned regarding the adequate involvement of patients with long COVID? Methods: First, a literature review based on a 3-stage snowball process was conducted to identify the tasks and challenges emerging in the context of the cocreation of digital assistive devices and services with patient groups. Second, a qualitative analysis was conducted in an attempt to extract relevant findings and criteria from the identified studies. Third, using the method of theory adaptation, this paper presents recommendations for the further development of the existing concepts of cocreation in relation to patients with long COVID. Results: The challenges of an active involvement of patients in cocreative development in health care include hierarchical barriers and differences in the levels of specific knowledge between professionals and patients. In the case of long COVID, patients themselves are still inexperienced in dealing with their symptoms and are hardly organized into established groups. This amplifies general hurdles and leads to questions of group identity, power structure, and knowledge creation, which are not sufficiently addressed by the current methods of cocreation. Conclusions: The adaptation of transdisciplinary methods to cocreative development approaches focusing on collaborative and inclusive communication can address the recurring challenges of actively integrating patients with long COVID into development processes. ",
doi="10.2196/46297",
url="https://www.jmir.org/2023/1/e46297",
url="http://www.ncbi.nlm.nih.gov/pubmed/37581906"
}


@Article{info:doi/10.2196/44399,
author="Chivela, L. Fernando
and Burch, E. Ashley
and Asagbra, Oghale",
title="An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="1",
volume="25",
pages="e44399",
keywords="patient portal",
keywords="multimorbidity",
keywords="chronic disease",
keywords="patient messaging",
keywords="rural",
keywords="mobile phone",
abstract="Background: Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. Objective: This study aimed to explore the factors associated with portal messaging use by rural patients. Methods: We assessed patient portal use among patients with ?1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. Results: A total of 65,178 patients (n=38,587, 59.2\% female and n=21,454, 32.92\% Black) were included in the final data set, of which 38,380 (58.88\%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ?7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. Conclusions: Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity. ",
doi="10.2196/44399",
url="https://www.jmir.org/2023/1/e44399",
url="http://www.ncbi.nlm.nih.gov/pubmed/37526967"
}


@Article{info:doi/10.2196/45166,
author="Lawrence, Katharine
and Singh, Nina
and Jonassen, Zoe
and Groom, L. Lisa
and Alfaro Arias, Veronica
and Mandal, Soumik
and Schoenthaler, Antoinette
and Mann, Devin
and Nov, Oded
and Dove, Graham",
title="Operational Implementation of Remote Patient Monitoring Within a Large Ambulatory Health System: Multimethod Qualitative Case Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="27",
volume="10",
pages="e45166",
keywords="digital health",
keywords="remote patient monitoring",
keywords="RPM",
keywords="human-centered design",
keywords="human-computer interaction",
keywords="implementation science",
abstract="Background: Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians' diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking. Objective: In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of ``early adopter'' clinicians and patients. Methods: Using a multimethod qualitative approach, we conducted (1) interviews with 13 clinicians across 9 specialties considered as early adopters and supporters of RPM and (2) speculative design sessions exploring the future of RPM in clinical care with 21 patients and patient representatives, to better understand experiences, preferences, and expectations of pragmatic RPM use for health care delivery. Results: We identified themes relevant to RPM implementation within the following areas: (1) data collection and practices, including impacts of taking real-world measures and issues of data sharing, security, and privacy; (2) proactive and preventive care, including proactive and preventive monitoring, and proactive interventions and support; and (3) health disparities and equity, including tailored and flexible care and implicit bias. We also identified evidence for mitigation and support to address challenges in each of these areas. Conclusions: This study highlights the unique contexts, perceptions, and challenges regarding the deployment of RPM in clinical practice, including its potential implications for clinical workflows and work experiences. Based on these findings, we offer implementation and design recommendations for health systems interested in deploying RPM-enabled health care. ",
doi="10.2196/45166",
url="https://humanfactors.jmir.org/2023/1/e45166",
url="http://www.ncbi.nlm.nih.gov/pubmed/37498668"
}


@Article{info:doi/10.2196/44218,
author="Kengne Talla, Pascaline
and Inquimbert, Camille
and Dawson, Aim{\'e}e
and Zidarov, Diana
and Bergeron, Fr{\'e}d{\'e}ric
and Chandad, Fatiha",
title="Barriers and Enablers to Implementing Teledentistry From the Perspective of Dental Health Care Professionals: Protocol for a Systematic Quantitative, Qualitative, and Mixed Studies Review",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="26",
volume="12",
pages="e44218",
keywords="teledentistry",
keywords="oral health",
keywords="barrier",
keywords="enabler",
keywords="dental health care providers",
keywords="information and communication technology",
keywords="protocol",
keywords="dental",
keywords="dentist",
keywords="telehealth",
keywords="telemedicine",
keywords="theoretical domain framework",
keywords="remote care",
keywords="virtual care",
keywords="perception",
keywords="facilitator",
keywords="systematic review",
keywords="review method",
keywords="librarian",
keywords="PRISMA",
abstract="Background: There is growing literature on the potential of digital technologies for improving access to, ensuring continuity and quality of health care, and to strengthen health systems. Some studies have reported the cost-effectiveness of teledentistry, its reliability for remote dental screening, diagnosis, consultation, and treatment planning. Nonetheless, current evidence suggests that teledentistry implementation faces many challenges and is not yet adopted by dental health care providers (DHCPs). Developing strategies to improve teledentistry adoption requires an understanding of the factors that promote or hinder its successful implementation. Objective: This systematic review aims to identify and synthetize barriers and enablers to implementing teledentistry as perceived by DHCPs in their clinical practices, using the Theoretical Domains Framework (TDF) and the Capacity, Opportunity, and Motivation Behavior (COM-B) model. Methods: This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols) checklist. Literature will be searched in the following databases: PubMed, Cochrane Library, Web of Science, CINAHL, Embase, and PsycINFO. We will perform additional searches on Google, Google Scholar, and ProQuest Dissertations \& Theses Global, screen the references of the included studies to capture additional relevant studies, and contact the authors of studies if we need more details. We will consider studies using qualitative, quantitative, and mixed methods. There will be no restrictions on the publication date and dental setting. We will include studies published in French, English, and Portuguese. Two independent reviewers will select the study, extract data, and assess methodological quality using the Mixed Methods Appraisal Tool's checklist. Data analysis will include a descriptive and a thematic content analysis. We will synthetize and categorize the barriers and enablers using the TDF and COM-B model and present a narrative synthesis of our results using tables, figures, and quotes. Results: By March 2023, the literature search has retrieved 7355 publications. We will identify the range of barriers and enablers to implementing teledentistry through DHCPs' perspectives. Considering the critical need for theory-based implementation interventions to improve the use of evidence-informed practices, we will synthesize the factors influencing the adoption of teledentistry based on the TDF domains and the 3 essential conditions predicting behavior change in accordance with the COM-B model. As needed, we will include additional determinants if not included in the TDF. We will conduct some subgroups analyses if studies are sufficient. We expect to complete the review by July 2024. Conclusions: This review will provide some insights on the determinants of teledentistry implementation as perceived by DHCPs in dental settings. These findings will cater to patients, families, DHCPs, researchers, academic and professional decision-makers, and policy makers. The results of the systematic review could be used to develop theory-led interventions in improving teledentistry implementation. Trial Registration: PROSPERO CRD42021293376; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=293376 International Registered Report Identifier (IRRID): PRR1-10.2196/44218 ",
doi="10.2196/44218",
url="https://www.researchprotocols.org/2023/1/e44218",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494093"
}


@Article{info:doi/10.2196/45922,
author="Braga Ferreira, Let{\'i}cia
and Lanna de Almeida, Rodrigo
and Arantes, Alair
and Abdulazeem, Hebatullah
and Weerasekara, Ishanka
and Ferreira, Norberto Leticia Santos Dias
and Fonseca de Almeida Messias, Luana
and Siuves Ferreira Couto, Luciana
and Parreiras Martins, Auxiliadora Maria
and Suelen Antunes, N{\'u}bia
and Fonseca C{\^a}ndido, Carolina Raissa
and Rosa Ferreira, Samuel
and Guerra Pezzini Assis, Tati
and Marques Pedroso, Thais
and Boersma, Eric
and Ribeiro, Antonio
and Marcolino, Soriano Milena",
title="Telemedicine-Based Management of Oral Anticoagulation Therapy: Systematic Review and Meta-analysis",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="10",
volume="25",
pages="e45922",
keywords="anticoagulation",
keywords="telemedicine",
keywords="eHealth",
keywords="warfarin",
keywords="DOACs",
keywords="atrial fibrillation",
abstract="Background: Oral anticoagulation is the cornerstone treatment of several diseases. Its management is often challenging, and different telemedicine strategies have been implemented to support it. Objective: The aim of the study is to systematically review the evidence on the impact of telemedicine-based oral anticoagulation management compared to usual care on thromboembolic and bleeding events. Methods: Randomized controlled trials were searched in 5 databases from inception to September 2021. Two independent reviewers performed study selection and data extraction. Total thromboembolic events, major bleeding, mortality, and time in therapeutic range were assessed. Results were pooled using random effect models. Results: In total, 25 randomized controlled trials were included (n=25,746 patients) and classified as moderate to high risk of bias by the Cochrane tool. Telemedicine resulted in lower rates of thromboembolic events, though not statistically significant (n=13 studies, relative risk [RR] 0.75, 95\% CI 0.53-1.07; I2=42\%), comparable rates of major bleeding (n=11 studies, RR 0.94, 95\% CI 0.82-1.07; I2=0\%) and mortality (n=12 studies, RR 0.96, 95\% CI 0.78-1.20; I2=11\%), and an improved time in therapeutic range (n=16 studies, mean difference 3.38, 95\% CI 1.12-5.65; I2=90\%). In the subgroup of the multitasking intervention, telemedicine resulted in an important reduction of thromboembolic events (RR 0.20, 95\% CI 0.08-0.48). Conclusions: Telemedicine-based oral anticoagulation management resulted in similar rates of major bleeding and mortality, a trend for fewer thromboembolic events, and better anticoagulation quality compared to standard care. Given the potential benefits of telemedicine-based care, such as greater access to remote populations or people with ambulatory restrictions, these findings may encourage further implementation of eHealth strategies for anticoagulation management, particularly as part of multifaceted interventions for integrated care of chronic diseases. Meanwhile, researchers should develop higher-quality evidence focusing on hard clinical outcomes, cost-effectiveness, and quality of life. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020159208; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=159208 ",
doi="10.2196/45922",
url="https://www.jmir.org/2023/1/e45922",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428532"
}


@Article{info:doi/10.2196/44188,
author="Cunha, Soraia Ana
and Pedro, Rita Ana
and Cordeiro, V. Jo{\~a}o",
title="Facilitators of and Barriers to Accessing Hospital Medical Specialty Telemedicine Consultations During the COVID-19 Pandemic: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="10",
volume="25",
pages="e44188",
keywords="health services accessibility",
keywords="COVID-19",
keywords="hospitals",
keywords="barriers",
keywords="facilitators",
keywords="telemedicine",
abstract="Background: The COVID-19 pandemic accelerated the digital transition in health care, which required a rapid adaptation for stakeholders. Telemedicine has emerged as an ideal tool to ensure continuity of care by allowing remote access to specialized medical services. However, its rapid implementation has exacerbated disparities in health care access, especially for the most susceptible populations. Objective: We aimed to characterize the determinant factors (facilitators and barriers) of access to hospital medical specialty telemedicine consultations during the COVID-19 pandemic and to identify the main opportunities and challenges (technological, ethical, legal, and social) generated by the use of telemedicine in the context of the COVID-19 pandemic. Methods: We conducted a systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 4 databases (Scopus, Web of Science, PubMed, and Cochrane COVID-19 Study Register) were searched for empirical studies published between January 3, 2020, and December 31, 2021, using established criteria. The protocol of this review was registered and published in PROSPERO (CRD42022302825). A methodological quality assessment was performed, and the results were integrated into a thematic synthesis. The identification of the main opportunities and challenges was done by interpreting and aggregating the thematic synthesis results. Results: Of the 106 studies identified, 9 met the inclusion criteria and the intended quality characteristics. All studies were originally from the United States. The following facilitating factors of telemedicine use were identified: health insurance coverage; prevention of SARS-CoV-2 infection; access to internet services; access to technological devices; better management of work-life balance; and savings in travel costs. We identified the following barriers to telemedicine use: lack of access to internet services; lack of access to technological devices; racial and ethnic disparities; low digital literacy; low income; age; language barriers; health insurance coverage; concerns about data privacy and confidentiality; geographic disparities; and the need for complementary diagnostic tests or the delivery of test results. Conclusions: The facilitating factors and barriers identified in this systematic review present different opportunities and challenges, including those of a technological nature (access to technological devices and internet services and level of digital literacy), a sociocultural and demographic nature (ethnic and racial disparities, geographic disparities, language barriers, and age), a socioeconomic nature (income level and health insurance coverage), and an ethical and legal nature (data privacy and confidentiality). To expand telemedicine access to hospital-based specialty medical consultations and provide high-quality care to all, including the most susceptible communities, the challenges identified must be thoroughly researched and addressed with informed and dedicated responses. ",
doi="10.2196/44188",
url="https://www.jmir.org/2023/1/e44188",
url="http://www.ncbi.nlm.nih.gov/pubmed/37262124"
}


@Article{info:doi/10.2196/43962,
author="Turrentine, Mark
and Nguyen, Buu-Hac
and Choby, Beth
and Kendig, Susan
and King, L. Tekoa
and Kotelchuck, Milton
and Moore Simas, A. Tiffany
and Srinivas, K. Sindhu
and Zahn, M. Christopher
and Peahl, Friedman Alex",
title="Frequency of Prenatal Care Visits: Protocol to Develop a Core Outcome Set for Prenatal Care Schedules",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="10",
volume="12",
pages="e43962",
keywords="core outcome set",
keywords="Delphi",
keywords="prenatal care schedules",
keywords="telemedicine",
keywords="prenatal",
keywords="pediatric",
keywords="maternal",
keywords="obstetric",
keywords="core outcome",
keywords="pregnant",
keywords="pregnancy",
keywords="care delivery",
keywords="care schedule",
keywords="infant",
keywords="review method",
keywords="systematic review",
abstract="Background: Prenatal care, one of the most common preventive care services in the United States, endeavors to improve pregnancy outcomes through evidence-based screenings and interventions. Despite the prevalence of prenatal care and its importance to maternal and infant health, there are several debates about the best methods of prenatal care delivery, including the most appropriate schedule frequency and content of prenatal visits. Current US national guidelines recommend that low-risk individuals receive a standard schedule of 12 to 14 in-office visits, a care delivery model that has remained unchanged for almost a century. Objective: In early 2020, to mitigate individuals' exposure to the SARS-CoV-2 virus, prenatal care providers implemented new paradigms that altered the schedule frequency, interval, and modality (eg, telemedicine) of how prenatal care services were offered. In this paper, we describe the development of a core outcome set (COS) that can be used to evaluate the effect of the frequency of prenatal care schedules on maternal and infant outcomes. Methods: We will systematically review the literature to identify previously reported outcomes important to individuals who receive prenatal care and the people who care for them. Stakeholders with expertise in prenatal care delivery (ie, patients or family members, health care providers, and public health professionals and policy makers) will rate the importance of identified outcomes in a web-based survey using a 3-round Delphi process. A digital consensus meeting will be held for a group of stakeholder representatives to discuss and vote on the outcomes to include in the final COS. Results: The Delphi survey was initiated in July 2022 with invited 71 stakeholders. A digital consensus conference was conducted on October 11, 2022. Data are currently under analysis with plans to submit them in a subsequent manuscript. Conclusions: More research about the optimal schedule frequency and modality for prenatal care delivery is needed. Standardizing outcomes that are measured and reported in evaluations of the recommended prenatal care schedules will assist evidence synthesis and results reported in systematic reviews and meta-analyses. Overall, this COS will expand the consistency and patient-centeredness of reported outcomes for various prenatal care delivery schedules and modalities, hopefully improving the overall efficacy of recommended care delivery for pregnant people and their families. International Registered Report Identifier (IRRID): DERR1-10.2196/43962 ",
doi="10.2196/43962",
url="https://www.researchprotocols.org/2023/1/e43962",
url="http://www.ncbi.nlm.nih.gov/pubmed/37261946"
}


@Article{info:doi/10.2196/48568,
author="Liu, Jialin
and Wang, Changyu
and Liu, Siru",
title="Utility of ChatGPT in Clinical Practice",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="28",
volume="25",
pages="e48568",
keywords="ChatGPT",
keywords="artificial intelligence",
keywords="large language models",
keywords="clinical practice",
keywords="large language model",
keywords="natural language processing",
keywords="NLP",
keywords="doctor-patient",
keywords="patient-physician",
keywords="communication",
keywords="challenges",
keywords="barriers",
keywords="recommendations",
keywords="guidance",
keywords="guidelines",
keywords="best practices",
keywords="risks",
doi="10.2196/48568",
url="https://www.jmir.org/2023/1/e48568",
url="http://www.ncbi.nlm.nih.gov/pubmed/37379067"
}


@Article{info:doi/10.2196/44164,
author="Boyle, Tehnaz
and Boggs, Krislyn
and Gao, Jingya
and McMahon, Maureen
and Bedenbaugh, Rachel
and Schmidt, Lauren
and Zachrison, Sauser Kori
and Goralnick, Eric
and Biddinger, Paul
and Camargo Jr, A. Carlos",
title="Hospital-Level Implementation Barriers, Facilitators, and Willingness to Use a New Regional Disaster Teleconsultation System: Cross-Sectional Survey Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Jun",
day="27",
volume="9",
pages="e44164",
keywords="disaster medicine",
keywords="disaster",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="teleconsultation",
keywords="remote consultation",
keywords="health care delivery",
keywords="e-consult",
keywords="notification",
keywords="alert",
keywords="emergency",
keywords="health system",
keywords="hospital management",
abstract="Background: The Region 1 Disaster Health Response System project is developing new telehealth capabilities to provide rapid, temporary access to clinical experts across US jurisdictions to support regional disaster health response. Objective: To guide future implementation, we identified hospital-level barriers, facilitators, and willingness to use a novel regional peer-to-peer disaster teleconsultation system for disaster health response. Methods: We used the National Emergency Department Inventory-USA database to identify all 189 hospital-based and freestanding emergency departments (EDs) in New England states. We digitally or telephonically surveyed emergency managers regarding notification systems used for large-scale no-notice emergency events, access to consultants in 6 disaster-relevant specialties, disaster credentialing requirements before system use, reliability and redundancy of internet or cellular service, and willingness to use a disaster teleconsultation system. We examined state-wise hospital and ED disaster response capability. Results: Overall, 164 (87\%) hospitals and EDs responded---126 (77\%) completed telephone surveys. Most (n=148, 90\%) receive emergency notifications from state-based systems. Forty (24\%) hospitals and EDs lacked access to burn specialists; toxicologists, 30 (18\%); radiation specialists, 25 (15\%); and trauma specialists, 20 (12\%). Among critical access hospitals (CAHs) or EDs with <10,000 annual visits (n=36), 92\% received routine nondisaster telehealth services but lacked toxicologist (25\%), burn (22\%), and radiation (17\%) specialist access. Most hospitals and EDs (n=115, 70\%) require disaster credentialing of teleconsultants before system use. Among 113 hospitals and EDs with written disaster credentialing procedures, 28\% expected completing disaster credentialing within 24 hours, and 55\% within 25-72 hours, which varied by state. Most (n=154, 94\%) reported adequate internet or cellular service for video-streaming; 81\% maintained cellular service despite internet disruption. Fewer rural hospitals and EDs reported reliable internet or cellular service (19/22, 86\% vs 135/142, 95\%) and ability to maintain cellular service with internet disruption (11/19, 58\% vs 113/135, 84\%) than urban hospitals and EDs. Overall, 133 (81\%) were somewhat or very likely to use a regional disaster teleconsultation system. Large-volume EDs (annual visits ?40,000) were less likely to use the service than smaller ones; all CAHs and nearly all rural hospitals or freestanding EDs were likely to use disaster consultation services. Among hospitals and EDs somewhat or very unlikely to use the system (n=26), sufficient consultant access (69\%) and reluctance to use new technology or systems (27\%) were common barriers. Potential delays (19\%), liability (19\%), privacy (15\%), and hospital information system security restrictions (15\%) were infrequent concerns. Conclusions: Most New England hospitals and EDs have access to state emergency notification systems, telecommunication infrastructure, and willingness to use a new regional disaster teleconsultation system. System developers should focus on ways to improve telecommunication redundancy in rural areas and use low-bandwidth technology to maintain service availability to CAHs and rural hospitals and EDs. Policies and procedures to accelerate and standardize disaster credentialing are needed for implementation across jurisdictions. ",
doi="10.2196/44164",
url="https://publichealth.jmir.org/2023/1/e44164",
url="http://www.ncbi.nlm.nih.gov/pubmed/37368481"
}


@Article{info:doi/10.2196/45179,
author="Nordmann, Kim
and Sauter, Stefanie
and M{\"o}bius-Lerch, Patricia
and Redlich, Marie-Christin
and Schaller, Michael
and Fischer, Florian",
title="Conceptualizing Interprofessional Digital Communication and Collaboration in Health Care: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="26",
volume="12",
pages="e45179",
keywords="digital technologies",
keywords="interdisciplinary communication",
keywords="intersectoral collaboration",
keywords="nurse",
keywords="physician",
keywords="collaboration",
keywords="interdisciplinary",
keywords="scoping review",
keywords="communication",
keywords="interprofessional",
abstract="Background: Effective communication and collaboration among health professionals are essential prerequisites for patient-centered care. However, interprofessional teams require suitable structures and tools to efficiently use their professional competencies in the service of high-quality care appropriate to the patient's life situation. In this context, digital tools potentially enhance interprofessional communication and collaboration and lead to an organizationally, socially, and ecologically sustainable health care system. However, there is a lack of studies systematically assessing the critical factors for successfully implementing tools for digitally supported interprofessional communication and collaboration in the health care setting. Furthermore, an operationalization of this concept is missing. Objective: The aim of the proposed scoping review is to (1) identify factors influencing the development, implementation, and adoption processes of digital tools for interprofessional communication in the health care sector and (2) analyze and synthesize the (implicit) definition, dimensions, and concepts of digitally supported communication and collaboration among health care professionals in the health care setting. Studies focusing on digital communication and collaboration practices among health care professionals, including medical doctors and qualified medical assistants, in any health care setting will be included in this review. Methods: To address these objectives, an in-depth analysis of heterogeneous studies is needed, which is best achieved through a scoping review. Within this proposed scoping review, which adheres to the Joanna Briggs Institute methodology, 5 databases (SCOPUS, CINAHL, PubMed, Embase, and PsycInfo) will be searched for studies assessing digital communication and collaboration among various health care professionals in different health care settings. Studies focusing on health care providers or patient interaction through digital tools and non--peer-reviewed studies will be excluded. Results: Key characteristics of the studies included will be summarized through descriptive analysis, using diagrams and tables. We will synthesize and map the data and conduct a qualitative in-depth thematic analysis of definitions and dimensions of interprofessional digital communication and collaboration among health care and nursing professionals. Conclusions: Results from this scoping review may help in establishing digitally supported collaborations between various stakeholders in the health care setting and successfully implementing new forms of interprofessional communication and collaboration. This could facilitate the transition to better coordinated care and encourage the development of digital frameworks. International Registered Report Identifier (IRRID): PRR1-10.2196/45179 ",
doi="10.2196/45179",
url="https://www.researchprotocols.org/2023/1/e45179",
url="http://www.ncbi.nlm.nih.gov/pubmed/37358886"
}


@Article{info:doi/10.2196/46842,
author="Abdulai, Abdul-Fatawu
and Naghdali, Hasti
and Tekie Ghirmay, Eden
and Adam, Fuseini
and Bawafaa, Eunice",
title="Trauma-Informed Care in Digital Health Technologies: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="23",
volume="12",
pages="e46842",
keywords="clinical intervention",
keywords="digital health technologies",
keywords="digital health",
keywords="psychological trauma",
keywords="stress",
keywords="trauma",
keywords="trauma-informed care",
abstract="Background: The use of digital health technologies is becoming increasingly common across the globe as they offer immense potential to enhance health care delivery by promoting accessibility, flexibility, and personalized care, connecting patients to health care professionals, and offering more efficient services and treatments to remote residents. At the same time, there is an increasing recognition of how digital health can inadvertently foment psychological trauma. This phenomenon has led to the adoption of trauma-informed care in designing and deploying digital health technologies. However, how trauma-informed care is defined and characterized, and the various trauma-informed care strategies used in designing and deploying digital health technologies remain unexplored. Objective: This scoping review aims to explore and synthesize the literature on how trauma-informed care is defined and characterized in digital health and the various trauma-informed care principles, strategies, or recommendations used in designing and deploying digital health. Methods: This review will draw on the Joanna Briggs Institute's updated methodological guidance for scoping reviews. A search will be conducted on CINAHL, PubMed, Embase, Compendex Engineering Village, Web of Science, Scopus, and PsycINFO. This review will consider published research studies and unpublished work (gray literature). Studies will be included if they applied trauma-informed care in designing or deploying digital health for patients across all geographical locations or provide trauma-informed recommendations on how web developers should develop digital health. Studies will be limited to publications within the past 10 years and studies in all languages will be considered. Two independent reviewers will screen the titles and abstracts, and then perform a full-text review. Data will be extracted into a data extraction tool developed for this study. Results: The scoping review was undergoing a full search as of April 2023. The main results will synthesize the peer-reviewed and gray literature on adopting trauma-informed care practices in digital health research and development. The study is expected to be completed by December 2023 and the results are expected to be published in a peer-reviewed journal. Conclusions: This review is expected to provide the knowledge base on the adoption of trauma-informed care in designing and deploying digital health. This knowledge can lead to more engaging, and likely, more effective digital health interventions that have less potential for harm. A synthesis of the various trauma-informed care strategies in digital health will also provide a trauma-informed language by enabling researchers and digital health developers to consider trauma as a critical factor in each stage of the design process. International Registered Report Identifier (IRRID): DERR1-10.2196/46842 ",
doi="10.2196/46842",
url="https://www.researchprotocols.org/2023/1/e46842",
url="http://www.ncbi.nlm.nih.gov/pubmed/37351935"
}


@Article{info:doi/10.2196/45822,
author="Touzani, Rajae
and Dembele, Elodie
and Schultz, Emilien
and Rouquette, Alexandra
and Seguin, Lor{\`e}ne
and Dufour, Jean-Charles
and Bannier, Marie
and Mancini, Julien",
title="The French General Population's Perception of New Information and Communication Technologies for Medical Consultations: National Survey",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="16",
volume="25",
pages="e45822",
keywords="new ICT",
keywords="video recording",
keywords="mHealth apps",
keywords="video broadcasting",
keywords="health literacy",
keywords="telehealth",
keywords="teleconsultation",
keywords="HLS19",
keywords="COVID-19",
keywords="France",
abstract="Background: The development of telehealth and telemedicine, in the form of increased teleconsultation and medical telemonitoring, accelerated during the COVID-19 health crisis in France to ensure continued access to care for the population. Since these new information and communication technologies (ICTs) are diverse and likely to transform how the health care system is organized, there is a need better to understand public attitudes toward them and their relationship with peoples' current experience of health care. Objective: This study aimed to determine the French general population's perception of the usefulness of video recording/broadcasting (VRB) and mobile Health (mHealth) apps for medical consultations in France during the COVID-19 health crisis and the factors associated with this perception. Methods: Data were collected for 2003 people in 2 waves of an online survey alongside the Health Literacy Survey 2019 (1003 in May 2020 and 1000 in January 2021) based on quota sampling. The survey collected sociodemographic characteristics, health literacy levels, trust in political representatives, and perceived health status. The perceived usefulness of VRB in medical consultations was measured by combining 2 responses concerning this technology for consultations. The perceived usefulness of mHealth apps was measured by combining 2 responses concerning their usefulness for booking doctor appointments and for communicating patient-reported outcomes to doctors. Results: The majority (1239/2003, 62\%) of respondents considered the use of mHealth apps useful, while only 27.6\% (551/2003) declared VRB useful. The factors associated with the perceived usefulness of both technologies were younger age (? 55 years), trust in political representatives (VRB: adjusted odds ratio [aOR] 1.68, 95\% CI 1.31-2.17; mHealth apps: aOR 1.88, 95\% CI 1.42-2.48), and higher (sufficient and excellent) health literacy. The period of the beginning of the COVID-19 epidemic, living in an urban area, and being limited in daily activities were also associated with perceiving VRB positively. The perceived usefulness of mHealth apps increased with the level of education. It was also higher in people who had 3 or more consultations with a medical specialist. Conclusions: There are important differences in attitudes toward new ICTs. Perceived usefulness was lower for VRB than for mHealth apps. Moreover, it decreased after the initial months of the COVID-19 pandemic. There is also the possibility of new inequalities. Hence, despite the potential benefits of VRB and mHealth apps, people with low health literacy considered them to be of little use for their health care, possibly increasing their difficulties in accessing health care in the future. As such, health care providers and policy makers need to consider those perceptions to guarantee that new ICTs are accessible and beneficial to all. ",
doi="10.2196/45822",
url="https://www.jmir.org/2023/1/e45822",
url="http://www.ncbi.nlm.nih.gov/pubmed/37327032"
}


@Article{info:doi/10.2196/40635,
author="Jackson-Triche, Maga
and Vetal, Don
and Turner, Eva-Marie
and Dahiya, Priya
and Mangurian, Christina",
title="Meeting the Behavioral Health Needs of Health Care Workers During COVID-19 by Leveraging Chatbot Technology: Development and Usability Study",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="8",
volume="25",
pages="e40635",
keywords="chatbot technology",
keywords="health care workers",
keywords="mental health equity",
keywords="COVID-19",
keywords="mental health chatbot",
keywords="behavioral health treatment",
keywords="mental health screening",
keywords="telehealth",
keywords="psychoeducation",
keywords="employee support",
abstract="Background: During the COVID-19 pandemic, health care systems were faced with the urgent need to implement strategies to address the behavioral health needs of health care workers. A primary concern of any large health care system is developing an easy-to-access, streamlined system of triage and support despite limited behavioral health resources. Objective: This study provides a detailed description of the design and implementation of a chatbot program designed to triage and facilitate access to behavioral health assessment and treatment for the workforce of a large academic medical center. The University of California, San Francisco (UCSF) Faculty, Staff, and Trainee Coping and Resiliency Program (UCSF Cope) aimed to provide timely access to a live telehealth navigator for triage and live telehealth assessment and treatment, curated web-based self-management tools, and nontreatment support groups for those experiencing stress related to their unique roles. Methods: In a public-private partnership, the UCSF Cope team built a chatbot to triage employees based on behavioral health needs. The chatbot is an algorithm-based, automated, and interactive artificial intelligence conversational tool that uses natural language understanding to engage users by presenting a series of questions with simple multiple-choice answers. The goal of each chatbot session was to guide users to services that were appropriate for their needs. Designers developed a chatbot data dashboard to identify and follow trends directly through the chatbot. Regarding other program elements, website user data were collected monthly and participant satisfaction was gathered for each nontreatment support group. Results: The UCSF Cope chatbot was rapidly developed and launched on April 20, 2020. As of May 31, 2022, a total of 10.88\% (3785/34,790) of employees accessed the technology. Among those reporting any form of psychological distress, 39.7\% (708/1783) of employees requested in-person services, including those who had an existing provider. UCSF employees responded positively to all program elements. As of May 31, 2022, the UCSF Cope website had 615,334 unique users, with 66,585 unique views of webinars and 601,471 unique views of video shorts. All units across UCSF were reached by UCSF Cope staff for special interventions, with >40 units requesting these services. Town halls were particularly well received, with >80\% of attendees reporting the experience as helpful. Conclusions: UCSF Cope used chatbot technology to incorporate individualized behavioral health triage, assessment, treatment, and general emotional support for an entire employee base (N=34,790). This level of triage for a population of this size would not have been possible without the use of chatbot technology. The UCSF Cope model has the potential to be scaled, adapted, and implemented across both academically and nonacademically affiliated medical settings. ",
doi="10.2196/40635",
url="https://www.jmir.org/2023/1/e40635",
url="http://www.ncbi.nlm.nih.gov/pubmed/37146178"
}


@Article{info:doi/10.2196/38176,
author="Karasz, Alison
and Merchant, Krupa
and Arnsten, Julia
and Feinberg, Judith
and Kim, Y. Arthur
and Lum, J. Paula
and McKee, Diane Melissa
and Mehta, H. Shruti
and Meissner, Paul
and Norton, L. Brianna
and Page, Kimberly
and Pericot-Valverde, Irene
and Singh, Reena
and Stein, Ellen
and Taylor, E. Lynn
and Tsui, I. Judith
and Wagner, Katherine
and Litwin, Alain",
title="A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="2",
volume="25",
pages="e38176",
keywords="mHealth",
keywords="video-observed therapy",
keywords="directly observed treatment",
keywords="hepatitis C virus",
keywords="persons who inject drugs",
keywords="antiviral",
keywords="adherence",
keywords="HCV",
keywords="opioid treatment",
keywords="mobile health",
keywords="adherence behavior",
keywords="behavior intervention",
keywords="telemedicine",
keywords="digital health",
keywords="perception",
keywords="therapy",
keywords="treatment",
abstract="Background: Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. Objective: This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. Methods: Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. Results: Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. Conclusions: VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required. ",
doi="10.2196/38176",
url="https://www.jmir.org/2023/1/e38176",
url="http://www.ncbi.nlm.nih.gov/pubmed/37266986"
}


@Article{info:doi/10.2196/44806,
author="Naghdi, Rozhin
and Nguyen, Gianhu
and Vazquez, Maria Cecile
and Antonio, Mark Christian
and Cabrera, Carlos
and Chandra, Austin
and Chok, Jay",
title="Assessing Health Care Professionals' Mindset in Adopting Telemedicine Post COVID-19: Pilot Questionnaire Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="2",
volume="7",
pages="e44806",
keywords="digital health",
keywords="patient perspective",
keywords="creative destruction of medicine",
keywords="pilot study",
keywords="patient-centered health",
keywords="willingness",
keywords="delivery model",
keywords="questionnaire",
keywords="telehealth",
keywords="accessibility",
keywords="implementation",
abstract="Background: Amidst the COVID-19 pandemic, the traditional health care model has evolved toward a more patient-centric model. In relation to this trend, digital health services have seen an acceleration, which may have significant implications for the health care model. Due to the impact of COVID-19 on health care facilities, it is important to explore health professionals' willingness to adopt a patient-centric digital health delivery model for medicine and health care. Objective: The aim of this study was to pilot a survey that assesses the impact and implementation of telehealth in view of health care providers prior to and post COVID-19. Methods: A total of 26 volunteer health care professionals participated in the pilot study, of which 19/26 (73\%) completed the general demographics portion. Among these respondents, 9/26 (35\%) completed the entirety of the survey. The questionnaire included questions relating to general demographics, accessibility and benefits, usability, and engagements with telemedicine. Participants were randomly assigned to 1 of the 4 questionnaire designs (A-D) based on their expertise in telehealth. Of the 9 total participants who completed their randomly assigned questionnaire, 1 (11\%) was randomly assigned to A, 3 (33\%) were randomly assigned to B, 2 (22\%) were randomly assigned to C, and 3 (33\%) were randomly assigned to D. Results: Responses and data from the study questionnaire were collected from Qualtrics. Microsoft Excel was used for data organization. Due to limited responses and data, no advanced statistical software was implemented. From the 9 participants who completed the entirety of the survey, responses from those with telehealth experience (n=4) showed that telehealth was preferred for follow-ups, lab results, and consultations, and that with telehealth, there was greater flexibility with appointment times and a decrease in the number of patients seen. Among the 4 health care providers with telehealth experience, all of them believed it improved accessibility and reduced physical barriers; health care professionals believed telehealth reduced translational barriers with patients. Among health care professionals without telehealth experience (n=5), 60\% (3/5) reported a decrease in appointments for in-office visits post COVID-19 and strongly agreed or agreed that telehealth could influence the quality of care for patients. All 5 participants also reported no general concerns about telehealth prior to the pandemic and agreed that it would provide accessibility for patients. Conclusions: Preliminary findings of our pilot study showed initial support of a dynamical shift within the health care model due to the rise in the use of telehealth services between health care providers and patients but no statistically significant results. Further research and investigation with a larger sample size is warranted to better understand the mindset of health care professionals in adopting telemedicine post COVID-19. ",
doi="10.2196/44806",
url="https://formative.jmir.org/2023/1/e44806",
url="http://www.ncbi.nlm.nih.gov/pubmed/37266997"
}


@Article{info:doi/10.2196/43707,
author="Gavin, M. Kathleen
and Kreitzberg, Daniel
and Gaudreau, Yvette
and Cruz, Marisa
and Bauer, A. Timothy",
title="Identification and Management of Thyroid Dysfunction Using At-Home Sample Collection and Telehealth Services: Retrospective Analysis of Real-World Data",
journal="J Med Internet Res",
year="2023",
month="May",
day="30",
volume="25",
pages="e43707",
keywords="telemedicine",
keywords="consumer-initiated testing",
keywords="dried blood spot",
keywords="adult",
keywords="human",
keywords="access to care",
keywords="monitoring",
keywords="telehealth",
keywords="home-based",
keywords="at home",
keywords="laboratory test",
keywords="blood test",
keywords="thyroid",
keywords="screening",
abstract="Background: Programs aimed at modernizing thyroid care by pairing at-home sample collection methods with telehealth options may serve an important and emerging role in thyroid care. Objective: The primary objective of this analysis was to evaluate telehealth use, demographics, and clinical characteristics of a cohort of consumer-initiated at-home laboratory thyroid test users who were also offered the option of follow-up telehealth consultations. Methods: This was a retrospective analysis of real-world data from a deidentified consumer database of home-collected, mail-in thyroid tests used from March to May 2021 (N=8152). The mean age was 38.6 (range 18-85) years, and 86.6\% (n=7061) of individuals identified as female. Results: In total, 7\% (n=587) of test takers fell into a thyroid dysfunction category (overt hypothyroidism: n=75, 0.9\%; subclinical hypothyroidism: n=236, 2.9\%; overt hyperthyroidism: n=5, 0.1\%; and subclinical hyperthyroidism: n=271, 3.3\%). Overall, 12\% (n=984) of the overall sample opted into a telehealth consultation, with 91.8\% (n=903) receiving a nontreatment telehealth consultation and 8.2\% (n=81) receiving a treatment telemedicine consultation. Furthermore, 16\% (n=96) of individuals with overt or subclinical thyroid dysfunction engaged in telehealth consultations. The majority of treatment consultations (59.3\%, n=48) were conducted with people reporting a history of thyroid issues, with 55.6\% (n=45) of people indicating wanting to discuss their current thyroid medication and 48\% (n=39) receiving a prescription medication. Conclusions: The combination of at-home sample collection and telehealth is an innovative model for screening thyroid disorders, monitoring thyroid function, and increasing access to care, which can be implemented at a large scale and across a wide range of age groups. ",
doi="10.2196/43707",
url="https://www.jmir.org/2023/1/e43707",
url="http://www.ncbi.nlm.nih.gov/pubmed/37252757"
}


@Article{info:doi/10.2196/42304,
author="Cernadas Ramos, Andr{\'e}s
and Fern{\'a}ndez Da Silva, {\'A}ngela
and Barral Buceta, Bran
and Bouzas-Lorenzo, Ram{\'o}n",
title="Offerings and User Demands of eHealth Services in Spain: National Survey",
journal="J Med Internet Res",
year="2023",
month="May",
day="18",
volume="25",
pages="e42304",
keywords="Spanish eHealth",
keywords="health policies",
keywords="digital health",
keywords="COVID-19",
keywords="eHealth offers",
keywords="eHealth demands",
abstract="Background: The accelerated development of information and communication technologies has made health care one of the pioneering fields in the incorporation of these tools. As new technologies have been applied, existing technologies have been sophisticated and improved and the concept of eHealth has expanded. However, these advances and expansion of eHealth do not seem to have served to adapt the supply of services to users' demands; rather, supply seems to be governed by other variables. Objective: The main objective of this work was to review the existing differences between user demands and the supply of eHealth services in Spain and their causes. The aim is to provide information on the level of use of the services and the causes of the variation in demand for these services, which can be useful in correcting existing differences and adapting them to the needs of users. Methods: A survey, ``Use and Attitudes Toward eHealth in Spain,'' was applied by telephone to a sample of 1695 people aged 18 years and over, taking into account sociodemographic profile characteristics (sex, age, habitat, educational level). The confidence level was set at 95\% and the margin of error was {\textpm}2.45 for the whole sample. Results: The survey results showed that the online doctor's appointment service is the most frequently used eHealth service by users: 72.48\% of respondents used this service at some point and 21.28\% stated that they use it regularly. The other services showed significantly lower percentages of use, including ``managing health cards'' (28.04\%), ``consulting medical history'' (20.37\%), ``managing test results'' (20.22\%), ``communicating with health professionals'' (17.80\%), and ``requesting a change of doctor'' (13.76\%). Despite this low usage, a large majority of respondents (80.00\%) attach great importance to all the services offered. Overall, 16.52\% of the users surveyed were willing to make new service requests to the regional websites, with 9.33\% of them highlighting services such as ``the availability of a complaints and claims mailbox,'' ``the possibility of consulting medical records,'' and ``the availability of more detailed information on medical centers (location, medical directory, waiting lists, etc).'' Other outstanding requests (8.00\%) were to simplify the procedures for using certain existing services. Conclusions: The data from the survey show that eHealth services are widely known and highly valued by users, but not all services are used with the same frequency or intensity. It appears that users find it difficult to suggest new services that might be useful to them in terms of demand for new services that do not currently exist. It would be useful to use qualitative studies to gain a deeper understanding of currently unmet needs and the possibilities of eHealth.  The lack of access to and use of these services and the unmet needs particularly affect more vulnerable populations who have the greatest difficulty in meeting their needs through alternative means to eHealth. ",
doi="10.2196/42304",
url="https://www.jmir.org/2023/1/e42304",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200072"
}


@Article{info:doi/10.2196/41358,
author="Aily, Bianca J{\'e}ssica
and Copson, Jennifer
and Voinier, Dana
and Jakiela, Jason
and Hinman, Rana
and Grosch, Megan
and Noonan, Colleen
and Armellini, Megan
and Schmitt, Laura
and White, Mika
and White, Daniel",
title="Understanding Recruitment Yield From Social Media Advertisements and Associated Costs of a Telehealth Randomized Controlled Trial: Descriptive Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="18",
volume="25",
pages="e41358",
keywords="remote recruitment",
keywords="Facebook ads",
keywords="knee osteoarthritis",
keywords="consent",
keywords="screening",
keywords="social media",
keywords="telehealth",
keywords="clinical",
keywords="recruitment",
keywords="treatment",
keywords="osteoarthritis",
keywords="knee",
abstract="Background: Recruiting study participants for clinical research is a challenging yet essential task. Social media platforms, such as Facebook, offer the opportunity to recruit participants through paid advertisements. These ad campaigns may be a cost-effective approach to reaching and recruiting participants who meet specific study criteria. However, little is known about the extent to which clicks on social media advertisements translate to the actual consent and enrollment of participants who meet the study criteria. Understanding this is especially important for clinical trials conducted remotely, such as telehealth-based studies, which open the possibility to recruit over large geographical areas and are becoming more common for the treatment of chronic health conditions, such as osteoarthritis (OA). Objective: The aim of this study was to report on the conversion of clicks on a Facebook advertisement campaign to consent to enrollment in an ongoing telehealth physical therapy study for adults with knee OA, and the costs associated with recruitment. Methods: This was a secondary analysis using data collected over the first 5 months of an ongoing study of adults with knee OA. The Delaware Physical Exercise and Activity for Knee Osteoarthritis program compares a virtually delivered exercise program to a control group receiving web-based resources among adults with knee OA. Advertisement campaigns were configured on Facebook to reach an audience who could be potentially eligible. Clicking on the advertisement directed potential participants to a web-based screening form to answer 6 brief questions related to the study criteria. Next, a research team member called individuals who met the criteria from the screening form and verbally asked additional questions related to the study criteria. Once considered eligible, an electronic informed consent form (ICF) was sent. We described the number of potential study participants who made it through each of these steps and then calculated the cost per participant who signed the ICF. Results: In sum, between July and November 2021, a total of 33,319 unique users saw at least one advertisement, 9879 clicks were made, 423 web-based screening forms were completed, 132 participants were successfully contacted, 70 were considered eligible, and 32 signed the ICF. Recruitment costed an average of US \$51.94 per participant. Conclusions: While there was a low conversion from clicks to actual consent, 32\% (32/100) of the total sample required for the study were expeditiously consented over 5 months with a per-subject cost well below traditional means of recruitment, which ranges from US \$90 to US \$1000 per participant. Trial Registration: Clinicaltrails.gov NCT04980300; https://clinicaltrials.gov/ct2/show/NCT04980300 ",
doi="10.2196/41358",
url="https://www.jmir.org/2023/1/e41358",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200067"
}


@Article{info:doi/10.2196/41884,
author="Ma, E. Jessica
and Lowe, Jared
and Berkowitz, Callie
and Kim, Azalea
and Togo, Ira
and Musser, Clayton R.
and Fischer, Jonathan
and Shah, Kevin
and Ibrahim, Salam
and Bosworth, B. Hayden
and Totten, M. Annette
and Dolor, Rowena",
title="Provider Interaction With an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: Secondary Analysis",
journal="J Med Internet Res",
year="2023",
month="May",
day="12",
volume="25",
pages="e41884",
keywords="advance care planning",
keywords="electronic health record",
keywords="notification",
keywords="EHR",
keywords="provider interaction",
keywords="primary care",
keywords="clinical study",
keywords="referral",
keywords="notifications",
keywords="alerts",
abstract="Background: Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multisite Meta-network Learning and Research Center ACP study, one health system deployed an electronic health record (EHR) notification and algorithm to alert providers about patients potentially appropriate for ACP and the clinical study. Objective: The aim of the study is to describe the implementation and usage of an EHR notification for referring patients to an ACP study, evaluate the association of notifications with study referrals and engagement in ACP, and assess provider interactions with and perspectives on the notifications. Methods: A secondary analysis assessed provider usage and their response to the notification (eg, acknowledge, dismiss, or engage patient in ACP conversation and refer patient to the clinical study). We evaluated all patients identified by the EHR algorithm during the Meta-network Learning and Research Center ACP study. Descriptive statistics compared patients referred to the study to those who were not referred to the study. Health care utilization, hospice referrals, and mortality as well as documentation and billing for ACP and related legal documents are reported. We evaluated associations between notifications with provider actions (ie, referral to study, ACP not documentation, and ACP billing). Provider free-text comments in the notifications were summarized qualitatively. Providers were surveyed on their satisfaction with the notification. Results: Among the 2877 patients identified by the EHR algorithm over 20 months, 17,047 unique notifications were presented to 45 providers in 6 clinics, who then referred 290 (10\%) patients. Providers had a median of 269 (IQR 65-552) total notifications, and patients had a median of 4 (IQR 2-8). Patients with more (over 5) notifications were less likely to be referred to the study than those with fewer notifications (57/1092, 5.2\% vs 233/1785, 13.1\%; P<.001). The most common free-text comment on the notification was lack of time. Providers who referred patients to the study were more likely to document ACP and submit ACP billing codes (P<.001). In the survey, 11 providers would recommend the notification (n=7, 64\%); however, the notification impacted clinical workflow (n=9, 82\%) and was difficult to navigate (n=6, 55\%). Conclusions: An EHR notification can be implemented to remind providers to both perform ACP conversations and refer patients to a clinical study. There were diminishing returns after the fifth EHR notification where additional notifications did not lead to more trial referrals, ACP documentation, or ACP billing. Creation and optimization of EHR notifications for study referrals and ACP should consider the provider user, their workflow, and alert fatigue to improve implementation and adoption. Trial Registration: ClinicalTrials.gov NCT03577002; https://clinicaltrials.gov/ct2/show/NCT03577002 ",
doi="10.2196/41884",
url="https://www.jmir.org/2023/1/e41884",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171856"
}


@Article{info:doi/10.2196/40993,
author="Qi, Miaojie
and Cui, Jiyu
and Li, Xing
and Han, Youli",
title="Influence of E-consultation on the Intention of First-Visit Patients to Select Medical Services: Results of a Scenario Survey",
journal="J Med Internet Res",
year="2023",
month="Apr",
day="28",
volume="25",
pages="e40993",
keywords="e-consultation",
keywords="medical selection",
keywords="influence mechanism",
keywords="scenario survey",
abstract="Background: E-consultation is expected to improve the information level of patients, affect patients' subsequent judgments of medical services, and guide patients to make a reasonable medical selection in the future. Thus, it is important to understand the influence mechanism of e-consultation on patients' medical selection. Objective: This study aims to explore the changes in first-visit patients' understanding of disease and medical resources after e-consultation as well as the choice of follow-up medical services. Methods: Patients' medical selection before and after e-consultation was compared using a scenario survey. Based on the service characteristics of the e-consultation platform, representative simulation scenarios were determined, and parallel control groups were set up considering the order effect in comparison. Finally, a total of 4 scenario simulation questionnaires were designed. A total of 4164 valid questionnaires were collected through the online questionnaire collection platform. Patients' perception of disease severity, evaluation of treatment capacity of medical institutions, selection of hospitals and doctors, and other outcome indicators were tested to analyze the differences in patients' evaluation and choice of medical services before and after e-consultation. Additionally, the results' stability was tested by regression analysis. Results: In scenario 1 (mild case), before e-consultation, 14.1\% (104/740) of participants considered their conditions as not serious. After e-consultation, 69.5\% (539/775) of them considered their diseases as not serious. Furthermore, participants' evaluation of the disease treatment capacity of medical institutions at all levels had improved after using e-consultation. In scenario 3 (severe case), before e-consultation, 54.1\% (494/913) of the participants believed their diseases were very serious. After e-consultation, 16.6\% (157/945) considered their diseases were very serious. The evaluation of disease treatment capacity of medical institutions in nontertiary hospitals decreased, whereas that of tertiary hospitals improved. In both mild and severe cases, before e-consultation, all of the participants were inclined to directly visit the hospital. After e-consultation, more than 71.4\% (553/775) of the patients with mild diseases chose self-treatment, whereas those with severe diseases still opted for a face-to-face consultation. After e-consultation, patients who were set on being treated in a hospital, regardless of the disease severity, preferred to select the tertiary hospitals. Of the patients with mild diseases who chose to go to a hospital, 25.7\% (57/222) wanted to consult online doctors face-to-face. By contrast, 56.4\% (506/897) of the severe cases wanted to consult online doctors face-to-face. Conclusions: E-consultation can help patients accurately enhance their awareness of the disease and guide them to make a more reasonable medical selection. However, it is likely that e-consultation makes online medical services centralized. Additionally, the guiding effect of e-consultation is limited, and e-consultation needs to be combined with other supporting systems conducive to medical selection to play an improved role. ",
doi="10.2196/40993",
url="https://www.jmir.org/2023/1/e40993",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115615"
}


@Article{info:doi/10.2196/44462,
author="Johansen, Kristoffer Simon
and Kanstrup, Marie Anne
and Haseli, Kian
and Stenmo, Hildebrandt Visti
and Thomsen, Laust Janus
and Rathleff, Skovdal Michael",
title="Exploring User Visions for Modeling mHealth Apps Toward Supporting Patient-Parent-Clinician Collaboration and Shared Decision-making When Treating Adolescent Knee Pain in General Practice: Workshop Study",
journal="JMIR Hum Factors",
year="2023",
month="Apr",
day="28",
volume="10",
pages="e44462",
keywords="mobile health",
keywords="mHealth",
keywords="design",
keywords="patient physician relationship",
keywords="collaborative care",
keywords="shared decision-making",
keywords="adolescents",
keywords="parents",
keywords="knee pain",
keywords="patellofemoral pain",
keywords="Osgood Schlatter",
keywords="musculoskeletal",
keywords="general practice",
keywords="primary care",
keywords="mobile phone",
abstract="Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, it remains unclear how mHealth apps should be designed to act as tools for supporting individual and collaborative management of adolescents' knee pain in a general practice setting. Objective: The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making. Methods: Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain. Results: Overall, 38\% (9/24) young adults with chronic knee pain since adolescence, 25\% (6/24) parents, and 38\% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making. Conclusions: An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 silver-bullet principles for consolidating mHealth core features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. ",
doi="10.2196/44462",
url="https://humanfactors.jmir.org/2023/1/e44462",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115609"
}


@Article{info:doi/10.2196/40318,
author="Peeters, Ken
and Giroldi, Esther
and Veldhuizen, Lotte
and Abdelaziz, Kahin
and Muris, Dennis
and Cals, Jochen",
title="General Practitioner Use of e-Consultation to Consult Hospital Specialists: Interview Study to Obtain Physician's Perceptions About Digital Interprofessional Communication",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="28",
volume="25",
pages="e40318",
keywords="e-consultation",
keywords="e-consult",
keywords="electronic consultation",
abstract="Background: In recent years, tasks have shifted from specialized hospital care to primary care, leading to both advantages and challenges for general practitioners (GPs). A frequently mentioned tool to face these challenges is e-consultation, a form of asynchronous digital interprofessional communication between GPs and hospital specialists. Objective: The objective of this study was to gain insight into GPs' and hospital specialists' views and experiences of e-consultation. Methods: We interviewed 47\% (15/32) GPs and 53\% (17/32) hospital specialists and performed a thematic analysis. Results: We found that both GPs and hospital specialists experience a positive effect on the quality of care and collaboration between GPs and hospital specialists. Positive effects were reported on the accessibility of care, efficiency of care, and relationship between the GP and the patient. Furthermore, communication between GP and hospital specialist became more efficient, and e-consultation offered educational value for the GP. Certain improvements are needed to further optimize e-consultation, regarding applicability, communication, and training purposes. Conclusions: In the future, clinicians and policy makers can use the insights gained from this study to further optimize and implement e-consultation in clinical practice. ",
doi="10.2196/40318",
url="https://www.jmir.org/2023/1/e40318",
url="http://www.ncbi.nlm.nih.gov/pubmed/36976626"
}


@Article{info:doi/10.2196/45211,
author="Dinh, Alana
and Tseng, Emily
and Yin, Lukas Andrew
and Estrin, Deborah
and Greenwald, Peter
and Fortenko, Alexander",
title="Perceptions About Augmented Reality in Remote Medical Care: Interview Study of Emergency Telemedicine Providers",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="28",
volume="7",
pages="e45211",
keywords="augmented reality",
keywords="telemedicine",
keywords="telehealth",
keywords="emergency medicine",
keywords="education",
keywords="mobile phone",
abstract="Background: Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR's implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. Objective: This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. Methods: Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR's potential in remote health care. Interviews were transcribed and analyzed via thematic coding. Results: Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR's adoption. Conclusions: AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine. ",
doi="10.2196/45211",
url="https://formative.jmir.org/2023/1/e45211",
url="http://www.ncbi.nlm.nih.gov/pubmed/36976628"
}


@Article{info:doi/10.2196/42335,
author="Whitehead, David
and Conley, Jared",
title="The Next Frontier of Remote Patient Monitoring: Hospital at Home",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="16",
volume="25",
pages="e42335",
keywords="hospital at home",
keywords="remote patient monitoring",
keywords="RPM",
keywords="digital health",
keywords="remote monitoring",
keywords="remote care",
keywords="vital sign",
keywords="telemetry",
keywords="fall",
keywords="cost",
keywords="care delivery",
keywords="service delivery",
doi="10.2196/42335",
url="https://www.jmir.org/2023/1/e42335",
url="http://www.ncbi.nlm.nih.gov/pubmed/36928088"
}


@Article{info:doi/10.2196/43496,
author="Blease, Charlotte
and Torous, John
and Dong, Zhiyong
and Davidge, Gail
and DesRoches, Catherine
and Kharko, Anna
and Turner, Andrew
and Jones, Ray
and H{\"a}gglund, Maria
and McMillan, Brian",
title="Patient Online Record Access in English Primary Care: Qualitative Survey Study of General Practitioners' Views",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="22",
volume="25",
pages="e43496",
keywords="electronic health records",
keywords="attitudes",
keywords="general practice",
keywords="patients",
keywords="online record access",
keywords="open notes",
keywords="opinions",
keywords="primary care",
keywords="qualitative research",
abstract="Background: In 2022, NHS England announced plans to ensure that all adult primary care patients in England would have full online access to new data added to their general practitioner (GP) record. However, this plan has not yet been fully implemented. Since April 2020, the GP contract in England has already committed to offering patients full online record access on a prospective basis and on request. However, there has been limited research into UK GPs' experiences and opinions about this practice innovation. Objective: This study aimed to explore the experiences and opinions of GPs in England about patients' access to their full web-based health record, including clinicians' free-text summaries of the consultation (so-called ``open notes''). Methods: In March 2022, using a convenience sample, we administered a web-based mixed methods survey of 400 GPs in the United Kingdom to explore their experiences and opinions about the impact on patients and GPs' practices to offer patients full online access to their health records. Participants were recruited using the clinician marketing service Doctors.net.uk from registered GPs currently working in England. We conducted a qualitative descriptive analysis of written responses (``comments'') to 4 open-ended questions embedded in a web-based questionnaire. Results: Of 400 GPs, 224 (56\%) left comments that were classified into 4 major themes: increased strain on GP practices, the potential to harm patients, changes to documentation, and legal concerns. GPs believed that patient access would lead to extra work for them, reduced efficiency, and increased burnout. The participants also believed that access would increase patient anxiety and incur risks to patient safety. Experienced and perceived documentation changes included reduced candor and changes to record functionality. Anticipated legal concerns encompassed fears about increased litigation risks and lack of legal guidance to GPs about how to manage documentation that would be read by patients and potential third parties. Conclusions: This study provides timely information on the views of GPs in England regarding patient access to their web-based health records. Overwhelmingly, GPs were skeptical about the benefits of access both for patients and to their practices. These views are similar to those expressed by clinicians in other countries, including Nordic countries and the United States before patient access. The survey was limited by the convenience sample, and it is not possible to infer that our sample was representative of the opinions of GPs in England. More extensive, qualitative research is required to understand the perspectives of patients in England after experiencing access to their web-based records. Finally, further research is needed to explore objective measures of the impact of patient access to their records on health outcomes, clinician workload, and changes to documentation. ",
doi="10.2196/43496",
url="https://www.jmir.org/2023/1/e43496",
url="http://www.ncbi.nlm.nih.gov/pubmed/36811939"
}


@Article{info:doi/10.2196/42540,
author="Chrimes, Dillon",
title="Using Decision Trees as an Expert System for Clinical Decision Support for COVID-19",
journal="Interact J Med Res",
year="2023",
month="Jan",
day="30",
volume="12",
pages="e42540",
keywords="assessment tool",
keywords="chatbot",
keywords="clinical decision support",
keywords="COVID-19",
keywords="decision tree",
keywords="digital health tool",
keywords="framework",
keywords="health informatics",
keywords="health intervention",
keywords="prototype",
doi="10.2196/42540",
url="https://www.i-jmr.org/2023/1/e42540",
url="http://www.ncbi.nlm.nih.gov/pubmed/36645840"
}


@Article{info:doi/10.2196/38518,
author="Weinberg, Vera
and van Haren, Eva
and Gombert-Handoko, B. Kim",
title="Improving Patient Access to Hospital Pharmacists Using eConsults: Retrospective Descriptive Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="27",
volume="7",
pages="e38518",
keywords="eConsult",
keywords="online consultation",
keywords="eHealth",
keywords="electronic patient portal",
keywords="hospital pharmacy",
keywords="medication reconciliation",
abstract="Background: eConsults are increasingly used worldwide to reduce specialist referrals and increase access to medical care. An additional benefit of using an eConsult tool is a reduction of health care costs while improving the quality of health care and patient participation. Currently, shared decision making is increasingly implemented and preferred by patients. eConsults are also a promising tool to improve access to the hospital pharmacist. Patients often have questions about their medication. When medication is started during a hospital admission or outpatient visit, community pharmacists are not always sufficiently informed to answer patient questions. Direct contact with hospital pharmacists may be more appropriate and efficient. This contact is facilitated through the eConsult feature in the hospital's patient portal. Objective: This study aims to evaluate the prevalence and contents of the eConsults sent by patients to hospital pharmacists. Methods: A first retrospective descriptive study was conducted at the Leiden University Medical Center in the Netherlands. Patients who sent at least one eConsult to a hospital pharmacist between March 2017 and December 2021 were included. Patient characteristics and the number of medications taken were extracted from electronic health records. The content of eConsults was analyzed and grouped into different subjects. Time of sending of the eConsults was analyzed. A comparison was made between the number of eConsults sent to the hospital pharmacy and the number sent to the medical center. Finally, the appropriateness for evaluation by the hospital pharmacist was assessed in all eConsults. Results: During the study period, 983 eConsults (from 808 patients) were sent to the hospital pharmacist. The average patient age was 56 (SD 15.9) years, and 51.4\% (415/808) were male; 47.8\% (386/808) of the patients used 0 to 4 medications, 33.0\% (267/808) used 5 to 9 medications, and 19.2\% (155/808) used ?10 medications. Of the eConsults, 10.9\% (107/983) were excluded due to not being medication-related or not intended for the hospital pharmacist. Patients being treated in 31 medical specialties sent eConsults to the hospital pharmacist. The most common medical specialty was cardiology with 22.5\% (197/876) of the eConsults. Most eConsults were sent during office hours (614/876, 70.2\%). eConsult subjects were medication verification (372/876, 42.5\%), logistics (243/876, 27.7\%), therapeutic effect and adverse events (100/876, 11.4\%), use of medication (87/876, 9.9\%), and other subjects (74/876, 8.4\%). Conclusions: Introducing eConsults allows patients to ask medication-related questions directly to hospital pharmacists. Our study shows that patients send medication reconciliation--related eConsults most often. Use of the eConsult tool leads to fast, direct, and documented communication between patient and hospital pharmacist. This can reduce medication-related errors, improve patient empowerment, and increase access to the hospital pharmacist. ",
doi="10.2196/38518",
url="https://formative.jmir.org/2023/1/e38518",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705957"
}


@Article{info:doi/10.2196/42563,
author="Dhanani, Zainub
and Ferguson, M. Jacqueline
and Van Campen, James
and Slightam, Cindie
and Jacobs, C. Josephine
and Heyworth, Leonie
and Zulman, Donna",
title="Overcoming Access Barriers for Veterans: Cohort Study of the Distribution and Use of Veterans Affairs' Video-Enabled Tablets Before and During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="26",
volume="25",
pages="e42563",
keywords="COVID-19",
keywords="veterans",
keywords="health care access",
keywords="video-based care",
keywords="telehealth",
keywords="barriers to care",
keywords="telemedicine",
keywords="veteran's association",
keywords="health disparity",
keywords="sociodemographic",
keywords="virtual health",
abstract="Background: During the COVID-19 pandemic, as health care services shifted to video- and phone-based modalities for patient and provider safety, the Veterans Affairs (VA) Office of Connected Care widely expanded its video-enabled tablet program to bridge digital divides for veterans with limited video care access. Objective: This study aimed to characterize veterans who received and used US Department of VA--issued video-enabled tablets before versus during the COVID-19 pandemic. Methods: We compared sociodemographic and clinical characteristics of veterans who received VA-issued tablets during 6-month prepandemic and pandemic periods (ie, from March 11, 2019, to September 10, 2019, and from March 11, 2020, to September 10, 2020). Then, we examined characteristics associated with video visit use for primary and mental health care within 6 months after tablet shipment, stratifying models by timing of tablet receipt. Results: There was a nearly 6-fold increase in the number of veterans who received tablets in the pandemic versus prepandemic study periods (n=36,107 vs n=6784, respectively). Compared to the prepandemic period, tablet recipients during the pandemic were more likely to be older (mean age 64 vs 59 years), urban-dwelling (24,504/36,107, 67.9\% vs 3766/6784, 55.5\%), and have a history of housing instability (8633/36,107, 23.9\% vs 1022/6784, 15.1\%). Pandemic recipients were more likely to use video care (21,090/36,107, 58.4\% vs 2995/6784, 44.2\%) and did so more frequently (5.6 vs 2.3 average encounters) within 6 months of tablet receipt. In adjusted models, pandemic and prepandemic video care users were significantly more likely to be younger, stably housed, and have a mental health condition than nonusers. Conclusions: Although the COVID-19 pandemic led to increased distribution of VA-issued tablets to veterans with complex clinical and social needs, tablet recipients who were older or unstably housed remained less likely to have a video visit. The VA's tablet distribution program expanded access to video-enabled devices, but interventions are needed to bridge disparities in video visit use among device recipients. ",
doi="10.2196/42563",
url="https://www.jmir.org/2023/1/e42563",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630650"
}


@Article{info:doi/10.2196/38310,
author="Cresswell, Kathrin
and Anderson, Stuart
and Mozaffar, Hajar
and Elizondo, Andrey
and Geiger, Marcia
and Williams, Robin",
title="Socio-Organizational Dimensions: The Key to Advancing the Shared Care Record Agenda in Health and Social Care",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="26",
volume="25",
pages="e38310",
keywords="integrated care",
keywords="sociotechnical",
keywords="socio-organizational",
keywords="shared care records",
keywords="health care",
keywords="healthcare",
keywords="social care",
keywords="digital health",
doi="10.2196/38310",
url="https://www.jmir.org/2023/1/e38310",
url="http://www.ncbi.nlm.nih.gov/pubmed/36701190"
}


@Article{info:doi/10.2196/42151,
author="Schnoor, Kyma
and Versluis, Anke
and Chavannes, H. Niels
and Talboom-Kamp, A. Esther P. W.",
title="The Usability of Homelab, a Digital Self-service at a Dutch General Practice, for Diagnostic Tests: Pilot Study With a Questionnaire",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="26",
volume="7",
pages="e42151",
keywords="eHealth",
keywords="diagnostic testing",
keywords="general practitioner",
keywords="general practice",
keywords="GP",
keywords="referral",
keywords="online testing",
keywords="diagnostic",
keywords="laboratory test",
keywords="usability",
keywords="digital health",
keywords="health care service",
keywords="service delivery",
abstract="Background: eHealth potentially can make health care more accessible and efficient and help reduce the workload in primary health care. Homelab is an eHealth tool implemented in a general practice environment, and it offers relatively simple laboratory diagnostic tests without the referral of the general practitioner. After logging in this eHealth tool, patients select and order a diagnostic test based on their symptoms. The test results are presented online to the general practitioner and the patient. Objective: This study aims to evaluate the use, usability, and user characteristics of Homelab. Further, it aims to evaluate whether Homelab replaces an appointment with the general practitioner. Methods: Homelab has been implemented since May 2021 as a pilot in a Dutch general practice. The number of requests and the ordered diagnostic packages are monitored. After using Homelab, patients are invited to complete a short questionnaire. The questionnaire contains demographic questions and assesses usability using the System Usability Scale (10 items). In addition, questions about requesting an appointment with the general practitioner without Homelab are included. All data were anonymous. Results: The questionnaire was filled by 74 individual patients. The mean age of the patients was 40.33 (SD 12.11) years, and half of them were females (39/74, 53\%). The majority of the patients were highly educated (56/74, 76\%) and employed (53/74, 72\%). Approximately 81\% (60/74) of the patients reported that they would use Homelab again in the future and 66\% (49/74) reported that they would have gone to the general practitioner if they had not used Homelab. The usability of Homelab was perceived higher by the younger age group (mean 73.96, SD 14.74) than by the older age group (mean 61.59, SD 14.37). In total, 106 test packages were ordered over 1 year, and the most requested diagnostic package was ``Am I still healthy? I want to do my annual health checkup.'' Homelab was used the most during the months of the COVID-19 lockdown. Conclusions: The use of Homelab, a digital self-service for ordering diagnostic tests, was monitored in this study, and its usability was perceived as above average. Our findings showed that patients are willing to use Homelab in the future and they would use it most of the time as a replacement for regular consultations. Homelab offers opportunities for more accessible and efficient health care for both the patient and the general practitioner. ",
doi="10.2196/42151",
url="https://formative.jmir.org/2023/1/e42151",
url="http://www.ncbi.nlm.nih.gov/pubmed/36701183"
}


@Article{info:doi/10.2196/41837,
author="Hellner, Megan
and Steinberg, Dori
and Baker, H. Jessica
and Blanton, Camilla",
title="Digitally Delivered Dietary Interventions for Patients with Eating Disorders Undergoing Family-Based Treatment: Protocol for a Randomized Feasibility Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="26",
volume="12",
pages="e41837",
keywords="eating disorders",
keywords="virtual treatment",
keywords="dietary interventions",
keywords="family-based treatment",
keywords="anorexia",
keywords="psychiatric disorder",
keywords="digital health intervention",
keywords="telehealth",
keywords="virtual health",
abstract="Background: Eating disorders (EDs) affect 9\% of the United States population, and anorexia nervosa (AN), specifically, has the second highest mortality rate of all psychiatric disorders. Yet, only 20\% are able to access treatment. Access to care issues include long waitlists, lack of trained specialists, financial, and geographic barriers, all of which highlight the need for effective telehealth interventions. Family-based therapy (FBT) is a first-line treatment for adolescents and young adults with EDs, and weight gain early in treatment is considered a primary predictor of success with FBT. However, nutrition requirements for patients with EDs are uniquely complex. A variety of dietary interventions for guiding the renourishment process are used in practice, but empirical data on the effectiveness and acceptability of the various interventions are sparse. The significance of nutritional restoration and issues with access to first-line treatments underscore the need for further research exploring virtually delivered dietary interventions. Objective: Our objective is to compare the effectiveness and acceptability of 2 digitally delivered dietary interventions frequently used in eating disorder treatment settings: (1) calorie-based meal plans and (2) the Plate-by-Plate approach. Specifically, we will explore any potential differences in weight restoration achieved over 8 weeks of treatment as a primary measure of effectiveness, as well as additional treatment outcomes (ED symptoms, anxiety, depression, caregiver burden, and perceived effectiveness and acceptability for both caregivers and clinicians). Methods: Patients (N=100) with either AN or avoidant restrictive food intake disorders (ARFID) aged 6-24 years seeking treatment at a nationwide virtual eating disorder treatment program, were enrolled between May and August 2022. Upon admission, patients were randomly assigned to receive either the calorie-based intervention or Plate-by-Plate approach from their registered dietitian, all of whom have received training as study interventionists. While we were primarily interested in responses during the first 8 weeks of treatment, patients will be followed for up to 12 months. Descriptive statistics were used to describe patient characteristics and demographics. Weight changes and other treatment outcomes between groups will be compared using generalized linear models. Semistructured caregiver and clinician interview transcripts will undergo qualitative analysis. Results: Enrollment ran from March to August 2022, and we anticipate completion of data collection by November 2022. Analyses will be completed in January 2023. Conclusions: This study contributes to existing FBT literature by thoroughly exploring the acceptability of dietary interventions and their influence on weight restoration, an area in which research is sparse. International Registered Report Identifier (IRRID): DERR1-10.2196/41837 ",
doi="10.2196/41837",
url="https://www.researchprotocols.org/2023/1/e41837",
url="http://www.ncbi.nlm.nih.gov/pubmed/36701182"
}


@Article{info:doi/10.2196/41045,
author="Claessens, Janneau
and van Egmond, Juultje
and Wanten, Joukje
and Bauer, No{\"e}l
and Nuijts, Rudy
and Wisse, Robert",
title="The Accuracy of a Web-Based Visual Acuity Self-assessment Tool Performed Independently by Eye Care Patients at Home: Method Comparison Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="25",
volume="7",
pages="e41045",
keywords="eHealth",
keywords="telemonitoring",
keywords="telemedicine",
keywords="telehealth",
keywords="visual acuity",
keywords="eye care",
keywords="ophthalmology",
abstract="Background: ?Telehealth solutions can play an important role in increasing access to eye care. Web-based eye tests can enable individuals to self-assess their visual function remotely without the assistance of an eye care professional. A web-based tool for self-assessing visual acuity (VA) has previously been studied in controlled, supervised conditions. The accuracy of this tool when performed independently by patients in their home environment, using their own devices, has not yet been examined. Objective: ?The objective of this paper was to examine the accuracy of a web-based tool with respect to measuring VA in ophthalmic patients in their home environment, compared with a conventional in-hospital assessment using a Snellen chart (the gold standard). Methods: ?From April through September 2020, consecutive adult patients with uveitis at the University Medical Center Utrecht, the Netherlands, performed the web-based VA test at home (the index test) before their upcoming conventional VA assessment at the hospital (the reference test). The agreement between the 2 tests was assessed by the Bland-Altman analysis. Additional analyses were performed to investigate associations between clinical characteristics and the accuracy of the web-based test. Results: ?A total of 98 eyes in 59 patients were included in the study. The difference in VA between the index and reference tests was not significant, with a mean difference of 0.02 (SD 0.12) logMAR (P=.09) and 95\% limits of agreement of --0.21 to 0.26 logMAR. The majority of the differences (77\%) fell within the predetermined acceptable deviation limit of 0.15 logMAR. In addition, no patient characteristics or clinical parameters were found to significantly affect the accuracy of the web-based test. Conclusions: ?This web-based test for measuring VA is a valid tool for remotely assessing VA, also when performed independently by patients at home. Implementation of validated web-based tools like this in the health care system may represent a valuable step forward in revolutionizing teleconsultations and can provide individual patients with the opportunity to self-monitor changes in VA. This is particularly relevant when the patient's access to ophthalmic care is limited. Future developments should focus on optimizing the testing conditions at home to reduce outliers. ",
doi="10.2196/41045",
url="https://formative.jmir.org/2023/1/e41045",
url="http://www.ncbi.nlm.nih.gov/pubmed/36696171"
}


@Article{info:doi/10.2196/31903,
author="Denny, Carter Mary
and Ancer Leal, Andrea
and Montiel, Casameni Tahani
and Wynne, J. Keona
and Edquilang, Gabrielle
and Vu, Thi Kim Yen
and Vahidy, Farhaan
and Savitz, I. Sean
and Beauchamp, ES Jennifer
and Sharrief, Anjail",
title="An Intervention Mapping Approach to Developing a Stroke Literacy Video for Recent Stroke Survivors: Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="4",
volume="7",
pages="e31903",
keywords="stroke",
keywords="stroke prevention",
keywords="health literacy",
keywords="stroke literacy",
keywords="patient education",
keywords="transition of care",
keywords="risk factors",
keywords="cardiac",
keywords="digital health",
abstract="Background: Most vascular events after stroke may be prevented by modifying vascular risk factors through medical and behavioral interventions. Stroke literacy---an understanding of stroke symptoms, risk factors, and treatment---likely contributes to vascular risk factor control and in turn stroke recurrence risk. Stroke literacy is the lowest among adults belonging to racial and ethnic minority populations in the United States. Video-based interventions targeting stroke literacy may help acute stroke survivors understand stroke and subsequently reduce the risk of stroke recurrence. However, the failure of prior stroke literacy interventions may be due in part to the fact that the interventions were not theory-driven. Intervention mapping (IM) provides a framework for use in the development, implementation, and evaluation of evidence-informed, health-related interventions. Objective: We aimed to develop a video-based educational intervention to improve stroke literacy in hospitalized patients with acute stroke. Methods: The 6-step iterative process of IM was used to develop a video-based educational intervention and related implementation and evaluation plans. The six steps included a needs assessment, the identification of outcomes and change objectives, the selection of theory- and video-based intervention methods and practical applications, the development of a video-based stroke educational intervention, plans for implementation, and evaluation strategies. Results: A 5-minute video-based educational intervention was developed. The IM approach led to successful intervention development by emphasizing stakeholder involvement, generation and adoption, and information retainment in the planning phase of the intervention. A planned approach to video adoption, implementation, and evaluation was also developed. Conclusions: An IM approach guided the development of a 5-minute video-based educational intervention to promote stroke literacy among acute stroke survivors. Future studies are needed to assess the use of technology and digital media to support widespread access and participation in video-based health literacy interventions for populations with acute and chronic stroke. Studies are needed to assess the impact of video-based educational interventions that are paired with stroke systems of care optimization to reduce the risk of stroke recurrence. Furthermore, studies on culturally and linguistically sensitive video-based stroke literacy interventions are needed to address known racial and ethnic disparities in stroke literacy. International Registered Report Identifier (IRRID): RR2-10.1371/journal.pone.0171952 ",
doi="10.2196/31903",
url="https://formative.jmir.org/2023/1/e31903",
url="http://www.ncbi.nlm.nih.gov/pubmed/35972729"
}


@Article{info:doi/10.2196/34823,
author="Koech, Angela
and Musitia, Muoga Peris
and Mwashigadi, Mkanjala Grace
and Kinshella, Woo Mai-Lei
and Vidler, Marianne
and Temmerman, Marleen
and Craik, Rachel
and von Dadelszen, Peter
and Noble, Alison J.
and Papageorghiou, T. Aris
and ",
title="Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study",
journal="JMIR Hum Factors",
year="2022",
month="Dec",
day="27",
volume="9",
number="4",
pages="e34823",
keywords="gestational age",
keywords="gestation",
keywords="gynecology",
keywords="gynecologist",
keywords="prenatal",
keywords="antenatal",
keywords="maternal",
keywords="fetus",
keywords="fetal",
keywords="ultrasound",
keywords="imaging",
keywords="pregnancy dating",
keywords="handheld",
keywords="portable",
keywords="trust",
keywords="artificial intelligence",
keywords="sub-Saharan Africa",
keywords="Africa",
keywords="low cost",
keywords="LMIC",
keywords="low income",
keywords="feasibility",
keywords="acceptability",
keywords="AI",
keywords="pregnancy",
keywords="pregnant",
keywords="maternity",
keywords="women's health",
keywords="obstetrics",
keywords="obstetrician",
keywords="rural",
keywords="remote",
keywords="remote location",
keywords="misconception",
keywords="eHealth",
keywords="digital health",
abstract="Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods: A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results: Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions: This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended. ",
doi="10.2196/34823",
url="https://humanfactors.jmir.org/2022/4/e34823",
url="http://www.ncbi.nlm.nih.gov/pubmed/36574278"
}


@Article{info:doi/10.2196/35880,
author="Perrot, Serge
and Trouvin, Anne-Priscille
and Clairaz-Mahiou, Beatrice
and Tempremant, Gr{\'e}gory
and Martial, Fran{\c{c}}ois
and Br{\'e}ment, Diane
and Cherkaoui, Asmaa",
title="A Computerized Pharmacy Decision Support System (PDSS) for Headache Management: Observational Pilot Study",
journal="Interact J Med Res",
year="2022",
month="Nov",
day="25",
volume="11",
number="2",
pages="e35880",
keywords="headache",
keywords="pharmacy",
keywords="counselling",
keywords="over-the-counter (OTC) medication",
keywords="self-medication",
keywords="decision support system",
keywords="patient perception",
abstract="Background: Headaches are common and often lead patients to seek advice from a pharmacist and consequently self-medicate for relief. Computerized pharmacy decision support systems (PDSSs) may be a valuable resource for health care professionals, particularly for community pharmacists when counseling patients with headache, to guide treatment with over-the-counter medications and recognize patients who require urgent or specialist care. Objective: This observational pilot study aimed to evaluate a newly developed PDSS web app for the management of patients seeking advice from a pharmacy for headache. This study examined the use of the PDSS web app and if it had an impact on patient or pharmacy personnel counseling, pharmacy personnel perception, and patient perception. Methods: The PDSS web app was developed according to Francophone des Sciences Pharmaceutiques Officinales (SFSPO) recommendations for headache management, and was made available to pharmacies in 2 regions of France: Hauts de France and New Aquitaine. Pharmacy personnel received 2 hours of training before using the PDSS web app. All people who visited the pharmacies for headache between June 29, 2020, and December 31, 2020, were offered an interview based on the PDSS web app and given information about the next steps in the management of headaches and advice on the proper use of their medication. Patients and pharmacy personnel reported satisfaction with the PDSS web app following consultations or during a follow-up period (January 18 to 25, 2021). Results: Of the 44 pharmacies that received the PDSS web app, 38 pharmacies representing 179 pharmacy personnel used the PDSS web app, and 435 people visited these pharmacies for headache during the study period. Of these, 70.0\% (305/435) asked for immediate over-the-counter analgesics for themselves and consulted with pharmacy personnel with the use of the PDSS web app. The majority of these patients were given advice and analgesics for self-medication (346/435, 79.5\%); however, 17.0\% (74/435) were given analgesics and referred to urgent medical services, and 3.5\% (15/435) were given analgesics and referred to their general practitioner. All pharmacy personnel (n=45) were satisfied or very satisfied with the use of the PDSS web app, and a majority thought it improved the quality of their care (41/44, 93.2\%). Most pharmacy personnel felt that the PDSS web app modified their approach to management of headache (29/45, 64.4\%). Most patients were very satisfied with the PDSS web app during their consultation (96/119, 80.7\%), and all felt mostly or completely reassured. Conclusions: Use of the PDSS web app for the management of patients with headache improved the perceived quality of care for pharmacy personnel and patients. The PDSS web app was well accepted and effectively identified patients who required specialist medical management. Further studies should identify additional ``red flags'' for more effective screening and management of patients via the PDSS web app. Larger studies can measure the impact of the PDSS web app on the lives of patients and how safe or appropriate pharmacy personnel recommendations are. ",
doi="10.2196/35880",
url="https://www.i-jmr.org/2022/2/e35880",
url="http://www.ncbi.nlm.nih.gov/pubmed/36427228"
}


@Article{info:doi/10.2196/42839,
author="Muschol, Jennifer
and Heinrich, Martin
and Heiss, Christian
and Hernandez, Mauricio Alher
and Knapp, Gero
and Repp, Holger
and Schneider, Henning
and Thormann, Ulrich
and Uhlar, Johanna
and Unzeitig, Kai
and Gissel, Christian",
title="Economic and Environmental Impact of Digital Health App Video Consultations in Follow-up Care for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="24",
volume="24",
number="11",
pages="e42839",
keywords="carbon neutrality",
keywords="digital health",
keywords="environmental impact",
keywords="health economics",
keywords="net-zero",
keywords="orthopedic",
keywords="sustainability",
keywords="telemedicine",
keywords="trauma surgery",
keywords="video consultations",
abstract="Background: Following the Riyadh Declaration, digital health technologies were prioritized in many countries to address the challenges of the COVID-19 pandemic. Digital health apps for telemedicine and video consultations help reduce potential disease spread in routine health care, including follow-up care in orthopedic and trauma surgery. In addition to the satisfaction, efficiency, and safety of telemedicine, its economic and environmental effects are highly relevant to decision makers, particularly for the goal of reaching carbon neutrality of health care systems. Objective: This study aims to provide the first comprehensive health economic and environmental analysis of video consultations in follow-up care after knee and shoulder interventions in an orthopedic and trauma surgery department of a German university hospital. The analysis is conducted from a societal perspective. We analyze both economic and environmental impacts of video consultations, taking into account the goal of carbon neutrality for the German health care system by 2030. Methods: We conducted a prospective randomized controlled trial comparing follow-up care with digital health app video consultations (intervention group) to conventional face-to-face consultations in the clinic (control group). Economic impact included the analysis of travel and time costs and production losses. Examination of the environmental impact comprised the emissions of greenhouse gases, carbon monoxide, volatile hydrocarbons, nitrogen oxides, and particulates, and the calculation of environmental costs. Sensitivity analysis included calculations with a higher cost per ton of carbon dioxide equivalent, which gives equal weight to the welfare of present and future generations. Results: Data from 52 patients indicated that, from the patients' point of view, telemedicine helped reduce travel costs, time costs, and production losses, resulting in mean cost savings of {\texteuro}76.52 per video consultation. In addition, emissions of 11.248 kg of greenhouse gases, 0.070 kg of carbon monoxide, 0.011 kg of volatile hydrocarbons, 0.028 kg of nitrogen oxides, and 0.0004 kg of particulates could be saved per patient through avoided travel. This resulted in savings of environmental costs between {\texteuro}3.73 and {\texteuro}9.53 per patient. Conclusions: We presented the first comprehensive analysis of economic and environmental effects of telemedicine in the follow-up care of patients in orthopedic and trauma surgery in Germany. Video consultations were found to reduce the environmental footprint of follow-up care; saved travel costs, travel time, and time costs for patients; and helped to lower production losses. Our findings can support the decision-making on the use of digital health during and beyond the COVID-19 pandemic, providing decision makers with data for both economic and environmental effects. Thanks to the pragmatic design of our study, our findings can be applied to a wide range of clinical contexts and potential digital health applications that substitute outpatient hospital visits with video consultations. Trial Registration: German Clinical Trials Register DRKS00023445; https://tinyurl.com/4pcvhz4n ",
doi="10.2196/42839",
url="https://www.jmir.org/2022/11/e42839",
url="http://www.ncbi.nlm.nih.gov/pubmed/36333935"
}


@Article{info:doi/10.2196/39542,
author="Banguilan, Louise Kaila
and Sonnenberg, Frank
and Chen, Catherine",
title="Physicians' Perspectives on Inpatient Portals: Systematic Review",
journal="Interact J Med Res",
year="2022",
month="Nov",
day="15",
volume="11",
number="2",
pages="e39542",
keywords="inpatient portals",
keywords="personal health record",
keywords="physician perspectives",
keywords="patient portals",
keywords="inpatients",
keywords="technology",
abstract="Background: Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite their potential to improve quality of care and empower patients and families to participate in their treatment, adoption remains low. Outpatient portal studies have shown that physician endorsement can drive patients' adoption of these systems. Insights on physicians' perspectives on use of these platforms can help improve patient and physician satisfaction and inpatient portal uptake. Objective: The purpose of this systematic review is to better understand physicians' perspectives toward inpatient portals. Methods: A systematic literature review was conducted for studies published between 1994 and November 2021 using keywords for physicians' perspectives toward patient portals and personal health records. Databases included PubMed, MEDLINE, Web of Science, and Scopus. Articles solely focused on nonphysician clinicians or addressing only outpatient settings or shared notes were excluded from this review. Two reviewers performed title, abstract, and full-text screening independently. Bias assessment was performed using the JBI SUMARI Critical Appraisal Tool (Joanna Briggs Institute). Inductive thematic analysis was done based on themes reported by original authors. Data were synthesized using narrative synthesis and reported according to overarching themes. Results: In all, 4199 articles were collected and 9 included. All but 2 of the studies were conducted in the United States. Common themes identified were communication and privacy, portal functionality and patient use, and workflow. In studies where physicians had no prior patient portal experience, concerns were expressed about communication issues created by patients' access to laboratory results and potential impact on existing workflow. Concerns about negative communication impacts were not borne out in postimplementation studies. Conclusions: Physicians perceived inpatient portals to be beneficial to patients and saw improvement in communication as a result. This is consistent with outpatient studies and highlights the need to improve training on portal use and include physicians during the design process. Health care organizations and information technology entities can take steps to increasing clinician comfort. Physician concerns involving patient portal usage and managing patient expectations also need to be addressed. With improved clinician support, initial pessimism about communication and workload issues can be overcome. Limitations of this review include the small number of pre- and postimplementation studies found. This is also not a review of perspectives on open notes, which merits separate discussion. ",
doi="10.2196/39542",
url="https://www.i-jmr.org/2022/2/e39542",
url="http://www.ncbi.nlm.nih.gov/pubmed/36378521"
}


@Article{info:doi/10.2196/38886,
author="Oakley-Girvan, Ingrid
and Docherty, P. John",
title="A New Approach to Enhancing Engagement in eHealth Apps",
journal="Interact J Med Res",
year="2022",
month="Nov",
day="9",
volume="11",
number="2",
pages="e38886",
keywords="user engagement",
keywords="eHealth",
keywords="attrition",
keywords="adherence",
keywords="apps",
keywords="app design",
keywords="user experience",
doi="10.2196/38886",
url="https://www.i-jmr.org/2022/2/e38886",
url="http://www.ncbi.nlm.nih.gov/pubmed/36279587"
}


@Article{info:doi/10.2196/38604,
author="Chu, Cherry
and Nayyar, Dhruv
and Bhattacharyya, Onil
and Martin, Danielle
and Agarwal, Payal
and Mukerji, Geetha",
title="Patient and Provider Experiences With Virtual Care in a Large, Ambulatory Care Hospital in Ontario, Canada During the COVID-19 Pandemic: Observational Study",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="25",
volume="24",
number="10",
pages="e38604",
keywords="virtual care",
keywords="telehealth",
keywords="COVID-19 pandemic",
keywords="patient experience",
keywords="provider experience",
keywords="virtual",
keywords="telemedicine",
keywords="COVID-19",
keywords="ethnicity",
keywords="social factors",
keywords="experience",
abstract="Background: Virtual care use increased during the COVID-19 pandemic. The impact of that shift on patient and provider experiences is unclear. Objective: We evaluated patient and provider experiences with virtual visits across an academic, ambulatory hospital in Toronto, Canada and assessed predictors of positive experience with virtual care. Methods: Survey data were analyzed from consenting patients who attended at least one virtual visit (video or telephone) and from consenting providers who delivered at least one virtual visit. Distributions for demographic variables and responses to survey questions are reported, with statistical significance assessed using chi-square tests and t tests. Ordinal logistic regression analysis was used to identify any patient predictors of responses. Results: During the study period, 253 patients (mean age 45.1, SD 15.6 years) completed 517 video visit surveys, and 147 patients (mean age 41.6, SD 16.4 years) completed 209 telephone visit surveys. A total of 75 and 94 providers completed the survey in June 2020 and June 2021, respectively. On a scale from 1 to 10 regarding likelihood to recommend virtual care to others, fewer providers rated a score of 8 or above compared with patients (providers: 62/94, 66\% for video and 49/94, 52\% for telephone; patients: 415/517, 80\% for video and 150/209, 72\% for telephone). Patients of non-White ethnicity had lower odds of rating a high score of 9 or 10 compared with White patients (odds ratio 0.52, 95\% CI 0.28-0.99). Conclusions: Patient experiences with virtual care were generally positive, but provider experiences were less so. Findings suggest potential differences in patient experience by ethnicity, warranting further investigation into equity concerns with virtual care. ",
doi="10.2196/38604",
url="https://www.jmir.org/2022/10/e38604",
url="http://www.ncbi.nlm.nih.gov/pubmed/36194862"
}


@Article{info:doi/10.2196/40876,
author="Imai, Chisato
and Amin, Janaki
and Prgomet, Mirela
and Pearce, Christopher
and Georgiou, Andrew",
title="An Increase in Antibiotic Prescribing for Respiratory Tract Infections Through Telehealth Consultations: Retrospective Study in Australian General Practice",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="18",
volume="24",
number="10",
pages="e40876",
keywords="general practice",
keywords="anti-infective agents",
keywords="antibiotics",
keywords="medication",
keywords="prescriptions",
keywords="respiratory tract infections",
keywords="infection",
keywords="telehealth",
keywords="telemedicine",
keywords="Australia",
doi="10.2196/40876",
url="https://www.jmir.org/2022/10/e40876",
url="http://www.ncbi.nlm.nih.gov/pubmed/36256826"
}


@Article{info:doi/10.2196/37844,
author="Birati, Yosefa
and Yefet, Enav
and Perlitz, Yuri
and Shehadeh, Naim
and Spitzer, Sivan",
title="Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="14",
volume="24",
number="10",
pages="e37844",
keywords="gestational diabetes mellitus",
keywords="maternal health",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="mobile phone",
keywords="telemedicine",
keywords="culture",
keywords="health literacy",
keywords="vulnerable populations",
keywords="pregnancy outcome",
abstract="Background: The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited. Objective: This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems' effectiveness in improving glycemic control and maternal and infant outcomes. Methods: We conducted a scoping review using a framework adapted from Arksey and O'Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented. Results: We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12\% (2/17) of the studies, and only 25\% (3/12) of the interventions scored ?3 out of 5 in our assessment of digital health literacy. Conclusions: mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women's self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes. ",
doi="10.2196/37844",
url="https://www.jmir.org/2022/10/e37844",
url="http://www.ncbi.nlm.nih.gov/pubmed/36240008"
}


@Article{info:doi/10.2196/40597,
author="Fossouo Tagne, Joel
and Yakob, Amin Reginald
and Mcdonald, Rachael
and Wickramasinghe, Nilmini",
title="Barriers and Facilitators Influencing Real-time and Digital-Based Reporting of Adverse Drug Reactions by Community Pharmacists: Qualitative Study Using the Task-Technology Fit Framework",
journal="Interact J Med Res",
year="2022",
month="Oct",
day="11",
volume="11",
number="2",
pages="e40597",
keywords="pharmacovigilance",
keywords="adverse drug reaction",
keywords="pharmacist",
keywords="Task-Technology Fit",
keywords="digital health",
abstract="Background: Medication use can result in adverse drug reactions (ADRs) that cause increased morbidity and health care consumption for patients and could potentially be fatal. Timely reporting of ADRs to regulators may contribute to patient safety by facilitating information gathering on drug safety data. Currently, little is known about how community pharmacists (CPs) monitor, handle, and report ADRs in Australia. Objective: This study aimed to identify perceived barriers to and facilitators of ADR reporting by CPs in Australia and suggest digital interventions. Methods: A qualitative study with individual interviews was conducted with CPs working across Victoria, Australia, between April 2022 and May 2022. A semistructured interview guide was used to identify perceived barriers to and facilitators of ADR reporting among CPs. The data were analyzed using thematic analysis. We constructed themes from the CP-reported barriers and facilitators. The themes were subsequently aligned with the Task-Technology Fit framework. Results: A total of 12 CPs were interviewed. Identified barriers were lack of knowledge of both the ADR reporting process and ADR reporting systems, time constraints, lack of financial incentives, lack of organizational support for ADR reporting, inadequate IT systems, and preference to refer consumers to physicians. The proposed facilitators of ADR reporting included enhancing CPs knowledge and awareness of ADRs, financial incentives for ADR reporting, workflow-integrated ADR reporting technology systems, feedback provision to CPs on the reported ADRs, and promoting consumer ADR reporting. Conclusions: Barriers to and facilitators of ADR reporting spanned both the task and technology aspects of the Task-Technology Fit model. Addressing the identified barriers to ADR reporting and providing workplace technologies that support ADR reporting may improve ADR reporting by CPs. Further investigations to observe ADR handling and reporting within community pharmacies can enhance patient safety by increasing ADR reporting by CPs. ",
doi="10.2196/40597",
url="https://www.i-jmr.org/2022/2/e40597",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222800"
}


@Article{info:doi/10.2196/37313,
author="Savoy, April
and Patel, Himalaya
and Shahid, Umber
and Offner, D. Alexis
and Singh, Hardeep
and Giardina, D. Traber
and Meyer, D. Ashley N.",
title="Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="22",
volume="9",
number="3",
pages="e37313",
keywords="clinicians",
keywords="community-based participatory research",
keywords="web-based design",
keywords="delivery of health care",
keywords="health intervention",
keywords="physicians",
keywords="primary health care",
keywords="videoconferencing",
abstract="Background: Participation from clinician stakeholders can improve the design and implementation of health care interventions. Participatory design methods, especially co-design methods, comprise stakeholder-led design activities that are time-consuming. Competing work demands and increasing workloads make clinicians' commitments to typical participatory methods even harder. The COVID-19 pandemic further exacerbated barriers to clinician participation in such interventions. Objective: The aim of this study was to explore a web-based participatory design approach to conduct economical, electronic co-design (ECO-design) workshops with primary care clinicians. Methods: We adapted traditional in-person co-design workshops to web-based delivery and adapted co-design workshop series to fit within a single 1-hour session. We applied the ECO-design workshop approach to codevelop feedback interventions regarding abnormal test result follow-up in primary care. We conducted ECO-design workshops with primary care clinicians at a medical center in Southern Texas, using videoconferencing software. Each workshop focused on one of three types of feedback interventions: conversation guide, email template, and dashboard prototype. We paired electronic materials and software features to facilitate participant interactions, prototyping, and data collection. The workshop protocol included four main activities: problem identification, solution generation, prototyping, and debriefing. Two facilitators were assigned to each workshop and one researcher resolved technical problems. After the workshops, our research team met to debrief and evaluate workshops. Results: A total of 28 primary care clinicians participated in our ECO-design workshops. We completed 4 parallel workshops, each with 5-10 participants. We conducted traditional analyses and generated a clinician persona (ie, representative description) and user interface prototypes. We also formulated recommendations for future ECO-design workshop recruitment, technology, facilitation, and data collection. Overall, our adapted workshops successfully enabled primary care clinicians to participate without increasing their workload, even during a pandemic. Conclusions: ECO-design workshops are viable, economical alternatives to traditional approaches. This approach fills a need for efficient methods to involve busy clinicians in the design of health care interventions. ",
doi="10.2196/37313",
url="https://humanfactors.jmir.org/2022/3/e37313",
url="http://www.ncbi.nlm.nih.gov/pubmed/36136374"
}


@Article{info:doi/10.2196/38926,
author="Mesk{\'o}, Bertalan",
title="COVID-19's Impact on Digital Health Adoption: The Growing Gap Between a Technological and a Cultural Transformation",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="19",
volume="9",
number="3",
pages="e38926",
keywords="COVID-19",
keywords="digital health",
keywords="future",
keywords="cultural transformation",
keywords="medical information",
keywords="technology adoption",
keywords="health care",
keywords="physician burnout",
keywords="burnout",
doi="10.2196/38926",
url="https://humanfactors.jmir.org/2022/3/e38926",
url="http://www.ncbi.nlm.nih.gov/pubmed/36121692"
}


@Article{info:doi/10.2196/36081,
author="Turner, Jane
and Clarke, Malcolm
and George, Grizelda
and Jones, Wynn Russell
and Pullinger, Rick
and Kharbanda, Rajesh
and Kennedy, James
and Hands, Linda",
title="An Assessment of the Potential Benefits of Video Consultation in the Emergency Department: Mixed Methods Study",
journal="Interact J Med Res",
year="2022",
month="Sep",
day="15",
volume="11",
number="2",
pages="e36081",
keywords="emergency medicine",
keywords="telemedicine",
keywords="health service research",
keywords="eHealth",
keywords="emergency",
keywords="video consultation",
keywords="remote",
keywords="specialist",
keywords="video conferencing",
keywords="videoconferencing",
keywords="video conference",
keywords="telehealth",
keywords="benefit",
keywords="patient management",
abstract="Background: District general hospital emergency departments may refer patients to a tertiary center depending on the information available to a generalist clinician in discussion with a specialist team. If there is uncertainty, the lowest-risk strategy is often to transfer the patient. Video consultation allowing the specialist team to see and talk to the patient and local clinician while still in the emergency department could improve decision-making for patient transfer. Objective: The aim of this study is to assess the potential benefit of real-time video consultation between remote specialists and emergency department patients and clinicians across all specialties. Methods: Detailed patient data were collected prospectively for 6 months (between January 16, 2012, and July 15, 2012) on all patients presenting to a district general hospital emergency department who required input from a specialist team at the nearest tertiary care center. These patients were discussed retrospectively with the specialist teams to determine whether videoconferencing could have benefited their management. The logistics for the use of videoconferencing were explored. Results: A total of 18,799 patients were seen in the emergency department during the study period. Among the 18,799 patients, 413 referrals (2.2\%) were made to the tertiary center specialist teams. A review of the patients transferred indicated that 193 (46.7\%) of the 413 patients who were referred might have benefited from video consultation (193/18,799, 1\% of all patients). If the specialist team could be accessed via videoconferencing only while a senior member was available in the hospital (8:00 AM-10:00 PM), then a maximum of 5 patients per week across all specialties would use the equipment. If 24-hour specialist access was available, this would increase to 7 patients per week. Conclusions: In regions where there is direct transportation of patients by ambulance to specialist centers and there is a regional picture archiving and communication system in place, video consultation between emergency department patients and specialists has limited potential to improve patient management. ",
doi="10.2196/36081",
url="https://www.i-jmr.org/2022/2/e36081",
url="http://www.ncbi.nlm.nih.gov/pubmed/36107488"
}


@Article{info:doi/10.2196/40108,
author="El-Dassouki, Noor
and Pfisterer, Kaylen
and Benmessaoud, Camila
and Young, Karen
and Ge, Kelly
and Lohani, Raima
and Saragadam, Ashish
and Pham, Quynh",
title="The Value of Technology to Support Dyadic Caregiving for Individuals Living With Heart Failure: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="7",
volume="24",
number="9",
pages="e40108",
keywords="heart failure",
keywords="digital therapeutics",
keywords="remote patient management",
keywords="caregiving",
keywords="dyadic management",
abstract="Background: The demand for health services to meet the chronic health needs of the aging population is significant and remains unmet because of the limited supply of clinical resources. Specifically, in managing heart failure (HF), digital health sought to address this gap during the COVID-19 pandemic but highlighted an access issue for those who could not use technology-mediated health care services without the support of their informal caregivers (ICs). The complexity of managing HF symptoms and recurrent exacerbations requires many patients to comanage their illness with their ICs in a care dyad, working together to optimize patient outcomes and health-related quality of life. However, most HF programs have missed the opportunity to consider the dyadic perspective despite interdependencies on HF outcomes. Objective: This study aims to characterize the value of technology in supporting caregiving for individuals living with HF. Methods: Motivated by an observed unique pattern of engagement in patients enrolled in our Medly HF management program at the Peter Munk Cardiac Centre in Toronto, Canada, we conducted 20 semistructured interviews with a convenience sample of ICs. All interviews were analyzed using the iterative refinement of a codeveloped codebook. The team maintained reflexivity journals to reflect the impact of their positionality on their coding. Themes were first derived deductively using HF typologies (patient-oriented dyads, caregiver-oriented dyads, and collaboratively oriented dyads) and then inductively refined and recategorized based on concepts from the van Houtven et al framework. Results: We believe that there is a need to formally and intentionally expand HF technologies to include dyadic needs and goals. We suggest defining 3 opportunities in which value can be added to technological design. First, identify how technology may be leveraged to increase psychological bandwidth by reducing uncertainty and providing peace of mind. We found that actionable feedback was highly desired by both partners. Second, develop technology that can serve as a member of the dyad's support system. In our experience, automated prompts for patients to take measurements can mimic the support typically provided by ICs and ease their workload. Third, consider how technology can mitigate the dyad's clinical knowledge requirements and learning curve. Our approach includes real-time actionable feedback paired with a human-in-the-loop, nurse-led model of care. Conclusions: Our findings identified a need to focus on improving the dyadic experience as a whole by building IC functionality into digital health self-management interventions. Through a shared model of care that supports the role of the patient in their own HF management, includes ICs to expand and enhance the patient's capacity to care, and acknowledges the need of ICs to care for themselves, we anticipate improved outcomes for both partners. ",
doi="10.2196/40108",
url="https://www.jmir.org/2022/9/e40108",
url="http://www.ncbi.nlm.nih.gov/pubmed/36069782"
}


@Article{info:doi/10.2196/38663,
author="Dahne, Jennifer
and Player, S. Marty
and Strange, Charlie
and Carpenter, J. Matthew
and Ford, W. Dee
and King, Kathryn
and Miller, Sarah
and Kruis, Ryan
and Hawes, Elizabeth
and Hidalgo, E. Johanna
and Diaz, A. Vanessa",
title="Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="30",
volume="24",
number="8",
pages="e38663",
keywords="electronic visits",
keywords="e-visit",
keywords="COPD",
keywords="chronic obstructive pulmonary disease",
keywords="smoking cessation",
keywords="telehealth",
keywords="electronic health record",
keywords="patient portal",
keywords="EHR",
keywords="feasibility",
keywords="efficacy",
keywords="intervention",
keywords="screening",
keywords="diagnosis",
keywords="prevention",
keywords="treatment",
keywords="management",
keywords="acceptability",
keywords="pulmonary",
keywords="function",
abstract="Background: Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. Objective: The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. Methods: In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ?2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration--approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ?50\%, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. Results: Of 85 participants assigned to the e-visits, 64 (75.3\%) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6\% (49/64) completed home spirometry, and 35.9\% (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). Conclusions: A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. Trial Registration: ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073 ",
doi="10.2196/38663",
url="https://www.jmir.org/2022/8/e38663",
url="http://www.ncbi.nlm.nih.gov/pubmed/36040766"
}


@Article{info:doi/10.2196/38424,
author="van de Vijver, Steven
and Hummel, Deirdre
and van Dijk, Hester Annericht
and Cox, Jan
and van Dijk, Oscar
and Van den Broek, Nicoline
and Metting, Esther",
title="Evaluation of a Digital Self-management Platform for Patients With Chronic Illness in Primary Care: Qualitative Study of Stakeholders' Perspectives",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e38424",
keywords="primary care",
keywords="chronic disease",
keywords="telemonitoring",
keywords="digital health",
keywords="self-management",
keywords="patient-centered care",
keywords="chronic care",
keywords="chronic care management",
keywords="illness",
keywords="healthcare",
keywords="healthcare professional",
keywords="user",
keywords="patient",
keywords="platform",
keywords="tool",
keywords="communication",
keywords="empowerment",
keywords="online",
abstract="Background: Population aging and multimorbidity has led to increasing chronic care needs associated with new challenges in managing growing costs, rising health care professional workloads, and the adoption of rigorous guidelines. These issues could all benefit from greater digitalization and a more patient-centered approach to chronic care, a situation brought to the fore by the COVID-19 pandemic. Little is known about real-life use in primary care. Objective: This study aimed to explore the views, thoughts, usability, and experiences concerning a recently introduced digital self-care platform for chronic conditions in 3 Dutch primary care practices. Methods: We conducted an explorative study combining questionnaires and interviews among patients and general practitioners from 3 general practices that used the digital platform. Questionnaires were sent to patients in each practice to seek the views and experiences of both patient nonusers (n=20) and patient users (n=58) of the platform, together with standardized questionnaires about illness perception and quality of life. In addition, patients (n=15) and general practitioners (n=4) who used the platform took part in semistructured interviews. We transcribed interviews verbatim and performed qualitative content analysis using a deductive approach. The results of the questionnaires were analyzed with descriptive analysis. Results: Among patients who had not actively used the platform but had received an explanation, only 35\% (7/20) would recommend its use due to concerns over communication and handling. However, this percentage increased to 76.3\% (45/59) among the people who actively used the platform. Interviews with patients and general practitioners who used the platform uncovered several key benefits, including reduced time requirements, reduced workload, improved care quality, and improved accessibility due to the greater patient-centeredness and use of different communication tools. In addition, the self-management tool led to greater patient autonomy and empowerment. Although users considered the platform feasible, usable, and easy to use, some technical issues remained and some patients expressed concerns about the reduction in human contact and feedback. Conclusions: The overall experience and usability of the platform was good. Support for the online self-management platform for chronic care increased when patients actively used the tool and could experience or identify important advantages. However, patients still noted several areas for improvement that need to be tackled in future iterations. To ensure benefit in the wider population, we must also evaluate this platform in cohorts with lower digital and health literacy. ",
doi="10.2196/38424",
url="https://formative.jmir.org/2022/8/e38424",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921145"
}


@Article{info:doi/10.2196/34826,
author="Lawrence, Katharine
and Nov, Oded
and Mann, Devin
and Mandal, Soumik
and Iturrate, Eduardo
and Wiesenfeld, Batia",
title="The Impact of Telemedicine on Physicians' After-hours Electronic Health Record ``Work Outside Work'' During the COVID-19 Pandemic: Retrospective Cohort Study",
journal="JMIR Med Inform",
year="2022",
month="Jul",
day="28",
volume="10",
number="7",
pages="e34826",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="COVID-19",
keywords="EHR",
keywords="electronic health record",
keywords="clinician workload",
keywords="impact",
keywords="transition",
keywords="workload",
keywords="cohort",
keywords="retrospective",
keywords="physician",
keywords="efficient",
keywords="doctor",
keywords="health care professional",
keywords="pandemic",
abstract="Background: Telemedicine as a mode of health care work has grown dramatically during the COVID-19 pandemic; the impact of this transition on clinicians' after-hours electronic health record (EHR)--based clinical and administrative work is unclear. Objective: This study assesses the impact of the transition to telemedicine during the COVID-19 pandemic on physicians' EHR-based after-hours workload (ie, ``work outside work'') at a large academic medical center in New York City. Methods: We conducted an EHR-based retrospective cohort study of ambulatory care physicians providing telemedicine services before the pandemic, during the acute pandemic, and after the acute pandemic, relating EHR-based after-hours work to telemedicine intensity (ie, percentage of care provided via telemedicine) and clinical load (ie, patient load per provider). Results: A total of 2129 physicians were included in this study. During the acute pandemic, the volume of care provided via telemedicine significantly increased for all physicians, whereas patient volume decreased. When normalized by clinical load (ie, average appointments per day by average clinical days per week), telemedicine intensity was positively associated with work outside work across time periods. This association was strongest after the acute pandemic. Conclusions: Taking physicians' clinical load into account, physicians who devoted a higher proportion of their clinical time to telemedicine throughout various stages of the pandemic engaged in higher levels of EHR-based after-hours work compared to those who used telemedicine less intensively. This suggests that telemedicine, as currently delivered, may be less efficient than in-person--based care and may increase the after-hours work burden of physicians. ",
doi="10.2196/34826",
url="https://medinform.jmir.org/2022/7/e34826",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749661"
}


@Article{info:doi/10.2196/39181,
author="Ishikawa, Tomoki
and Sato, Jumpei
and Hattori, Junko
and Goda, Kazuo
and Kitsuregawa, Masaru
and Mitsutake, Naohiro",
title="The Association Between Telehealth Utilization and Policy Responses on COVID-19 in Japan: Interrupted Time-Series Analysis",
journal="Interact J Med Res",
year="2022",
month="Jul",
day="12",
volume="11",
number="2",
pages="e39181",
keywords="telehealth",
keywords="COVID-19",
keywords="health services research",
keywords="interrupted time series",
abstract="Background: Telehealth using telephones or online communication is being promoted as a policy initiative in several countries. However, there is a lack of research on telehealth utilization in a country such as Japan that offers free access to medical care and regulates telehealth provision---particularly with respect to COVID-19. Objective: The present study aimed to clarify telehealth utilization, the characteristics of patients and medical institutions using telehealth, and the changes to telehealth in Japan in order to support the formulation of policy strategies for telehealth provision. Methods: Using a medical administrative claim database of the National Health Insurance and Advanced Elderly Medical Service System in Mie Prefecture, we investigated patients who used telehealth from January 2017 to September 2021. We examined telehealth utilization with respect to both patients and medical institutions, and we determined their characteristics. Using April 2020 as the reference time point for COVID-19, we conducted an interrupted time-series analysis (ITSA) to assess changes in the monthly proportion of telehealth users to beneficiaries. Results: The number of telehealth users before the reference time point was 13,618, and after the reference time point, it was 28,853. Several diseases and conditions were associated with an increase in telehealth utilization. Telehealth consultations were mostly conducted by telephone and for prescriptions. The ITSA results showed a sharp increase in the proportion of telehealth use to beneficiaries after the reference time point (rate ratio 2.97; 95\% CI 2.14-2.31). However, no apparent change in the trend of increasing or decreasing telehealth use was evident after the reference time point (rate ratio 1.00; 95\% CI 1.00-1.01). Conclusions: We observed a sharp increase in telehealth utilization after April 2020, but no change in the trend of telehealth use was evident. We identified changes in the characteristics of patients and providers using telehealth. ",
doi="10.2196/39181",
url="https://www.i-jmr.org/2022/2/e39181",
url="http://www.ncbi.nlm.nih.gov/pubmed/35752952"
}


@Article{info:doi/10.2196/37880,
author="Chen, Ying-Hsien
and Wu, Hui-Wen
and Huang, Ching-Chang
and Lee, Jen-Kuang
and Yang, Li-Tan
and Hsu, Tse-Pin
and Hung, Chi-Sheng
and Ho, Yi-Lwun",
title="The Logistics of Medication and Patient Flow in Video-Based Virtual Clinics During a Sudden COVID-19 Outbreak in Taiwan: Observational Study",
journal="Interact J Med Res",
year="2022",
month="Jun",
day="10",
volume="11",
number="1",
pages="e37880",
keywords="COVID-19",
keywords="telemedicine",
keywords="video-based virtual clinic",
abstract="Background: The COVID-19 pandemic was well controlled in Taiwan until an outbreak in May 2021. Telemedicine was rapidly implemented to avoid further patient exposure and to unload the already burdened medical system. Objective: To understand the effect of COVID-19 on the implementation of video-based virtual clinic visits during this outbreak, we analyzed the logistics of prescribing medications and patient flow for such virtual visits at a tertiary medical center. Methods: We retrospectively collected information on video-based virtual clinic visits and face-to-face outpatient visits from May 1 to August 31, 2021, from the administrative database at National Taiwan University Hospital. The number of daily new confirmed COVID-19 cases in Taiwan was obtained from an open resource. Results: There were 782 virtual clinic visits during these 3 months, mostly for the departments of internal medicine, neurology, and surgery. The 3 most common categories of medications prescribed were cardiovascular, diabetic, and gastrointestinal, of which cardiovascular medications comprised around one-third of all medications prescribed during virtual clinic visits. The number of virtual clinic visits was significantly correlated with the number of daily new confirmed COVID-19 cases, with approximately a 20-day delay (correlation coefficient 0.735; P<.001). The patient waiting time for video-based virtual clinic visits was significantly shorter compared with face-to-face clinic visits during the same period (median 3, IQR 2-6 min vs median 20, IQR 9-42 min; rank sum P<.001). Although the time saved was appreciated by the patients, online payment with direct delivery of medications without the need to visit a hospital was still their major concern. Conclusions: Our data showed that video-based virtual clinics can be implemented rapidly after a COVID-19 outbreak. The virtual clinics were efficient, as demonstrated by the significantly reduced waiting time. However, there are still some barriers to the large-scale implementation of video-based virtual clinics. Better preparation is required to improve performance in possible future large outbreaks. ",
doi="10.2196/37880",
url="https://www.i-jmr.org/2022/1/e37880",
url="http://www.ncbi.nlm.nih.gov/pubmed/35687404"
}


@Article{info:doi/10.2196/37204,
author="Le{\'o}n, Alejandra Maria
and Pannunzio, Valeria
and Kleinsmann, Maaike",
title="The Impact of Perioperative Remote Patient Monitoring on Clinical Staff Workflows: Scoping Review",
journal="JMIR Hum Factors",
year="2022",
month="Jun",
day="6",
volume="9",
number="2",
pages="e37204",
keywords="remote patient monitoring",
keywords="telemonitoring",
keywords="workflow",
keywords="nurses",
keywords="physicians",
keywords="perioperative care",
keywords="perioperative medicine",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: Remote patient monitoring (RPM) interventions are being increasingly implemented in health care environments, given their benefits for different stakeholders. However, the effects of these interventions on the workflow of clinical staff are not always considered in RPM research and practice. Objective: This review explored how contemporary RPM interventions affect clinical staff and their workflows in perioperative settings. Methods: We conducted a scoping review of recent articles reporting the impact of RPM interventions implemented in perioperative settings on clinical staff and their workflow. The databases accessed were Embase and PubMed. A qualitative analysis was performed to identify the main problems and advantages that RPM brings to staff, in addition to the approaches taken to evaluate the impact of those interventions. Different themes were identified in terms of the challenges of RPM for clinical staff as well as in terms of benefits, risk-reduction strategies, and methods for measuring the impact of these interventions on the workflow of clinical staff. Results: A total of 1063 papers were found during the initial search, of which 21 (1.98\%) met the inclusion criteria. Of the 21 included papers, 15 (71\%) focused on evaluating new RPM systems, 4 (19\%) focused on existing systems, and 2 (10\%) were reviews. Conclusions: The reviewed literature shows that the impact on staff work experience is a crucial factor to consider when developing and implementing RPM interventions in perioperative settings. However, we noticed both underdevelopment and lack of standardization in the methods for assessing the impact of these interventions on clinical staff and their workflow. On the basis of the reviewed literature, we recommend the development of more robust methods for evaluating the impact of RPM interventions on staff experience in perioperative care; the adoption of a stronger focus on transition management when introducing these interventions in clinical practice; and the inclusion of longer periods of assessment, including the evaluation of long-term goals. ",
doi="10.2196/37204",
url="https://humanfactors.jmir.org/2022/2/e37204",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666574"
}


@Article{info:doi/10.2196/27273,
author="Doubelt, Irena
and Springer, M. Jason
and Kermani, A. Tanaz
and Sreih, G. Antoine
and Burroughs, Cristina
and Cuthbertson, David
and Carette, Simon
and Khalidi, A. Nader
and Koening, L. Curry
and Langford, Carol
and McAlear, A. Carol
and Moreland, W. Larry
and Monach, A. Paul
and Shaw, G. Dianne
and Seo, Philip
and Specks, Ulrich
and Warrington, J. Kenneth
and Young, Kalen
and Merkel, A. Peter
and Pagnoux, Christian",
title="Self-Reported Data and Physician-Reported Data in Patients With Eosinophilic Granulomatosis With Polyangiitis: Comparative Analysis",
journal="Interact J Med Res",
year="2022",
month="May",
day="25",
volume="11",
number="1",
pages="e27273",
keywords="eosinophilic granulomatosis with polyangiitis",
keywords="patient-reported outcomes measures",
keywords="clinical outcomes",
keywords="granulomatosis",
keywords="patient outcomes",
keywords="digital health",
keywords="health network",
keywords="health databases",
keywords="research network",
abstract="Background: Patient-based registries can help advance research on rare diseases such as eosinophilic granulomatosis with polyangiitis (EGPA), a complex multiorgan form of antineutrophil cytoplasmic antibody (ANCA)--associated vasculitis. Objective: The aim of this study is to compare patient-reported and physician-reported data on manifestations, treatments, and outcomes for patients with EGPA. Methods: We completed a comparative analysis of patients ?18 years with EGPA in Canada and the United States from the following 2 cohorts: (1) The Vasculitis Patient-Powered Research Network (VPPRN), a self-enrolled secure portal with patient-entered data updated quarterly (2014-2019) and (2) the Vasculitis Clinical Research Consortium (VCRC) observational studies, a physician-entered database (2003-2019) of patients who fulfilled the 1990 American College of Rheumatology classification criteria for EGPA. The studied parameters included demographic characteristics, clinical manifestations, ANCA status, treatments, and relapses. Results: Data from 195 patients with a validated diagnosis of EGPA in the VPPRN and 354 patients enrolled in the VCRC were analyzed. Compared to the VCRC cohort, the patients in the VPPRN cohort were more likely to be female (135/195, 69.2\% compared to 209/354, 59\%; P=.02) and younger at diagnosis (47.3 compared to 50.0 years; P=.03); both cohorts reported similar frequencies of asthma (177/184, 96.2\% in the VPPRN cohort compared to 329/354, 92.9\% in the VCRC cohort; P=.13) and cardiac manifestations (44/153, 28.8\% compared to 75/354, 21.2\%; P=.06), but the VPPRN cohort reported less frequent lung manifestations other than asthma and more frequent disease manifestations in all other organ systems. The ANCA positivity was 48.9\% (64/131) in the VPPRN patients compared to 38.9\% (123/316; P=.05) in the VCRC cohort. Relapsing disease after study enrollment was reported in 32.3\% (63/195) of patients in the VPPRN compared to 35.7\% (99/277) of patients in the VCRC. Most therapies (GC, cyclophosphamide, mepolizumab) were used at similar frequencies in both groups, except for rituximab with VPPRN patients reporting more use than the VCRC cohort (47/195, 24.1\% compared to 29/277, 10.5\%; P<.001). Conclusions: Overall, patients and physicians report manifestations of EGPA at similar frequencies. However, observed differences between patient and physician reports imply the potential occurrence of selection biases. These results support the use of patient-reported data in EGPA but also the need for careful consideration of disease-specific definitions for the study of EGPA and how patient- and physician-reported data are collected. Trial Registration: ClinicalTrials.gov NCT00315380, https://clinicaltrials.gov/ct2/show/NCT00315380; ClinicalTrials.gov NCT01241305, https://clinicaltrials.gov/ct2/show/NCT01241305 ",
doi="10.2196/27273",
url="https://www.i-jmr.org/2022/1/e27273",
url="http://www.ncbi.nlm.nih.gov/pubmed/35612893"
}


@Article{info:doi/10.2196/35929,
author="Singh, Hardeep
and Tang, Terence
and Steele Gray, Carolyn
and Kokorelias, Kristina
and Thombs, Rachel
and Plett, Donna
and Heffernan, Matthew
and Jarach, M. Carlotta
and Armas, Alana
and Law, Susan
and Cunningham, V. Heather
and Nie, Xin Jason
and Ellen, E. Moriah
and Thavorn, Kednapa
and Nelson, LA Michelle",
title="Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review",
journal="JMIR Aging",
year="2022",
month="May",
day="19",
volume="5",
number="2",
pages="e35929",
keywords="transitions",
keywords="health",
keywords="medical informatics",
keywords="aged",
keywords="mobile phone",
abstract="Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 ",
doi="10.2196/35929",
url="https://aging.jmir.org/2022/2/e35929",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587874"
}


@Article{info:doi/10.2196/36775,
author="Mercadal Rotger, Josep
and Cabr{\'e}, Victor",
title="Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study",
journal="JMIR Ment Health",
year="2022",
month="May",
day="2",
volume="9",
number="5",
pages="e36775",
keywords="online psychological intervention",
keywords="therapeutic alliance",
keywords="digital health",
keywords="mental health",
keywords="mental health education",
keywords="mental health treatment",
keywords="health interventions",
keywords="health professional",
keywords="online health",
keywords="web-based health",
keywords="intervention modality",
abstract="Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2\%) of whom were men and 142 were (48.8\%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances---observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=--42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. ",
doi="10.2196/36775",
url="https://mental.jmir.org/2022/5/e36775",
url="http://www.ncbi.nlm.nih.gov/pubmed/35499910"
}


@Article{info:doi/10.2196/33926,
author="Jalilian, Laleh
and Wu, Irene
and Ing, Jakun
and Dong, Xuezhi
and Sadik, Joshua
and Pan, George
and Hitson, Heather
and Thomas, Erin
and Grogan, Tristan
and Simkovic, Michael
and Kamdar, Nirav",
title="Evaluation of Telemedicine Use for Anesthesiology Pain Division: Retrospective, Observational Case Series Study",
journal="JMIR Perioper Med",
year="2022",
month="Apr",
day="27",
volume="5",
number="1",
pages="e33926",
keywords="COVID-19",
keywords="pain management",
keywords="telemedicine",
keywords="cost savings",
keywords="patient satisfaction",
abstract="Background: An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, health care providers have used telemedicine for pain management of both interventional patients and those with chronic pain. Objective: In this study, we aimed to describe the implementation of a telemedicine program for pain management in an academic pain division in a large metropolitan area. We also aimed to estimate patient cost savings from telemedicine, before and after the California COVID-19 ``Safer at Home'' directive, and to estimate patient satisfaction with telemedicine for pain management care. Methods: This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1398 patients and conducted 2948 video visits for remote pain management care. We used the publicly available Internal Revenue Service's Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimated median travel time and travel distance with Google Maps' Distance Matrix application programming interface, direct cost of travel with median value for regular fuel cost in California, and time-based opportunity savings from estimated hourly earnings and round-trip time. We reported patient satisfaction scores derived from a postvisit satisfaction survey containing questions with responses on a 5-point Likert scale. Results: Patients who attended telemedicine visits avoided an estimated median round-trip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within the sample, their median hourly earnings were US \$28 (IQR US \$21-\$39) per hour. Patients saved a median of US \$22 on gas and parking and a median total of US \$52 (IQR US \$36-\$75) per telemedicine visit based on estimated hourly earnings and travel time. Patients who were evaluated serially with telemedicine for medication management saved a median of US \$156 over a median of 3 visits. A total of 91.4\% (286/313) of patients surveyed were satisfied with their telemedicine experience. Conclusions: Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for patients with pain. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings. ",
doi="10.2196/33926",
url="https://periop.jmir.org/2022/1/e33926",
url="http://www.ncbi.nlm.nih.gov/pubmed/35023841"
}


@Article{info:doi/10.2196/27207,
author="Cullington, Helen
and Kitterick, Padraig
and Darnton, Philippa
and Finch, Tracy
and Greenwell, Kate
and Riggs, Carol
and Weal, Mark
and Walker, Dawn-Marie
and Sibley, Andrew",
title="Telemedicine for Adults With Cochlear Implants in the United Kingdom (CHOICE): Protocol for a Prospective Interventional Multisite Study",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="13",
volume="11",
number="4",
pages="e27207",
keywords="cochlear implants",
keywords="hearing",
keywords="deafness",
keywords="telemedicine",
keywords="patient-centered care",
abstract="Background: Cochlear implants provide hearing to approximately 750,000 people with deafness worldwide; these patients require lifelong follow-up. Care for adults with implants in the United Kingdom occurs at one of 19 centers, which may be far from the patients' homes. In a previous randomized controlled trial, we successfully introduced person-centered care. We designed, implemented, and evaluated the following remote care pathway: a personalized web-based support tool, home hearing check, self--device adjustment, and upgrading of sound processors at home rather than in the clinic. The remote care group had a significant increase in empowerment after using the tools, and the patients and clinicians were keen to continue. We would now like to scale up these improvements as an option for >12,000 UK adults using implants; we are commissioning an independent evaluation of this intervention and rollout to establish if it achieves its aims of more empowered and confident patients; more accessible and equitable care; stable hearing; more efficient, person-centered, and scalable service; and more satisfied and engaged patients and clinicians. Objective: This study aims to evaluate the impact and rollout of a person-centered clinical care pathway via telemedicine for adults with cochlear implants in the United Kingdom, using both outcomes and process evaluation. Methods: This project will scale up and evaluate a person-centered long-term follow-up pathway for adults using cochlear implants through a personalized website, including a home hearing check, uploading photos of cochlear implant site, listening in noise and music practice, ordering of spares, questionnaires, and other resources. Both quantitative and qualitative analyses will be conducted, and they will be both an outcome and process evaluation. Results: As of July 2021, the trial is closed, and all data collection is complete. The evaluation report is expected to be published in December 2021, and the research data have not yet been analyzed. Conclusions: This project will present the results of the first scaling up of a remote care pathway for adults with cochlear implants in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN51668922; https://www.isrctn.com/ISRCTN51668922 International Registered Report Identifier (IRRID): DERR1-10.2196/27207 ",
doi="10.2196/27207",
url="https://www.researchprotocols.org/2022/4/e27207",
url="http://www.ncbi.nlm.nih.gov/pubmed/35416780"
}


@Article{info:doi/10.2196/31162,
author="Waycott, Jenny
and Zhao, Wei
and Kelly, M. Ryan
and Robertson, Elena",
title="Technology-Mediated Enrichment in Aged Care: Survey and Interview Study",
journal="JMIR Aging",
year="2022",
month="Apr",
day="12",
volume="5",
number="2",
pages="e31162",
keywords="aged care",
keywords="older adults",
keywords="technology",
keywords="social enrichment",
keywords="virtual reality",
keywords="robots",
keywords="videoconferencing",
keywords="care providers",
abstract="Background: Digital technologies such as virtual reality (VR), humanoid robots, and digital companion pets have the potential to provide social and emotional enrichment for people living in aged care. However, there is currently limited knowledge about how technologies are being used to provide enrichment, what benefits they provide, and what challenges arise when deploying these technologies in aged care settings. Objective: This study aims to investigate how digital technologies are being used for social and emotional enrichment in the Australian aged care industry and identify the benefits and challenges of using technology for enrichment in aged care. Methods: A web-based survey (N=20) was distributed among people working in the Australian aged care sector. The survey collected information about the types of technologies being deployed and their perceived value. The survey was followed by semistructured interviews (N=12) with aged care workers and technology developers to investigate their experiences of deploying technologies with older adults living in aged care. Survey data were analyzed using summary descriptive statistics and categorizing open-ended text responses. Interview data were analyzed using reflexive thematic analysis. Results: The survey revealed that a range of commercial technologies, such as VR, tablet devices, and mobile phones, are being used in aged care to support social activities and provide entertainment. Respondents had differing views about the value of emerging technologies, such as VR, social robots, and robot pets, but were more united in their views about the value of videoconferencing. Interviews revealed 4 types of technology-mediated enrichment experiences: enhancing social engagement, virtually leaving the care home, reconnecting with personal interests, and providing entertainment and distraction. Our analysis identified 5 barriers: resource constraints, the need to select appropriate devices and apps, client challenges, limited staff and organizational support, and family resistance. Conclusions: This study demonstrates that technologies can be used in aged care to create personally meaningful enrichment experiences for aged care clients. To maximize the effectiveness of technology-mediated enrichment, we argue that a person-centered care approach is crucial. Although enrichment experiences can be created using available technologies, they must be carefully selected and co-deployed with aged care clients. However, significant changes may be required within organizations to allow caregivers to facilitate individual technology-based activities for enrichment. ",
doi="10.2196/31162",
url="https://aging.jmir.org/2022/2/e31162",
url="http://www.ncbi.nlm.nih.gov/pubmed/34975014"
}


@Article{info:doi/10.2196/27775,
author="Underwood, Jody
and McCloskey, Susan
and Raldow, Ann
and Kishan, Amar
and Zalkin, Chad
and Navarro, Daniel
and Holt, Scott Lisa
and Webb, Andrew
and Lynch, A. Kathleen
and Atkinson, M. Thomas",
title="Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Apr",
day="12",
volume="6",
number="4",
pages="e27775",
keywords="neoplasms",
keywords="patient outcome assessment",
keywords="radiation oncology",
keywords="toxicity",
keywords="public health informatics",
keywords="mobile apps",
keywords="mobile health",
keywords="mobile administration system",
keywords="radiation therapy",
keywords="eHealth",
abstract="Background: Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits. Objective: This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy. Methods: English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire. Results: We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52\%; White patients: n=13; 52\%; non-Hispanic patients: n=19, 76\%; college graduates: n=17, 68\%). Patients almost equally preferred the SAYS (n=14, 56\%) or STEP (n=11, 44\%) interfaces, with 21 patients (84\%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76\%) agreeing that they would recommend mPROS to others. Conclusions: The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy--related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial. ",
doi="10.2196/27775",
url="https://formative.jmir.org/2022/4/e27775",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412466"
}


@Article{info:doi/10.2196/32570,
author="Dang, Stuti
and Muralidhar, Kiranmayee
and Li, Shirley
and Tang, Fei
and Mintzer, Michael
and Ruiz, Jorge
and Valencia, Marcos Willy",
title="Gap in Willingness and Access to Video Visit Use Among Older High-risk Veterans: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="8",
volume="24",
number="4",
pages="e32570",
keywords="high-risk veterans",
keywords="older adults",
keywords="telemedicine",
keywords="video visits",
keywords="health disparities",
keywords="Area Deprivation Index",
keywords="mobile phone",
abstract="Background: The recent shift to video care has exacerbated disparities in health care access, especially among high-need, high-risk (HNHR) adults. Developing data-driven approaches to improve access to care necessitates a deeper understanding of HNHR adults' attitudes toward telemedicine and technology access. Objective: This study aims to identify the willingness, access, and ability of HNHR veterans to use telemedicine for health care. Methods: WWe designed a questionnaire conducted via mail or telephone or in person. Among HNHR veterans who were identified using predictive modeling with national Veterans Affairs data, we assessed willingness to use video visits for health care, access to necessary equipment, and comfort with using technology. We evaluated physical health, including frailty, physical function, performance of activities of daily living (ADL) and instrumental ADL (IADL); mental health; and social needs, including Area Deprivation Index, transportation, social support, and social isolation. Results: The average age of the 602 HNHR veteran respondents was 70.6 (SD 9.2; range 39-100) years; 99.7\% (600/602) of the respondents were male, 61\% (367/602) were White, 36\% (217/602) were African American, 17.3\% (104/602) were Hispanic, 31.2\% (188/602) held at least an associate degree, and 48.2\% (290/602) were confident filling medical forms. Of the 602 respondents, 327 (54.3\%) reported willingness for video visits, whereas 275 (45.7\%) were unwilling. Willing veterans were younger (P<.001) and more likely to have an associate degree (P=.002), be health literate (P<.001), live in socioeconomically advantaged neighborhoods (P=.048), be independent in IADLs (P=.02), and be in better physical health (P=.04). A higher number of those willing were able to use the internet and email (P<.001). Of the willing veterans, 75.8\% (248/327) had a video-capable device. Those with video-capable technology were younger (P=.004), had higher health literacy (P=.01), were less likely to be African American (P=.007), were more independent in ADLs (P=.005) and IADLs (P=.04), and were more adept at using the internet and email than those without the needed technology (P<.001). Age, confidence in filling forms, general health, and internet use were significantly associated with willingness to use video visits. Conclusions: Approximately half of the HNHR respondents were unwilling for video visits and a quarter of those willing lacked requisite technology. The gap between those willing and without requisite technology is greater among older, less health literate, African American veterans; those with worse physical health; and those living in more socioeconomically disadvantaged neighborhoods. Our study highlights that HNHR veterans have complex needs, which risk being exacerbated by the video care shift. Although technology holds vast potential to improve health care access, certain vulnerable populations are less likely to engage, or have access to, technology. Therefore, targeted interventions are needed to address this inequity, especially among HNHR older adults. ",
doi="10.2196/32570",
url="https://www.jmir.org/2022/4/e32570",
url="http://www.ncbi.nlm.nih.gov/pubmed/35394440"
}


@Article{info:doi/10.2196/30638,
author="Khetrapal, Pramit
and Stafford, Ronnie
and {\'O} Scanaill, P{\'a}draig
and Kocadag, Huriye
and Timinis, Constantinos
and Chang, L. Angela H.
and Hadjivasiliou, Adamos
and Liu, Yansong
and Gibbs, Olivia
and Pickford, Eleanor
and Walker, David
and Baker, Hilary
and Duncan, Jacqueline
and Tan, Melanie
and Williams, Norman
and Catto, James
and Drobnjak, Ivana
and Kelly, John",
title="Measuring Patient Compliance With Remote Monitoring Following Discharge From Hospital After Major Surgery (DREAMPath): Protocol for a Prospective Observational Study",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="6",
volume="11",
number="4",
pages="e30638",
keywords="digital health",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="telehealth",
keywords="surgery",
keywords="hospital",
keywords="compliance",
keywords="patient monitoring",
keywords="wearable technology",
keywords="smart devices",
abstract="Background: The incidence of major surgery is on the rise globally, and more than 20\% of patients are readmitted to hospital following discharge from hospital. During their hospital stay, patients are monitored for early detection of clinical deterioration, which includes regularly measuring physiological parameters such as blood pressure, heart rate, respiratory rate, temperature, and pulse oximetry. This monitoring ceases upon hospital discharge, as patients are deemed clinically stable. Monitoring after discharge is relevant to detect adverse events occurring in the home setting and can be made possible through the development of digital technologies and mobile networks. Smartwatches and other technological devices allow patients to self-measure physiological parameters in the home setting, and Bluetooth connectivity can facilitate the automatic collection and transfer of this data to a secure server with minimal input from the patient. Objective: This paper presents the protocol for the DREAMPath (Domiciliary Recovery After Medicalization Pathway) study, which aims to measure compliance with a multidevice remote monitoring kit after discharge from hospital following major surgery. Methods: DREAMPath is a single-center, prospective, observational, cohort study, comprising 30 patients undergoing major intracavity surgery. The primary outcome is to assess patient compliance with wearable and interactive smart technology in the first 30 days following discharge from hospital after major surgery. Secondary outcomes will explore the relation between unplanned health care events and physiological data collected in the study, as well as to explore a similar relationship with daily patient-reported outcome measures (Quality of Recovery--15 score). Secondary outcomes will be analyzed using appropriate regression methods. Cardiopulmonary exercise testing data will also be collected to assess correlations with wearable device data. Results: Recruitment was halted due to COVID-19 restrictions and will progress once research staff are back from redeployment. We expect that the study will be completed in the first quarter of 2022. Conclusions: Digital health solutions have been recently made possible due to technological advances, but urgency in rollout has been expedited due to COVID-19. The DREAMPath study will inform readers about the feasibility of remote monitoring for a patient group that is at an increased risk of acute deterioration. Trial Registration: ISRCTN Registry ISRCTN62293620; https://www.isrctn.com/ISRCTN62293620 International Registered Report Identifier (IRRID): DERR1-10.2196/30638 ",
doi="10.2196/30638",
url="https://www.researchprotocols.org/2022/4/e30638",
url="http://www.ncbi.nlm.nih.gov/pubmed/35383570"
}


@Article{info:doi/10.2196/33787,
author="Smits, Merlijn
and Kim, Mi Chan
and van Goor, Harry
and Ludden, S. Geke D.",
title="From Digital Health to Digital Well-being: Systematic Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="4",
volume="24",
number="4",
pages="e33787",
keywords="well-being",
keywords="design",
keywords="evaluation",
keywords="technology assessment",
keywords="digital health",
keywords="eHealth",
keywords="mHealth",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: Digital health refers to the proper use of technology for improving the health and well-being of people and enhancing the care of patients through the intelligent processing of clinical and genetic data. Despite increasing interest in well-being in both health care and technology, there is no clear understanding of what constitutes well-being, which leads to uncertainty in how to create well-being through digital health. In an effort to clarify this uncertainty, Brey developed a framework to define problems in technology for well-being using the following four categories: epistemological problem, scope problem, specification problem, and aggregation problem. Objective: This systematic scoping review aims to gain insights into how to define and address well-being in digital health. Methods: We followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Papers were identified from 6 databases and included if they addressed the design or evaluation of digital health and reported the enhancement of patient well-being as their purpose. These papers were divided into design and evaluation papers. We studied how the 4 problems in technology for well-being are considered per paper. Results: A total of 117 studies were eligible for analysis (n=46, 39.3\% design papers and n=71, 60.7\% evaluation papers). For the epistemological problem, the thematic analysis resulted in various definitions of well-being, which were grouped into the following seven values: healthy body, functional me, healthy mind, happy me, social me, self-managing me, and external conditions. Design papers mostly considered well-being as healthy body and self-managing me, whereas evaluation papers considered the values of healthy mind and happy me. Users were rarely involved in defining well-being. For the scope problem, patients with chronic care needs were commonly considered as the main users. Design papers also regularly involved other users, such as caregivers and relatives. These users were often not involved in evaluation papers. For the specification problem, most design and evaluation papers focused on the provision of care support through a digital platform. Design papers used numerous design methods, whereas evaluation papers mostly considered pre-post measurements and randomized controlled trials. For the aggregation problem, value conflicts were rarely described. Conclusions: Current practice has found pragmatic ways of circumventing or dealing with the problems of digital health for well-being. Major differences exist between the design and evaluation of digital health, particularly regarding their conceptualization of well-being and the types of users studied. In addition, we found that current methodologies for designing and evaluating digital health can be improved. For optimal digital health for well-being, multidisciplinary collaborations that move beyond the common dichotomy of design and evaluation are needed. ",
doi="10.2196/33787",
url="https://www.jmir.org/2022/4/e33787",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377328"
}


@Article{info:doi/10.2196/33128,
author="Velayati, Farnia
and Ayatollahi, Haleh
and Hemmat, Morteza
and Dehghan, Reza",
title="Telehealth Business Models and Their Components: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="29",
volume="24",
number="3",
pages="e33128",
keywords="telehealth",
keywords="telemedicine",
keywords="mobile health",
keywords="business model",
keywords="value",
keywords="commerce",
keywords="revenue",
keywords="market",
keywords="systematic review",
keywords="health care",
abstract="Background: Telehealth technology is an excellent solution to resolve the problems of health care delivery. However, this technology may fail during large-scale implementation. As a result, business models can be used to facilitate commercialization of telehealth products and services. Objective: The purpose of this study was to review different types of business models or frameworks and their components used in the telehealth industry. Methods: This was a systematic review conducted in 2020. The databases used for searching related articles included Ovid, PubMed, Scopus, Web of Science, Emerald, and ProQuest. Google Scholar was also searched. These databases and Google Scholar were searched until the end of January 2020 and duplicate references were removed. Finally, articles meeting the inclusion criteria were selected and the Critical Appraisal Skills Programme (CASP) checklist was used for appraising the strengths and limitations of each study. Data were extracted using a data extraction form, and the results were synthesized narratively. Results: Initially, 4998 articles were found and after screening, 23 were selected to be included in the study. The results showed that new telehealth business models were presented in 13 studies, and the applications of the existing business models were reported in 10 studies. These studies were related to different types of services, namely, telemonitoring (4 studies), telemedicine (3 studies), mobile health (3 studies), telerehabilitation (3 studies), telehealth (2 studies), assisted living technologies (2 studies), sensor-based systems (2 studies), and mobile teledermoscopy, teleradiology, telecardiology, and teletreatment (1 study related to each area). In most of the business models, value proposition, financial variables, and revenue streams were the main components. Conclusions: Applying business models in the commercialization of telehealth services will be useful to gain a better understanding of the required components, market challenges, and possible future changes. The results showed that different business models can be used for different telehealth technologies in various health systems and cultures. However, it is necessary to evaluate the effectiveness of these models in practice. Moreover, comparing the usefulness of these models in different domains of telehealth services will help identify the strengths and weaknesses of these models for future optimization. ",
doi="10.2196/33128",
url="https://www.jmir.org/2022/3/e33128",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348471"
}


@Article{info:doi/10.2196/26461,
author="Stambler, Mollie Danielle
and Feddema, Erin
and Riggins, Olivia
and Campeau, Kari
and Breuch, Kastman Lee-Ann
and Kessler, M. Molly
and Misono, Stephanie",
title="REDCap Delivery of a Web-Based Intervention for Patients With Voice Disorders: Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="25",
volume="9",
number="1",
pages="e26461",
keywords="web-based intervention",
keywords="REDCap",
keywords="voice disorders",
keywords="usability study",
keywords="heuristics",
keywords="eHealth",
keywords="online",
keywords="health",
keywords="web-based participation",
keywords="patients",
keywords="web-based platform",
abstract="Background: Web-based health interventions are increasingly common and are promising for patients with voice disorders because web-based participation does not require voice use. To address needs such as Health Insurance Portability and Accountability Act compliance, unique user access, the ability to send automated reminders, and a limited development budget, we used the Research Electronic Data Capture (REDCap) data management platform to deliver a patient-facing psychological intervention designed for patients with voice disorders. This was a novel use of REDCap. Objective: We aimed to evaluate the usability of the intervention, with this intervention serving as a use case for REDCap-based patient-facing interventions. Methods: We used REDCap survey instruments to develop the web-based voice intervention modules, then conducted usability evaluations using (1) heuristic evaluations by 2 evaluators, and (2) formal usability testing with 7 participants, consisting of predetermined tasks, a think-aloud protocol, ease-of-use measurements, a product reaction card, and a debriefing interview. Results: Heuristic evaluations found strengths in visibility of system status and real-world match, and weaknesses in user control and help documentation. Based on this feedback, changes to the intervention were made before usability testing. Overall, usability testing participants found the intervention useful and easy to use, although testing revealed some concerns with design, content, and terminology. Some concerns were readily addressed, and others required adaptations within REDCap. Conclusions: The REDCap version of a complex web-based patient-facing intervention performed well in heuristic evaluation and formal usability testing. REDCap can effectively be used for patient-facing intervention delivery, particularly if the limitations of the platform are anticipated and mitigated. ",
doi="10.2196/26461",
url="https://humanfactors.jmir.org/2022/1/e26461",
url="http://www.ncbi.nlm.nih.gov/pubmed/35333191"
}


@Article{info:doi/10.2196/28639,
author="Knop, Michael
and Weber, Sebastian
and Mueller, Marius
and Niehaves, Bjoern",
title="Human Factors and Technological Characteristics Influencing the Interaction of Medical Professionals With Artificial Intelligence--Enabled Clinical Decision Support Systems: Literature Review",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="24",
volume="9",
number="1",
pages="e28639",
keywords="artificial intelligence",
keywords="clinical decision support systems",
keywords="CDSS",
keywords="decision-making",
keywords="diagnostic decision support",
keywords="human--computer interaction",
keywords="human--AI collaboration",
keywords="machine learning",
keywords="patient outcomes",
keywords="deep learning",
keywords="trust",
keywords="literature review",
abstract="Background: The digitization and automation of diagnostics and treatments promise to alter the quality of health care and improve patient outcomes, whereas the undersupply of medical personnel, high workload on medical professionals, and medical case complexity increase. Clinical decision support systems (CDSSs) have been proven to help medical professionals in their everyday work through their ability to process vast amounts of patient information. However, comprehensive adoption is partially disrupted by specific technological and personal characteristics. With the rise of artificial intelligence (AI), CDSSs have become an adaptive technology with human-like capabilities and are able to learn and change their characteristics over time. However, research has not reflected on the characteristics and factors essential for effective collaboration between human actors and AI-enabled CDSSs. Objective: Our study aims to summarize the factors influencing effective collaboration between medical professionals and AI-enabled CDSSs. These factors are essential for medical professionals, management, and technology designers to reflect on the adoption, implementation, and development of an AI-enabled CDSS. Methods: We conducted a literature review including 3 different meta-databases, screening over 1000 articles and including 101 articles for full-text assessment. Of the 101 articles, 7 (6.9\%) met our inclusion criteria and were analyzed for our synthesis. Results: We identified the technological characteristics and human factors that appear to have an essential effect on the collaboration of medical professionals and AI-enabled CDSSs in accordance with our research objective, namely, training data quality, performance, explainability, adaptability, medical expertise, technological expertise, personality, cognitive biases, and trust. Comparing our results with those from research on non-AI CDSSs, some characteristics and factors retain their importance, whereas others gain or lose relevance owing to the uniqueness of human-AI interactions. However, only a few (1/7, 14\%) studies have mentioned the theoretical foundations and patient outcomes related to AI-enabled CDSSs. Conclusions: Our study provides a comprehensive overview of the relevant characteristics and factors that influence the interaction and collaboration between medical professionals and AI-enabled CDSSs. Rather limited theoretical foundations currently hinder the possibility of creating adequate concepts and models to explain and predict the interrelations between these characteristics and factors. For an appropriate evaluation of the human-AI collaboration, patient outcomes and the role of patients in the decision-making process should be considered. ",
doi="10.2196/28639",
url="https://humanfactors.jmir.org/2022/1/e28639",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323118"
}


@Article{info:doi/10.2196/35134,
author="Lee, M. Jennifer
and Woon, Rex
and Ramsum, Mandy
and Halperin, S. Daniel
and Jain, Roshini",
title="User Engagement and Assessment of Treatment Effectiveness in Patients Using a Novel Digital mHealth App During Spinal Cord Stimulation Screening Trials",
journal="JMIR eHum Factors",
year="2022",
month="Mar",
day="23",
volume="9",
number="1",
pages="e35134",
keywords="spinal cord stimulation",
keywords="SCS",
keywords="chronic pain",
keywords="digital health",
keywords="smartphone app",
keywords="mobile health",
keywords="mHealth",
keywords="smart device",
keywords="digital application",
keywords="application",
keywords="app",
keywords="spine",
abstract="Background: Patient outcomes and experience during a Spinal Cord Stimulation (SCS) screening trial can have a significant effect on whether to proceed with long-term, permanent implantation of an SCS device for the treatment of chronic pain. Enhancing the ability to track and assess patients during this initial trial evaluation offers the potential for improved understanding regarding the suitability of permanent device implantation as well as identification of the SCS-based neurostimulative modalities and parameters that may provide substantial analgesia in a patient-specific manner. Objective: In this report, we aimed to describe a preliminary, real-world assessment of a new, real time tracking, smart, device-based digital app used by patients with chronic pain undergoing trial screening for SCS therapy. Methods: This is a real-world, retrospective evaluation of 13,331 patients diagnosed with chronic pain who used the new ``mySCS'' mobile app during an SCS screening trial. The app design is health insurance portability and accountability act (HIPAA)-compliant and compatible with most commercially available smartphones (eg, Apple, iPhone, and Android). The app enables tracking of user-inputted health-related responses (ie, pain relief, activity level, and sleep quality) in addition to personal trial goals and a summary of overall experience during the SCS trial. A deidentified, aggregate analysis of user engagement, user-submitted responses, and overall trial success was conducted. Results: When provided the opportunity, the percentage of users who engaged with the tracking app for ?50\% of the time during their trial was found to be 64.43\% (n=8589). Among the 13,331 patients who used the app, 58.24\% (n=7764) entered a trial goal. Most patients underwent SCS screening with a trial duration of at least 7 days (n=7739, 58.05\%). Of those patients who undertook a 7-day SCS trial, 62.30\% (n=3456) engaged the app for 4 days or more. In addition, among all who submitted descriptive responses using the app, health-related improvements were reported by 77.84\% (n=10,377) of patients who reached day 3 of the screening phase assessment and by 83.04\% (n=11,070) of those who reached trial completion. A trial success rate of 91\% was determined for those who used the app (versus 85\% success rate for nonusers). Conclusions: Data from this initial, real-world examination of a mobile, digital-health--based tracking app (``mySCS''), as used during the SCS screening phase, demonstrate that substantial patient engagement can be achieved while also providing for the acquisition of more real time patient-outcome measures that may help facilitate improved SCS trial success. ",
doi="10.2196/35134",
url="https://humanfactors.jmir.org/2022/1/e35134",
url="http://www.ncbi.nlm.nih.gov/pubmed/35167484"
}


@Article{info:doi/10.2196/29108,
author="?Lee, Sejong
and Kim, Jaehyeon
and Kwon, Yongseok
and Kim, Teasung
and Cho, Sunghyun",
title="Privacy Preservation in Patient Information Exchange Systems Based on Blockchain: System Design Study",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="22",
volume="24",
number="3",
pages="e29108",
keywords="electronic medical records",
keywords="consortium blockchain",
keywords="data security",
keywords="medical data management",
keywords="privacy preservation",
keywords="smart contract",
keywords="proxy re-encryption",
keywords="patient-centered medical system",
keywords="InterPlanetary File System",
abstract="Background: With the increasing sophistication of the medical industry, various advanced medical services such as medical artificial intelligence, telemedicine, and personalized health care services have emerged. The demand for medical data is also rapidly increasing today because advanced medical services use medical data such as user data and electronic medical records (EMRs) to provide services. As a result, health care institutions and medical practitioners are researching various mechanisms and tools to feed medical data into their systems seamlessly. However, medical data contain sensitive personal information of patients. Therefore, ensuring security while meeting the demand for medical data is a very important problem in the information age for which a solution is required. Objective: Our goal is to design a blockchain-based decentralized patient information exchange (PIE) system that can safely and efficiently share EMRs. The proposed system preserves patients' privacy in the EMRs through a medical information exchange process that includes data encryption and access control. Methods: We propose a blockchain-based EMR-sharing system that allows patients to manage their EMRs scattered across multiple hospitals and share them with other users. Our PIE system protects the patient's EMR from security threats such as counterfeiting and privacy attacks during data sharing. In addition, it provides scalability by using distributed data-sharing methods to quickly share an EMR, regardless of its size or type. We implemented simulation models using Hyperledger Fabric, an open source blockchain framework. Results: We performed a simulation of the EMR-sharing process and compared it with previous works on blockchain-based medical systems to check the proposed system's performance. During the simulation, we found that it takes an average of 0.01014 (SD 0.0028) seconds to download 1 MB of EMR in our proposed PIE system. Moreover, it has been confirmed that data can be freely shared with other users regardless of the size or format of the data to be transmitted through the distributed data-sharing technique using the InterPlanetary File System. We conducted a security analysis to check whether the proposed security mechanism can effectively protect users of the EMR-sharing system from security threats such as data forgery or unauthorized access, and we found that the distributed ledger structure and re-encryption--based data encryption method can effectively protect users' EMRs from forgery and privacy leak threats and provide data integrity. Conclusions: Blockchain is a distributed ledger technology that provides data integrity to enable patient-centered health information exchange and access control. PIE systems integrate and manage fragmented patient EMRs through blockchain and protect users from security threats during the data exchange process among users. To increase safety and efficiency in the EMR-sharing process, we used access control using security levels, data encryption based on re-encryption, and a distributed data-sharing scheme. ",
doi="10.2196/29108",
url="https://www.jmir.org/2022/3/e29108",
url="http://www.ncbi.nlm.nih.gov/pubmed/35315778"
}


@Article{info:doi/10.2196/34144,
author="Yao, Rui
and Zhang, Wenli
and Evans, Richard
and Cao, Guang
and Rui, Tianqi
and Shen, Lining",
title="Inequities in Health Care Services Caused by the Adoption of Digital Health Technologies: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="21",
volume="24",
number="3",
pages="e34144",
keywords="health inequities",
keywords="digital health technologies",
keywords="health care services",
keywords="socially disadvantaged groups",
keywords="scoping review",
keywords="mobile phone",
abstract="Background: Digital health technologies (ie, the integration of digital technology and health information) aim to increase the efficiency of health care delivery; they are rapidly adapting to health care contexts to provide improved medical services for citizens. However, contrary to expectations, their rapid adoption appears to have led to health inequities, with differences in health conditions or inequality in the distribution of health care resources among different populations. Objective: This scoping review aims to identify and describe the inequities of health care services brought about by the adoption of digital health technologies. The factors influencing such inequities, as well as the corresponding countermeasures to ensure health equity among different groups of citizens, were also studied. Methods: Primary studies and literature, including articles and reviews, published in English between 1990 and 2020 were retrieved using appropriate search strategies across the following three electronic databases: Clarivate Analytics' Web of Science, PubMed, and Scopus. Data management was performed by two authors (RY and WZ) using Thomson Endnote (Clarivate Analytics, Inc), by systematically screening and identifying eligible articles for this study. Any conflicts of opinion were resolved through discussions with the corresponding author. A qualitative descriptive synthesis was performed to determine the outcomes of this scoping review. Results: A total of 2325 studies were collected during the search process, of which 41 (1.76\%) papers were identified for further analysis. The quantity of literature increased until 2016, with a peak in 2020. The United States, the United Kingdom, and Norway ranked among the top 3 countries for publication output. Health inequities caused by the adoption of digital health technologies in health care services can be reflected in the following two dimensions: the inability of citizens to obtain and adopt technology and the different disease outcomes found among citizens under technical intervention measures. The factors that influenced inequities included age, race, region, economy, and education level, together with health conditions and eHealth literacy. Finally, action can be taken to alleviate inequities in the future by government agencies and medical institutions (eg, establishing national health insurance), digital health technology providers (eg, designing high-quality tools), and health care service recipients (eg, developing skills to access digital technologies). Conclusions: The application of digital health technologies in health care services has caused inequities to some extent. However, existing research has certain limitations. The findings provide a comprehensive starting point for future research, allowing for further investigation into how digital health technologies may influence the unequal distribution of health care services. The interaction between individual subjective factors as well as social support and influencing factors should be included in future studies. Specifically, access to and availability of digital health technologies for socially disadvantaged groups should be of paramount importance. ",
doi="10.2196/34144",
url="https://www.jmir.org/2022/3/e34144",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311682"
}


@Article{info:doi/10.2196/32075,
author="Nwosu, Callistus Amara
and McGlinchey, Tamsin
and Sanders, Justin
and Stanley, Sarah
and Palfrey, Jennifer
and Lubbers, Patrick
and Chapman, Laura
and Finucane, Anne
and Mason, Stephen",
title="Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="21",
volume="5",
number="1",
pages="e32075",
keywords="palliative care",
keywords="terminal care",
keywords="supportive care",
keywords="quality of life",
keywords="symptom management",
keywords="digital health",
keywords="technology",
abstract="Background: Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. Objective: The aim of this study is to identify research priority areas for digital health in palliative care. Methods: We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. Results: A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3\%) participated in the second round. The final consensus meetings were attended by 10.7\% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. Conclusions: The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm. ",
doi="10.2196/32075",
url="https://aging.jmir.org/2022/1/e32075",
url="http://www.ncbi.nlm.nih.gov/pubmed/35311674"
}


@Article{info:doi/10.2196/34677,
author="Akbas, Samira
and Said, Sadiq
and Roche, Raoul Tadzio
and N{\"o}thiger, B. Christoph
and Spahn, R. Donat
and Tscholl, W. David
and Bergauer, Lisa",
title="User Perceptions of Different Vital Signs Monitor Modalities During High-Fidelity Simulation: Semiquantitative Analysis",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="18",
volume="9",
number="1",
pages="e34677",
keywords="avatar",
keywords="patient monitoring",
keywords="semiquantitative research",
keywords="simulation study",
keywords="situation awareness",
keywords="user-centered design",
keywords="visual-patient-avatar",
abstract="Background: Patient safety during anesthesia is crucially dependent on the monitoring of vital signs. However, the values obtained must also be perceived and correctly classified by the attending care providers. To facilitate these processes, we developed Visual-Patient-avatar, an animated virtual model of the monitored patient, which innovatively presents numerical and waveform data following user-centered design principles. After a high-fidelity simulation study, we analyzed the participants' perceptions of 3 different monitor modalities, including this newly introduced technique. Objective: The aim of this study was to collect and evaluate participants' opinions and experiences regarding 3 different monitor modalities, which are Visual-Patient-avatar, Split Screen (avatar and Conventional monitor alongside each other), and Conventional monitor after using them during simulated critical anesthetic events. Methods: This study was a researcher-initiated, single-center, semiquantitative study. We asked 92 care providers right after finishing 3 simulated emergency scenarios about their positive and negative opinions concerning the different monitor modalities. We processed the field notes obtained and derived the main categories and corresponding subthemes following qualitative research methods. Results: We gained a total of 307 statements. Through a context-based analysis, we identified the 3 main categories of ``Visual-Patient-avatar,'' ``Split Screen,'' and ``Conventional monitor'' and divided them into 11 positive and negative subthemes. We achieved substantial interrater reliability in assigning the statements to 1 of the topics. Most of the statements concerned the design and usability features of the avatar or the Split Screen mode. Conclusions: This study semiquantitatively reviewed the clinical applicability of the Visual-Patient-avatar technique in a high-fidelity simulation study and revealed the strengths and limitations of the avatar only and Split Screen modality. In addition to valuable suggestions for improving the design, the requirement for training prior to clinical implementation was emphasized. The responses to the Split Screen suggest that this symbiotic modality generates better situation awareness in combination with numerical data and accurate curves. As a subsequent development step, a real-life introduction study is planned, where we will test the avatar in Split Screen mode under actual clinical conditions. ",
doi="10.2196/34677",
url="https://humanfactors.jmir.org/2022/1/e34677",
url="http://www.ncbi.nlm.nih.gov/pubmed/35119375"
}


@Article{info:doi/10.2196/32538,
author="Jenkins, L. Catherine
and Imran, Sumayyah
and Mahmood, Aamina
and Bradbury, Katherine
and Murray, Elizabeth
and Stevenson, Fiona
and Hamilton, L. Fiona",
title="Digital Health Intervention Design and Deployment for Engaging Demographic Groups Likely to Be Affected by the Digital Divide: Protocol for a Systematic Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="18",
volume="11",
number="3",
pages="e32538",
keywords="digital divide",
keywords="digital health interventions",
keywords="DHIs",
keywords="eHealth",
keywords="digital health literacy",
keywords="health inequalities",
keywords="health inequities",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Digital health interventions refer to interventions designed to support health-related knowledge transfer and are delivered via digital technologies, such as mobile apps. Digital health interventions are a double-edged sword: they have the potential to reduce health inequalities, for example, by making treatments available remotely to rural populations underserved by health care facilities or by helping to overcome language barriers via in-app translation services; however, if not designed and deployed with care, digital health interventions also have the potential to increase health inequalities and exacerbate the effects of the digital divide. Objective: The aim of this study is to review ways to mitigate the digital divide through digital health intervention design, deployment, and engagement mechanisms sensitive to the needs of digitally excluded populations. Methods: This protocol outlines the procedure for a systematic scoping review that follows the methodology recommended by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidance. The following databases will be searched for primary research studies published in English from October 1, 2011, to October 1, 2021: Cochrane Library, Epistemonikos, NICE Evidence, PROSPERO, PubMed (with MEDLINE and Europe PMC), and Trip. In addition, the following sources of gray literature will be searched: Conference Proceedings Citation Index, Health Management Information Consortium, International HTA Database, OpenGrey, The Grey Literature Report, Google Scholar Basic Search UK, MedNar Deep Web Search Engine, and Carrot2. We will select publications that meet the following inclusion criteria: primary research papers that evaluated digital health interventions that describe features of digital health intervention design and deployment that enable or hinder access to and engagement with digital health interventions by adults from demographic groups likely to be affected by the digital divide (eg, older age, minority ethnic groups, lower income, and lower education level). A random selection of 25 publications identified from the search will be double screened by four reviewers. If there is >75\% agreement for included/excluded publications, the team will continue to screen all the identified publications. For all included publications, study characteristics will be extracted by one author and checked for agreement by a second author, with any disagreements resolved by consensus among the study team. Consultation digital health intervention design and deployment, and digital health intervention users will also be conducted in parallel. Results: The review is underway and is anticipated to be completed by September 2022. Conclusions: The results will have implications for researchers and policy makers using digital health interventions for health improvement peripandemic and post pandemic, and will inform best practices in the design and delivery of digital health interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/32538 ",
doi="10.2196/32538",
url="https://www.researchprotocols.org/2022/3/e32538",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302946"
}


@Article{info:doi/10.2196/31164,
author="Gulde, Philipp
and Rieckmann, Peter",
title="The Association Between Actigraphy-Derived Behavioral Clusters and Self-Reported Fatigue in Persons With Multiple Sclerosis: Cross-sectional Study",
journal="JMIR Rehabil Assist Technol",
year="2022",
month="Mar",
day="17",
volume="9",
number="1",
pages="e31164",
keywords="multiple sclerosis",
keywords="actigraphy",
keywords="cluster analysis",
keywords="fatigue",
keywords="physical activity",
keywords="neurology",
keywords="neurorehabilitation",
keywords="rehabilitation",
keywords="digital health",
keywords="health technology",
keywords="digital tools",
abstract="Background: Persons with multiple sclerosis frequently report increased levels of fatigue and fatigability. However, behavioral surrogates that are strongly associated with self-reports are lacking, which limits research and treatment. Objective: The aim of this study was to derive distinct behavioral syndromes that are reflected by self-reports concerning fatigue and fatigability. Methods: We collected actigraphic data of 30 persons with multiple sclerosis over a period of 1 week during an inpatient stay at a neurorehabilitation facility. Further, participants completed the German fatigue severity scale. A principal component analysis of actigraphic parameters was performed to extract the latent component levels of behaviors that reflect fatigue (quantity of activity) and fatigability (fragmentation of activity). The resulting components were used in a cluster analysis. Results: Analyses suggested 3 clusters, one with high activity (d=0.65-1.57) and low clinical disability levels (d=0.91-1.39), one with high levels of sedentary behavior (d=1.06-1.58), and one with strong activity fragmentation (d=1.39-1.94). The cluster with high levels of sedentary behavior further revealed strong differences from the other clusters concerning participants' reported levels of fatigue (d=0.99-1.28). Conclusions: Cluster analysis data proved to be feasible to meaningfully differentiate between different behavioral syndromes. Self-reports reflected the different behavioral syndromes strongly. Testing of additional domains (eg, volition or processing speed) and assessments during everyday life seem warranted to better understand the origins of reported fatigue symptomatology. ",
doi="10.2196/31164",
url="https://rehab.jmir.org/2022/1/e31164",
url="http://www.ncbi.nlm.nih.gov/pubmed/35297774"
}


@Article{info:doi/10.2196/24172,
author="ten Klooster, Iris
and Wentzel, Jobke
and Sieverink, Floor
and Linssen, Gerard
and Wesselink, Robin
and van Gemert-Pijnen, Lisette",
title="Personas for Better Targeted eHealth Technologies: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="15",
volume="9",
number="1",
pages="e24172",
keywords="personas",
keywords="clustering",
keywords="heart failure",
keywords="eHealth",
keywords="user-centered design",
abstract="Background: The full potential of eHealth technologies to support self-management and disease management for patients with chronic diseases is not being reached. A possible explanation for these lacking results is that during the development process, insufficient attention is paid to the needs, wishes, and context of the prospective end users. To overcome such issues, the user-centered design practice of creating personas is widely accepted to ensure the fit between a technology and the target group or end users throughout all phases of development. Objective: In this study, we integrate several approaches to persona development into the Persona Approach Twente to attain a more holistic and structured approach that aligns with the iterative process of eHealth development. Methods: In 3 steps, a secondary analysis was carried out on different parts of the data set using the Partitioning Around Medoids clustering method. First, we used health-related electronic patient record data only. Second, we added person-related data that were gathered through interviews and questionnaires. Third, we added log data. Results: In the first step, 2 clusters were found, with average silhouette widths of 0.12 and 0.27. In the second step, again 2 clusters were found, with average silhouette widths of 0.08 and 0.12. In the third step, 3 clusters were identified, with average silhouette widths of 0.09, 0.12, and 0.04. Conclusions: The Persona Approach Twente is applicable for mixed types of data and allows alignment of this user-centered design method to the iterative approach of eHealth development. A variety of characteristics can be used that stretches beyond (standardized) medical and demographic measurements. Challenges lie in data quality and fitness for (quantitative) clustering. ",
doi="10.2196/24172",
url="https://humanfactors.jmir.org/2022/1/e24172",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289759"
}


@Article{info:doi/10.2196/33531,
author="Keizer, Julia
and Bente, E. Britt
and Al Naiemi, Nashwan
and Van Gemert-Pijnen, JEWC Lisette
and Beerlage-De Jong, Nienke",
title="Improving the Development and Implementation of Audit and Feedback Systems to Support Health Care Workers in Limiting Antimicrobial Resistance in the Hospital: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="11",
volume="24",
number="3",
pages="e33531",
keywords="scoping review",
keywords="audit and feedback",
keywords="eHealth",
keywords="development",
keywords="implementation",
keywords="antimicrobial resistance",
keywords="antibiotic stewardship",
keywords="infection control",
abstract="Background: For eHealth technologies in general and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential, as it increases the likelihood of achieving desired outcomes by ensuring a fit among eHealth technology, stakeholders, and their context. In addition, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies but is often not elaborated on in publications. Objective: This scoping review aims to provide insights into the development and implementation strategies for AF systems for a real-world problem that threatens modern health care---antimicrobial resistance---and provide an interdisciplinary conceptual framework that can serve as a checklist and guidance for making informed choices in the development and implementation of future AF systems. Methods: A scoping review was conducted by querying PubMed, Scopus, Web of Science, IEEE Xplore Digital Library, and Embase (?2010) for studies describing either the development or implementation process, or both, of an AF system for antimicrobial resistance or infections in hospitals. Studies reporting only on effectiveness or impact were excluded. A total of 3 independent reviewers performed the study selection, and 2 reviewers constructed the conceptual framework through the axial and selective coding of often-used theories, models, and frameworks (TMFs) from the literature on AF and eHealth development and implementation. Subsequently, the conceptual framework was used for the systematic extraction and interpretation of the studies' descriptions of AF systems and their development and implementation. Results: The search resulted in 2125 studies that were screened for eligibility, of which 12 (0.56\%); 2012-2020) were included. These studies described the development and implementation processes heterogeneously in terms of study aims, study targets, target groups, methods, and theoretical underpinnings. Few studies have explicitly explained how choices for the development and implementation of AF systems were substantiated by the TMFs. The conceptual framework provided insights into what is reported on the development and implementation process and revealed underreported AF system constructs (eg, AF system design; engagement with the AF system; and comparison, goal setting, and action planning) and development and implementation (eg, champions) constructs. Conclusions: This scoping review showed the current heterogeneous reporting of AF systems and their development and implementation processes and exemplified how interdisciplinary TMFs can (and should) be balanced in a conceptual framework to capture relevant AF systems and development and implementation constructs. Thereby, it provides a concrete checklist and overall guidance that supports the professionalization and harmonization of AF system development and implementation. For the development and implementation of future AF systems and other eHealth technologies, researchers and health care workers should be supported in selecting and integrating TMFs into their development and implementation process and encouraged to explicitly report on theoretical underpinnings and the substantiation of choices. ",
doi="10.2196/33531",
url="https://www.jmir.org/2022/3/e33531",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275082"
}


@Article{info:doi/10.2196/34088,
author="Sharma, E. Anjana
and Khoong, C. Elaine
and Sierra, Maribel
and Rivadeneira, A. Natalie
and Nijagal, A. Malini
and Su, George
and Lyles, R. Courtney
and DeFries, Triveni
and Tuot, S. Delphine
and Sarkar, Urmimala",
title="System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic",
journal="JMIR Form Res",
year="2022",
month="Mar",
day="10",
volume="6",
number="3",
pages="e34088",
keywords="telemedicine",
keywords="safety-net hospitals",
keywords="health care delivery",
keywords="ambulatory care",
keywords="vulnerable populations",
keywords="COVID-19",
keywords="survey",
keywords="vulnerable",
keywords="telehealth",
keywords="hospital",
keywords="safety",
keywords="delivery",
keywords="video",
keywords="implementation",
keywords="health system",
abstract="Background: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective: This study aimed to assess health system--level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system--level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4\%. Clinician respondents (N=311) included 34.7\% (n=108) primary or urgent care, 35.1\% (n=109) medical, and 7.4\% (n=23) surgical specialties. Our sample included 178 (57.2\%) high telephone adopters and 81 (26.05\%) video adopters. Among high telephone adopters, 72.2\% utilized personal devices for telemedicine (vs 59.0\% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6\% vs 27.2\%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3\%, compared to 50.4\% of medical and 37.5\% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1\%, compared to 14.8\% of primary care and 12.5\% of surgical specialties, P<.001). Conclusions: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine. ",
doi="10.2196/34088",
url="https://formative.jmir.org/2022/3/e34088",
url="http://www.ncbi.nlm.nih.gov/pubmed/35148271"
}


@Article{info:doi/10.2196/26515,
author="Beks, Hannah
and King, Olivia
and Clapham, Renee
and Alston, Laura
and Glenister, Kristen
and McKinstry, Carol
and Quilliam, Claire
and Wellwood, Ian
and Williams, Catherine
and Wong Shee, Anna",
title="Community Health Programs Delivered Through Information and Communications Technology in High-Income Countries: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="9",
volume="24",
number="3",
pages="e26515",
keywords="telemedicine",
keywords="delivery of health care",
keywords="pandemics",
keywords="community health services",
keywords="information and communications technology",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic has required widespread and rapid adoption of information and communications technology (ICT) platforms by health professionals. Transitioning health programs from face-to-face to remote delivery using ICT platforms has introduced new challenges. Objective: The objective of this review is to scope for ICT-delivered health programs implemented within the community health setting in high-income countries and rapidly disseminate findings to health professionals. Methods: The Joanna Briggs Institute's scoping review methodology guided the review of the literature. Results: The search retrieved 7110 unique citations. Each title and abstract was screened by at least two reviewers, resulting in 399 citations for full-text review. Of these 399 citations, 72 (18\%) were included. An additional 27 citations were identified through reviewing the reference lists of the included studies, resulting in 99 citations. Citations examined 83 ICT-delivered programs from 19 high-income countries. Variations in program design, ICT platforms, research design, and outcomes were evident. Conclusions: Included programs and research were heterogeneous, addressing prevalent chronic diseases. Evidence was retrieved for the effectiveness of nurse and allied health ICT-delivered programs. Findings indicated that outcomes for participants receiving ICT-delivered programs, when compared with participants receiving in-person programs, were either equivalent or better. Gaps included a paucity of co-designed programs, qualitative research around group programs, programs for patients and carers, and evaluation of cost-effectiveness. During COVID-19 and beyond, health professionals in the community health setting are encouraged to build on existing knowledge and address evidence gaps by developing and evaluating innovative ICT-delivered programs in collaboration with consumers and carers. ",
doi="10.2196/26515",
url="https://www.jmir.org/2022/3/e26515",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262498"
}


@Article{info:doi/10.2196/29506,
author="Yang, Hsuan-Chia
and Rahmanti, Ristya Annisa
and Huang, Chih-Wei
and Li, Jack Yu-Chuan",
title="How Can Research on Artificial Empathy Be Enhanced by Applying Deepfakes?",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="4",
volume="24",
number="3",
pages="e29506",
keywords="artificial empathy",
keywords="deepfakes",
keywords="doctor-patient relationship",
keywords="face emotion recognition",
keywords="artificial intelligence",
keywords="facial recognition",
keywords="facial emotion recognition",
keywords="medical images",
keywords="patient",
keywords="physician",
keywords="therapy",
doi="10.2196/29506",
url="https://www.jmir.org/2022/3/e29506",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254278"
}


@Article{info:doi/10.2196/34894,
author="Helminski, Danielle
and Kurlander, E. Jacob
and Renji, Deep Anjana
and Sussman, B. Jeremy
and Pfeiffer, N. Paul
and Conte, L. Marisa
and Gadabu, J. Oliver
and Kokaly, N. Alex
and Goldberg, Rebecca
and Ranusch, Allison
and Damschroder, J. Laura
and Landis-Lewis, Zach",
title="Dashboards in Health Care Settings: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="2",
volume="11",
number="3",
pages="e34894",
keywords="dashboard",
keywords="mHealth",
keywords="medical informatics",
keywords="quality improvement",
keywords="scoping review",
keywords="health care",
keywords="Cochrane library",
keywords="Cochrane",
keywords="stakeholder",
keywords="health care sector",
keywords="digital health",
keywords="design",
keywords="end user",
keywords="development",
keywords="implementation",
keywords="evaluation",
keywords="user need",
abstract="Background: Health care organizations increasingly depend on business intelligence tools, including ``dashboards,'' to capture, analyze, and present data on performance metrics. Ideally, dashboards allow users to quickly visualize actionable data to inform and optimize clinical and organizational performance. In reality, dashboards are typically embedded in complex health care organizations with massive data streams and end users with distinct needs. Thus, designing effective dashboards is a challenging task and theoretical underpinnings of health care dashboards are poorly characterized; even the concept of the dashboard remains ill-defined. Researchers, informaticists, clinical managers, and health care administrators will benefit from a clearer understanding of how dashboards have been developed, implemented, and evaluated, and how the design, end user, and context influence their uptake and effectiveness. Objective: This scoping review first aims to survey the vast published literature of ``dashboards'' to describe where, why, and for whom they are used in health care settings, as well as how they are developed, implemented, and evaluated. Further, we will examine how dashboard design and content is informed by intended purpose and end users. Methods: In July 2020, we searched MEDLINE, Embase, Web of Science, and the Cochrane Library for peer-reviewed literature using a targeted strategy developed with a research librarian and retrieved 5188 results. Following deduplication, 3306 studies were screened in duplicate for title and abstract. Any abstracts mentioning a health care dashboard were retrieved in full text and are undergoing duplicate review for eligibility. Articles will be included for data extraction and analysis if they describe the development, implementation, or evaluation of a dashboard that was successfully used in routine workflow. Articles will be excluded if they were published before 2015, the full text is unavailable, they are in a non-English language, or they describe dashboards used for public health tracking, in settings where direct patient care is not provided, or in undergraduate medical education. Any discrepancies in eligibility determination will be adjudicated by a third reviewer. We chose to focus on articles published after 2015 and those that describe dashboards that were successfully used in routine practice to identify the most recent and relevant literature to support future dashboard development in the rapidly evolving field of health care informatics. Results: All articles have undergone dual review for title and abstract, with a total of 2019 articles mentioning use of a health care dashboard retrieved in full text for further review. We are currently reviewing all full-text articles in duplicate. We aim to publish findings by mid-2022. Findings will be reported following guidance from the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Conclusions: This scoping review will provide stakeholders with an overview of existing dashboard tools, highlighting the ways in which dashboards have been developed, implemented, and evaluated in different settings and for different end user groups, and identify potential research gaps. Findings will guide efforts to design and use dashboards in the health care sector more effectively. International Registered Report Identifier (IRRID): DERR1-10.2196/34894 ",
doi="10.2196/34894",
url="https://www.researchprotocols.org/2022/3/e34894",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234650"
}


@Article{info:doi/10.2196/30883,
author="Zhang, Zhan
and Joy, Karen
and Harris, Richard
and Ozkaynak, Mustafa
and Adelgais, Kathleen
and Munjal, Kevin",
title="Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="28",
volume="9",
number="1",
pages="e30883",
keywords="smart glasses",
keywords="hands-free technologies",
keywords="emergency medical services",
keywords="user studies",
keywords="mobile phone",
abstract="Background: Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective: The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods: We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users' perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results: We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions: Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology. ",
doi="10.2196/30883",
url="https://humanfactors.jmir.org/2022/1/e30883",
url="http://www.ncbi.nlm.nih.gov/pubmed/35225816"
}


@Article{info:doi/10.2196/32738,
author="Lee, Robert
and Hitt, James
and Hobika, G. Geoffrey
and Nader, D. Nader",
title="The Case for the Anesthesiologist-Informaticist",
journal="JMIR Perioper Med",
year="2022",
month="Feb",
day="28",
volume="5",
number="1",
pages="e32738",
keywords="anesthesia",
keywords="anesthesiology",
keywords="AIMS",
keywords="anesthesia information management systems",
keywords="clinical informatics",
keywords="anesthesia informatics",
keywords="perioperative informatics",
keywords="health information",
keywords="perioperative medicine",
keywords="health technology",
doi="10.2196/32738",
url="https://periop.jmir.org/2022/1/e32738",
url="http://www.ncbi.nlm.nih.gov/pubmed/35225822"
}


@Article{info:doi/10.2196/29519,
author="Nitiema, Pascal",
title="Telehealth Before and During the COVID-19 Pandemic: Analysis of Health Care Workers' Opinions",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="25",
volume="24",
number="2",
pages="e29519",
keywords="telehealth",
keywords="telemedicine",
keywords="COVID-19",
keywords="pandemic",
keywords="physical examination",
keywords="sentiment score",
keywords="structural topic modeling",
keywords="opinion",
keywords="health care worker",
keywords="social media",
keywords="discussion",
abstract="Background: The COVID-19 pandemic and the lockdowns for controlling the spread of infection have led to a surge in telehealth adoption by many health care organizations. It is unclear how this pandemic has impacted health professionals' view about telehealth. The analysis of textual data, such as comments posted on a discussion forum, can uncover information that may not be captured by a structured survey. Objective: This study aims to examine the opinions of health care workers about telehealth services during the time frame of March 2013-December 2020. Methods: Comments about telehealth posted by health care workers from at least 46 countries were collected from an online discussion forum dedicated to health professionals. The analysis included the computation of sentiment scores from the textual data and the use of structural topic modeling to identify the topics of discussions as well as the factors that may be associated with the prevalence of these topics. Results: The analysis of the comments revealed positive opinions about the perceived benefits of telehealth services before and during the pandemic, especially the ability to reach patients who cannot come to the health facility for diverse reasons. However, opinions about these benefits were less positive during the pandemic compared to the prepandemic period. Specific issues raised during the pandemic included technical difficulties encountered during telehealth sessions and the inability to perform certain care routines through telehealth platforms. Although comments on the quality of care provided through telehealth were associated with a negative sentiment score overall, the average score was less negative during the pandemic compared to the prepandemic period, signaling a shift in opinion about the quality of telehealth services. In addition, the analysis uncovered obstacles to the adoption of telehealth, including the absence of adequate legal dispositions for telehealth services and issues regarding the payment of these services by health insurance organizations. Conclusions: Enhancing the adoption of telehealth services beyond the pandemic requires addressing issues related to the quality of care, payment of services, and legal dispositions for delivering these services. ",
doi="10.2196/29519",
url="https://www.jmir.org/2022/2/e29519",
url="http://www.ncbi.nlm.nih.gov/pubmed/34978532"
}


@Article{info:doi/10.2196/33062,
author="Ridho, Abdurahman
and Alfian, D. Sofa
and van Boven, M. Job F.
and Levita, Jutti
and Yalcin, Aki Esin
and Le, Ly
and Alffenaar, Jan-Willem
and Hak, Eelko
and Abdulah, Rizky
and Pradipta, S. Ivan",
title="Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="23",
volume="24",
number="2",
pages="e33062",
keywords="tuberculosis",
keywords="intervention",
keywords="eHealth",
keywords="medication adherence technology",
keywords="nonadherence",
keywords="digital health",
keywords="systematic review",
keywords="treatment outcomes",
abstract="Background: Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. Objective: This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. Methods: A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. Results: In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95\% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95\% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95\% CI 1.07-1.59) and SMS reminders (OR 2.47; 95\% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. Conclusions: It was found that DHT interventions can be a promising approach. However, the interventions exhibited variable effects regarding effect direction and the extent of improving TB medication adherence and clinical outcomes. Developing DHT interventions with personalized feedback is required to have a consistent and beneficial effect on medication adherence and outcomes among patients with TB. ",
doi="10.2196/33062",
url="https://www.jmir.org/2022/2/e33062",
url="http://www.ncbi.nlm.nih.gov/pubmed/35195534"
}


@Article{info:doi/10.2196/25238,
author="Zheng, Fuhao
and Wang, Ling
and Zeng, Zhaonan
and Wu, Siying",
title="International Technologies on Prevention and Treatment of Neurological and Psychiatric Diseases: Bibliometric Analysis of Patents",
journal="JMIR Ment Health",
year="2022",
month="Feb",
day="22",
volume="9",
number="2",
pages="e25238",
keywords="neurological diseases",
keywords="psychiatric diseases",
keywords="patent",
keywords="bibliometric analysis",
keywords="prevention",
keywords="treatment",
abstract="Background: Neurological and psychiatric disorders are serious and expensive global public health problems. Therefore, exploring effective intervention technologies plays an important role in improving patients' clinical symptoms and social functions, as well as reducing medical burden. Objective: The aim of this study is to analyze and summarize the key new technologies and innovative development trends witnessed globally for neurological illness and psychiatric disorders by mining the relevant patent data. Methods: A bibliometric analysis was conducted on patent applications, priority countries, main patentees, hot technologies, and other patent information on neurological and psychiatric disorders, revealing the current situation along with the trend of technology development in this field. Results: In recent years, inventions and innovations related to neurological and psychiatric diseases have become very active, with China being the largest patent priority country. Of the top patent holders, Visicu (headquartered in the United States) is the leader. The distribution of patent holders in China remains relatively scattered, with no monopoly organization at present. Global technologies on neurological illness and psychiatric disorders are mainly concentrated around A61B (diagnosis, surgery, and identification). Conclusions: This paper analyzed and summarized the key new technologies and global innovative development trends of neurological and psychiatric diseases by mining the relevant patent data, and provides practical references and research perspectives for the prevention and treatment of the aforesaid diseases. ",
doi="10.2196/25238",
url="https://mental.jmir.org/2022/2/e25238",
url="http://www.ncbi.nlm.nih.gov/pubmed/35191849"
}


@Article{info:doi/10.2196/24956,
author="Chow, Aloysius
and Teo, Huang Sok
and Kong, Wen Jing
and Lee, Simon
and Heng, Kiat Yee
and van Steensel, Maurice
and Smith, Helen",
title="Patients' Experiences of Telemedicine for Their Skin Problems: Qualitative Study",
journal="JMIR Dermatol",
year="2022",
month="Feb",
day="22",
volume="5",
number="1",
pages="e24956",
keywords="teledermatology",
keywords="qualitative",
keywords="patients experience",
keywords="telemedicine",
keywords="dermatology",
keywords="Singapore",
abstract="Background: Teledermatology is a cost-effective treatment modality for the management of skin disorders. Most evaluations use quantitative data, and far less is understood about the patients' experience. Objective: This qualitative study aimed to explore patients' perceptions of a teledermatology service linking public primary care clinics to the national specialist dermatology clinic in Singapore. A better understanding of patients' experiences can help refine and develop the care provided. Methods: Semistructured in-depth interviews were conducted with patients who had been referred to the teledermatology service. The interviews were digitally recorded and transcribed before undergoing thematic content analysis. Results: A total of 21 patients aged between 22 and 72 years were recruited. The following 3 themes were identified from the data of patients' experiences: positive perceptions of teledermatology, concerns about teledermatology, and ideas for improving the teledermatology service. The patients found the teledermatology service convenient, saving them time and expense and liberating them from the stresses incurred when making an in-person visit to a specialist facility. They valued the confidence and reassurance they gained from having a dermatologist involved in deciding their management. The patients' concern included data security and the quality of the images shared. Nonetheless, they were keen to see the service expanded beyond the polyclinics. Their experiences and perceptions will inform future service refinement and development. Conclusions: This narrative exploration of users' experiences of teledermatology produced rich data enabling a better understanding of the patients' journey, the way they understand and interpret their experiences, and ideas for service refinement. Telemedicine reduces traveling and enables safe distancing, factors that are much needed during pandemics. ",
doi="10.2196/24956",
url="https://derma.jmir.org/2022/1/e24956",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632855"
}


@Article{info:doi/10.2196/29579,
author="Janssen, Anna
and Fletcher, Jennifer
and Keep, Melanie
and Ahmadpour, Naseem
and Rouf, Anika
and Marthick, Michael
and Booth, Rebecca",
title="Experiences of Patients Undergoing Chemotherapy With Virtual Reality: Mixed Methods Feasibility Study",
journal="JMIR Serious Games",
year="2022",
month="Feb",
day="21",
volume="10",
number="1",
pages="e29579",
keywords="eHealth",
keywords="digital health",
keywords="virtual reality",
keywords="cancer",
keywords="chemotherapy",
keywords="mixed methods research",
keywords="virtual health",
keywords="serious games",
keywords="treatment",
abstract="Background: Current research into virtual reality (VR) use during chemotherapy shows that it can be an effective distraction intervention. However, there is limited research in adult patients and to investigate how VR can be sustainably implemented in health care organizations. Objective: The aim of this study was to explore the feasibility and acceptability of using VR for adult patients undergoing chemotherapy, and to identify the factors that would enable the sustained use of VR during chemotherapy in health care organizations. Methods: Patients undergoing chemotherapy were recruited to participate in a VR intervention during chemotherapy infusion. Participants were observed during the session and completed a postintervention survey. Each participant was invited to participate in a semistructured interview about their experience. Results: A total of 18 patients participated in the study, 5 of whom participated in semistructured interviews. Findings indicated that the use of VR was acceptable for patients undergoing chemotherapy and the intervention was also feasible. Some participants felt that the VR was an effective distraction during chemotherapy infusion, although most still seemed to be aware of how long their treatment was taking. Although VR was acceptable and feasible to patients, interviews identified several barriers to sustained implementation, including access to a reliable app library and impact on staff workloads. Conclusions: VR was acceptable to patients with a diagnosis of cancer undergoing chemotherapy treatment. Patients found VR beneficial for breaking up the monotony of treatment, to provide an additional choice of activity in addition to other recreation, and in some instances as a distraction from the treatment itself. However, there are challenges to address if VR is to be implemented in practice for this patient group. ",
doi="10.2196/29579",
url="https://games.jmir.org/2022/1/e29579",
url="http://www.ncbi.nlm.nih.gov/pubmed/35188474"
}


@Article{info:doi/10.2196/28979,
author="Baird, Aaron
and Cheng, Yichen
and Xia, Yusen",
title="Telehealth Adoption and Discontinuation by US Hospitals: Results From 2 Quasi-Natural Experiments",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="18",
volume="6",
number="2",
pages="e28979",
keywords="telehealth",
keywords="hospitals",
keywords="adoption",
keywords="discontinuation",
keywords="health information system",
abstract="Background: Prior US hospital telehealth (video visit) studies have focused on describing factors that influence telehealth adoption or performance effects for specific patient segments, hospital systems, or geographic regions. To our knowledge, a larger-scale, national-level (US) study has yet to be conducted on the causal impacts of hospital telehealth adoption as well as discontinuation. Objective: The aim of this study is to understand the causal impact of US hospital telehealth adoption or discontinuation on hospital performance from 2016 to 2018. Methods: We analyzed impacts of telehealth adoption or discontinuation by US hospitals on emergency department visits, total ambulatory visits (minus emergency department visits), outpatient services revenue, total facility expenses, and total hospital revenue for the 2016-2018 period. We specifically focused on performance effects for hospitals that switched from not having telehealth to adopting telehealth, or vice versa, during the 2016-2018 period, thus exploiting 2 quasi-natural experiments. We applied a difference-in-differences research design to each of the 2 main analyses. We compared hospitals that have made a telehealth change to groups of hospitals with similar characteristics that did not make a telehealth change, which established a counterfactual. To appropriately match hospitals between treatment and control groups, we applied propensity score matching. Our primary data were from the American Hospital Association Annual Survey and the Healthcare Cost Report Information System data. Several control variables were obtained from additional sources, including the Area Health Resource File and the Federal Communications Commission. Results: We found that telehealth adoption by US hospitals during the 2016-2018 period resulted in, on average, an increased number of total ambulatory visits (P=.008), increased total facility expenses (P<.001), and increased hospital revenue (P=.004) compared with the control group. We found that telehealth discontinuation during the same period resulted in, on average, decreased outpatient services revenue (P=.02) compared with the control group. Conclusions: Our findings suggest that telehealth adoption increases use but has mixed impacts on performance, given that cost and revenue increase. However, once telehealth is offered, removing it can have a negative impact on performance, implying that returning to prior performance levels, if telehealth is removed, may be challenging. ",
doi="10.2196/28979",
url="https://formative.jmir.org/2022/2/e28979",
url="http://www.ncbi.nlm.nih.gov/pubmed/35179503"
}


@Article{info:doi/10.2196/28735,
author="Mendes, M. Jean P.
and Moura, R. Ivan
and Van de Ven, Pepijn
and Viana, Davi
and Silva, S. Francisco J.
and Coutinho, R. Luciano
and Teixeira, Silmar
and Rodrigues, C. Joel J. P.
and Teles, Soares Ariel",
title="Sensing Apps and Public Data Sets for Digital Phenotyping of Mental Health: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="17",
volume="24",
number="2",
pages="e28735",
keywords="mental health",
keywords="digital phenotyping",
keywords="sensing apps",
keywords="data sets",
keywords="sensor data",
abstract="Background: Mental disorders are normally diagnosed exclusively on the basis of symptoms, which are identified from patients' interviews and self-reported experiences. To make mental health diagnoses and monitoring more objective, different solutions have been proposed such as digital phenotyping of mental health (DPMH), which can expand the ability to identify and monitor health conditions based on the interactions of people with digital technologies. Objective: This article aims to identify and characterize the sensing applications and public data sets for DPMH from a technical perspective. Methods: We performed a systematic review of scientific literature and data sets. We searched 8 digital libraries and 20 data set repositories to find results that met the selection criteria. We conducted a data extraction process from the selected articles and data sets. For this purpose, a form was designed to extract relevant information, thus enabling us to answer the research questions and identify open issues and research trends. Results: A total of 31 sensing apps and 8 data sets were identified and reviewed. Sensing apps explore different context data sources (eg, positioning, inertial, ambient) to support DPMH studies. These apps are designed to analyze and process collected data to classify (n=11) and predict (n=6) mental states/disorders, and also to investigate existing correlations between context data and mental states/disorders (n=6). Moreover, general-purpose sensing apps are developed to focus only on contextual data collection (n=9). The reviewed data sets contain context data that model different aspects of human behavior, such as sociability, mood, physical activity, sleep, with some also being multimodal. Conclusions: This systematic review provides in-depth analysis regarding solutions for DPMH. Results show growth in proposals for DPMH sensing apps in recent years, as opposed to a scarcity of public data sets. The review shows that there are features that can be measured on smart devices that can act as proxies for mental status and well-being; however, it should be noted that the combined evidence for high-quality features for mental states remains limited. DPMH presents a great perspective for future research, mainly to reach the needed maturity for applications in clinical settings. ",
doi="10.2196/28735",
url="https://www.jmir.org/2022/2/e28735",
url="http://www.ncbi.nlm.nih.gov/pubmed/35175202"
}


@Article{info:doi/10.2196/30810,
author="Moon, Khatiya
and Sobolev, Michael
and Kane, M. John",
title="Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review",
journal="JMIR Ment Health",
year="2022",
month="Feb",
day="16",
volume="9",
number="2",
pages="e30810",
keywords="collaborative care",
keywords="integrated care",
keywords="augmented care",
keywords="digital health",
keywords="mobile health",
keywords="behavioral health",
keywords="review",
abstract="Background: The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective: This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods: This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results: A total of 3982 nonduplicate reports were identified, of which 20 (0.5\%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35\%), there were no differences between groups, or the differences were modest. Conclusions: The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials. ",
doi="10.2196/30810",
url="https://mental.jmir.org/2022/2/e30810",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171105"
}


@Article{info:doi/10.2196/28612,
author="Milne-Ives, Madison
and Leyden, John
and Maramba, Inocencio
and Chatterjee, Arunangsu
and Meinert, Edward",
title="The Potential Impacts of a Digital Preoperative Assessment Service on Appointments, Travel-Related Carbon Dioxide Emissions, and User Experience: Case Study",
journal="JMIR Perioper Med",
year="2022",
month="Feb",
day="16",
volume="5",
number="1",
pages="e28612",
keywords="preoperative care",
keywords="preoperative period",
keywords="telemedicine",
keywords="telehealth",
keywords="appointments",
keywords="cost-effective",
keywords="economic",
abstract="Background: The National Health Service (NHS) cannot keep up with the demand for operations and procedures. Preoperative assessments can be conducted on the internet to improve efficiency and reduce wait times for operations. MyPreOp is a cloud-based platform where patients can complete preoperative questionnaires. These are reviewed by a nurse who determines whether they need a subsequent face-to-face appointment. Objective: The primary objective of this study is to describe the potential impact of MyPreOp (Ultramed Ltd) on the number of face-to-face appointments. The secondary objectives are to examine the time spent on preoperative assessments completed using MyPreOp in NHS Trusts and user ratings of usability and acceptability. Methods: The study design was a case study service evaluation. Data were collected using the MyPreOp system from 2 NHS Trusts (Guy's and St Thomas' and Royal United Hospitals Bath) and the private BMI Bath Clinic during the 4-month period from September to December 2020. Participants were adults of any age and health status at the participating hospitals who used MyPreOp to complete a preoperative assessment before a scheduled surgery. The primary outcome was the number of face-to-face appointments avoided by patients who used MyPreOp. The investigated secondary outcomes included the length of time spent by nurses completing preoperative assessments, associated travel-related carbon dioxide emissions compared with standard care, and quantitative user feedback. User feedback was assessed at all 3 sites; however, the other outcomes could only be examined in the Royal United Hospitals Bath sample because of data limitations. Results: Data from 2500 participants were included. Half of the assessed patients did not need a further face-to-face appointment and required a median of only 5.3 minutes of nurses' time to review. The reduction in appointments was associated with a small saving of carbon dioxide equivalent emissions (9.05 tons). Patient feedback was generally positive: 79.8\% (317/397) of respondents rated MyPreOp as easy or very easy to use, and 85.2\% (340/399) thought the overall experience was good or very good. Conclusions: This evaluation demonstrates the potential benefits of MyPreOp. However, further research using rigorous scientific methodology and a larger sample of NHS Trusts and users is needed to provide strong evidence of MyPreOp's efficacy, usability, and cost-effectiveness. ",
doi="10.2196/28612",
url="https://periop.jmir.org/2022/1/e28612",
url="http://www.ncbi.nlm.nih.gov/pubmed/35171104"
}


@Article{info:doi/10.2196/32568,
author="Bangash, Hana
and Makkawy, Ahmed
and Gundelach, H. Justin
and Miller, A. Alexandra
and Jacobson, A. Kimberly
and Kullo, J. Iftikhar",
title="Web-Based Tool (FH Family Share) to Increase Uptake of Cascade Testing for Familial Hypercholesterolemia: Development and Evaluation",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="15",
volume="9",
number="1",
pages="e32568",
keywords="familial hypercholesterolemia",
keywords="cascade testing",
keywords="communication",
keywords="genetic counselors",
keywords="digital tools",
keywords="website",
keywords="usability",
keywords="user experience",
keywords="public health",
abstract="Background: Familial hypercholesterolemia, a prevalent genetic disorder, remains significantly underdiagnosed in the United States. Cascade testing, wherein individuals diagnosed with familial hypercholesterolemia--- probands---contact their family members to inform them of their risk for familial hypercholesterolemia, has low uptake in the United States. Digital tools are needed to facilitate communication between familial hypercholesterolemia probands and their family members and to promote sharing of familial hypercholesterolemia--related risk information. Objective: We aimed to create and evaluate a web-based tool designed to enhance familial communication and promote cascade testing for familial hypercholesterolemia. Methods: A hybrid type 1 implementation science framework and a user-centered design process were used to develop an interactive web-based tool---FH Family Share---that enables familial hypercholesterolemia probands to communicate information about their familial hypercholesterolemia diagnosis with at-risk relatives. Probands can also use the tool to draw a family pedigree and learn more about familial hypercholesterolemia through education modules and curated knowledge resources. Usability guidelines and standards were taken into account during the design and development of the tool. The initial prototype underwent a cognitive walkthrough, which was followed by usability testing with key stakeholders including genetic counselors and patients with familial hypercholesterolemia. Participants navigated the prototype using the think-aloud technique, and their feedback was used to refine features of the tool. Results: Key themes that emerged from the cognitive walkthrough were design, format, navigation, terminology, instructions, and learnability. Expert feedback from the cognitive walkthrough resulted in a rebuild of the web-based tool to align it with institutional standards. Usability testing with genetic counselors and patients with familial hypercholesterolemia provided insights on user experience, satisfaction and interface design and highlighted specific modifications that were made to refine the features of FH Family Share. Genetic counselors and patients with familial hypercholesterolemia suggested inclusion of the following features in the web-based tool: (1) a letter-to-family-member email template, (2) education modules, and (3) knowledge resources. Surveys revealed that 6 of 9 (67\%) genetic counselors found information within FH Family Share very easy to find, and 5 of 9 (56\%) genetic counselors found information very easy to understand; 5 of 9 (56\%) patients found information very easy to find within the website, and 7 of 9 (78\%) patients found information very easy to understand. All genetic counselors and patients indicated that FH Family Share was a resource worth returning to. Conclusions: FH Family Share facilitates communication between probands and their relatives. Once informed, at-risk family members have the option to seek testing and treatment for familial hypercholesterolemia. ",
doi="10.2196/32568",
url="https://humanfactors.jmir.org/2022/1/e32568",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166678"
}


@Article{info:doi/10.2196/28890,
author="Santos, Mauro
and Vollam, Sarah
and Pimentel, AF Marco
and Areia, Carlos
and Young, Louise
and Roman, Cristian
and Ede, Jody
and Piper, Philippa
and King, Elizabeth
and Harford, Mirae
and Shah, Akshay
and Gustafson, Owen
and Tarassenko, Lionel
and Watkinson, Peter",
title="The Use of Wearable Pulse Oximeters in the Prompt Detection of Hypoxemia and During Movement: Diagnostic Accuracy Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="15",
volume="24",
number="2",
pages="e28890",
keywords="diagnostic accuracy",
keywords="hypoxia",
keywords="hypoxemia",
keywords="wearable pulse oximeter",
keywords="continuous monitoring",
keywords="mHealth",
keywords="wearable technology",
keywords="patient monitoring",
keywords="deterioration",
keywords="blood oxygen",
keywords="hospital",
abstract="Background: Commercially available wearable (ambulatory) pulse oximeters have been recommended as a method for managing patients at risk of physiological deterioration, such as active patients with COVID-19 disease receiving care in hospital isolation rooms; however, their reliability in usual hospital settings is not known. Objective: We report the performance of wearable pulse oximeters in a simulated clinical setting when challenged by motion and low levels of arterial blood oxygen saturation (SaO2). Methods: The performance of 1 wrist-worn (Wavelet) and 3 finger-worn (CheckMe O2+, AP-20, and WristOx2 3150) wearable, wireless transmission--mode pulse oximeters was evaluated. For this, 7 motion tasks were performed: at rest, sit-to-stand, tapping, rubbing, drinking, turning pages, and using a tablet. Hypoxia exposure followed, in which inspired gases were adjusted to achieve decreasing SaO2 levels at 100\%, 95\%, 90\%, 87\%, 85\%, 83\%, and 80\%. Peripheral oxygen saturation (SpO2) estimates were compared with simultaneous SaO2 samples to calculate the root-mean-square error (RMSE). The area under the receiver operating characteristic curve was used to analyze the detection of hypoxemia (ie, SaO2<90\%). Results: SpO2 estimates matching 215 SaO2 samples in both study phases, from 33 participants, were analyzed. Tapping, rubbing, turning pages, and using a tablet degraded SpO2 estimation (RMSE>4\% for at least 1 device). All finger-worn pulse oximeters detected hypoxemia, with an overall sensitivity of ?0.87 and specificity of ?0.80, comparable to that of the Philips MX450 pulse oximeter. Conclusions: The SpO2 accuracy of wearable finger-worn pulse oximeters was within that required by the International Organization for Standardization guidelines. Performance was degraded by motion, but all pulse oximeters could detect hypoxemia. Our findings support the use of wearable, wireless transmission--mode pulse oximeters to detect the onset of clinical deterioration in hospital settings. Trial Registration: ISRCTN Registry 61535692; http://www.isrctn.com/ISRCTN61535692 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-034404 ",
doi="10.2196/28890",
url="https://www.jmir.org/2022/2/e28890",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166690"
}


@Article{info:doi/10.2196/16128,
author="Graf, Joachim
and Sickenberger, Nina
and Brusniak, Katharina
and Matthies, Maria Lina
and Deutsch, M. Thomas
and Simoes, Elisabeth
and Plappert, Claudia
and Keilmann, Lucia
and Hartkopf, Andreas
and Walter, Barbara Christina
and Hahn, Markus
and Engler, Tobias
and Wallwiener, Stephanie
and Schuetz, Florian
and Fasching, A. Peter
and Schneeweiss, Andreas
and Brucker, Yvonne Sara
and Wallwiener, Markus",
title="Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="8",
volume="24",
number="2",
pages="e16128",
keywords="eHealth",
keywords="electronic patient-reported outcomes",
keywords="evaluation",
keywords="acceptability",
keywords="breast cancer",
abstract="Background: One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective: The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods: Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results: Patients regarded the ePRO assessment as more suitable (80/106, 75.5\%), less stressful (73/106, 68.9\%), and less difficult (69/106, 65.1\%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1\%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app's evaluation parameters. Conclusions: The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills. ",
doi="10.2196/16128",
url="https://www.jmir.org/2022/2/e16128",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133288"
}


@Article{info:doi/10.2196/28199,
author="Scheder-Bieschin, Justus
and Bl{\"u}mke, Bibiana
and de Buijzer, Erwin
and Cotte, Fabienne
and Echterdiek, Fabian
and Nacsa, J{\'u}lia
and Ondresik, Marta
and Ott, Matthias
and Paul, Gregor
and Schilling, Tobias
and Schmitt, Anne
and Wicks, Paul
and Gilbert, Stephen",
title="Improving Emergency Department Patient-Physician Conversation Through an Artificial Intelligence Symptom-Taking Tool: Mixed Methods Pilot Observational Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="7",
volume="6",
number="2",
pages="e28199",
keywords="symptom assessment application",
keywords="anamnesis",
keywords="health care system",
keywords="patient history taking",
keywords="diagnosis",
keywords="emergency department",
abstract="Background: Establishing rapport and empathy between patients and their health care provider is important but challenging in the context of a busy and crowded emergency department (ED). Objective: We explore the hypotheses that rapport building, documentation, and time efficiency might be improved in the ED by providing patients a digital tool that uses Bayesian reasoning--based techniques to gather relevant symptoms and history for handover to clinicians. Methods: A 2-phase pilot evaluation was carried out in the ED of a German tertiary referral and major trauma hospital that treats an average of 120 patients daily. Phase 1 observations guided iterative improvement of the digital tool, which was then further evaluated in phase 2. All patients who were willing and able to provide consent were invited to participate, excluding those with severe injury or illness requiring immediate treatment, with traumatic injury, incapable of completing a health assessment, and aged <18 years. Over an 18-day period with 1699 patients presenting to the ED, 815 (47.96\%) were eligible based on triage level. With available recruitment staff, 135 were approached, of whom 81 (60\%) were included in the study. In a mixed methods evaluation, patients entered information into the tool, accessed by clinicians through a dashboard. All users completed evaluation Likert-scale questionnaires rating the tool's performance. The feasibility of a larger trial was evaluated through rates of recruitment and questionnaire completion. Results: Respondents strongly endorsed the tool for facilitating conversation (61/81, 75\% of patients, 57/78, 73\% of physician ratings, and 10/10, 100\% of nurse ratings). Most nurses judged the tool as potentially time saving, whereas most physicians only agreed for a subset of medical specialties (eg, surgery). Patients reported high usability and understood the tool's questions. The tool was recommended by most patients (63/81, 78\%), in 53\% (41/77) of physician ratings, and in 76\% (61/80) of nurse ratings. Questionnaire completion rates were 100\% (81/81) by patients and 96\% (78/81 enrolled patients) by physicians. Conclusions: This pilot confirmed that a larger study in the setting would be feasible. The tool has clear potential to improve patient--health care provider interaction and could also contribute to ED efficiency savings. Future research and development will extend the range of patients for whom the history-taking tool has clinical utility. Trial Registration: German Clinical Trials Register DRKS00024115; https://drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00024115 ",
doi="10.2196/28199",
url="https://formative.jmir.org/2022/2/e28199",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129452"
}


@Article{info:doi/10.2196/30880,
author="Gardner, Tania
and Schultz, Regina
and Haskelberg, Hila
and Newby, M. Jill
and Wheatley, Jane
and Millard, Michael
and Faux, G. Steven
and Shiner, T. Christine",
title="The Effect of Adjunct Telephone Support on Adherence and Outcomes of the Reboot Online Pain Management Program: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="3",
volume="24",
number="2",
pages="e30880",
keywords="chronic pain",
keywords="online pain management",
keywords="telephone support",
keywords="clinician guidance",
keywords="adherence",
keywords="digital health",
keywords="eHealth",
keywords="internet interventions",
keywords="multidisciplinary",
abstract="Background: Internet-based treatment programs present a solution for providing access to pain management for those unable to access clinic-based multidisciplinary pain programs. Attrition from internet interventions is a common issue. Clinician-supported guidance can be an important feature in web-based interventions; however, the optimal level of therapist guidance and expertise required to improve adherence remains unclear. Objective: The aim of this study is to evaluate whether augmenting the existing Reboot Online program with telephone support by a clinician improves program adherence and effectiveness compared with the web-based program alone. Methods: A 2-armed, CONSORT (Consolidated Standards of Reporting Trials)--compliant, registered randomized controlled trial with one-to-one group allocation was conducted. It compared a web-based multidisciplinary pain management program, Reboot Online, combined with telephone support (n=44) with Reboot Online alone (n=45) as the control group. Participants were recruited through web-based social media and the This Way Up service provider network. The primary outcome for this study was adherence to the Reboot Online program. Adherence was quantified through three metrics: completion of the program, the number of participants who enrolled into the program, and the number of participants who commenced the program. Data on adherence were collected automatically through the This Way Up platform. Secondary measures of clinical effectiveness were also collected. Results: Reboot Online combined with telephone support had a positive effect on enrollment and commencement of the program compared with Reboot Online without telephone support. Significantly more participants from the Reboot Online plus telephone support group enrolled (41/44, 93\%) into the course than those from the control group (35/45, 78\%; $\chi$21=4.2; P=.04). Furthermore, more participants from the intervention group commenced the course than those from the control group (40/44, 91\% vs 27/45, 60\%, respectively; $\chi$21=11.4; P=.001). Of the participants enrolled in the intervention group, 43\% (19/44) completed the course, and of those in the control group, 31\% (14/45) completed the course. When considering the subgroup of those who commenced the program, there was no significant difference between the proportions of people who completed all 8 lessons in the intervention (19/40, 48\%) and control groups (14/27, 52\%; $\chi$21=1.3; P=.24). The treatment efficacy on clinical outcome measures did not differ between the intervention and control groups. Conclusions: Telephone support improves participants' registration, program commencement, and engagement in the early phase of the internet intervention; however, it did not seem to have an impact on overall course completion or efficacy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001076167; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12619001076167 ",
doi="10.2196/30880",
url="https://www.jmir.org/2022/2/e30880",
url="http://www.ncbi.nlm.nih.gov/pubmed/35113021"
}


@Article{info:doi/10.2196/34702,
author="Weatherburn, Christopher",
title="Digital Inclusion as a Foundation for Health Equity. Comment on ``Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study''",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="3",
volume="24",
number="2",
pages="e34702",
keywords="technology-enabled care",
keywords="video consultations",
keywords="quality improvement",
keywords="COVID-19",
keywords="PERCS framework",
keywords="remote consultation",
keywords="Scotland",
keywords="general practice",
keywords="digital inclusion",
keywords="digital divide",
keywords="digital health equity",
doi="10.2196/34702",
url="https://www.jmir.org/2022/2/e34702",
url="http://www.ncbi.nlm.nih.gov/pubmed/35038303"
}


@Article{info:doi/10.2196/32581,
author="Wasmann, Jan-Willem
and Pragt, Leontien
and Eikelboom, Robert
and Swanepoel, Wet De",
title="Digital Approaches to Automated and Machine Learning Assessments of Hearing: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e32581",
keywords="audiology",
keywords="automated audiometry",
keywords="automatic audiometry",
keywords="automation",
keywords="digital health technologies",
keywords="digital hearing health care",
keywords="machine learning",
keywords="remote care",
keywords="self-administered audiometry",
keywords="self-assessment audiometry",
keywords="user-operated audiometry",
keywords="digital health",
keywords="hearing loss",
keywords="digital hearing",
keywords="digital devices",
keywords="mobile phone",
keywords="telehealth",
abstract="Background: Hearing loss affects 1 in 5 people worldwide and is estimated to affect 1 in 4 by 2050. Treatment relies on the accurate diagnosis of hearing loss; however, this first step is out of reach for >80\% of those affected. Increasingly automated approaches are being developed for self-administered digital hearing assessments without the direct involvement of professionals. Objective: This study aims to provide an overview of digital approaches in automated and machine learning assessments of hearing using pure-tone audiometry and to focus on the aspects related to accuracy, reliability, and time efficiency. This review is an extension of a 2013 systematic review. Methods: A search across the electronic databases of PubMed, IEEE, and Web of Science was conducted to identify relevant reports from the peer-reviewed literature. Key information about each report's scope and details was collected to assess the commonalities among the approaches. Results: A total of 56 reports from 2012 to June 2021 were included. From this selection, 27 unique automated approaches were identified. Machine learning approaches require fewer trials than conventional threshold-seeking approaches, and personal digital devices make assessments more affordable and accessible. Validity can be enhanced using digital technologies for quality surveillance, including noise monitoring and detecting inconclusive results. Conclusions: In the past 10 years, an increasing number of automated approaches have reported similar accuracy, reliability, and time efficiency as manual hearing assessments. New developments, including machine learning approaches, offer features, versatility, and cost-effectiveness beyond manual audiometry. Used within identified limitations, automated assessments using digital devices can support task-shifting, self-care, telehealth, and clinical care pathways. ",
doi="10.2196/32581",
url="https://www.jmir.org/2022/2/e32581",
url="http://www.ncbi.nlm.nih.gov/pubmed/34919056"
}


@Article{info:doi/10.2196/33034,
author="Milos Nymberg, Veronica
and Elleg{\aa}rd, Maria Lina
and Kjellsson, Gustav
and Wolff, Moa
and Borgstr{\"o}m Bolmsj{\"o}, Beata
and Wallman, Thorne
and Calling, Susanna",
title="Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="2",
volume="9",
number="1",
pages="e33034",
keywords="remote health care",
keywords="telemedicine",
keywords="primary health care",
keywords="respiratory tract infections",
keywords="COVID-19",
abstract="Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Sk{\aa}ne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. ",
doi="10.2196/33034",
url="https://humanfactors.jmir.org/2022/1/e33034",
url="http://www.ncbi.nlm.nih.gov/pubmed/34846304"
}


@Article{info:doi/10.2196/32384,
author="Hadian, Kimia
and Fernie, Geoff
and Roshan Fekr, Atena",
title="A New Performance Metric to Estimate the Risk of Exposure to Infection in a Health Care Setting: Descriptive Study",
journal="JMIR Form Res",
year="2022",
month="Feb",
day="2",
volume="6",
number="2",
pages="e32384",
keywords="hand hygiene",
keywords="health care-acquired",
keywords="infection control",
keywords="compliance",
keywords="electronic monitoring",
keywords="exposure",
keywords="risk",
keywords="hygiene",
keywords="monitoring",
keywords="surveillance",
keywords="performance",
keywords="metric",
keywords="method",
keywords="estimate",
keywords="predict",
keywords="development",
abstract="Background: Despite several measures to monitor and improve hand hygiene (HH) in health care settings, health care-acquired infections (HAIs) remain prevalent. The measures used to calculate HH performance are not able to fully benefit from the high-resolution data collected using electronic monitoring systems. Objective: This study proposes a novel parameter for quantifying the HAI exposure risk of individual patients by considering temporal and spatial features of health care workers' HH adherence. Methods: Patient exposure risk is calculated as a function of the number of consecutive missed HH opportunities, the number of unique rooms visited by the health care professional, and the time duration that the health care professional spends inside and outside the patient's room without performing HH. The patient exposure risk is compared to the entrance compliance rate (ECR) defined as the ratio of the number of HH actions performed at a room entrance to the total number of entrances into the room. The compliance rate is conventionally used to measure HH performance. The ECR and the patient exposure risk are analyzed using the data collected from an inpatient nursing unit for 12 weeks. Results: The analysis of data collected from 59 nurses and more than 25,600 records at a musculoskeletal rehabilitation unit at the Toronto Rehabilitation Institute, KITE, showed that there is no strong linear relation between the ECR and patient exposure risk (r=0.7, P<.001). Since the ECR is calculated based on the number of missed HH actions upon room entrance, this parameter is already included in the patient exposure risk. Therefore, there might be scenarios that these 2 parameters are correlated; however, in several cases, the ECR contrasted with the reported patient exposure risk. Generally, the patients in rooms with a significantly high ECR can be potentially exposed to a considerable risk of infection. By contrast, small ECRs do not necessarily result in a high patient exposure risk. The results clearly explained the important role of the factors incorporated in patient exposure risk for quantifying the risk of infection for the patients. Conclusions: Patient exposure risk might provide a more reliable estimation of the risk of developing HAIs compared to ECR by considering both the temporal and spatial aspects of HH records. ",
doi="10.2196/32384",
url="https://formative.jmir.org/2022/2/e32384",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107424"
}


@Article{info:doi/10.2196/33081,
author="Huang, Pei-hua
and Kim, Ki-hun
and Schermer, Maartje",
title="Ethical Issues of Digital Twins for Personalized Health Care Service: Preliminary Mapping Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="31",
volume="24",
number="1",
pages="e33081",
keywords="digital twins",
keywords="digital health",
keywords="personalized health care service",
keywords="data-driven health care",
keywords="value-sensitive design",
keywords="ethics of health care technology",
abstract="Background: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps the major ethical risks of digital twins for personalized health care services. Objective: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. Methods: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. Results: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. Conclusions: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner. ",
doi="10.2196/33081",
url="https://www.jmir.org/2022/1/e33081",
url="http://www.ncbi.nlm.nih.gov/pubmed/35099399"
}


@Article{info:doi/10.2196/31920,
author="Yu, Jiyeon
and de Antonio, Angelica
and Villalba-Mora, Elena",
title="Design of an Integrated Acceptance Framework for Older Users and eHealth: Influential Factor Analysis",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="28",
volume="24",
number="1",
pages="e31920",
keywords="eHealth",
keywords="older people",
keywords="older user",
keywords="health technology",
keywords="acceptance factors",
keywords="adoption",
keywords="acceptance framework",
keywords="systematic review",
keywords="thematic analysis",
keywords="influential factor analysis",
keywords="mobile phone",
abstract="Background: eHealth and telehealth play a crucial role in assisting older adults who visit hospitals frequently or who live in nursing homes and can benefit from staying at home while being cared for. Adapting to new technologies can be difficult for older people. Thus, to better apply these technologies to older adults' lives, many studies have analyzed the acceptance factors for this particular population. However, there is not yet a consensual framework that can be used in further development and to search for solutions. Objective: This paper aims to present an integrated acceptance framework (IAF) for older users' acceptance of eHealth based on 43 studies selected through a systematic review. Methods: We conducted a 4-step study. First, through a systematic review in the field of eHealth from 2010 to 2020, the acceptance factors and basic data for analysis were extracted. Second, we conducted a thematic analysis to group the factors into themes to propose an integrated framework for acceptance. Third, we defined a metric to evaluate the impact of the factors addressed in the studies. Finally, the differences among the important IAF factors were analyzed according to the participants' health conditions, verification time, and year. Results: Through a systematic review, 731 studies were found in 5 major databases, resulting in 43 (5.9\%) selected studies using the PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) methodology. First, the research methods and acceptance factors for eHealth were compared and analyzed, extracting a total of 105 acceptance factors, which were grouped later, resulting in an IAF. A total of 5 dimensions (ie, personal, user--technology relational, technological, service-related, and environmental) emerged, with a total of 23 factors. In addition, we assessed the quality of evidence and then conducted a stratification analysis to reveal the more appropriate factors depending on the health condition and assessment time. Finally, we assessed the factors and dimensions that have recently become more important. Conclusions: The result of this investigation is a framework for conducting research on eHealth acceptance. To elaborately analyze the impact of the factors of the proposed framework, the criteria for evaluating the evidence from the studies that have the extracted factors are presented. Through this process, the impact of each factor in the IAF has been presented, in addition to the framework proposal. Moreover, a meta-analysis of the current status of research is presented, highlighting the areas where specific measures are needed to facilitate eHealth acceptance. ",
doi="10.2196/31920",
url="https://www.jmir.org/2022/1/e31920",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089155"
}


@Article{info:doi/10.2196/23833,
author="Schilling, George
and Villarosa, Leonardo",
title="An Information Directory App InHouse Call for Streamlining Communication to Optimize Efficiency and Patient Care in a Hospital: Pilot Mixed Methods Design and Utility Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="27",
volume="9",
number="1",
pages="e23833",
keywords="InHouse Call",
keywords="communication",
keywords="hospital directory",
keywords="healthcare",
keywords="health care",
keywords="health informatics",
keywords="mHealth",
keywords="mobile app",
keywords="digital health",
keywords="patient records",
keywords="electronic health",
abstract="Background: Communication failures disrupt physician workflow, lead to poor patient outcomes, and are associated with significant economic burden. To increase efficiency when contacting a team member in a hospital, we have designed an information directory app, InHouse Call. Objective: This study aimed to describe the design of InHouse Call, objectively compare the usefulness of the app versus that of traditional methods (operator or pocket cards, etc), and determine its subjective usefulness through user surveys and a net promoter score (NPS). Methods: This pilot study utilizing before-after trials was carried out at a tertiary academic hospital and involved 20 clinicians, including physiatrists, hospitalists, internal medicine and family medicine residents, and advanced practice providers/nurse practitioners/physician assistants. InHouse Call was designed to efficiently supply contact information to providers through a simple, user-friendly interface. The participants used InHouse Call in timed trials to contact a health care team member in the hospital via a telephone call. The effectiveness of InHouse Call in connecting the user with a contact in the hospital was measured through timed trials comparing the amount of time spent in attempting to make the connection using traditional methods versus the app. Usability was measured through exit surveys and NPS. Results: The average time spent connecting to the correct contact using traditional methods was 59.5 seconds, compared to 13.8 seconds when using InHouse Call. The degree of variance when using traditional methods was 1544.2, compared to 19.7 with InHouse Call. A call made using the traditional methods deviated from the mean by 39.3 seconds, compared to 4.4 seconds when using InHouse Call. InHouse Call achieved an NPS of 95. Conclusions: InHouse Call significantly reduced the average amount of time spent connecting with the correct contact as well as the variability to complete the task, thus proving to be the superior method of communication for health care providers. The app garnered a high NPS and positive subjective feedback. ",
doi="10.2196/23833",
url="https://humanfactors.jmir.org/2022/1/e23833",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084350"
}


@Article{info:doi/10.2196/28366,
author="Yamanaka, Syunsuke
and Goto, Tadahiro
and Morikawa, Koji
and Watase, Hiroko
and Okamoto, Hiroshi
and Hagiwara, Yusuke
and Hasegawa, Kohei",
title="Machine Learning Approaches for Predicting Difficult Airway and First-Pass Success in the Emergency Department: Multicenter Prospective Observational Study",
journal="Interact J Med Res",
year="2022",
month="Jan",
day="25",
volume="11",
number="1",
pages="e28366",
keywords="intubation",
keywords="machine learning",
keywords="difficult airway",
keywords="first-pass success",
abstract="Background: There is still room for improvement in the modified LEMON (look, evaluate, Mallampati, obstruction, neck mobility) criteria for difficult airway prediction and no prediction tool for first-pass success in the emergency department (ED). Objective: We applied modern machine learning approaches to predict difficult airways and first-pass success. Methods: In a multicenter prospective study that enrolled consecutive patients who underwent tracheal intubation in 13 EDs, we developed 7 machine learning models (eg, random forest model) using routinely collected data (eg, demographics, initial airway assessment). The outcomes were difficult airway and first-pass success. Model performance was evaluated using c-statistics, calibration slopes, and association measures (eg, sensitivity) in the test set (randomly selected 20\% of the data). Their performance was compared with the modified LEMON criteria for difficult airway success and a logistic regression model for first-pass success. Results: Of 10,741 patients who underwent intubation, 543 patients (5.1\%) had a difficult airway, and 7690 patients (71.6\%) had first-pass success. In predicting a difficult airway, machine learning models---except for k-point nearest neighbor and multilayer perceptron---had higher discrimination ability than the modified LEMON criteria (all, P?.001). For example, the ensemble method had the highest c-statistic (0.74 vs 0.62 with the modified LEMON criteria;?P<.001). Machine learning models---except k-point nearest neighbor and random forest models---had higher discrimination ability for first-pass success. In particular, the ensemble model had the highest c-statistic (0.81 vs 0.76 with the reference regression;?P<.001). Conclusions: Machine learning models demonstrated greater ability for predicting difficult airway and first-pass success in the ED. ",
doi="10.2196/28366",
url="https://www.i-jmr.org/2022/1/e28366",
url="http://www.ncbi.nlm.nih.gov/pubmed/35076398"
}


@Article{info:doi/10.2196/33631,
author="Thesen, Terje
and Himle, A. Joseph
and Martinsen, W. Egil
and Walseth, T. Liv
and Thorup, Frode
and Gallefoss, Frode
and Jonsbu, Egil",
title="Effectiveness of Internet-Based Cognitive Behavioral Therapy With Telephone Support for Noncardiac Chest Pain: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="24",
volume="24",
number="1",
pages="e33631",
keywords="noncardiac chest pain",
keywords="internet-based treatment",
keywords="internet-assisted treatment",
keywords="cognitive behavioral therapy",
keywords="psychosomatic medicine",
keywords="randomized controlled trial",
keywords="pain",
keywords="treatment",
keywords="internet-based cognitive behavioral therapy",
keywords="effectiveness",
keywords="support",
keywords="intervention",
abstract="Background: Noncardiac chest pain has a high prevalence and is associated with reduced quality of life, anxiety, avoidance of physical activity, and high societal costs. There is a lack of an effective, low-cost, easy to distribute intervention to assist patients with noncardiac chest pain. Objective: In this study, we aimed to investigate the effectiveness of internet-based cognitive behavioral therapy with telephone support for noncardiac chest pain. Methods: We conducted a randomized controlled trial, with a 12-month follow-up period, to compare internet-based cognitive behavioral therapy to a control condition (treatment as usual). A total of 162 participants aged 18 to 70 years with a diagnosis of noncardiac chest pain were randomized to either internet-based cognitive behavioral therapy (n=81) or treatment as usual (n=81). The participants in the experimental condition received 6 weekly sessions of internet-based cognitive behavioral therapy. The sessions covered different topics related to coping with noncardiac chest pain (education about the heart, physical activity, interpretations/attention, physical reactions to stress, optional panic treatment, and maintaining change). Between sessions, the participants also engaged in individually tailored physical exercises with increasing intensity. In addition to internet-based cognitive behavioral therapy sessions, participants received a brief weekly call from a clinician to provide support, encourage adherence, and provide access to the next session. Participants in the treatment-as-usual group received standard care for their noncardiac chest pain without any restrictions. Primary outcomes were cardiac anxiety, measured with the Cardiac Anxiety Questionnaire, and fear of bodily sensations, measured with the Body Sensations Questionnaire. Secondary outcomes were depression, measured using the Patient Health Questionnaire; health-related quality of life, measured using the EuroQol visual analog scale; and level of physical activity, assessed with self-report question. Additionally, a subgroup analysis of participants with depressive symptoms at baseline (PHQ-9 score ?5) was conducted. Assessments were conducted at baseline, posttreatment, and at 3- and 12-month follow-ups. Linear mixed models were used to evaluate treatment effects. Cohen d was used to calculate effect sizes. Results: In the main intention-to-treat analysis at the 12-month follow-up time point, participants in the internet-based cognitive behavioral therapy group had significant improvements in cardiac anxiety (--3.4 points, 95\% CI --5.7 to --1.1; P=.004, d=0.38) and a nonsignificant improvement in fear of bodily sensations (--2.7 points, 95\% CI --5.6 to 0.3; P=.07) compared with the treatment-as-usual group. Health-related quality of life at the 12-month follow-up improved with statistical and clinical significance in the internet-based cognitive behavioral therapy group (8.8 points, 95\% CI 2.8 to 14.8; P=.004, d=0.48) compared with the treatment-as-usual group. Physical activity had significantly (P<.001) increased during the 6-week intervention period for the internet-based cognitive behavioral therapy group. Depression significantly improved posttreatment (P=.003) and at the 3-month follow-up (P=.03), but not at the 12-month follow-up (P=.35). Participants with depressive symptoms at baseline seemed to have increased effect of the intervention on cardiac anxiety (d=0.55) and health-related quality of life (d=0.71) at the 12-month follow-up. In the internet-based cognitive behavioral therapy group, 84\% of the participants (68/81) completed at least 5 of the 6 sessions. Conclusions: This study provides evidence that internet-based cognitive behavioral therapy with minimal therapist contact and a focus on physical activity is effective in reducing cardiac anxiety and increasing health related quality of life in patients with noncardiac chest pain. Trial Registration: ClinicalTrials.gov NCT03096925; http://clinicaltrials.gov/ct2/show/NCT03096925 ",
doi="10.2196/33631",
url="https://www.jmir.org/2022/1/e33631",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072641"
}


@Article{info:doi/10.2196/33188,
author="Eze, E. Chinwe
and West, T. Brady
and Dorsch, P. Michael
and Coe, B. Antoinette
and Lester, A. Corey
and Buis, R. Lorraine
and Farris, Karen",
title="Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="24",
volume="24",
number="1",
pages="e33188",
keywords="hypertension",
keywords="mHealth",
keywords="remote monitoring",
keywords="telemonitoring",
keywords="smartphones",
keywords="tablets",
keywords="text messaging",
keywords="Health Information National Trends Survey",
keywords="mobile health",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered ``Yes'' to the question ``Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?'', which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9\%, SE 0.9\% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor's office through email or internet (odds ratio 2.93, 95\% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95\% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient's technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. ",
doi="10.2196/33188",
url="https://www.jmir.org/2022/1/e33188",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072647"
}


@Article{info:doi/10.2196/33518,
author="Willis, C. Van
and Thomas Craig, Jean Kelly
and Jabbarpour, Yalda
and Scheufele, L. Elisabeth
and Arriaga, E. Yull
and Ajinkya, Monica
and Rhee, B. Kyu
and Bazemore, Andrew",
title="Digital Health Interventions to Enhance Prevention in Primary Care: Scoping Review",
journal="JMIR Med Inform",
year="2022",
month="Jan",
day="21",
volume="10",
number="1",
pages="e33518",
keywords="digital technology",
keywords="primary health care",
keywords="preventive medicine",
keywords="telemedicine",
keywords="clinical decision support systems",
abstract="Background: Disease prevention is a central aspect of primary care practice and is comprised of primary (eg, vaccinations), secondary (eg, screenings), tertiary (eg, chronic condition monitoring), and quaternary (eg, prevention of overmedicalization) levels. Despite rapid digital transformation of primary care practices, digital health interventions (DHIs) in preventive care have yet to be systematically evaluated. Objective: This review aimed to identify and describe the scope and use of current DHIs for preventive care in primary care settings. Methods: A scoping review to identify literature published from 2014 to 2020 was conducted across multiple databases using keywords and Medical Subject Headings terms covering primary care professionals, prevention and care management, and digital health. A subgroup analysis identified relevant studies conducted in US primary care settings, excluding DHIs that use the electronic health record (EHR) as a retrospective data capture tool. Technology descriptions, outcomes (eg, health care performance and implementation science), and study quality as per Oxford levels of evidence were abstracted. Results: The search yielded 5274 citations, of which 1060 full-text articles were identified. Following a subgroup analysis, 241 articles met the inclusion criteria. Studies primarily examined DHIs among health information technologies, including EHRs (166/241, 68.9\%), clinical decision support (88/241, 36.5\%), telehealth (88/241, 36.5\%), and multiple technologies (154/241, 63.9\%). DHIs were predominantly used for tertiary prevention (131/241, 54.4\%). Of the core primary care functions, comprehensiveness was addressed most frequently (213/241, 88.4\%). DHI users were providers (205/241, 85.1\%), patients (111/241, 46.1\%), or multiple types (89/241, 36.9\%). Reported outcomes were primarily clinical (179/241, 70.1\%), and statistically significant improvements were common (192/241, 79.7\%). Results were summarized across the following 5 topics for the most novel/distinct DHIs: population-centered, patient-centered, care access expansion, panel-centered (dashboarding), and application-driven DHIs. The quality of the included studies was moderate to low. Conclusions: Preventive DHIs in primary care settings demonstrated meaningful improvements in both clinical and nonclinical outcomes, and across user types; however, adoption and implementation in the US were limited primarily to EHR platforms, and users were mainly clinicians receiving alerts regarding care management for their patients. Evaluations of negative results, effects on health disparities, and many other gaps remain to be explored. ",
doi="10.2196/33518",
url="https://medinform.jmir.org/2022/1/e33518",
url="http://www.ncbi.nlm.nih.gov/pubmed/35060909"
}


@Article{info:doi/10.2196/29635,
author="Turner, Kea
and Bobonis Babilonia, Margarita
and Naso, Cristina
and Nguyen, Oliver
and Gonzalez, D. Brian
and Oswald, B. Laura
and Robinson, Edmondo
and Elston Lafata, Jennifer
and Ferguson, J. Robert
and Alishahi Tabriz, Amir
and Patel, B. Krupal
and Hallanger-Johnson, Julie
and Aldawoodi, Nasrin
and Hong, Young-Rock
and Jim, L. Heather S.
and Spiess, E. Philippe",
title="Health Care Providers' and Professionals' Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="19",
volume="24",
number="1",
pages="e29635",
keywords="telehealth",
keywords="telemedicine",
keywords="teleoncology",
keywords="digital health",
keywords="remote monitoring",
keywords="cancer",
keywords="oncology",
keywords="coronavirus disease",
keywords="COVID-19",
abstract="Background: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective: The aim of this qualitative study was to explore oncology HPPs' experiences with telehealth implementation during the COVID-19 pandemic. Methods: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results: Approximately half of the 40 participants were physicians (n=22, 55\%), and one-quarter of the participants were advanced practice providers (n=10, 25\%). Other participants included social workers (n=3, 8\%), psychologists (n=2, 5\%), dieticians (n=2, 5\%), and a pharmacist (n=1, 3\%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity. ",
doi="10.2196/29635",
url="https://www.jmir.org/2022/1/e29635",
url="http://www.ncbi.nlm.nih.gov/pubmed/34907900"
}


@Article{info:doi/10.2196/17568,
author="Dannapfel, Petra
and Thomas, Kristin
and Chakhunashvili, Alexander
and Melin, Jeanette
and Trolle Lagerros, Ylva",
title="A Self-help Tool to Facilitate Implementation of eHealth Initiatives in Health Care (E-Ready): Formative Evaluation",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="17",
volume="6",
number="1",
pages="e17568",
keywords="implementation science",
keywords="health care sector",
keywords="telemedicine",
keywords="organizational readiness for change",
abstract="Background: eHealth interventions have the potential to increase the efficiency and effectiveness of health care. However, research has shown that implementing eHealth in routine health care practice is difficult. Organizational readiness to change has been shown to be central to successful implementation. This paper describes the development and formative evaluation of a generic self-help tool, E-Ready, designed to be used by managers, project leaders, or others responsible for implementation in a broad range of health care settings. Objective: The aim of this study is to develop and evaluate a tool that could facilitate eHealth implementation in, for example, health care. Methods: A first version of the tool was generated based on implementation theory (E-Ready 1.0). A formative evaluation was undertaken through expert panels (n=15), cognitive interviews (n=17), and assessment of measurement properties on E-Ready items from 3 different workplaces (n=165) using Rasch analyses. E-Ready 1.0 was also field tested among the target population (n=29). Iterative revisions were conducted during the formative evaluation process, and E-Ready 2.0 was generated. Results: The E-Ready Tool consists of a readiness assessment survey and a hands-on manual. The survey measures perceived readiness for change (willingness and capability) at individual and collective levels: perceived conditions for change at the workplace, perceived individual conditions for change, perceived support and engagement among management, perceived readiness among colleagues, perceived consequences on status quo, and perceived workplace attitudes. The manual contains a brief introduction, instructions on how to use the tool, information on the themes of E-Ready, instructions on how to create an implementation plan, brief advice for success, and tips for further reading on implementation theory. Rasch analyses showed overall acceptable measurement properties in terms of fit validity. The subscale Individual conditions for change (3 items) had the lowest person reliability (0.56), whereas Perceived consequences on status quo (5 items) had the highest person reliability (0.87). Conclusions: E-Ready 2.0 is a new self-help tool to guide implementation targeting health care provider readiness and engagement readiness ahead of eHealth initiatives in, for example, health care settings. E-Ready can be improved further to capture additional aspects of implementation; improvements can also be made by evaluating the tool in a larger sample. ",
doi="10.2196/17568",
url="https://formative.jmir.org/2022/1/e17568",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037884"
}


@Article{info:doi/10.2196/27272,
author="Chen, Nuoya
and Liu, Pengqi",
title="Assessing Elderly User Preference for Telehealth Solutions in China: Exploratory Quantitative Study",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="12",
volume="10",
number="1",
pages="e27272",
keywords="telehealth solutions",
keywords="preference",
keywords="motivation",
keywords="elderly user",
keywords="China",
abstract="Background: In the next 15 to 20 years, the Chinese population will reach a plateau and start to decline. With the changing family structure and rushed urbanization policies, there will be greater demand for high-quality medical resources at urban centers and home-based elderly care driven by telehealth solutions. This paper describes an exploratory study regarding elderly users' preference for telehealth solutions in the next 5 to 10 years in 4 cities, Shenzhen, Hangzhou, Wuhan, and Yichang. Objective: The goal is to analyze why users choose telehealth solutions over traditional health solutions based on a questionnaire study involving 4 age groups (50-60, 61-70, 71-80, and 80+) in 4 cities (Shenzhen, Hangzhou, Wuhan, and Yichang) in the next 10 to 20 years. The legal retirement age for female workers in China is 50 to 55 years and 60 years for male workers. To simulate reality in terms of elderly care in China, the authors use the Chinese definition of elderly for employees, defined as being 50 to 60 years old rather than 65 years, as defined by the World Health Organization. Methods: The questionnaires were collected from Shenzhen, Hangzhou, Wuhan, and Yichang randomly with 390 valid data samples. The questionnaire consists of 31 questions distributed offline on tablet devices by local investigators. Subsequently, Stata 16.0 and SPSS 24.0 were used to analyze the data. O-logit ordered regression and principal component analysis (PCA) were the main theoretical models used. The study is currently in the exploratory stage and therefore does not seek generalization of the results. Results: Approximately 71.09\% (280/390) of the respondents reported having at least 1 type of chronic disease. We started with PCA and categorized all Likert scale variables into 3 factors. The influence of demographic variables on Factors 1, 2, and 3 was verified using analysis of variance (ANOVA) and t tests. The ordered logit regression results suggest that health-related motivations are positively related to the willingness to use telehealth solutions, and trust on data collected from telehealth solutions is negatively correlated with the willingness to use telehealth solutions. Conclusions: The findings suggest that there is a need to address the gap in community health care and ensure health care continuity between different levels of health care institutions in China by providing telehealth solutions. Meanwhile, telehealth solution providers must focus on improving users' health awareness and lower health risk for chronic diseases by addressing lifestyle changes such as regular exercise and social activity. The interoperability between the electronic health record system and telehealth solutions remains a hurdle for telehealth solutions to add value in health care. The hurdle is that doctors neither adjust health care plans nor diagnose based on data collected by telehealth solutions. ",
doi="10.2196/27272",
url="https://mhealth.jmir.org/2022/1/e27272",
url="http://www.ncbi.nlm.nih.gov/pubmed/35019852"
}


@Article{info:doi/10.2196/17273,
author="Huang, Ming
and Fan, Jungwei
and Prigge, Julie
and Shah, D. Nilay
and Costello, A. Brian
and Yao, Lixia",
title="Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e17273",
keywords="patient portal",
keywords="secure message",
keywords="patient-clinician communication",
keywords="workload",
keywords="response time",
keywords="message round",
abstract="Background: Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care. Objective: The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester. Methods: We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity. Results: During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely ``physician---primary care,'' ``registered nurse---specialty,'' and ``physician---specialty,'' bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The ``nurse practitioner or physician assistant---primary care'' and ``physician---primary care'' categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0\% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4\% (22,121/408,526) of their daily messages. The clinicians replied to 72.2\% (1,272,069/1,761,739) patient messages within 1 day and 90.6\% (1,595,702/1,761,739) within 3 days. In 95.1\% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds. Conclusions: Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients' needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency. ",
doi="10.2196/17273",
url="https://www.jmir.org/2022/1/e17273",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014964"
}


@Article{info:doi/10.2196/33873,
author="Andrade, Q. Andre
and Calabretto, Jean-Pierre
and Pratt, L. Nicole
and Kalisch-Ellett, M. Lisa
and Kassie, M. Gizat
and LeBlanc, T. Vanessa
and Ramsay, Emmae
and Roughead, E. Elizabeth",
title="Implementation and Evaluation of a Digitally Enabled Precision Public Health Intervention to Reduce Inappropriate Gabapentinoid Prescription: Cluster Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="10",
volume="24",
number="1",
pages="e33873",
keywords="audit and feedback",
keywords="digital health",
keywords="precision public health",
keywords="digital intervention",
keywords="primary care",
keywords="physician",
keywords="health professional",
keywords="health education",
abstract="Background: Digital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale. Objective: The aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior. Methods: This study was developed as part of the Veterans' Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans' Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention. Results: The trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2\%, P=.004; postal: mean reduction of 11.2\%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: --0.058, postal: --0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8\%, postal: 2.0\%, P=.02). Conclusions: Our digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions. ",
doi="10.2196/33873",
url="https://www.jmir.org/2022/1/e33873",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006086"
}


@Article{info:doi/10.2196/33399,
author="Tseng, Henry Chinyang
and Chen, Ray-Jade
and Tsai, Shang-Yu
and Wu, Tsung-Ren
and Tsaur, Woei-Jiunn
and Chiu, Hung-Wen
and Yang, Cheng-Yi
and Lo, Yu-Sheng",
title="Exploring the COVID-19 Pandemic as a Catalyst for Behavior Change Among Patient Health Record App Users in Taiwan: Development and Usability Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="6",
volume="24",
number="1",
pages="e33399",
keywords="personal health records",
keywords="COVID-19",
keywords="My Health Bank",
keywords="blockchain",
keywords="public health",
abstract="Background: During the COVID-19 pandemic, personal health records (PHRs) have enabled patients to monitor and manage their medical data without visiting hospitals and, consequently, minimize their infection risk. Taiwan's National Health Insurance Administration (NHIA) launched the My Health Bank (MHB) service, a national PHR system through which insured individuals to access their cross-hospital medical data. Furthermore, in 2019, the NHIA released the MHB software development kit (SDK), which enables development of mobile apps with which insured individuals can retrieve their MHB data. However, the NHIA MHB service has its limitations, and the participation rate among insured individuals is low. Objective: We aimed to integrate the MHB SDK with our developed blockchain-enabled PHR mobile app, which enables patients to access, store, and manage their cross-hospital PHR data. We also collected and analyzed the app's log data to examine patients' MHB use during the COVID-19 pandemic. Methods: We integrated our existing blockchain-enabled mobile app with the MHB SDK to enable NHIA MHB data retrieval. The app utilizes blockchain technology to encrypt the downloaded NHIA MHB data. Existing and new indexes can be synchronized between the app and blockchain nodes, and high security can be achieved for PHR management. Finally, we analyzed the app's access logs to compare patients' activities during high and low COVID-19 infection periods. Results: We successfully integrated the MHB SDK into our mobile app, thereby enabling patients to retrieve their cross-hospital medical data, particularly those related to COVID-19 rapid and polymerase chain reaction testing and vaccination information and progress. We retrospectively collected the app's log data for the period of July 2019 to June 2021. From January 2020, the preliminary results revealed a steady increase in the number of people who applied to create a blockchain account for access to their medical data and the number of app subscribers among patients who visited the outpatient department (OPD) and emergency department (ED). Notably, for patients who visited the OPD and ED, the peak proportions with respect to the use of the app for OPD and ED notes and laboratory test results also increased year by year. The highest proportions were 52.40\% for ED notes in June 2021, 88.10\% for ED laboratory test reports in May 2021, 34.61\% for OPD notes in June 2021, and 41.87\% for OPD laboratory test reports in June 2021. These peaks coincided with Taiwan's local COVID-19 outbreak lasting from May to June 2021. Conclusions: This study developed a blockchain-enabled mobile app, which can periodically retrieve and integrate PHRs from the NHIA MHB's cross-hospital data and the investigated hospital's self-pay medical data. Analysis of users' access logs revealed that the COVID-19 pandemic substantially increased individuals' use of PHRs and their health awareness with respect to COVID-19 prevention. ",
doi="10.2196/33399",
url="https://www.jmir.org/2022/1/e33399",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951863"
}


@Article{info:doi/10.2196/34567,
author="Santonen, Teemu
and Petsani, Despoina
and Julin, Mikko
and Garschall, Markus
and Kropf, Johannes
and Van der Auwera, Vicky
and Bernaerts, Sylvie
and Losada, Raquel
and Almeida, Rosa
and Garatea, Jokin
and Mu{\~n}oz, Idoia
and Nagy, Eniko
and Kehayia, Eva
and de Guise, Elaine
and Nadeau, Sylvie
and Azevedo, Nancy
and Segkouli, Sofia
and Lazarou, Ioulietta
and Petronikolou, Vasileia
and Bamidis, Panagiotis
and Konstantinidis, Evdokimos",
title="Cocreating a Harmonized Living Lab for Big Data--Driven Hybrid Persona Development: Protocol for Cocreating, Testing, and Seeking Consensus",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="6",
volume="11",
number="1",
pages="e34567",
keywords="Living Lab",
keywords="everyday living",
keywords="technology",
keywords="big data",
keywords="harmonization",
keywords="personas",
keywords="small-scale real-life testing",
keywords="mobile phone",
abstract="Background: Living Labs are user-centered, open innovation ecosystems based on a systematic user cocreation approach, which integrates research and innovation processes in real-life communities and settings. The Horizon 2020 Project VITALISE (Virtual Health and Wellbeing Living Lab Infrastructure) unites 19 partners across 11 countries. The project aims to harmonize Living Lab procedures and enable effective and convenient transnational and virtual access to key European health and well-being research infrastructures, which are governed by Living Labs. The VITALISE consortium will conduct joint research activities in the fields included in the care pathway of patients: rehabilitation, transitional care, and everyday living environments for older adults. This protocol focuses on health and well-being research in everyday living environments. Objective: The main aim of this study is to cocreate and test a harmonized research protocol for developing big data--driven hybrid persona, which are hypothetical user archetypes created to represent a user community. In addition, the use and applicability of innovative technologies will be investigated in the context of various everyday living and Living Lab environments. Methods: In phase 1, surveys and structured interviews will be used to identify the most suitable Living Lab methods, tools, and instruments for health-related research among VITALISE project Living Labs (N=10). A series of web-based cocreation workshops and iterative cowriting processes will be applied to define the initial protocols. In phase 2, five small-scale case studies will be conducted to test the cocreated research protocols in various real-life everyday living settings and Living Lab infrastructures. In phase 3, a cross-case analysis grounded on semistructured interviews will be conducted to identify the challenges and benefits of using the proposed research protocols. Furthermore, a series of cocreation workshops and the consensus seeking Delphi study process will be conducted in parallel to cocreate and validate the acceptance of the defined harmonized research protocols among wider Living Lab communities. Results: As of September 30, 2021, project deliverables Ethics and safety manual and Living lab standard version 1 have been submitted to the European Commission review process. The study will be finished by March 2024. Conclusions: The outcome of this research will lead to harmonized procedures and protocols in the context of big data--driven hybrid persona development among health and well-being Living Labs in Europe and beyond. Harmonized protocols enable Living Labs to exploit similar research protocols, devices, hardware, and software for interventions and complex data collection purposes. Economies of scale and improved use of resources will speed up and improve research quality and offer novel possibilities for open data sharing, multidisciplinary research, and comparative studies beyond current practices. Case studies will also provide novel insights for implementing innovative technologies in the context of everyday Living Lab research. International Registered Report Identifier (IRRID): DERR1-10.2196/34567 ",
doi="10.2196/34567",
url="https://www.researchprotocols.org/2022/1/e34567",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989697"
}


@Article{info:doi/10.2196/26684,
author="Gupta, Aarushi
and Cafazzo, A. Joseph
and IJzerman, J. Maarten
and Swart, F. Joost
and Vastert, Sebastiaan
and Wulffraat, M. Nico
and Benseler, Susanne
and Marshall, Deborah
and Yeung, Rae
and Twilt, Marinka",
title="Genomic Health Literacy Interventions in Pediatrics: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="24",
volume="23",
number="12",
pages="e26684",
keywords="pediatrics",
keywords="patient education",
keywords="genetics",
keywords="genomics",
keywords="mHealth",
keywords="digital health",
keywords="internet",
keywords="genetic knowledge",
keywords="genomic health literacy",
keywords="children",
keywords="adolescents",
abstract="Background: The emergence of genetic and genomic sequencing approaches for pediatric patients has raised questions about the genomic health literacy levels, attitudes toward receiving genomic information, and use of this information to inform treatment decisions by pediatric patients and their parents. However, the methods to educate pediatric patients and their parents about genomic concepts through digital health interventions have not been well-established. Objective: The primary objective of this scoping review is to investigate the current levels of genomic health literacy and the attitudes toward receiving genomic information among pediatric patients and their parents. The secondary aim is to investigate patient education interventions that aim to measure and increase genomic health literacy among pediatric patients and their parents. The findings from this review will be used to inform future digital health interventions for patient education. Methods: A scoping review using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and protocols was completed using the following databases: MEDLINE, Embase, CINAHL, and Scopus. Our search strategy included genomic information inclusive of all genetic and genomic terms, pediatrics, and patient education. Inclusion criteria included the following: the study included genetic, genomic, or a combination of genetic and genomic information; the study population was pediatric (children and adolescents <18 years) and parents of patients with pediatric illnesses or only parents of patients with pediatric illnesses; the study included an assessment of the knowledge, attitudes, and intervention regarding genomic information; the study was conducted in the last 12 years between 2008 and 2020; and the study was in the English language. Descriptive data regarding study design, methodology, disease population, and key findings were extracted. All the findings were collated, categorized, and reported thematically. Results: Of the 4618 studies, 14 studies (n=6, 43\% qualitative, n=6, 43\% mixed methods, and n=2, 14\% quantitative) were included. Key findings were based on the following 6 themes: knowledge of genomic concepts, use of the internet and social media for genomic information, use of genomic information for decision-making, hopes and attitudes toward receiving genomic information, experiences with genetic counseling, and interventions to improve genomic knowledge. Conclusions: This review identified that older age is related to the capacity of understanding genomic concepts, increased genomic health literacy levels, and the perceived ability to participate in decision-making related to genomic information. In addition, internet-searching plays a major role in obtaining genomic information and filling gaps in communication with health care providers. However, little is known about the capacity of pediatric patients and their parents to understand genomic information and make informed decisions based on the genomic information obtained. More research is required to inform digital health interventions and to leverage the leading best practices to educate these genomic concepts. ",
doi="10.2196/26684",
url="https://www.jmir.org/2021/12/e26684",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951592"
}


@Article{info:doi/10.2196/27033,
author="Shorey, Shefaly
and Tan, Chye Thiam
and 
and Mathews, Jancy
and Yu, Yan Chun
and Lim, Hoon Siew
and Shi, Luming
and Ng, Debby Esperanza
and Chan, Huak Yiong
and Law, Evelyn
and Chee, Cornelia
and Chong, Seng Yap",
title="Development of a Supportive Parenting App to Improve Parent and Infant Outcomes in the Perinatal Period: Development Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="24",
volume="23",
number="12",
pages="e27033",
keywords="depression",
keywords="development",
keywords="education",
keywords="parent",
keywords="perinatal",
keywords="support",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: The transition to parenthood can be challenging, and parents are vulnerable to psychological disorders during the perinatal period. This may have adverse long-term consequences on a child's development. Given the rise in technology and parents' preferences for mobile health apps, a supportive mobile health intervention is optimal. However, there is a lack of a theoretical framework and technology-based perinatal educational intervention for couples with healthy infants. Objective: The aim of this study is to describe the Supportive Parenting App (SPA) development procedure and highlight the challenges and lessons learned. Methods: The SPA development procedure was guided by the information systems research framework, which emphasizes a nonlinear, iterative, and user-centered process involving 3 research cycles---the relevance cycle, design cycle, and rigor cycle. Treatment fidelity was ensured, and team cohesiveness was maintained using strategies from the Tuckman model of team development. Results: In the relevance cycle, end-user requirements were identified through focus groups and interviews. In the rigor cycle, the user engagement pyramid and well-established theories (social cognitive theory proposed by Bandura and attachment theory proposed by Bowlby) were used to inform and justify the features of the artifact. In the design cycle, the admin portal was developed using Microsoft Visual Studio 2017, whereas the SPA, which ran on both iOS and Android, was developed using hybrid development tools. The SPA featured knowledge-based content, informational videos and audio clips, a discussion forum, chat groups, and a frequently asked questions and expert advice section. The intervention underwent iterative testing by a small group of new parents and research team members. Qualitative feedback was obtained for further app enhancements before official implementation. Testing revealed user and technological issues, such as web browser and app incompatibility, a lack of notifications for both administrators and users, and limited search engine capability. Conclusions: The information systems research framework documented the technical details of the SPA but did not take into consideration the interpersonal and real-life challenges. Ineffective communication between the health care research team and the app developers, limited resources, and the COVID-19 pandemic were the main challenges faced during content development. Quick adaptability, team cohesion, and hindsight budgeting are crucial for intervention development. Although the effectiveness of the SPA in improving parental and infant outcomes is currently unknown, this detailed intervention development study highlights the key aspects that need to be considered for future app development. ",
doi="10.2196/27033",
url="https://www.jmir.org/2021/12/e27033",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260376"
}


@Article{info:doi/10.2196/28958,
author="Jaafa, Kasiiti Noah
and Mokaya, Benard
and Savai, Muhindi Simon
and Yeung, Ada
and Siika, Mosigisi Abraham
and Were, Martin",
title="Implementation of Fingerprint Technology for Unique Patient Matching and Identification at an HIV Care and Treatment Facility in Western Kenya: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="22",
volume="23",
number="12",
pages="e28958",
keywords="biometrics",
keywords="patient matching",
keywords="fingerprints",
keywords="unique patient identification",
keywords="electronic medical record systems",
keywords="low- and middle-income countries (LMICs)",
abstract="Background: Unique patient identification remains a challenge in many health care settings in low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on demographic-based approaches that have proven suboptimal. Affordable biometrics-based approaches, implemented with consideration of contextual ethical, legal, and social implications, have the potential to address this challenge and improve patient safety and reporting accuracy. However, limited studies exist to evaluate the actual performance of biometric approaches and perceptions of these systems in LMICs. Objective: The aim of this study is to evaluate the performance and acceptability of fingerprint technology for unique patient matching and identification in the LMIC setting of Kenya. Methods: In this cross-sectional study conducted at an HIV care and treatment facility in Western Kenya, an open source fingerprint application was integrated within an implementation of the Open Medical Record System, an open source electronic medical record system (EMRS) that is nationally endorsed and deployed for HIV care in Kenya and in more than 40 other countries; hence, it has potential to translate the findings across multiple countries. Participants aged >18 years were conveniently sampled and enrolled into the study. Participants' left thumbprints were captured and later used to retrieve and match records. The technology's performance was evaluated using standard measures: sensitivity, false acceptance rate, false rejection rate, and failure to enroll rate. The Wald test was used to compare the accuracy of the technology with the probabilistic patient-matching technique of the EMRS. Time to retrieval and matching of records were compared using the independent samples 2-tailed t test. A survey was administered to evaluate patient acceptance and satisfaction with use of the technology. Results: In all, 300 participants were enrolled; their mean age was 36.3 (SD 12.2) years, and 58\% (174/300) were women. The relevant values for the technology's performance were sensitivity 89.3\%, false acceptance rate 0\%, false rejection rate 11\%, and failure to enroll rate 2.3\%. The technology's mean record retrieval speed was 3.2 (SD 1.1) seconds versus 9.5 (SD 1.9) seconds with demographic-based record retrieval in the EMRS (P<.001). The survey results revealed that 96.3\% (289/300) of the participants were comfortable with the technology and 90.3\% (271/300) were willing to use it. Participants who had previously used fingerprint biometric systems for identification were estimated to have more than thrice increased odds of accepting the technology (odds ratio 3.57, 95\% CI 1.0-11.92). Conclusions: Fingerprint technology performed very well in identifying adult patients in an LMIC setting. Patients reported a high level of satisfaction and acceptance. Serious considerations need to be given to the use of fingerprint technology for patient identification in LMICs, but this has to be done with strong consideration of ethical, legal, and social implications as well as security issues. ",
doi="10.2196/28958",
url="https://www.jmir.org/2021/12/e28958",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941557"
}


@Article{info:doi/10.2196/31737,
author="Curtis, G. Rachel
and Bartel, Bethany
and Ferguson, Ty
and Blake, T. Henry
and Northcott, Celine
and Virgara, Rosa
and Maher, A. Carol",
title="Improving User Experience of Virtual Health Assistants: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="21",
volume="23",
number="12",
pages="e31737",
keywords="virtual assistant",
keywords="conversational agent",
keywords="chatbot",
keywords="eHealth",
keywords="digital health",
keywords="design",
keywords="user experience",
keywords="mobile phone",
abstract="Background: Virtual assistants can be used to deliver innovative health programs that provide appealing, personalized, and convenient health advice and support at scale and low cost. Design characteristics that influence the look and feel of the virtual assistant, such as visual appearance or language features, may significantly influence users' experience and engagement with the assistant. Objective: This scoping review aims to provide an overview of the experimental research examining how design characteristics of virtual health assistants affect user experience, summarize research findings of experimental research examining how design characteristics of virtual health assistants affect user experience, and provide recommendations for the design of virtual health assistants if sufficient evidence exists. Methods: We searched 5 electronic databases (Web of Science, MEDLINE, Embase, PsycINFO, and ACM Digital Library) to identify the studies that used an experimental design to compare the effects of design characteristics between 2 or more versions of an interactive virtual health assistant on user experience among adults. Data were synthesized descriptively. Health domains, design characteristics, and outcomes were categorized, and descriptive statistics were used to summarize the body of research. Results for each study were categorized as positive, negative, or no effect, and a matrix of the design characteristics and outcome categories was constructed to summarize the findings. Results: The database searches identified 6879 articles after the removal of duplicates. We included 48 articles representing 45 unique studies in the review. The most common health domains were mental health and physical activity. Studies most commonly examined design characteristics in the categories of visual design or conversational style and relational behavior and assessed outcomes in the categories of personality, satisfaction, relationship, or use intention. Over half of the design characteristics were examined by only 1 study. Results suggest that empathy and relational behavior and self-disclosure are related to more positive user experience. Results also suggest that if a human-like avatar is used, realistic rendering and medical attire may potentially be related to more positive user experience; however, more research is needed to confirm this. Conclusions: There is a growing body of scientific evidence examining the impact of virtual health assistants' design characteristics on user experience. Taken together, data suggest that the look and feel of a virtual health assistant does affect user experience. Virtual health assistants that show empathy, display nonverbal relational behaviors, and disclose personal information about themselves achieve better user experience. At present, the evidence base is broad, and the studies are typically small in scale and highly heterogeneous. Further research, particularly using longitudinal research designs with repeated user interactions, is needed to inform the optimal design of virtual health assistants. ",
doi="10.2196/31737",
url="https://www.jmir.org/2021/12/e31737",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931997"
}


@Article{info:doi/10.2196/31130,
author="Choemprayong, Songphan
and Charoenlap, Chris
and Piromsopa, Krerk",
title="Exploring Usability Issues of a Smartphone-Based Physician-to-Physician Teleconsultation App in an Orthopedic Clinic: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Dec",
day="20",
volume="8",
number="4",
pages="e31130",
keywords="teleconsultation",
keywords="remote consultation",
keywords="mobile applications",
keywords="usability",
keywords="orthopedics",
keywords="physician-to-physician consultation",
keywords="electronic medical records",
keywords="mobile phone",
abstract="Background: Physician-to-physician teleconsultation has increasingly played an essential role in delivering optimum health care services, particularly in orthopedic practice. In this study, the usability of a smartphone app for teleconsultation among orthopedic specialists was investigated to explore issues informing further recommendations for improvement in the following iterations. Objective: This study aimed to explore usability issues emerging from users' interactions with MEDIC app, a smartphone-based patient-centered physician-to-physician teleconsultation system. Methods: Five attending physicians in the Department of Orthopedics in a large medical school in Bangkok, Thailand, were recruited and asked to perform 5 evaluation tasks, namely, group formation, patient registration, clinical data capturing, case record form creation, and teleconsultation. In addition, one expert user was recruited as the control participant. Think aloud was adopted while performing the tasks. Semistructured interviews were conducted after each task and prior to the exit. Quantitative and qualitative measures were used to identify usability issues in 7 domains based on the People At the Centre of Mobile Application Development model: effectiveness, efficiency, satisfaction, learnability, memorability, error, and cognitive load. Results: Several measures indicate various aspects of usability of the app, including completion rates, time to completion, number of clicks, number of screens, errors, incidents where participants were unable to perform tasks, which had previously been completed, and perceived task difficulty. Major and critical usability issues based on participant feedback were rooted from the limitation of screen size and resolution. Errors in data input (eg, typing errors, miscalculation), action failures, and misinterpretation of data (ie, radiography) were the most critical and common issues found in this study. A few participants did not complete the assigned tasks mostly owing to the navigation design and misreading/misunderstanding icons. However, the novice users were quite positive that they would be able to become familiar with the app in a short period of time. Conclusions: The usability issues in physician-to-physician teleconsultation systems in smartphones, in general, are derived from the limitations of smartphones and their operating systems. Although some recommendations were devised to handle these usability issues, usability evaluation for additional development should still be further investigated. ",
doi="10.2196/31130",
url="https://humanfactors.jmir.org/2021/4/e31130",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931991"
}


@Article{info:doi/10.2196/31232,
author="Pronk, Yvette
and Pilot, Peter
and van der Weegen, Walter
and Brinkman, Justus-Martijn
and Schreurs, Willem Berend",
title="A Patient-Reported Outcome Tool to Triage Total Hip Arthroplasty Patients to Hospital or Video Consultation: Pilot Study With Expert Panels and a Cohort of 1228 Patients",
journal="JMIR Form Res",
year="2021",
month="Dec",
day="20",
volume="5",
number="12",
pages="e31232",
keywords="PROMs",
keywords="total hip arthroplasty",
keywords="triage tool",
keywords="video consultation",
keywords="telemedicine",
keywords="digital transformation",
abstract="Background: The digital transformation in health care has been accelerated by the COVID-19 pandemic. Video consultation has become the alternative for hospital consultation. It remains unknown how to select patients suitable for video consultation. Objective: This study aimed to develop a tool based on patient-reported outcomes (PROs) to triage total hip arthroplasty (THA) patients to hospital or video consultation. Methods: A pilot study with expert panels and a retrospective cohort with prospectively collected data from 1228 THA patients was executed. The primary outcome was a PRO triage tool to allocate THA patients to hospital or video consultation 6 weeks postoperatively. Expert panels defined the criteria and selected the patient-reported outcome measure (PROM) questions including thresholds. Data were divided into training and test cohorts. Distribution, floor effect, correlation, responsiveness, PRO patient journey, and homogeneity of the selected questions were investigated in the training cohort. The test cohort was used to provide an unbiased evaluation of the final triage tool. Results: The expert panels selected moderate or severe pain and using 2 crutches as the triage tool criteria. PROM questions included in the final triage tool were numeric rating scale (NRS) pain during activity, 3-level version of the EuroQol 5 dimensions (EQ-5D-3L) questions 1 and 4, and Oxford Hip Score (OHS) questions 6, 8, and 12. Of the training cohort, 201 (201/703, 28.6\%) patients needed a hospital consultation, which was statistically equal to the 150 (150/463, 32.4\%) patients in the test cohort who needed a hospital consultation (P=.19). Conclusions: A PRO triage tool based on moderate or severe pain and using 2 crutches was developed. Around 70\% of THA patients could safely have a video consultation, and 30\% needed a hospital consultation 6 weeks postoperatively. This tool is promising for selecting patients for video consultation while using an existing PROM infrastructure. ",
doi="10.2196/31232",
url="https://formative.jmir.org/2021/12/e31232",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931989"
}


@Article{info:doi/10.2196/22672,
author="Doyle, Julie
and Murphy, Emma
and Gavin, Shane
and Pascale, Alessandra
and Deparis, St{\'e}phane
and Tommasi, Pierpaolo
and Smith, Suzanne
and Hannigan, Caoimhe
and Sillevis Smitt, Myriam
and van Leeuwen, Cora
and Lastra, Julia
and Galvin, Mary
and McAleer, Patricia
and Tompkins, Lorraine
and Jacobs, An
and M Marques, Marta
and Medina Maestro, Jaime
and Boyle, Gordon
and Dinsmore, John",
title="A Digital Platform to Support Self-management of Multiple Chronic Conditions (ProACT): Findings in Relation to Engagement During a One-Year Proof-of-Concept Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="15",
volume="23",
number="12",
pages="e22672",
keywords="digital health",
keywords="aging",
keywords="multimorbidity",
keywords="chronic disease",
keywords="self-management",
keywords="integrated care",
keywords="longitudinal study",
keywords="engagement",
keywords="usability",
keywords="mobile phone",
abstract="Background: Populations globally are ageing, resulting in higher incidence rates of chronic diseases. Digital health platforms, designed to support those with chronic conditions to self-manage at home, offer a promising solution to help people monitor their conditions and lifestyle, maintain good health, and reduce unscheduled clinical visits. However, despite high prevalence rates of multimorbidity or multiple chronic conditions, most platforms tend to focus on a single disease. A further challenge is that despite the importance of users actively engaging with such systems, little research has explored engagement. Objective: The objectives of this study are to design and develop a digital health platform, ProACT, for facilitating older adults self-managing multimorbidity, with support from their care network, and evaluate end user engagement and experiences with this platform through a 12-month trial. Methods: The ProACT digital health platform is presented in this paper. The platform was evaluated in a year-long proof-of-concept action research trial with 120 older persons with multimorbidity in Ireland and Belgium. Alongside the technology, participants had access to a clinical triage service responding to symptom alerts and a technical helpdesk. Interactions with the platform during the trial were logged to determine engagement. Semistructured interviews were conducted with participants and analyzed using inductive thematic analysis, whereas usability and user burden were examined using validated questionnaires. Results: This paper presents the ProACT platform and its components, along with findings on engagement with the platform and its usability. Of the 120 participants who participated, 24 (20\%) withdrew before the end of the study, whereas 3 (2.5\%) died. The remaining 93 participants actively used the platform until the end of the trial, on average, taking 2 or 3 health readings daily over the course of the trial in Ireland and Belgium, respectively. The participants reported ProACT to be usable and of low burden. Findings from interviews revealed that participants experienced multiple benefits as a result of using ProACT, including improved self-management, health, and well-being and support from the triage service. For those who withdrew, barriers to engagement were poor health and frustration when technology, in particular sensing devices, did not work as expected. Conclusions: This is the first study to present findings from a longitudinal study of older adults using digital health technology to self-manage multimorbidity. Our findings show that older adults sustained engagement with the technology and found it usable. Potential reasons for these results include a strong focus on user-centered design and engagement throughout the project lifecycle, resulting in a platform that meets user needs, as well as the integration of behavior change techniques and personal analytics into the platform. The provision of triage and technical support services alongside the platform during the trial were also important facilitators of engagement. International Registered Report Identifier (IRRID): RR2-10.2196/22125 ",
doi="10.2196/22672",
url="https://www.jmir.org/2021/12/e22672",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914612"
}


@Article{info:doi/10.2196/22125,
author="Dinsmore, John
and Hannigan, Caoimhe
and Smith, Suzanne
and Murphy, Emma
and Kuiper, L. Janneke M.
and O'Byrne, Emma
and Galvin, Mary
and Jacobs, An
and Sillevis Smitt, Myriam
and van Leeuwen, Cora
and McAleer, Patricia
and Tompkins, Lorraine
and Brady, Anne-Marie
and McCarron, Mary
and Doyle, Julie",
title="A Digital Health Platform for Integrated and Proactive Patient-Centered Multimorbidity Self-management and Care (ProACT): Protocol for an Action Research Proof-of-Concept Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="15",
volume="10",
number="12",
pages="e22125",
keywords="multimorbidity",
keywords="digital health",
keywords="chronic disease",
keywords="self-management",
keywords="older adults",
keywords="integrated care",
keywords="behaviour change",
keywords="mobile phone",
keywords="smart phone",
keywords="smart device",
abstract="Background: Multimorbidity is defined as the presence of two or more chronic diseases and associated comorbidities. There is a need to improve best practices around the provision of well-coordinated, person-centered care for persons with multimorbidities. Present health systems across the European Union (EU) focus on supporting a single-disease framework of care; the primary challenge is to create a patient-centric, integrated care ecosystem to understand and manage multimorbidity. ProACT is a large-scale project funded by the European Commission under the Horizon 2020 programme, that involved the design, development, and evaluation of a digital health platform to improve and advance home-based integrated care, and supported self-management, for older adults (aged ?65 years) living with multimorbidity. Objective: This paper describes the trial implementation protocol of a proof-of-concept digital health platform (ProACT) in 2 EU member states (Ireland and Belgium) to support older persons with multimorbidities self-managing at home, supported by their care network (CN). Methods: Research was conducted across 2 EU member states, Ireland and Belgium. A 12-month action research trial design, divided into 3 evaluation cycles and lasting 3 months each, with a reflective redesign and development phase of 1 month after cycles 1 and 2 was conducted. Participants were 120 (60/120, 50\% in Ireland and 60/120, 50\% in Belgium) older persons with multimorbidities diagnosed with two or more of the following chronic conditions: diabetes, chronic obstructive pulmonary disease, chronic heart failure, and cardiovascular diseases. With permission from persons with multimorbidities, members of their CN were invited to participate in the study. Persons with multimorbidities were provided with ProACT technologies (tablet, devices, or sensors) to support them in self-managing their conditions. CN members also received access to an app to remotely support their persons with multimorbidity. Qualitative and quantitative feedback and evaluation data from persons with multimorbidity and CN participants were collected across four time points: baseline (T1), at the end of each 3-month action research cycle (T2 and T3), and in a final posttrial interview (T4). Thematic analysis was used to analyze the qualitative interview data. Quantitative data were analyzed via platform use statistics (to assess engagement) and standardized questionnaires (using descriptive and inferential statistics). This study is approved by the ethics committees of Ireland and Belgium. Results: The trial implementation phase for this 44-month (2016-2019) funded study was April 2018 to June 2019. The trial outcomes are at various stages of publication since 2021. Conclusions: ProACT aims to co-design and develop a digital intervention with persons with multimorbidities and their CN, incorporating clinical guidelines with the state of the art in human-computer interaction, behavioral science, health psychology, and data analytic methods to deliver a digital health platform to advance self-management of multimorbidity at home, as part of a proactive, integrated model of supported person-centered care. International Registered Report Identifier (IRRID): RR1-10.2196/22125 ",
doi="10.2196/22125",
url="https://www.researchprotocols.org/2021/12/e22125",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914613"
}


@Article{info:doi/10.2196/33364,
author="Alkureishi, Alcocer Maria
and Choo, Zi-Yi
and Rahman, Ali
and Ho, Kimberly
and Benning-Shorb, Jonah
and Lenti, Gena
and Vel{\'a}zquez S{\'a}nchez, Itzel
and Zhu, Mengqi
and Shah, D. Sachin
and Lee, Wei Wei",
title="Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions",
journal="JMIR Hum Factors",
year="2021",
month="Dec",
day="15",
volume="8",
number="4",
pages="e33364",
keywords="telemedicine",
keywords="digital divide",
keywords="patient experience",
keywords="qualitative study",
abstract="Background: As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the ``digital divide,'' the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients' perspectives of the divide and its impacts remain unclear. Objective: We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. Methods: Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. Results: Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. Conclusions: Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected. ",
doi="10.2196/33364",
url="https://humanfactors.jmir.org/2021/4/e33364",
url="http://www.ncbi.nlm.nih.gov/pubmed/34705664"
}


@Article{info:doi/10.2196/22681,
author="Sajnani, Jocelyn
and Swan, Kimberly
and Wolff, Sharon
and Drummond, Kelsi",
title="Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study",
journal="JMIR Perioper Med",
year="2021",
month="Dec",
day="14",
volume="4",
number="2",
pages="e22681",
keywords="communication",
keywords="hysterectomy",
keywords="minimally invasive",
keywords="laparoscopy",
keywords="postoperative",
keywords="patient satisfaction",
abstract="Background: With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. Objective: ?This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. Methods: ?We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US \$2.85 per patient. Results: ?A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80\% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ?9 on a 10-point scale, was 74\% (46/62) in the texting group and 63\% (47/75) in the control group (P=.15). Connectedness (score ?9) was reported by 64\% (40/62) in the texting group compared with 44\% (33/75) in the control group (P=.02). Overall, 65\% (40/62) of those in the texting group found the texts valuable (score ?9). Conclusions: ?Postoperative text messages increased patients' perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate. ",
doi="10.2196/22681",
url="https://periop.jmir.org/2021/2/e22681",
url="http://www.ncbi.nlm.nih.gov/pubmed/34904957"
}


@Article{info:doi/10.2196/30151,
author="Bekkelund, Ivar Svein
and M{\"u}ller, Ivar Kai",
title="One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="13",
volume="23",
number="12",
pages="e30151",
keywords="chronic headache",
keywords="remission",
keywords="video consultation",
keywords="telemedicine",
keywords="eHealth",
keywords="digital consultation",
keywords="consultation",
keywords="treatment",
keywords="follow-up",
keywords="RCT",
keywords="randomized controlled trial",
abstract="Background: Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective: The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods: Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Troms{\o}) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ?15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results: From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0\% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7\% (86/120) in the video group and 67.3\% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0\% (37/86) in the video group and 39.5\% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5\% (32/37; video) and 93.3\% (28/30; face-to-face; P=.25). A total of 30\% (11/37) in the video group and 53\% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions: One-year remission rate from chronic headache was about 40\% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration: ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177 ",
doi="10.2196/30151",
url="https://www.jmir.org/2021/12/e30151",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898455"
}


@Article{info:doi/10.2196/26794,
author="Ali, Lilas
and Wallstr{\"o}m, Sara
and Fors, Andreas
and Barenfeld, Emmelie
and Fredholm, Eva
and Fu, Michael
and Goudarzi, Mahboubeh
and Gyllensten, Hanna
and Lindstr{\"o}m Kjellberg, Irma
and Swedberg, Karl
and Vanfleteren, W. Lowie E. G.
and Ekman, Inger",
title="Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="13",
volume="23",
number="12",
pages="e26794",
keywords="chronic heart failure",
keywords="chronic obstructive pulmonary disease",
keywords="digital platform",
keywords="eHealth",
keywords="patient-centered care",
keywords="person-centered care",
keywords="randomized controlled trial",
keywords="telehealth",
abstract="Background: Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. Objective: The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. Methods: A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5\%) or PCC combined with usual care (110/222, 49.5\%). The intervention's main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. Results: No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. Conclusions: PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. Trial Registration: ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817 ",
doi="10.2196/26794",
url="https://www.jmir.org/2021/12/e26794",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898447"
}


@Article{info:doi/10.2196/26002,
author="Alodhayani, A. Abdulaziz
and Hassounah, Mazen Marwah
and Qadri, R. Fatima
and Abouammoh, A. Noura
and Ahmed, Zakiuddin
and Aldahmash, M. Abdullah",
title="Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="8",
volume="23",
number="12",
pages="e26002",
keywords="connected health",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="culture",
keywords="Islam",
keywords="Arab",
keywords="mobile phone",
abstract="Background: There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill. Objective: This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia. Methods: A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. Results: A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program. Conclusions: We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers. ",
doi="10.2196/26002",
url="https://www.jmir.org/2021/12/e26002",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889740"
}


@Article{info:doi/10.2196/25170,
author="Rauwerdink, Anneloek
and Kasteleyn, J. Marise
and Chavannes, H. Niels
and Schijven, P. Marlies",
title="Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="25",
volume="23",
number="11",
pages="e25170",
keywords="CSIRO framework",
keywords="evaluation strategy",
keywords="eHealth",
keywords="telemedicine",
keywords="qualitative research",
keywords="formative evaluation",
keywords="digital health",
abstract="Background: A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. Objective: The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. Methods: To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. Results: The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. Conclusions: The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. International Registered Report Identifier (IRRID): RR2-10.1016/j.ceh.2020.12.002 ",
doi="10.2196/25170",
url="https://www.jmir.org/2021/11/e25170",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842536"
}


@Article{info:doi/10.2196/32951,
author="De Santis, Karolina Karina
and Jahnel, Tina
and Sina, Elida
and Wienert, Julian
and Zeeb, Hajo",
title="Digitization and Health in Germany: Cross-sectional Nationwide Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="22",
volume="7",
number="11",
pages="e32951",
keywords="digital health",
keywords="literacy",
keywords="survey",
keywords="attitude",
keywords="usage",
keywords="eHEALS",
keywords="COVID-19",
keywords="physical activity",
keywords="general population",
keywords="misinformation",
abstract="Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07\% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47\% (674/1014) completed up to tertiary (primary and secondary) education and 45.07\% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US \$1.18). Over half (579/1014, 57.10\%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56\%) noted that digitization will be important for therapy and health care, in the future. Only 25.64\% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70\% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47\% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01\% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0\%) found such technologies easy to use and 140 (63.6\%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10\%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95\% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95\% CI 0.94-0.96) and more education (OR 1.22, 95\% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age ($\beta$=--.22, P<.001), higher household income ($\beta$=.21, P<.001), and more education ($\beta$=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. ",
doi="10.2196/32951",
url="https://publichealth.jmir.org/2021/11/e32951",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813493"
}


@Article{info:doi/10.2196/29554,
author="Hou, Xinyao
and Zhang, Yu
and Wang, Yanping
and Wang, Xinyi
and Zhao, Jiahao
and Zhu, Xiaobo
and Su, Jianbo",
title="A Markerless 2D Video, Facial Feature Recognition--Based, Artificial Intelligence Model to Assist With Screening for Parkinson Disease: Development and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="19",
volume="23",
number="11",
pages="e29554",
keywords="Parkinson disease",
keywords="facial features",
keywords="artificial intelligence",
keywords="diagnosis",
abstract="Background: Masked face is a characteristic clinical manifestation of Parkinson disease (PD), but subjective evaluations from different clinicians often show low consistency owing to a lack of accurate detection technology. Hence, it is of great significance to develop methods to make monitoring easier and more accessible. Objective: The study aimed to develop a markerless 2D video, facial feature recognition--based, artificial intelligence (AI) model to assess facial features of PD patients and investigate how AI could help neurologists improve the performance of early PD diagnosis. Methods: We collected 140 videos of facial expressions from 70 PD patients and 70 matched controls from 3 hospitals using a single 2D video camera. We developed and tested an AI model that performs masked face recognition of PD patients based on the acquisition and evaluation of facial features including geometric and texture features. Random forest, support vector machines, and k-nearest neighbor were used to train the model. The diagnostic performance of the AI model was compared with that of 5 neurologists. Results: The experimental results showed that our AI models can achieve feasible and effective facial feature recognition ability to assist with PD diagnosis. The accuracy of PD diagnosis can reach 83\% using geometric features. And with the model trained by random forest, the accuracy of texture features is up to 86\%. When these 2 features are combined, an F1 value of 88\% can be reached, where the random forest algorithm is used. Further, the facial features of patients with PD were not associated with the motor and nonmotor symptoms of PD. Conclusions: PD patients commonly exhibit masked facial features. Videos of a facial feature recognition--based AI model can provide a valuable tool to assist with PD diagnosis and the potential of realizing remote monitoring of the patient's condition, especially during the COVID-19 pandemic. ",
doi="10.2196/29554",
url="https://www.jmir.org/2021/11/e29554",
url="http://www.ncbi.nlm.nih.gov/pubmed/34806994"
}


@Article{info:doi/10.2196/30394,
author="Woelfle, Tim
and Pless, Silvan
and Wiencierz, Andrea
and Kappos, Ludwig
and Naegelin, Yvonne
and Lorscheider, Johannes",
title="Practice Effects of Mobile Tests of Cognition, Dexterity, and Mobility on Patients With Multiple Sclerosis: Data Analysis of a Smartphone-Based Observational Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="18",
volume="23",
number="11",
pages="e30394",
keywords="multiple sclerosis",
keywords="digital biomarkers",
keywords="practice effects",
keywords="learning effects",
keywords="learning curves",
keywords="nonlinear mixed models",
keywords="quantile regression",
keywords="information processing speed",
keywords="symbol digit modalities test",
keywords="smartphones",
keywords="wearable electronic devices",
keywords="mobile phones",
abstract="Background: Smartphones and their built-in sensors allow for measuring functions in disease-related domains through mobile tests. This could improve disease characterization and monitoring, and could potentially support treatment decisions for multiple sclerosis (MS), a multifaceted chronic neurological disease with highly variable clinical manifestations. Practice effects can complicate the interpretation of both improvement over time by potentially exaggerating treatment effects and stability by masking deterioration. Objective: The aim of this study is to identify short-term learning and long-term practice effects in 6 active tests for cognition, dexterity, and mobility in user-scheduled, high-frequency smartphone-based testing. Methods: We analyzed data from 264 people with self-declared MS with a minimum of 5 weeks of follow-up and at least 5 repetitions per test in the Floodlight Open study, a self-enrollment study accessible by smartphone owners from 16 countries. The collected data are openly available to scientists. Using regression and bounded growth mixed models, we characterized practice effects for the following tests: electronic Symbol Digit Modalities Test (e-SDMT) for cognition; Finger Pinching and Draw a Shape for dexterity; and Two Minute Walk, U-Turn, and Static Balance for mobility. Results: Strong practice effects were found for e-SDMT (n=4824 trials), Finger Pinching (n=19,650), and Draw a Shape (n=19,019) with modeled boundary improvements of 40.8\% (39.9\%-41.6\%), 86.2\% (83.6\%-88.7\%), and 23.1\% (20.9\%-25.2\%) over baseline, respectively. Half of the practice effect was reached after 11 repetitions for e-SDMT, 28 repetitions for Finger Pinching, and 17 repetitions for Draw a Shape; 90\% was reached after 35, 94, and 56 repetitions, respectively. Although baseline performance levels were highly variable across participants, no significant differences between the short-term learning effects in low performers (5th and 25th percentile), median performers, and high performers (75th and 95th percentile) were found for e-SDMT up to the fifth trial ($\beta$=1.50-2.00). Only small differences were observed for Finger Pinching ($\beta$=1.25-2.5). For U-Turn (n=15,051) and Static Balance (n=16,797), only short-term learning effects could be observed, which ceased after a maximum of 5 trials. For Two Minute Walk (n=14,393), neither short-term learning nor long-term practice effects were observed. Conclusions: Smartphone-based tests are promising for monitoring the disease trajectories of MS and other chronic neurological diseases. Our findings suggest that strong long-term practice effects in cognitive and dexterity functions have to be accounted for to identify disease-related changes in these domains, especially in the context of personalized health and in studies without a comparator arm. In contrast, changes in mobility may be more easily interpreted because of the absence of long-term practice effects, even though short-term learning effects might have to be considered. ",
doi="10.2196/30394",
url="https://www.jmir.org/2021/11/e30394",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792480"
}


@Article{info:doi/10.2196/33509,
author="Schopow, Nikolas
and Osterhoff, Georg
and von Dercks, Nikolaus
and Girrbach, Felix
and Josten, Christoph
and Stehr, Sebastian
and Hepp, Pierre",
title="Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review",
journal="JMIR Public Health Surveill",
year="2021",
month="Nov",
day="18",
volume="7",
number="11",
pages="e33509",
keywords="telemedical consultation",
keywords="patient allocation",
keywords="algorithm-based treatment",
keywords="telemedicine",
keywords="telehealth",
keywords="consultation",
keywords="allocation",
keywords="algorithm",
keywords="treatment",
keywords="COVID-19",
keywords="coordination",
keywords="Germany",
keywords="economic",
keywords="review",
keywords="establishment",
keywords="management",
abstract="Background: During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. Objective: This study describes the establishment and management of a CCCC at a German university hospital. Methods: We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. Results: During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3\%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69\%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8\% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2\% (291/1068) of patients were admitted to normal wards, and 12.9\% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than {\texteuro}52,000 (US \$60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4\%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. Conclusions: Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient's life against another's. ",
doi="10.2196/33509",
url="https://publichealth.jmir.org/2021/11/e33509",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623955"
}


@Article{info:doi/10.2196/33027,
author="Strubbia, Carla
and Levack, MM William
and Grainger, Rebecca
and Takahashi, Kayoko
and Tomori, Kounosuke",
title="Use of an iPad App (Aid for Decision-making in Occupational Choice) for Collaborative Goal Setting in Interprofessional Rehabilitation: Qualitative Descriptive Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Nov",
day="18",
volume="8",
number="4",
pages="e33027",
keywords="rehabilitation",
keywords="goals",
keywords="digital technology",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Goal setting is a key part of the rehabilitation process. The use of technology and electronic tools such as smartphone apps and websites has been suggested as a way of improving the engagement of users in meaningful goal setting and facilitating shared decision-making between patients and health professionals. Objective: This study aims to describe experiences of health professionals and patients in the use of the English language version of the iPad app Aid for Decision-making in Occupational Choice (ADOC) to facilitate collaborative goal setting in rehabilitation. Methods: We recruited participants from 3 acute and postacute care rehabilitation wards in both public and private organizations in New Zealand. Participants were registered allied health professionals, including physiotherapists, occupational therapists, and speech-language therapists, who engage in goal setting as part of their normal work, and their adult patients. We collected data via semistructured interviews to gather information about the experiences of the participants in the use of ADOC for goal setting. Data were analyzed with thematic analysis. Results: A total of 8 health professionals and 8 patients participated in the study. Six main themes emerged from the data: changing patients' perspective on what is possible, changing health professionals' perspective on what is important, facilitating shared decision-making, lack of guides for users, logistic and organizational barriers, and app-related and technical issues. Conclusions: Health professionals and patients found ADOC to be a valuable tool when setting shared rehabilitation goals. The use of ADOC promoted a patient-centered approach that empowered patients to engage in collaborative goal setting. The technological limitations of the app that negatively impacted experiences can be addressed in the future implementation of ADOC in rehabilitation settings. ",
doi="10.2196/33027",
url="https://rehab.jmir.org/2021/4/e33027",
url="http://www.ncbi.nlm.nih.gov/pubmed/34792475"
}


@Article{info:doi/10.2196/30432,
author="Hodgson, Tobias
and Burton-Jones, Andrew
and Donovan, Raelene
and Sullivan, Clair",
title="The Role of Electronic Medical Records in Reducing Unwarranted Clinical Variation in Acute Health Care: Systematic Review",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="17",
volume="9",
number="11",
pages="e30432",
keywords="clinical variation",
keywords="unwarranted clinical variation",
keywords="electronic health record",
keywords="EHR",
keywords="electronic medical record",
keywords="EMR",
keywords="PowerPlan",
keywords="SmartSet",
keywords="acute care",
keywords="eHealth",
keywords="digital health",
keywords="health care",
keywords="health care outcomes",
keywords="outcome",
keywords="review",
keywords="standard of care",
keywords="hospital",
keywords="research",
keywords="literature",
keywords="variation",
keywords="intervention",
abstract="Background: The use of electronic medical records (EMRs)/electronic health records (EHRs) provides potential to reduce unwarranted clinical variation and thereby improve patient health care outcomes. Minimization of unwarranted clinical variation may raise and refine the standard of patient care provided and satisfy the quadruple aim of health care. Objective: A systematic review of the impact of EMRs and specific subcomponents (PowerPlans/SmartSets) on variation in clinical care processes in hospital settings was undertaken to summarize the existing literature on the effects of EMRs on clinical variation and patient outcomes. Methods: Articles from January 2000 to November 2020 were identified through a comprehensive search that examined EMRs/EHRs and clinical variation or PowerPlans/SmartSets. Thirty-six articles met the inclusion criteria. Articles were examined for evidence for EMR-induced changes in variation and effects on health care outcomes and mapped to the quadruple aim of health care. Results: Most of the studies reported positive effects of EMR-related interventions (30/36, 83\%). All of the 36 included studies discussed clinical variation, but only half measured it (18/36, 50\%). Those studies that measured variation generally examined how changes to variation affected individual patient care (11/36, 31\%) or costs (9/36, 25\%), while other outcomes (population health and clinician experience) were seldom studied. High-quality study designs were rare. Conclusions: The literature provides some evidence that EMRs can help reduce unwarranted clinical variation and thereby improve health care outcomes. However, the evidence is surprisingly thin because of insufficient attention to the measurement of clinical variation, and to the chain of evidence from EMRs to variation in clinical practices to health care outcomes. ",
doi="10.2196/30432",
url="https://medinform.jmir.org/2021/11/e30432",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787585"
}


@Article{info:doi/10.2196/30485,
author="Par{\'e}, Guy
and Raymond, Louis
and Castonguay, Alexandre
and Grenier Ouimet, Antoine
and Trudel, Marie-Claude",
title="Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="16",
volume="9",
number="11",
pages="e30485",
keywords="medical appointment scheduling system",
keywords="electronic booking",
keywords="e-booking",
keywords="primary care",
keywords="accessibility of care",
keywords="availability of care",
keywords="advance access",
keywords="electronic medical record",
abstract="Background: The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. Objective: This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? Methods: A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. Results: A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly ``automated appointment confirmation and reminders'' and ``online appointment confirmation, modification, or cancellation by the patient.'' More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic's electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. Conclusions: The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions. ",
doi="10.2196/30485",
url="https://medinform.jmir.org/2021/11/e30485",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783670"
}


@Article{info:doi/10.2196/31527,
author="Burmann, Anja
and Tischler, Max
and Fa{\ss}bach, Mira
and Schneitler, Sophie
and Meister, Sven",
title="The Role of Physicians in Digitalizing Health Care Provision: Web-Based Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="11",
volume="9",
number="11",
pages="e31527",
keywords="digitalization",
keywords="digital transformation",
keywords="health care",
keywords="human factor",
keywords="physicians",
keywords="digital natives",
keywords="web-based survey",
keywords="digital health",
abstract="Background: Digitalization affects all areas of society, including the health care sector. However, the digitalization of health care provision is progressing slowly compared to other sectors. In the professional and political literature, physicians are partially portrayed as digitalization sceptics. Thus, the role of physicians in this process requires further investigation. The theory of ``digital natives'' suggests a lower hurdle for younger generations to engage with digital technologies. Objective: The objective of this study was to investigate the role of physicians in the process of digitalizing health care provision in Germany and to assess the age factor. Methods: We conducted a large-scale study to assess the role of this professional group in the progress of the digital transformation of the German health care sector. Therefore, in an anonymous online survey, we inquired about the current digital penetration of the personal working environment, expectations, attitude toward, and concerns regarding digitalization. Based on these data, we studied associations with the nominal variable age and variations across 2 age groups. Results: The 1274 participants included in the study generally showed a high affinity towards digitalization with a mean of 3.88 on a 5-point Likert scale; 723 respondents (56.75\%) stated they personally use mobile apps in their everyday working life, with a weak tendency to be associated with the respondents' age ($\eta$=0.26). Participants saw the most noticeable existing benefits through digitalization in data quality and readability (882/1274, 69.23\%) and the least in patient engagement (213/1274, 16.72\%). Medical practitioners preponderantly expect further improvements through increased digitalization across almost all queried areas but the most in access to medical knowledge (1136/1274, 89.17\%), treatment of orphan diseases (1016/1274, 79.75\%), and medical research (1023/1274, 80.30\%). Conclusions: Respondents defined their role in the digitalization of health care provision as ambivalent: ``scrutinizing'' on the one hand but ``active'' and ``open'' on the other. A gap between willingness to participate and digital sovereignty was indicated. Thus, education on digitalization as a means to support health care provision should not only be included in the course of study but also in the continuing process of further and advanced training. ",
doi="10.2196/31527",
url="https://medinform.jmir.org/2021/11/e31527",
url="http://www.ncbi.nlm.nih.gov/pubmed/34545813"
}


@Article{info:doi/10.2196/27748,
author="Javier, J. Sarah
and Wu, Justina
and Smith, L. Donna
and Kanwal, Fasiha
and Martin, A. Lindsey
and Clark, Jack
and Midboe, M. Amanda",
title="A Web-Based, Population-Based Cirrhosis Identification and Management System for Improving Cirrhosis Care: Qualitative Formative Evaluation",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="9",
volume="5",
number="11",
pages="e27748",
keywords="cirrhosis",
keywords="informatics",
keywords="care coordination",
keywords="implementation",
keywords="Consolidated Framework for Implementation Research (CFIR)",
keywords="quality improvement",
abstract="Background: Cirrhosis, or scarring of the liver, is a debilitating condition that affects millions of US adults. Early identification, linkage to care, and retention of care are critical for preventing severe complications and death from cirrhosis. Objective: The purpose of this study is to conduct a preimplementation formative evaluation to identify factors that could impact implementation of the Population-Based Cirrhosis Identification and Management System (P-CIMS) in clinics serving patients with cirrhosis. P-CIMS is a web-based informatics tool designed to facilitate patient outreach and cirrhosis care management. Methods: Semistructured interviews were conducted between January and May 2016 with frontline providers in liver disease and primary care clinics at 3 Veterans Health Administration medical centers. A total of 10 providers were interviewed, including 8 physicians and midlevel providers from liver-related specialty clinics and 2 primary care providers who managed patients with cirrhosis. The Consolidated Framework for Implementation Research guided the development of the interview guides. Inductive consensus coding and content analysis were used to analyze transcribed interviews and abstracted coded passages, elucidated themes, and insights. Results: The following themes and subthemes emerged from the analyses: outer setting: needs and resources for patients with cirrhosis; inner setting: readiness for implementation (subthemes: lack of resources, lack of leadership support), and implementation climate (subtheme: competing priorities); characteristics of individuals: role within clinic; knowledge and beliefs about P-CIMS (subtheme: perceived and realized benefits; useful features; suggestions for improvement); and perceptions of current practices in managing cirrhosis cases (subthemes: preimplementation process for identifying and linking patients to cirrhosis care; structural and social barriers to follow-up). Overall, P-CIMS was viewed as a powerful tool for improving linkage and retention, but its integration in the clinical workflow required leadership support, time, and staffing. Providers also cited the need for more intuitive interface elements to enhance usability. Conclusions: P-CIMS shows promise as a powerful tool for identifying, linking, and retaining care in patients living with cirrhosis. The current evaluation identified several improvements and advantages of P-CIMS over current care processes and provides lessons for others implementing similar population-based identification and management tools in populations with chronic disease. ",
doi="10.2196/27748",
url="https://formative.jmir.org/2021/11/e27748",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751653"
}


@Article{info:doi/10.2196/27568,
author="Keniston, Angela
and McBeth, Lauren
and Pell, Jonathan
and Bowden, Kasey
and Metzger, Anna
and Nordhagen, Jamie
and Anthony, Amanda
and Rice, John
and Burden, Marisha",
title="The Effectiveness of a Multidisciplinary Electronic Discharge Readiness Tool: Prospective, Single-Center, Pre-Post Study",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="8",
volume="8",
number="4",
pages="e27568",
keywords="discharge planning",
keywords="health information technology",
keywords="quasi-experimental design",
keywords="multidisciplinary",
keywords="teamwork",
abstract="Background: In the face of hospital capacity strain, hospitals have developed multifaceted plans to try to improve patient flow. Many of these initiatives have focused on the timing of discharges and on lowering lengths of stay, and they have met with variable success. We deployed a novel tool in the electronic health record to enhance discharge communication. Objective: The aim of this study is to evaluate the effectiveness of a discharge communication tool. Methods: This was a prospective, single-center, pre-post study. Hospitalist physicians and advanced practice providers (APPs) used the Discharge Today Tool to update patient discharge readiness every morning and at any time the patient status changed throughout the day. Primary outcomes were tool use, time of day the clinician entered the discharge order, time of day the patient left the hospital, and hospital length of stay. We used linear mixed modeling and generalized linear mixed modeling, with team and discharging provider included in all the models to account for patients cared for by the same team and the same provider. Results: During the pilot implementation period from March 5, 2019, to July 31, 2019, a total of 4707 patients were discharged (compared with 4558 patients discharged during the preimplementation period). A total of 352 clinical staff had used the tool, and 84.85\% (3994/4707) of the patients during the pilot period had a discharge status assigned at least once. In a survey, most respondents reported that the tool was helpful (32/34, 94\% of clinical staff) and either saved time or did not add additional time to their workflow (21/24, 88\% of providers, and 34/34, 100\% of clinical staff). Although improvements were not observed in either unadjusted or adjusted analyses, after including starting morning census per team as an effect modifier, there was a reduction in the time of day the discharge order was entered into the electronic health record by the discharging physician and in the time of day the patient left the hospital (decrease of 2.9 minutes per additional patient, P=.07, and 3 minutes per additional patient, P=.07, respectively). As an effect modifier, for teams that included an APP, there was a significant reduction in the time of day the patient left the hospital beyond the reduction seen for teams without an APP (decrease of 19.1 minutes per patient, P=.04). Finally, in the adjusted analysis, hospital length of stay decreased by an average of 3.7\% (P=.06). Conclusions: The Discharge Today tool allows for real time documentation and sharing of discharge status. Our results suggest an overall positive response by care team members and that the tool may be useful for improving discharge time and length of stay if a team is staffed with an APP or in higher-census situations. ",
doi="10.2196/27568",
url="https://humanfactors.jmir.org/2021/4/e27568",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747702"
}


@Article{info:doi/10.2196/25159,
author="Trupia, Vanessa Dilara
and Mathieu-Fritz, Alexandre
and Duong, Anh Tu",
title="The Sociological Perspective of Users' Invisible Work: A Qualitative Research Framework for Studying Digital Health Innovations Integration",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="4",
volume="23",
number="11",
pages="e25159",
keywords="digital health innovations",
keywords="qualitative analysis",
keywords="sociological framework",
keywords="invisible work",
keywords="patient work",
keywords="user work",
keywords="participatory health care",
keywords="chronic illness",
keywords="self-quantification",
abstract="Background: When new technology is integrated into a care pathway, it faces resistance due to the changes it introduces into the existing context. To understand the success or failure of digital health innovations, it is necessary to pay attention to the adjustments that users must perform to make them work, by reshaping the context and sometimes by altering the ways in which they perform activities. This adaptation work, most of which remains invisible, constitutes an important factor in the success of innovations and the ways in which they transform care practices. Objective: This work aims to present a sociological framework for studying new health technology uses through a qualitative analysis of the different types of tasks and activities that users, both health professionals and patients, must perform to integrate these technologies and make them work in their daily routine. Methods: This paper uses a three-part method to structure a theoretical model to study users' invisible work. The first part of the method includes a thematic literature review, previously published by one of the coauthors, of major sociological studies conducted on digital health innovations integration into existing care organizations and practices. The second part extends this review to introduce definitions and applications of the users' invisible work concept. The third part consists of producing a theoretical framework to study the concept according to the different contexts and practices of the users. Results: The paper proposes four dimensions (organizational, interactional, practical, and experiential), each composed of a set of criteria that allow a comparative analysis of different users' work according to different health technologies. Conclusions: This framework can be applied both as an analytical tool in a research protocol and as an agenda to identify less visible adoption criteria for digital health technologies. ",
doi="10.2196/25159",
url="https://www.jmir.org/2021/11/e25159",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734832"
}


@Article{info:doi/10.2196/33047,
author="Hatch, Gabe S.
and Lobaina, Diana
and Doss, D. Brian",
title="Optimizing Coaching During Web-Based Relationship Education for Low-Income Couples: Protocol for Precision Medicine Research",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="4",
volume="10",
number="11",
pages="e33047",
keywords="online relationship education",
keywords="precision medicine",
keywords="low-income couples",
keywords="coaching",
keywords="OurRelationship",
keywords="ePREP",
abstract="Background: In-person relationship education classes funded by the federal government tend to experience relatively high attrition rates and have only a limited effect on relationships. In contrast, low-income couples tend to report meaningful gains from web-based relationship education when provided with individualized coach contact. However, little is known about the method and intensity of practitioner contact that a couple requires to complete the web-based program and receive the intended benefit. Objective: The aim of this study is to use within-group models to create an algorithm to assign future couples to different programs and levels of coach contact, identify the most powerful predictors of treatment adherence and gains in relationship satisfaction within 3 different levels of coaching, and examine the most powerful predictors of treatment adherence and gains in relationship satisfaction among the 3 levels of coach contact. Methods: To accomplish these goals, this project intends to use data from a web-based Sequential Multiple Assignment Randomized Trial of the OurRelationship and web-based Prevention and Relationship Enhancement programs, in which the method and type of coach contact were randomly varied across 1248 couples (2496 individuals), with the hope of advancing theory in this area and generating accurate predictions. This study was funded by the US Department of Health and Human Services, Administration for Children and Families (grant number 90PD0309). Results: Data collection from the Sequential Multiple Assignment Randomized Trial of the OurRelationship and web-based Prevention and Relationship Enhancement Program was completed in October of 2020. Conclusions: Some of the direct benefits of this study include benefits to social services program administrators, tailoring of more effective relationship education, and effective delivery of evidence- and web-based relationship health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/33047 ",
doi="10.2196/33047",
url="https://www.researchprotocols.org/2021/11/e33047",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734838"
}


@Article{info:doi/10.2196/30711,
author="Winkler, Olga
and Dhaliwal, Raman
and Greenshaw, Andrew
and O'Shea, Katie
and Abba-Aji, Adam
and Chima, Chidi
and Purdon, E. Scot
and Burback, Lisa",
title="Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="4",
volume="10",
number="11",
pages="e30711",
keywords="suicide",
keywords="trauma",
keywords="eye movement desensitization and reprocessing (EMDR)",
keywords="telemedicine",
keywords="psychotherapy",
keywords="digital health",
keywords="eHealth",
keywords="remote delivery",
keywords="virtual care",
abstract="Background: Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. Objective: The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. Methods: In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. Results: The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. Conclusions: The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. Trial Registration: ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047 International Registered Report Identifier (IRRID): DERR1-10.2196/30711 ",
doi="10.2196/30711",
url="https://www.researchprotocols.org/2021/11/e30711",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734835"
}


@Article{info:doi/10.2196/32264,
author="Guinemer, Camille
and Boeker, Martin
and F{\"u}rstenau, Daniel
and Poncette, Akira-Sebastian
and Weiss, Bj{\"o}rn
and M{\"o}rgeli, Rudolf
and Balzer, Felix",
title="Telemedicine in Intensive Care Units: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="3",
volume="23",
number="11",
pages="e32264",
keywords="tele-ICU",
keywords="telemedicine",
keywords="critical care",
keywords="implementation",
keywords="telehealth",
keywords="health care system",
keywords="intensive care unit",
keywords="health technology",
keywords="digital health",
keywords="care compliance",
keywords="tertiary hospitals",
keywords="hospital",
keywords="review",
abstract="Background: The role of telemedicine in intensive care has been increasing steadily. Tele--intensive care unit (ICU) interventions are varied and can be used in different levels of treatment, often with direct implications for the intensive care processes. Although a substantial body of primary and secondary literature has been published on the topic, there is a need for broadening the understanding of the organizational factors influencing the effectiveness of telemedical interventions in the ICU. Objective: This scoping review aims to provide a map of existing evidence on tele-ICU interventions, focusing on the analysis of the implementation context and identifying areas for further technological research. Methods: A research protocol outlining the method has been published in JMIR Research Protocols. This review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). A core research team was assembled to provide feedback and discuss findings. Results: A total of 3019 results were retrieved. After screening, 25 studies were included in the final analysis. We were able to characterize the context of tele-ICU studies and identify three use cases for tele-ICU interventions. The first use case is extending coverage, which describes interventions aimed at extending the availability of intensive care capabilities. The second use case is improving compliance, which includes interventions targeted at improving patient safety, intensive care best practices, and quality of care. The third use case, facilitating transfer, describes telemedicine interventions targeted toward the management of patient transfers to or from the ICU. Conclusions: The benefits of tele-ICU interventions have been well documented for centralized systems aimed at extending critical care capabilities in a community setting and improving care compliance in tertiary hospitals. No strong evidence has been found on the reduction of patient transfers following tele-ICU intervention. International Registered Report Identifier (IRRID): RR2-10.2196/19695 ",
doi="10.2196/32264",
url="https://www.jmir.org/2021/11/e32264",
url="http://www.ncbi.nlm.nih.gov/pubmed/34730547"
}


@Article{info:doi/10.2196/28999,
author="Rodrigo, Hansapani
and Beukes, W. Eldr{\'e}
and Andersson, Gerhard
and Manchaiah, Vinaya",
title="Exploratory Data Mining Techniques (Decision Tree Models) for Examining the Impact of Internet-Based Cognitive Behavioral Therapy for Tinnitus: Machine Learning Approach",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="2",
volume="23",
number="11",
pages="e28999",
keywords="tinnitus",
keywords="internet interventions",
keywords="digital therapeutics",
keywords="cognitive behavioral therapy",
keywords="artificial intelligence",
keywords="machine learning",
keywords="data mining",
keywords="decision tree",
keywords="random forest",
abstract="Background: There is huge variability in the way that individuals with tinnitus respond to interventions. These experiential variations, together with a range of associated etiologies, contribute to tinnitus being a highly heterogeneous condition. Despite this heterogeneity, a ``one size fits all'' approach is taken when making management recommendations. Although there are various management approaches, not all are equally effective. Psychological approaches such as cognitive behavioral therapy have the most evidence base. Managing tinnitus is challenging due to the significant variations in tinnitus experiences and treatment successes. Tailored interventions based on individual tinnitus profiles may improve outcomes. Predictive models of treatment success are, however, lacking. Objective: This study aimed to use exploratory data mining techniques (ie, decision tree models) to identify the variables associated with the treatment success of internet-based cognitive behavioral therapy (ICBT) for tinnitus. Methods: Individuals (N=228) who underwent ICBT in 3 separate clinical trials were included in this analysis. The primary outcome variable was a reduction of 13 points in tinnitus severity, which was measured by using the Tinnitus Functional Index following the intervention. The predictor variables included demographic characteristics, tinnitus and hearing-related variables, and clinical factors (ie, anxiety, depression, insomnia, hyperacusis, hearing disability, cognitive function, and life satisfaction). Analyses were undertaken by using various exploratory machine learning algorithms to identify the most influencing variables. In total, 6 decision tree models were implemented, namely the classification and regression tree (CART), C5.0, GB, XGBoost, AdaBoost algorithm and random forest models. The Shapley additive explanations framework was applied to the two optimal decision tree models to determine relative predictor importance. Results: Among the six decision tree models, the CART (accuracy: mean 70.7\%, SD 2.4\%; sensitivity: mean 74\%, SD 5.5\%; specificity: mean 64\%, SD 3.7\%; area under the receiver operating characteristic curve [AUC]: mean 0.69, SD 0.001) and gradient boosting (accuracy: mean 71.8\%, SD 1.5\%; sensitivity: mean 78.3\%, SD 2.8\%; specificity: 58.7\%, SD 4.2\%; AUC: mean 0.68, SD 0.02) models were found to be the best predictive models. Although the other models had acceptable accuracy (range 56.3\%-66.7\%) and sensitivity (range 68.6\%-77.9\%), they all had relatively weak specificity (range 31.1\%-50\%) and AUCs (range 0.52-0.62). A higher education level was the most influencing factor for ICBT outcomes. The CART decision tree model identified 3 participant groups who had at least an 85\% success probability following the undertaking of ICBT. Conclusions: Decision tree models, especially the CART and gradient boosting models, appeared to be promising in predicting ICBT outcomes. Their predictive power may be improved by using larger sample sizes and including a wider range of predictive factors in future studies. ",
doi="10.2196/28999",
url="https://www.jmir.org/2021/11/e28999",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726612"
}


@Article{info:doi/10.2196/28105,
author="Cher, Y. Benjamin A.
and Wilson, A. Eric
and Pinsky, M. Alexa
and Townshend, F. Ryan
and Wolski, V. Ann
and Broderick, Michael
and Milen, M. Allison
and Lau, Audrey
and Singh, Amrit
and Cinti, K. Sandro
and Engelke, G. Carl
and Saha, K. Anjan",
title="Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="1",
volume="23",
number="11",
pages="e28105",
keywords="triage",
keywords="telephone",
keywords="COVID-19",
keywords="utility",
keywords="telemedicine",
keywords="telehealth",
keywords="patient information",
keywords="concern",
keywords="implementation",
keywords="innovation",
keywords="hospital",
abstract="Background: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42\%), nursing hotlines (1338/3929, 34\%), or employee health services (709/3929, 18\%). Cough (126/370 of callers, 34\%), shortness of breath (101/370, 27\%), upper respiratory infection (28/111, 25\%), and fever (89/370, 24\%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6\%) and age >65 years (18/370, 5\%) were the most commonly reported risk factors. Conclusions: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases. ",
doi="10.2196/28105",
url="https://www.jmir.org/2021/11/e28105",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559669"
}


@Article{info:doi/10.2196/30768,
author="Nelligan, K. Rachel
and Hinman, S. Rana
and McManus, Fiona
and Lamb, E. Karen
and Bennell, L. Kim",
title="Moderators of the Effect of a Self-directed Digitally Delivered Exercise Program for People With Knee Osteoarthritis: Exploratory Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="29",
volume="23",
number="10",
pages="e30768",
keywords="digital",
keywords="text messaging",
keywords="exercise",
keywords="moderators",
keywords="osteoarthritis",
keywords="RCT",
keywords="clinical trial",
keywords="subgroups",
keywords="pain",
keywords="function",
keywords="knee osteoarthritis",
keywords="rehabilitation",
keywords="digital health",
abstract="Background: A 24-week self-directed digitally delivered intervention was found to improve pain and function in people with knee osteoarthritis (OA). However, it is possible that this intervention may be better suited to certain subgroups of people with knee OA compared to others. Objective: The aim of this study was to explore whether certain individual baseline characteristics moderate the effects of a self-directed digitally delivered intervention on changes in pain and function over 24 weeks in people with knee OA. Methods: An exploratory analysis was conducted on data from a randomized controlled trial involving 206 people with a clinical diagnosis of knee OA. This trial compared a self-directed digitally delivered intervention comprising of web-based education, exercise, and physical activity program supported by automated exercise behavior change mobile phone text messages to web-based education alone (control). The primary outcomes were changes in overall knee pain (assessed on an 11-point numerical rating scale) and physical function (assessed using the Western Ontario and McMaster Universities Osteoarthritis Index function subscale [WOMAC]) at 24 weeks. Five baseline patient characteristics were selected as the potential moderators: (1) number of comorbidities, (2) number of other painful joints, (3) pain self-efficacy, (4) exercise self-efficacy, and (5) self-perceived importance of exercise. Separate linear regression models for each primary outcome and each potential moderator were fit, including treatment group, moderator, and interaction between treatment group and moderator, adjusting for the outcome at baseline. Results: There was evidence that pain self-efficacy moderated the effect of the intervention on physical function compared to the control at 24 weeks (interaction P=.02). Posthoc assessment of the mean change in WOMAC function by treatment arm showed that each 1-unit increase in baseline pain self-efficacy was associated with a 1.52 (95\% CI 0.27 to 2.78) unit improvement in the control group. In contrast, a reduction of 0.62 (95\% CI --1.93 to 0.68) units was observed in the intervention group with each unit increase in pain self-efficacy. There was only weak evidence that pain self-efficacy moderated the effect of the intervention on pain and that number of comorbidities, number of other painful joints, exercise self-efficacy, or exercise importance moderated the effect of the intervention on pain or function. Conclusions: With the exception of pain self-efficacy, which moderated changes in function but not pain, we found limited evidence that our selected baseline patient characteristics moderated intervention outcomes. This indicates that people with a range of baseline characteristics respond similarly to the unsupervised digitally delivered exercise intervention. As these findings are exploratory in nature, they require confirmation in future studies. ",
doi="10.2196/30768",
url="https://www.jmir.org/2021/10/e30768",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714252"
}


@Article{info:doi/10.2196/28618,
author="Reese, J. Thomas
and Del Fiol, Guilherme
and Morgan, Keaton
and Hurwitz, T. Jason
and Kawamoto, Kensaku
and Gomez-Lumbreras, Ainhoa
and Brown, L. Mary
and Thiess, Henrik
and Vazquez, R. Sara
and Nelson, D. Scott
and Boyce, Richard
and Malone, Daniel",
title="A Shared Decision-making Tool for Drug Interactions Between Warfarin and Nonsteroidal Anti-inflammatory Drugs: Design and Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="Oct",
day="26",
volume="8",
number="4",
pages="e28618",
keywords="shared decision-making",
keywords="user-centered design",
keywords="drug interaction",
keywords="clinical decision support",
abstract="Background: Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric. Objective: This study aims to design and study the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs. Methods: We used an SDM framework and user-centered design methods to guide the design and usability of DDInteract---an SDM electronic health record app to prevent harm from clinically significant DDIs. The design involved iterative prototypes, qualitative feedback from stakeholders, and a heuristic evaluation. The usability evaluation included patients and clinicians. Patients participated in a simulated SDM discussion using clinical vignettes. Clinicians were asked to complete eight tasks using DDInteract and to assess the tool using a survey adapted from the System Usability Scale. Results: The designed DDInteract prototype includes the following features: a patient-specific risk profile, dynamic risk icon array, patient education section, and treatment decision tree. A total of 4 patients and 11 clinicians participated in the usability study. After an SDM session where patients and clinicians review the tool concurrently, patients generally favored pain treatments with less risk of gastrointestinal bleeding. Clinicians successfully completed the tasks with a mean of 144 (SD 74) seconds and rated the usability of DDInteract as 4.32 (SD 0.52) of 5. Conclusions: This study expands the use of SDM to DDIs. The next steps are to determine if DDInteract can improve shared decision-making quality and to implement it across health systems using interoperable technology. ",
doi="10.2196/28618",
url="https://humanfactors.jmir.org/2021/4/e28618",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698649"
}


@Article{info:doi/10.2196/29218,
author="Oppelaar, C. Martinus
and van den Wijngaart, S. Lara
and Merkus, M. Peter J. F.
and Croonen, A. Ellen
and Hugen, C. Cindy A.
and Brouwer, L. Marianne
and Boehmer, M. Annemie L.
and Roukema, Jolt",
title="It Is Not Just the FEV1 That Matters, but the Personal Goals We Reach Along the Way: Qualitative, Multicenter, Prospective, Observational Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="20",
volume="23",
number="10",
pages="e29218",
keywords="eHealth",
keywords="asthma",
keywords="pediatrics",
keywords="telemonitoring",
keywords="lung function tests",
keywords="lung function",
keywords="spirometry",
keywords="home monitoring",
keywords="mHealth",
keywords="app",
keywords="smartphone",
keywords="asthma control",
keywords="child",
keywords="outpatients",
keywords="remote consultations",
keywords="quality improvement",
keywords="patient care management",
keywords="telemetry",
keywords="application",
keywords="FEV1",
keywords="pulmonary care",
abstract="Background: The COVID-19 pandemic has boosted the use of forced expiratory volume in 1 second (FEV1) telemonitoring in pediatric asthma, but a consensus on its most efficient and effective implementation is still lacking. To find answers, it is important to study how such an intervention is perceived, experienced, and used by both patients and health care professionals (HCPs). Objective: The aim of this study was to provide perspectives on how FEV1 home monitoring should be used in pediatric asthma. Methods: This is a qualitative, multicenter, prospective, observational study which included patients with asthma aged 6-16 and HCPs. Primary outcomes were results of 2 surveys that were sent to all participants at study start and after 3-4 months. Secondary outcomes consisted of FEV1 device usage during 4 months after receiving the FEV1 device. Results: A total of 39 participants (26 patients and 13 HCPs) were included in this study. Survey response rates were 97\% (38/39) at the start and 87\% (34/39) at the end of the study. Both patients and HCPs were receptive toward online FEV1 home monitoring and found it contributive to asthma control, self-management, and disease perception. The main concerns were about reliability of the FEV1 device and validity of home-performed lung function maneuvers. FEV1 devices were used with a median frequency of 7.5 (IQR 3.3-25.5) during the 4-month study period. Conclusions: Patients and HCPs are receptive toward online FEV1 home monitoring. Frequency of measurements varied largely among individuals, yet perceived benefits remained similar. This emphasizes that online FEV1 home monitoring strategies should be used as a means to reach individual goals, rather than being a goal on their own. ",
doi="10.2196/29218",
url="https://www.jmir.org/2021/10/e29218",
url="http://www.ncbi.nlm.nih.gov/pubmed/34668868"
}


@Article{info:doi/10.2196/31224,
author="Moon, Youngjin
and Hyun, Jaeho
and Oh, Jeongmin
and Lee, Kwanhee
and Lee, Se Yoon
and Kim, Ki Jun",
title="A Wi-Fi--Based Mask-Type Laryngoscope for Telediagnosis During the COVID-19 Pandemic: Instrument Validation Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="18",
volume="23",
number="10",
pages="e31224",
keywords="smartphone-based endoscope",
keywords="mobile health",
keywords="telediagnosis",
keywords="continuum segment",
keywords="articulable endoscope",
keywords="COVID-19",
keywords="point-of-care diagnostics",
keywords="validation",
keywords="medical device",
keywords="endoscope",
keywords="sensor",
keywords="innovation",
keywords="video",
keywords="transmission",
abstract="Background: Owing to the COVID-19 pandemic, social distancing has become mandatory. Wireless endoscopy in contactless examinations promises to protect health care workers and reduce viral spread. Objective: This study aimed to introduce a contactless endoscopic diagnosis system using a wireless endoscope resembling a mask. Methods: The Wi-Fi--based contactless mask endoscopy system comprises a disposable endoscope and a controller. First, the effective force applied by the tip during insertion was evaluated in a simple transoral model consisting of a force sensor on a simulated oropharynx wall. Second, the delay in video streaming was evaluated by comparing the frame rate and delays between a movement and its image over direct and Wi-Fi connections. Third, the system was applied to a detailed laryngopharyngeal tract phantom. Results: The smartphone-controlled wireless endoscopy system was successfully evaluated. The mean, maximum, and minimum collision forces against the wall of the transoral model were 296 mN (30 gf), 363 mN (37 gf), and 235 mN (24 gf), respectively. The delay resulting from the wireless connection was 0.72 seconds. Using the phantom, an inexperienced user took around 1 minute to orient the endoscope to a desired area via the app. Conclusions: Device articulation does not pose a significant risk of laryngopharyngeal wall penetration, and latency does not significantly impede its use. Contactless wireless video streaming was successful within the access point range regardless of the presence of walls. The mask endoscope can be controlled and articulated wirelessly, minimizing contact between patients and device operators. By minimizing contact, the device can protect health care workers from infectious viruses like the coronavirus. ",
doi="10.2196/31224",
url="https://www.jmir.org/2021/10/e31224",
url="http://www.ncbi.nlm.nih.gov/pubmed/34518154"
}


@Article{info:doi/10.2196/29868,
author="Nilsson, Evalill
and Sverker, Annette
and Bendtsen, Preben
and Eldh, Catrine Ann",
title="A Human, Organization, and Technology Perspective on Patients' Experiences of a Chat-Based and Automated Medical History--Taking Service in Primary Health Care: Interview Study Among Primary Care Patients",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="18",
volume="23",
number="10",
pages="e29868",
keywords="digital encounter",
keywords="digital healthcare",
keywords="e-consultation",
keywords="e-health",
keywords="interview",
keywords="patient perspective",
keywords="primary healthcare",
keywords="qualitative study",
keywords="telemedicine",
keywords="telehealth",
abstract="Background: The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective: This study aims to explore patients' experiences using a chat-based and automated medical history--taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods: Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history--taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results: The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history--taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one's time and reflect on one's situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions: Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service. ",
doi="10.2196/29868",
url="https://www.jmir.org/2021/10/e29868",
url="http://www.ncbi.nlm.nih.gov/pubmed/34661544"
}


@Article{info:doi/10.2196/33009,
author="Mathews, C. Simon
and Templeton, Sandy
and Taylor, K. Stephanie
and Harris, Sten
and Stewart, Margaret
and Raja, M. Shruti",
title="Evaluation of a Digital Handheld Hydrogen Breath Monitor to Diagnose Lactose Malabsorption: Interventional Crossover Study",
journal="JMIR Form Res",
year="2021",
month="Oct",
day="18",
volume="5",
number="10",
pages="e33009",
keywords="digital health",
keywords="lactose intolerance",
keywords="digestive disease",
keywords="evaluation",
keywords="medical device",
keywords="detection",
keywords="diagnostic",
keywords="digestion",
keywords="testing",
keywords="performance",
keywords="gastrointestinal",
keywords="diagnosis",
abstract="Background: Lactose malabsorption is a common condition that affects a broad segment of the population. Clinical diagnosis based on symptom recall can be unreliable and conventional testing can be inconvenient, requiring expensive laboratory-based equipment and conduction of the testing in a clinical setting. Objective: The aim of this study is to assess the performance of a digital handheld hydrogen breath monitor (GIMate) in diagnosing lactose malabsorption compared to a US Food and Drug Administration (FDA)--cleared device (H2 Check) for the same indication. Methods: An interventional crossover study was performed in adult participants with a prior confirmed diagnosis of lactose malabsorption or a suspected history of lactose intolerance. Results: A total of 31 participants (mean age 33.9 years) were enrolled in the study. There was 100\% positive percent agreement and 100\% negative percent agreement between the GIMate monitor and the H2 Check. Correlation between gastrointestinal symptoms and hydrogen values was positive at 0.82 (P<.001). Conclusions: The digital handheld GIMate breath monitor achieved equivalent diagnostic performance to that of an FDA-cleared device in the diagnosis of lactose malabsorption. Trial Registration: ClinicalTrials.gov NCT04754724; https://clinicaltrials.gov/ct2/show/NCT04754724 ",
doi="10.2196/33009",
url="https://formative.jmir.org/2021/10/e33009",
url="http://www.ncbi.nlm.nih.gov/pubmed/34544034"
}


@Article{info:doi/10.2196/27507,
author="Spadaro, Benedetta
and Martin-Key, A. Nayra
and Bahn, Sabine",
title="Building the Digital Mental Health Ecosystem: Opportunities and Challenges for Mobile Health Innovators",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="13",
volume="23",
number="10",
pages="e27507",
keywords="digital implementation",
keywords="digital mental health",
keywords="digital psychiatry",
keywords="digital technology",
keywords="viewpoint",
doi="10.2196/27507",
url="https://www.jmir.org/2021/10/e27507",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643537"
}


@Article{info:doi/10.2196/30841,
author="Bastoni, Sofia
and Wrede, Christian
and da Silva, Cristina Marcia
and Sanderman, Robbert
and Gaggioli, Andrea
and Braakman-Jansen, Annemarie
and van Gemert-Pijnen, Lisette",
title="Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review",
journal="JMIR Aging",
year="2021",
month="Oct",
day="8",
volume="4",
number="4",
pages="e30841",
keywords="eHealth",
keywords="assistive technologies",
keywords="dementia",
keywords="informal care",
keywords="home care",
keywords="implementation",
abstract="Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used ``by informal caregivers,'' ``by people with dementia,'' and ``with people with dementia.'' Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. ",
doi="10.2196/30841",
url="https://aging.jmir.org/2021/4/e30841",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623314"
}


@Article{info:doi/10.2196/25163,
author="Stollfuss, Barbara
and Richter, Manuel
and Dr{\"o}mann, Daniel
and Klose, Hans
and Schwaiblmair, Martin
and Gruenig, Ekkehard
and Ewert, Ralf
and Kirchner, C. Martin
and Kleinjung, Frank
and Irrgang, Valeska
and Mueller, Christian",
title="Digital Tracking of Physical Activity, Heart Rate, and Inhalation Behavior in Patients With Pulmonary Arterial Hypertension Treated With Inhaled Iloprost: Observational Study (VENTASTEP)",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="8",
volume="23",
number="10",
pages="e25163",
keywords="6-minute walk distance",
keywords="6MWD",
keywords="Breelib",
keywords="daily physical activity",
keywords="digital monitoring",
keywords="health-related quality of life",
keywords="iloprost",
keywords="Ventavis",
keywords="inhalation behavior",
keywords="mobile phone",
keywords="pulmonary arterial hypertension",
keywords="PAH",
keywords="sleeping behavior",
keywords="behavior",
keywords="sleep",
keywords="monitoring",
keywords="physical activity",
keywords="heart",
keywords="cardiology",
abstract="Background: Pulmonary arterial hypertension restricts the ability of patients to perform routine physical activities. As part of pulmonary arterial hypertension treatment, inhaled iloprost can be administered via a nebulizer that tracks inhalation behavior. Pulmonary arterial hypertension treatment is guided by intermittent clinical measurements, such as 6-minute walk distance, assessed during regular physician visits. Continuous digital monitoring of physical activity may facilitate more complete assessment of the impact of pulmonary arterial hypertension on daily life. Physical activity tracking with a wearable has not yet been assessed with simultaneous tracking of pulmonary arterial hypertension medication intake. Objective: We aimed to digitally track the physical parameters of patients with pulmonary arterial hypertension who were starting treatment with iloprost using a Breelib nebulizer. The primary objective was to investigate correlations between changes in digital physical activity measures and changes in traditional clinical measures and health-related quality of life over 3 months. Secondary objectives were to evaluate inhalation behavior, adverse events, and changes in heart rate and sleep quality. Methods: We conducted a prospective, multicenter observational study of adults with pulmonary arterial hypertension in World Health Organization functional class III who were adding inhaled iloprost to existing pulmonary arterial hypertension therapy. Daily distance walked, step count, number of standing-up events, heart rate, and 6-minute walk distance were digitally captured using smartwatch (Apple Watch Series 2) and smartphone (iPhone 6S) apps during a 3-month observation period (which began when iloprost treatment began). Before and at the end of the observation period (within 2 weeks), we also evaluated 6-minute walk distance, Borg dyspnea, functional class, B-type natriuretic peptide (or N-terminal pro--B-type natriuretic peptide) levels, health-related quality of life (EQ-5D questionnaire), and sleep quality (Pittsburgh Sleep Quality Index). Results: Of 31 patients, 18 were included in the full analysis (observation period: median 91.5 days, IQR 88.0 to 92.0). Changes from baseline in traditional and digital 6-minute walk distance were moderately correlated (r=0.57). Physical activity (daily distance walked: median 0.4  km, IQR --0.2 to 1.9; daily step count: median 591, IQR ?509 to 2413) and clinical measures (traditional 6-minute walk distance: median 26 m, IQR 0 to 40) changed concordantly from baseline to the end of the observation period. Health-related quality of life showed little change. Total sleep score and resting heart rate slightly decreased. Distance walked and step count showed short-term increases after each iloprost inhalation. No new safety signals were identified (safety analysis set: n=30). Conclusions: Our results suggest that despite challenges, parallel monitoring of physical activity, heart rate, and iloprost inhalation is feasible in patients with pulmonary arterial hypertension and may complement traditional measures in guiding treatment; however, the sample size of this study limits generalizability. Trial Registration: ClinicalTrials.gov NCT03293407; https://clinicaltrials.gov/ct2/show/NCT03293407 International Registered Report Identifier (IRRID): RR2-10.2196/12144 ",
doi="10.2196/25163",
url="https://www.jmir.org/2021/10/e25163",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623313"
}


@Article{info:doi/10.2196/31374,
author="Wherton, Joseph
and Greenhalgh, Trisha
and Shaw, E. Sara",
title="Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="7",
volume="23",
number="10",
pages="e31374",
keywords="technology-enabled care",
keywords="video consultations",
keywords="quality improvement",
keywords="COVID-19",
keywords="PERCS framework",
abstract="Background: Scotland---a country of 5.5 million people---has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective: To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland's video consultation services both before and during the pandemic. Methods: Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results: By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78\%), patients reported no technical problems during their postconsultation survey. Health care organizations' general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions: The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn. ",
doi="10.2196/31374",
url="https://www.jmir.org/2021/10/e31374",
url="http://www.ncbi.nlm.nih.gov/pubmed/34516389"
}


@Article{info:doi/10.2196/30165,
author="Payne, H. Thomas
and Keller, Carolyn
and Arora, Pallavi
and Brusati, Allison
and Levin, Jesse
and Salgaonkar, Monica
and Li, Xi
and Zech, Jennifer
and Lees, Fischer A.",
title="Writing Practices Associated With Electronic Progress Notes and the Preferences of Those Who Read Them: Descriptive Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="6",
volume="23",
number="10",
pages="e30165",
keywords="electronic documentation",
keywords="electronic health records",
keywords="hospital progress notes",
keywords="copy-paste",
keywords="EHR",
keywords="patient records",
keywords="workflow",
keywords="human factors",
keywords="clinical communication",
keywords="physician communication",
keywords="hospital",
abstract="Background: Hospital progress notes can serve as an important communication tool. However, they are criticized for their length, preserved content, and for the time physicians spend writing them. Objective: We aimed to describe hospital progress note content, writing and reading practices, and the preferences of those who create and read them prior to the implementation of a new electronic health record system. Methods: Using a sample of hospital progress notes from 1000 randomly selected admissions, we measured note length, similarity of content in successive daily notes for the same patient, the time notes were signed and read, and who read them. We conducted focus group sessions with note writers, readers, and clinical leaders to understand their preferences. Results: We analyzed 4938 inpatient progress notes from 418 authors. The average length was 886 words, and most were in the Assessment \& Plan note section. A total of 29\% of notes (n=1432) were signed after 4 PM. Notes signed later in the day were read less often. Notes were highly similar from one day to the next, and 26\% (23/88) had clinical risk associated with the preserved content. Note content of the highest value varied according to the reader's professional role. Conclusions: Progress note length varied widely. Notes were often signed late in the day when they were read less often and were highly similar to the note from the previous day. Measuring note length, signing time, when and by whom notes are read, and the amount and safety of preserved content will be useful metrics for measuring how the new electronic health record system is used, and can aid improvements. ",
doi="10.2196/30165",
url="https://www.jmir.org/2021/10/e30165",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612825"
}


@Article{info:doi/10.2196/29990,
author="Gandrakota, Nikhila
and Ali, K. Mohammed
and Shah, K. Megha",
title="Trends in Health Information Technology Use Among the US Population With and Without Cardiovascular Risk Factors, 2012-2018: Evidence From the National Health Interview Survey",
journal="JMIR Public Health Surveill",
year="2021",
month="Sep",
day="30",
volume="7",
number="9",
pages="e29990",
keywords="telemedicine",
keywords="cardiovascular risk factors",
keywords="health information technology",
keywords="telehealth",
keywords="digital health",
keywords="public health",
keywords="surveillance",
abstract="Background: The COVID-19 pandemic has required clinicians to pivot to offering services via telehealth; however, it is unclear which patients (users of care) are equipped to use digital health. This is especially pertinent for adults managing chronic diseases, such as obesity, hypertension, and diabetes, which require regular follow-up, medication management, and self-monitoring. Objective: The aim of this study is to measure the trends and assess factors affecting health information technology (HIT) use among members of the US population with and without cardiovascular risk factors. Methods: We used serial cross-sectional data from the National Health Interview Survey for the years 2012-2018 to assess trends in HIT use among adults, stratified by age and cardiovascular risk factor status. We developed multivariate logistic regression models adjusted for age, sex, race, insurance status, marital status, geographic region, and perceived health status to assess the likelihood of HIT use among patients with and without cardiovascular disease risk factors. Results: A total of 14,304 (44.6\%) and 14,644 (58.7\%) participants reported using HIT in 2012 and 2018, respectively. When comparing the rates of HIT use for the years 2012 and 2018, among participants without cardiovascular risk factors, the HIT use proportion increased from 51.1\% to 65.8\%; among those with one risk factor, it increased from 43.9\% to 59\%; and among those with more than one risk factor, it increased from 41.3\% to 54.7\%. Increasing trends in HIT use were highest among adults aged >65 years (annual percentage change [APC] 8.3\%), who had more than one cardiovascular risk factor (APC 5\%) and among those who did not graduate from high school (APC 8.8\%). Likelihood of HIT use was significantly higher in individuals who were younger, female, and non-Hispanic White; had higher education and income; were married; and reported very good or excellent health status. In 2018, college graduates were 7.18 (95\% CI 5.86-8.79), 6.25 (95\% CI 5.02-7.78), or 7.80 (95\% CI 5.87-10.36) times more likely to use HIT compared to adults without high school education among people with multiple cardiovascular risk factors, one cardiovascular risk factor, or no cardiovascular risk factors, respectively. Conclusions: Over 2012-2018, HIT use increased nationally, with greater use noted among younger and higher educated US adults. Targeted strategies are needed to engage wider age, racial, education, and socioeconomic groups by lowering barriers to HIT access and use. ",
doi="10.2196/29990",
url="https://publichealth.jmir.org/2021/9/e29990",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591026"
}


@Article{info:doi/10.2196/31247,
author="Correia, D. Fernando
and Molinos, Maria
and Neves, Carlos
and Janela, Dora
and Carvalho, Diana
and Luis, Sara
and Francisco, E. Gerard
and Lains, Jorge
and Bento, Virgilio",
title="Digital Rehabilitation for Acute Ankle Sprains: Prospective Longitudinal Cohort Study",
journal="JMIR Rehabil Assist Technol",
year="2021",
month="Sep",
day="30",
volume="8",
number="3",
pages="e31247",
keywords="acute ankle sprains",
keywords="physical rehabilitation",
keywords="home-based digital rehabilitation",
keywords="digital therapy",
keywords="rehabilitation",
keywords="sprain",
keywords="digital health",
keywords="therapy",
keywords="prospective",
keywords="longitudinal",
keywords="cohort",
keywords="ankle",
keywords="soft tissue",
keywords="physical therapy",
keywords="pain",
keywords="outcome",
keywords="fatigue",
abstract="Background: Ankle sprains are one of the most prevalent soft-tissue injuries worldwide. Physical therapy, especially progressive exercise, has proven effective in improving function, while preventing recurrence. Objective: We aim to present the results of a fully remote and digitally guided rehabilitation program for acute ankle sprains. Methods: We performed a prospective longitudinal cohort study of individuals eligible for workers' compensation, who were referred for digital rehabilitation therapy for a sprained ankle. Therapeutic exercise sessions were to be performed independently by the patient at home using the biofeedback device provided by SWORD Health. Primary endpoints were the change in self-reported Numerical Pain Rating Scale (NPRS) and Foot and Ankle Ability Measure--activities of daily living (FAAM--ADL) and FAAM--Sports scores. Participants were assessed at baseline, end of the program, and 6 months after program completion. Secondary outcomes included digital therapy dosage, pain and fatigue during sessions, and satisfaction. Results: In total, 93 (89.4\%) patients completed the program and 79 (76.0\%) were available for follow-up. Changes in the primary outcomes between baseline and the 6-month follow-up were both significant (P<.001) and clinically meaningful: mean difference of --2.72 points (95\% CI --3.31 to --2.13) on the NPRS (49.8\% reduction), 21.7 points (95\% CI 17.13-26.27) on the FAAM--ADL (41.1\% increase), and 37.8 points (95\% CI 30.45-45.15) on the FAAM-Sports (151.8\% increase). Longer waiting periods between the accident date and treatment initiation were found to negatively impact functional status at baseline and at the end of the program, triggering an extension in the program duration. The total training volume (12.5 hours, SD 10.5 hours) was similar to that of other interventions for ankle sprains, but the dosage per week was much higher (2.4 hours per week, SD 0.87 hours per week). The mean patient satisfaction score was 8.8 (SD 1.57) out of 10. Among program completers, 83.9\% attained full recovery and were discharged with no residual disability. Conclusions: Being far less demanding in terms of human resources, the digital program presented constituted a viable, clinically effective, and convenient solution for ankle sprain rehabilitation, particularly during the pandemic. This is the first study presenting a fully remote home-based rehabilitation program for acute ankle sprains, with patients achieving sustained long-term results.  This was a prospective cohort study and, as such, did not include a control group, but the results appear comparable to those published for face-to-face interventions. Trial Registration: ClinicalTrials.gov NCT04819022; https://clinicaltrials.gov/ct2/show/NCT04819022 ",
doi="10.2196/31247",
url="https://rehab.jmir.org/2021/3/e31247",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499038"
}


@Article{info:doi/10.2196/19232,
author="Damery, Sarah
and Jones, Janet
and O'Connell Francischetto, Elaine
and Jolly, Kate
and Lilford, Richard
and Ferguson, James",
title="Remote Consultations Versus Standard Face-to-Face Appointments for Liver Transplant Patients in Routine Hospital Care: Feasibility Randomized Controlled Trial of myVideoClinic",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="17",
volume="23",
number="9",
pages="e19232",
keywords="digital health",
keywords="remote consultation",
keywords="patient satisfaction",
keywords="feasibility",
keywords="VSQ-9",
keywords="secondary care",
keywords="liver transplant patients",
keywords="mobile phone",
abstract="Background: Using technology to reduce the pressure on the National Health Service (NHS) in England and Wales is a key government target, and the NHS Long-Term Plan outlines a strategy for digitally enabled outpatient care to become mainstream by 2024. In 2020, the COVID-19 response saw the widespread introduction of remote consultations for patient follow-up, regardless of individual preferences. Despite this rapid change, there may be enduring barriers to the effective implementation of remote appointments into routine practice once the unique drivers for change during the COVID-19 pandemic no longer apply, to which pre-COVID implementation studies can offer important insights. Objective: This study aims to evaluate the feasibility of using real-time remote consultations between patients and secondary care physicians for routine patient follow-up at a large hospital in the United Kingdom and to assess whether patient satisfaction differs between intervention and usual care patients. Methods: Clinically stable liver transplant patients were randomized to real-time remote consultations in which their hospital physician used secure videoconferencing software (intervention) or standard face-to-face appointments (usual care). Participants were asked to complete postappointment questionnaires over 12 months. Data were analyzed on an intention-to-treat basis. The primary outcome was the difference in scores between baseline and study end by patient group for the three domains of patient satisfaction (assessed using the Visit-Specific Satisfaction Instrument). An embedded qualitative process evaluation used interviews to assess patient and staff experiences. Results: Of the 54 patients who were randomized, 29 (54\%) received remote consultations, and 25 (46\%) received usual care (recruitment rate: 54/203, 26.6\%). The crossover between study arms was high (13/29, 45\%). A total of 129 appointments were completed, with 63.6\% (82/129) of the questionnaires being returned. Patient satisfaction at 12 months increased in both the intervention (25 points) and usual care (14 points) groups. The within-group analysis showed that the increases were significant for both intervention (P<.001) and usual care (P=.02) patients; however, the between-group difference was not significant after controlling for baseline scores (P=.10). The qualitative process evaluation showed that---according to patients---remote consultations saved time and money, were less burdensome, and caused fewer negative impacts on health. Technical problems with the software were common, and only 17\% (5/29) of patients received all appointments over video. Both consultants and patients saw remote consultations as positive and beneficial. Conclusions: Using technology to conduct routine follow-up appointments remotely may ease some of the resource and infrastructure challenges faced by the UK NHS and free up clinic space for patients who must be seen face-to-face. Our findings regarding the advantages and challenges of using remote consultations for routine follow-ups of liver transplant patients have important implications for service organization and delivery in the postpandemic NHS. Trial Registration: ISRCTN Registry 14093266; https://www.isrctn.com/ISRCTN14093266 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2953-4 ",
doi="10.2196/19232",
url="https://www.jmir.org/2021/9/e19232",
url="http://www.ncbi.nlm.nih.gov/pubmed/34533461"
}


@Article{info:doi/10.2196/18307,
author="Zhi, Lihua
and Yin, Pei
and Ren, Jingjing
and Wei, Guoqing
and Zhou, Jun
and Wu, Jun
and Shen, Qun",
title="Running an Internet Hospital in China: Perspective Based on a Case Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e18307",
keywords="internet hospitals",
keywords="telemedicine",
keywords="medical service",
keywords="medical procedures",
keywords="operation management",
keywords="network security",
doi="10.2196/18307",
url="https://www.jmir.org/2021/9/e18307",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342267"
}


@Article{info:doi/10.2196/29672,
author="Ziadni, S. Maisa
and Gonzalez-Castro, Lluvia
and Anderson, Steven
and Krishnamurthy, Parthasarathy
and Darnall, D. Beth",
title="Efficacy of a Single-Session ``Empowered Relief'' Zoom-Delivered Group Intervention for Chronic Pain: Randomized Controlled Trial Conducted During the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="10",
volume="23",
number="9",
pages="e29672",
keywords="single-session",
keywords="empowered relief",
keywords="Zoom-delivered",
keywords="pain catastrophizing",
keywords="pain intensity",
keywords="randomized-controlled trial",
keywords="chronic pain",
abstract="Background: Cognitive behavioral therapy--pain is an evidence-based treatment for chronic pain that can have significant patient burden, including health care cost, travel, multiple sessions, and lack of access in remote areas. Objective: The study aims to pilot test the efficacy of a single-session videoconference-delivered empowered relief (ER) intervention compared to waitlist control (WLC) conditions among individuals with chronic pain. We hypothesized that ER would be superior to WLC in reducing pain catastrophizing, pain intensity, and other pain-related outcomes at 1-3 months posttreatment. Methods: We conducted a randomized controlled trial involving a web-based sample of adults (N=104) aged 18-80 years with self-reported chronic pain. Participants were randomized (1:1) to 1 of 2 unblinded study groups: ER (50/104, 48.1\%) and WLC (54/104, 51.9\%). Participants allocated to ER completed a Zoom-delivered class, and all participants completed follow-up surveys at 2 weeks and 1, 2, and 3 months posttreatment. All the study procedures were performed remotely and electronically. The primary outcome was pain catastrophizing 1-month posttreatment, with pain intensity, pain bothersomeness, and sleep disruption as secondary outcomes. We also report a more rigorous test of the durability of treatment effects at 3 months posttreatment. Data were collected from September 2020 to February 2021 and analyzed using intention-to-treat analysis. The analytic data set included participants (18/101, 17.8\% clinic patients; 83/101, 82.1\% community) who completed at least one study survey: ER (50/101, 49.5\%) and WLC (51/104, 49\%). Results: Participants (N=101) were 69.3\% (70/101) female, with a mean age of 49.76 years (SD 13.90; range 24-78); 32.7\% (33/101) had an undergraduate degree and self-reported chronic pain for 3 months. Participants reported high engagement (47/50, 94\%), high satisfaction with ER (mean 8.26, SD 1.57; range 0-10), and high satisfaction with the Zoom platform (46/50, 92\%). For the between-groups factor, ER was superior to WLC for all primary and secondary outcomes at 3 months posttreatment (highest P<.001), and between-groups Cohen d effect sizes ranged from 0.45 to 0.79, indicating that the superiority was of moderate to substantial clinical importance. At 3 months, clinically meaningful pain catastrophizing scale (PCS) reductions were found for ER but not for WLC (ER: PCS ?8.72, 42.25\% reduction; WLC: PCS ?2.25, 11.13\% reduction). ER resulted in significant improvements in pain intensity, sleep disturbance, and clinical improvements in pain bothersomeness. Conclusions: Zoom-delivered ER had high participant satisfaction and very high engagement. Among adults with chronic pain, this single-session, Zoom-delivered, skills-based pain class resulted in clinically significant improvement across a range of pain-related outcomes that was sustained at 3 months. Web-based delivery of ER could allow greater accessibility of home-based pain treatment and could address the inconveniences and barriers faced by patients when attempting to receive in-person care. Trial Registration: ClinicalTrials.gov NCT04546685; https://clinicaltrials.gov/ct2/show/NCT04546685 ",
doi="10.2196/29672",
url="https://www.jmir.org/2021/9/e29672",
url="http://www.ncbi.nlm.nih.gov/pubmed/34505832"
}


@Article{info:doi/10.2196/30530,
author="Funkhouser, H. Colton
and Funkhouser, E. Martha
and Wolverton, E. Jay
and Maurer, Toby",
title="Teledermatology Consults in a County Hospital Setting: Retrospective Analysis",
journal="JMIR Dermatol",
year="2021",
month="Sep",
day="8",
volume="4",
number="2",
pages="e30530",
keywords="dermatology",
keywords="teledermatology",
keywords="telemedicine",
keywords="referrals",
keywords="primary care",
keywords="keratosis",
keywords="digital health",
keywords="skin cancer",
keywords="dermatitis",
doi="10.2196/30530",
url="https://derma.jmir.org/2021/2/e30530",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632816"
}


@Article{info:doi/10.2196/29018,
author="Park, Sulki
and Kum, Hye-Chung
and Morrisey, A. Michael
and Zheng, Qi
and Lawley, A. Mark",
title="Adherence to Telemonitoring Therapy for Medicaid Patients With Hypertension: Case Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="6",
volume="23",
number="9",
pages="e29018",
keywords="telemedicine",
keywords="hypertension",
keywords="Medicaid",
keywords="blood pressure",
keywords="pulse",
keywords="telemonitoring",
keywords="mobile phone",
abstract="Background: Almost 50\% of the adults in the United States have hypertension. Although clinical trials indicate that home blood pressure monitoring can be effective in managing hypertension, the reported results might not materialize in practice because of patient adherence problems. Objective: The aims of this study are to characterize the adherence of Medicaid patients with hypertension to daily telemonitoring, identify the impacts of adherence reminder calls, and investigate associations with blood pressure control. Methods: This study targeted Medicaid patients with hypertension from the state of Texas. A total of 180 days of blood pressure and pulse data in 2016-2018 from a telemonitoring company were analyzed for mean transmission rate and mean blood pressure change. The first 30 days of data were excluded because of startup effects. The protocols required the patients to transmit readings by a specified time daily. Patients not transmitting their readings received an adherence reminder call to troubleshoot problems and encourage transmission. The patients were classified into adherent and nonadherent cohorts; adherent patients were those who transmitted data on at least 80\% of the days. Results: The mean patient age was 73.2 (SD 11.7) years. Of the 823 patients, 536 (65.1\%) were women, and 660 (80.2\%) were urban residents. The adherent cohort (475/823, 57.7\%) had mean transmission rates of 74.9\% before the adherence reminder call and 91.3\% after the call, whereas the nonadherent cohort (348/823, 42.3\%) had mean transmission rates of 39\% and 58\% before and after the call, respectively. From month 1 to month 5, the transmission rates dropped by 1.9\% and 10.2\% for the adherent and nonadherent cohorts, respectively. The systolic and diastolic blood pressure values improved by an average of 2.2 and 0.7 mm Hg (P<.001 and P=.004), respectively, for the adherent cohort during the study period, whereas only the systolic blood pressure value improved by an average of 1.6 mm Hg (P=.02) for the nonadherent cohort. Conclusions: Although we found that patients can achieve high levels of adherence, many experience adherence problems. Although adherence reminder calls help, they may not be sufficient. Telemonitoring lowered blood pressure, as has been observed in clinical trials. Furthermore, blood pressure control was positively associated with adherence. ",
doi="10.2196/29018",
url="https://www.jmir.org/2021/9/e29018",
url="http://www.ncbi.nlm.nih.gov/pubmed/34486977"
}


@Article{info:doi/10.2196/28381,
author="Momattin, Hisham
and Arafa, Shokry
and Momattin, Shahad
and Rahal, Rayan
and Waterson, James",
title="Robotic Pharmacy Implementation and Outcomes in Saudi Arabia: A 21-Month Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="Sep",
day="1",
volume="8",
number="3",
pages="e28381",
keywords="patient satisfaction",
keywords="automation",
keywords="integration",
keywords="medication error",
keywords="outpatient",
keywords="medication management",
keywords="usability",
keywords="medication dispensing",
keywords="robotics",
keywords="pharmacy",
keywords="medication records",
keywords="error",
keywords="record",
keywords="implementation",
keywords="outcome",
abstract="Background: We describe the introduction, use, and evaluation of an automation and integration pharmacy development program in a private facility in Saudi Arabia. The project was specifically undertaken to increase throughput, reduce medication dispensing error rates, improve patient satisfaction, and free up pharmacists' time to allow for increased face-to-face consultations with patients. Objective: We forecasted growth of our outpatient service at 25\% per annum over 5- and 10-year horizons and set out to prepare our outpatient pharmacy service to meet this demand. Initial project goals were set as a 50\% reduction in the average patient wait time, a 15\% increase in patient satisfaction regarding pharmacy wait time and pharmacy services, a 25\% increase in pharmacist productivity, and zero dispensing errors. This was expected to be achieved within 10 months of go-live. Realignment of pharmacist activity toward counseling and medication review with patients was a secondary goal, along with the rapid development of a reputation in the served community for patient-centered care. Methods: Preimplementation data for patient wait time for dispensing of prescribed medications as a specific measure of patient satisfaction was gathered as part of wider ongoing data collection in this field. Pharmacist activity and productivity in terms of patient interaction time were gathered. Reported and discovered dispensing errors per 1000 prescriptions were also aggregated. All preimplementation data was gathered over an 11-month period. Results: From go-live, data were gathered on the above metrics in 1-month increments. At the 10-month point, there had been a 53\% reduction in the average wait time, a 20\% increase in patient satisfaction regarding pharmacy wait time, with a 22\% increase in overall patient satisfaction regarding pharmacy services, and a 33\% increase in pharmacist productivity. A zero dispensing error rate was reported. Conclusions: The robotic pharmacy solution studied was highly effective, but a robust upstream supply chain is vital to ensure stock levels, particularly when automated filling is planned. The automation solution must also be seamlessly and completely integrated into the facility's software systems for appointments, medication records, and prescription generation in order to garner its full benefits. Overall patient satisfaction with pharmacy services is strongly influenced by wait time and follow-up studies are required to identify how to use this positive effect and make optimal use of freed-up pharmacist time. The extra time spent by pharmacists with patients and the opportunity for complete overview of the patient's medication history, which full integration provides, may allow us to address challenging issues such as medication nonadherence. Reduced wait times may also allow for smaller prescription fill volumes, and more frequent outpatient department visits, allowing patients to have increased contact time with pharmacists. ",
doi="10.2196/28381",
url="https://humanfactors.jmir.org/2021/3/e28381",
url="http://www.ncbi.nlm.nih.gov/pubmed/34304149"
}


@Article{info:doi/10.2196/25549,
author="Quinn, Marie Lauren
and Olajide, Oluwafumbi
and Green, Marsha
and Sayed, Hazem
and Ansar, Humera",
title="Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="31",
volume="23",
number="8",
pages="e25549",
keywords="antenatal",
keywords="virtual clinic",
keywords="technology",
keywords="COVID-19",
keywords="United Kingdom",
keywords="pandemic",
keywords="feasibility",
keywords="effective",
keywords="telehealth",
keywords="virtual health",
abstract="Background: The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective: We evaluated patients' and professionals' experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods: A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62\% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82\% response rate). Results: We showed that women were highly satisfied with the virtual clinics, with 86\% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56\% (83/148) preferred face-to-face appointments, 44\% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67\% (18/27) rated their experience of virtual clinics as good or very good, 78\% (21/27) described their experience as the same or better than face-to-face clinics, 15\% (4/27) preferred virtual clinics, and 44\% (12/27) had no preference. Importantly, 67\% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90\% of HCPs agreed virtual clinics should be implemented long-term. Conclusions: Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals. ",
doi="10.2196/25549",
url="https://www.jmir.org/2021/8/e25549",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254940"
}


@Article{info:doi/10.2196/25873,
author="Khairat, Saif
and McDaniel, Phillip
and Jansen, Matthew
and Francis, Tia
and Edson, Barbara
and Gianforcaro, Robert",
title="Analysis of Social Determinants and the Utilization of Pediatric Tele--Urgent Care During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Pediatr Parent",
year="2021",
month="Aug",
day="30",
volume="4",
number="3",
pages="e25873",
keywords="telehealth",
keywords="pediatrics",
keywords="social",
keywords="determinants",
keywords="COVID-19",
keywords="use",
keywords="children",
keywords="infant",
keywords="consultation",
keywords="telemedicine",
keywords="urgent care",
keywords="vulnerable population",
keywords="cross-sectional",
keywords="minority",
abstract="Background: Telehealth is increasingly used to provide specialty consultations to infants and children receiving care. However, there is uncertainty if the COVID-19 pandemic has influenced the use of telehealth among vulnerable populations. Objective: This research aims to compare the overall use of tele--urgent care visits for pediatric patients before and after the pandemic, especially among vulnerable populations. Methods: We conducted a cross-sectional analysis of pediatric tele--urgent care visits at a virtual care center at a southeastern health care center. The main outcome of this study was the use of pediatrics tele--urgent visits across geographical regions with different levels of social disparities and between 2019 and 2020. Results: Of 584 tele--urgent care visits, 388 (66.4\%) visits occurred in 2020 during the pandemic compared to 196 (33.6\%) visits in 2019. Among 808 North Carolina zip codes, 181 (22\%) consisted of a high concentration of vulnerable populations, where 17.7\% (56/317) of the tele--urgent care visits originated from. The majority (215/317, 67.8\%) of tele--urgent care visits originated from zip codes with a low concentration of vulnerable populations. There was a significant association between the rate of COVID-19 cases and the concentration level of social factors in a given Zip Code Tabulation Area. Conclusions: The use of tele--urgent care visits for pediatric care doubled during the COVID-19 pandemic. The majority of the tele--urgent care visits after COVID-19 originated from regions where there is a low presence of vulnerable populations. In addition, our geospatial analysis found that geographic regions with a high concentration of vulnerable populations had a significantly higher rate of COVID-19--confirmed cases and deaths compared to regions with a low concentration of vulnerable populations. ",
doi="10.2196/25873",
url="https://pediatrics.jmir.org/2021/3/e25873",
url="http://www.ncbi.nlm.nih.gov/pubmed/34459742"
}


@Article{info:doi/10.2196/27977,
author="Gmunder, Nicole Kristin
and Ruiz, W. Jose
and Franceschi, Dido
and Suarez, M. Maritza",
title="Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study",
journal="JMIR Med Inform",
year="2021",
month="Aug",
day="27",
volume="9",
number="8",
pages="e27977",
keywords="telemedicine",
keywords="COVID-19",
keywords="patient portals",
keywords="delivery of health care",
keywords="telehealth",
keywords="pandemic",
keywords="digital health",
abstract="Background: With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. Objective: The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. Methods: Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. Results: Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95\% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95\% CI 0.305-0.325), provider's specialty (primary care vs medical specialty) (OR 1.514, 95\% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95\% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95\% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. Conclusions: The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider's specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff. ",
doi="10.2196/27977",
url="https://medinform.jmir.org/2021/8/e27977",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254936"
}


@Article{info:doi/10.2196/27247,
author="Shaballout, Nour
and Aloumar, Anas
and Manuel, Jorge
and May, Marcus
and Beissner, Florian",
title="Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e27247",
keywords="digital pain drawings",
keywords="visceral referred pain",
keywords="referred pain",
keywords="head zones",
keywords="mydriasis",
keywords="chest pain",
keywords="clinical examination",
keywords="differential diagnosis",
keywords="digital health",
keywords="digital drawings",
keywords="pain",
keywords="health technology",
keywords="image analysis",
abstract="Background: The differential diagnosis of acute visceral diseases is a challenging clinical problem. Older literature suggests that patients with acute visceral problems show segmental signs such as hyperalgesia, skin resistance, or muscular defense as manifestations of referred visceral pain in somatic or visceral tissues with overlapping segmental innervation. According to these sources, the lateralization and segmental distribution of such signs may be used for differential diagnosis. Segmental signs and symptoms may be accompanied by spontaneous (visceral) pain, which, however, shows a nonsegmental distribution. Objective: This study aimed to investigate the lateralization (ie, localization on one side of the body, in preference to the other) and segmental distribution (ie, surface ratio of the affected segments) of spontaneous pain and (referred) segmental signs in acute visceral diseases using digital pain drawing technology. Methods: We recruited 208 emergency room patients that were presenting for acute medical problems considered by triage as related to internal organ disease. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and spontaneous visceral pain. They were further asked their segmental symptoms such as nausea, meteorism, and urinary retention. We collected spontaneous pain and segmental signs as digital drawings and segmental symptoms as binary values on a tablet PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated mean distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters, analyzing the segmental distribution of these signs and the lateralization. Results: Of the 208 recruited patients, 110 (52.9\%) were later diagnosed with a single-organ problem. These recruited patients had a mean age of 57.3 (SD 17.2) years, and 40.9\% (85/208) were female. Of these 110 patients, 85 (77.3\%) reported spontaneous visceral pain. Of the 110, 81 (73.6\%) had at least 1 segmental sign, and the most frequent signs were hyperalgesia (46/81, 57\%), and muscle resistance (39/81, 48\%). While pain was distributed along the body midline, segmental signs for the heart, stomach, and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (37/110, 33.6\%) further showed ipsilateral mydriasis. Conclusions: This study underlines the usefulness of including digitally recorded segmental signs in bodily examinations of patients with acute medical problems. ",
doi="10.2196/27247",
url="https://www.jmir.org/2021/8/e27247",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448718"
}


@Article{info:doi/10.2196/24890,
author="Lyles, Rees Courtney
and Adler-Milstein, Julia
and Thao, Crishyashi
and Lisker, Sarah
and Nouri, Sarah
and Sarkar, Urmimala",
title="Alignment of Key Stakeholders' Priorities for Patient-Facing Tools in Digital Health: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="26",
volume="23",
number="8",
pages="e24890",
keywords="medical informatics",
keywords="medical informatics apps",
keywords="information technology",
keywords="implementation science",
keywords="mixed methods",
abstract="Background: There is widespread agreement on the promise of patient-facing digital health tools to transform health care. Yet, few tools are in widespread use or have documented clinical effectiveness. Objective: The aim of this study was to gain insight into the gap between the potential of patient-facing digital health tools and real-world uptake. Methods: We interviewed and surveyed experts (in total, n=24) across key digital health stakeholder groups---venture capitalists, digital health companies, payers, and health care system providers or leaders---guided by the Consolidated Framework for Implementation Research. Results: Our findings revealed that external policy, regulatory demands, internal organizational workflow, and integration needs often take priority over patient needs and patient preferences for digital health tools, which lowers patient acceptance rates. We discovered alignment, across all 4 stakeholder groups, in the desire to engage both patients and frontline health care providers in broader dissemination and evaluation of digital health tools. However, major areas of misalignment between stakeholder groups have stymied the progress of digital health tool uptake---venture capitalists and companies focused on external policy and regulatory demands, while payers and providers focused on internal organizational workflow and integration needs. Conclusions: Misalignment of the priorities of digital health companies and their funders with those of providers and payers requires direct attention to improve uptake of patient-facing digital health tools and platforms. ",
doi="10.2196/24890",
url="https://www.jmir.org/2021/8/e24890",
url="http://www.ncbi.nlm.nih.gov/pubmed/34435966"
}


@Article{info:doi/10.2196/26227,
author="Bae, Seul Ye
and Kim, Hwan Kyung
and Choi, Won Sae
and Ko, Taehoon
and Lim, Seo Jun
and Piao, Meihua",
title="Satisfaction and Usability of an Information and Communications Technology--Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="26",
volume="5",
number="8",
pages="e26227",
keywords="COVID-19",
keywords="mobile app",
keywords="telemedicine",
keywords="wearable device",
keywords="vital sign",
keywords="satisfaction",
keywords="usability",
abstract="Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)--based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the ``self-reporting'' item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. ",
doi="10.2196/26227",
url="https://formative.jmir.org/2021/8/e26227",
url="http://www.ncbi.nlm.nih.gov/pubmed/34254946"
}


@Article{info:doi/10.2196/26565,
author="Nies, Sarah
and Patel, Shae
and Shafer, Melissa
and Longman, Laura
and Sharif, Iman
and Pina, Paulo",
title="Understanding Physicians' Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="13",
volume="5",
number="8",
pages="e26565",
keywords="telemedicine",
keywords="federally qualified health care center",
keywords="primary care",
keywords="COVID-19",
keywords="telehealth",
keywords="physician",
keywords="doctor",
keywords="preference",
keywords="perspective",
keywords="dissemination",
keywords="appropriate",
keywords="cross-sectional",
keywords="survey",
abstract="Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. Results: Of 272 health care providers who were sent the electronic survey, 157 (58\%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80\% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91\%] vs 65/90 [72\%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95\% CI 1.7-16.2; younger age: odds ratio 1.05, 95\% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. Conclusions: The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. ",
doi="10.2196/26565",
url="https://formative.jmir.org/2021/8/e26565",
url="http://www.ncbi.nlm.nih.gov/pubmed/34227993"
}


@Article{info:doi/10.2196/30862,
author="Jambaulikar, D. Guruprasad
and Marshall, Andrew
and Hasdianda, Adrian Mohammad
and Cao, Chenzhe
and Chen, Paul
and Miyawaki, Steven
and Baugh, W. Christopher
and Zhang, Haipeng
and McCabe, Jonathan
and Su, Jennifer
and Landman, B. Adam
and Chai, Ray Peter",
title="Electronic Paper Displays in Hospital Operations: Proposal for Deployment and Implementation",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="4",
volume="5",
number="8",
pages="e30862",
keywords="electronic ink",
keywords="patient satisfaction",
keywords="display systems",
keywords="whiteboards",
keywords="hospital",
keywords="deployment",
keywords="proposal",
keywords="implementation",
keywords="communication",
keywords="engagement",
keywords="efficiency",
keywords="usage",
abstract="Background: Display signage is ubiquitous and essential in hospitals to serve several clerical, operational, and clinical functions, including displaying notices, providing directions, and presenting clinical information. These functions improve efficiency and patient engagement, reduce errors, and enhance the continuity of care. Over time, signage has evolved from analog approaches such as whiteboards and handwritten notices to digital displays such as liquid crystal displays, light emitting diodes, and, now, electronic ink displays. Electronic ink displays are paper-like displays that are not backlit and show content by aligning microencapsulated color beads in response to an applied electric current. Power is only required to generate content and not to retain it. These displays are very readable, with low eye strain; minimize the emission of blue light; require minimal power; and can be driven by several data sources, ranging from virtual servers to electronic health record systems. These attributes make adapting electronic ink displays to hospitals an ideal use case. Objective: In this paper, we aimed to outline the use of signage and displays in hospitals with a focus on electronic ink displays. We aimed to assess the advantages and limitations of using these displays in hospitals and outline the various public-facing and patient-facing applications of electronic ink displays. Finally, we aimed to discuss the technological considerations and an implementation framework that must be followed when adopting and deploying electronic ink displays. Methods: The public-facing applications of electronic ink displays include signage and way-finders, timetables for shared workspaces, and noticeboards and bulletin boards. The clinical display applications may be smaller form factors such as door signs or bedside cards. The larger, ?40-inch form factors may be used within patient rooms or at clinical command centers as a digital whiteboard to display general information, patient and clinician information, and care plans. In all these applications, such displays could replace analog whiteboards, noticeboards, and even other digital screens. Results: We are conducting pilot research projects to delineate best use cases and practices in adopting electronic ink displays in clinical settings. This will entail liaising with key stakeholders, gathering objective logistical and feasibility data, and, ultimately, quantifying and describing the effect on clinical care and patient satisfaction. Conclusions: There are several use cases in a clinical setting that may lend themselves perfectly to electronic ink display use. The main considerations to be studied in this adoption are network connectivity, content management, privacy and security robustness, and detailed comparison with existing modalities. Electronic ink displays offer a superior opportunity to future-proof existing practices. There is a need for theoretical considerations and real-world testing to determine if the advantages outweigh the limitations of electronic ink displays. ",
doi="10.2196/30862",
url="https://formative.jmir.org/2021/8/e30862",
url="http://www.ncbi.nlm.nih.gov/pubmed/34346904"
}


@Article{info:doi/10.2196/26149,
author="Zhang, Jia
and Mihai, Carina
and T{\"u}shaus, Laura
and Scebba, Gaetano
and Distler, Oliver
and Karlen, Walter",
title="Wound Image Quality From a Mobile Health Tool for Home-Based Chronic Wound Management With Real-Time Quality Feedback: Randomized Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="30",
volume="9",
number="7",
pages="e26149",
keywords="data quality",
keywords="remote assessment",
keywords="digital ulcers",
keywords="scleroderma",
keywords="mobile app",
keywords="digital health",
keywords="ehealth",
keywords="mhealth",
keywords="telemedicine",
keywords="teledermatology",
abstract="Background: Travel to clinics for chronic wound management is burdensome to patients. Remote assessment and management of wounds using mobile and telehealth approaches can reduce this burden and improve patient outcomes. An essential step in wound documentation is the capture of wound images, but poor image quality can have a negative influence on the reliability of the assessment. To date, no study has investigated the quality of remotely acquired wound images and whether these are suitable for wound self-management and telemedical interpretation of wound status. Objective: Our goal was to develop a mobile health (mHealth) tool for the remote self-assessment of digital ulcers (DUs) in patients with systemic sclerosis (SSc). We aimed to define and validate objective measures for assessing the image quality, evaluate whether an automated feedback feature based on real-time assessment of image quality improves the overall quality of acquired wound images, and evaluate the feasibility of deploying the mHealth tool for home-based chronic wound self-monitoring by patients with SSc. Methods: We developed an mHealth tool composed of a wound imaging and management app, a custom color reference sticker, and a smartphone holder. We introduced 2 objective image quality parameters based on the sharpness and presence of the color checker to assess the quality of the image during acquisition and enable a quality feedback mechanism in an advanced version of the app. We randomly assigned patients with SSc and DU to the 2 device groups (basic and feedback) to self-document their DU at home over 8 weeks. The color checker detection ratio (CCDR) and color checker sharpness (CCS) were compared between the 2 groups. We evaluated the feasibility of the mHealth tool by analyzing the usability feedback from questionnaires, user behavior and timings, and the overall quality of the wound images. Results: A total of 21 patients were enrolled, of which 15 patients were included in the image quality analysis. The average CCDR was 0.96 (191/199) in the feedback group and 0.86 (158/183) in the basic group. The feedback group showed significantly higher (P<.001) CCS compared to the basic group. The usability questionnaire results showed that the majority of patients were satisfied with the tool, but could benefit from disease-specific adaptations. The median assessment duration was <50 seconds in all patients, indicating the mHealth tool was efficient to use and could be integrated into the daily routine of patients. Conclusions: We developed an mHealth tool that enables patients with SSc to acquire good-quality DU images and demonstrated that it is feasible to deploy such an app in this patient group. The feedback mechanism improved the overall image quality. The introduced technical solutions consist of a further step towards reliable and trustworthy digital health for home-based self-management of wounds. ",
doi="10.2196/26149",
url="https://mhealth.jmir.org/2021/7/e26149",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328440"
}


@Article{info:doi/10.2196/25836,
author="Mundt, P. Adrian
and Irarr{\'a}zaval, Mat{\'i}as
and Mart{\'i}nez, Pablo
and Fern{\'a}ndez, Olga
and Mart{\'i}nez, Vania
and Rojas, Graciela",
title="Telepsychiatry Consultation for Primary Care Treatment of Children and Adolescents Receiving Child Protective Services in Chile: Mixed Methods Feasibility Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jul",
day="22",
volume="7",
number="7",
pages="e25836",
keywords="telemedicine",
keywords="psychiatry",
keywords="primary health care",
keywords="child protective services",
abstract="Background: Children and adolescents living under the supervision of child protective services have complex mental health care needs. The scarcity and uneven distribution of specialized mental health teams in Chile may limit the provision and quality of care for this vulnerable population. Telepsychiatry can address such health inequities. Objective: The objective of this study was to evaluate the feasibility of a telepsychiatry consultation program for primary health care (PHC) treatment of children and adolescents living under the supervision of child protective services. Methods: We developed a telepsychiatry consultation program for two rural PHC clinics located in central Chile (Valpara{\'i}so Region) and evaluated its implementation using a mixed methods study design. The program consisted of videoconferencing mental health consultation sessions scheduled twice per month (each 90 minutes long), over a 6-month period, delivered by child and adolescent psychiatrists based in Santiago, Chile. We described the number of mental health consultation sessions, participant characteristics, perceived usefulness and acceptability, and experiences with the telepsychiatry consultation program. Results: During the 6-month study period, 15 videoconferencing mental health consultation sessions were held. The telepsychiatry consultation program assisted PHC clinicians in assigning the most adequate diagnoses and making treatment decisions on pharmacotherapy and/or psychotherapy of 11 minors with complex care needs. The intervention was perceived to be useful by PHC clinicians for improving the resolution capacity in the treatments of this patient population. Limitations such as connectivity issues were resolved in most sessions. Conclusions: The telepsychiatry consultation program was feasible and potentially useful to support PHC clinicians in the management of institutionalized children and adolescents with complex psychosocial care needs living in a poorly resourced setting. A larger scale trial should assess clinical outcomes in the patient population. Regulations and resources for this service model are needed to facilitate sustainability and large-scale implementation. ",
doi="10.2196/25836",
url="https://publichealth.jmir.org/2021/7/e25836",
url="http://www.ncbi.nlm.nih.gov/pubmed/34292164"
}


@Article{info:doi/10.2196/24917,
author="Winward, Sam
and Patel, Tejal
and Al-Saffar, Mazin
and Noble, Matthew",
title="The Effect of 24/7, Digital-First, NHS Primary Care on Acute Hospital Spending: Retrospective Observational Analysis",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="22",
volume="23",
number="7",
pages="e24917",
keywords="primary health care",
keywords="family practice",
keywords="general practice",
keywords="cost",
keywords="cost analysis",
keywords="telemedicine",
keywords="digital technology",
keywords="digital health",
keywords="digital care",
keywords="virtual care",
keywords="hospital",
keywords="retrospective",
keywords="observational",
keywords="cohort",
keywords="finance",
keywords="economics",
keywords="health services research",
abstract="Background: Digital health has the potential to revolutionize health care by improving accessibility, patient experience, outcomes, productivity, safety, and cost efficiency. In England, the NHS (National Health Service) Long Term Plan promised the right to access digital-first primary care by March 31, 2024. However, there are few global, fully digital-first providers and limited research into their effects on cost from a health system perspective. Objective: The aim of this study was to evaluate the impact of highly accessible, digital-first primary care on acute hospital spending. Methods: A retrospective, observational analysis compared acute hospital spending on patients registered to a 24/7, digital-first model of NHS primary care with that on patients registered to all other practices in North West London Collaboration of Clinical Commissioning Groups. Acute hospital spending data per practice were obtained under a freedom of information request. Three versions of NHS techniques designed to fairly allocate funding according to need were used to standardize or ``weight'' the practice populations; hence, there are 3 results for each year. The weighting adjusted the populations for characteristics that impact health care spending, such as age, sex, and deprivation. The total spending was divided by the number of standardized or weighted patients to give the spending per weighted patient, which was used to compare the 2 groups in the NHS financial years (FY) 2018-2019 (FY18/19) and 2019-2020 (FY19/20). FY18/19 costs were adjusted for inflation, so they were comparable with the values of FY19/20. Results: The NHS spending on acute hospital care for 2.43 million and 2.54 million people (FY18/19 and FY19/20) across 358 practices and 49 primary care networks was {\textsterling}1.6 billion and {\textsterling}1.65 billion (a currency exchange rate of {\textsterling}1=US \$1.38 is applicable), respectively. The spending on acute care per weighted patient for Babylon GP at Hand members was 12\%, 31\%, and 54\% ({\textsterling}93, P=.047; {\textsterling}223, P<.001; and {\textsterling}389, P<.001) lower than the regional average in FY18/19 for the 3 weighting methodologies used. In FY19/20, it was 15\%, 35\%, and 51\% ({\textsterling}114, P=.006; {\textsterling}246, P<.001; and {\textsterling}362, P<.001) lower. This amounted to lower costs for the Babylon GP at Hand population of {\textsterling}1.37, {\textsterling}4.40 million, and {\textsterling}11.6 million, respectively, in FY18/19; and {\textsterling}3.26 million, {\textsterling}9.54 million, and {\textsterling}18.8 million, respectively, in FY19/20. Conclusions: Patients with access to 24/7, digital-first primary care incurred significantly lower acute hospital costs. ",
doi="10.2196/24917",
url="https://www.jmir.org/2021/7/e24917",
url="http://www.ncbi.nlm.nih.gov/pubmed/34292160"
}


@Article{info:doi/10.2196/27094,
author="Primholdt Christensen, Nina
and Skou, Emilie Karen
and Boe Danbj{\o}rg, Dorthe",
title="Health Care Professionals' Experiences With the Use of Video Consultation: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="21",
volume="5",
number="7",
pages="e27094",
keywords="video consultation",
keywords="hematology",
keywords="outpatient clinic",
keywords="telehealth",
keywords="doctor's perspective",
abstract="Background: The number of remote video consultations between doctors and patients has increased during the last few years and especially during the COVID-19 pandemic. The health care service is faced with rising rates of chronic illness and many patients who are more confident in self-management of their illnesses. In addition, there is an improved long-term outlook for serious conditions, such as cancer, that might require flexibility in everyday life. Objective: This study aimed to investigate how medical doctors in the outpatient clinic use and experience the use of video consultations with hematological patients, with a focus on relational and organizational aspects. Methods: The study was designed as an explorative and qualitative study. Data were collected via participant observations and focus group interviews with medical doctors. Results: The study identified possibilities and barriers in relation to adapting to the alternative way of meeting patients in the clinical setting. One of the main findings in this study is that the medical doctors were afraid that they missed important observations, as they were not able to perform a physical examination, if needed. They also emphasized that handshake and eye contact were important in order to get an overall impression of the patient's situation. It also became clear that the medical doctors used body language a lot more during video consultation compared with consultation in a physical setting. The medical doctors found the contact with the patients via the screen to be good, and the fact that the technology was working well made them feel comfortable with the video consultation. Conclusions: In this study, we found that the medical doctors were able to maintain good contact with the patients despite the screen and were able to assess the patients in a satisfying manner. However, there were still uncertainties among some doctors about the fact that they could not examine the patients physically. New knowledge about how to use gestures and body language during video consultation was obtained. ",
doi="10.2196/27094",
url="https://formative.jmir.org/2021/7/e27094",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287207"
}


@Article{info:doi/10.2196/24274,
author="Shen, Nelson
and Jankowicz, Damian
and Strudwick, Gillian",
title="Patient and Family Engagement Approaches for Digital Health Initiatives: Protocol for a Case Study",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="21",
volume="10",
number="7",
pages="e24274",
keywords="digital health",
keywords="patient engagement",
keywords="case study",
keywords="patient and family engagement",
keywords="mental health",
abstract="Background: Digital health initiatives such as patient portals, virtual care platforms, and smartphone-based apps are being implemented at a rapid pace in health care organizations worldwide. This is often done to improve access beyond traditional in-person care and enhance care quality. Recent studies have indicated that better outcomes of using these initiatives and technologies may be achieved when patients and their family members are engaged in all aspects of planning, implementation, use, and evaluation. However, little guidance exists for how health care administrators can achieve effective engagement in digital health initiatives specifically. Objective: The objective of this study is to document processes related to planning and implementing patient and family engagement (PFE) in digital health initiatives. This information will be used to develop tangible resources (eg, a field guide) that other organizations can use to implement PFE approaches for digital health initiatives in their organizations. Methods: A previously developed multidimensional conceptual framework for PFE in health and health care contexts will be used to guide this work. To understand the intricacies involved in using PFE approaches in digital health strategies, a case study will be conducted. More specifically, this work will employ an embedded single-case design with PFE in digital health initiatives at a large Canadian mental health and addictions teaching hospital. Multiple digital health projects being undertaken at the study site will be explored to better understand where the PFE is intended to support the design, implementation, and operation of the digital health platform or technology. These projects will form the individual units of analysis. Data collection will involve field notes and artifact collection by a participant observer and interviews with the various digital health project teams. Data analysis will include a content and thematic analysis, triangulation of the findings, and a chronological mapping of data to a PFE process. Results: Funding for this work was provided by the Canadian Institutes of Health Research (CIHR), via a Health System Impact Fellowship. As of August 2020, digital health projects that will form the case study units have been identified, and the participant observer has started to embed themselves into these projects. Although the development and collection of field notes and artifacts, respectively, have begun, interviews have not been conducted. The study is expected to conclude in September 2021. Once this study is complete, the development of a field guide and resources to support the uptake of PFE strategies in digital health will begin. Conclusions: By better understanding the processes involved in PFE in digital health projects, guidance can be provided to relevant stakeholders and organizations about how to do this work in an effective manner. It is then anticipated that with the increasing use of PFE approaches, there may be improved uptake, experience, and outcomes associated with using digital health technologies. International Registered Report Identifier (IRRID): PRR1-10.2196/24274 ",
doi="10.2196/24274",
url="https://www.researchprotocols.org/2021/7/e24274",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287212"
}


@Article{info:doi/10.2196/26030,
author="Haun, N. Jolie
and Paykel, Jacquelyn
and Melillo, Christine",
title="Transforming Health and Resiliency Through Integration of Values-based Experiences: Implementation of an Electronic Evidence-based Whole Health Clinical Program",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="29",
volume="5",
number="6",
pages="e26030",
keywords="virtual care",
keywords="group medical appointment",
keywords="complementary and integrative health",
keywords="veteran",
keywords="implementation",
abstract="Background: Complementary and integrative health (CIH) is the foundation of the Department of Veterans Affairs (VA) Whole Health System program (WH), including Transforming Health and Resiliency through Integration of Values-based Experiences (THRIVE). The global COVID-19 pandemic prompted an urgent need to provide services such as THRIVE while following guidelines for social distancing. Objective: The objective of this paper was to describe the systematic implementation of THRIVE using an electronic delivery model. Methods: The study involved an observational clinical program implementation project using the RE-AIM framework to contextualize the implementation strategies and results, and then the implementation of an electronically delivered CIH group medical appointment program (eTHRIVE). Results: Clinical staff transitioned to 100\% electronic delivery of the THRIVE curriculum using the new eTHRIVE delivery model. The current electronic delivery model, eTHRIVE, has effectively enrolled 10-12 veterans per cohort, with 8 cohorts, totaling 87 veterans to date. eTHRIVE attrition has been 6\% (5/87) since initiation. Conclusions: The current climate of the VA WH programmatic initiative combined with the public health needs during a global pandemic prompted the move of THRIVE program into an electronic format to broaden scalability and reach. ",
doi="10.2196/26030",
url="https://formative.jmir.org/2021/6/e26030",
url="http://www.ncbi.nlm.nih.gov/pubmed/34184996"
}


@Article{info:doi/10.2196/26505,
author="Aminoff, Hedvig
and Meijer, Sebastiaan
and Arnelo, Urban
and Groth, Kristina",
title="Modeling the Implementation Context of a Telemedicine Service: Work Domain Analysis in a Surgical Setting",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="21",
volume="5",
number="6",
pages="e26505",
keywords="telemedicine",
keywords="telementoring",
keywords="implementation context",
keywords="surgical guidance",
keywords="health technology",
keywords="usability",
keywords="work domain analysis",
keywords="cognitive work analysis",
abstract="Background: A telemedicine service enabling remote surgical consultation had shown promising results. When the service was to be scaled up, it was unclear how contextual variations among different clinical sites could affect the clinical outcomes and implementation of the service. It is generally recognized that contextual factors and work system complexities affect the implementation and outcomes of telemedicine. However, it is methodologically challenging to account for context in complex health care settings. We conducted a work domain analysis (WDA), an engineering method for modeling and analyzing complex work environments, to investigate and represent contextual influences when a telemedicine service was to be scaled up to multiple hospitals. Objective: We wanted to systematically characterize the implementation contexts at the clinics participating in the scale-up process. Conducting a WDA would allow us to identify, in a systematic manner, the functional constraints that shape clinical work at the implementation sites and set the sites apart. The findings could then be valuable for informed implementation and assessment of the telemedicine service. Methods: We conducted observations and semistructured interviews with a variety of stakeholders. Thematic analysis was guided by concepts derived from the WDA framework. We identified objects, functions, priorities, and values that shape clinical procedures. An iterative ``discovery and modeling'' approach allowed us to first focus on one clinic and then readjust the scope as our understanding of the work systems deepened. Results: We characterized three sets of constraints (ie, facets) in the domain: the treatment facet, administrative facet (providing resources for procedures), and development facet (training, quality improvement, and research). The constraints included medical equipment affecting treatment options; administrative processes affecting access to staff and facilities; values and priorities affecting assessments during endoscopic retrograde cholangiopancreatography; and resources for conducting the procedure. Conclusions: The surgical work system is embedded in multiple sets of constraints that can be modeled as facets of the system. We found variations between the implementation sites that might interact negatively with the telemedicine service. However, there may be enough motivation and resources to overcome these initial disruptions given that values and priorities are shared across the sites. Contrasting the development facets at different sites highlighted the differences in resources for training and research. In some cases, this could indicate a risk that organizational demands for efficiency and effectiveness might be prioritized over the long-term outcomes provided by the telemedicine service, or a reduced willingness or ability to accept a service that is not yet fully developed or adapted. WDA proved effective in representing and analyzing these complex clinical contexts in the face of technological change. The models serve as examples of how to analyze and represent a complex sociotechnical context during telemedicine design, implementation, and assessment. ",
doi="10.2196/26505",
url="https://formative.jmir.org/2021/6/e26505",
url="http://www.ncbi.nlm.nih.gov/pubmed/34152278"
}


@Article{info:doi/10.2196/27823,
author="Polsky, Michael
and Moraveji, Neema",
title="Early Identification of COVID-19 Infection Using Remote Cardiorespiratory Monitoring: Three Case Reports",
journal="Interact J Med Res",
year="2021",
month="Jun",
day="16",
volume="10",
number="2",
pages="e27823",
keywords="COVID-19",
keywords="remote patient monitoring",
keywords="wearable sensors",
keywords="monitoring",
keywords="case study",
keywords="preidentification",
keywords="lung",
keywords="data collection",
keywords="respiration",
keywords="prediction",
abstract="Background: The adoption of remote patient monitoring (RPM) in routine medical care requires increased understanding of the physiologic changes accompanying disease development and the proactive interventions that will improve outcomes. Objective: The aim of this study is to present three case reports that highlight the capability of RPM to enable early identification of viral infection with COVID-19 in patients with chronic respiratory disease. Methods: Patients at a large pulmonary practice who were enrolled in a respiratory RPM program and who had contracted COVID-19 were identified. The RPM system (Spire Health) contains three components: (1) Health Tags (Spire Health), undergarment waistband-adhered physiologic monitors that include a respiratory rate sensor; (2) an app on a smartphone; and (3) a web dashboard for use by respiratory therapists. The physiologic data of 9 patients with COVID out of 1000 patients who were enrolled for monitoring were retrospectively reviewed, and 3 instances were identified where the RPM system had notified clinicians of physiologic deviation due to the viral infection. Results: Physiologic deviations from respective patient baselines occurred during infection onset and, although the infection manifested differently in each case, were identified by the RPM system. In the first case, the patient was symptomatic; in the second case, the patient was presymptomatic; and in the third case, the patient varied from asymptomatic to mildly symptomatic. Conclusions: RPM systems intended for long-term use and that use patient-specific baselines can highlight physiologic changes early in the course of acute disease, such as COVID-19 infection. These cases demonstrate opportunities for earlier diagnosis, treatment, and isolation. This study supports the need for further research into how RPM can be effectively integrated into clinical practice. ",
doi="10.2196/27823",
url="https://www.i-jmr.org/2021/2/e27823",
url="http://www.ncbi.nlm.nih.gov/pubmed/34086588"
}


@Article{info:doi/10.2196/27940,
author="Koppel, D. Paula
and De Gagne, C. Jennie",
title="Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="14",
volume="10",
number="6",
pages="e27940",
keywords="nursing",
keywords="oncology ambulatory care",
keywords="provider-patient relationship",
keywords="rapport",
keywords="telehealth",
keywords="videoconferencing visits",
abstract="Background: Telehealth videoconferencing has largely been embraced by health care providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests that videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships exist across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, and body language to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, evidence regarding the effects of these strategies on rapport and clinical care outcomes is lacking. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. Objective: This study aims to investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. The objectives include exploring how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and similarities and differences identified by patients with cancer and nurses between experiences of rapport in videoconferencing and in-person visits. Methods: Semistructured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate an understanding of the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, although not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, and the team will maintain a detailed audit trail of analytical decisions. In addition, member checking will enhance the rigor of the study. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side by side in the final analysis to provide a comparative analysis. Data management and analysis will be performed using NVivo 12. Results: Data collection will begin during summer 2021, with results from the data analysis anticipated by winter 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. Conclusions: This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted in videoconferencing telehealth visits, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits. International Registered Report Identifier (IRRID): PRR1-10.2196/27940 ",
doi="10.2196/27940",
url="https://www.researchprotocols.org/2021/6/e27940",
url="http://www.ncbi.nlm.nih.gov/pubmed/34125073"
}


@Article{info:doi/10.2196/25787,
author="Iftikhar, Aleeha
and Bond, R. Raymond
and McGilligan, Victoria
and Leslie, J. Stephen
and Rjoob, Khaled
and Knoery, Charles
and Quigg, Ciara
and Campbell, Ryan
and Boyd, Kyle
and McShane, Anne
and Peace, Aaron",
title="Comparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study",
journal="JMIR Hum Factors",
year="2021",
month="May",
day="26",
volume="8",
number="2",
pages="e25787",
keywords="digital forms",
keywords="health care",
keywords="usability evaluation",
keywords="single-page form",
keywords="multipage form",
keywords="conversational forms",
abstract="Background: Even in the era of digital technology, several hospitals still rely on paper-based forms for data entry for patient admission, triage, drug prescriptions, and procedures. Paper-based forms can be quick and convenient to complete but often at the expense of data quality, completeness, sustainability, and automated data analytics. Digital forms can improve data quality by assisting the user when deciding on the appropriate response to certain data inputs (eg, classifying symptoms). Greater data quality via digital form completion not only helps with auditing, service improvement, and patient record keeping but also helps with novel data science and machine learning research. Although digital forms are becoming more prevalent in health care, there is a lack of empirical best practices and guidelines for their design. The study-based hospital had a definite plan to abolish the paper form; hence, it was not necessary to compare the digital forms with the paper form. Objective: This study aims to assess the usability of three different interactive forms: a single-page digital form (in which all data input is required on one web page), a multipage digital form, and a conversational digital form (a chatbot). Methods: The three digital forms were developed as candidates to replace the current paper-based form used to record patient referrals to an interventional cardiology department (Cath-Lab) at Altnagelvin Hospital. We recorded usability data in a counterbalanced usability test (60 usability tests: 20 subjects{\texttimes}3 form usability tests). The usability data included task completion times, System Usability Scale (SUS) scores, User Experience Questionnaire data, and data from a postexperiment questionnaire. Results: We found that the single-page form outperformed the other two digital forms in almost all usability metrics. The mean SUS score for the single-page form was 76 (SD 15.8; P=.01) when compared with the multipage form, which had a mean score of 67 (SD 17), and the conversational form attained the lowest scores in usability testing and was the least preferred choice of users, with a mean score of 57 (SD 24). An SUS score of >68 was considered above average. The single-page form achieved the least task completion time compared with the other two digital form styles. Conclusions: In conclusion, the digital single-page form outperformed the other two forms in almost all usability metrics; it had the least task completion time compared with those of the other two digital forms. Moreover, on answering the open-ended question from the final customized postexperiment questionnaire, the single-page form was the preferred choice. ",
doi="10.2196/25787",
url="https://humanfactors.jmir.org/2021/2/e25787",
url="http://www.ncbi.nlm.nih.gov/pubmed/34037531"
}


@Article{info:doi/10.2196/25371,
author="Lorenz, Arnold Kent
and Yeshurun, Shlomo
and Aziz, Richard
and Ortiz-Delatorre, Julissa
and Bagley, Robert James
and Mor, Merav
and Kern, Marialice",
title="A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study",
journal="Interact J Med Res",
year="2021",
month="May",
day="17",
volume="10",
number="2",
pages="e25371",
keywords="resting metabolic rate",
keywords="Lumen",
keywords="ParvoMedics TrueOne 2400",
keywords="validation",
keywords="respiratory exchange ratio",
keywords="metabolism",
keywords="fuel utilization",
keywords="indirect calorimetry",
keywords="breath",
keywords="lung",
keywords="respiratory",
keywords="young adult",
keywords="measurement",
keywords="testing",
abstract="Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as \% CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen \% CO2. Results: Both RER and Lumen \% CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. ",
doi="10.2196/25371",
url="https://www.i-jmr.org/2021/2/e25371",
url="http://www.ncbi.nlm.nih.gov/pubmed/33870899"
}


@Article{info:doi/10.2196/20183,
author="Bristowe, Kristina Sean
and Ghosh, Monty Sumantra
and Trew, Michael
and 
and Rittenbach, Katherine",
title="Virtual Overdose Response for People Who Use Opioids Alone: Protocol for a Feasibility and Clinical Trial Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="12",
volume="10",
number="5",
pages="e20183",
keywords="harm reduction",
keywords="opioid crisis",
keywords="overdose response",
keywords="people with lived experience",
keywords="peers",
abstract="Background: A recent quarterly report released by Alberta Health reports that on average 2.5 Albertans die every day from accidental overdose deaths, and that between April 1, 2020, and June 30, 2020, the province lost a total of 301 people. In Canada, between January 2016 and March 2020, a total of 16,364 people died due to opioid-related overdose. The World Health Organization reports that 70\% of the 0.5 million deaths worldwide caused by drugs are related to opioid overdose. Although supervised consumption sites or safe injection sites have been shown to be effective in reducing the harms associated with the use of illicit substances and increasing uptake of addiction treatment and other health services, there is still significant stigma associated with them, and it is unlikely that all of the people who would benefit from supervised consumption service will ever access a site. Objective: To help prevent deaths in populations that cannot or will not access physical safer consumption services in Alberta, we propose to provide virtual (telephone-based) overdose response services, staffed by people with lived experience.The primary outcome for this study is uptake of the service as measured by the number of calls to the service. Secondary outcomes will include patterns of use of the phone line (days of the week and time of calls) and outcomes from the calls (number of emergency medical services dispatches for overdoses from the service and the results of those dispatches). Methods: This phase 1 clinical study is set to officially launch in early May 2020. The service will be available to up to 15 participants who self-disclose as using opioids unobserved and have given informed consent for both data collection and interviews. This group will have access to a toll-free telephone number and be invited to call when they plan to use opioids alone. Results: The analysis will include mixed methods. To improve the design of the service and ensure safety of all involved, quantitative data will be collected on phone calls and participant health care usage, while qualitative data will be collected from both participants and virtual overdose response operators Conclusions: This clinical trial aims to test the feasibility of a service that provides virtual overdose response in order to help prevent deaths in populations that cannot or will not access physical supervised consumption services in Alberta. Trial Registration: ClinicalTrials.gov NCT04391192; https://www.clinicaltrials.gov/ct2/show/NCT04391192 International Registered Report Identifier (IRRID): DERR1-10.2196/20183 ",
doi="10.2196/20183",
url="https://www.researchprotocols.org/2021/5/e20183",
url="http://www.ncbi.nlm.nih.gov/pubmed/33978598"
}


@Article{info:doi/10.2196/24118,
author="Haque, Naim Saira
and DeStefano, Sydney
and Banger, Alison
and Rutledge, Regina
and Romaire, Melissa",
title="Factors Influencing Telehealth Implementation and Use in Frontier Critical Access Hospitals: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="5",
volume="5",
number="5",
pages="e24118",
keywords="telehealth",
keywords="rural health",
keywords="health IT",
keywords="telemedicine",
keywords="virtual care",
abstract="Background: Telehealth has potential to help individuals in rural areas overcome geographical barriers and to improve access to care. The factors that influence the implementation and use of telehealth in critical access hospitals are in need of exploration. Objective: The aim of this study is to understand the factors that influenced telehealth uptake and use in a set of frontier critical access hospitals in the United States. Methods: This work was conducted as part of a larger evaluation of a Centers for Medicare \& Medicaid Services--funded demonstration program to expand cost-based reimbursement for services for Medicare beneficiaries for frontier critical access hospitals. Our sample was 8 critical access hospitals in Montana, Nevada, and North Dakota that implemented the telehealth aspect of that demonstration. We reviewed applications and progress reports for the demonstration program and conducted in-person site visits. We used a semistructured discussion guide to facilitate conversations with clinical, administrative, and information technology staff. Using NVivo software (QSR International), we coded the notes from the interviews and then analyzed the themes. Results: Several factors influenced the implementation and use of telehealth in critical access hospitals, including making changes to workflow and infrastructure as well as practitioner acceptance and availability. Participants also cited technical assistance and support for implementation as supportive factors. Conclusions: Frontier critical access hospitals may adopt telehealth to overcome challenges such as distance from specialty practitioners and workforce challenges. Telehealth can be used for provider-to-patient and provider-to-provider interactions to improve access to care, remove barriers, and improve quality. However, the ability of telehealth to improve outcomes is limited by factors such as workflow and infrastructure changes, practitioner acceptance and availability, and financing. ",
doi="10.2196/24118",
url="https://formative.jmir.org/2021/5/e24118",
url="http://www.ncbi.nlm.nih.gov/pubmed/33949958"
}


@Article{info:doi/10.2196/25541,
author="Mahoney, Christopher Martin
and Park, Eunhee
and Schlienz, J. Nicolas
and Duerr, CeCe
and Hawk, W. Larry",
title="Transitioning to Remote Clinic Visits in a Smoking Cessation Trial During the COVID-19 Pandemic: Mixed Methods Evaluation",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="30",
volume="5",
number="4",
pages="e25541",
keywords="smoking",
keywords="cessation",
keywords="clinical trial",
keywords="telehealth",
keywords="COVID-19",
keywords="coronavirus",
keywords="telemedicine",
keywords="conferencing",
keywords="mixed methods",
keywords="experience",
keywords="patient",
abstract="Background: The pandemic of SARS-CoV-2, which causes COVID-19, has caused disruptions in ongoing clinical trials and is expected to accelerate interest in conducting research studies remotely. Objective: A quasi-experimental, mixed methods approach was used to examine the rates of visit completion as well as the opinions and experiences of participants enrolled in an ongoing clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or telephone conferencing due to the COVID-19 pandemic. Methods: For quantitative comparisons, we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, COVID-19 cohort) to a comparable cohort of participants followed over a similar time period in the calendar years 2018 and 2019 (n=51, pre--COVID-19 cohort) to examine the rates of completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from in-person to remote visits. Results: Participants in the COVID-19 cohort completed an average of 83.6\% of remote clinic visits (95\% CI 73.1\%-91.2\%), which was not significantly different than the in-person completion rate of 89.8\% in the pre--COVID-19 cohort. Participants in the COVID-19 cohort returned an average of 93.2\% (95\% CI 83.5\%-98.1\%) of saliva specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100\% in the pre--COVID-19 cohort. Two broad themes emerged from the qualitative data: (1) the benefits of remote visits and (2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most participants expressed a willingness to engage in remote visits in the future. Conclusions: Even in the context of a rapid transition from in-person to remote visits necessitated by the COVID-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes may impact study outcomes. Trial Registration: ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/study/NCT03262662 ",
doi="10.2196/25541",
url="https://formative.jmir.org/2021/4/e25541",
url="http://www.ncbi.nlm.nih.gov/pubmed/33878020"
}


@Article{info:doi/10.2196/28314,
author="Bentvelsen, Gerard Robbert
and Veldkamp, Ellen Karin
and Chavannes, H. Niels",
title="A Smartphone App for Engaging Patients With Catheter-Associated Urinary Tract Infections: Protocol for an Interrupted Time-Series Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="23",
volume="10",
number="3",
pages="e28314",
keywords="catheter-associated urinary tract infections",
keywords="infection control",
keywords="patient empowerment",
keywords="urinary catheter",
keywords="eHealth",
abstract="Background: Catheter-associated urinary tract infections (CAUTIs) are the main cause of health care--associated infections, and they increase the disease burden, antibiotic usage, and hospital stay. Inappropriate placement and unnecessarily prolonged usage of a catheter lead to an elevated and preventable risk of infection. The smartphone app Participatient has been developed to involve hospitalized patients in communication and decision-making related to catheter use and to control unnecessary (long-term) catheter use to prevent CAUTIs. Sustained behavioral changes for infection prevention can be promoted by empowering patients through Participatient. Objective: The primary aim of our multicenter prospective interrupted time-series analysis is to reduce inappropriate catheter usage by 15\%. We will evaluate the efficacy of Participatient in this quality improvement study in clinical wards. Our secondary endpoints are to reduce CAUTIs and to increase patient satisfaction, involvement, and trust with health care services. Methods: We will conduct a multicenter interrupted time-series analysis---a strong study design when randomization is not feasible---consisting of a pre- and postintervention point-prevalence survey distributed among participating wards to investigate the efficacy of Participatient in reducing the inappropriate usage of catheters. After customizing Participatient to the wards' requirements, it will be implemented with a catheter indication checklist among clinical wards in 4 large hospitals in the Netherlands. We will collect clinical data every 2 weeks for 6 months in the pre- and postintervention periods. Simultaneously, we will assess the impact of Participatient on patient satisfaction with health care services and providers and the patients' perceived involvement in health care through questionnaires, and the barriers and facilitators of eHealth implementation through interviews with health care workers. Results: To reduce the inappropriate use of approximately 40\% of catheters (currently in use) by 15\%, we aim to collect 9-12 data points from 70-100 patients per survey date per hospital. Thereafter, we will conduct an interrupted time-series analysis and present the difference between the unadjusted and adjusted rate ratios with a corresponding 95\% CI. Differences will be considered significant when P<.05. Conclusions: Our protocol may help reduce the inappropriate use of catheters and subsequent CAUTIs. By sharing reliable information and daily checklists with hospitalized patients via an app, we aim to provide them a tool to be involved in health care--related decision-making and to increase the quality of care. Trial Registration: Netherlands Trial Register NL7178; https://www.trialregister.nl/trial/7178 International Registered Report Identifier (IRRID): DERR1-10.2196/28314 ",
doi="10.2196/28314",
url="https://www.researchprotocols.org/2021/3/e28314",
url="http://www.ncbi.nlm.nih.gov/pubmed/33755026"
}


@Article{info:doi/10.2196/15443,
author="Boet, Sylvain
and Etherington, Cole
and Lam, Sandy
and L{\^e}, Maxime
and Proulx, Laurie
and Britton, Meghan
and Kenna, Julie
and Przybylak-Brouillard, Antoine
and Grimshaw, Jeremy
and Grantcharov, Teodor
and Singh, Sukhbir",
title="Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="16",
volume="23",
number="3",
pages="e15443",
keywords="patient safety",
keywords="implementation science",
keywords="quality improvement",
keywords="health personnel",
keywords="operating rooms",
abstract="Background: A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective: We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods: Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results: During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions: This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients. ",
doi="10.2196/15443",
url="https://www.jmir.org/2021/3/e15443",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724199"
}


@Article{info:doi/10.2196/25505,
author="Husain, Amna
and Cohen, Eyal
and Dubrowski, Raluca
and Jamieson, Trevor
and Kurahashi, Miyoshi Allison
and Lokuge, Bhadra
and Rapoport, Adam
and Saunders, Stephanie
and Stasiulis, Elaine
and Stinson, Jennifer
and Subramaniam, Saranjah
and Wegier, Pete
and Barwick, Melanie",
title="A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="3",
volume="23",
number="3",
pages="e25505",
keywords="coordination of care",
keywords="complexity",
keywords="internet communication technology",
keywords="collaborative care",
keywords="implementation science",
keywords="theory of behavior",
keywords="interprofessional team",
keywords="patient engagement",
keywords="social networking technology",
keywords="user-centered design",
keywords="Consolidated Framework for Implementation Research",
keywords="Quality Improvement Framework",
keywords="Implementation Outcome Taxonomy",
abstract="Background: Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. Objective: The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. Methods: The study was a hybrid type II mixed methods design to simultaneously evaluate Loop's clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. Results: We recruited 25 initiating health care providers  across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop's potential value for engaging the patient and caregiver, and for improving communication within the patient's circle of care, Loop's relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. Conclusions: Fundamental structural and implementation challenges persist toward realizing Loop's potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication. ",
doi="10.2196/25505",
url="https://www.jmir.org/2021/3/e25505",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656445"
}


@Article{info:doi/10.2196/17672,
author="Tian, Jaminal Peter George
and Harris, Richard Jeffrey
and Seikaly, Hadi
and Chambers, Thane
and Alvarado, Sara
and Eurich, Dean",
title="Characteristics and Outcomes of Physician-to-Physician Telephone Consultation Programs: Environmental Scan",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="23",
volume="5",
number="2",
pages="e17672",
keywords="telephone consultations",
keywords="teleconsultations",
keywords="remote consultations",
keywords="telemedicine",
keywords="eHealth",
keywords="environmental scan",
abstract="Background: Telephone consultations between physicians provide quick access to medical advice, allowing patients to be cared for by calling physicians in their local settings. Objective: As part of a quality assurance study of a physician-to-physician consultation program in Alberta, Canada, this environmental scan aims to identify the characteristics and outcomes of physician-to-physician telephone consultation programs across several countries. Methods: We searched 7 databases to identify English publications in 2007-2017 describing physician-to-physician consultations using telephones as the main technology. To identify Canadian programs, the literature search was supplemented with an additional internet search. Results: The literature search yielded 2336 citations, of which 17 publications were included. Across 7 countries, 14 telephone consultation programs provided primary care providers with access to various specialists through hotlines, paging systems, or call centers. The programs reported on the avoidance of hospitalizations, emergency department visits and specialty visits, caller satisfaction with the telephone consultation, and cost avoidance. Conclusions: Telephone consultation programs between health care providers have facilitated access to specialist care and prevented acute care use.\emspace ",
doi="10.2196/17672",
url="https://formative.jmir.org/2021/2/e17672",
url="http://www.ncbi.nlm.nih.gov/pubmed/33620325"
}


@Article{info:doi/10.2196/26190,
author="Hull, D. Thomas
and Levine, Jacob
and Bantilan, Niels
and Desai, N. Angel
and Majumder, S. Maimuna",
title="Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="9",
volume="5",
number="2",
pages="e26190",
keywords="digital phenotyping",
keywords="COVID-19",
keywords="telehealth",
keywords="digital mental health",
keywords="natural language processing",
keywords="machine learning",
keywords="mental health",
keywords="phenotyping",
keywords="burden",
keywords="treatment",
keywords="symptom",
abstract="Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients' pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19--related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. ",
doi="10.2196/26190",
url="http://formative.jmir.org/2021/2/e26190/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502999"
}


@Article{info:doi/10.2196/14378,
author="Depp, Colin
and Ehret, Blaire
and Villa, Jennifer
and Perivoliotis, Dimitri
and Granholm, Eric",
title="A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="8",
volume="10",
number="2",
pages="e14378",
keywords="prevention",
keywords="mental health services",
keywords="psychosis",
keywords="technology",
abstract="Background: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378 ",
doi="10.2196/14378",
url="https://www.researchprotocols.org/2021/2/e14378",
url="http://www.ncbi.nlm.nih.gov/pubmed/33555265"
}


@Article{info:doi/10.2196/15598,
author="O'Cathail, Micheal
and Aznar-Garcia, Luis
and Sivanandan, Ananth
and Diver, Claire
and Patel, Poulam
and Tang, Pui-Shan
and Christian, Judith",
title="Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="5",
volume="5",
number="2",
pages="e15598",
keywords="telemedicine",
keywords="teleconsultations",
keywords="brain metastases",
keywords="stereotactic radiosurgery",
keywords="mobile phone",
abstract="Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2\%) were new patient appointments and 73 (61.3\%) were follow-ups. Of the 69 patients, 24 (35\%) took part in teleconsultations (41/119, 34.5\%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of {\textsterling}441.48 (US \$599.83) to {\textsterling}10.78 (US \$14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. ",
doi="10.2196/15598",
url="http://formative.jmir.org/2021/2/e15598/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33544082"
}


@Article{info:doi/10.2196/25495,
author="Laukka, Elina
and P{\"o}lkki, Tarja
and Heponiemi, Tarja
and Kaihlanen, Anu-Marja
and Kanste, Outi",
title="Leadership in Digital Health Services: Protocol for a Concept Analysis",
journal="JMIR Res Protoc",
year="2021",
month="Feb",
day="4",
volume="10",
number="2",
pages="e25495",
keywords="health care",
keywords="leadership",
keywords="health services",
keywords="concept analysis",
keywords="telehealth",
abstract="Background: Due to the rapid digitalization of health care, leadership is becoming more complex. Leadership in digital health services is a term that has been used in the literature with various meanings. Conceptualization of leadership in digital health services is needed to deliver higher quality digital health services, update existing leadership practices, and advance research. Objective: The aim of this study is to outline a concept analysis that aims to clarify and define the concept of leadership in digital health services. Methods: The concept analysis will be performed using the Walker and Avant model, which involves eight steps: concept selection, determination of aims, identification of uses, determination of defining attributes, construction of a model case, construction of additional cases, identification of antecedents and consequences, and definition of empirical referents. A scoping literature search will be performed following the search protocol for scoping reviews by the Joanna Briggs Institute to identify all relevant literature on leadership in digital health services. Searches will be conducted in 6 scientific databases (CINAHL, MEDLINE, Scopus, ProQuest, Web of Science, and the Finnish database Medic), and unpublished studies and gray literature will be searched using Google Scholar, EBSCO Open Dissertations, and MedNar. Results: An initial limited search of MEDLINE was undertaken on October 19, 2020, resulting in 883 records. The results of the concept analysis will be submitted for publication by July 2021. Conclusions: A robust conceptualization of leadership in digital health services is needed to support research, leadership, and education. The concept analysis model of Walker and Avant will be used to meet this need. As leadership in digital health services appears to be an interprofessional and intersectoral collaboration, defining this concept may also facilitate collaboration between professionals and sectors. The concept analysis to be conducted will also expand our understanding of leadership in digital health services. International Registered Report Identifier (IRRID): PRR1-10.2196/25495 ",
doi="10.2196/25495",
url="http://www.researchprotocols.org/2021/2/e25495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33538702"
}


@Article{info:doi/10.2196/21825,
author="Xu, Xingyan
and Cai, Yingying
and Wu, Siying
and Guo, Jianhui
and Yang, Le
and Lan, Jieli
and Sun, Yi
and Wang, Bingbing
and Wu, Jieyu
and Wang, Tinggui
and Huang, Shuna
and Lin, Yawen
and Hu, Yuduan
and Chen, Mingjun
and Gao, Xuecai
and Xie, Xiaoxu",
title="Assessment of Internet Hospitals in China During the COVID-19 Pandemic: National Cross-Sectional Data Analysis Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="20",
volume="23",
number="1",
pages="e21825",
keywords="internet hospital",
keywords="COVID-19",
keywords="prevention",
keywords="control",
keywords="health care",
keywords="China",
keywords="cross-sectional",
keywords="digital health",
keywords="accessibility",
abstract="Background: Internet hospitals in China are being rapidly developed as an innovative approach to providing health services. The ongoing COVID-19 pandemic has triggered the development of internet hospitals that promote outpatient service delivery to the public via internet technologies. To date, no studies have assessed China's internet hospitals during the COVID-19 pandemic. Objective: This study aimed to elucidate the characteristics of China's internet hospitals and assess the health service capacity of these hospitals. Methods: Data on 711 internet hospitals were collected from official websites, the WeChat (Tencent Inc) platform, smartphone apps, and the Baidu search engine until July 16, 2020. Results: As of July 16, 2020, 711 internet hospitals were developed in mainland China. More than half of these internet hospitals (421/711, 59.2\%) were established during 2019 (206/711, 29\%) and 2020 (215/711, 30.2\%). Furthermore, about one-third (215/711, 30.2\%) of internet hospitals were established at the beginning of 2020 as an emergency response to the COVID-19 epidemic. The 711 internet hospitals consisted of the following 3 types of hospitals: government-oriented (42/711, 5.91\%), hospital-oriented (143/711, 20.11\%), and enterprise-oriented internet hospitals (526/711, 73.98\%). The vast majority of internet hospitals were traditional hospitals (526/711, 74\%). Nearly 46.1\% (221/711) of internet hospitals requested doctors to provide health services at a specific web clinic. Most patients (224/639, 35.1\%) accessed outpatient services via WeChat. Internet hospitals' consulting methods included SMS text messaging consultations involving the use of graphics (552/570, 96.8\%), video consultations (248/570, 43.5\%), and telephone consultations (238/570, 41.8\%). The median number of available web-based doctors was 43, and the median consultation fees of fever clinics and other outpatient clinics were {\textyen}0 (US \$0) per consultation and {\textyen}6 (US \$0.93) per consultation, respectively. Internet hospitals have provided various services during the COVID-19 pandemic, including medical prescription, drug delivery, and medical insurance services. Conclusions: The dramatic increase of internet hospitals in China has played an important role in the prevention and control of COVID-19. Internet hospitals provide different and convenient medical services for people in need. ",
doi="10.2196/21825",
url="http://www.jmir.org/2021/1/e21825/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33417586"
}


@Article{info:doi/10.2196/21752,
author="Sandell, Tiffany
and Sch{\"u}tze, Heike
and Miller, Andrew",
title="A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="19",
volume="10",
number="1",
pages="e21752",
keywords="radiation oncology",
keywords="general practice",
keywords="health technology",
keywords="communication",
keywords="cancer",
keywords="shared care",
keywords="follow-up",
abstract="Background: The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective: The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods: This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results: Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions: Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients' preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID): PRR1-10.2196/21752 ",
doi="10.2196/21752",
url="http://www.researchprotocols.org/2021/1/e21752/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464209"
}


@Article{info:doi/10.2196/22450,
author="Jackowich, A. Robyn
and Mooney, M. Kayla
and Hecht, Evelyn
and Pukall, F. Caroline",
title="Online Pelvic Floor Group Education Program for Women With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Descriptive Feasibility Study",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="11",
volume="5",
number="1",
pages="e22450",
keywords="persistent genital arousal disorder",
keywords="genitopelvic dysesthesia",
keywords="online program",
keywords="pelvic floor",
keywords="pilot",
abstract="Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as ``genital arousal,'' which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants' abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms. ",
doi="10.2196/22450",
url="http://formative.jmir.org/2021/1/e22450/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427673"
}


@Article{info:doi/10.2196/20692,
author="Aminoff, Hedvig
and Meijer, Sebastiaan
and Arnelo, Urban
and Frennert, Susanne",
title="Telemedicine for Remote Surgical Guidance in Endoscopic Retrograde Cholangiopancreatography: Mixed Methods Study of Practitioner Attitudes",
journal="JMIR Form Res",
year="2021",
month="Jan",
day="11",
volume="5",
number="1",
pages="e20692",
keywords="telemedicine",
keywords="telementoring",
keywords="teleconsulting",
keywords="technology acceptance model",
keywords="professional users",
keywords="specialties, surgical/education",
keywords="attitude",
keywords="clinical staff",
keywords="surgery",
keywords="framework",
keywords="surgeon",
keywords="user-centered",
keywords="interview",
keywords="survey",
abstract="Background: Telemedicine innovations are rarely adopted into routine health care, the reasons for which are not well understood. Teleguidance, a promising service for remote surgical guidance during endoscopic retrograde cholangiopancreatography (ERCP) was due to be scaled up, but there were concerns that user attitudes might influence adoption. Objective: Our objective was to gain a deeper understanding of ERCP practitioners' attitudes toward teleguidance. These findings could inform the implementation process and future evaluations. Methods: We conducted semistructured interviews with ERCP staff about challenges during work and beliefs about teleguidance. Theoretical constructs from the technology acceptance model (TAM) guided the thematic analysis. Our findings became input to a 16-item questionnaire, investigating surgeons' beliefs about teleguidance's contribution to performance and factors that might interact with implementation. Results: Results from 20 interviews with ERCP staff from 5 hospitals were used to adapt a TAM questionnaire, exchanging the standard ``Ease of Use'' items for ``Compatibility and Implementation Climate.'' In total, 23 ERCP specialists from 15 ERCP clinics responded to the questionnaire: 9 novices (<500 ERCP procedures) and 14 experts (>500 ERCP procedures). The average agreement ratings for usefulness items were 64\% ({\textasciitilde}9/14) among experts and 75\% ({\textasciitilde}7/9) among novices. The average agreement ratings for compatibility items were somewhat lower (experts 64\% [{\textasciitilde}9/14], novices 69\% [{\textasciitilde}6/9]). The averages have been calculated from the sum of several items and therefore, they only approximate the actual values. While 11 of the 14 experts (79\%) and 8 of the 9 novices (89\%) agreed that teleguidance could improve overall quality and patient safety during ERCP procedures, only 8 of the 14 experts (57\%) and 6 of the 9 novices (67\%) agreed that teleguidance would not create new patient safety risks. Only 5 of the 14 experts (36\%) and 3 of the 9 novices (33\%) were convinced that video and image transmission would function well. Similarly, only 6 of the 14 experts (43\%) and 6 of the 9 novices (67\%) agreed that administration would work smoothly. There were no statistically significant differences between the experts and novices on any of the 16 items (P<.05). Conclusions: Both novices and experts in ERCP procedures had concerns that teleguidance might disrupt existing work practices. However, novices were generally more positive toward teleguidance than experts, especially with regard to the possibility of developing technical skills and work practices. While newly trained specialists were the main target for teleguidance, the experts were also intended users. As experts are more likely to be key decision makers, their attitudes may have a greater relative impact on adoption. We present suggestions to address these concerns. We conclude that using the TAM as a conceptual framework can support user-centered inquiry into telemedicine design and implementation by connecting qualitative findings to well-known analytical themes. ",
doi="10.2196/20692",
url="https://formative.jmir.org/2021/1/e20692",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427670"
}


@Article{info:doi/10.2196/25435,
author="An, Ho Min
and You, Chan Seng
and Park, Woong Rae
and Lee, Seongwon",
title="Using an Extended Technology Acceptance Model to Understand the Factors Influencing Telehealth Utilization After Flattening the COVID-19 Curve in South Korea: Cross-sectional Survey Study",
journal="JMIR Med Inform",
year="2021",
month="Jan",
day="8",
volume="9",
number="1",
pages="e25435",
keywords="telemedicine",
keywords="telehealth",
keywords="COVID-19",
keywords="pandemic",
keywords="model",
keywords="South Korea",
keywords="acceptance",
keywords="anxiety",
keywords="cross-sectional",
abstract="Background: Although telehealth is considered a key component in combating the worldwide crisis caused by COVID-19, the factors that influence its acceptance by the general population after the flattening of the COVID-19 curve remain unclear. Objective: We aimed to identify factors affecting telehealth acceptance, including anxiety related to COVID-19, after the initial rapid spread of the disease in South Korea. Methods: We proposed an extended technology acceptance model (TAM) and performed a cross-sectional survey of individuals aged ?30 years. In total, 471 usable responses were collected. Confirmatory factor analysis was used to examine the validity of measurements, and the partial least squares (PLS) method was used to investigate factors influencing telehealth acceptance and the impacts of COVID-19. Results: PLS analysis showed that increased accessibility, enhanced care, and ease of telehealth use had positive effects on its perceived usefulness (P=.002, P<.001, and P<.001, respectively). Furthermore, perceived usefulness, ease, and privacy/discomfort significantly impacted the acceptance of telehealth (P<.001, P<.001, and P<.001, respectively). However, anxiety toward COVID-19 was not associated with telehealth acceptance (P=.112), and this insignificant relationship was consistent in the cluster (n=216, 46\%) of respondents with chronic diseases (P=.185). Conclusions: Increased accessibility, enhanced care, usefulness, ease of use, and privacy/discomfort are decisive variables affecting telehealth acceptance in the Korean general population, whereas anxiety about COVID-19 is not. This study may lead to a tailored promotion of telehealth after the pandemic subsides. ",
doi="10.2196/25435",
url="http://medinform.jmir.org/2021/1/e25435/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33395397"
}


@Article{info:doi/10.2196/21815,
author="Petracca, Francesco
and Ciani, Oriana
and Cucciniello, Maria
and Tarricone, Rosanna",
title="Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="30",
volume="22",
number="12",
pages="e21815",
keywords="mobile apps",
keywords="coronavirus",
keywords="COVID-19",
keywords="digital health",
keywords="mHealth",
keywords="organizational context",
keywords="public health",
keywords="telemedicine",
doi="10.2196/21815",
url="http://www.jmir.org/2020/12/e21815/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33351777"
}


@Article{info:doi/10.2196/18835,
author="Waqas, Ahmed
and Teoh, Huat Soo
and Lap{\~a}o, Velez Lu{\'i}s
and Messina, Ary Luiz
and Correia, C{\'e}sar Jorge",
title="Harnessing Telemedicine for the Provision of Health Care: Bibliometric and Scientometric Analysis",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="2",
volume="22",
number="10",
pages="e18835",
keywords="telemedicine",
keywords="scientometric analysis",
keywords="evidence synthesis",
keywords="health information technology",
keywords="research",
keywords="theme",
abstract="Background: In recent decades, advances in information technology have given new momentum to telemedicine research. These advances in telemedicine range from individual to population levels, allowing the exchange of patient information for diagnosis and management of health problems, primary care prevention, and education of physicians via distance learning. Objective: This scientometric investigation aims to examine collaborative research networks, dominant research themes and disciplines, and seminal research studies that have contributed most to the field of telemedicine. This information is vital for scientists, institutions, and policy stakeholders to evaluate research areas where more infrastructural or scholarly contributions are required. Methods: For analyses, we used CiteSpace (version 4.0 R5; Drexel University), which is a Java-based software that allows scientometric analysis, especially visualization of collaborative networks and research themes in a specific field. Results: We found that scholarly activity has experienced a significant increase in the last decade. Most important works were conducted by institutions located in high-income countries. A discipline-specific shift from radiology to telestroke, teledermatology, telepsychiatry, and primary care was observed. The most important innovations that yielded a collaborative influence were reported in the following medical disciplines, in descending order: public environmental and occupational health, psychiatry, pediatrics, health policy and services, nursing, rehabilitation, radiology, pharmacology, surgery, respiratory medicine, neurosciences, obstetrics, and geriatrics. Conclusions: Despite a continuous rise in scholarly activity in telemedicine, we noticed several gaps in the literature. For instance, all the primary and secondary research central to telemedicine was conducted in the context of high-income countries, including the evidence synthesis approaches that pertained to implementation aspects of telemedicine. Furthermore, the research landscape and implementation of telemedicine infrastructure are expected to see exponential progress during and after the COVID-19 era. ",
doi="10.2196/18835",
url="https://www.jmir.org/2020/10/e18835",
url="http://www.ncbi.nlm.nih.gov/pubmed/33006571"
}


@Article{info:doi/10.2196/20786,
author="Ramaswamy, Ashwin
and Yu, Miko
and Drangsholt, Siri
and Ng, Eric
and Culligan, J. Patrick
and Schlegel, N. Peter
and Hu, C. Jim",
title="Patient Satisfaction With Telemedicine During the COVID-19 Pandemic: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="9",
volume="22",
number="9",
pages="e20786",
keywords="telemedicine",
keywords="medicine",
keywords="pandemics",
keywords="patient satisfaction",
keywords="remote consultation",
keywords="disruptive technology",
keywords="medical informatics",
keywords="health care delivery",
keywords="practice patterns",
keywords="physicians",
keywords="health policy",
keywords="health services research",
keywords="health care reform",
keywords="COVID-19",
abstract="Background: New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective: This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods: In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre--COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results: We experienced an 8729\% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9\% vs 92.5\%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95\% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95\% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE --2.05; 95\% CI --2.66 to --1.22), female gender (PE --0.73; 95\% CI --0.96 to --0.50), and new visit type (PE --0.75; 95\% CI --1.00 to --0.49) were associated with lower patient satisfaction. Conclusions: Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine. ",
doi="10.2196/20786",
url="http://www.jmir.org/2020/9/e20786/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32810841"
}


@Article{info:doi/10.2196/19033,
author="Schink{\"o}the, Timo
and Gabri, Rolando Mariano
and Mitterer, Manfred
and Gouveia, Pedro
and Heinemann, Volker
and Harbeck, Nadia
and Subklewe, Marion",
title="A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development",
journal="JMIR Public Health Surveill",
year="2020",
month="Jun",
day="1",
volume="6",
number="2",
pages="e19033",
keywords="COVID-19",
keywords="eHealth",
keywords="connected care",
keywords="telecare",
keywords="cloud solution",
keywords="telehealth",
keywords="public health",
keywords="infectious disease",
keywords="pandemic",
keywords="outbreak",
abstract="Background: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. Objective: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. Methods: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. Results: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. Conclusions: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19. ",
doi="10.2196/19033",
url="http://publichealth.jmir.org/2020/2/e19033/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32406855"
}


@Article{info:doi/10.2196/17255,
author="Christie, Liane Hannah
and Schichel, Philomela Mignon Chlo{\"e}
and Tange, Johannes Huibert
and Veenstra, Yvonne Marja
and Verhey, Josef Frans Rochus
and de Vugt, Elizabeth Marjolein",
title="Perspectives From Municipality Officials on the Adoption, Dissemination, and Implementation of Electronic Health Interventions to Support Caregivers of People With Dementia: Inductive Thematic Analysis",
journal="JMIR Aging",
year="2020",
month="May",
day="13",
volume="3",
number="1",
pages="e17255",
keywords="dementia",
keywords="caregiver",
keywords="internet",
keywords="eHealth",
keywords="implementation, senior friendly communities",
abstract="Background: Very few evidence-based electronic health (eHealth) interventions for caregivers of people with dementia are implemented into practice. As part of a cross-border collaboration focusing on dementia and depression in older people, two eHealth interventions for caregivers of people with dementia (``Myinlife'' and ``Partner in Balance'') were adopted by nine municipalities in the Euregion Meuse-Rhine. Objective: This study aimed to (1) identify determinants for the implementation of eHealth interventions for caregivers of people with dementia in a municipality context and (2) formulate implementation strategies for these interventions. Methods: Eight municipality officials were interviewed using open-ended, semistructured interviews about their background, thoughts on the implementation of the intervention, recommended strategies, and thoughts on eHealth in general. One additional municipality discontinued the implementation project and submitted answers to the interview questions via email. The interviews were transcribed and independently analyzed using inductive thematic analysis. Results: The interviews provided information on the perspectives of municipality officials on implementing eHealth for caregivers of people with dementia in their local communities. Key findings from the inductive thematic analysis included the importance of face-to-face interviews in developing tailor-made implementation plans, the need for regular meetings, the enthusiasm of municipality officials to implement these interventions, the need for long-term sustainability planning through collecting data on the required resources and benefits, and the effect of name brand recognition in adoption. Conclusions: The findings contribute toward filling the previously identified gap in the literature on the implementation context of eHealth interventions for caregivers of people with dementia. Municipality officials' views indicated which implementation determinants they expected would influence the adoption, dissemination, and future implementation of eHealth interventions for caregivers of people with dementia in a municipal context. These insights were applied to tailored implementation strategies to facilitate the future implementation of interventions such as Myinlife and Partner in Balance. ",
doi="10.2196/17255",
url="http://aging.jmir.org/2020/1/e17255/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32401217"
}


@Article{info:doi/10.2196/19577,
author="Hong, Zhen
and Li, Nian
and Li, Dajiang
and Li, Junhua
and Li, Bing
and Xiong, Weixi
and Lu, Lu
and Li, Weimin
and Zhou, Dong",
title="Telemedicine During the COVID-19 Pandemic: Experiences From Western China",
journal="J Med Internet Res",
year="2020",
month="May",
day="8",
volume="22",
number="5",
pages="e19577",
keywords="COVID-19",
keywords="coronavirus disease",
keywords="medical education",
keywords="pandemics",
keywords="teleteaching",
keywords="tele-education",
keywords="telemedicine",
doi="10.2196/19577",
url="http://www.jmir.org/2020/5/e19577/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32349962"
}


@Article{info:doi/10.2196/19106,
author="P{\'e}rez Sust, Pol
and Solans, Oscar
and Fajardo, Carles Joan
and Medina Peralta, Manuel
and Rodenas, Pepi
and Gabald{\`a}, Jordi
and Garcia Eroles, Luis
and Comella, Adri{\`a}
and Velasco Mu{\~n}oz, C{\'e}sar
and Sallent Ribes, Josu{\`e}
and Roma Monfa, Rosa
and Piera-Jimenez, Jordi",
title="Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak",
journal="JMIR Public Health Surveill",
year="2020",
month="May",
day="4",
volume="6",
number="2",
pages="e19106",
keywords="digital health",
keywords="eHealth",
keywords="telemedicine",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
keywords="public health",
keywords="policymaking",
doi="10.2196/19106",
url="http://publichealth.jmir.org/2020/2/e19106/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32339998"
}


@Article{info:doi/10.2196/14201,
author="Chen, Chien-I Sonia
and Hu, Ridong
and McAdam, Rodney",
title="Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="28",
volume="22",
number="4",
pages="e14201",
keywords="connected health care",
keywords="smart health care",
keywords="health care quality",
keywords="access",
keywords="remote monitoring",
keywords="precision medicine",
keywords="self-management",
abstract="Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care's direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. ",
doi="10.2196/14201",
url="http://www.jmir.org/2020/4/e14201/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343254"
}


@Article{info:doi/10.2196/11544,
author="Grace-Farfaglia, Patricia",
title="Social Cognitive Theories and Electronic Health Design: Scoping Review",
journal="JMIR Hum Factors",
year="2019",
month="Jul",
day="19",
volume="6",
number="3",
pages="e11544",
keywords="social theory",
keywords="design",
keywords="health promotion",
keywords="behavioral economics",
keywords="social support",
keywords="social media",
keywords="serious games",
abstract="Background: There are several social cognitive theories (SCTs) and models that support platform design in electronic health (eHealth) promotion trials. The rationale for this scoping review was to determine how social design features (informational aid, expressive support, gaming, and tailored content) are used to promote self-efficacy, engagement, knowledge, and behavior change. Objective: This study aimed to review a broad spectrum of digital health interventions in the literature seeking trials that use SCTs for the design of eHealth applications. Methods: The author conducted a systematic scoping review of 161 Web-based health interventions from published randomized clinical trials using 1 or more tools to address the social cognitive determinants in their website design from January 2006 to April 2016. An iterative approach was used in the selection of studies and data extraction. The studies were analyzed for quality and coded for type of social design features employed. Results: Expressive interaction tools were found in 48.6\% (54/111) of studies categorized as a strong recommendation by the Joanna Briggs Institute criteria. Overall, less than half of the studies addressed participant social support and motivational needs (43.8\%). The vast majority of studies (100\%) relied on the use of the Web for delivery of informational aid and tailored content for the individual participant (75.9\%). Conclusions: This review fills a research gap by linking social theory to Web strategy to improve the impact and sustainability of eHealth interventions. A Digital Health Intervention Model was developed to provide a framework to enhance future Web-based health intervention design and execution. ",
doi="10.2196/11544",
url="https://humanfactors.jmir.org/2019/3/e11544/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31325290"
}


@Article{info:doi/10.2196/12100,
author="van Hartskamp, Michael
and Consoli, Sergio
and Verhaegh, Wim
and Petkovic, Milan
and van de Stolpe, Anja",
title="Artificial Intelligence in Clinical Health Care Applications: Viewpoint",
journal="Interact J Med Res",
year="2019",
month="Apr",
day="05",
volume="8",
number="2",
pages="e12100",
keywords="artificial intelligence",
keywords="deep learning",
keywords="clinical data",
keywords="Bayesian modeling",
keywords="medical informatics",
doi="10.2196/12100",
url="https://www.i-jmr.org/2019/2/e12100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30950806"
}


@Article{info:doi/10.2196/ijmr.8423,
author="Holt, Adellund Kamila
and Karnoe, Astrid
and Overgaard, Dorthe
and Nielsen, Edith Sidse
and Kayser, Lars
and R{\o}der, Einar Michael
and From, Gustav",
title="Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical Outpatients",
journal="Interact J Med Res",
year="2019",
month="Apr",
day="05",
volume="8",
number="2",
pages="e8423",
keywords="health literacy",
keywords="computer literacy",
keywords="questionnaires",
keywords="telemedicine",
keywords="consumer health informatics",
abstract="Background: Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective: The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods: Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results: In total, 95.1\% (234/246) of the participants used their personal digital ID (NemID), 57.7\% (142/246) were in contact with their GPs electronically, and 54.0\% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control. The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions: Information about patients' eHL may provide clinicians an understanding of patients' reasons for not using digital health services, better than sociodemographic data or self-rated health. ",
doi="10.2196/ijmr.8423",
url="http://www.i-jmr.org/2019/2/e8423/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30950809"
}


@Article{info:doi/10.2196/10336,
author="Vo, Vinh Jonathan Duc
and Gorbach, M. Alexander",
title="A Platform to Record Patient Events During Physiological Monitoring With Wearable Sensors: Proof-of-Concept Study",
journal="Interact J Med Res",
year="2019",
month="Jan",
day="03",
volume="8",
number="1",
pages="e10336",
keywords="data collection",
keywords="mobile phone",
keywords="mobile-based platform",
keywords="patient journal",
keywords="sensors",
abstract="Background: Patient journals have been used as valuable resources in clinical studies. However, the full potential value of such journals can be undermined by inefficiencies and ambiguities associated with handwritten patient reports. The increasing number of mobile phones and mobile-based health care approaches presents an opportunity to improve communications from patients to clinicians and clinical researchers through the use of digital patient journals. Objective: The objective of this project was to develop a smartphone-based platform that would enable patients to record events and symptoms on the same timeline as clinical data collected by wearable sensors. Methods: This platform consists of two major components: a smartphone for patients to record their journals and wireless sensors for clinical data collection. The clinical data and patient records are then exported to a clinical researcher interface, and the data and journal are processed and combined into a single time-series graph for analysis. This paper gives a block diagram of the platform's principal components and compares its features to those of other methods but does not explicitly discuss the process of design or development of the system. Results: As a proof of concept, body temperature data were obtained in a 4-hour span from a 22-year-old male, during which the subject simultaneously recorded relevant activities and events using the iPhone platform. After export to a clinical researcher's desktop, the digital records and temperature data were processed and fused into a single time-series graph. The events were filtered based on specific keywords to facilitate data analysis. Conclusions: We have developed a user-friendly patient journal platform, based on widely available smartphone technology, that gives clinicians and researchers a simple method to track and analyze patient activities and record the activities on a shared timeline with clinical data from wearable devices. ",
doi="10.2196/10336",
url="https://www.i-jmr.org/2019/1/e10336/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30609977"
}


@Article{info:doi/10.2196/jmir.8914,
author="Hung, Chi-Sheng
and Lee, Jenkuang
and Chen, Ying-Hsien
and Huang, Ching-Chang
and Wu, Vin-Cent
and Wu, Hui-Wen
and Chuang, Pao-Yu
and Ho, Yi-Lwun",
title="Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2018",
month="Jan",
day="24",
volume="20",
number="1",
pages="e23",
keywords="telehealth",
keywords="contract compliance rate",
keywords="chronic kidney disease",
abstract="Background: Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95\% CI 0.837-0.896). Objective: This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD. Methods: We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates. Results: The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD. Conclusions: Our study showed that there was a triphasic relationship between contract compliance rate to the telehealth program and risk of hospitalization. Renal function status was associated with risk of hospitalization among these patients, and there was a significant interaction with contract compliance rate. ",
doi="10.2196/jmir.8914",
url="http://www.jmir.org/2018/1/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29367185"
}


@Article{info:doi/10.2196/ijmr.7352,
author="Babac, Ana
and Litzkendorf, Svenja
and Schmidt, Katharina
and Pauer, Fr{\'e}d{\'e}ric
and Damm, Kathrin
and Frank, Martin
and Graf von der Schulenburg, Johann-Matthias",
title="Shaping an Effective Health Information Website on Rare Diseases Using a Group Decision-Making Tool: Inclusion of the Perspectives of Patients, Their Family Members, and Physicians",
journal="Interact J Med Res",
year="2017",
month="Nov",
day="20",
volume="6",
number="2",
pages="e23",
keywords="rare diseases",
keywords="decision making",
keywords="health information needs",
keywords="preferences",
keywords="patients",
keywords="relatives",
keywords="physicians",
abstract="Background: Despite diverging definitions on rare conditions, people suffering from rare diseases share similar difficulties. A lack of experience by health professionals, a long wait from first symptoms to diagnosis, scarce medical and scientific knowledge, and unsatisfactory treatment options all trigger the search for health information by patients, family members, and physicians. Examining and systematically integrating stakeholder needs can help design information platforms that effectively support this search. Objective: The aim of this study was to innovate on the group decision-making process involving patients, family members, and physicians for the establishment of a national rare disease Internet platform. We determined differences in the relevance of health information---especially examining quantifiable preference weights---between these subgroups and elucidated the structure and distribution of these differences in people suffering from rare diseases, their family members, and physicians, thus providing information crucial to their collaboration. Methods: The included items were identified using a systematic Internet research and verified through a qualitative interview study. The identified major information needs included medical issues, research, social help offers, and current events. These categories further comprised sublevels of diagnosis, therapy, general disease pattern, current studies, study results, registers, psychosocial counseling, self-help, and sociolegal advice. The analytic hierarchy process was selected as the group decision-making tool. A sensitivity analysis was used to determine the stability and distribution of results. t tests were utilized to examine the results' significance. Results: A total of 176 questionnaires were collected; we excluded some questionnaires in line with our chosen consistency level of 0.2. Ultimately, 120 patients, 24 family members, and 32 physicians participated in the study (48 men and 128 women, mean age=48 years, age range=17-87 years). Rankings and preference weights were highly heterogeneous. Global ranking positions of patients, family members, and physicians are shown in parentheses, as follows: medical issues (3/4, 4, 4), research (3/4, 2/3, 3), social help offers (1, 2/3, 2), and current events (2, 1, 1); diagnosis (6, 8, 9), therapy (5, 9, 7), general disease pattern (9, 4/5/6, 6), current studies (7, 4/5/6, 3), study results (8, 7, 8), registers (4, 1, 5), psychosocial counseling (1, 2, 4), self-help (3, 3, 2), and sociolegal advice (2, 4/5/6, 1). Differences were verified for patients for 5 information categories (P=.03), physicians for 6 information categories (P=.03), and family members for 4 information categories (P=.04). Conclusions: Our results offer a clear-cut information structure that can transparently translate group decisions into practice. Furthermore, we found different preference structures for rare disease information among patients, family members, and physicians. Some websites already address differences in comprehension between those subgroups. Similar to pharmaceutical companies, health information providers on rare diseases should also acknowledge different information needs to improve the accessibility of information. ",
doi="10.2196/ijmr.7352",
url="http://www.i-jmr.org/2017/2/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29158209"
}


@Article{info:doi/10.2196/mhealth.8257,
author="Pecina, L. Jennifer
and Wyatt, D. Kirk
and Comfere, I. Nneka
and Bernard, E. Matthew
and North, Frederick",
title="Uses of Mobile Device Digital Photography of Dermatologic Conditions in Primary Care",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="08",
volume="5",
number="11",
pages="e165",
keywords="telemedicine",
keywords="teledermatology",
keywords="mobile phone",
keywords="mobile applications",
keywords="primary health care",
keywords="smartphone",
keywords="remote consultation",
abstract="Background: PhotoExam is a mobile app that incorporates digital photographs into the electronic health record (EHR) using iPhone operating system (iOS, Apple Inc)--based mobile devices. Objective: The aim of this study was to describe usage patterns of PhotoExam in primary care and to assess clinician-level factors that influence the use of the PhotoExam app for teledermatology (TD) purposes. Methods: Retrospective record review of primary care patients who had one or more photos taken with the PhotoExam app between February 16, 2015 to February 29, 2016 were reviewed for 30-day outcomes for rates of dermatology consult request, mode of dermatology consultation (curbside phone consult, eConsult, and in-person consult), specialty and training level of clinician using the app, performance of skin biopsy, and final pathological diagnosis (benign vs malignant). Results: During the study period, there were 1139 photo sessions on 1059 unique patients. Of the 1139 sessions, 395 (34.68\%) sessions documented dermatologist input in the EHR via dermatology curbside consultation, eConsult, and in-person dermatology consult. Clinicians utilized curbside phone consults preferentially over eConsults for TD. By clinician type, nurse practitioners (NPs) and physician assistants (PAs) were more likely to utilize the PhotoExam for TD as compared with physicians. By specialty type, pediatric clinicians were more likely to utilize the PhotoExam for TD as compared with family medicine and internal medicine clinicians. A total of 108 (9.5\%) photo sessions had a biopsy performed of the photographed site. Of these, 46 biopsies (42.6\%) were performed by a primary care clinician, and 27 (25.0\%) biopsies were interpreted as a malignancy. Of the 27 biopsies that revealed malignant findings, 6 (22\%) had a TD consultation before biopsy, and 10 (37\%) of these biopsies were obtained by primary care clinicians. Conclusions: Clinicians primarily used the PhotoExam for non-TD purposes. Nurse practitioners and PAs utilized the app for TD purposes more than physicians. Primary care clinicians requested curbside dermatology consults more frequently than dermatology eConsults. ",
doi="10.2196/mhealth.8257",
url="http://mhealth.jmir.org/2017/11/e165/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29117934"
}


@Article{info:doi/10.2196/ijmr.7461,
author="Kaga, Satoshi
and Suzuki, Teppei
and Ogasawara, Katsuhiko",
title="Willingness to Pay for Elderly Telecare Service Using the Internet and Digital Terrestrial Broadcasting",
journal="Interact J Med Res",
year="2017",
month="Oct",
day="24",
volume="6",
number="2",
pages="e21",
keywords="health services for the elderly",
keywords="health information",
keywords="remote consultation",
abstract="Background: In Japan over the past few years, more attention has been focused on unnoticed solitary death in the context of an aging society and the trend toward nuclear family. A number of institutions and companies have implemented a prevention measure with digital terrestrial broadcasting telecare services for the elderly: Hokkaido University; TV-Asahi Corporation; Hitachi, Ltd; Iwamizawa City; Hokkaido Television Broadcasting Co, Ltd; and Hamanasu Information Co, Ltd. Although this system is provided free of charge as a demonstration test, determining the appropriate price for the service is required for its sustainable operation. Objective: The aim of this study was to quantify individual willingness to pay (WTP) so as to test the tenability of digital terrestrial broadcasting service for elderly telecare. Methods: We used the contingent valuation method (CVM) to estimate the WTP for this service among 305 citizens (valid response rate 76.0\%) living in Japan. A questionnaire survey was conducted for people aged 18 to 100 years according to Japanese age distribution from September 2016. To elicit WTP, we adopted a double-bound dichotomous choice method to ask the respondents whether they agree or disagree with the price we offered. Results: The median WTP for this service's monthly fee is estimated to be 431 JPY (approximately US \$3.7). The finding suggests that gender (0.66, P=.01), health consciousness (1.08, P=.01), willingness to use (2.38, P<.001), and seeing others less than once a week (1.00, P=.06) made a positive effect on WTP. Conclusions: We conclude that reliable WTP was elicited by CVM based on an Internet survey. Calculated median WTP for digital terrestrial broadcasting service for elderly telecare was 431 JPY (approximately US \$3.7). In the analysis of factors that affect WTP, constant factors, log-bid, health consciousness, gender, see others less than one time for week, and willingness to use made positive effect to probability of acceptance. In comparison of WTP in different groups, age groups showed that WTP of the elderly group was higher than WTP of the middle age group and younger age group. However, WTP surveys need to be carefully conducted to minimize the sampling bias and allocate accurate structure of gender distribution. ",
doi="10.2196/ijmr.7461",
url="http://www.i-jmr.org/2017/2/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29066428"
}


@Article{info:doi/10.2196/mhealth.8290,
author="Chen, Ying-Hsien
and Hung, Chi-Sheng
and Huang, Ching-Chang
and Hung, Yu-Chien
and Hwang, Juey-Jen
and Ho, Yi-Lwun",
title="Atrial Fibrillation Screening in Nonmetropolitan Areas Using a Telehealth Surveillance System With an Embedded Cloud-Computing Algorithm: Prospective Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Sep",
day="26",
volume="5",
number="9",
pages="e135",
keywords="atrial fibrillation",
keywords="screen",
keywords="cloud-computing algorithm",
keywords="electrocardiography",
abstract="Background: Atrial fibrillation (AF) is a common form of arrhythmia that is associated with increased risk of stroke and mortality. Detecting AF before the first complication occurs is a recognized priority. No previous studies have examined the feasibility of undertaking AF screening using a telehealth surveillance system with an embedded cloud-computing algorithm; we address this issue in this study. Objective: The objective of this study was to evaluate the feasibility of AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm. Methods: We conducted a prospective AF screening study in a nonmetropolitan area using a single-lead electrocardiogram (ECG) recorder. All ECG measurements were reviewed on the telehealth surveillance system and interpreted by the cloud-computing algorithm and a cardiologist. The process of AF screening was evaluated with a satisfaction questionnaire. Results: Between March 11, 2016 and August 31, 2016, 967 ECGs were recorded from 922 residents in nonmetropolitan areas. A total of 22 (2.4\%, 22/922) residents with AF were identified by the physician's ECG interpretation, and only 0.2\% (2/967) of ECGs contained significant artifacts. The novel cloud-computing algorithm for AF detection had a sensitivity of 95.5\% (95\% CI 77.2\%-99.9\%) and specificity of 97.7\% (95\% CI 96.5\%-98.5\%). The overall satisfaction score for the process of AF screening was 92.1\%. Conclusions: AF screening in nonmetropolitan areas using a telehealth surveillance system with an embedded cloud-computing algorithm is feasible. ",
doi="10.2196/mhealth.8290",
url="https://mhealth.jmir.org/2017/9/e135/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28951384"
}


@Article{info:doi/10.2196/medinform.6799,
author="Wang, Yaogang
and Sun, Li
and Hou, Jie",
title="Hierarchical Medical System Based on Big Data and Mobile Internet: A New Strategic Choice in Health Care",
journal="JMIR Med Inform",
year="2017",
month="Aug",
day="08",
volume="5",
number="3",
pages="e22",
keywords="medical services",
keywords="continuity of patient care",
keywords="mobile health",
doi="10.2196/medinform.6799",
url="http://medinform.jmir.org/2017/3/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28790024"
}


@Article{info:doi/10.2196/jmir.7921,
author="Lowenstein, Margaret
and Bamgbose, Olusinmi
and Gleason, Nathaniel
and Feldman, D. Mitchell",
title="Psychiatric Consultation at Your Fingertips: Descriptive Analysis of Electronic Consultation From Primary Care to Psychiatry",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="04",
volume="19",
number="8",
pages="e279",
keywords="mental health",
keywords="primary care",
keywords="health care delivery",
keywords="teleconsultation",
keywords="telehealth",
keywords="Internet care delivery",
abstract="Background: Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties.  eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Objective: Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. Methods: We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Results: Depression was the most common consult template selected by PCPs (20/50, 40\%), followed by the generic template (12/50, 24\%) and anxiety (8/50, 16\%). Most questions (49/50, 98\%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56\%) and management (50/50, 100\%), responded in an average of 1.4 days, and recommended in-person consultation for 26\% (13/50) of patients. PCPs implemented psychiatrist recommendations 76\% (38/50) of the time. Conclusions: For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. ",
doi="10.2196/jmir.7921",
url="http://www.jmir.org/2017/8/e279/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28778852"
}


@Article{info:doi/10.2196/jmir.8114,
author="Wang, Huei Shan",
title="Web-Based Medical Service: Technology Attractiveness, Medical Creditability, Information Source, and Behavior Intention",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="02",
volume="19",
number="8",
pages="e285",
keywords="web-based medical service",
keywords="technology attractiveness",
keywords="medical creditability",
keywords="information source",
keywords="behavior intention",
abstract="Background: Web-based medical service (WBMS), a cooperative relationship between medical service and Internet technology, has been called one of the most innovative services of the 21st century. However, its business promotion and implementation in the medical industry have neither been expected nor executed. Few studies have explored this phenomenon from the viewpoint of inexperienced patients. Objective: The primary goal of this study was to explore whether technology attractiveness, medical creditability, and diversified medical information sources could increase users' behavior intention. Methods: This study explored the effectiveness of web-based medical service by using three situations to manipulate sources of medical information. A total of 150 questionnaires were collected from people who had never used WBMS before. Hierarchical regression was used to examine the mediation and moderated-mediation effects. Results: Perceived ease of use (P=.002) and perceived usefulness (P=.001) significantly enhance behavior intentions. Medical credibility is a mediator (P=.03), but the relationship does not significantly differ under diverse manipulative information channels (P=.39). Conclusions: Medical credibility could explain the extra variation between technology attractiveness and behavior intention, but not significant under different moderating effect of medical information sources. ",
doi="10.2196/jmir.8114",
url="http://www.jmir.org/2017/8/e285/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28768608"
}


@Article{info:doi/10.2196/rehab.7511,
author="Peretti, Alessandro
and Amenta, Francesco
and Tayebati, Khosrow Seyed
and Nittari, Giulio
and Mahdi, Sarosh Syed",
title="Telerehabilitation: Review of the State-of-the-Art and Areas of Application",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Jul",
day="21",
volume="4",
number="2",
pages="e7",
keywords="telerehabilitation",
keywords="rehabilitation",
keywords="telemedicine",
keywords="health care",
keywords="remote rehabilitation assistance",
abstract="Background: Telemedicine applications have been increasing due to the development of new computer science technologies and of more advanced telemedical devices. Various types of telerehabilitation treatments and their relative intensities and duration have been reported. Objective: The objective of this review is to provide a detailed overview of the rehabilitation techniques for remote sites (telerehabilitation) and their fields of application, with analysis of the benefits and the drawbacks related to use. We discuss future applications of telerehabilitation techniques with an emphasis on the development of high-tech devices, and on which new tools and applications can be used in the future. Methods: We retrieved relevant information and data on telerehabilitation from books, articles and online materials using the Medical Subject Headings (MeSH) ``telerehabilitation,'' ``telemedicine,'' and ``rehabilitation,'' as well as ``disabling pathologies.'' Results: Telerehabilitation can be considered as a branch of telemedicine. Although this field is considerably new, its use has rapidly grown in developed countries. In general, telerehabilitation reduces the costs of both health care providers and patients compared with traditional inpatient or person-to-person rehabilitation. Furthermore, patients who live in remote places, where traditional rehabilitation services may not be easily accessible, can benefit from this technology. However, certain disadvantages of telerehabilitation, including skepticism on the part of patients due to remote interaction with their physicians or rehabilitators, should not be underestimated. Conclusions: This review evaluated different application fields of telerehabilitation, highlighting its benefits and drawbacks. This study may be a starting point for improving approaches and devices for telerehabilitation. In this context, patients' feedback may be important to adapt rehabilitation techniques and approaches to their needs, which would subsequently help to improve the quality of rehabilitation in the future. The need for proper training and education of people involved in this new and emerging form of intervention for more effective treatment can't be overstated. ",
doi="10.2196/rehab.7511",
url="http://rehab.jmir.org/2017/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28733271"
}


@Article{info:doi/10.2196/ijmr.6214,
author="Giordano, Vincenzo
and Koch, Hilton
and Godoy-Santos, Alexandre
and Dias Belangero, William
and Esteves Santos Pires, Robinson
and Labronici, Pedro",
title="WhatsApp Messenger as an Adjunctive Tool for Telemedicine: An Overview",
journal="Interact J Med Res",
year="2017",
month="Jul",
day="21",
volume="6",
number="2",
pages="e11",
keywords="whatsapp",
keywords="telemedicine",
keywords="smartphone",
keywords="mobile application",
abstract="Background: The advent of telemedicine has allowed physicians to deliver medical treatment to patients from a distance. Mobile apps such as WhatsApp Messenger, an instant messaging service, came as a novel concept in all fields of social life, including medicine. The use of instant messaging services has been shown to improve communication within medical teams by providing means for quick teleconsultation, information sharing, and starting treatment as soon as possible. Objective: The aim of this study was to perform a comprehensive systematic review of present literature on the use of the WhatsApp Messenger app as an adjunctive health care tool for medical doctors. Methods: Searches were performed in PubMed, EMBASE, and the Cochrane Library using the term ``whatsapp*'' in articles published before January 2016. A bibliography of all relevant original articles that used the WhatsApp Messenger app was created. The level of evidence of each study was determined according to the Oxford Levels of Evidence ranking system produced by the Oxford Centre for Evidence-Based Medicine. The impact and the indications of WhatsApp Messenger are discussed in order to understand the extent to which this app currently functions as an adjunctive tool for telemedicine. Results: The database search identified a total of 30 studies in which the term ``whatsapp*'' was used. Each article's list of references was evaluated item-by-item. After literature reviews, letters to the editor, and low-quality studies were excluded, a total of 10 studies were found to be eligible for inclusion. Of these studies, 9 had been published in the English language and 1 had been published in Spanish. Five were published by medical doctors. Conclusions: The pooled data presents compelling evidence that the WhatsApp Messenger app is a promising system, whether used as a communication tool between health care professionals, as a means of communication between health care professionals and the general public, or as a learning tool for providing health care information to professionals or to the general population. However, high-quality and properly evaluated research is needed, as are improvements in descriptions of the methodology and the study processes. These improvements will allow WhatsApp Messenger to be categorically defined as an effective telemedicine tool in many different fields of health care. ",
doi="10.2196/ijmr.6214",
url="http://www.i-jmr.org/2017/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28733273"
}


@Article{info:doi/10.2196/jmir.7854,
author="Xie, Xiaoxu
and Zhou, Weimin
and Lin, Lingyan
and Fan, Si
and Lin, Fen
and Wang, Long
and Guo, Tongjun
and Ma, Chuyang
and Zhang, Jingkun
and He, Yuan
and Chen, Yixin",
title="Internet Hospitals in China: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="04",
volume="19",
number="7",
pages="e239",
keywords="eHealth",
keywords="Internet",
keywords="health care",
keywords="medical informatics",
keywords="China",
abstract="Background: The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China's Internet hospitals have not been systematically investigated. Objective: The aim of this study was to describe the characteristics of China's Internet hospitals, and to assess their health service capacity. Methods: We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as ``Internet hospital,'' ``web hospital,'' or ``cloud hospital.'' All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. Results: We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30\%) were in the hospital informatization stage, 24 (56\%) were in the Web ward stage, and 6 (14\%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74\%, 32/43), app (42\%, 18/43), or offline medical consultation facility (37\%, 16/43) from the Internet hospital. Furthermore, 25 (58\%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42\%) did not. The consulting methods included video chat (60\%, 26/43), telephone (19\%, 8/43), and graphic message (28\%, 12/43); 13 (30\%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was {\textyen}20 (approximately US \$2.90, IQR {\textyen}0 to {\textyen}200). Conclusions: Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and the unavailability of health insurance coverage. China's Internet hospitals are heading in the right direction to improve provision of health services, but much more remains to be done. ",
doi="10.2196/jmir.7854",
url="http://www.jmir.org/2017/7/e239/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28676472"
}


@Article{info:doi/10.2196/jmir.7405,
author="Kooij, Laura
and Groen, G. Wim
and van Harten, H. Wim",
title="The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="22",
volume="19",
number="6",
pages="e221",
keywords="review",
keywords="integrated healthcare systems",
keywords="health information systems",
keywords="chronic disease",
abstract="Background: In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective: Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods: PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness---in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes---were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results: The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes---for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs' satisfaction, and confidence. Conclusions: IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods. ",
doi="10.2196/jmir.7405",
url="http://www.jmir.org/2017/6/e221/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28642218"
}


@Article{info:doi/10.2196/jmir.5221,
author="M{\"u}ller, Ivar Kai
and Alstadhaug, Bj{\o}rnar Karl
and Bekkelund, Ivar Svein",
title="Acceptability, Feasibility, and Cost of Telemedicine for Nonacute Headaches: A Randomized Study Comparing Video and Traditional Consultations",
journal="J Med Internet Res",
year="2016",
month="May",
day="30",
volume="18",
number="5",
pages="e140",
keywords="headache",
keywords="management",
keywords="consultation",
keywords="telemedicine",
keywords="burden",
keywords="cost",
keywords="feasibility",
keywords="rural",
keywords="randomization",
abstract="Background: The feasibility of telemedicine in diagnosing and treating nonacute headaches, such as primary headaches (migraine and tension-type) and medication-overuse headaches has not been previously investigated. By eliminating the need of travel to specialists, telemedicine may offer significant time and money savings. Objectives: Our objective was to estimate the acceptance of telemedicine and investigate the feasibility and cost savings of telemedicine consultations in diagnosing and treating nonacute headaches. Methods: From September 2012 to March 2015, nonacute headache patients from Northern Norway who were referred to neurologists through an electronic application system were consecutively screened and randomized to participate in either telemedicine or traditional specialist visits. All patients were consulted by two neurologists at the neurological department in Troms{\o} University Hospital. Feasibility outcomes were compared between telemedicine and traditional groups. Baseline characteristics and costs were then compared between rural and urban patients. Travel costs were calculated by using the probabilistic method of the Norwegian traveling agency: the cheapest means of public transport for each study participant. Loss of pay was calculated based on the Norwegian full-time employee's average salary: < 3.5 hours=a half day's salary, > 3.5 hours spent on travel and consultation=one day's salary. Distance and time spent on travel were estimated by using Google Maps. Results: Of 557 headache patients screened, 479 were found eligible and 402 accepted telemedicine participation (83.9\%, 402/479) and were included in the final analyses. Of these, 202 received traditional specialist consultations and 200 received telemedicine. All patients in the telemedicine group were satisfied with the video quality, and 198 (99\%, 198/200) were satisfied with the sound quality. The baseline characteristics as well as headache diagnostics and follow-up appointments, and the investigation, advice, and prescription practices were not statistically different between the two randomized groups. In addition, telemedicine consultations were shorter than traditional visits (38.8 vs 43.7 min, P<.001). The travel cost per rural individual (292/402, 73\%) was {\texteuro}249, and estimated lost income was {\texteuro}234 per visit. The travel cost in the urban area (110/402, 27\%) was {\texteuro}6, and estimated lost income was {\texteuro}117 per visit. The median traveling distance for rural patients was 526 km (range 1892 km), and the median traveling time was 7.8 hours (range 27.3 hours). Rural patients had a longer waiting time than urban patients (64 vs 47 days, P=.001), and fewer women were referred from rural areas (P=.04). Rural women reported higher pain scores than urban women (P=.005). Conclusion: Our study shows that telemedicine is an accepted, feasible, time-saving, and cost-saving alternative to traditional specialist consultations for nonacute headaches. Trial Registration: Clinicaltrials.gov NCT02270177; http://clinicaltrials.gov/ct2/show/NCT02270177 (Archived by WebCite at http://www.webcitation.org/6hmoHGo9Q) ",
doi="10.2196/jmir.5221",
url="http://www.jmir.org/2016/5/e140/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27241876"
}


@Article{info:doi/10.2196/ijmr.5462,
author="Long, Ju
and Yuan, Juntao Michael
and Poonawala, Robina",
title="An Observational Study to Evaluate the Usability and Intent to Adopt an Artificial Intelligence--Powered Medication Reconciliation Tool",
journal="Interact J Med Res",
year="2016",
month="May",
day="16",
volume="5",
number="2",
pages="e14",
keywords="medication reconciliation",
keywords="adverse drug event",
keywords="medication errors",
keywords="medication adherence",
keywords="patient medication knowledge",
keywords="decision making, shared",
abstract="Background: Medication reconciliation (the process of creating an accurate list of all medications a patient is taking) is a widely practiced procedure to reduce medication errors. It is mandated by the Joint Commission and reimbursed by Medicare. Yet, in practice, medication reconciliation is often not effective owing to knowledge gaps in the team. A promising approach to improve medication reconciliation is to incorporate artificial intelligence (AI) decision support tools into the process to engage patients and bridge the knowledge gap. Objective: The aim of this study was to improve the accuracy and efficiency of medication reconciliation by engaging the patient, the nurse, and the physician as a team via an iPad tool. With assistance from the AI agent, the patient will review his or her own medication list from the electronic medical record (EMR) and annotate changes, before reviewing together with the physician and making decisions on the shared iPad screen. Methods: In this study, we developed iPad-based software tools, with AI decision support, to engage patients to ``self-service'' medication reconciliation and then share the annotated reconciled list with the physician. To evaluate the software tool's user interface and workflow, a small number of patients (10) in a primary care clinic were recruited, and they were observed through the whole process during a pilot study. The patients are surveyed for the tool's usability afterward. Results: All patients were able to complete the medication reconciliation process correctly. Every patient found at least one error or other issues with their EMR medication lists. All of them reported that the tool was easy to use, and 8 of 10 patients reported that they will use the tool in the future. However, few patients interacted with the learning modules in the tool. The physician and nurses reported the tool to be easy-to-use, easy to integrate into existing workflow, and potentially time-saving. Conclusions: We have developed a promising tool for a new approach to medication reconciliation. It has the potential to create more accurate medication lists faster, while better informing the patients about their medications and reducing burden on clinicians. ",
doi="10.2196/ijmr.5462",
url="http://www.i-jmr.org/2016/2/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27185210"
}


@Article{info:doi/10.2196/jmir.5718,
author="Hung, Chi-Sheng
and Yu, Jiun-Yu
and Lin, Yen-Hung
and Chen, Ying-Hsien
and Huang, Ching-Chang
and Lee, Jen-Kuang
and Chuang, Pao-Yu
and Ho, Yi-Lwun
and Chen, Ming-Fong",
title="Mortality Benefit of a Fourth-Generation Synchronous Telehealth Program for the Management of Chronic Cardiovascular Disease: A Longitudinal Study",
journal="J Med Internet Res",
year="2016",
month="May",
day="13",
volume="18",
number="5",
pages="e102",
keywords="cardiovascular diseases",
keywords="telemedicine",
keywords="all-cause mortality",
keywords="outcome assessment (health care)",
abstract="Background: We have shown that a fourth-generation telehealth program that analyzes and responds synchronously to data transferred from patients is associated with fewer hospitalizations and lower medical costs. Whether a fourth-generation telehealth program can reduce all-cause mortality has not yet been reported for patients with chronic cardiovascular disease. Objective: We conducted a clinical epidemiology study retrospectively to determine whether a fourth-generation telehealth program can reduce all-cause mortality for patients with chronic cardiovascular disease. Methods: We enrolled 576 patients who had joined a telehealth program and compared them with 1178 control patients. A Cox proportional hazards model was fitted to analyze the impact of risk predictors on all-cause mortality. The model adjusted for age, sex, and chronic comorbidities. Results: There were 53 (9.3\%) deaths in the telehealth group and 136 (11.54\%) deaths in the control group. We found that the telehealth program violated the proportional hazards assumption by the Schoenfeld residual test. Thus, we fitted a Cox regression model with time-varying covariates. The results showed an estimated hazard ratio (HR) of 0.866 (95\% CI 0.837-0.896, P<.001; number needed to treat at 1 year=55.6, 95\% CI 43.2-75.7 based on HR of telehealth program) for the telehealth program on all-cause mortality after adjusting for age, sex, and comorbidities. The time-varying interaction term in this analysis showed that the beneficial effect of telehealth would increase over time. Conclusions: The results suggest that our fourth-generation telehealth program is associated with less all-cause mortality compared with usual care after adjusting for chronic comorbidities. ",
doi="10.2196/jmir.5718",
url="http://www.jmir.org/2016/5/e102/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27177497"
}


@Article{info:doi/10.2196/ijmr.5196,
author="Tagliente, Irene
and Trieste, Leopoldo
and Solvoll, Terje
and Murgia, Fabrizio
and Bella, Sergio",
title="Telemonitoring in Cystic Fibrosis: A 4-year Assessment and Simulation for the Next 6 Years",
journal="Interact J Med Res",
year="2016",
month="May",
day="03",
volume="5",
number="2",
pages="e11",
keywords="cystic fibrosis",
keywords="telemonitoring",
keywords="cost effectiveness",
keywords="follow-up",
keywords="eHealth",
abstract="Background: Innovative technologies and informatics offer a wide range of services to health districts, doctors, nurses, and patients, and is changing the traditional concept of health care. In the last few years, the availability of portable devices, their easiness to transport and use, and the capability to collect and transmit various clinical data have resulted in the fast development of telemedicine. However, despite its potential impact in improving patient conditions, and its cost effectiveness reported in literature, telemedicine is not in daily practice. Objective: The aim of this study is to provide evidence of the positive impact of telemonitoring proving the sustainability of an application by sending spirometry outcomes from patients' homes to the hospital doctors via the Internet, and from doctors to patients by an additional phone call solution. Methods: We examined collected data related to clinical improvement of patients with cystic fibrosis (CF). The patients were followed-up at home using telemonitoring for a period of 10 years, with the aims to prove the sustainability of the methodology (transmissions of spirometry from the patients' home to the doctors and feedback from the doctors to the patients by phone call from the hospital). We stored and analyzed all spirometry transmissions received, and tested the possible presence to decrease the costs between the standard clinical trial (only ambulatory visits) and standard clinical trial with telemonitoring for the follow-up of patients with CF (telemedicine). This was done through an economic analysis of the costs for patients followed at home by telemonitoring. We assessed four years of observation and a simulation of total long-term costs between 2010 and 2020. Results: We discovered a potential saving of {\texteuro}40,397.00 per patient for 10 years, actualized at {\texteuro}36,802.97 for the follow-up of all patients enrolled. Conclusions: The results from the study suggest that telemedicine can improve the health of patients with CF. It is a relatively cheap and potentially sustainable solution, compared to standard clinical trials. However, to establish and prove the long-term effectiveness and cost-effectiveness, more controlled psychological and behavioral studies are needed. ",
doi="10.2196/ijmr.5196",
url="http://www.i-jmr.org/2016/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27142963"
}


@Article{info:doi/10.2196/ijmr.5015,
author="Valenzuela Espinoza, Alexis
and De Smedt, Ann
and Guldolf, Kaat
and Vandervorst, Fenne
and Van Hooff, Robbert-Jan
and Fernandez Tellez, Helio
and Desmaele, Sara
and Cambron, Melissa
and Hubloue, Ives
and Brouns, Raf",
title="Opinions and Beliefs About Telemedicine for Emergency Treatment During Ambulance Transportation and for Chronic Care at Home",
journal="Interact J Med Res",
year="2016",
month="Mar",
day="30",
volume="5",
number="1",
pages="e9",
keywords="telemedicine",
keywords="stroke",
keywords="adoption",
keywords="diagnostic techniques and procedures",
keywords="emergency care",
keywords="patient-centered care",
abstract="Background: Telemedicine is a valid alternative to face-to-face patient care in many areas. However, the opinion of all stakeholders is decisive for successful adoption of this technique, especially as telemedicine expands into novel domains such as emergency teleconsultations during ambulance transportation and chronic care at home. Objective: We evaluate the viewpoints of the broad public, patients, and professional caregivers in these situations. Methods: A 10-question survey was developed and obtained via face-to-face interviews of visitors at the Universitair Ziekenhuis Brussel (UZB). The online questionnaire was also distributed among professional caregivers via the intranet of the UZB and among the broad public using social media. Results: In total, 607 individuals responded to the questionnaire, expressing a positive opinion regarding telemedicine for in-ambulance emergency treatment and for chronic care at home. Privacy issues were not perceived as relevant, and most respondents were ready to participate in future teleconsultations. Lack of telecommunication knowledge (213/566, 37.6\%) was the only independent factor associated with rejection of telemedicine at home and respondents via social media (250/607, 41.2\%) were less concerned about privacy issues than respondents via face-to-face interviews (visitors, 234/607, 38.6\%). The visitors were more positive towards in-ambulance telemedicine and more likely to agree with future participation in teleconsultations than respondents via social media. Conclusions: The broad public, professional caregivers, and patients reported a positive attitude towards telemedicine for emergency treatment during ambulance transportation and for chronic care at home. These results support further improvement of telemedicine solutions in these domains. ",
doi="10.2196/ijmr.5015",
url="http://www.i-jmr.org/2016/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27029999"
}


@Article{info:doi/10.2196/jmir.5257,
author="Dinesen, Birthe
and Nonnecke, Brandie
and Lindeman, David
and Toft, Egon
and Kidholm, Kristian
and Jethwani, Kamal
and Young, M. Heather
and Spindler, Helle
and Oestergaard, Ugilt Claus
and Southard, A. Jeffrey
and Gutierrez, Mario
and Anderson, Nick
and Albert, M. Nancy
and Han, J. Jay
and Nesbitt, Thomas",
title="Personalized Telehealth in the Future: A Global Research Agenda",
journal="J Med Internet Res",
year="2016",
month="Mar",
day="01",
volume="18",
number="3",
pages="e53",
keywords="telehealth",
keywords="research",
keywords="individualized medicine",
keywords="telemonitoring",
keywords="prevention",
keywords="mobile phone",
doi="10.2196/jmir.5257",
url="http://www.jmir.org/2016/3/e53/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26932229"
}


@Article{info:doi/10.2196/medinform.4842,
author="Cuba Gyllensten, Illapha
and Bonomi, G. Alberto
and Goode, M. Kevin
and Reiter, Harald
and Habetha, Joerg
and Amft, Oliver
and Cleland, GF John",
title="Early Indication of Decompensated Heart Failure in Patients on Home-Telemonitoring: A Comparison of Prediction Algorithms Based on Daily Weight and Noninvasive Transthoracic Bio-impedance",
journal="JMIR Med Inform",
year="2016",
month="Feb",
day="18",
volume="4",
number="1",
pages="e3",
keywords="Heart failure",
keywords="telemonitoring",
keywords="deterioration detection",
keywords="alert algorithms",
keywords="ambulatory monitoring",
keywords="impedance",
abstract="Background: Heart Failure (HF) is a common reason for hospitalization. Admissions might be prevented by early detection of and intervention for decompensation. Conventionally, changes in weight, a possible measure of fluid accumulation, have been used to detect deterioration. Transthoracic impedance may be a more sensitive and accurate measure of fluid accumulation. Objective: In this study, we review previously proposed predictive algorithms using body weight and noninvasive transthoracic bio-impedance (NITTI) to predict HF decompensations. Methods: We monitored 91 patients with chronic HF for an average of 10 months using a weight scale and a wearable bio-impedance vest. Three algorithms were tested using either simple rule-of-thumb differences (RoT), moving averages (MACD), or cumulative sums (CUSUM). Results: Algorithms using NITTI in the 2 weeks preceding decompensation predicted events (P<.001); however, using weight alone did not. Cross-validation showed that NITTI improved sensitivity of all algorithms tested and that trend algorithms provided the best performance for either measurement (Weight-MACD: 33\%, NITTI-CUSUM: 60\%) in contrast to the simpler rules-of-thumb (Weight-RoT: 20\%, NITTI-RoT: 33\%) as proposed in HF guidelines. Conclusions: NITTI measurements decrease before decompensations, and combined with trend algorithms, improve the detection of HF decompensation over current guideline rules; however, many alerts are not associated with clinically overt decompensation. ",
doi="10.2196/medinform.4842",
url="http://medinform.jmir.org/2016/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26892844"
}


@Article{info:doi/10.2196/ijmr.4217,
author="Talboom-Kamp, PWA Esther
and Verdijk, A. Noortje
and Harmans, M. Lara
and Numans, E. Mattijs
and Chavannes, H. Niels",
title="An eHealth Platform to Manage Chronic Disease in Primary Care: An Innovative Approach",
journal="Interact J Med Res",
year="2016",
month="Feb",
day="09",
volume="5",
number="1",
pages="e5",
keywords="eHealth",
keywords="self-management",
keywords="anticoagulation clinic",
keywords="chronic obstructive pulmonary disease",
keywords="venous thromboembolism",
keywords="integrated disease management",
keywords="chronically ill",
keywords="telemonitoring",
keywords="primary care",
doi="10.2196/ijmr.4217",
url="http://www.i-jmr.org/2016/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26860333"
}


@Article{info:doi/10.2196/ijmr.4910,
author="Bird, Marie-Louise
and Callisaya, L. Michele
and Cannell, John
and Gibbons, Timothy
and Smith, T. Stuart
and Ahuja, DK Kiran",
title="Accuracy, Validity, and Reliability of an Electronic Visual Analog Scale for Pain on a Touch Screen Tablet in Healthy Older Adults: A Clinical Trial",
journal="Interact J Med Res",
year="2016",
month="Jan",
day="14",
volume="5",
number="1",
pages="e3",
keywords="pain",
keywords="VAS",
keywords="technology",
keywords="scale",
abstract="Background: New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians; however, this new technology has not been tested for accuracy, reliability, or validity. Objective: This study aims to test the accuracy of visual analog scale (VAS) for pain on a newly designed application on the iPad (iPadVAS) and measure the reliability and validity of iPadVAS compared to a paper copy (paperVAS). Methods: Accuracy was determined by physically measuring an iPad scale on screen and comparing it to the results from the program, with a researcher collecting 101 data points. A total of 22 healthy community dwelling older adults were then recruited to test reliability and validity. Each participant completed 8 VAS (4 using each tool) in a randomized order. Reliability was measured using interclass correlation coefficient (ICC) and validity measured using Bland-Altman graphs and correlations. Results: Of the measurements for accuracy, 64 results were identical, 2 results were manually measured as being 1 mm higher than the program, and 35 as 1 mm lower. Reliability for the iPadVAS was excellent with individual ICC 0.90 (95\% CI 0.82-0.95) and averaged ICC 0.97 (95\% CI 0.95-1.0) observed. Linear regression demonstrated a strong relationship with a small negative bias towards the iPad (?2.6, SD 5.0) with limits of agreement from ?12.4 to 7.1. Conclusions: The iPadVAS provides a convenient, user-friendly, and efficient way of collecting data from participants in measuring their current pain levels. It has potential use in documentation management and may encourage participatory healthcare. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR): 367297; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367297\&isReview=true (Archived by Webcite at http://www.webcitation.org/6d9xYoUbD). ",
doi="10.2196/ijmr.4910",
url="http://www.i-jmr.org/2016/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26769149"
}


@Article{info:doi/10.2196/ijmr.4270,
author="Dario, Claudio
and Delise, Pietro
and Gubian, Lorenzo
and Saccavini, Claudio
and Brandolino, Glauco
and Mancin, Silvia",
title="Large Controlled Observational Study on Remote Monitoring of Pacemakers and Implantable Cardiac Defibrillators: A Clinical, Economic, and Organizational Evaluation",
journal="Interact J Med Res",
year="2016",
month="Jan",
day="13",
volume="5",
number="1",
pages="e4",
keywords="healthcare economics and organization",
keywords="telehealth and telemonitoring",
keywords="implantable cardiac defibrillator",
keywords="cardiac pacemaker",
abstract="Background: Patients with implantable devices such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs) should be followed up every 3--12 months, which traditionally required in-clinic visits. Innovative devices allow data transmission and technical or medical alerts to be sent from the patient's home to the physician (remote monitoring). A number of studies have shown its effectiveness in timely detection and management of both clinical and technical events, and endorsed its adoption. Unfortunately, in daily practice, remote monitoring has been implemented in uncoordinated and rather fragmented ways, calling for a more strategic approach. Objective: The objective of the study was to analyze the impact of remote monitoring for PM and ICD in a ``real world'' context compared with in-clinic follow-up. The evaluation focuses on how this service is carried out by Local Health Authorities, the impact on the cardiology unit and the health system, and organizational features promoting or hindering its effectiveness and efficiency. Methods: A multi-center, multi-vendor, controlled, observational, prospective study was conducted to analyze the impact of remote monitoring implementation. A total of 2101 patients were enrolled in the study: 1871 patients were followed through remote monitoring of PM/ICD (I-group) and 230 through in-clinic visits (U-group). The follow-up period was 12 months. Results: In-clinic device follow-ups and cardiac visits were significantly lower in the I-group compared with the U-group, respectively: PM, I-group = 0.43, U-group = 1.07, P<.001; ICD, I-group = 0.98, U-group = 2.14, P<.001. PM, I-group = 0.37, U-group = 0.85, P<.001; ICD, I-group = 1.58, U-group = 1.69, P=.01. Hospitalizations for any cause were significantly lower in the I-group for PM patients only (I-group = 0.37, U-group = 0.50, P=.005). There were no significant differences regarding use of the emergency department for both PM and ICD patients. In the I-group, 0.30 (PM) and 0.37 (ICD) real clinical events per patient per year were detected within a mean (SD) time of 1.18 (2.08) days. Mean time spent by physicians to treat a patient was lower in the I-group compared to the U-group  (-4.1 minutes PM; -13.7 minutes ICD). Organizational analysis showed that remote monitoring  implementation was rather haphazard and fragmented. From a health care system perspective, the economic analysis showed statistically significant gains (P<.001) for the I-group using PM. Conclusions: This study contributes to build solid evidence regarding the usefulness of RM in detecting and managing clinical and technical events with limited use of manpower and other health care resources. To fully gain the benefits of RM of PM/ICD, it is vital that organizational processes be streamlined and standardized within an overarching strategy. ",
doi="10.2196/ijmr.4270",
url="http://www.i-jmr.org/2016/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26764170"
}


@Article{info:doi/10.2196/ijmr.4549,
author="Kern, Raimar
and Haase, Rocco
and Eisele, Christina Judith
and Thomas, Katja
and Ziemssen, Tjalf",
title="Designing an Electronic Patient Management System for Multiple Sclerosis: Building a Next Generation Multiple Sclerosis Documentation System",
journal="Interact J Med Res",
year="2016",
month="Jan",
day="08",
volume="5",
number="1",
pages="e2",
keywords="health information technology",
keywords="computers",
keywords="Internet",
keywords="multiple sclerosis",
keywords="eHealth",
keywords="disease management",
abstract="Background: Technologies like electronic health records or telemedicine devices support the rapid mediation of health information and clinical data independent of time and location between patients and their physicians as well as among health care professionals. Today, every part of the treatment process from diagnosis, treatment selection, and application to patient education and long-term care may be enhanced by a quality-assured implementation of health information technology (HIT) that also takes data security standards and concerns into account. In order to increase the level of effectively realized benefits of eHealth services, a user-driven needs assessment should ensure the inclusion of health care professional perspectives into the process of technology development as we did in the development process of the Multiple Sclerosis Documentation System 3D. After analyzing the use of information technology by patients suffering from multiple sclerosis, we focused on the needs of neurological health care professionals and their handling of health information technology. Objective: Therefore, we researched the status quo of eHealth adoption in neurological practices and clinics as well as health care professional opinions about potential benefits and requirements of eHealth services in the field of multiple sclerosis. Methods: We conducted a paper-and-pencil--based mail survey in 2013 by sending our questionnaire to 600 randomly chosen neurological practices in Germany. The questionnaire consisted of 24 items covering characteristics of participating neurological practices (4 items), the current use of network technology and the Internet in such neurological practices (5 items), physicians' attitudes toward the general and MS-related usefulness of eHealth systems (8 items) and toward the clinical documentation via electronic health records (4 items), and physicians' knowledge about the Multiple Sclerosis Documentation System (3 items). Results: From 600 mailed surveys, 74 completed surveys were returned. As much as 9 of the 10 practices were already connected to the Internet (67/74), but only 49\% preferred a permanent access. The most common type of HIT infrastructure was a complete practice network with several access points. Considering data sharing with research registers, 43\% opted for an online interface, whereas 58\% decided on an offline method of data transmission. eHealth services were perceived as generally useful for physicians and nurses in neurological practices with highest capabilities for improvements in clinical documentation, data acquisition, diagnosis of specific MS symptoms, physician-patient communication, and patient education. Practices specialized in MS in comparison with other neurological practices presented an increased interest in online documentation. Among the participating centers, 91\% welcomed the opportunity of a specific clinical documentation for MS and 87\% showed great interest in an extended and more interconnected electronic documentation of MS patients. Clinical parameters (59/74) were most important in documentation, followed by symptomatic parameters like measures of fatigue or depression (53/74) and quality of life (47/74). Conclusions: Physicians and nurses may significantly benefit from an electronically assisted documentation and patient management. Many aspects of patient documentation and education will be enhanced by eHealth services if the most informative measures are integrated in an easy-to-use and easily connectable approach. MS-specific eHealth services were highly appreciated, but the current level of adoption is still behind the level of interest in an extended and more interconnected electronic documentation of MS patients. ",
doi="10.2196/ijmr.4549",
url="http://www.i-jmr.org/2016/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26746977"
}


@Article{info:doi/10.2196/jmir.4825,
author="Kato, P. Naoko
and Johansson, Peter
and Okada, Ikuko
and de Vries, E. Arjen
and Kinugawa, Koichiro
and Str{\"o}mberg, Anna
and Jaarsma, Tiny",
title="Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey",
journal="J Med Internet Res",
year="2015",
month="Nov",
day="13",
volume="17",
number="11",
pages="e258",
keywords="disease management",
keywords="expectation",
keywords="heart failure",
keywords="implementation barriers",
keywords="nurses",
keywords="perception",
keywords="physicians",
keywords="telemedicine",
abstract="Background: Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries. Objective: We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden. Methods: This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring. Results: The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2\%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0\%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6\%, 82/378; in Sweden: 30.0\%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1\%, 352/374) and Sweden (88.7\%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9\%, 100/115) and to do remote drug titration (79.1\%, 91/115). Just under a quarter of Japanese (22.4\%, 85/378) and over a third of Swedish (38.1\%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers ``how are we going to do it?'' (categories include structure and resource), health care professionals themselves ``what do we need to know and do'' (reservation), and barriers related to patients ``not everybody would benefit'' (internal and external shortcomings). Conclusions: Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients' hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring. ",
doi="10.2196/jmir.4825",
url="http://www.jmir.org/2015/11/e258/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26567061"
}


@Article{info:doi/10.2196/ijmr.3610,
author="Ferrando, Fernando
and Mira, Yolanda",
title="Effective and Safe Management of Oral Anticoagulation Therapy in Patients Who Use the Internet-Accessed Telecontrol Tool SintromacWeb",
journal="Interact J Med Res",
year="2015",
month="Apr",
day="21",
volume="4",
number="2",
pages="e10",
keywords="oral anticoagulant therapy",
keywords="International Normalized Ratio",
keywords="Internet",
keywords="self-management software",
keywords="telecontrol",
keywords="SintromacWeb",
abstract="Background: Despite the existing evidence that highlights the benefits of oral anticoagulation therapy (OAT) self-testing and self-management by patients in comparison with conventional control, significant progress is still needed in the implementation of computer-based, Internet-assisted systems for OAT within health care centers. The telecontrol tool ``SintromacWeb'' is a previously validated system for OAT management at home, which is currently operative and accessed by patients through a hospital Web portal. Objective: The intent of the study was to assess the effectiveness and safety of OAT management in patients using the SintromacWeb telecontrol system in reference to control in patients using the conventional system (management at the hematology department), in terms of time in therapeutic range (TTR) of International Normalized Ratio (INR). Methods: In this observational prospective study, patients were identified by their physician and divided in two groups according to the OAT management system that they were already using (conventional control or telecontrol with SintromacWeb). For 6 months, patients were required to visit the hematology department every time their physician considered it necessary according to usual clinical practice. Sociodemographic and clinical variables for the study were collected at first visit (baseline) and at those visits closest to 2, 4, and 6 months after first visit. Results: A total of 173 patients were evaluated, 87 with conventional control and 86 with telecontrol. Follow-up time was a median of 6.3 (range 5.2-8.1) months. The average time of OAT treatment prior to enrollment was 9.2 (SD 6.4) years. Patients in the telecontrol group tested their INR a median of 21 (range 4-22) days versus a median of 35 (range 14-45) days in patients in the conventional control group (P<.001). TTR in the telecontrol group was 107 (SD 37) days versus 94 (SD 37) days in the conventional control group (an increase of 12.6\%; P=.02). In all visits, the percentage of TTR was higher in the telecontrol group (at the third visit: 59\% vs 48\%; P=.01). Higher TTR (positive coefficient) was associated with patients under OAT telecontrol (P=.03). Under-anticoagulation (INR<1.5) and over-anticoagulation (INR>5) were observed in 34 (19.7\%, 34/173) and 38 (22.0\%, 38/173) patients, respectively (no differences between treatment groups). Seven thrombotic and/or bleeding events were serious, 12 were non-serious, and most of them (5 and 10, respectively) occurred in the conventional control group. Conclusions: In clinical practice, OAT management with the Internet-based tool SintromacWeb is effective and safe for those patients who are eligible for OAT telecontrol. ",
doi="10.2196/ijmr.3610",
url="http://www.i-jmr.org/2015/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25900775"
}


@Article{info:doi/10.2196/jmir.4174,
author="Kitsiou, Spyros
and Par{\'e}, Guy
and Jaana, Mirou",
title="Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews",
journal="J Med Internet Res",
year="2015",
month="Mar",
day="12",
volume="17",
number="3",
pages="e63",
keywords="home telemonitoring",
keywords="telemedicine",
keywords="telehealth",
keywords="remote monitoring",
keywords="remote consultation",
keywords="heart failure",
keywords="chronic diseases",
keywords="continuity of patient care",
keywords="physiologic monitoring",
keywords="ambulatory monitoring",
keywords="home care services",
keywords="review",
keywords="umbrella review",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective: This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods: A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4\%-6.5\% and 3.7\%-8.2\%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95\% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (?28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95\% CrI 0.42-0.89) and HR 0.67 (95\% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. ",
doi="10.2196/jmir.4174",
url="http://www.jmir.org/2015/3/e63/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25768664"
}


@Article{info:doi/10.2196/ijmr.3955,
author="Disler, T. Rebecca
and Inglis, C. Sally
and Newton, J. Phillip
and Currow, C. David
and Macdonald, S. Peter
and Glanville, R. Allan
and Donesky, DorAnne
and Carrieri-Kohlman, Virginia
and Davidson, M. Patricia",
title="Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey",
journal="Interact J Med Res",
year="2015",
month="Mar",
day="06",
volume="4",
number="1",
pages="e5",
keywords="chronic obstructive pulmonary disease",
keywords="chronic disease",
keywords="self-management",
keywords="self-care",
keywords="telemedicine, eHealth",
keywords="mHealth",
abstract="Background: Self-management education for cardiopulmonary diseases is primarily provided through time-limited, face-to-face programs, with access limited to a small percentage of patients. Telecommunication tools will increasingly be an important component of future health care delivery. Objective: The purpose of this study was to describe the patterns of technology use in patients attending a cardiopulmonary clinic in an academic medical center. Methods: A prevalence survey was developed to collect data on participant demographics (age in years, sex, and socioeconomic status); access to computers, Internet, and mobile phones; and use of current online health support sites or programs. Surveys were offered by reception staff to all patients attending the outpatient clinic. Results: A total of 123 surveys were collected between March and April 2014. Technological devices were a pervasive part of everyday life with respondents engaged in regular computer (102/123, 82.9\%), mobile telephone (115/117, 98.3\%), and Internet (104/121, 86.0\%) use. Emailing (101/121, 83.4\%), researching and reading news articles (93/121, 76.9\%), social media (71/121, 58.7\%), and day-to-day activities (65/121, 53.7\%) were the most common telecommunication activities. The majority of respondents reported that access to health support programs and assistance through the Internet (82/111, 73.9\%) would be of use, with benefits reported as better understanding of health information (16/111, 22.5\%), avoidance of difficult travel requirements and time-consuming face-to-face appointments (13/111, 18.3\%), convenient and easily accessible help and information (12/111, 16.9\%), and access to peer support and sharing (9/111, 12.7\%). The majority of patients did not have concerns over participating in the online environment (87/111, 78.4\%); the few concerns noted related to privacy and security (10/15), information accuracy (2/15), and computer literacy and access (2/15). Conclusions: Chronic disease burden and long-term self-management tasks provide a compelling argument for accessible and convenient avenues to obtaining ongoing treatment and peer support. Online access to health support programs and assistance was reported as useful and perceived as providing convenient, timely, and easily accessible health support and information. Distance from the health care facility and a lack of information provision through traditional health sources were both barriers and enablers to telehealth. This is particularly important in the context of a cardiopulmonary clinic that attracts patients from a large geographical area, and in patients who are most likely to have high health care utilization needs in the future. Telecommunication interfaces will be an increasingly important adjunct to traditional forms of health care delivery. ",
doi="10.2196/ijmr.3955",
url="http://www.i-jmr.org/2015/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25798814"
}


@Article{info:doi/10.2196/jmir.4056,
author="Lyngstad, Merete
and Hofoss, Dag
and Grimsmo, Anders
and Helles{\o}, Ragnhild",
title="Predictors for Assessing Electronic Messaging Between Nurses and General Practitioners as a Useful Tool for Communication in Home Health Care Services: A Cross-Sectional Study",
journal="J Med Internet Res",
year="2015",
month="Feb",
day="17",
volume="17",
number="2",
pages="e47",
keywords="electronic mail",
keywords="home healthcare nursing",
keywords="collaborating",
keywords="general practitioners",
abstract="Background: Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. Objective: The aim of this study was to explore home health care nurses' assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. Methods: The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Results: Over two-thirds (425/632, 67.2\%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2\%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). Conclusions: This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses' assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services. ",
doi="10.2196/jmir.4056",
url="http://www.jmir.org/2015/2/e47/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25691234"
}


@Article{info:doi/10.2196/medinform.3179,
author="Burgos, Felip
and Melia, Umberto
and Vallverd{\'u}, Montserrat
and Velickovski, Filip
and Lluch-Ariet, Mag{\'i}
and Caminal, Pere
and Roca, Josep",
title="Clinical Decision Support System to Enhance Quality Control of Spirometry Using Information and Communication Technologies",
journal="JMIR Med Inform",
year="2014",
month="Oct",
day="21",
volume="2",
number="2",
pages="e29",
keywords="spirometry",
keywords="telemedicine",
keywords="information communication technologies",
keywords="primary care",
keywords="quality control",
abstract="Background: We recently demonstrated that quality of spirometry in primary care could markedly improve with remote offline support from specialized professionals. It is hypothesized that implementation of automatic online assessment of quality of spirometry using information and communication technologies may significantly enhance the potential for extensive deployment of a high quality spirometry program in integrated care settings. Objective: The objective of the study was to elaborate and validate a Clinical Decision Support System (CDSS) for automatic online quality assessment of spirometry. Methods: The CDSS was done through a three step process including: (1) identification of optimal sampling frequency; (2) iterations to build-up an initial version using the 24 standard spirometry curves recommended by the American Thoracic Society; and (3) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 spirometry curves from 291 patients were analyzed for validation purposes. Results: The CDSS generated appropriate online classification and certification in 685/778 (88.1\%) of spirometry testing, with 96\% sensitivity and 95\% specificity. Conclusions: Consequently, only 93/778 (11.9\%) of spirometry testing required offline remote classification by an expert, indicating a potential positive role of the CDSS in the deployment of a high quality spirometry program in an integrated care setting. ",
doi="10.2196/medinform.3179",
url="http://medinform.jmir.org/2014/2/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25600957"
}


@Article{info:doi/10.2196/medinform.3251,
author="Install{\'e}, JF Arnaud
and Van den Bosch, Thierry
and De Moor, Bart
and Timmerman, Dirk",
title="Clinical Data Miner: An Electronic Case Report Form System With Integrated Data Preprocessing and Machine-Learning Libraries Supporting Clinical Diagnostic Model Research",
journal="JMIR Med Inform",
year="2014",
month="Oct",
day="20",
volume="2",
number="2",
pages="e28",
keywords="data collection",
keywords="machine-learning",
keywords="clinical decision support systems",
keywords="data analysis",
abstract="Background: Using machine-learning techniques, clinical diagnostic model research extracts diagnostic models from patient data. Traditionally, patient data are often collected using electronic Case Report Form (eCRF) systems, while mathematical software is used for analyzing these data using machine-learning techniques. Due to the lack of integration between eCRF systems and mathematical software, extracting diagnostic models is a complex, error-prone process. Moreover, due to the complexity of this process, it is usually only performed once, after a predetermined number of data points have been collected, without insight into the predictive performance of the resulting models. Objective: The objective of the study of Clinical Data Miner (CDM) software framework is to offer an eCRF system with integrated data preprocessing and machine-learning libraries, improving efficiency of the clinical diagnostic model research workflow, and to enable optimization of patient inclusion numbers through study performance monitoring. Methods: The CDM software framework was developed using a test-driven development (TDD) approach, to ensure high software quality. Architecturally, CDM's design is split over a number of modules, to ensure future extendability. Results: The TDD approach has enabled us to deliver high software quality. CDM's eCRF Web interface is in active use by the studies of the International Endometrial Tumor Analysis consortium, with over 4000 enrolled patients, and more studies planned. Additionally, a derived user interface has been used in six separate interrater agreement studies.CDM's integrated data preprocessing and machine-learning libraries simplify some otherwise manual and error-prone steps in the clinical diagnostic model research workflow. Furthermore, CDM's libraries provide study coordinators with a method to monitor a study's predictive performance as patient inclusions increase. Conclusions: To our knowledge, CDM is the only eCRF system integrating data preprocessing and machine-learning libraries. This integration improves the efficiency of the clinical diagnostic model research workflow. Moreover, by simplifying the generation of learning curves, CDM enables study coordinators to assess more accurately when data collection can be terminated, resulting in better models or lower patient recruitment costs. ",
doi="10.2196/medinform.3251",
url="http://medinform.jmir.org/2014/2/e28/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25600863"
}


@Article{info:doi/10.2196/medinform.3590,
author="Haque, Waqar
and Urquhart, Bonnie
and Berg, Emery
and Dhanoa, Ramandeep",
title="Using Business Intelligence to Analyze and Share Health System Infrastructure Data in a Rural Health Authority",
journal="JMIR Med Inform",
year="2014",
month="Aug",
day="06",
volume="2",
number="2",
pages="e16",
keywords="business intelligence",
keywords="health care systems",
keywords="availability of health services",
keywords="data visualization",
abstract="Background: Health care organizations gather large volumes of data, which has been traditionally stored in legacy formats making it difficult to analyze or use effectively. Though recent government-funded initiatives have improved the situation, the quality of most existing data is poor, suffers from inconsistencies, and lacks integrity. Generating reports from such data is generally not considered feasible due to extensive labor, lack of reliability, and time constraints. Advanced data analytics is one way of extracting useful information from such data. Objective: The intent of this study was to propose how Business Intelligence (BI) techniques can be applied to health system infrastructure data in order to make this information more accessible and comprehensible for a broader group of people. Methods: An integration process was developed to cleanse and integrate data from disparate sources into a data warehouse. An Online Analytical Processing (OLAP) cube was then built to allow slicing along multiple dimensions determined by various key performance indicators (KPIs), representing population and patient profiles, case mix groups, and healthy community indicators. The use of mapping tools, customized shape files, and embedded objects further augment the navigation. Finally, Web forms provide a mechanism for remote uploading of data and transparent processing of the cube. For privileged information, access controls were implemented. Results: Data visualization has eliminated tedious analysis through legacy reports and provided a mechanism for optimally aligning resources with needs. Stakeholders are able to visualize KPIs on a main dashboard, slice-and-dice data, generate ad hoc reports, and quickly find the desired information. In addition, comparison, availability, and service level reports can also be generated on demand. All reports can be drilled down for navigation at a finer granularity. Conclusions: We have demonstrated how BI techniques and tools can be used in the health care environment to make informed decisions with reference to resource allocation and enhancement of the quality of patient care. The data can be uploaded immediately upon collection, thus keeping reports current. The modular design can be expanded to add new datasets such as for smoking rates, teen pregnancies, human immunodeficiency virus (HIV) rates, immunization coverage, and vital statistical summaries. ",
doi="10.2196/medinform.3590",
url="http://medinform.jmir.org/2014/2/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25599727"
}


@Article{info:doi/10.2196/medinform.3316,
author="Elliott, Pamela
and Martin, Desmond
and Neville, Doreen",
title="Electronic Clinical Safety Reporting System: A Benefits Evaluation",
journal="JMIR Med Inform",
year="2014",
month="Jun",
day="11",
volume="2",
number="1",
pages="e12",
keywords="electronic occurrence reporting",
keywords="electronic clinical safety reporting",
keywords="adverse event reporting in health care",
keywords="evaluating electronic reporting systems in health care",
keywords="health information technology evaluations",
abstract="Background: Eastern Health, a large health care organization in Newfoundland and Labrador (NL), started a staged implementation of an electronic occurrence reporting system (used interchangeably with ``clinical safety reporting system'') in 2008, completing Phase One in 2009. The electronic clinical safety reporting system (CSRS) was designed to replace a paper-based system. The CSRS involves reporting on occurrences such as falls, safety/security issues, medication errors, treatment and procedural mishaps, medical equipment malfunctions, and close calls. The electronic system was purchased from a vendor in the United Kingdom that had implemented the system in the United Kingdom and other places, such as British Columbia. The main objective of the new system was to improve the reporting process with the goal of improving clinical safety. The project was funded jointly by Eastern Health and Canada Health Infoway. Objective: The objectives of the evaluation were to: (1) assess the CSRS on achieving its stated objectives (particularly, the benefits realized and lessons learned), and (2) identify contributions, if any, that can be made to the emerging field of electronic clinical safety reporting. Methods: The evaluation involved mixed methods, including extensive stakeholder participation, pre/post comparative study design, and triangulation of data where possible.  The data were collected from several sources, such as project documentation, occurrence reporting records, stakeholder workshops, surveys, focus groups, and key informant interviews. Results: The findings provided evidence that frontline staff and managers support the CSRS, identifying both benefits and areas for improvement. Many benefits were realized, such as increases in the number of occurrences reported, in occurrences reported within 48 hours, in occurrences reported by staff other than registered nurses, in close calls reported, and improved timelines for notification. There was also user satisfaction with the tool regarding ease of use, accessibility, and consistency. The implementation process encountered challenges related to customizing the software and the development of the classification system for coding occurrences. This impacted on the ability of the managers to close-out files in a timely fashion. The issues that were identified, and suggestions for improvements to the form itself, were shared with the Project Team as soon as they were noted. Changes were made to the system before the rollout. Conclusions: There were many benefits realized from the new system that can contribute to improved clinical safety. The participants preferred the electronic system over the paper-based system. The lessons learned during the implementation process resulted in recommendations that informed the rollout of the system in Eastern Health, and in other health care organizations in the province of Newfoundland and Labrador. This study also informed the evaluation of other health organizations in the province, which was completed in 2013. ",
doi="10.2196/medinform.3316",
url="http://medinform.jmir.org/2014/1/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25600569"
}


@Article{info:doi/10.2196/ijmr.2811,
author="Cook, A. David
and Enders, Felicity
and Linderbaum, A. Jane
and Zwart, Dale
and Lloyd, J. Farrell",
title="Speed and Accuracy of a Point of Care Web-Based Knowledge Resource for Clinicians: A Controlled Crossover Trial",
journal="Interact J Med Res",
year="2014",
month="Feb",
day="21",
volume="3",
number="1",
pages="e7",
keywords="medical education",
keywords="Web-based learning",
keywords="educational technology",
keywords="clinical decision support",
keywords="health information technology",
abstract="Background: Effective knowledge translation at the point of care requires that clinicians quickly find correct answers to clinical questions, and that they have appropriate confidence in their answers. Web-based knowledge resources can facilitate this process. Objective: The objective of our study was to evaluate a novel Web-based knowledge resource in comparison with other available Web-based resources, using outcomes of accuracy, time, and confidence. Methods: We conducted a controlled, crossover trial involving 59 practicing clinicians. Each participant answered questions related to two clinical scenarios. For one scenario, participants used a locally developed Web-based resource, and for the second scenario, they used other self-selected Web-based resources. The local knowledge resource (``AskMayoExpert'') was designed to provide very concise evidence-based answers to commonly asked clinical questions. Outcomes included time to a correct response with at least 80\% confidence (primary outcome), accuracy, time, and confidence. Results: Answers were more often accurate when using the local resource than when using other Web-based resources, with odds ratio 6.2 (95\% CI 2.6-14.5; P<.001) when averaged across scenarios. Time to find an answer was faster, and confidence in that answer was consistently higher, for the local resource (P<.001). Overconfidence was also less frequent with the local resource. In a time-to-event analysis, the chance of responding correctly with at least 80\% confidence was 2.5 times greater when using the local resource than with other resources (95\% CI 1.6-3.8; P<.001). Conclusions: Clinicians using a Web-based knowledge resource designed to provide quick, concise answers at the point of care found answers with greater accuracy and confidence than when using other self-selected Web-based resources. Further study to improve the design and implementation of knowledge resources may improve point of care learning. ",
doi="10.2196/ijmr.2811",
url="http://www.i-jmr.org/2014/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24566739"
}


@Article{info:doi/10.2196/ijmr.3060,
author="Isetta, Valentina
and Le{\'o}n, Carmen
and Torres, Marta
and Embid, Cristina
and Roca, Josep
and Navajas, Daniel
and Farr{\'e}, Ramon
and Montserrat, M. Josep",
title="Telemedicine-Based Approach for Obstructive Sleep Apnea Management: Building Evidence",
journal="Interact J Med Res",
year="2014",
month="Feb",
day="19",
volume="3",
number="1",
pages="e6",
keywords="telemedicine",
keywords="sleep apnea",
keywords="CPAP therapy",
keywords="teleconsultation",
abstract="Background: Telemedicine seems to offer reliable solutions to health care challenges, but significant contradictory results were recently found. Therefore, it is crucial to carefully select outcomes and target patients who may take advantage of this technology. Continuous positive airway pressure (CPAP) therapy compliance is essential to treat patients with obstructive sleep apnea (OSA). We believe that OSA patients could benefit greatly from a telemedicine approach for CPAP therapy management. Objective: The objective of our study was to evaluate the application of a telemedicine-based approach in the CPAP therapy management, focusing on patients' CPAP follow-up and training. Methods: We performed two studies. First, (study 1) we enrolled 50 consecutive OSA patients who came to our sleep center for the CPAP follow-up visit. Patients performed a teleconsultation with a physician, and once finalized, they were asked to answer anonymously to a questionnaire regarding their opinion about the teleconsultation. In a second randomized controlled trial (RCT) (study 2), we included 40 OSA patients scheduled for CPAP training. There were 20 that received the usual face-to-face training and 20 that received the training via videoconference. After the session, they were blindly evaluated on what they learned about OSA and mask placement. Results: More than 95\% (49/50) of the interviewed patients were satisfied with the teleconsultation, and 66\% (33/50) of them answered that the teleconsultation could replace 50\%-100\% of their CPAP follow-up visits. Regarding the RCT, patients who received the CPAP training via videoconference demonstrated the same knowledge about OSA and CPAP therapy as the face-to-face group (mean 93.6\% of correct answers vs mean 92.1\%; P=.935). Performance on practical skills (mask and headgear placement, leaks avoidance) was also similar between the two groups. Conclusions: OSA patients gave a positive feedback about the use of teleconsultation for CPAP follow-up, and the CPAP training based on a telemedicine approach proved to be as effective as face-to-face training. These results support the use of this telemedicine-based approach as a valuable strategy for patients' CPAP training and clinical follow-up. ",
doi="10.2196/ijmr.3060",
url="http://www.i-jmr.org/2014/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24554392"
}


@Article{info:doi/10.2196/ijmr.2885,
author="Hjollund, Ingvar Niels Henrik
and Larsen, Pape Louise
and Biering, Karin
and Johnsen, Paaske Soren
and Riiskj{\ae}r, Erik
and Schougaard, Marit Liv",
title="Use of Patient-Reported Outcome (PRO) Measures at Group and Patient Levels: Experiences From the Generic Integrated PRO System, WestChronic",
journal="Interact J Med Res",
year="2014",
month="Feb",
day="11",
volume="3",
number="1",
pages="e5",
keywords="data collection",
keywords="decision support systems",
keywords="health care economics and organizations",
keywords="health education",
keywords="Internet",
keywords="longitudinal studies",
keywords="outcome assessment",
keywords="patient-reported outcomes",
keywords="questionnaires",
keywords="quality improvement",
abstract="Background: Patient-reported outcome (PRO) measures may be used at a group level for research and quality improvement and at the individual patient level to support clinical decision making and ensure efficient use of resources. The challenges involved in implementing PRO measures are mostly the same regardless of aims and diagnostic groups and include logistic feasibility, high response rates, robustness, and ability to adapt to the needs of patient groups and settings. If generic PRO systems can adapt to specific needs, advanced technology can be shared between medical specialties and for different aims. Objective: We describe methodological, organizational, and practical experiences with a generic PRO system, WestChronic, which is in use among a range of diagnostic groups and for a range of purposes. Methods: The WestChronic system supports PRO data collection, with integration of Web and paper PRO questionnaires (mixed-mode) and automated procedures that enable adherence to implementation-specific schedules for the collection of PRO. For analysis, we divided functionalities into four elements: basic PRO data collection and logistics, PRO-based clinical decision support, PRO-based automated decision algorithms, and other forms of communication. While the first element is ubiquitous, the others are optional and only applicable at a patient level. Methodological and organizational experiences were described according to each element. Results: WestChronic has, to date, been implemented in 22 PRO projects within 18 diagnostic groups, including cardiology, neurology, rheumatology, nephrology, orthopedic surgery, gynecology, oncology, and psychiatry. The aims of the individual projects included epidemiological research, quality improvement, hospital evaluation, clinical decision support, efficient use of outpatient clinic resources, and screening for side effects and comorbidity. In total 30,174 patients have been included, and  59,232 PRO assessments have been collected using 92 different PRO questionnaires. Response rates of up to 93\% were achieved for first-round questionnaires and up to 99\% during follow-up. For 6 diagnostic groups, PRO data were displayed graphically to the clinician to facilitate flagging of important symptoms and decision support, and in 5 diagnostic groups PRO data were used for automatic algorithm-based decisions. Conclusions: WestChronic has allowed the implementation of all proposed protocol for data collection and processing. The system has achieved high response rates, and longitudinal attrition is limited. The relevance of the questions, the mixed-mode principle, and automated procedures has contributed to the high response rates. Furthermore, development and implementation of a number of approaches and methods for clinical use of PRO has been possible without challenging the generic property. Generic multipurpose PRO systems may enable sharing of automated and efficient logistics, optimal response rates, and other advanced options for PRO data collection and processing, while still allowing adaptation to specific aims and patient groups. ",
doi="10.2196/ijmr.2885",
url="http://www.i-jmr.org/2014/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24518281"
}


@Article{info:doi/10.2196/ijmr.2820,
author="Davidson, Emma
and Simpson, R. Colin
and Demiris, George
and Sheikh, Aziz
and McKinstry, Brian",
title="Integrating Telehealth Care-Generated Data With the Family Practice Electronic Medical Record: Qualitative Exploration of the Views of Primary Care Staff",
journal="Interact J Med Res",
year="2013",
month="Nov",
day="26",
volume="2",
number="2",
pages="e29",
keywords="telehealth care",
keywords="family practice",
keywords="data management",
abstract="Background: Telehealth care is increasingly being employed in the management of long-term illness. Current systems are largely managed via ``stand-alone'' websites, which require additional log-ons for clinicians to view their patients' symptom records and physiological measurements leading to frustrating delays and sometimes failure to engage with the record. However, there are challenges to the full integration of patient-acquired data into family physicians' electronic medical records (EMR) in terms of reliability, how such data can best be summarized and presented to avoid overload to the clinicians, and how clarity of responsibility is managed when multiple agencies are involved. Objective: We aimed to explore the views of primary care clinicians on the acceptability, clinical utility, and, in particular, the benefits and risks of integrating patient-generated telehealth care data into the family practice EMR and to explore how these data should be summarized and presented in order to facilitate use in routine care. Methods: In our qualitative study, we carried out semi-structured interviews with clinicians with experience of and na{\"i}ve to telehealth care following demonstration of pilot software, which illustrated various methods by which data could be incorporated into the EMR. Results: We interviewed 20 clinicians and found 2 overarching themes of ``workload'' and ``safety''. Although clinicians were largely positive about integrating telehealth care data into the EMR, they were concerned about the potential increased workload and safety issues, particularly in respect to error due to data overload. They suggested these issues could be mitigated by good system design that summarized and presented data such that they facilitated seamless integration with clinicians' current routine processes for managing data flows, and ensured clear lines of communication and responsibility between multiple professionals involved in patients' care. Conclusions: Family physicians and their teams are likely to be receptive to and see the benefits of integrating telehealth-generated data into the EMR. Our study identified some of the key challenges that must be overcome to facilitate integration of telehealth care data. This work particularly underlines the importance of actively engaging with clinicians to ensure that systems are designed that align well with existing practice data-flow management systems and facilitate safe multiprofessional patient care. ",
doi="10.2196/ijmr.2820",
url="http://www.i-jmr.org/2013/2/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24280631"
}


@Article{info:doi/10.2196/ijmr.2824,
author="Luzi, Mario
and De Simone, Antonio
and Leoni, Loira
and Amellone, Claudia
and Pisan{\`o}, Ennio
and Favale, Stefano
and Iacoviello, Massimo
and Luise, Raffaele
and Bongiorni, Grazia Maria
and Stabile, Giuseppe
and La Rocca, Vincenzo
and Folino, Franco
and Capucci, Alessandro
and D'Onofrio, Antonio
and Accardi, Francesco
and Valsecchi, Sergio
and Buia, Gianfranco",
title="Remote Monitoring for Implantable Defibrillators: A Nationwide Survey in Italy",
journal="Interact J Med Res",
year="2013",
month="Sep",
day="20",
volume="2",
number="2",
pages="e27",
keywords="implantable defibrillator",
keywords="remote monitoring",
keywords="follow-up",
abstract="Background: Remote monitoring (RM) permits home interrogation of implantable cardioverter defibrillator (ICD) and provides an alternative option to frequent in-person visits. Objective: The Italia-RM survey aimed to investigate the current practice of ICD follow-up in Italy and to evaluate the adoption and routine use of RM. Methods: An ad hoc questionnaire on RM adoption and resource use during in-clinic and remote follow-up sessions was completed in 206 Italian implanting centers. Results: The frequency of routine in-clinic ICD visits was 2 per year in 158/206 (76.7\%) centers, 3 per year in 37/206 (18.0\%) centers, and 4 per year in 10/206 (4.9\%) centers. Follow-up examinations were performed by a cardiologist in 203/206 (98.5\%) centers, and by more than one health care worker in 184/206 (89.3\%) centers. There were 137/206 (66.5\%) responding centers that had already adopted an RM system, the proportion of ICD patients remotely monitored being 15\% for single- and dual-chamber ICD and 20\% for cardiac resynchronization therapy ICD. Remote ICD interrogations were scheduled every 3 months, and were performed by a cardiologist in 124/137 (90.5\%) centers. After the adoption of RM, the mean time between in-clinic visits increased from 5 (SD 1) to 8 (SD 3) months (P<.001). Conclusions: In current clinical practice, in-clinic ICD follow-up visits consume a large amount of health care resources. The results of this survey show that RM has only partially been adopted in Italy and, although many centers have begun to implement RM in their clinical practice, the majority of their patients continue to be routinely followed-up by means of in-clinic visits. ",
doi="10.2196/ijmr.2824",
url="http://www.i-jmr.org/2013/2/e27/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24055720"
}


@Article{info:doi/10.2196/ijmr.2700,
author="Pearce, Martin Christopher
and de Lusignan, Simon
and Phillips, Christine
and Hall, Sally
and Travaglia, Joanne",
title="The Computerized Medical Record as a Tool for Clinical Governance in Australian Primary Care",
journal="Interact J Med Res",
year="2013",
month="Aug",
day="12",
volume="2",
number="2",
pages="e26",
keywords="clinical governance",
keywords="electronic health records",
keywords="general practice",
keywords="realist evaluation",
keywords="quality assurance",
keywords="health care",
abstract="Background: Computerized medical records (CMR) are used in most Australian general practices. Although CMRs have the capacity to amalgamate and provide data to the clinician about their standard of care, there is little research on the way in which they may be used to support clinical governance: the process of ensuring quality and accountability that incorporates the obligation that patients are treated according to best evidence. Objective: The objective of this study was to explore the capability, capacity, and acceptability of CMRs to support clinical governance. Methods: We conducted a realist review of the role of seven CMR systems in implementing clinical governance, developing a four-level maturity model for the CMR.  We took Australian primary care as the context, CMR to be the mechanism, and looked at outcomes for individual patients, localities, and for the population in terms of known evidence-based surrogates or true outcome measures. Results: The lack of standardization of CMRs makes national and international benchmarking challenging. The use of the CMR was largely at level two of our maturity model, indicating a relatively simple system in which most of the process takes place outside of the CMR, and which has little capacity to support benchmarking, practice comparisons, and population-level activities. Although national standards for coding and projects for record access are proposed, they are not operationalized. Conclusions: The current CMR systems can support clinical governance activities; however, unless the standardization and data quality issues are addressed, it will not be possible for current systems to work at higher levels. ",
doi="10.2196/ijmr.2700",
url="http://www.i-jmr.org/2013/2/e26/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23939340"
}


@Article{info:doi/10.2196/ijmr.2480,
author="Bosl, William
and Mandel, Joshua
and Jonikas, Magdalena
and Ramoni, Badovinac Rachel
and Kohane, S. Isaac
and Mandl, D. Kenneth",
title="Scalable Decision Support at the Point of Care: A Substitutable Electronic Health Record App for Monitoring Medication Adherence",
journal="Interact J Med Res",
year="2013",
month="Jul",
day="22",
volume="2",
number="2",
pages="e13",
keywords="electronic health record",
keywords="personal electronic health record",
keywords="hospital information systems",
keywords="medical informatics applications",
keywords="accountable care organizations",
keywords="medication adherence",
abstract="Background: Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated \$100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. Objective: The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as ``iPhone like platforms'' by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. Methods: The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients' prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. Results: The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns.  The MPR Monitor app is installed in the SMART reference container as the ``MPR Monitor'', where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. Conclusions: The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality. ",
doi="10.2196/ijmr.2480",
url="http://www.i-jmr.org/2013/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23876796"
}


@Article{info:doi/10.2196/ijmr.2384,
author="Vasconcellos-Silva, Roberto Paulo
and Carvalho, Darlinton
and Lucena, Carlos",
title="Word Frequency and Content Analysis Approach to Identify Demand Patterns in a Virtual Community of Carriers of Hepatitis C",
journal="Interact J Med Res",
year="2013",
month="Jul",
day="04",
volume="2",
number="2",
pages="e12",
keywords="Internet",
keywords="online communities",
keywords="hepatitis C virus carrier",
keywords="social support",
keywords="qualitative research",
keywords="content analysis",
keywords="social behavior",
abstract="Background: Orkut, a Brazilian virtual social network, is responsible for popularization of the Internet among people of low income and educational level. It's observed that rapid growth of virtual communities can be reached by low cost Internet access in community local area network houses. Orkut poses an important social resource for Brazilian patients with chronic conditions like hepatitis C virus (HCV) carriers, who face several obstacles in adapting to everyday difficulties. Objective: Identify Patterns of Recurring Demands (PRD) expressed in messages posted by members of virtual communities dedicated to HCV carriers. Methods: Pre-selection: we identified terms commonly associated to HCV on generic Internet searches (primary Keywords - Kps); Kps were used to identify the most representative HCV communities in a virtual community site (Orkut); all messages published along 8 years on all topics of the community were collected and tabulated; the word frequency was used to construct a ``word cloud'' (graphic representation of the word frequency) on which was applied a content analysis technique. Results: The most cited terms expressed: search for information about medications (prescribed and ``forbidden''); emphasis on counting time, which were interpreted as surviving expectations; frequent mention of God, doctors, and ``husbands'' (female carriers were 68\%). These elements provided material for further research -- they will be useful in the construction of categories in discourse analysis. Conclusions: The present work is a disclosure of preliminary findings considered original and promising. The word frequency/content analysis approach expressed needs of social support and material assistance that may provide subsidies for further qualitative approach and public health policies aimed to HCV carriers. The study of PRD by word frequency may be useful in identifying demands underestimated by other means. ",
doi="10.2196/ijmr.2384",
url="http://www.i-jmr.org/2013/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23827772"
}


@Article{info:doi/10.2196/ijmr.2454,
author="Klann, G. Jeffrey
and McCoy, B. Allison
and Wright, Adam
and Wattanasin, Nich
and Sittig, F. Dean
and Murphy, N. Shawn",
title="Health Care Transformation Through Collaboration on Open-Source Informatics Projects: Integrating a Medical Applications Platform, Research Data Repository, and Patient Summarization",
journal="Interact J Med Res",
year="2013",
month="May",
day="30",
volume="2",
number="1",
pages="e11",
keywords="clinical information systems",
keywords="medical informatics",
keywords="knowledge bases",
keywords="user-computer interface",
keywords="data display",
keywords="diffusion of innovation",
abstract="Background: The Strategic Health IT Advanced Research Projects (SHARP) program seeks to conquer well-understood challenges in medical informatics through breakthrough research. Two SHARP centers have found alignment in their methodological needs: (1) members of the National Center for Cognitive Informatics and Decision-making (NCCD) have developed knowledge bases to support problem-oriented summarizations of patient data, and (2) Substitutable Medical Apps, Reusable Technologies (SMART), which is a platform for reusable medical apps that can run on participating platforms connected to various electronic health records (EHR). Combining the work of these two centers will ensure wide dissemination of new methods for synthesized views of patient data. Informatics for Integrating Biology and the Bedside (i2b2) is an NIH-funded clinical research data repository platform in use at over 100 sites worldwide. By also working with a co-occurring initiative to SMART-enabling i2b2, we can confidently write one app that can be used extremely broadly. Objective: Our goal was to facilitate development of intuitive, problem-oriented views of the patient record using NCCD knowledge bases that would run in any EHR. To do this, we developed a collaboration between the two SHARPs and an NIH center, i2b2. Methods: First, we implemented collaborative tools to connect researchers at three institutions. Next, we developed a patient summarization app using the SMART platform and a previously validated NCCD problem-medication linkage knowledge base derived from the National Drug File-Reference Terminology (NDF-RT). Finally, to SMART-enable i2b2, we implemented two new Web service ``cells'' that expose the SMART application programming interface  (API), and we made changes to the Web interface of i2b2 to host a ``carousel'' of SMART apps. Results: We deployed our SMART-based, NDF-RT-derived patient summarization app in this SMART-i2b2 container.  It displays a problem-oriented view of medications and presents a line-graph display of laboratory results. Conclusions: This summarization app can be run in any EHR environment that either supports SMART or runs SMART-enabled i2b2.  This i2b2 ``clinical bridge'' demonstrates a pathway for reusable app development that does not require EHR vendors to immediately adopt the SMART API. Apps can be developed in SMART and run by clinicians in the i2b2 repository, reusing clinical data extracted from EHRs. This may encourage the adoption of SMART by supporting SMART app development until EHRs adopt the platform.  It also allows a new variety of clinical SMART apps, fueled by the broad aggregation of data types available in research repositories. The app (including its knowledge base) and SMART-i2b2 are open-source and freely available for download. ",
doi="10.2196/ijmr.2454",
url="http://www.i-jmr.org/2013/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23722634"
}


@Article{info:doi/10.2196/jmir.2495,
author="Chen, Wei-Hsin
and Hsieh, Sheau-Ling
and Hsu, Kai-Ping
and Chen, Han-Ping
and Su, Xing-Yu
and Tseng, Yi-Ju
and Chien, Yin-Hsiu
and Hwu, Wuh-Liang
and Lai, Feipei",
title="Web-Based Newborn Screening System for Metabolic Diseases: Machine Learning Versus Clinicians",
journal="J Med Internet Res",
year="2013",
month="May",
day="23",
volume="15",
number="5",
pages="e98",
keywords="Web-based services",
keywords="neonatal screening",
keywords="tandem mass spectrometry",
keywords="information systems",
keywords="metabolism",
keywords="inborn errors",
abstract="Background: A hospital information system (HIS) that integrates screening data and interpretation of the data is routinely requested by hospitals and parents. However, the accuracy of disease classification may be low because of the disease characteristics and the analytes used for classification. Objective: The objective of this study is to describe a system that enhanced the neonatal screening system of the Newborn Screening Center at the National Taiwan University Hospital. The system was designed and deployed according to a service-oriented architecture (SOA) framework under the Web services .NET environment. The system consists of sample collection, testing, diagnosis, evaluation, treatment, and follow-up services among collaborating hospitals. To improve the accuracy of newborn screening, machine learning and optimal feature selection mechanisms were investigated for screening newborns for inborn errors of metabolism. Methods: The framework of the Newborn Screening Hospital Information System (NSHIS) used the embedded Health Level Seven (HL7) standards for data exchanges among heterogeneous platforms integrated by Web services in the C\# language. In this study, machine learning classification was used to predict phenylketonuria (PKU), hypermethioninemia, and 3-methylcrotonyl-CoA-carboxylase (3-MCC) deficiency. The classification methods used 347,312 newborn dried blood samples collected at the Center between 2006 and 2011. Of these, 220 newborns had values over the diagnostic cutoffs (positive cases) and 1557 had values that were over the screening cutoffs but did not meet the diagnostic cutoffs (suspected cases). The original 35 analytes and the manifested features were ranked based on F score, then combinations of the top 20 ranked features were selected as input features to support vector machine (SVM) classifiers to obtain optimal feature sets. These feature sets were tested using 5-fold cross-validation and optimal models were generated. The datasets collected in year 2011 were used as predicting cases. Results: The feature selection strategies were implemented and the optimal markers for PKU, hypermethioninemia, and 3-MCC deficiency were obtained. The results of the machine learning approach were compared with the cutoff scheme. The number of the false positive cases were reduced from 21 to 2 for PKU, from 30 to 10 for hypermethioninemia, and 209 to 46 for 3-MCC deficiency. Conclusions: This SOA Web service--based newborn screening system can accelerate screening procedures effectively and efficiently. An SVM learning methodology for PKU, hypermethioninemia, and 3-MCC deficiency metabolic diseases classification, including optimal feature selection strategies, is presented. By adopting the results of this study, the number of suspected cases could be reduced dramatically. ",
doi="10.2196/jmir.2495",
url="http://www.jmir.org/2013/5/e98/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23702487"
}


@Article{info:doi/10.2196/ijmr.2468,
author="Li, Junhua
and Talaei-Khoei, Amir
and Seale, Holly
and Ray, Pradeep
and MacIntyre, Raina C.",
title="Health Care Provider Adoption of eHealth: Systematic Literature Review",
journal="Interact J Med Res",
year="2013",
month="Apr",
day="16",
volume="2",
number="1",
pages="e7",
keywords="technology acceptance",
keywords="eHealth",
keywords="health care provider",
keywords="adoption",
abstract="Background: eHealth is an application of information and communication technologies across the whole range of functions that affect health. The benefits of eHealth (eg, improvement of health care operational efficiency and quality of patient care) have previously been documented in the literature. Health care providers (eg, medical doctors) are the key driving force in pushing eHealth initiatives. Without their acceptance and actual use, those eHealth benefits would be unlikely to be reaped. Objective: To identify and synthesize influential factors to health care providers' acceptance of various eHealth systems. Methods: This systematic literature review was conducted in four steps. The first two steps facilitated the location and identification of relevant articles. The third step extracted key information from those articles including the studies' characteristics and results. In the last step, identified factors were analyzed and grouped in accordance with the Unified Theory of Acceptance and Use of Technology (UTAUT). Results: This study included 93 papers that have studied health care providers' acceptance of eHealth. From these papers, 40 factors were identified and grouped into 7 clusters: (1) health care provider characteristics, (2) medical practice characteristics, (3) voluntariness of use, (4) performance expectancy, (5) effort expectancy, (6) social influence, and (7) facilitating or inhibiting conditions. Conclusions: The grouping results demonstrated that the UTAUT model is useful for organizing the literature but has its limitations. Due to the complex contextual dynamics of health care settings, our work suggested that there would be potential to extend theories on information technology adoption, which is of great benefit to readers interested in learning more on the topic. Practically, these findings may help health care decision makers proactively introduce interventions to encourage acceptance of eHealth and may also assist health policy makers refine relevant policies to promote the eHealth innovation. ",
doi="10.2196/ijmr.2468",
url="http://www.i-jmr.org/2013/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23608679"
}


@Article{info:doi/10.2196/ijmr.2437,
author="Nambisan, Priya
and Kreps, L. Gary
and Polit, Stan",
title="Understanding Electronic Medical Record Adoption in the United States: Communication and Sociocultural Perspectives",
journal="Interact J Med Res",
year="2013",
month="Mar",
day="26",
volume="2",
number="1",
pages="e5",
keywords="electronic health records adoption",
keywords="communication",
keywords="systems approach",
abstract="Background: This paper adopts a communication and sociocultural perspective to analyze the factors behind the lag in electronic medical record (EMR) adoption in the United States. Much of the extant research on this topic has emphasized economic factors, particularly, lack of economic incentives, as the primary cause of the delay in EMR adoption. This prompted the Health Information Technology on Economic and Clinical Health Act that allow financial incentives through the Centers of Medicare and Medicaid Services for many health care organizations planning to adopt EMR. However, financial incentives alone have not solved the problem; many new innovations do not diffuse even when offered for free. Thus, this paper underlines the need to consider communication and sociocultural factors to develop a better understanding of the impediments of EMR adoption. Objective: The objective of this paper was to develop a holistic understanding of EMR adoption by identifying and analyzing the impact of communication and sociocultural factors that operate at 3 levels: macro (environmental), meso (organizational), and micro (individual). Methods: We use the systems approach to focus on the 3 levels (macro, meso, and micro) and developed propositions at each level drawing on the communication and sociocultural perspectives. Results: Our analysis resulted in 10 propositions that connect communication and sociocultural aspects with EMR adoption. Conclusions: This paper brings perspectives from the social sciences that have largely been missing in the extant literature of health information technology (HIT) adoption. In doing so, it implies how communication and sociocultural factors may complement (and in some instances, reinforce) the impact of economic factors on HIT adoption. ",
doi="10.2196/ijmr.2437",
url="http://www.i-jmr.org/2013/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612390"
}


@Article{info:doi/10.2196/ijmr.2402,
author="Yuan, Juntao Michael
and Finley, Mike George
and Long, Ju
and Mills, Christy
and Johnson, Kim Ron",
title="Evaluation of User Interface and Workflow Design of a Bedside Nursing Clinical Decision Support System",
journal="Interact J Med Res",
year="2013",
month="Jan",
day="31",
volume="2",
number="1",
pages="e4",
keywords="clinical decision support systems",
keywords="user-computer interface",
keywords="software design",
keywords="human computer interaction",
keywords="usability testing",
keywords="heuristic evaluations",
keywords="software performance",
keywords="patient-centered care",
abstract="Background: Clinical decision support systems (CDSS) are important tools to improve health care outcomes and reduce preventable medical adverse events. However, the effectiveness and success of CDSS depend on their implementation context and usability in complex health care settings. As a result, usability design and validation, especially in real world clinical settings, are crucial aspects of successful CDSS implementations. Objective: Our objective was to develop a novel CDSS to help frontline nurses better manage critical symptom changes in hospitalized patients, hence reducing preventable failure to rescue cases. A robust user interface and implementation strategy that fit into existing workflows was key for the success of the CDSS. Methods: Guided by a formal usability evaluation framework, UFuRT (user, function, representation, and task analysis), we developed a high-level specification of the product that captures key usability requirements and is flexible to implement. We interviewed users of the proposed CDSS to identify requirements, listed functions, and operations the system must perform.  We then designed visual and workflow representations of the product to perform the operations.The user interface and workflow design were evaluated via heuristic and end user performance evaluation. The heuristic evaluation was done after the first prototype, and its results were incorporated into the product before the end user evaluation was conducted. First, we recruited 4 evaluators with strong domain expertise to study the initial prototype. Heuristic violations were coded and rated for severity. Second, after development of the system, we assembled a panel of nurses, consisting of 3 licensed vocational nurses and 7 registered nurses, to evaluate the user interface and workflow via simulated use cases. We recorded whether each session was successfully completed and its completion time. Each nurse was asked to use the National Aeronautics and Space Administration (NASA) Task Load Index to self-evaluate the amount of cognitive and physical burden associated with using the device. Results: A total of 83 heuristic violations were identified in the studies. The distribution of the heuristic violations and their average severity are reported. The nurse evaluators successfully completed all 30 sessions of the performance evaluations. All nurses were able to use the device after a single training session. On average, the nurses took 111 seconds (SD 30 seconds) to complete the simulated task. The NASA Task Load Index results indicated that the work overhead on the nurses was low. In fact, most of the burden measures were consistent with zero. The only potentially significant burden was temporal demand, which was consistent with the primary use case of the tool. Conclusions: The evaluation has shown that our design was functional and met the requirements demanded by the nurses' tight schedules and heavy workloads. The user interface embedded in the tool provided compelling utility to the nurse with minimal distraction. ",
doi="10.2196/ijmr.2402",
url="http://www.i-jmr.org/2013/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612350"
}


@Article{info:doi/10.2196/ijmr.2092,
author="Castiglione, Filippo
and Diaz, Vanessa
and Gaggioli, Andrea
and Li{\`o}, Pietro
and Mazz{\`a}, Claudia
and Merelli, Emanuela
and Meskers, G.M Carel
and Pappalardo, Francesco
and von Ammon, Rainer",
title="Physio-Environmental Sensing and Live Modeling",
journal="Interact J Med Res",
year="2013",
month="Jan",
day="30",
volume="2",
number="1",
pages="e3",
keywords="personalized health care, mobile networks, computer models, telediagnosis",
doi="10.2196/ijmr.2092",
url="http://www.i-jmr.org/2013/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612245"
}


@Article{info:doi/10.2196/ijmr.2089,
author="{\"O}hlund, Sten-Erik
and {\AA}strand, Bengt
and Petersson, G{\"o}ran",
title="Improving Interoperability in ePrescribing",
journal="Interact J Med Res",
year="2012",
month="Nov",
day="22",
volume="1",
number="2",
pages="e17",
keywords="eHealth, Electronic prescribing, Electronic prescription, Information quality, Interoperability",
abstract="Background: The increased application of eServices in health care, in general, and ePrescribing (electronic prescribing) in particular, have brought quality and interoperability to the forefront.The application of standards has been put forward as one important factor in improving interoperability. However, less focus has been placed on other factors, such as stakeholders' involvement and the measurement of interoperability.An information system (IS) can be regarded to comprise an instrument for technology-mediated work communication. In this study, interoperability refers to the interoperation in the ePrescribing process, involving people, systems, procedures and organizations. We have focused on the quality of the ePrescription message as one component of the interoperation in the ePrescribing process. Objective: The objective was to analyze how combined efforts in improving interoperability with the introduction of the new national ePrescription format (NEF) have impacted interoperability in the ePrescribing process in Sweden, with the focus on the quality of the ePrescription message. Methods: Consecutive sampling of electronic prescriptions in Sweden before and after the introduction of NEF was undertaken in April 2008 (pre-NEF) and April 2009 (post-NEF).Interoperability problems were identified and classified based on message format specifications and prescription rules. Results: The introduction of NEF improved the interoperability of ePrescriptions substantially. In the pre-NEF sample, a total of 98.6\% of the prescriptions had errors. In the post-NEF sample, only 0.9\% of the prescriptions had errors. The mean number of errors was fewer for the erroneous prescriptions: 4.8 in pre-NEF compared to 1.0 in post-NEF. Conclusions: We conclude that a systematic comprehensive work on interoperability, covering technical, semantical, professional, judicial and process aspects, involving the stakeholders, resulted in an improved interoperability of ePrescriptions. ",
doi="10.2196/ijmr.2089",
url="http://www.i-jmr.org/2012/2/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612314"
}


@Article{info:doi/10.2196/ijmr.2163,
author="Parra, Carlos
and J{\'o}dar-S{\'a}nchez, Francisco
and Jim{\'e}nez-Hern{\'a}ndez, Dolores M.
and Vigil, Eduardo
and Palomino-Garc{\'i}a, Alfredo
and Moniche-{\'A}lvarez, Francisco
and De la Torre-Laviana, Javier Francisco
and Bonachela, Patricia
and Fern{\'a}ndez, Jos{\'e} Francisco
and Cayuela-Dom{\'i}nguez, Aurelio
and Leal, Sandra",
title="Development, Implementation, and Evaluation of a Telemedicine Service for the Treatment of Acute Stroke Patients: TeleStroke",
journal="Interact J Med Res",
year="2012",
month="Nov",
day="15",
volume="1",
number="2",
pages="e15",
keywords="Telemedicine",
keywords="Standardization",
keywords="Stroke",
keywords="Fibrinolysis",
abstract="Background: Health care service based on telemedicine can reduce both physical and time barriers in stroke treatments. Moreover, this service connects centers specializing in stroke treatment with other centers and practitioners, thereby increasing accessibility to neurological specialist care and fibrinolytic treatment. Objective: Development, implementation, and evaluation of a care service for the treatment of acute stroke patients based on telemedicine (TeleStroke) at Virgen del Roc{\'i}o University Hospital. Methods: The evaluation phase, conducted from October 2008 to January 2011, involved patients who presented acute stroke symptoms confirmed by the emergency physician; they were examined using TeleStroke in two hospitals, at a distance of 16 and 110 kilometers from Virgen del Roc{\'i}o University Hospital. We analyzed the number of interconsultation sheets, the percentage of patients treated with fibrinolysis, and the number of times they were treated. To evaluate medical professionals' acceptance of the TeleStroke system, we developed a web-based questionnaire using a Technology Acceptance Model. Results: A total of 28 patients were evaluated through the interconsultation sheet. Out of 28 patients, 19 (68\%) received fibrinolytic treatment. The most common reasons for not treating with fibrinolysis included: clinical criteria in six out of nine patients (66\%) and beyond the time window in three out of nine patients (33\%). The mean ``onset-to-hospital'' time was 69 minutes, the mean time from admission to CT image was 33 minutes, the mean ``door-to-needle'' time was 82 minutes, and the mean ``onset-to-needle'' time was 150 minutes. Out of 61 medical professionals, 34 (56\%) completed a questionnaire to evaluate the acceptability of the TeleStroke system. The mean values for each item were over 6.50, indicating that respondents positively evaluated each item. This survey was assessed using the Cronbach alpha test to determine the reliability of the questionnaire and the results obtained, giving a value of 0.97. Conclusions: The implementation of TeleStroke has made it possible for patients in the acute phase of stroke to receive effective treatment, something that was previously impossible because of the time required to transfer them to referral hospitals. ",
doi="10.2196/ijmr.2163",
url="http://www.i-jmr.org/2012/2/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612154"
}


@Article{info:doi/10.2196/ijmr.2126,
author="Carmona-Cejudo, M. Jos{\'e}
and Hortas, Luisa Maria
and Baena-Garc{\'i}a, Manuel
and Lana-Linati, Jorge
and Gonz{\'a}lez, Carlos
and Redondo, Maximino
and Morales-Bueno, Rafael",
title="DB4US: A Decision Support System for Laboratory Information Management",
journal="Interact J Med Res",
year="2012",
month="Nov",
day="14",
volume="1",
number="2",
pages="e16",
keywords="Automation, laboratory",
keywords="Medical Informatics Applications",
keywords="Data Mining",
keywords="Quality Indicators, Health Care",
abstract="Background: Until recently, laboratory automation has focused primarily on improving hardware. Future advances are concentrated on intelligent software since laboratories performing clinical diagnostic testing require improved information systems to address their data processing needs. In this paper, we propose DB4US, an application that automates information related to laboratory quality indicators information. Currently, there is a lack of ready-to-use management quality measures. This application addresses this deficiency through the extraction, consolidation, statistical analysis, and visualization of data related to the use of demographics, reagents, and turn-around times. The design and implementation issues, as well as the technologies used for the implementation of this system, are discussed in this paper. Objective: To develop a general methodology that integrates the computation of ready-to-use management quality measures and a dashboard to easily analyze the overall performance of a laboratory, as well as automatically detect anomalies or errors. The novelty of our approach lies in the application of integrated web-based dashboards as an information management system in hospital laboratories. Methods: We propose a new methodology for laboratory information management based on the extraction, consolidation, statistical analysis, and visualization of data related to demographics, reagents, and turn-around times, offering a dashboard-like user web interface to the laboratory manager. The methodology comprises a unified data warehouse that stores and consolidates multidimensional data from different data sources. The methodology is illustrated through the implementation and validation of DB4US, a novel web application based on this methodology that constructs an interface to obtain ready-to-use indicators, and offers the possibility to drill down from high-level metrics to more detailed summaries. The offered indicators are calculated beforehand so that they are ready to use when the user needs them. The design is based on a set of different parallel processes to precalculate indicators. The application displays information related to tests, requests, samples, and turn-around times. The dashboard is designed to show the set of indicators on a single screen. Results: DB4US was deployed for the first time in the Hospital Costa del Sol in 2008. In our evaluation we show the positive impact of this methodology for laboratory professionals,    since the use of our application has reduced the time needed for the elaboration of the different statistical indicators and has also provided information that has been used to optimize the usage of laboratory resources by the discovery of anomalies in the indicators. DB4US users benefit from Internet-based communication of results, since this information is available from any computer without having to install any additional software. Conclusions: The proposed methodology and the accompanying web application, DB4US, automates the processing of information related to laboratory quality indicators and offers a novel approach for managing laboratory-related information, benefiting from an Internet-based communication mechanism. The application of this methodology has been shown to improve the usage of time, as well as other laboratory resources. ",
doi="10.2196/ijmr.2126",
url="http://www.i-jmr.org/2012/2/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23608745"
}


@Article{info:doi/10.2196/ijmr.2064,
author="Heyworth, Leonie
and Zhang, Fang
and Jenter, A. Chelsea
and Kell, Rachel
and Volk, A. Lynn
and Tripathi, Micky
and Bates, W. David
and Simon, R. Steven",
title="Physician Satisfaction Following Electronic Health Record Adoption in Three Massachusetts Communities",
journal="Interact J Med Res",
year="2012",
month="Nov",
day="08",
volume="1",
number="2",
pages="e12",
keywords="electronic health record",
keywords="physician satisfaction",
keywords="implementation",
keywords="Massachusetts eHealth collaborative",
abstract="Background: Despite mandates and incentives for electronic health record (EHR) adoption, little is known about factors predicting physicians' satisfaction following EHR implementation. Objective: To measure predictors of physician satisfaction following EHR adoption. Methods: A total of 163 physicians completed a mailed survey before and after EHR implementation through a statewide pilot project in Massachusetts. Multivariable logistic regression identified predictors of physician satisfaction with their current practice situation in 2009 and generalized estimating equations accounted for clustering. Results: The response rate was 77\% in 2005 and 68\% in 2009. In 2005, prior to EHR adoption, 28\% of physicians were very satisfied with their current practice situation compared to 25\% in 2009, following EHR adoption (P?<?.001). In multivariate analysis, physician satisfaction following EHR adoption was correlated with self-reported ease of EHR implementation (adjusted odds ratio [OR]?=?5.7, 95\% CI 2.1?-?16), resources for practice improvement (adjusted OR?=?2.6, 95\% CI 1.2?-?6.1), pre-intervention satisfaction (adjusted OR?=?4.8, 95\% CI 1.5?-?15), and stress (adjusted OR?=?5.3, 95\% CI 1.1?-?25). Male physicians reported lower satisfaction following EHR adoption (adjusted OR?=?0.3, 95\% CI 0.2?-?0.6). Conclusions: Interventions to expand EHR use should consider additional support for practices with fewer resources for improvement and ensure ease of EHR implementation. EHR adoption may be a factor in alleviating physicians' stress. Addressing physicians' satisfaction prior to practice transformation and anticipating greater dissatisfaction among male physicians will be essential to retaining the physician workforce and ensuring the quality of care they deliver. ",
doi="10.2196/ijmr.2064",
url="http://www.i-jmr.org/2012/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611987"
}


@Article{info:doi/10.2196/ijmr.2137,
author="Landolt, Sarah
and Hirschel, J{\"u}rg
and Schlienger, Thomas
and Businger, Walter
and Zbinden, M. Alex",
title="Assessing and Comparing Information Security in Swiss Hospitals",
journal="Interact J Med Res",
year="2012",
month="Nov",
day="07",
volume="1",
number="2",
pages="e11",
keywords="information security",
keywords="information protection",
keywords="computer security standards",
keywords="electronic health records organization \& administration",
keywords="hospital information systems",
keywords="Switzerland.",
abstract="Background: Availability of information in hospitals is an important prerequisite for good service. Significant resources have been invested to improve the availability of information, but it is also vital that the security of this information can be guaranteed. Objective: The goal of this study was to assess information security in hospitals through a questionnaire based on the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) standard ISO/IEC 27002, evaluating Information technology -- Security techniques -- Code of practice for information-security management, with a special focus on the effect of the hospitals' size and type. Methods: The survey, set up as a cross-sectional study, was conducted in January 2011. The chief information officers (CIOs) of 112 hospitals in German-speaking Switzerland were invited to participate. The online questionnaire was designed to be fast and easy to complete to maximize participation. To group the analyzed controls of the ISO/IEC standard 27002 in a meaningful way, a factor analysis was performed. A linear score from 0 (not implemented) to 3 (fully implemented) was introduced. The scores of the hospitals were then analyzed for significant differences in any of the factors with respect to size and type of hospital. The participating hospitals were offered a benchmark report about their status. Results: The 51 participating hospitals had an average score of 51.1\% (range 30.6\%?-?81.9\%) out of a possible 100\% where all items in the questionnaire were fully implemented. Room for improvement could be identified, especially for the factors covering ``process and quality management'' (average score 1.3?{\textpm}?0.8 out of a maximum of 3) and ``organization and risk management'' (average score 1.3?{\textpm}?0.7 out of a maximum of 3). Private hospitals scored significantly higher than university hospitals in the implementation of ``security zones'' and ``backup'' (P?=?.008). Conclusions: Half (50.00\%, 8588/17,177) of all assessed hospital beds in German-speaking Switzerland are in hospitals that have a score of 49\% or less of the maximum possible score in information security. Patient data need to be better protected because of the data protection laws and because sensitive, personal data should be guaranteed confidentiality, integrity, and availability. ",
doi="10.2196/ijmr.2137",
url="http://www.i-jmr.org/2012/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611956"
}


@Article{info:doi/10.2196/ijmr.2107,
author="Richesson, Lynn Rachel
and Shereff, Denise
and Andrews, Everett James",
title="Standardization of Questions in Rare Disease Registries: The PRISM Library Project",
journal="Interact J Med Res",
year="2012",
month="Oct",
day="10",
volume="1",
number="2",
pages="e10",
keywords="Patient registries",
keywords="data standards",
keywords="rare diseases",
keywords="metadata",
abstract="Background: Patient registries are often a helpful first step in estimating the impact and understanding the etiology of rare diseases - both requisites for the development of new diagnostics and therapeutics. The value and utility of patient registries rely on the use of both well-constructed structured research questions and relevant answer sets accompanying them. There are currently no clear standards or specifications for developing registry questions, and there are no banks of existing questions to support registry developers. Objective: This paper introduces the [Rare Disease] PRISM (Patient Registry Item Specifications and Metadata for Rare Disease) project, a library of standardized questions covering a broad spectrum of rare diseases that can be used to support the development of new registries, including Internet-based registries. Methods: A convenience sample of questions was identified from well-established (>5 years) natural history studies in various diseases and from several existing registries. Face validity of the questions was determined by review by many experts (both terminology experts at the College of American Pathologists (CAP) and research and informatics experts at the University of South Florida (USF)) for commonality, clarity, and organization. Questions were re-worded slightly, as needed, to make the full semantics of the question clear and to make the questions generalizable to multiple diseases where possible. Questions were indexed with metadata (structured and descriptive information) using a standard metadata framework to record such information as context, format, question asker and responder, and data standards information. Results: At present, PRISM contains over 2,200 questions, with content of PRISM relevant to virtually all rare diseases. While the inclusion of disease-specific questions for thousands of rare disease organizations seeking to develop registries would present a challenge for traditional standards development organizations, the PRISM library could serve as a platform to liaison between rare disease communities and existing standardized controlled terminologies, item banks, and coding systems. Conclusions: If widely used, PRISM will enable the re-use of questions across registries, reduce variation in registry data collection, and facilitate a bottom-up standardization of patient registries. Although it was initially developed to fulfill an urgent need in the rare disease community for shared resources, the PRISM library of patient-directed registry questions can be a valuable resource for registries in any disease -- whether common or rare. Trial Registration: N/A ",
doi="10.2196/ijmr.2107",
url="http://www.i-jmr.org/2012/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611924"
}


@Article{info:doi/10.2196/ijmr.2193,
author="Spanakis, G. Emmanouil
and Chiarugi, Franco
and Kouroubali, Angelina
and Spat, Stephan
and Beck, Peter
and Asanin, Stefan
and Rosengren, Peter
and Gergely, Tamas
and Thestrup, Jesper",
title="Diabetes Management Using Modern Information and Communication Technologies and New Care Models",
journal="Interact J Med Res",
year="2012",
month="Oct",
day="04",
volume="1",
number="2",
pages="e8",
keywords="Medical Information Systems",
keywords="Medical Expert Systems",
keywords="Biomedical Engineering",
keywords="Biomedical Informatics",
keywords="Biomedical Computing",
keywords="Telemedicine",
keywords="Diabetes",
abstract="Background: Diabetes, a metabolic disorder, has reached epidemic proportions in developed countries. The disease has two main forms: type 1 and type 2. Disease management entails administration of insulin in combination with careful blood glucose monitoring (type 1) or involves the adjustment of diet and exercise level, the use of oral anti-diabetic drugs, and insulin administration to control blood sugar (type 2). Objective: State-of-the-art technologies have the potential to assist healthcare professionals, patients, and informal carers to better manage diabetes insulin therapy, help patients understand their disease, support self-management, and provide a safe environment by monitoring adverse and potentially life-threatening situations with appropriate crisis management. Methods: New care models incorporating advanced information and communication technologies have the potential to provide service platforms able to improve health care, personalization, inclusion, and empowerment of the patient, and to support diverse user preferences and needs in different countries. The REACTION project proposes to create a service-oriented architectural platform based on numerous individual services and implementing novel care models that can be deployed in different settings to perform patient monitoring, distributed decision support, health care workflow management, and clinical feedback provision. Results: This paper presents the work performed in the context of the REACTION project focusing on the development of a health care service platform able to support diabetes management in different healthcare regimes, through clinical applications, such as monitoring of vital signs, feedback provision to the point of care, integrative risk assessment, and event and alarm handling. While moving towards the full implementation of the platform, three major areas of research and development have been identified and consequently approached: the first one is related to the glucose sensor technology and wearability, the second is related to the platform architecture, and the third to the implementation of the end-user services. The Glucose Management System, already developed within the REACTION project, is able to monitor a range of parameters from various sources including glucose levels, nutritional intakes, administered drugs, and patient's insulin sensitivity, offering decision support for insulin dosing to professional caregivers on a mobile tablet platform that fulfills the need of the users and supports medical workflow procedures in compliance with the Medical Device Directive requirements. Conclusions: Good control of diabetes, as well as increased emphasis on control of lifestyle factors, may reduce the risk profile of most complications and contribute to health improvement. The REACTION project aims to respond to these challenges by providing integrated, professional, management, and therapy services to diabetic patients in different health care regimes across Europe in an interoperable communication platform. ",
doi="10.2196/ijmr.2193",
url="http://www.jmir.org/2012/2/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612026"
}


@Article{info:doi/10.2196/ijmr.2101,
author="Tielemans, M. Merel
and Jansen, BMJ Jan
and van Oijen, GH Martijn",
title="Open Access Capture of Patients With Gastroesophageal Reflux Disease Using an Online Patient-Reported Outcomes Instrument",
journal="Interact J Med Res",
year="2012",
month="Sep",
day="26",
volume="1",
number="2",
pages="e7",
keywords="Gastroesophageal reflux",
keywords="proton pump inhibitor",
keywords="Internet",
keywords="open access questionnaire",
keywords="partial responsiveness",
abstract="Background: Persons with gastroesophageal reflux disease (GERD) frequently search online for information about causes and treatment options. The GerdQ self-assessment questionnaire can be used for diagnosis of GERD and follow-up of symptoms. Objectives: To assess whether it is feasible (1) to study the prevalence and impact of GERD in persons visiting a GERD information website, and (2) to identify partial responsiveness to proton pump inhibitor (PPI) therapy using the GerdQ. Methods: All visitors (aged 18--79 years) to a GERD information website between November 2008 and May 2011 were invited to complete the GerdQ online. The GerdQ questionnaire consists of 6 questions (score per question: 0--3). In respondents who did not use PPIs, we used the questionnaire to identify those with GERD (total score ?8) and assess the influence of these symptoms on their daily life, divided into low (total score <3 on impact questions) and high impact (total score ?3 on impact questions). In PPI users, we used the GerdQ to quantify partial responsiveness by any report of heartburn, regurgitation, sleep disturbance, or over-the-counter medication use for more than 1 day in the preceding week. We subsequently asked GerdQ respondents scoring ?8 to complete the disease-specific Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire. Results: A total of 131,286 visitors completed the GerdQ, of whom 80.23\% (n = 105,329) did not use a PPI. Of these, we identified 67,379 respondents (63.97\%) to have GERD (n = 32,935; 48.88\% high impact). We invited 14,028 non-PPI users to complete the QOLRAD questionnaire, of whom 1231 (8.78\%) completed the questionnaire. Mean total QOLRAD scores were 5.14 (SEM 0.04) for those with high-impact GERD and 5.77 (SEM 0.04) for those with low-impact GERD (P < .001). In PPI users, 22,826 of 25,957 respondents (87.94\%) reported partial responsiveness. We invited 6238 PPI users to complete the QOLRAD questionnaire, of whom 599 (9.60\%) completed the disease-specific quality-of-life questionnaire. Mean total QOLRAD scores were 4.62 (SEM 0.05) for partial responders and 5.88 (SEM 0.14) for adequate responders (P < .001). Conclusions: The GerdQ identified GERD in many website respondents and measured partial responsiveness in the majority of PPI users. Both non-PPI users with GERD and PPI users with partial responsiveness were associated with a decreased health-related quality of life. We have shown the feasibility of GERD patient identification online. ",
doi="10.2196/ijmr.2101",
url="http://www.jmir.org/2012/2/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611985"
}


@Article{info:doi/10.2196/ijmr.2022,
author="Wu, C. Robert
and Lo, Vivian
and Rossos, Peter
and Kuziemsky, Craig
and O'Leary, J. Kevin
and Cafazzo, A. Joseph
and Reeves, Scott
and Wong, M. Brian
and Morra, Dante",
title="Improving Hospital Care and Collaborative Communications for the 21st Century: Key Recommendations for General Internal Medicine",
journal="Interact J Med Res",
year="2012",
month="Sep",
day="24",
volume="1",
number="2",
pages="e9",
keywords="hospital care communication",
keywords="technology",
keywords="knowledge transfer",
keywords="interprofessional collaboration",
abstract="Background: Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to look at alternative communication technologies to address some of these inefficiencies and to improve interprofessional collaboration. Objective: To develop recommendations that assist health care organizations in improving communication and collaboration in order to develop effective methods for evaluation. Methods: An interprofessional meeting was held in a large urban city in Canada with 19 nationally and internationally renowned experts to discuss suitable recommendations for an ideal communication and collaboration system as well as a research framework for general internal medicine (GIM) environments. Results: In designing an ideal GIM communication and collaboration system, attendees believed that the new system should possess attributes that aim to: a) improve workflow through prioritization of information and detection of individuals' contextual situations; b) promote stronger interprofessional relationships with adequate exchange of information; c) enhance patient-centered care by allowing greater patient autonomy over their health care information; d) enable interoperability and scalability between and within institutions; and e) function across different platforms. In terms of evaluating the effects of technology in GIM settings, participants championed the use of rigorous scientific methods that span multiple perspectives and disciplines. Specifically, participants recommended that consistent measures and definitions need to be established so that these impacts can be examined across individual, group, and organizational levels. Conclusions: Discussions from our meeting demonstrated the complexities of technological implementations in GIM settings. Recommendations on the design principles and research paradigms for an improved communication system are described. ",
doi="10.2196/ijmr.2022",
url="http://www.i-jmr.org/2012/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23612055"
}


@Article{info:doi/10.2196/ijmr.2131,
author="Steele, Scott
and Bilchik, Anton
and Eberhardt, John
and Kalina, Philip
and Nissan, Aviram
and Johnson, Eric
and Avital, Itzhak
and Stojadinovic, Alexander",
title="Using Machine-Learned Bayesian Belief Networks to Predict Perioperative Risk of Clostridium Difficile Infection Following Colon Surgery",
journal="Interact J Med Res",
year="2012",
month="Sep",
day="19",
volume="1",
number="2",
pages="e6",
keywords="Clostridium difficile",
keywords="Bayesian belief network",
keywords="pseudomembranous colitis",
keywords="colectomy",
keywords="NIS",
abstract="Background: Clostridium difficile (C-Diff) infection following colorectal resection is an increasing source of morbidity and mortality. Objective: We sought to determine if machine-learned Bayesian belief networks (ml-BBNs) could preoperatively provide clinicians with postoperative estimates of C-Diff risk. Methods: We performed a retrospective modeling of the Nationwide Inpatient Sample (NIS) national registry dataset with independent set validation. The NIS registries for 2005 and 2006 were used for initial model training, and the data from 2007 were used for testing and validation. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were used to identify subjects undergoing colon resection and postoperative C-Diff development. The ml-BBNs were trained using a stepwise process. Receiver operating characteristic (ROC) curve analysis was conducted and area under the curve (AUC), positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results: From over 24 million admissions, 170,363 undergoing colon resection met the inclusion criteria. Overall, 1.7\% developed postoperative C-Diff. Using the ml-BBN to estimate C-Diff risk, model AUC is 0.75. Using only known a priori features, AUC is 0.74. The model has two configurations: a high sensitivity and a high specificity configuration. Sensitivity, specificity, PPV, and NPV are 81.0\%, 50.1\%, 2.6\%, and 99.4\% for high sensitivity and 55.4\%, 81.3\%, 3.5\%, and 99.1\% for high specificity. C-Diff has 4 first-degree associates that influence the probability of C-Diff development: weight loss, tumor metastases, inflammation/infections, and disease severity. Conclusions: Machine-learned BBNs can produce robust estimates of postoperative C-Diff infection, allowing clinicians to identify high-risk patients and potentially implement measures to reduce its incidence or morbidity. ",
doi="10.2196/ijmr.2131",
url="http://www.jmir.org/2012/2/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611947"
}


@Article{info:doi/10.2196/ijmr.2150,
author="Malo, Christian
and Neveu, Xavier
and Archambault, Michel Patrick
and {\'E}mond, Marcel
and Gagnon, Marie-Pierre",
title="Exploring Nurses' Intention to Use a Computerized Platform in the Resuscitation Unit: Development and Validation of a Questionnaire Based on the Theory of Planned Behavior",
journal="Interact J Med Res",
year="2012",
month="Sep",
day="13",
volume="1",
number="2",
pages="e5",
keywords="Primary care nurses",
keywords="adoption of new behavior",
keywords="intention",
keywords="theory of planned behaviour",
keywords="emergency department",
keywords="trauma care",
keywords="electronic health record",
keywords="clinical decision support system",
abstract="Background: In emergency department resuscitation units, writing down information related to interventions, physical examination, vital signs, investigations, and treatments ordered is a crucial task carried out by nurses. To facilitate this task, a team composed of emergency physicians, nurses, and one computer engineer created a novel electronic platform equipped with a tactile screen that allows systematic collection of critical data. This electronic platform also has medical software (ReaScribe+) that functions as an electronic medical record and a clinical decision support system. Objective: To develop and validate a questionnaire that can help evaluate nurses' intention to use a novel computerized platform in an emergency department resuscitation unit, based on Ajzen's theory of planned behavior (TPB). Methods: The sample for this study was composed of 87 nurses who worked in the resuscitation unit of a tertiary trauma center. We held three focus groups with nurses working in the resuscitation unit to identify the salient modal beliefs regarding their intended use of a new electronic medical charting system for the care of trauma patients. The system included a clinical decision support tool. We developed a questionnaire in which salient modal beliefs were used as items to evaluate the TPB constructs. We also added 13 questions to evaluate nurses' computer literacy. The final questionnaire was composed of 46 questions to be answered on a 7-point Likert scale. All nurses in the resuscitation unit and present during a regular work shift were individually contacted by the principal investigator or a research assistant (phase 1). A subsample of the nurses who completed the questionnaire was invited to complete it a second time 2 weeks later (phase 2). Results: In phase 1, we received 62 of the 70 questionnaires administered (89\% response rate). Of the 27 questionnaires administered in phase 2 (retest phase), 25 were completed (93\% response rate). The questionnaire showed very good internal consistency, as Cronbach alpha was higher than .7 for all constructs. Temporal stability was acceptable with intraclass correlations between .41 and .66. The intention to use the electronic platform to chart the resuscitation of trauma patients was very high among the respondents. In the logistic regression model, the only construct that predicted nurses' intention to adopt the computerized platform was the professional norm (odds ratio 3.31, 95\% confidence interval 1.41--7.78). Conclusions: We developed and validated a questionnaire that can now be used in other emergency departments prior to implementation of the computerized platform. The intention to adopt was very high among the respondents, which suggests that the implementation of this innovation could be successful at our institution. ",
doi="10.2196/ijmr.2150",
url="http://www.jmir.org/2012/2/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611903"
}


@Article{info:doi/10.2196/ijmr.2113,
author="Bassi, Jesdeep
and Lau, Francis
and Lesperance, Mary",
title="Perceived Impact of Electronic Medical Records in Physician Office Practices: A Review of Survey-Based Research",
journal="Interact J Med Res",
year="2012",
month="Jul",
day="28",
volume="1",
number="2",
pages="e3",
keywords="Health care surveys",
keywords="evaluation studies",
keywords="ambulatory care information systems",
abstract="Background: Physician office practices are increasingly adopting electronic medical records (EMRs). Therefore, the impact of such systems needs to be evaluated to ensure they are helping practices to realize expected benefits. In addition to experimental and observational studies examining objective impacts, the user's subjective view needs to be understood, since ultimate acceptance and use of the system depends on them. Surveys are commonly used to elicit these views. Objective: To determine which areas of EMR implementation in office practices have been addressed in survey-based research studies, to compare the perceived impacts between users and nonusers for the most-addressed areas, and to contribute to the knowledge regarding survey-based research for assessing the impact of health information systems (HIS). Methods: We searched databases and systematic review citations for papers published between 2000 and 2012 (May) that evaluated the perceived impact of using an EMR system in an office-based practice, were based on original data, had providers as the primary end user, and reported outcome measures related to the system's positive or negative impact. We identified all the reported metrics related to EMR use and mapped them to the Clinical Adoption Framework to analyze the gap. We then subjected the impact-specific areas with the most reported results to a meta-analysis, which examined overall positive and negative perceived impacts for users and nonusers. Results: We selected 19 papers for the review. We found that most impact-specific areas corresponded to the micro level of the framework and that appropriateness or effectiveness and efficiency were well addressed through surveys. However, other areas such as access, which includes patient and caregiver participation and their ability to access services, had very few metrics. We selected 7 impact-specific areas for meta-analysis: security and privacy; quality of patient care or clinical outcomes; patient--physician relationship and communication; communication with other providers; accessibility of records and information; business or practice efficiency; and costs or savings. All the results for accessibility of records and information and for communication with providers indicated a positive view. The area with the most mixed results was security and privacy. Conclusions: Users sometimes were likelier than nonusers to have a positive view of the selected areas. However, when looking at the two groups separately, we often found more positive views for most of the examined areas regardless of use status. Despite limitations of a small number of papers and their heterogeneity, the results of this review are promising in terms of finding positive perceptions of EMR adoption for users and nonusers. In addition, we identified issues related to survey-based research for HIS evaluation, particularly regarding constructs for evaluation and quality of study design and reporting. ",
doi="10.2196/ijmr.2113",
url="http://www.jmir.org/2012/2/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23611832"
}