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Färber A, Schwabe C, Stalder PH, Dolata M, Schwabe G. Physicians' and Patients' Expectations From Digital Agents for Consultations: Interview Study Among Physicians and Patients. JMIR Hum Factors 2024; 11:e49647. [PMID: 38498022 PMCID: PMC10985611 DOI: 10.2196/49647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 12/09/2023] [Accepted: 01/15/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Physicians are currently overwhelmed by administrative tasks and spend very little time in consultations with patients, which hampers health literacy, shared decision-making, and treatment adherence. OBJECTIVE This study aims to examine whether digital agents constructed using fast-evolving generative artificial intelligence, such as ChatGPT, have the potential to improve consultations, adherence to treatment, and health literacy. We interviewed patients and physicians to obtain their opinions about 3 digital agents-a silent digital expert, a communicative digital expert, and a digital companion (DC). METHODS We conducted in-depth interviews with 25 patients and 22 physicians from a purposeful sample, with the patients having a wide age range and coming from different educational backgrounds and the physicians having different medical specialties. Transcripts of the interviews were deductively coded using MAXQDA (VERBI Software GmbH) and then summarized according to code and interview before being clustered for interpretation. RESULTS Statements from patients and physicians were categorized according to three consultation phases: (1) silent and communicative digital experts that are part of the consultation, (2) digital experts that hand over to a DC, and (3) DCs that support patients in the period between consultations. Overall, patients and physicians were open to these forms of digital support but had reservations about all 3 agents. CONCLUSIONS Ultimately, we derived 9 requirements for designing digital agents to support consultations, treatment adherence, and health literacy based on the literature and our qualitative findings.
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Affiliation(s)
- Andri Färber
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | | | - Philipp H Stalder
- ZHAW School of Management and Law, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Mateusz Dolata
- Department of Informatics, University of Zurich, Zurich, Switzerland
| | - Gerhard Schwabe
- Department of Informatics, University of Zurich, Zurich, Switzerland
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Franzoi MA, Bayle A, Vaz-Luis I. Changing cancer representations toward comprehensive portraits to empower patients in their care journey. Ann Oncol 2023; 34:1082-1087. [PMID: 37816461 DOI: 10.1016/j.annonc.2023.09.3117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/22/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Affiliation(s)
- M A Franzoi
- Cancer Survivorship Group, Inserm U981, Gustave Roussy, Villejuif.
| | - A Bayle
- Bureau Biostatistique et Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif; INSERM, Université Paris-Saclay, CESP U1018 Oncostat, labelisé Ligue contre le cancer, Villejuif, France
| | - I Vaz-Luis
- Cancer Survivorship Group, Inserm U981, Gustave Roussy, Villejuif
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Das D, Sengar A. Analysis of factors inhibiting the customer engagement of eHealth in India: Modeling the barriers using ISM-Fuzzy MICMAC analysis. Int J Med Inform 2023; 178:105199. [PMID: 37647674 DOI: 10.1016/j.ijmedinf.2023.105199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The current study aims to evaluate and measure the relationship between the customer engagement barriers influencing the adoption of eHealth in India. Previous studies have shown that low levels of engagement can lead to worse health outcomes, so this study is an expanded version of those findings to highlight those challenges. METHODOLOGY For this, the study followed three phases of research: factor identification through a review of the literature; expert opinion for selecting key and pertinent factors for the study; and application of interpretive structural modelling approach to capture the proper association between various factors. Using fuzzy-MICMAC analysis, the factors were divided into independent, dependent, autonomous and linkage categories. RESULTS A model is created in this study that shows the relationship between different barriers that aid the Indian healthcare industry in better implementation and also Indian citizens in better adoption of eHealth services. According to the research and derived model, some of the biggest obstacles in the eHealth are need of product portfolio, Lack of Customer support and Low first call resolution rate. CONCLUSION This study contributes to the body of knowledge by offering novel perspective into the types of hierarchical relationships that exist among barriers. These insights will be valuable to academicians and practitioners interested in India's healthcare market and its strategic expansion.
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Affiliation(s)
- Dikhita Das
- School of Business, University of Petroleum & Energy Studies, Dehradun, India.
| | - Anita Sengar
- School of Business, University of Petroleum & Energy Studies, Dehradun, India.
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Luan Z, Zhang Z, Gao Y, Du S, Wu N, Chen Y, Peng X. Electronic health records in nursing from 2000 to 2020: A bibliometric analysis. Front Public Health 2023; 11:1049411. [PMID: 36844821 PMCID: PMC9947559 DOI: 10.3389/fpubh.2023.1049411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Background Electronic health records (EHR) is the longitudinal data generated by patients in medical institutions and recorded by electronic medical information systems in the form of digital, which is also the most widespread application of big data in medicine. The purpose of this study was to explore the application of electronic health records in the field of nursing and determine the current research status and hotspots. Methods A bibliometric analysis of electronic health records in nursing was undertaken from 2000 to 2020. The literature comes from Web of Science Core Collection database. We used CiteSpace (version 5.7 R5; Drexel University), which is a Java-based software that especially visualized collaborative networks and research topics. Results A total of 2616 publications were included in the study. We found that publications increased year by year. The Journal of American Medical Informatics Association (n = 921) is the most cited. The United States (n = 1,738) has the most publications in this field. University Penn (n = 63) is the institution with the most publications. There is no influential cooperation network among the authors, of which Bates, David W (n = 12) have the largest number of publications. The relevant publications also focus on the fields of health care science and services, and medical informatics. In keywords, EHR, long-term care, mobile application, inpatient falls, and advance care planning has been researching hotspots in recent years. Conclusion With the popularization of information systems, the publications of EHR in the nursing field have increased year by year. This study provides the basic structure, potential cooperation, and research trends of EHR in the field of nursing from 2000 to 2020, and provides a reference for nurses to effectively use EHR to help clinical work or scientific researchers explore the potential significances of EHR.
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Affiliation(s)
- Ze Luan
- School of Nursing, Jilin University, Changchun, China
| | - Zhiru Zhang
- The First Hospital of Jilin University, Bethune First Hospital of Jilin University, Changchun, China
| | - Yanan Gao
- The First Hospital of Jilin University, Bethune First Hospital of Jilin University, Changchun, China
| | - Shiyuan Du
- School of Nursing, Jilin University, Changchun, China
| | - Nan Wu
- School of Nursing, Jilin University, Changchun, China
| | - Yulu Chen
- School of Nursing, Jilin University, Changchun, China
| | - Xin Peng
- School of Nursing, Jilin University, Changchun, China,*Correspondence: Xin Peng ✉
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5
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MacEwan SR, Sieck CJ, McAlearney AS. Geographic Location Impacts Patient Portal Use via Desktop and Mobile Devices. J Med Syst 2022; 46:97. [PMID: 36383266 DOI: 10.1007/s10916-022-01881-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
Disparities in patient portal use are impacted by individuals' access to technology and the internet as well as their skills and health behaviors. An individual's geographic location may impact these factors as well as contribute to their decision to use a portal, their choice of device to access the portal, and their use of portal functions. This study evaluated patient portal use by geographic location according to three comparators: proximity to the medical center offering the portal, urban/rural classification, and degree of digital distress. Patients residing farther from the medical center, in rural areas, or in areas of higher digital distress were less likely to be active portal users. Patients in areas of higher digital distress were more likely to use the mobile portal application instead of the desktop portal website alone. Users of the mobile portal application used portal functions more frequently, and being a mobile user had a greater impact on the use of some portal functions by patients residing in areas of higher digital distress. Mobile patient portal applications have the potential to increase portal use, but work is needed to ensure equitable internet access, to promote mobile patient portal applications, and to cultivate individuals' skills to use portals.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA.
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Cynthia J Sieck
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Center for Health Equity, Dayton Children's Hospital, Dayton, OH, USA
| | - Ann Scheck McAlearney
- The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Park T, Kim H, Song S, Griggs SK. Economic Evaluation of Pharmacist-Led Digital Health Interventions: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11996. [PMID: 36231307 PMCID: PMC9565470 DOI: 10.3390/ijerph191911996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
There has been growing interest in integrating digital technologies in healthcare. The purpose of this study was to systematically review the economic value of pharmacist-led digital interventions. PubMed, Web of Science, and the Cochrane databases were searched to select studies that had conducted economic evaluations of digital interventions by pharmacists for the period from January 2001 to February 2022. Economic evidence from 14 selected studies was synthesized in our analysis. Pharmacists used telephones, computers, web-based interventions, videotapes, smartphones, and multiple technologies for their digital interventions. Prior studies have reported the results of telephone-based interventions to be cost-effective. Alternatively, these interventions were found to be cost-effective when reevaluated with recently cited willingness-to-pay thresholds. In addition, pharmacist-led interventions based on computers, web-based interventions, smartphones, and multiple technologies have been reported to be cost-effective in previous studies. However, videotape-based intervention was found cost-ineffective because there was no significant difference in outcomes between the intervention and the usual care groups. If this intervention had been intensive enough to improve outcomes in the intervention group, favorable cost-effectiveness results could have been obtained. The economic evidence in the previous studies represented short-term economic values. Economic evaluations of the long-term value of digital interventions are warranted in future studies.
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Affiliation(s)
- Taehwan Park
- Pharmacy Administration and Public Health, College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Hyemin Kim
- College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Seunghyun Song
- College of Pharmacy and Health Sciences, St. John’s University, Queens, NY 11439, USA
| | - Scott K. Griggs
- Pharmacy Administration, University of Health Sciences and Pharmacy in St. Louis, St. Louis, MO 63110, USA
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Lubell-Doughtie P, Bhatt S, Wong R, Shankar AH. Transforming Rapid Diagnostic Tests for Precision Public Health: Open Guidelines for Manufacturers and Users. JMIR BIOMEDICAL ENGINEERING 2022; 7:e26800. [PMID: 38875688 PMCID: PMC11041428 DOI: 10.2196/26800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/24/2021] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Precision public health (PPH) can maximize impact by targeting surveillance and interventions by temporal, spatial, and epidemiological characteristics. Although rapid diagnostic tests (RDTs) have enabled ubiquitous point-of-care testing in low-resource settings, their impact has been less than anticipated, owing in part to lack of features to streamline data capture and analysis. OBJECTIVE We aimed to transform the RDT into a tool for PPH by defining information and data axioms and an information utilization index (IUI); identifying design features to maximize the IUI; and producing open guidelines (OGs) for modular RDT features that enable links with digital health tools to create an RDT-OG system. METHODS We reviewed published papers and conducted a survey with experts or users of RDTs in the sectors of technology, manufacturing, and deployment to define features and axioms for information utilization. We developed an IUI, ranging from 0% to 100%, and calculated this index for 33 World Health Organization-prequalified RDTs. RDT-OG specifications were developed to maximize the IUI; the feasibility and specifications were assessed through developing malaria and COVID-19 RDTs based on OGs for use in Kenya and Indonesia. RESULTS The survey respondents (n=33) included 16 researchers, 7 technologists, 3 manufacturers, 2 doctors or nurses, and 5 other users. They were most concerned about the proper use of RDTs (30/33, 91%), their interpretation (28/33, 85%), and reliability (26/33, 79%), and were confident that smartphone-based RDT readers could address some reliability concerns (28/33, 85%), and that readers were more important for complex or multiplex RDTs (33/33, 100%). The IUI of prequalified RDTs ranged from 13% to 75% (median 33%). In contrast, the IUI for an RDT-OG prototype was 91%. The RDT open guideline system that was developed was shown to be feasible by (1) creating a reference RDT-OG prototype; (2) implementing its features and capabilities on a smartphone RDT reader, cloud information system, and Fast Healthcare Interoperability Resources; and (3) analyzing the potential public health impact of RDT-OG integration with laboratory, surveillance, and vital statistics systems. CONCLUSIONS Policy makers and manufacturers can define, adopt, and synergize with RDT-OGs and digital health initiatives. The RDT-OG approach could enable real-time diagnostic and epidemiological monitoring with adaptive interventions to facilitate control or elimination of current and emerging diseases through PPH.
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Affiliation(s)
| | | | - Roger Wong
- Ona Systems Inc, Burlington, VT, United States
| | - Anuraj H Shankar
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Eijkman-Oxford Clinical Research Unit, Jakarta, Indonesia
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Rolnick J, Ward R, Tait G, Patel N. Early Adopters of Apple Health Records at a Large Academic Medical Center: Cross-sectional Survey of Users. J Med Internet Res 2022; 24:e29367. [PMID: 35076397 PMCID: PMC8826150 DOI: 10.2196/29367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/28/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background
Mobile applications offer a new approach to personal health records, which are internet-based tools for patients to consolidate and manage their health information. The University of Pennsylvania Health System (UPHS) was one of the first health systems to participate in Apple Health Records (AHR), a prominent example of this new generation of personal health records.
Objective
This study aimed to characterize early adoption of AHR among UPHS patients and understand user perspectives.
Methods
An email-based survey with fixed answer, Likert scale, and open-ended questions was administered to all UPHS patients using AHR in the first 10 months of enrollment. Survey data linked to the UPHS electronic health record system were used to analyze responses. Multivariable logistic regression modeled the association of patient characteristics with user ratings. Content analysis was used to analyze open-ended questions.
Results
At the time of the survey, a total of 1458 patients had used AHR at least once. Mean age of AHR users was 47.5 years, 66.3% (967/1458) were male, 70.9% (1033/1458) were white, and 80.8% (1178/1458) had private insurance. Response rate was 26.8% (391/1458); 46.3% (180/389) were very satisfied with AHR, and 67.7% (264/390) described it as very easy to use. The most commonly utilized features were lab results (324/391, 82.9%), clinical vitals (264/391, 67.5%), and medications (253/391, 64.7%). No patient characteristics were associated with reporting high satisfaction or ease of use. The most common reason for using AHR was convenience/ease of use, and 58.2% (160/275) of users reported allowing no other apps to access their health information, citing privacy as one consideration.
Conclusions
Early adopters of AHR were demographically white, male, and privately insured. Convenience was an important facilitator, and users were selective in which apps they allowed to access their health information.
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Affiliation(s)
- Joshua Rolnick
- United States Department of Veterans Affairs, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Robin Ward
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Gordon Tait
- University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Neha Patel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
- University of Pennsylvania Health System, Philadelphia, PA, United States
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9
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Wang P, Li T, Yu L, Zhou L, Yan T. Towards an effective framework for integrating patient-reported outcomes in electronic health records. Digit Health 2022; 8:20552076221112152. [PMID: 35860613 PMCID: PMC9290150 DOI: 10.1177/20552076221112152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background In the past decade, electronic modalities are increasingly deployed to integrate patient-reported outcomes into electronic health records. Most popularly, patient portals are used for remote questionnaires, and tablets are provided to patients in-office in case they need help. They are both useful. But some barriers are still in the way, which place burdens on patients and clinicians in the process of routine data collection. Objective This study aims to describe a portable and scalable framework which can simplify the patient-reported outcome integration by mitigating the related burdens. Methods A framework was proposed to use a modular approach to replace the tethered approach. The framework was open-sourced on GitHub. After development and testing, it was evaluated on an instrument with 24 questions in a real clinical setting. Patients were randomly selected in every modality-based group. For objective analysis, completion time and response rate were collected. No-show data was collected and analyzed. For subjective analysis, the NASA Task Load Index was used to measure workload, and the Net Promoter Score was used to assess user satisfaction. Results The model could contain 46,656 questions. A quick response code could store 1120 encoded items. For remote visits, the response rate was improved compared to the portal group (76.6% vs. 61.1%). The completion time was reduced by 37.5% when compared to the tablet group and was reduced by 43.4% when compared to the portal group. The workload for clinicians and patients was both reduced significantly (p < 0.001). A higher Net Promoter Score was rated by both clinicians (89.3%) and patients (86.5%). Compared to the portal group, the no-show rate was reduced (11.7% vs. 8.6%). Conclusions Collecting patient-reported outcomes over a quick response code appears to be an alternative modality to enable a simplified integration. This study provides new insights to collect patient-reported outcomes with interoperability and substitutability in mind.
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Affiliation(s)
- Panzhang Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Li
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lei Yu
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Liang Zhou
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Yan
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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10
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Pendergrass J, Ranganathan C. Institutional factors affecting the electronic health information exchange by ambulatory providers. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Fujioka JK, Bickford J, Gritke J, Stamenova V, Jamieson T, Bhatia RS, Desveaux L. Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study. J Med Internet Res 2021; 23:e28924. [PMID: 34709195 PMCID: PMC8587179 DOI: 10.2196/28924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/27/2021] [Accepted: 08/12/2021] [Indexed: 12/03/2022] Open
Abstract
Background Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. Objective This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. Methods This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. Results Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. Conclusions Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement.
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Affiliation(s)
- Jamie Keiko Fujioka
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | | | | | - Vess Stamenova
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada
| | - Trevor Jamieson
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Unity Health Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Laura Desveaux
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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12
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Friel CP, Cornelius T, Diaz KM. Factors associated with long-term wearable physical activity monitor user engagement. Transl Behav Med 2021; 11:262-269. [PMID: 31671174 DOI: 10.1093/tbm/ibz153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Wearable physical activity monitors (PAMs) have potential to positively influence physical activity. However, high rates of disengagement have been reported, which dampens enthusiasm, as these devices are unlikely to impact habitual physical activity if they are not worn for a sustained period of time. The purpose of this study was to identify demographic and device-use characteristics (e.g., data sharing) associated with sustained device engagement. Current PAM users (n = 418; mean age: 35.0 ± 12.5; 78% female) from across the USA were recruited online and completed a baseline web-based survey in 2015-2016 comprising questions about demographics and device use. Participants were followed-up again in 2017, at which time they reported whether or not they still used a PAM. Sustained PAM engagement was defined as those who continued use at follow-up. The median follow-up time was 15.5 (±3.7) months. In fully adjusted models, the following were significantly associated with long-term engagement: age (odds ratio [OR]: 1.03; 95% confidence interval [CI]: 1.01-1.05, p = .014), Hispanic ethnicity (OR: 3.67; 95% CI: 1.20-11.26, p = .023), running as a preferred exercise (OR: 1.82; 95% CI: 1.02-3.24, p = .043), wanting to monitor health variables as a reason for choosing to use a PAM (OR: 1.73; 95% CI: 1.02-2.92, p = .042), and sharing data from the PAM publicly on social media (e.g., Facebook and Twitter; OR: 5.11; 95% CI: 1.64-15.93, p = .005). A number of sociodemographic and use characteristics were associated with sustained device use over a median follow-up of 1.3 years. One modifiable factor that may lead to longer device engagement is encouraging users to share data publicly.
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Affiliation(s)
- Ciarán P Friel
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA.,Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
| | - Keith M Diaz
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, USA
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13
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Fang HSA, Tan TH, Tan YFC, Tan CJM. Blockchain Personal Health Records: Systematic Review. J Med Internet Res 2021; 23:e25094. [PMID: 33847591 PMCID: PMC8080150 DOI: 10.2196/25094] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/25/2020] [Accepted: 03/16/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Blockchain technology has the potential to enable more secure, transparent, and equitable data management. In the health care domain, it has been applied most frequently to electronic health records. In addition to securely managing data, blockchain has significant advantages in distributing data access, control, and ownership to end users. Due to this attribute, among others, the use of blockchain to power personal health records (PHRs) is especially appealing. OBJECTIVE This review aims to examine the current landscape, design choices, limitations, and future directions of blockchain-based PHRs. METHODS Adopting the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a cross-disciplinary systematic review was performed in July 2020 on all eligible articles, including gray literature, from the following 8 databases: ACM, IEEE Xplore, MEDLINE, ScienceDirect, Scopus, SpringerLink, Web of Science, and Google Scholar. Three reviewers independently performed a full-text review and data abstraction using a standardized data collection form. RESULTS A total of 58 articles met the inclusion criteria. In the review, we found that the blockchain PHR space has matured over the past 5 years, from purely conceptual ideas initially to an increasing trend of publications describing prototypes and even implementations. Although the eventual application of blockchain in PHRs is intended for the health care industry, the majority of the articles were found in engineering or computer science publications. Among the blockchain PHRs described, permissioned blockchains and off-chain storage were the most common design choices. Although 18 articles described a tethered blockchain PHR, all of them were at the conceptual stage. CONCLUSIONS This review revealed that although research interest in blockchain PHRs is increasing and that the space is maturing, this technology is still largely in the conceptual stage. Being the first systematic review on blockchain PHRs, this review should serve as a basis for future reviews to track the development of the space.
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Affiliation(s)
| | - Teng Hwee Tan
- National University Health System, Singapore, Singapore
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14
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Wasserman RC, Fiks AG. The Future(s) of Pediatric Primary Care. Acad Pediatr 2021; 21:414-424. [PMID: 33130066 DOI: 10.1016/j.acap.2020.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
Pediatric primary care (PPC) arose in the early 20th century as the fusion of acute and chronic pediatric illness care with preventive elements borrowed from public and maternal and child health. Well-established and thriving by the 1930s, PPC saw major changes in childhood morbidity and mortality in the latter half of the 20th century with the recognition of the "new morbidity" of school, behavior, and social problems. At the same time, PPC experienced changes in its workforce, which became increasingly female and added nurse practitioners and physician assistants as practitioners. Independent practice, previously the dominant business model, decreased in prominence at the end of the 20th century as health systems bought practices and other sites morphed into federally qualified health centers. In the present century, electronic health records (EHRs) have brought profound changes in PPC workflows and practitioner experience. In addition, disruptive market competition such as retail clinics and corporate telemedicine providers coupled with changes in health insurance from fee-for-service to value-based payment further challenge the care model and economics of PPC. Finally, recognition of family social circumstances as major determinants of children's health presents another challenge to the status quo. As such, although one PPC future may resemble its present state, a more innovative future is likely to include clinics and practices more oriented toward and linked to communities and directed at the social determinants of health. In addition, the rise in physical, behavioral, and social problems in practice call for a growing focus on wellness, including sleep, nutrition, and activity, that promises to reorient the PPC future in productive new directions. The half-way technology of current EHR systems will ideally be spun into electronic hubs that facilitate teamwork between PPC, specialists, and community groups. Research and practice improvement strategies including involvement in "learning health systems" will be critical to making PPC effective in an evolving society. Although threatened by 21st century forces and hard-to-anticipate change, PPC is ideally positioned to build upon its core functions to create multidisciplinary teams that reach into the community, promoting a holistic wellness for children consistent with the broadest definition of health.
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Affiliation(s)
- Richard C Wasserman
- Larner College of Medicine, University of Vermont (RC Wasserman), Charlotte, Vt.
| | - Alexander G Fiks
- Children's Hospital of Philadelphia, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, and the Possibilities Project, Roberts Center for Pediatric Research (AG Fiks), Philadelphia, Pa
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15
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Zayas-Cabán T, Chaney KJ, Rucker DW. National health information technology priorities for research: A policy and development agenda. J Am Med Inform Assoc 2021; 27:652-657. [PMID: 32090265 DOI: 10.1093/jamia/ocaa008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/03/2020] [Accepted: 01/16/2020] [Indexed: 01/17/2023] Open
Abstract
The growth of digitized health data presents exciting opportunities to leverage the health information technology (IT) infrastructure for advancing biomedical and health services research. However, challenges impede use of those resources effectively and at scale to improve outcomes. The Office of the National Coordinator for Health Information Technology (ONC) led a collaborative effort to identify challenges, priorities, and actions to leverage health IT and electronic health data for research. Specifically, ONC led a review of relevant literature and programs, key informant interviews, and a stakeholder workshop to identify electronic health data and health IT infrastructure gaps. This effort resulted in the National Health IT Priorities for Research: A Policy and Development Agenda, which articulates an optimized health information ecosystem for scientific discovery. This article outlines 9 priorities and recommended actions to be implemented in collaboration with the research and informatics communities for realizing this vision.
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Affiliation(s)
- Teresa Zayas-Cabán
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Kevin J Chaney
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, USA
| | - Donald W Rucker
- Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services, Washington, DC, USA
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16
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Sheehan J, Laver K, Bhopti A, Rahja M, Usherwood T, Clemson L, Lannin NA. Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: A Systematic Narrative Review. J Multidiscip Healthc 2021; 14:493-511. [PMID: 33654406 PMCID: PMC7910528 DOI: 10.2147/jmdh.s295549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background There is a compelling rationale that effective communication between hospital allied health and primary care practitioners may improve the quality and continuity of patient care. It is not known which methods of communication to use, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health and primary care practitioners. Methods Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital-based allied health professionals communicating with community-based primary care practitioners. Risk of bias in the different study designs was appraised using recognized tools and a content analysis conducted of the methodologies used. Results From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health communicating in some form with primary care practitioners. While none of the included studies specifically investigated the methods or effectiveness of communication between hospital allied health and primary care practitioners, 12 of the 24 studies described processes that addressed components of their discharge communication. Four enablers to effective communication between hospital allied health and primary care practitioners were identified: multidisciplinary care plans, patient and caregiver involvement, health information technology and a designated person for follow up/care management. Conclusion There is currently no “gold standard” method or measure of communication between hospital allied health and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced information technologies to improve collaboration across care settings and facilitate the continuity of integrated people-centered care.
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Affiliation(s)
- Jacinta Sheehan
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Miia Rahja
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Tim Usherwood
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Natasha A Lannin
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia.,Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health (Allied Health), Melbourne, Australia
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17
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Gimpel H, Manner-Romberg T, Schmied F, Winkler TJ. Understanding the evaluation of mHealth app features based on a cross-country Kano analysis. ELECTRONIC MARKETS 2021; 31:765-794. [PMID: 35602116 PMCID: PMC7987738 DOI: 10.1007/s12525-020-00455-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/11/2020] [Indexed: 05/05/2023]
Abstract
While mobile health (mHealth) apps play an increasingly important role in digitalized health care, little is known regarding the effects of specific mHealth app features on user satisfaction across different healthcare system contexts. Using personal health record (PHR) apps as an example, this study identifies how potential users in Germany and Denmark evaluate a set of 26 app features, and whether evaluation differences can be explained by the differences in four pertinent user characteristics, namely privacy concerns, mHealth literacy, mHealth self-efficacy, and adult playfulness. Based on survey data from both countries, we employed the Kano method to evaluate PHR features and applied a quartile-based sample-split approach to understand the underlying relationships between user characteristics and their perceptions of features. Our results not only reveal significant differences in 14 of the features between Germans and Danes, they also demonstrate which of the user characteristics best explain each of these differences. Our two key contributions are, first, to explain the evaluation of specific PHR app features on user satisfaction in two different healthcare contexts and, second, to demonstrate how to extend the Kano method in terms of explaining subgroup differences through user characteristic antecedents. The implications for app providers and policymakers are discussed.
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Affiliation(s)
- Henner Gimpel
- University of Hohenheim, Schloss Hohenheim 1, 70599 Stuttgart, Germany
- FIM Research Center, University of Augsburg, Universitaetsstr. 12, 86159 Augsburg, Germany
- Project Group Business & Information Systems Engineering, Fraunhofer FIT, Universitaetsstr. 12, 86159 Augsburg, Germany
| | - Tobias Manner-Romberg
- FIM Research Center, University of Augsburg, Universitaetsstr. 12, 86159 Augsburg, Germany
| | - Fabian Schmied
- FIM Research Center, University of Augsburg, Universitaetsstr. 12, 86159 Augsburg, Germany
- Project Group Business & Information Systems Engineering, Fraunhofer FIT, Universitaetsstr. 12, 86159 Augsburg, Germany
| | - Till J. Winkler
- University of Hagen, Universitaetsstr. 47, 58097 Hagen, Germany
- Copenhagen Business School, Howitzvej 60, 2000 Frederiksberg, Denmark
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18
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Choi BK, Park YT, Kwon LS, Kim YS. Analysis of Platforms and Functions of Mobile-Based Personal Health Record Systems. Healthc Inform Res 2020; 26:311-320. [PMID: 33190465 PMCID: PMC7674811 DOI: 10.4258/hir.2020.26.4.311] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/23/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Little is known about the platforms and functionalities of mobile-based personal health record (PHR) applications. The objective of this study was to investigate these two features of PHR systems. METHODS The unit of analysis was general hospitals with more than 100 beds. This study was based on a PHR survey conducted from May 1 to June 30, 2020 and the National Health Insurance administrative data as of March 31, 2020. The study considered the platform, Android and iPhone operation system (iOS), and types of functionalities of PHR systems. Among the 316 target hospitals, 103 hospitals had adopted PHR systems. A logistic regression analysis was used. RESULTS This study found that 103 hospitals had adopted mobile-based PHR systems for their patients. Sixty-four hospitals (62.1%) were adopting both Android and iOS, but 36 (35.0%) and 3 (2.9%) hospitals were adopting Android only or iOS only, respectively. The PHR systems of hospitals adopting both platforms were more likely to have functions for viewing prescriptions, clinical diagnostic test results, and upcoming appointment status compared to those adopting a single platform (p < 0.001). The number of beds (odds ratio [OR] = 1.004; confidence interval [CI], 1.001-1.007; p = 0.0029) and the number of computed tomography systems (CTs) per 100 beds (OR = 6.350; CI, 1.006-40.084; p = 0.0493) were significantly associated with the adoption of both platforms. CONCLUSIONS More than 60% of hospitals had adopted both Android and iOS platforms for their patients in Korea. Hospitals adopting both platforms had additional functionalities and significant association with the number of beds and CTs.
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Affiliation(s)
| | - Young-Taek Park
- Research Institute for Health Insurance Review and Assessment, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Lee-Seung Kwon
- Department of Health Care Management, Catholic Kwandong University, Gangneung, Korea
| | - Yeon Sook Kim
- Department of Nursing, California State University, San Bernardino, CA, USA
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Abstract
OBJECTIVE Behavioral health homes, which provide onsite primary medical care in mental health clinics, face challenges in integrating information across multiple health records. This study tested whether a mobile personal health record application improved quality of medical care for individuals treated in these settings. METHODS This randomized study enrolled 311 participants with a serious mental illness and one or more cardiometabolic risk factors across two behavioral health homes to receive a mobile personal health record application (N=156) or usual care (N=155). A secure mobile personal health record (mPHR) app provided participants in the intervention group with key information about diagnoses, medications, and laboratory test values and allowed them to track health goals. The primary study outcome was a chart-derived composite measure of quality of cardiometabolic and preventive services. RESULTS At 12-month follow-up, participants in the mPHR group maintained high quality of care (70% of indicated services at baseline and at 12-month follow-up), in contrast to a decline in quality for the usual-care group (71% at baseline and 67% at follow-up), resulting in a statistically significant but clinically modest differential impact between the groups. No differences between the study groups were found in secondary self-reported outcomes, including delivery of chronic illness care, patient activation, and quality of life related to mental or general medical health. CONCLUSIONS Use of a mPHR app was associated with a statistically significant but clinically modest differential benefit for quality of medical care among individuals with serious mental illness and comorbid cardiometabolic conditions.
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Affiliation(s)
- Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Jianheng Li
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Stephanie Tapscott
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Cathy A Lally
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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20
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Confronting the Post-ACA American Health Crisis: Designing Health Care for Value and Equity. J Ambul Care Manage 2020; 42:202-210. [PMID: 31136391 DOI: 10.1097/jac.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The United States is in the midst of a health crisis marked by unprecedented 3-year declines in life expectancy. Addressing this national crisis requires alignment of public policies, public health policies, and health care policies, with the overarching aim of improving national health and health equity. Aligning national polices to support human needs provides a foundation for implementing post-Affordable Care Act national health care reform. Reform should start with the twin goals of improving health care value and equity. A focus on value, that is, outcomes and processes desired by patients, is critical to ensuring that resources are judiciously deployed to optimize individual and population health. A focus on health care equity ensures that the health care system is intentionally designed to minimize inequities in health care processes and outcomes, particularly for member of socially disadvantaged groups. All sectors related to the health care system-from policies and payment mechanisms to delivery design, measurement, patient engagement/democratization, training, and research-should be tightly aligned with improving health care value and equity during this next era of health care reform.
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Yamamoto K, Takahashi T, Urasaki M, Nagayasu Y, Shimamoto T, Tateyama Y, Matsuzaki K, Kobayashi D, Kubo S, Mito S, Abe T, Matsuura H, Iwami T. Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study. JMIR Mhealth Uhealth 2020; 8:e19902. [PMID: 32568728 PMCID: PMC7340163 DOI: 10.2196/19902] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required. Personal health records (PHRs) are suitable for the daily management of physical conditions. Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19. Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items. Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19. To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app. OBJECTIVE This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs. METHODS We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center. At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers). Email addresses are used by the app when a health observer sends data to the public health center. Each health observer downloads the app and installs it on their smartphone. Self-observed health data are entered daily into the app. These data are then sent via the app by email at a designated time. Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers. RESULTS We used the app as part of an active epidemiological investigation executed at a public health center. During the investigation, 72 close contacts were discovered. Among them, 57 had adopted the use of the health observation app. Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours. After the introduction of the app, a single epidemiological officer can carry out health observations. The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan. Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities. CONCLUSIONS Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases. Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases. Ultimately, similar actions may help to prevent the spread of COVID-19.
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Affiliation(s)
- Keiichi Yamamoto
- Information Technology Center, Wakayama Medical University, Wakayama, Japan
| | | | - Miwa Urasaki
- Wakayama City Public Health Center, Wakayama City, Japan
| | | | | | | | | | | | - Satoshi Kubo
- Suzuka University of Medical Science, Mie, Japan
| | | | | | | | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
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22
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Reeves JJ, Hollandsworth HM, Torriani FJ, Taplitz R, Abeles S, Tai-Seale M, Millen M, Clay BJ, Longhurst CA. Rapid response to COVID-19: health informatics support for outbreak management in an academic health system. J Am Med Inform Assoc 2020; 27:853-859. [PMID: 32208481 PMCID: PMC7184393 DOI: 10.1093/jamia/ocaa037] [Citation(s) in RCA: 244] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/19/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.
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Affiliation(s)
- J Jeffery Reeves
- Department of Surgery, University of California, La Jolla, San Diego, California, USA
| | | | - Francesca J Torriani
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, California
| | - Randy Taplitz
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, California
| | - Shira Abeles
- Department of Medicine, Division of Infectious Disease and Global Public Health, University of California, San Diego, California
| | - Ming Tai-Seale
- Department of Family Medicine and Public Health, University of California, La Jolla, San Diego, California, USA
| | - Marlene Millen
- Department of Medicine, Division of Biomedical Informatics, University of California, La Jolla, San Diego, California, USA
| | - Brian J Clay
- Department of Medicine, Division of Biomedical Informatics, University of California, La Jolla, San Diego, California, USA
| | - Christopher A Longhurst
- Department of Medicine, Division of Biomedical Informatics, University of California, La Jolla, San Diego, California, USA
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Luh F, Yen Y. Cybersecurity in Science and Medicine: Threats and Challenges. Trends Biotechnol 2020; 38:825-828. [PMID: 32441258 DOI: 10.1016/j.tibtech.2020.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/22/2020] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
Technology offers opportunities to revolutionize medicine and research but can threaten privacy and patient confidentiality. As the scale of patient data explodes, the safety and integrity of medical information are increasingly at stake. We highlight security and privacy issues associated with genomic research, medical devices, and wearable technology.
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Affiliation(s)
- Frank Luh
- Sino-American Cancer Foundation, Covina, CA 91722, USA
| | - Yun Yen
- Taipei Medical University, Taipei, Taiwan.
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24
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Van Puyvelde H, Basto M, Chung ASJ, Van Bruwaene S. Making surgery safer in an increasingly digital world: the internet-friend or foe? World J Urol 2020; 38:1391-1395. [PMID: 32270282 DOI: 10.1007/s00345-020-03145-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE The internet has resulted in huge efficiency gains in health care, the ability to deal with massive data accumulation and better manage patient data. However, potential and real pitfalls exist, including breeches in security of data and patient confidentiality, data storage issues, errors, and user interface issues. METHODS A MEDLINE review was performed using MeSH terms "health care" and "information technology." Cross-referencing was used to explore the different opportunities and challenges the internet has to offer. RESULTS As health professionals, we are fast adopting technologies at our fingertips, such as WhatsApp and video capabilities, into our clinical practice to increase productivity and improve patient care. However, the potential security breaches are significant for the health professional and health service. Further, electronic medical records have theoretical advantages to improve patient care, reduce medication errors, and expedite referrals. The downside is a less personalized approach to patient care, as well as the potential for these systems to be even more cumbersome. In regard to the acquisition of knowledge, there is no doubt the internet is our friend. Health care professionals as well as patients have unlimited resources for learning, including podcasts videos, apps, simulators, and wearable devices. Unfortunately, this comes with a risk of misinformation and poorly referenced data with little to no regulation of content. CONCLUSION In this increasing digital world, it is our task as health care providers to embrace these new technologies but develop guidelines and control systems to minimize the pitfalls.
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Affiliation(s)
- H Van Puyvelde
- Department of Urology, AZ Groeninge Hospital, Kortrijk, Belgium
| | - M Basto
- Department of Urology, Eastern Health, Box Hill, VIC, Australia
| | - A S J Chung
- Department of Urology, Royal North Shore Hospital, The University of Sydney, Sydney, NSW, Australia. .,Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia. .,Department of Urology, Concord Repatriation General Hospital, The University of Sydney, Sydney, NSW, Australia.
| | - S Van Bruwaene
- Department of Urology, AZ Groeninge Hospital, Kortrijk, Belgium
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25
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Neinstein A, Thao C, Savage M, Adler-Milstein J. Deploying Patient-Facing Application Programming Interfaces: Thematic Analysis of Health System Experiences. J Med Internet Res 2020; 22:e16813. [PMID: 31983680 PMCID: PMC7165308 DOI: 10.2196/16813] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 01/21/2020] [Accepted: 01/26/2020] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Health systems have recently started to activate patient-facing application programming interfaces (APIs) to facilitate patient access to health data and other interactions. OBJECTIVE This study sought to ascertain health systems' understanding, strategies, governance, and organizational infrastructure around patient-facing APIs, as well as their business drivers and barriers, to facilitate national learning, policy, and progress toward adoption. METHODS We performed a content analysis of semistructured interviews with a convenience sample of 10 health systems known to be leading adopters of health technology, having either implemented or planning to implement patient-facing APIs. RESULTS Of the 10 health systems, eight had operational patient-facing APIs, with organizational strategy driven most by federal policy, the emergence of Health Records on iPhone, and feelings of ethical obligation. The two priority use cases identified were enablement of a patient's longitudinal health record and digital interactions with the health system. The themes most frequently cited as barriers to the increased use of patient-facing APIs were security concerns, an immature app ecosystem that does not currently offer superior functionality compared with widely adopted electronic health record (EHR)-tethered portals, a lack of business drivers, EHR vendor hesitation toward data sharing, and immature technology and standards. CONCLUSIONS Our findings reveal heterogeneity in health system understanding and approaches to the implementation and use of patient-facing APIs. Ongoing study, targeted policy interventions, and sharing of best practices appear necessary to achieve successful national implementation.
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Affiliation(s)
- Aaron Neinstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, United States
| | - Crishyashi Thao
- Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mark Savage
- Center for Digital Health Innovation, University of California, San Francisco, San Francisco, CA, United States
| | - Julia Adler-Milstein
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Center for Clinical Informatics and Improvement Research, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Tully J, Dameff C, Longhurst CA. Wave of Wearables: Clinical Management of Patients and the Future of Connected Medicine. Clin Lab Med 2020; 40:69-82. [PMID: 32008641 DOI: 10.1016/j.cll.2019.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The future of connected health care will involve the collection of patient data or enhancement of clinician workflows through various biosensors and displays found on wearable electronic devices, many of which are marketed directly to consumers. The adoption of wearables in health care is being driven by efforts to reduce health care costs, improve care quality, and increase clinician efficiency. Wearables have significant potential to achieve these goals but are currently limited by lack of widespread integrations into electronic health records, biosensor data collection types, and a lack of scientifically rigorous literature showing benefit.
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Affiliation(s)
- Jeffrey Tully
- Department of Anesthesiology and Pain Medicine, University of California Davis Medical Center, 2315 Stockton Boulevard, Sacramento, CA 95817, USA.
| | - Christian Dameff
- Department of Emergency Medicine, University of California San Diego, 200 West Arbor Drive #8676, San Diego, CA 92103, USA; Department of Biomedical Informatics, UC San Diego Health, University of California San Diego, 9500 Gilman Drive, MC 0728, La Jolla, California 92093-0728, USA; Department of Computer Science and Engineering, University of California San Diego, 9500 Gilman Drive, Mail Code 0404, La Jolla, CA 92093-0404, USA
| | - Christopher A Longhurst
- Department of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA
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Nazir A. A Method to the Madness: Using Technology to Enhance Team-Based Care Coordination. J Am Med Dir Assoc 2020; 21:135-136. [DOI: 10.1016/j.jamda.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/19/2019] [Indexed: 11/29/2022]
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Gordon WJ, Bates DW, Fuchs D, Pappas J, Silacci S, Landman A. Comparing Characteristics of Patients Who Connect Their iPhones to an Electronic Health Records System Versus Patients Who Connect Without Personal Devices: Cohort Study. J Med Internet Res 2019; 21:e14871. [PMID: 31441430 PMCID: PMC6727627 DOI: 10.2196/14871] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/21/2019] [Accepted: 08/13/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND While individual access to health records has traditionally been through paper and other physical media, there has been a recent push toward digitizing this process. Direct patient access to health data through application programming interfaces (APIs) is an important part of current United States policy initiatives, and Apple has created the product "Health Records on iPhone" to leverage APIs for this purpose. OBJECTIVE The objective of this study was to examine the characteristics of patients at our institution who connected their personal iPhone devices to our electronic health records (EHRs) system through "Health Records on iPhone", as compared to patients at our institution who used our patient portal but did not connect a personal device to our system. METHODS We examined adult patients at our institution who had authorized an iPhone device to download their health data from the Partners HealthCare EHR via APIs through "Health Records on iPhone" from February 18, 2018 (the date this feature was enabled at our health system) until February 17, 2019. We compared these patients to adult patients who used our portal at least once during this period but did not authorize an iPhone device to download their data via APIs. RESULTS Variables associated with an increased likelihood of using "Health Records on iPhone" included male gender (adjusted OR 3.36; 95% CI 3.11-3.62; P<.001) and younger age, particularly below 50 years of age. With each decade of age over 50, people were less likely to be "Health Records on iPhone" product users. Asian patients were more likely to use the product than Caucasian patients (adjusted OR 1.32; 95% CI 1.16-1.51; P<.001), though there was no significant difference between African Americans and Caucasians (adjusted OR 1.15; 95% CI 0.94-1.41; P=.17). Patients who resided in higher ZIP code income quartiles were more likely to be users than those in the lowest quartile. CONCLUSIONS Early results from the implementation of patient-facing APIs at a single institution suggest that there are opportunities for expanding these technologies to ensure all patients are aware of, and have access to, their health data on their personal devices. More work is needed on expanding these technologies to different patient populations.
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Affiliation(s)
- William J Gordon
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Partners HealthCare, Somerville, MA, United States
| | - David W Bates
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Daniel Fuchs
- Partners HealthCare, Somerville, MA, United States
| | - John Pappas
- Partners HealthCare, Somerville, MA, United States
| | - Sara Silacci
- Massachusetts General Hospital, Boston, MA, United States
| | - Adam Landman
- Harvard Medical School, Boston, MA, United States
- Partners HealthCare, Somerville, MA, United States
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States
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Adler-Milstein J, Longhurst C. Assessment of Patient Use of a New Approach to Access Health Record Data Among 12 US Health Systems. JAMA Netw Open 2019; 2:e199544. [PMID: 31411708 PMCID: PMC6694389 DOI: 10.1001/jamanetworkopen.2019.9544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This cross-sectional study measures patient use of smartphone applications to download health record data.
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Affiliation(s)
| | - Brian Clay
- University of California San Diego Health, San Diego
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Affiliation(s)
- William D Freeman
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
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Morse KE, Schremp J, Pageler NM, Palma JP. Your Patient Has a New Health App? Start With Its Data Source. J Particip Med 2019; 11:e14288. [PMID: 33055064 PMCID: PMC7434101 DOI: 10.2196/14288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/25/2022] Open
Abstract
Recent regulatory and technological advances have enabled a new era of health apps that are controlled by patients and contain valuable health information. These health apps will be numerous and use novel interfaces that appeal to patients but will likely be unfamiliar to practitioners. We posit that understanding the origin of the health data is the most meaningful and versatile way for physicians to understand and effectively use these apps in patient care. This will allow providers to better support patients and encourage patient engagement in their own care.
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Affiliation(s)
- Keith E Morse
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States.,Department of Clinical Informatics, Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Jonathan Schremp
- Department of Clinical Informatics, Lucile Packard Children's Hospital, Palo Alto, CA, United States
| | - Natalie M Pageler
- Department of Clinical Informatics, Lucile Packard Children's Hospital, Palo Alto, CA, United States.,Division of Pediatric Critical Care Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Jonathan P Palma
- Department of Clinical Informatics, Lucile Packard Children's Hospital, Palo Alto, CA, United States.,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
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Virtual Care 2.0—a Vision for the Future of Data-Driven Technology-Enabled Healthcare. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:21. [DOI: 10.1007/s11936-019-0727-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Tai-Seale M, Downing NL, Jones VG, Milani RV, Zhao B, Clay B, Sharp CD, Chan AS, Longhurst CA. Technology-Enabled Consumer Engagement: Promising Practices At Four Health Care Delivery Organizations. Health Aff (Millwood) 2019; 38:383-390. [DOI: 10.1377/hlthaff.2018.05027] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ming Tai-Seale
- Ming Tai-Seale is a professor in the Department of Family Medicine and Public Health at the University of California San Diego (UCSD) School of Medicine, director of outcomes analysis and scholarship at UC San Diego Health, and director of research at UCSD Health Sciences International, in La Jolla
| | - N. Lance Downing
- N. Lance Downing is a clinical assistant professor of medicine at the Stanford School of Medicine and program director for the Stanford Program in AI-Assisted Care, both in Palo Alto, California
| | - Veena Goel Jones
- Veena Goel Jones is medical director of digital patient experience and a pediatric hospitalist at Sutter Health and an adjunct clinical assistant professor of pediatrics at the Stanford School of Medicine
| | - Richard V. Milani
- Richard V. Milani is chief clinical transformation officer at Ochsner Health System in New Orleans, Louisiana
| | - Beiqun Zhao
- Beiqun Zhao is a National Library of Medicine/National Institutes of Health biomedical informatics fellow and a general surgery resident at UC San Diego Health
| | - Brian Clay
- Brian Clay is a chief medical information officer at UC San Diego Health and a clinical professor of medicine at the UCSD School of Medicine
| | - Christopher Demuth Sharp
- Christopher Demuth Sharp is chief medical information officer at Stanford Health Care and a clinical associate professor at the Stanford School of Medicine
| | - Albert Solomon Chan
- Albert Solomon Chan is chief of digital patient experience and an investigator at Sutter Health and an adjunct professor at the Stanford Center for Biomedical Informatics Research, Stanford School of Medicine
| | - Christopher A. Longhurst
- Christopher A. Longhurst is chief information officer and associate chief medical officer at UC San Diego Health, and a clinical professor of medicine and pediatrics at the UCSD School of Medicine
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