%0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e68546 %T The Impact of Online Labor Platforms on Workforce Management in Health Care %A Ahmadi Shad,Maryam %A Simon,Michael %A Liberatore,Florian %K online labor platform %K temporary work %K workforce management %K gig work %K health care %K personnel staffing and scheduling %D 2025 %7 2.5.2025 %9 %J Interact J Med Res %G English %X Online labor platforms (OLPs) have the potential to change how the workforce is allocated and managed in health care. The contracting, coordination, and communication of bookings and work assignments happen on these platforms in near real-time with no delay and without any human interactions. This perspective paper describes the worldwide trend toward OLPs in health care, gives an overview of the functioning of these platforms, and discusses the prospects and challenges for health care management. As a real-world case, the platform logic, growth and traffic of a Swiss OLP designed for temporary nurse deployment are presented. OLPs facilitate managing different work arrangements (float pools and temporary work) through (1) offering health care staff flexible work options, which in turn lowers the dropout rates of health care professionals; and (2) effectively managing internal staffing allowing human resource sharing within and across health care organizations. For health care management research, OLPs yield data that can be used to analyze the characteristics, use, and dynamics of flexible work arrangements and temporary work in health care. %R 10.2196/68546 %U https://www.i-jmr.org/2025/1/e68546 %U https://doi.org/10.2196/68546 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e60548 %T Effective Recruitment or Bot Attack? The Challenge of Internet-Based Research Surveys and Recommendations to Reduce Risk and Improve Robustness %A Donkin,Liesje %A Henry,Nathan %A Kercher,Amy %A Pedersen,Mangor %A Wilson,Holly %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K internet-based research %K research methodology %K surveys %K data integrity %K bot attacks %K technology %K data manipulation %K spam %K false %K falsification %K fraudulent %K fraud %K bots %K research methods %K data collection %K verify %K verification %K participants %D 2025 %7 14.3.2025 %9 Viewpoint %J Interact J Med Res %G English %X Internet-based research has exploded in popularity in recent years, enabling researchers to offer both investigations and interventions to broader participant populations than ever before. However, challenges associated with internet-based research have also increased—notably, difficulties verifying participant data and deliberate data manipulation by bot and spam responses. This study presents a viewpoint based on 2 case studies where internet-based research was affected by bot and spam attacks. We aim to share the learnings from these experiences with recommendations for future research practice that may reduce the likelihood or impact of future attacks. The screening and verification processes used are presented and discussed, including the limitations of these. Based on our experience, security and screening within internet-based research platforms are partly effective, but no solution is available to protect researchers completely against bot attacks. Implications for future research and advice for health researchers are discussed. %M 40086470 %R 10.2196/60548 %U https://www.i-jmr.org/2025/1/e60548 %U https://doi.org/10.2196/60548 %U http://www.ncbi.nlm.nih.gov/pubmed/40086470 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e51598 %T How to Design Electronic Case Report Form (eCRF) Questions to Maximize Semantic Interoperability in Clinical Research %A Rinaldi,Eugenia %A Stellmach,Caroline %A Thun,Sylvia %K case report form %K CRF %K interoperability %K standard data model %K data format %K metadata %K core data elements %K data quality %D 2025 %7 3.3.2025 %9 %J Interact J Med Res %G English %X Case report forms (CRFs) are the instruments used by research organizations worldwide to collect information about patients and study participants with the purpose of answering specific questions, assessing the efficacy and safety of medical products, and in general improving prevention and treatment in health care. To obtain significant research results out of the collected data, CRFs should be designed following the recommendations issued by regulatory authorities. However, we believe that semantic interoperability in CRFs has not yet been properly addressed. Within an international consortium comprising several COVID-19 cohorts, we scrutinized the questions included in the different CRFs with the purpose of establishing semantic interoperability across the different study data elements so that data could be merged and jointly analyzed. We realized that similar concepts were structured very differently across the different CRFs, making it hard to find and match the information. Based on the experience acquired, we developed 5 guiding principles on how to design CRFs to support semantic interoperability and increase data quality while also facilitating the sharing of data. Our aim in this viewpoint is to provide general suggestions that, in our opinion, should support researchers in designing CRFs. We conclude by urging authorities to establish an international coordination board for standards and interoperable clinical study data with competence in clinical data, interoperability standards, and data protection as part of a preparedness plan for future pandemics or other health threats. %R 10.2196/51598 %U https://www.i-jmr.org/2025/1/e51598 %U https://doi.org/10.2196/51598 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e70282 %T Use of Clinical Public Databases in Hidradenitis Suppurativa Research %A Liu,Xu %A Guo,Linghong %A Jiang,Xian %+ Department of Dermatology, West China Hospital, Sichuan University, #37 Guoxue Alley, Wuhou District, Chengdu, 610041, China, 86 028 85423315, jiangxian@scu.edu.cn %K hidradenitis suppurativa %K clinical public databases %K disease progression %K patient data %K HS %D 2025 %7 18.2.2025 %9 Viewpoint %J Interact J Med Res %G English %X In this viewpoint, we argue that recent studies using clinical public databases have revolutionized our understanding of hidradenitis suppurativa (HS), a chronic inflammatory skin condition with significant impacts on patients’ quality of life. Our key messages are as follows: (1) these databases enable large-scale studies integrating genetic, epidemiological, and clinical data, providing crucial insights into HS’s genetic predispositions, comorbidities, and treatment outcomes; (2) findings highlight a strong genetic component, with mutations in the γ-secretase complex playing a key role in HS pathogenesis and shaping targeted therapies; (3) studies also reveal elevated risks for comorbidities like obesity, diabetes, cardiovascular disease, and systemic inflammation in patients with HS, with diet-driven inflammatory pathways potentially exacerbating disease severity; (4) while these databases offer unprecedented research opportunities, limitations such as data representativeness and quality must be considered; (5) nonetheless, their benefits outweigh potential drawbacks, allowing the identification of rare comorbidities, disease progression patterns, and personalized treatment strategies; and (6) increased funding for HS research is crucial to harness these databases’ full potential, develop targeted therapies, and ultimately improve patient outcomes. As HS’s impact is disproportionate to current research investments, we believe advocating for more resources and addressing database limitations will be key to advancing HS understanding and care. %M 39965202 %R 10.2196/70282 %U https://www.i-jmr.org/2025/1/e70282 %U https://doi.org/10.2196/70282 %U http://www.ncbi.nlm.nih.gov/pubmed/39965202 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e46007 %T An Automated Clinical Laboratory Decision Support System for Test Utilization, Medical Necessity Verification, and Payment Processing %A Beqaj,Safedin %A Shrestha,Rojeet %A Hamill,Tim %+ Medical Database, Inc, 1 Post, Suite 200, Irvine, CA, 92618, United States, 1 8477693701, sajo@medicaldatabase.com %K clinical decision system %K CDSS %K laboratory decision system %K laboratory testing %K test utilization %K test ordering %K lab test %K laboratory %K testing %K payment %K decision-making %K user %K utilization %K processing %K decision %D 2025 %7 11.2.2025 %9 Viewpoint %J Interact J Med Res %G English %X Physicians could improve the efficiency of the health care system if a reliable resource were available to aid them in better understanding, selecting, and interpreting the diagnostic laboratory tests. It has been well established and widely recognized that (1) laboratory testing provides 70%-85% of the objective data that physicians use in the diagnosis and treatment of their patients; (2) orders for laboratory tests in the United States have increased, with an estimated volume of 4-5 billion tests per year; (3) there is a lack of user-friendly tools to guide physicians in their test selection and ordering; and (4) laboratory test overutilization and underutilization continue to represent a pervasive source of inefficiency in the health care system. These inappropriate test orders not only lead to slower or incorrect diagnoses for patients but also add a significant financial burden. In addition, many ordered tests are not reimbursed by Medicare because they are inappropriate for the medical condition or were ordered with the incorrect International Statistical Classification of Diseases and Related Health Problems, Tenth Revision diagnostic code, not meeting the medical necessity. Therefore, current clinical laboratory test ordering procedures experience a quality gap. Often, providers do not have access to an appropriate tool that uses evidence-based guidelines or algorithms to ensure that tests are not duplicated, overused, or underused. This viewpoint lays out the potential use of an automated laboratory clinical decision support system that helps providers order the right test for the right disease and documents the right reason or medical necessity to pay for the testing. %M 39808833 %R 10.2196/46007 %U https://www.i-jmr.org/2025/1/e46007 %U https://doi.org/10.2196/46007 %U http://www.ncbi.nlm.nih.gov/pubmed/39808833 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e59823 %T The Clinicians’ Guide to Large Language Models: A General Perspective With a Focus on Hallucinations %A Roustan,Dimitri %A Bastardot,François %+ Emergency Medicine Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10, Brussels, 1200, Belgium, 32 477063174, dim.roustan@gmail.com %K medical informatics %K large language model %K clinical informatics %K decision-making %K computer assisted %K decision support techniques %K decision support %K decision %K AI %K artificial intelligence %K artificial intelligence tool %K LLM %K electronic data system %K hallucinations %K false information %K technical framework %D 2025 %7 28.1.2025 %9 Viewpoint %J Interact J Med Res %G English %X Large language models (LLMs) are artificial intelligence tools that have the prospect of profoundly changing how we practice all aspects of medicine. Considering the incredible potential of LLMs in medicine and the interest of many health care stakeholders for implementation into routine practice, it is therefore essential that clinicians be aware of the basic risks associated with the use of these models. Namely, a significant risk associated with the use of LLMs is their potential to create hallucinations. Hallucinations (false information) generated by LLMs arise from a multitude of causes, including both factors related to the training dataset as well as their auto-regressive nature. The implications for clinical practice range from the generation of inaccurate diagnostic and therapeutic information to the reinforcement of flawed diagnostic reasoning pathways, as well as a lack of reliability if not used properly. To reduce this risk, we developed a general technical framework for approaching LLMs in general clinical practice, as well as for implementation on a larger institutional scale. %M 39874574 %R 10.2196/59823 %U https://www.i-jmr.org/2025/1/e59823 %U https://doi.org/10.2196/59823 %U http://www.ncbi.nlm.nih.gov/pubmed/39874574 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e66694 %T The Evolution of Uroflowmetry and Bladder Diary and the Emerging Trend of Using Home Devices From Hospital to Home %A Li,Ming-wei %A Tsai,Yao-Chou %A Yang,Stephen Shei-Dei %A Pong,Yuan-Hung %A Tsai,Yu-Ting %A Tsai,Vincent Fang-Sheng %+ Division of Urology, Department of Surgery, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 16F, No 289, Jianguo Road, New Taipei City, 231016, Taiwan, 886 952 691807, ntubala@gmail.com %K lower urinary tract symptoms %K uroflowmetry %K bladder diary %K home devices %K bladder %K noninvasive %K evaluations %K viewpoint %K diagnostic %K mobile health %D 2025 %7 28.1.2025 %9 Viewpoint %J Interact J Med Res %G English %X Although uroflowmetry and bladder diaries are widely used for noninvasive evaluation of lower urinary tract symptoms, they still have limitations in diagnostic capability and users’ convenience. The aim of this paper is to discuss potential solutions by reviewing (1) the evolution and current clinical use of uroflowmetry and bladder diary, including clinical guidelines, daily practice applications, and their historical development; (2) a growing trend toward using home devices with various technologies; and (3) a comprehensive comparison of the strengths and weaknesses of these home devices. In our opinion, the following points can be highlighted: (1) the emerging trend of using home devices can enhance diagnostic capabilities through repeated measurements and the convenience of at-home testing and (2) home devices, which provide both frequency-volume and uroflowmetry information, have the potential to transform the management of lower urinary tract symptoms. %M 39874564 %R 10.2196/66694 %U https://www.i-jmr.org/2025/1/e66694 %U https://doi.org/10.2196/66694 %U http://www.ncbi.nlm.nih.gov/pubmed/39874564 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57332 %T Patient-Centric Approach to Personalized Electronic Medical Records via QR Code in Japan %A Izumida,Yoshihiko %A Omura,Takashi %A Fujiwara,Masahiro %A Nukaya,Shoko %A Yoneyama,Akio %A Boubacar,Sow %A Yabe,Shinichiro %A Noguchi,Rika %A Nakayama,Shima %A Muraoka,Wataru %A Okuno,Yuki %A Miyashita,Sho %A Ishihara,Yurika %A Moriwaki,Yuto %A Otani,Ryoji %A Adachi,Junichiro %A Tanabe,Kenichiro %A Yamano,Yoshihisa %A Takai,Yasushi %A Honjo,Masaru %+ Department of Endocrinology and Diabetes, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe, Saitama, 350-8550, Japan, 81 492283570, izumida@saitama-med.ac.jp %K Sync for Science-J %K S4S-J %K electronic medical record %K personal health record %K privacy preference manager %K patient-generated health data %K Health Level 7 Fast Health Care Interoperability Resources %K HL7-FHIR %K logical observation identifiers names and codes %K LOINC %K open science %K mobile health %K app %K digital health %K digital intervention %D 2024 %7 23.12.2024 %9 Viewpoint %J Interact J Med Res %G English %X Government policies in the United States and the European Union promote standardization and value creation in the use of FAIR (findability, accessibility, interoperability, and reusability) data, which can enhance trust in digital health systems and is crucial for their success. Trust is built through elements such as FAIR data access, interoperability, and improved communication, which are essential for fostering innovation in digital health technologies. This Viewpoint aims to report on exploratory research demonstrating the feasibility of testing a patient-centric data flow model facilitating semantic interoperability on precision medical information. In this global trend, the interoperable interface called Sync for Science-J (S4S-J) for linking electronic medical records (EMRs) and personal health records was launched as part of the Basic Policy for Economic and Fiscal Management and Reform in Japan. S4S-J controls data distribution consisting of EMR and patient-generated health data and converts this information into QR codes that can be scanned by mobile apps. This system facilitates data sharing based on personal information beliefs and unlocks siloed Internet of Things systems with a privacy preference manager. In line with Japanese information handling practices, the development of a mobile cloud network will lower barriers to entry and enable accelerated data sharing. To ensure cross-compatibility and compliance with future international data standardization, S4S-J conforms to the Health Level 7 Fast Health Care Interoperability Resources standard and uses the international standardized logical observation identifiers names and codes (LOINC) to redefine medical terms used in different terminology standards in different medical fields. It is developed as an applied standard in medical information intended for industry, health care services, and research through secondary use of data. A multicenter collaborative study was initiated to investigate the effectiveness of this system; this was a registered, multicenter, randomized controlled clinical trial, the EMBRACE study of the mobile health app M♡Link for hyperglycemic disorders in pregnancy, which implements an EMR–personal health record interoperable interface via S4S-J. Nevertheless, the aforementioned new challenges, the pivotal Health Level 7 Fast Health Care Interoperability Resources system, and LOINC data mapping were successfully implemented. Moreover, the preliminary input of EMR-integrated patient-generated health data was successfully shared between authorized medical facilities and health care providers in accordance with the patients’ preferences. The patient-centric data flow of the S4S-J in Japan is expected to guarantee the right to data portability, which promotes the maximum benefit of use by patients themselves, which in turn contributes to the promotion of open science. %M 39715547 %R 10.2196/57332 %U https://www.i-jmr.org/2024/1/e57332 %U https://doi.org/10.2196/57332 %U http://www.ncbi.nlm.nih.gov/pubmed/39715547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64226 %T Economics and Equity of Large Language Models: Health Care Perspective %A Nagarajan,Radha %A Kondo,Midori %A Salas,Franz %A Sezgin,Emre %A Yao,Yuan %A Klotzman,Vanessa %A Godambe,Sandip A %A Khan,Naqi %A Limon,Alfonso %A Stephenson,Graham %A Taraman,Sharief %A Walton,Nephi %A Ehwerhemuepha,Louis %A Pandit,Jay %A Pandita,Deepti %A Weiss,Michael %A Golden,Charles %A Gold,Adam %A Henderson,John %A Shippy,Angela %A Celi,Leo Anthony %A Hogan,William R %A Oermann,Eric K %A Sanger,Terence %A Martel,Steven %+ Children's Hospital of Orange County, 1201 W. La Veta Ave, Orange, CA, 92868, United States, 1 714 997 3000, Radha.Nagarajan@choc.org %K large language model %K LLM %K health care %K economics %K equity %K cloud service providers %K cloud %K health outcome %K implementation %K democratization %D 2024 %7 14.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X Large language models (LLMs) continue to exhibit noteworthy capabilities across a spectrum of areas, including emerging proficiencies across the health care continuum. Successful LLM implementation and adoption depend on digital readiness, modern infrastructure, a trained workforce, privacy, and an ethical regulatory landscape. These factors can vary significantly across health care ecosystems, dictating the choice of a particular LLM implementation pathway. This perspective discusses 3 LLM implementation pathways—training from scratch pathway (TSP), fine-tuned pathway (FTP), and out-of-the-box pathway (OBP)—as potential onboarding points for health systems while facilitating equitable adoption. The choice of a particular pathway is governed by needs as well as affordability. Therefore, the risks, benefits, and economics of these pathways across 4 major cloud service providers (Amazon, Microsoft, Google, and Oracle) are presented. While cost comparisons, such as on-demand and spot pricing across the cloud service providers for the 3 pathways, are presented for completeness, the usefulness of managed services and cloud enterprise tools is elucidated. Managed services can complement the traditional workforce and expertise, while enterprise tools, such as federated learning, can overcome sample size challenges when implementing LLMs using health care data. Of the 3 pathways, TSP is expected to be the most resource-intensive regarding infrastructure and workforce while providing maximum customization, enhanced transparency, and performance. Because TSP trains the LLM using enterprise health care data, it is expected to harness the digital signatures of the population served by the health care system with the potential to impact outcomes. The use of pretrained models in FTP is a limitation. It may impact its performance because the training data used in the pretrained model may have hidden bias and may not necessarily be health care–related. However, FTP provides a balance between customization, cost, and performance. While OBP can be rapidly deployed, it provides minimal customization and transparency without guaranteeing long-term availability. OBP may also present challenges in interfacing seamlessly with downstream applications in health care settings with variations in pricing and use over time. Lack of customization in OBP can significantly limit its ability to impact outcomes. Finally, potential applications of LLMs in health care, including conversational artificial intelligence, chatbots, summarization, and machine translation, are highlighted. While the 3 implementation pathways discussed in this perspective have the potential to facilitate equitable adoption and democratization of LLMs, transitions between them may be necessary as the needs of health systems evolve. Understanding the economics and trade-offs of these onboarding pathways can guide their strategic adoption and demonstrate value while impacting health care outcomes favorably. %M 39541580 %R 10.2196/64226 %U https://www.jmir.org/2024/1/e64226 %U https://doi.org/10.2196/64226 %U http://www.ncbi.nlm.nih.gov/pubmed/39541580 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58803 %T Automated Psychotherapy in a Spaceflight Environment: Advantages, Drawbacks, and Unknowns %A Smith,Logan %+ Oklahoma State University, 306 Psychology Building, Stillwater, OK, 74078, United States, 1 772 242 5012, logan.smith12@okstate.edu %K mental health %K deep space %K astronauts %K aerospace medicine %K spaceflight %K flight %K psychotherapy %K privacy %K communication %D 2024 %7 9.10.2024 %9 Viewpoint %J Interact J Med Res %G English %X Various behavioral and mental health issues have been reported by space crews for decades, with the overall number of mental health complications expected to be higher than is publicly known. The broad range of mental health complications encountered in space is expected to grow as people venture deeper into space. Issues with privacy, dual relationships, and delayed communications make rendering effective psychological therapy difficult in a spaceflight environment and nearly impossible in deep space. Automated psychotherapy offers a way to provide psychotherapy to astronauts both in deep space and low Earth orbit. Although automated psychotherapy is growing in popularity on Earth, little is known about its efficacy in space. This viewpoint serves to highlight the knowns and unknowns regarding this treatment modality for future deep space missions, and places an emphasis on the need for further research into the applicability and practicality of automated psychotherapy for the spaceflight environment, especially as it relates to long-duration, deep space missions. %M 39382952 %R 10.2196/58803 %U https://www.i-jmr.org/2024/1/e58803 %U https://doi.org/10.2196/58803 %U http://www.ncbi.nlm.nih.gov/pubmed/39382952 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57435 %T Narrowing the Digital Divide: Framework for Creating Telehealth Equity Dashboards %A Luke,Michael J %A Craig,Sansanee %A Pak-Gorstein,Suzinne %A Arellano,Marlíse %A Zhang,Jessica %A Wright,S Margaret %A Chuo,John %A Scribano,Philip V %+ Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 267 426 6634, lukem1@chop.edu %K telehealth %K equity %K dashboard %K data %K framework %K televisit %K healthcare %K disparity %K disparities %K clinician %K clinicians %K informaticist %K informaticists %K researcher %K researchers %K pediatric %K pediatrics %K health system %K health systems %K dashboards %K access to care %K data source mapping %D 2024 %7 4.9.2024 %9 Viewpoint %J Interact J Med Res %G English %X Telehealth presents both the potential to improve access to care and to widen the digital divide contributing to health care disparities and obliging health care systems to standardize approaches to measure and display telehealth disparities. Based on a literature review and the operational experience of clinicians, informaticists, and researchers in the Supporting Pediatric Research on Outcomes and Utilization of Telehealth (SPROUT)–Clinical and Translational Science Awards (CTSA) Network, we outline a strategic framework for health systems to develop and optimally use a telehealth equity dashboard through a 3-phased approach of (1) defining data sources and key equity-related metrics of interest; (2) designing a dynamic and user-friendly dashboard; and (3) deploying the dashboard to maximize engagement among clinical staff, investigators, and administrators. %M 39231423 %R 10.2196/57435 %U https://www.i-jmr.org/2024/1/e57435 %U https://doi.org/10.2196/57435 %U http://www.ncbi.nlm.nih.gov/pubmed/39231423 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e54687 %T Resilience Informatics: Role of Informatics in Enabling and Promoting Public Health Resilience to Pandemics, Climate Change, and Other Stressors %A Iyengar,M Sriram %A Block Ngaybe,Maiya G %A Gonzalez,Myla %A Arora,Mona %+ University of Arizona College of Medicine, 475 North 5th Street, E967C, Phoenix, AZ, 85004, United States, 1 2817934733, msiyengar@arizona.edu %K health informatics %K data science %K climate change %K pandemics %K COVID-19 %K migrations %K mobile phone %D 2024 %7 12.8.2024 %9 Viewpoint %J Interact J Med Res %G English %X Climate change, local epidemics, future pandemics, and forced displacements pose significant public health threats worldwide. To cope successfully, people and communities are faced with the challenging task of developing resilience to these stressors. Our viewpoint is that the powerful capabilities of modern informatics technologies including artificial intelligence, biomedical and environmental sensors, augmented or virtual reality, data science, and other digital hardware or software, have great potential to promote, sustain, and support resilience in people and communities. However, there is no “one size fits all” solution for resilience. Solutions must match the specific effects of the stressor, cultural dimensions, social determinants of health, technology infrastructure, and many other factors. %M 39133540 %R 10.2196/54687 %U https://www.i-jmr.org/2024/1/e54687 %U https://doi.org/10.2196/54687 %U http://www.ncbi.nlm.nih.gov/pubmed/39133540 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e49618 %T Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period %A Pilunthanakul,Thanita %A Tan,Giles Ming Yee %+ MOH Holdings Pte Ltd, 1 Maritime Square, Singapore, 099253, Singapore, 65 66220980, thanita.pilunthanakul@mohh.com.sg %K dementia %K COVID-19 %K high dependency psychiatric unit %K psychiatric intensive care unit %K caregiver stress %K SARS-CoV-2 %K psychiatric %K psychiatry %K mental health %K health care system %K Alzheimer %K ward %K care facility %D 2024 %7 11.6.2024 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic led to behavioral exacerbations in people with dementia. Increased hospitalizations and lack of bed availability in specialized dementia wards at a tertiary psychiatric hospital in Singapore resulted in lodging people with dementia in the High Dependency Psychiatric Unit (HDPCU). Customizations to create a dementia-friendly environment at the HDPCU included: (1) environmental modifications to facilitate orientation and engender familiarity; (2) person-centered care to promote attachment, inclusion, identity, occupation, and comfort; (3) risk management for delirium; and (4) training core competencies. Such practical solutions can also be implemented elsewhere to help overcome resource constraints and repurpose services to accommodate increasing populations of people living with dementia. %M 38861715 %R 10.2196/49618 %U https://www.i-jmr.org/2024/1/e49618 %U https://doi.org/10.2196/49618 %U http://www.ncbi.nlm.nih.gov/pubmed/38861715 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53311 %T Using Routine Data to Improve Lesbian, Gay, Bisexual, and Transgender Health %A Saunders,Catherine L %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom, 44 1223337106, cs834@medschl.cam.ac.uk %K lesbian %K gay %K bisexual %K trans %K LGBTQ+ %K routine data %K England %K United Kingdom %K health %K viewpoint %K sexual orientation %K health services %K infrastructure data %K policy %K gender %K health outcome %K epidemiology %K risk prediction %K risk %D 2024 %7 1.5.2024 %9 Viewpoint %J Interact J Med Res %G English %X The collection of sexual orientation in routine data, generated either from contacts with health services or in infrastructure data resources designed and collected for policy and research, has improved substantially in the United Kingdom in the last decade. Inclusive measures of gender and transgender status are now also beginning to be collected. This viewpoint considers current data collections, and their strengths and limitations, including accessing data, sample size, measures of sexual orientation and gender, measures of health outcomes, and longitudinal follow-up. The available data are considered within both sociopolitical and biomedical models of health for individuals who are lesbian, gay, bisexual, transgender, queer, or of other identities including nonbinary (LGBTQ+). Although most individual data sets have some methodological limitations, when put together, there is now a real depth of routine data for LGBTQ+ health research. This paper aims to provide a framework for how these data can be used to improve health and health care outcomes. Four practical analysis approaches are introduced—descriptive epidemiology, risk prediction, intervention development, and impact evaluation—and are discussed as frameworks for translating data into research with the potential to improve health. %M 38691398 %R 10.2196/53311 %U https://www.i-jmr.org/2024/1/e53311 %U https://doi.org/10.2196/53311 %U http://www.ncbi.nlm.nih.gov/pubmed/38691398 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e51974 %T Designing mHealth Apps to Incorporate Evidence-Based Techniques for Prolonging User Engagement %A Monachelli,Rebecca %A Davis,Sharon Watkins %A Barnard,Allison %A Longmire,Michelle %A Docherty,John P %A Oakley-Girvan,Ingrid %+ Medable Inc, 525 University Ave, Palo Alto, CA, 94301, United States, 1 8778206259, oakley@stanford.edu %K adherence %K app design %K attrition %K mHealth %K user engagement %K user experience %K proof-of-concept %D 2024 %7 26.3.2024 %9 Viewpoint %J Interact J Med Res %G English %X Maintaining user engagement with mobile health (mHealth) apps can be a challenge. Previously, we developed a conceptual model to optimize patient engagement in mHealth apps by incorporating multiple evidence-based methods, including increasing health literacy, enhancing technical competence, and improving feelings about participation in clinical trials. This viewpoint aims to report on a series of exploratory mini-experiments demonstrating the feasibility of testing our previously published engagement conceptual model. We collected data from 6 participants using an app that showed a series of educational videos and obtained additional data via questionnaires to illustrate and pilot the approach. The videos addressed 3 elements shown to relate to engagement in health care app use: increasing health literacy, enhancing technical competence, and improving positive feelings about participation in clinical trials. We measured changes in participants’ knowledge and feelings, collected feedback on the videos and content, made revisions based on this feedback, and conducted participant reassessments. The findings support the feasibility of an iterative approach to creating and refining engagement enhancements in mHealth apps. Systematically identifying the key evidence-based elements intended to be included in an app’s design and then systematically testing the implantation of each element separately until a satisfactory level of positive impact is achieved is feasible and should be incorporated into standard app design. While mHealth apps have shown promise, participants are more likely to drop out than to be retained. This viewpoint highlights the potential for mHealth researchers to test and refine mHealth apps using approaches to better engage users. %M 38416858 %R 10.2196/51974 %U https://www.i-jmr.org/2024/1/e51974 %U https://doi.org/10.2196/51974 %U http://www.ncbi.nlm.nih.gov/pubmed/38416858 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e54527 %T An Extraordinary Voice Expressed Through Humor: A Tribute to Casey Quinlan %A Woods,Susan S %A Oldenburg,Jan %A van Leeuwen,Daniel %A Sarasohn-Kahn,Jane %A Hudson,Matthew F %+ Tufts University School of Medicine, 145 Harrison St, Boston, MA, 02111, United States, suewoods50@gmail.com %K participatory medicine %K co-design %K co-production %K patient engagement %K patient empowerment %K electronic health record %K patient portal %K open notes %K evidence-based medicine %K shared decision-making %D 2023 %7 12.12.2023 %9 Extraordinary Lives %J J Particip Med %G English %X The Journal of Participatory Medicine introduces Extraordinary Lives, a new journal section celebrating the voices and work of steadfast advocates of participatory medicine that we have lost. This inaugural essay spotlights Casey Quinlan, a patient activist who effectively used her humor and incisive analysis of health care to encourage others to strive for meaningful change. A first-generation “professional patient,” Casey served as a role model who inspired many to share their stories and achieve genuine partnerships in care delivery. A maker of “good trouble,” her voice and stance were part of her power and influence in disrupting the status quo. We present her fight for personal access to health data, her aspiration for personally customized evidence, and her drive for all people to control their health and their health care. %M 38085561 %R 10.2196/54527 %U https://jopm.jmir.org/2023/1/e54527 %U https://doi.org/10.2196/54527 %U http://www.ncbi.nlm.nih.gov/pubmed/38085561 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45197 %T Understanding Loneliness in Younger People: Review of the Opportunities and Challenges for Loneliness Interventions %A Shah,Hurmat Ali %A Househ,Mowafa %+ Hamad bin Khalifa University, Education City - Gate 8, Ar Rayyan, Doha, Qatar, 974 44547278, mhouseh@hbku.edu.qa %K health informatics %K loneliness informatics %K loneliness theory %K health effects %K loneliness interventions %K information and communication technology %K ICT-based interventions %K social-media–based interventions %K social media %K ICT %K lonely %K loneliness %K social isolation %K mental health %K psychological %D 2023 %7 2.11.2023 %9 Viewpoint %J Interact J Med Res %G English %X Loneliness affects the quality of life of people all around the world. Loneliness is also shown to be directly associated with mental health issues and is often the cause of mental health problems. It is also shown to increase the risk of heart diseases and other physical illnesses. Loneliness is studied both from the social and medical sciences perspectives. There are also interventions on the basis of health informatics, information and communication technologies (ICTs), social media, and other technological solutions. In the literature, loneliness is studied from various angles and perspectives ranging from biological to socioeconomical and through anthropological understandings of technology. From the ICT and technological sides, there are multiple reviews studying the effectiveness of intervention strategies and solutions. However, there is a lack of a comprehensive review on loneliness that engulfs the psychological, social, and technological studies of loneliness. From the perspective of loneliness informatics (ie, the application of health informatics practices and tools), it is important to understand the psychological and biological basis of loneliness. When it comes to technological interventions to fight off loneliness, the majority of interventions focus on older people. While loneliness is highest among older people, theoretical and demographical studies of loneliness give a U-shaped distribution age-wise to loneliness; that is, younger people and older people are the demographics most affected by loneliness. But the strategies and interventions designed for older people cannot be directly applied to younger people. We present the dynamics of loneliness in younger people and also provide an overview of the technological interventions for loneliness in younger people. This paper presents an approach wherein the studies carried out from the perspectives of digital health and informatics are discussed in detail. A comprehensive overview of the understanding of loneliness and the study of the overall field of tools and strategies of loneliness informatics was carried out. The need to study loneliness in younger people is addressed and particular digital solutions and interventions developed for younger people are presented. This paper can be used to overcome the challenges of technological gaps in the studies and strategies developed for loneliness. The findings of this study show that the majority of interventions and reviews are focused on older people, with ICT-based and social media–based interventions showing promise for countering the effects of loneliness. There are new technologies, such as conversational agents and robots, which are tailored to the particular needs of younger people. This literature review suggests that the digital solutions developed to overcome loneliness can benefit people, and younger people in particular, more if they are made interactive in order to retain users. %M 37917125 %R 10.2196/45197 %U https://www.i-jmr.org/2023/1/e45197 %U https://doi.org/10.2196/45197 %U http://www.ncbi.nlm.nih.gov/pubmed/37917125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42960 %T Building a Chatbot in a Pandemic %A Rambaud,Kimberly %A van Woerden,Simon %A Palumbo,Leonardo %A Salvi,Cristiana %A Smallwood,Catherine %A Rockenschaub,Gerald %A Okoliyski,Michail %A Marinova,Lora %A Fomaidi,Galina %A Djalalova,Malika %A Faruqui,Nabiha %A Melo Bianco,Viviane %A Mosquera,Mario %A Spasov,Ivaylo %A Totskaya,Yekaterina %+ World Health Organization Regional Office for Europe, Marmorvej 51, Copenhagen, Denmark, 45 627164307, kimb.ramb@gmail.com %K COVID-19 %K chatbots %K evidence-based communication channels %K conversational agent %K user-centered %K health promotion %K digital health intervention %K online health information %K digital health tool %K health communication %D 2023 %7 10.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Easy access to evidence-based information on COVID-19 within an infodemic has been a challenging task. Chatbots have been introduced in times of emergency, when human resources are stretched thin and individuals need a user-centered resource. The World Health Organization Regional Office for Europe and UNICEF (United Nations Children's Fund) Europe and Central Asia came together to build a chatbot, HealthBuddy+, to assist country populations in the region to access accurate COVID-19 information in the local languages, adapted to the country context. Working in close collaboration with thematic technical experts, colleagues and counterparts at the country level allowed the project to be tailored to a diverse range of subtopics. To ensure that HealthBuddy+ was relevant and useful in countries across the region, the 2 regional offices worked closely with their counterparts in country offices, which were essential in partnering with national authorities, engaging communities, promoting the tool, and identifying the most relevant communication channels in which to embed HealthBuddy+. Over the past 2 years, the project has expanded from a web-based chatbot in 7 languages to a multistream, multifunction chatbot available in 16 regional languages, and HealthBuddy+ continues to expand and adjust to meet emerging health emergency needs. %M 37074958 %R 10.2196/42960 %U https://www.jmir.org/2023/1/e42960 %U https://doi.org/10.2196/42960 %U http://www.ncbi.nlm.nih.gov/pubmed/37074958 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44310 %T Normal Workflow and Key Strategies for Data Cleaning Toward Real-World Data: Viewpoint %A Guo,Manping %A Wang,Yiming %A Yang,Qiaoning %A Li,Rui %A Zhao,Yang %A Li,Chenfei %A Zhu,Mingbo %A Cui,Yao %A Jiang,Xin %A Sheng,Song %A Li,Qingna %A Gao,Rui %+ Xiyuan Hospital, China Academy of Chinese Medical Sciences, GCP, Xiyuan Hospital, 1 Xiyuan Playground, Haidian District, Beijing, 100091, China, 86 010 62835653, ruigao@126.com %K data cleaning %K data quality %K key technologies %K real-world data %K viewpoint %D 2023 %7 21.9.2023 %9 Viewpoint %J Interact J Med Res %G English %X With the rapid development of science, technology, and engineering, large amounts of data have been generated in many fields in the past 20 years. In the process of medical research, data are constantly generated, and large amounts of real-world data form a “data disaster.” Effective data analysis and mining are based on data availability and high data quality. The premise of high data quality is the need to clean the data. Data cleaning is the process of detecting and correcting “dirty data,” which is the basis of data analysis and management. Moreover, data cleaning is a common technology for improving data quality. However, the current literature on real-world research provides little guidance on how to efficiently and ethically set up and perform data cleaning. To address this issue, we proposed a data cleaning framework for real-world research, focusing on the 3 most common types of dirty data (duplicate, missing, and outlier data), and a normal workflow for data cleaning to serve as a reference for the application of such technologies in future studies. We also provided relevant suggestions for common problems in data cleaning. %M 37733421 %R 10.2196/44310 %U https://www.i-jmr.org/2023/1/e44310 %U https://doi.org/10.2196/44310 %U http://www.ncbi.nlm.nih.gov/pubmed/37733421 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e39154 %T Supporting Public Health Research Capacity, Quality, and Productivity in a Diverse Region %A AlHamawi,Rana %A Saad,Randa K %A Abdul Rahim,Hanan F %A Mir Islam Saeed,Khwaja %A Husseini,Abdullatif %A Khader,Yousef %A Al Nsour,Mohannad %+ Global Health Development/Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No. 42, Amman, 11196, Jordan, 962 6 5519962, randaksaad@gmail.com %K health research %K Public health %K Eastern Mediterranean region %K Research capacity %K Research Quality %D 2023 %7 31.7.2023 %9 Viewpoint %J Interact J Med Res %G English %X Public health research plays a critical role in strengthening health systems and improving their performance and impact. However, scholarly production in public health coming from the Eastern Mediterranean Region (EMR) remains well below the world average and lacks a tangible growth trend over time. During the seventh Eastern Mediterranean Public Health Network Regional Conference, a roundtable session brought together a panel of public health experts representing Global Health Development/Eastern Mediterranean Public Health Network affiliates, universities or academia, and research institutions from the region, where they shared insights on the current situation of public health research; challenges and barriers to research facing the different countries in the EMR and the region in general; and how research agendas, productivity, and quality can be supported through strengthening research capacity in the region. Although the region is diverse in terms of health system capacity and socioeconomic development, several common challenges were identified, including a lack of strategic prioritization to guide health research, insufficient funding, ineffective transfer of knowledge to policy and practice, limited availability of research facilities, and limited national and international research collaboration. Occupied countries and countries in a state of conflict, such as Palestine, face additional barriers, such as personal and social security, lack of control of borders and natural resources, travel and movement restrictions, and confidentiality challenges because of the continuing war conditions and occupation. However, there have been success stories in the EMR regarding research publications and their positive and effective impact on policy and decision-makers. To improve research resilience and public health care in the region, a collaborative approach involving institutions, policymakers, and relevant stakeholders is critical. %M 37523227 %R 10.2196/39154 %U https://www.i-jmr.org/2023/1/e39154 %U https://doi.org/10.2196/39154 %U http://www.ncbi.nlm.nih.gov/pubmed/37523227 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42831 %T Information and Communication Technology Medicine: Integrative Specialty for the Future of Medicine %A Jongen,Peter Joseph %+ MS4 Research Institute, Ubbergseweg 34, Nijmegen, 6522 KJ, Netherlands, 31 24 3239146, ms4ri@kpnmail.nl %K information and communication technology %K ICT %K integrative %K transdisciplinary %K eHealth %K internet %K medical informatics %K application %K artificial intelligence %K digital medicine %K technologies %D 2023 %7 13.7.2023 %9 Viewpoint %J Interact J Med Res %G English %X The impact of information and communication technology (ICT) on medicine is unprecedented and ever-increasing. This has made it more and more difficult for doctors to keep pace with ICT developments and to adequately match the input of ICT experts. As a result, medical disciplines may not be able to take full advantage of growing possibilities. In this personal viewpoint paper, I argue for the establishment of a novel medical specialty, ICT medicine. ICT medicine is needed to optimally face the challenges of ICT-based developments, including artificial intelligence (AI), and to ensure their efficient and beneficial use. ICT medicine is rooted in both medicine and ICT, and in contrast to existing medical specialties it is integrative in nature, as long-standing structural collaborations with ICT and other stakeholders cross the boundaries between disciplines. Thus, new concepts and theories may evolve that are better suited to addressing ICT-related issues in medicine. ICT doctors will be instrumental in the conception, development, implementation, and evaluation of digital tools, systems, and services. They provide a bridge between ICT professionals and clinical users and educate doctors in digital applications and services. Notably, ICT doctors may have a pivotal role in the validation, verification, and evaluation of AI models. ICT medicine institutes offer a home to these new professionals, enhancing their independence within health care organizations and in relation to ICT companies. Importantly, in an era of growing technicalization and use of AI algorithms, ICT doctors may safeguard the human factor in medicine. And, from a societal perspective, they may promote digital inclusion and the continuing high quality of digital services and provide leadership in the future digitalization of medicine. %M 37440294 %R 10.2196/42831 %U https://www.i-jmr.org/2023/1/e42831 %U https://doi.org/10.2196/42831 %U http://www.ncbi.nlm.nih.gov/pubmed/37440294 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42016 %T The Utility of Predictive Modeling and a Systems Process Approach to Reduce Emergency Department Crowding: A Position Paper %A Monahan,Ann Corneille %A Feldman,Sue S %+ University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 205 934 4011, monahanannc@gmail.com %K emergency care, prehospital %K information systems %K crowding %K healthcare service %K healthcare system %K emergency department %K boarding %K exit block %K medical informatics, application %K health services research %K personalized medicine %K predictive medicine %K model, probabilistic %K polynomial model %K decision support technique %K systems approach %K predict %K evidence based health care %K hospital bed management %K management information systems %K position paper %D 2023 %7 10.7.2023 %9 Viewpoint %J Interact J Med Res %G English %X Emergency department (ED) crowding and its main causes, exit block and boarding, continue to threaten the quality and safety of ED care. Most interventions to reduce crowding have not been comprehensive or system solutions, only focusing on part of the care procession and not directly affecting boarding reduction. This position paper proposes that the ED crowding problem can be optimally addressed by applying a systems approach using predictive modeling to identify patients at risk of being admitted to the hospital and uses that information to initiate the time-consuming bed management process earlier in the care continuum, shortening the time during which patients wait in the ED for an inpatient bed assignment, thus removing the exit block that causes boarding and subsequently reducing crowding. %M 37428536 %R 10.2196/42016 %U https://www.i-jmr.org/2023/1/e42016 %U https://doi.org/10.2196/42016 %U http://www.ncbi.nlm.nih.gov/pubmed/37428536 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e40358 %T Strategies to Bridge Equitable Implementation of Telehealth %A Gustavson,Allison M %A Lewinski,Allison A %A Fitzsimmons-Craft,Ellen E %A Coronado,Gloria D %A Linke,Sarah E %A O'Malley,Denalee M %A Adams,Alyce S %A Glasgow,Russell E %A Klesges,Lisa M %+ Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, 1 Veterans Drive, Minneapolis, MN, 55417, United States, 1 612 467 3406, allison.gustavson@va.gov %K implementation science %K equity %K telehealth %K equitable implementation %K digital age %K post pandemic %D 2023 %7 15.5.2023 %9 Viewpoint %J Interact J Med Res %G English %X During the COVID-19 pandemic, the rapid scaling of telehealth limited the extent to which proactive planning for equitable implementation was possible. The deployment of telehealth will persist in the postpandemic era, given patient preferences, advances in technologies, growing acceptance of telehealth, and the potential to overcome barriers to serve populations with limited access to high-quality in-person care. However, aspects and unintended consequences of telehealth may leave some groups underserved or unserved, and corrective implementation plans that address equitable access will be needed. The purposes of this paper are to (1) describe equitable implementation in telehealth and (2) integrate an equity lens into actionable equitable implementation. %M 37184909 %R 10.2196/40358 %U https://www.i-jmr.org/2023/1/e40358 %U https://doi.org/10.2196/40358 %U http://www.ncbi.nlm.nih.gov/pubmed/37184909 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42685 %T Evolution of Health Information Sharing Between Health Care Organizations: Potential of Nonfungible Tokens %A Esmaeilzadeh,Pouyan %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A Maidique Campus, 11200 SW 8th St, RB 261B, Miami, FL, 33199, United States, 1 305 348 3302, pesmaeil@fiu.edu %K health information exchange %K HIE %K personal health information %K PHI %K blockchain %K nonfungible token %K NFT %K evolution of technology %D 2023 %7 12.4.2023 %9 Viewpoint %J Interact J Med Res %G English %X This study attempts to explain the development and progress of the technology used for sharing health information across health care organizations (such as hospitals and physicians’ offices). First, we describe the strengths and weaknesses of traditional sharing models, health information exchange (HIE), and blockchain-based HIE. Second, the potential use of nonfungible token (NFT) protocols in HIE models is proposed as the next possible move for information-sharing initiatives in health care. In addition to some potential opportunities and distinguishing features (eg, ownability, verifiability, and incentivization), we identify the uncertainty and risks associated with the application of NFTs, such as the lack of a dedicated regulatory framework for legal ownership of digital patient data. This paper is among the first to discuss the potential of NFTs in health care. The use of NFTs in HIE networks could generate a new stream of research for future studies. This study provides practical insights into how the technological foundations of information-sharing efforts in health care have developed and diversified from earlier forms. %M 37043269 %R 10.2196/42685 %U https://www.i-jmr.org/2023/1/e42685 %U https://doi.org/10.2196/42685 %U http://www.ncbi.nlm.nih.gov/pubmed/37043269 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41190 %T Strengthening the One Health Approach in the Eastern Mediterranean Region %A Hailat,Ekhlas %A Amiri,Mirwais %A Debnath,Nitish %A Rahman,Mahmudur %A Nurul Islam,Md %A Fatima,Zahida %A Khader,Yousef %A Al Nsour,Mohannad %+ Global Health Development | Eastern Mediterranean Public Health Network, Shmeisani, Abdallah Ben Abbas Street, Bldg No 42, Amman, 11196, Jordan, 962 792985349, mamiri@globalhealthdev.org %K One Health %K operationalization %K zoonosis %K antimicrobial resistance, Eastern Mediterranean region countries %D 2023 %7 21.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X One Health aims to use a multidisciplinary approach to combat health threats at animal, human, and environmental health interfaces. Among its broad focus areas are issues related to food safety, the control of zoonoses, laboratory services, neglected tropical diseases, environmental health, biosafety and biosecurity, and combatting antimicrobial resistance. A roundtable session was conducted on November 18, 2021, as part of the Eastern Mediterranean Public Health Network's (EMPHNET) seventh regional conference to highlight what role Global Health Development (GHD)|EMPHNET can play to strengthen the One Health approach. This viewpoint summarizes the findings of the roundtable discussion to highlight the experts’ viewpoints on strengthening the One Health approach, including the extent of zoonotic diseases and the dynamics of pathogens and emerging diseases; the occurrence of antimicrobial-resistant pathogens as a silent pandemic; issues surrounding the globalization of trade and food safety; the importance of integrated solutions as a new norm; issues around the institutionalization and governance toward effective operationalization of the One Health approach in the region; and how the One Health approach can be operationalized at global, regional, and local levels. The panel concluded that One Health is an integrated unifying approach that aims to sustainably balance and optimize the health of people, animals, and ecosystems, and provided recommendations to strengthen the One Health approach. It also discussed how GHD|EMPHNET can play its role in transferring the concept of One Health from theory to practice via a solid operationalization road map guide at the Eastern Mediterranean region level. The five broad priority areas of this operational guide include (1) establishing and strengthening a governance architecture, legal framework, and policy and advocacy structure for One Health operationalization in the region; (2) fostering coordination, communication, and collaboration for One Health actions across the region and beyond; (3) building the workforce capacity for effective One Health operationalization in the region; (4) supporting regional platforms for timely, effective, and efficient data sharing and exchange on all One Health–related issues; and (5) supporting risk communication, behavior change communication, and community engagement efforts in the region. %M 36943329 %R 10.2196/41190 %U https://www.i-jmr.org/2023/1/e41190 %U https://doi.org/10.2196/41190 %U http://www.ncbi.nlm.nih.gov/pubmed/36943329 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41182 %T The Impact of Digital Health on Smoking Cessation %A Cobos-Campos,Raquel %A Cordero-Guevara,Jose Aurelio %A Apiñaniz,Antxon %A de Lafuente,Arantza Sáez %A Bermúdez Ampudia,Cristina %A Argaluza Escudero,Julene %A Pérez Llanos,Iraida %A Parraza Diez,Naiara %+ Epidemiology and Public Health Group, Bioaraba Health Research Institute, José Atxotegi s/n, Vitoria-Gasteiz, 01009, Spain, 34 680953032, raquelcobos1976@gmail.com %K smoking cessation %K smoking %K cessation %K smoker %K quit %K care delivery %K service delivery %K health technology %K mHealth %K mobile applications %K mobile health %K digital health %K mobile app %K health app %K smartphone %K health service %K eHealth %K trend %D 2023 %7 15.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X Background: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients’ quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation–relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. Objective: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. Methods: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. Results: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. Conclusions: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources. %M 36920468 %R 10.2196/41182 %U https://www.i-jmr.org/2023/1/e41182 %U https://doi.org/10.2196/41182 %U http://www.ncbi.nlm.nih.gov/pubmed/36920468 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43274 %T Neck Collar Assessment for People Living With Motor Neuron Disease: Are Current Outcome Measures Suitable? %A Spears,Samuel D J %A Abdulle,Yusuf F %A Korovilas,Dionisios %A Torii,Ryo %A Kalaskar,Deepak M %A Sharma,Nikhil %+ Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Sciences, University College London, Royal Free Hospital, 10 Pond Street, London, NW3 2PS, United Kingdom, 44 207 794 0500, d.kalaskar@ucl.ac.uk %K motor neuron disease %K outcome measures %K neck collar %K bespoke orthoses %K 3D scanning %D 2023 %7 14.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X A majority of people living with motor neuron disease (MND) experience weakness of the neck and as a result, experience head drop. This exacerbates problems with everyday activities (eating, talking, breathing, etc). Neck collars are often used to support head drop; however, these are typically designed for prehospitalization settings to manage and brace the cervical region of the spine. As a result, it has been recorded that people living with MND often reject these collars for a variety of reasons but most notably because they are too restricting. The current standardized outcome measures (most notably restricting cervical range of motion) used for neck collars are summarized herein along with whether they are suitable for a bespoke neck collar specifically designed for people living with MND. %M 36917160 %R 10.2196/43274 %U https://www.i-jmr.org/2023/1/e43274 %U https://doi.org/10.2196/43274 %U http://www.ncbi.nlm.nih.gov/pubmed/36917160 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e36356 %T Toward Public Health Resilience in the Eastern Mediterranean Region: Findings From the Seventh Eastern Mediterranean Public Health Network Regional Conference %A , %+ The Eastern Mediterranean Public Health Network (EMPHNET), Abdallah Ben Abbas St, Building No 42, Amman, 11196, Jordan, 962 6 5519962, executive.director@globalhealthdev.org %K COVID-19 %K surveillance %K public health %K health system %K conference %K Eastern Mediterranean Region %D 2023 %7 9.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X The resilience of public health in the Eastern Mediterranean Region (EMR) varies from country to country, mostly based on the governmental and financial situation of the countries. With the theme of Towards Public Health Resilience in the EMR: Breaking Barriers, the seventh Eastern Mediterranean Public Health Network regional conference, held from November 14 to 18, 2021, was dedicated to exploring ways for achieving public health resilience. A total of 101 oral presentations and 13 poster presentations were presented on various public health topics. The conference included 6 keynote sessions, 10 roundtable sessions, and 5 preconference workshops. The preconference workshops were conducted on border health; the mobilization of Field Epidemiology Training Program (FETP) residents and graduates and rapid responders in EMR countries; continuous professional development for the public health workforce; brucellosis surveillance using the “One Health” approach; and strategies to integrate and use noncommunicable diseases data sources. The roundtable sessions included discussions on the following topics: the role of FETPs in responding to COVID-19, institutionalization of rapid response to public health emergencies, health systems resilience, integration of early warning and response with event-based and indicator-based surveillance, sustaining international health regulations, strengthening the “One Health” approach, the anticipated future of public health in the post COVID-19 era, supporting public health research capacity in a diverse region, and COVID-19 vaccines and routine immunization synergies and drawbacks. The keynote speaker sessions covered topics on essential public health functions and the universal health coverage challenge in the EMR, lessons from the US COVID-19 public health response, learning from COVID-19, reshaping public health after the pandemic era, COVID-19 resilient primary health care, and the cohesion of society during and after a pandemic. The conference sessions provided highly promising opportunities to explore ways to achieve such goals in the EMR and shed light on the latest scientific findings, important lessons learned, and discussions on the ways in which current barriers can be broken down through coordination and collaboration. %M 36892927 %R 10.2196/36356 %U https://www.i-jmr.org/2023/1/e36356 %U https://doi.org/10.2196/36356 %U http://www.ncbi.nlm.nih.gov/pubmed/36892927 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e36765 %T Web-Based Co-design in Health Care: Considerations for Renewed Participation %A Mallakin,Maryam %A Dery,Christina %A Vaillancourt,Samuel %A Gupta,Sahil %A Sellen,Katherine %+ Health Design Studio, OCAD University, 42 Parkway Ave, Toronto, ON, M6R 1T5, Canada, 1 647 448 4902, katherinesellen@gmail.com %K web-based design research %K co-design %K web-based co-design %K virtual platform %K virtual learning platforms %K internet research ethics %K collaboration %K health communication %K sensemaking %K health design %K tangible tools and games %D 2023 %7 3.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic has shifted the work environment to a new reality of remote work and virtual collaboration. This shift has occurred in various work settings with an impact on spaces, approaches, applied techniques, and tools. This has resulted in the broad use of virtual tools in the health care sector to avoid physical encounters and in-person interactions that will likely outlast the COVID-19 pandemic. Developing effective virtual approaches requires the knowledge and skills of using digital technologies collaboratively combined with a deep understanding of the context or contexts in which these approaches may be used. The implementation of virtual health design methods, including web-based co-design, has increased to meet the realities of COVID-19 restrictions and is likely to outlast them. Adapting the use of co-design methodologies to a virtual configuration requires rethinking methods of collaboration and communication, adapting to virtual environments, and creating new methods of engagement and facilitation. With this viewpoint, we reviewed the current work on co-design (in person and web based) to propose techniques for the design, planning, and implementation of web-based co-design. We propose 7 considerations that may enable web-based co-design projects in the health care sector. The key considerations that affect the success of a web-based co-design approach should be considered in the process of planning, developing, and conducting web-based co-design sessions. These include facilitation, collaboration, accessibility and equity, communication, sensemaking, tangible tools and games, and web-based research ethics. We illustrate this work with a case study of co-design for an emergency department discharge tool developed during the pandemic. %M 36595738 %R 10.2196/36765 %U https://www.i-jmr.org/2023/1/e36765 %U https://doi.org/10.2196/36765 %U http://www.ncbi.nlm.nih.gov/pubmed/36595738 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e42540 %T Using Decision Trees as an Expert System for Clinical Decision Support for COVID-19 %A Chrimes,Dillon %+ School of Health Information Science, Human and Social Development, University of Victoria, HSD Building, A202, Victoria, BC, V8W2Y2, Canada, 1 250 472 4474, dchrimes@uvic.ca %K assessment tool %K chatbot %K clinical decision support %K COVID-19 %K decision tree %K digital health tool %K framework %K health informatics %K health intervention %K prototype %D 2023 %7 30.1.2023 %9 Viewpoint %J Interact J Med Res %G English %X COVID-19 has impacted billions of people and health care systems globally. However, there is currently no publicly available chatbot for patients and care providers to determine the potential severity of a COVID-19 infection or the possible biological system responses and comorbidities that can contribute to the development of severe cases of COVID-19. This preliminary investigation assesses this lack of a COVID-19 case-by-case chatbot into consideration when building a decision tree with binary classification that was stratified by age and body system, viral infection, comorbidities, and any manifestations. After reviewing the relevant literature, a decision tree was constructed using a suite of tools to build a stratified framework for a chatbot application and interaction with users. A total of 212 nodes were established that were stratified from lung to heart conditions along body systems, medical conditions, comorbidities, and relevant manifestations described in the literature. This resulted in a possible 63,360 scenarios, offering a method toward understanding the data needed to validate the decision tree and highlighting the complicated nature of severe cases of COVID-19. The decision tree confirms that stratification of the viral infection with the body system while incorporating comorbidities and manifestations strengthens the framework. Despite limitations of a viable clinical decision tree for COVID-19 cases, this prototype application provides insight into the type of data required for effective decision support. %M 36645840 %R 10.2196/42540 %U https://www.i-jmr.org/2023/1/e42540 %U https://doi.org/10.2196/42540 %U http://www.ncbi.nlm.nih.gov/pubmed/36645840 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41144 %T Health System Resilience in the Eastern Mediterranean Region: Perspective on the Recent Lessons Learned %A Amiri,Mirwais %A Al Nsour,Mohannad %A Alonso-Garbayo,Alvaro %A Al Serouri,Abdulwahed %A Maiteh,Adna %A Badr,Elsheikh %+ Global Health Development, Eastern Mediterranean Public Health Network, Shmeisani, Abdallah Ben Abbas Street, Bldg No 42, Amman, 11196, Jordan, 962 792985349, mamiri@globalhealthdev.org %K health systems resilience %K resilience %K vulnerability %K public health %K Eastern Mediterranean Region countries %K COVID-19 %D 2022 %7 21.12.2022 %9 Viewpoint %J Interact J Med Res %G English %X Background: Public health has a pivotal role in strengthening resilience at individual, community, and system levels as well as building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. To engage national, regional, and international public health entities and experts in a discussion of challenges hindering achievement of health system resilience (HSR) in the Eastern Mediterranean Region, the Eastern Mediterranean Public Health Network (EMPHNET) held its seventh regional conference in Amman, Jordan, between November 15 and 18, 2021, under the theme “Towards Resilient Health Systems in the Eastern Mediterranean: Breaking Barriers.” This viewpoint paper portrays the roundtable discussion of experts on the core themes of that conference. Objective: Our aim was to provide insights on lessons learned from the past and explore new opportunities to attain more resilient health systems to break current barriers. Methods: The roundtable brought together a panel of public health experts representing Field Epidemiology Training Programs (FETPs), Centers for Disease Control and Prevention in Atlanta, World Health Organization, EMPHNET, universities or academia, and research institutions at regional and global levels. To set the ground, the session began with four 10-12–minute presentations introducing the concept of HSR and its link to workforce development with an overall reflection on the matter and lessons learned through collective experiences. The presentations were followed by an open question and answer session to allow for an interactive debate among panel members and the roundtable audience. Results: The panel discussed challenges faced by health systems and lessons learned in times of the new public health threats to move toward more resilient health systems, overcome current barriers, and explore new opportunities to enhance the HSR. They presented field experiences in building resilient health systems and the role of FETPs with an example from Yemen FETP. Furthermore, they debated the lessons learned from COVID-19 response and how it can reshape our thinking and strategies for approaching HSR. Finally, the panel discussed how health systems can effectively adapt and prosper in the face of challenges and barriers to recover from extreme disruptions while maintaining the core functions of the health systems. Conclusions: Considering the current situation in the region, there is a need to strengthen both pandemic preparedness and health systems, through investing in essential public health functions including those required for all-hazards emergency risk management. Institutionalized mechanisms for whole-of-society engagement, strengthening primary health care approaches for health security and universal health coverage, as well as promoting enabling environments for research, innovation, and learning should be ensured. Investing in building epidemiological capacity through continuous support to FETPs to work toward strengthening surveillance systems and participating in regional and global efforts in early response to outbreaks is crucial. %M 36480685 %R 10.2196/41144 %U https://www.i-jmr.org/2022/2/e41144 %U https://doi.org/10.2196/41144 %U http://www.ncbi.nlm.nih.gov/pubmed/36480685 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38655 %T Levels of Autonomous Radiology %A Ghuwalewala,Suraj %A Kulkarni,Viraj %A Pant,Richa %A Kharat,Amit %+ DeepTek Medical Imaging Pvt Ltd, 3rd Floor, Ideas to Impact, 3, Baner Rd, Pallod Farms, Baner, Pune, 411045, India, 91 72760 60080, richa.pant@deeptek.ai %K artificial intelligence %K automation %K machine learning %K radiology %K explainability %K model decay %K generalizability %K fairness and bias %K distributed learning %K autonomous radiology %K AI assistance %D 2022 %7 7.12.2022 %9 Viewpoint %J Interact J Med Res %G English %X Radiology, being one of the younger disciplines of medicine with a history of just over a century, has witnessed tremendous technological advancements and has revolutionized the way we practice medicine today. In the last few decades, medical imaging modalities have generated seismic amounts of medical data. The development and adoption of artificial intelligence applications using this data will lead to the next phase of evolution in radiology. It will include automating laborious manual tasks such as annotations, report generation, etc, along with the initial radiological assessment of patients and imaging features to aid radiologists in their diagnostic and treatment planning workflow. We propose a level-wise classification for the progression of automation in radiology, explaining artificial intelligence assistance at each level with the corresponding challenges and solutions. We hope that such discussions can help us address challenges in a structured way and take the necessary steps to ensure the smooth adoption of new technologies in radiology. %M 36476422 %R 10.2196/38655 %U https://www.i-jmr.org/2022/2/e38655 %U https://doi.org/10.2196/38655 %U http://www.ncbi.nlm.nih.gov/pubmed/36476422 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40655 %T Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research %A Fischer,Aurelie %A Elbeji,Abir %A Aguayo,Gloria %A Fagherazzi,Guy %+ Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, 1A-B, rue Thomas Edison, Strassen, L-1445, Luxembourg, 352 26970230, aurelie.fischer@lih.lu %K vocal biomarker %K COVID-19 symptoms %K digital health %K remote monitoring %K artificial intelligence %K voice %K COVID-19 %K Long COVID %K digital health solution %K voice-based technology %K health technology %K health monitoring %K digital health monitoring %K health care application %K remote patient monitoring %D 2022 %7 15.11.2022 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic accelerated the use of remote patient monitoring in clinical practice or research for safety and emergency reasons, justifying the need for innovative digital health solutions to monitor key parameters or symptoms related to COVID-19 or Long COVID. The use of voice-based technologies, and in particular vocal biomarkers, is a promising approach, voice being a rich, easy-to-collect medium with numerous potential applications for health care, from diagnosis to monitoring. In this viewpoint, we provide an overview of the potential benefits and limitations of using voice to monitor COVID-19, Long COVID, and related symptoms. We then describe an optimal pipeline to bring a vocal biomarker candidate from research to clinical practice and discuss recommendations to achieve such a clinical implementation successfully. %M 36378504 %R 10.2196/40655 %U https://www.i-jmr.org/2022/2/e40655 %U https://doi.org/10.2196/40655 %U http://www.ncbi.nlm.nih.gov/pubmed/36378504 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38886 %T A New Approach to Enhancing Engagement in eHealth Apps %A Oakley-Girvan,Ingrid %A Docherty,John P %+ Research, Value and Strategy, Medable Inc, 525 University Ave, Suite A70, Palo Alto, CA, 94301, United States, 1 877 820 6259, Ingrid@medable.com %K user engagement %K eHealth %K attrition %K adherence %K apps %K app design %K user experience %D 2022 %7 9.11.2022 %9 Viewpoint %J Interact J Med Res %G English %X This viewpoint presents a 3-phase conceptual model of the process of user engagement with eHealth apps. We also describe how knowledge gleaned from psychosocial, behavioral, and cognitive science can be incorporated into this model to enhance user engagement with an eHealth app in each phase of the engagement process. %M 36279587 %R 10.2196/38886 %U https://www.i-jmr.org/2022/2/e38886 %U https://doi.org/10.2196/38886 %U http://www.ncbi.nlm.nih.gov/pubmed/36279587 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39323 %T How Digital Therapeutics Are Urging the Need for a Paradigm Shift: From Evidence-Based Health Care to Evidence-Based Well-being %A Smits,Merlijn %A Ludden,Geke D S %A Verbeek,Peter-Paul %A van Goor,Harry %+ Department of Surgery, Radboud university medical center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 634165922, merlijnsmits@hotmail.com %K digital therapeutics %K digital health %K paradigm shift %K paradigm %K health policy %K health care %K evidence %K evidence-based %K decision-making %K challenges %K implementation %K well-being %K digital %K technology %D 2022 %7 20.10.2022 %9 Viewpoint %J Interact J Med Res %G English %X A scientific paradigm consists of a set of shared rules, beliefs, values, methods, and instruments for addressing scientific problems. Currently, health care embraces the paradigm of evidence-based health care (EBH). This paradigm prompts health care institutions to base decisions on the best available evidence, which is commonly generated in large-scale randomized controlled trials. We illustrate the application of EBH via the evaluation of drugs. We show how EBH is challenged when it is applied to the evaluation of digital therapeutics, which refers to technology and data to prevent, manage, or treat a medical disorder or disease. We conclude that amid the growing application of digital therapeutics, the paradigm of EBH is challenged in four domains: population, intervention, comparison, outcome. In the second part of this viewpoint, we argue for a paradigm shift in health care so we can optimally evaluate and implement digital therapeutics, and we sketch out the contours of this novel paradigm. We address the need for considering design in health care and evaluation processes, studying user values so that health care can move from a focus on health to well-being, focusing on individual experiences rather than the average, addressing the need for evaluation in authentic use contexts, and stressing the need for continuous evaluation of the dynamic relations between users, context, and digital therapeutics. We conclude that the transition from EBH toward evidence-based well-being would improve the successful implementation of digital technologies in health care. %M 36264624 %R 10.2196/39323 %U https://www.i-jmr.org/2022/2/e39323 %U https://doi.org/10.2196/39323 %U http://www.ncbi.nlm.nih.gov/pubmed/36264624 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e37584 %T Addressing Medicine’s Dark Matter %A Rose,Christian %A Díaz,Mark %A Díaz,Tomás %+ Department of Emergency Medicine, School of Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4159159585, ccrose@stanford.edu %K big data %K AI %K artificial intelligence %K equity %K data collection %K health care %K prediction %K model %K predict %K representative %K unrepresented %D 2022 %7 17.8.2022 %9 Viewpoint %J Interact J Med Res %G English %X In the 20th century, the models used to predict the motion of heavenly bodies did not match observation. Investigating this incongruity led to the discovery of dark matter—the most abundant substance in the universe. In medicine, despite years of using a data-hungry approach, our models have been limited in their ability to predict population health outcomes—that is, our observations also do not meet our expectations. We believe this phenomenon represents medicine’s “dark matter”— the features which have a tremendous effect on clinical outcomes that we cannot directly observe yet. Advancing the information science of health care systems will thus require unique solutions and a humble approach that acknowledges its limitations. Dark matter changed the way the scientific community understood the universe; what might medicine learn from what it cannot yet see? %M 35976194 %R 10.2196/37584 %U https://www.i-jmr.org/2022/2/e37584 %U https://doi.org/10.2196/37584 %U http://www.ncbi.nlm.nih.gov/pubmed/35976194 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e36102 %T Recommendations for Better Adoption of Medical Photography as a Clinical Tool %A Wongvibulsin,Shannon %A Feterik,Kristian %+ Division of Dermatology, Department of Medicine, University of California, Los Angeles, 200 Medical Plaza Suite 450, Los Angeles, CA, 90095, United States, 1 (310) 794 5659, swongvibulsin@mednet.ucla.edu %K medical photography %K photo documentation %K EMR %K electronic medical record %K electronic health record %K EHR %K interoperability %K interoperable %K photography %K photograph %K imaging %K image capture %K image %K image storage %K clinical instrument %K clinical tool %D 2022 %7 18.7.2022 %9 Viewpoint %J Interact J Med Res %G English %X The use of photography in routine clinical practice has the potential to increase the efficiency of overall patient care as well as improve clinical documentation and provider-to-provider communication. This is particularly important in the setting of provider burnout in the electronic health record era and during the COVID-19 pandemic. Despite the potential of photographs to enhance workflows and patient care, challenges remain that hinder the successful incorporation of medical photography into clinical practice, often because of inconsistent structure and implementation. Our proposed consolidated framework for clinical photography consists of five key aspects: appropriate informed consent; proper preparation and positioning; image acquisition with consideration of the field of view, orientation, focus, resolution, scale, and color calibration; streamlined and secure image storage and documentation; and interoperable file exchange. Overall, this viewpoint is a forward-looking paper on leveraging medical photography as an electronic health record tool for clinical care, research, and education. %M 35849427 %R 10.2196/36102 %U https://www.i-jmr.org/2022/2/e36102 %U https://doi.org/10.2196/36102 %U http://www.ncbi.nlm.nih.gov/pubmed/35849427 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e30755 %T Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union %A John,Oommen %A Sarbadhikari,Suptendra Nath %A Prabhu,Thanga %A Goel,Ashvini %A Thomas,Alexander %A Shroff,Sunil %A Allaudin,Fazilah %A Weerabaddana,Chaminda %A Alhuwail,Dari %A Koirala,Udaya %A Johnrose,Jayalal %A Codyre,Patricia %A Bleaden,Andy %A Singh,Shubnum %A Bajaj,Shuchin %+ The George Institute for Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, 110025, India, 91 9717669574, supten@gmail.com %K telehealth policy and practice %K implementation lessons %K challenges in scaling up %K capacity building of human resources %K data privacy %K telehealth %K health policy %K telemedicine %K implementation %K challenges %K human resources %K digital health %K data security %D 2022 %7 8.2.2022 %9 Viewpoint %J Interact J Med Res %G English %X This viewpoint summarizes the discussion that occurred during the “Translating Policy to Practice in Telehealth–Lessons from Global Implementation Experiences” panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth. %M 35133279 %R 10.2196/30755 %U https://www.i-jmr.org/2022/1/e30755 %U https://doi.org/10.2196/30755 %U http://www.ncbi.nlm.nih.gov/pubmed/35133279 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e22271 %T Cyberspace and Libel: A Dangerous Balance for Physicians %A Chiruvella,Varsha %A Guddati,Achuta Kumar %+ Medical College of Georgia, Augusta University, 1411 Laney Walker Blvd, CN Building, Room 5327, Augusta, GA, 30912, United States, 1 3124048928, aguddati@augusta.edu %K libel %K reputation %K physician %K law %K legal %K defamation %D 2021 %7 27.5.2021 %9 Viewpoint %J Interact J Med Res %G English %X Freedom of speech and expression is one of the core tenets of modern societies. It was deemed to be so fundamentally essential to early American life that it was inscribed as the First Amendment of the United States Constitution. Over the past century, the rise of modern life also marked the rise of the digital era and age of social media. Freedom of speech thus transitioned from print to electronic media. Access to such content is almost instantaneous and available to a vast audience. From social media to online rating websites, online defamation may cause irreparable damage to a physician’s reputation and practice. It is especially relevant in these times of political turbulence where the battle to separate facts from misinformation has started a debate about the responsibility of social media. The historical context of libel and its applicability in the age of increasing online presence is important for physicians since they are also bound by duty to protect the privacy of their patients. The use of public rating sites and social media will continue to be important for physicians, as online presence and incidents of defamation impact the practice of medicine. %M 34042594 %R 10.2196/22271 %U https://www.i-jmr.org/2021/2/e22271 %U https://doi.org/10.2196/22271 %U http://www.ncbi.nlm.nih.gov/pubmed/34042594 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e22269 %T Ethical Issues in Patient Data Ownership %A Chiruvella,Varsha %A Guddati,Achuta Kumar %+ Augusta University, 1411 Laney Walker Blvd, CN building, Room 5327, Augusta, GA, 30912, United States, 1 3124048928, aguddati@augusta.edu %K data %K privacy %K ownership %D 2021 %7 21.5.2021 %9 Viewpoint %J Interact J Med Res %G English %X Patient data have conventionally been thought to be well protected by the privacy laws outlined in the United States. The increasing interest of for-profit companies in acquiring the databases of large health care systems poses new challenges to the protection of patients’ privacy. It also raises ethical concerns of sharing patient data with entities that may exploit it for commercial interests and even target vulnerable populations. Recognizing that every breach in the confidentiality of large databases exposes millions of patients to the potential of being exploited is important in framing new rules for governing the sharing of patient data. Similarly, the ethical aspects of data voluntarily and altruistically provided by patients for research, which may be exploited for commercial interests due to patient data sharing between health care entities and third-party companies, need to be addressed. The rise of technologies such as artificial intelligence and the availability of personal data gleaned by data vendor companies place American patients at risk of being exploited both intentionally and inadvertently because of the sharing of their data by their health care provider institutions and third-party entities. %M 34018968 %R 10.2196/22269 %U https://www.i-jmr.org/2021/2/e22269 %U https://doi.org/10.2196/22269 %U http://www.ncbi.nlm.nih.gov/pubmed/34018968 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 1 %P e21640 %T Visibility Versus Privacy of Physicians in the Age of Social Media %A Patel,Sunny J %A Guddati,Achuta K %+ Medical College of Georgia, Augusta University, 1411 Laney Walker Blvd, Augusta, GA, 30912, United States, 1 3124048928, aguddati@augusta.edu %K social media %K privacy %K internet %D 2021 %7 8.3.2021 %9 Viewpoint %J Interact J Med Res %G English %X As access to the internet has grown over the years, social media has become an important resource in the health care sector. Third-party physician-rating websites in particular have gained popularity. However, there are ethical implications of such websites. These websites provide a platform for patients to evaluate and review physicians and likewise increase visibility and advertisement of physicians, but they also violate the rights to privacy that these doctors should have. This paper aims to study and assess the ethical implications of these websites on the visibility and privacy of physicians. After presenting the ethical dilemma associated with such websites, it provides guidelines that can be incorporated by both physicians and third-party sites to help maintain physician privacy while providing public service in the form of advertisement and visibility. %M 33683211 %R 10.2196/21640 %U https://www.i-jmr.org/2021/1/e21640 %U https://doi.org/10.2196/21640 %U http://www.ncbi.nlm.nih.gov/pubmed/33683211 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e19144 %T Protection of Health Care Professionals During an Epidemic: Medical, Ethical, and Legal Ramifications %A Guddati,Achuta %+ Augusta University, 1411 Laney Walker Blvd, Unit 3, Augusta, NY, 30912, United States, 1 3124048928, drgakumar@yahoo.com %K medical ethics %K harm %K protection %K COVID-19 %D 2020 %7 8.7.2020 %9 Viewpoint %J Interact J Med Res %G English %X The welfare of health care professionals working in hazardous environments is a concerning issue. Personal protective equipment such as face masks, disposable gowns, hair covers, gloves, and shoe covers is often used to prevent contamination from patient contact and droplets. This is especially relevant during an epidemic, when health care professionals are at elevated risk of infection. Failure to provide adequate protection to health care workers during epidemics has medical, ethical, and legal ramifications. %M 32603309 %R 10.2196/19144 %U https://www.i-jmr.org/2020/3/e19144 %U https://doi.org/10.2196/19144 %U http://www.ncbi.nlm.nih.gov/pubmed/32603309 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12100 %T Artificial Intelligence in Clinical Health Care Applications: Viewpoint %A van Hartskamp,Michael %A Consoli,Sergio %A Verhaegh,Wim %A Petkovic,Milan %A van de Stolpe,Anja %+ Philips Research, HTC11, p247, High Tech Campus, Eindhoven, 5656AE, Netherlands, 31 612784841, anja.van.de.stolpe@philips.com %K artificial intelligence %K deep learning %K clinical data %K Bayesian modeling %K medical informatics %D 2019 %7 05.04.2019 %9 Viewpoint %J Interact J Med Res %G English %X The idea of artificial intelligence (AI) has a long history. It turned out, however, that reaching intelligence at human levels is more complicated than originally anticipated. Currently, we are experiencing a renewed interest in AI, fueled by an enormous increase in computing power and an even larger increase in data, in combination with improved AI technologies like deep learning. Healthcare is considered the next domain to be revolutionized by artificial intelligence. While AI approaches are excellently suited to develop certain algorithms, for biomedical applications there are specific challenges. We propose six recommendations—the 6Rs—to improve AI projects in the biomedical space, especially clinical health care, and to facilitate communication between AI scientists and medical doctors: (1) Relevant and well-defined clinical question first; (2) Right data (ie, representative and of good quality); (3) Ratio between number of patients and their variables should fit the AI method; (4) Relationship between data and ground truth should be as direct and causal as possible; (5) Regulatory ready; enabling validation; and (6) Right AI method. %M 30950806 %R 10.2196/12100 %U https://www.i-jmr.org/2019/2/e12100/ %U https://doi.org/10.2196/12100 %U http://www.ncbi.nlm.nih.gov/pubmed/30950806