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Design and evaluation of a web-based personal health record for patients under dialysis. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Sutton RT, Pincock D, Baumgart DC, Sadowski DC, Fedorak RN, Kroeker KI. An overview of clinical decision support systems: benefits, risks, and strategies for success. NPJ Digit Med 2020; 3:17. [PMID: 32047862 PMCID: PMC7005290 DOI: 10.1038/s41746-020-0221-y] [Citation(s) in RCA: 711] [Impact Index Per Article: 177.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 12/19/2019] [Indexed: 12/16/2022] Open
Abstract
Computerized clinical decision support systems, or CDSS, represent a paradigm shift in healthcare today. CDSS are used to augment clinicians in their complex decision-making processes. Since their first use in the 1980s, CDSS have seen a rapid evolution. They are now commonly administered through electronic medical records and other computerized clinical workflows, which has been facilitated by increasing global adoption of electronic medical records with advanced capabilities. Despite these advances, there remain unknowns regarding the effect CDSS have on the providers who use them, patient outcomes, and costs. There have been numerous published examples in the past decade(s) of CDSS success stories, but notable setbacks have also shown us that CDSS are not without risks. In this paper, we provide a state-of-the-art overview on the use of clinical decision support systems in medicine, including the different types, current use cases with proven efficacy, common pitfalls, and potential harms. We conclude with evidence-based recommendations for minimizing risk in CDSS design, implementation, evaluation, and maintenance.
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Affiliation(s)
- Reed T. Sutton
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - David Pincock
- Chief Medical Information Office, Alberta Health Services, Edmonton, Canada
| | - Daniel C. Baumgart
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Daniel C. Sadowski
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Richard N. Fedorak
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Karen I. Kroeker
- Department of Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Canada
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Karampela M, Ouhbi S, Isomursu M. Personal health data: A systematic mapping study. Int J Med Inform 2018; 118:86-98. [PMID: 30153927 DOI: 10.1016/j.ijmedinf.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/20/2018] [Accepted: 08/02/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Personal health data (PHD) research has been intensified over the last years, attracting the attention of scientists from different fields, such as software engineers, computer scientists and medical professionals. The increasing interest of researchers can be attributed to the exponential growth of the available PHD due to the widespread adoption of ubiquitous technology in everyday life, as well as to the potential of the ongoing digital transformation in healthcare. This increasing interest requires that academia has an overview of the published scientific literature to plan future endeavors. OBJECTIVE The main objective of this study is to identify and address research gaps in literature regarding PHD. METHOD This paper conducts a systematic mapping study to summarize the existing PHD approaches in literature and to organize the selected studies according to six classification criteria: publication source, publication year, research types, empirical types, contribution types and research topic. RESULTS In total 79 papers have been included after fulfilling the inclusion criteria and have been classified accordingly. There is an increasing amount of attention that has been paid to PHD since 2014. The majority of papers is published in journals. The two main research types found were solution proposals and evaluation research. The majority of the selected papers were empirically evaluated. The main contribution types were methods and frameworks. Data privacy is the most frequently addressed topic in PHD literature, followed by data sharing. CONCLUSIONS The findings of this systematic mapping study have implications for both researchers who are planning new studies in PHD and for practitioners who are working in connected health and would like to have an overview on the existent studies on PHD research area.
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Affiliation(s)
- Maria Karampela
- IT University of Copenhagen, Copenhagen, Rued Langgaards Vej 7, DK-2300 Copenhagen S, Denmark.
| | - Sofia Ouhbi
- TICLab, FIL, International University of Rabat, Technopolis Rabat-Shore Rocade Rabat-Salé, Rabat, Morocco.
| | - Minna Isomursu
- IT University of Copenhagen, Copenhagen, Rued Langgaards Vej 7, DK-2300 Copenhagen S, Denmark.
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Davis S, Roudsari A, Raworth R, Courtney KL, MacKay L. Shared decision-making using personal health record technology: a scoping review at the crossroads. J Am Med Inform Assoc 2018; 24:857-866. [PMID: 28158573 DOI: 10.1093/jamia/ocw172] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/29/2016] [Indexed: 11/13/2022] Open
Abstract
Objective This scoping review aims to determine the size and scope of the published literature on shared decision-making (SDM) using personal health record (PHR) technology and to map the literature in terms of system design and outcomes. Materials and Methods Literature from Medline, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, Engineering Village, and Web of Science (2005-2015) using the search terms "personal health records," "shared decision making," "patient-provider communication," "decision aid," and "decision support" was included. Articles ( n = 38) addressed the efficacy or effectiveness of PHRs for SDM in engaging patients in self-care and decision-making or ways patients can be supported in SDM via PHR. Results Analysis resulted in an integrated SDM-PHR conceptual framework. An increased interest in SDM via PHR is apparent, with 55% of articles published within last 3 years. Sixty percent of the literature originates from the United States. Twenty-six articles address a particular clinical condition, with 10 focused on diabetes, and one-third offer empirical evidence of patient outcomes. The tethered and standalone PHR architectural types were most studied, while the interconnected PHR type was the focus of more recently published methodological approaches and discussion articles. Discussion The study reveals a scarcity of rigorous research on SDM via PHR. Research has focused on one or a few of the SDM elements and not on the intended complete process. Conclusion Just as PHR technology designed on an interconnected architecture has the potential to facilitate SDM, integrating the SDM process into PHR technology has the potential to drive PHR value.
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Affiliation(s)
- Selena Davis
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Abdul Roudsari
- School of Health Information Science, University of Victoria, Victoria, Canada
| | | | - Karen L Courtney
- School of Health Information Science, University of Victoria, Victoria, Canada
| | - Lee MacKay
- Kootenay Lake Hospital Diabetes Clinic and Kootenay Boundary Division of Family Practice, Nelson, BC, Canada
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Roehrs A, da Costa CA, Righi RDR, de Oliveira KSF. Personal Health Records: A Systematic Literature Review. J Med Internet Res 2017; 19:e13. [PMID: 28062391 PMCID: PMC5251169 DOI: 10.2196/jmir.5876] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/16/2016] [Accepted: 12/18/2016] [Indexed: 02/07/2023] Open
Abstract
Background Information and communication technology (ICT) has transformed the health care field worldwide. One of the main drivers of this change is the electronic health record (EHR). However, there are still open issues and challenges because the EHR usually reflects the partial view of a health care provider without the ability for patients to control or interact with their data. Furthermore, with the growth of mobile and ubiquitous computing, the number of records regarding personal health is increasing exponentially. This movement has been characterized as the Internet of Things (IoT), including the widespread development of wearable computing technology and assorted types of health-related sensors. This leads to the need for an integrated method of storing health-related data, defined as the personal health record (PHR), which could be used by health care providers and patients. This approach could combine EHRs with data gathered from sensors or other wearable computing devices. This unified view of patients’ health could be shared with providers, who may not only use previous health-related records but also expand them with data resulting from their interactions. Another PHR advantage is that patients can interact with their health data, making decisions that may positively affect their health. Objective This work aimed to explore the recent literature related to PHRs by defining the taxonomy and identifying challenges and open questions. In addition, this study specifically sought to identify data types, standards, profiles, goals, methods, functions, and architecture with regard to PHRs. Methods The method to achieve these objectives consists of using the systematic literature review approach, which is guided by research questions using the population, intervention, comparison, outcome, and context (PICOC) criteria. Results As a result, we reviewed more than 5000 scientific studies published in the last 10 years, selected the most significant approaches, and thoroughly surveyed the health care field related to PHRs. We developed an updated taxonomy and identified challenges, open questions, and current data types, related standards, main profiles, input strategies, goals, functions, and architectures of the PHR. Conclusions All of these results contribute to the achievement of a significant degree of coverage regarding the technology related to PHRs.
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Affiliation(s)
- Alex Roehrs
- Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Cristiano André da Costa
- Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
| | - Rodrigo da Rosa Righi
- Programa de Pós-Graduação em Computação Aplicada, Universidade do Vale do Rio dos Sinos, São Leopoldo, Brazil
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Hong H, Chen D, Sun Z. A practical application of CP-ABE for mobile PHR system: a study on the user accountability. SPRINGERPLUS 2016; 5:1320. [PMID: 27563515 PMCID: PMC4980854 DOI: 10.1186/s40064-016-3002-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 08/05/2016] [Indexed: 11/19/2022]
Abstract
Background Attribute based encryption has been widely applied for secure data protection in PHR systems. However, since different users may share the same attributes in the system, a user may leaks his private key for illegal data sharing without being detected. This will add more threat to the private data stored in PHR system. Finding To help users achieve higher efficiency and more secure data sharing in mobile PHR system, based on previous works, we study the traitor tracing mechanism in attribute based cryptosystem and propose a high efficient attribute based encryption with user accountability in mobile PHR system. If a malicious PHR user exposes his private key for illegal data sharing, his identity can be accurately pinpointed by the system manager. During the whole process of data sharing, no bilinear pairing operations are needed, hence this will the mobile terminal devices from heavy computation burden. Conclusion As a further study, in this short report, we show that using a novel attribute based encryption with user accountability can help users achieve better efficiency and more secure data sharing in mobile PHR system.
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Affiliation(s)
- Hanshu Hong
- Key Lab of Broadband Wireless Communication and Sensor Network Technology, Nanjing University of Posts and Telecommunications, Nanjing, China
| | - Di Chen
- Inter-College Program in Genetics, Pennsylvania State University, University Park, PA USA
| | - Zhixin Sun
- Key Lab of Broadband Wireless Communication and Sensor Network Technology, Nanjing University of Posts and Telecommunications, Nanjing, China
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Alpert JM, Krist AH, Aycock RA, Kreps GL. Designing User-Centric Patient Portals: Clinician and Patients' Uses and Gratifications. Telemed J E Health 2016; 23:248-253. [PMID: 27333468 DOI: 10.1089/tmj.2016.0096] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Legislation mandates that clinicians make patients' medical information available digitally. This has resulted in hurriedly installing patient portals that do not fully meet the needs of patients or clinicians. This study examined a specific portal, MyPreventiveCare (MPC), a patient-centered portal designed to promote preventive care to consumers, to elicit recommendations from patients and clinicians about how it could be more beneficial by uncovering their uses and gratifications (U&G). MATERIALS AND METHODS In-depth interviews with 31 patients and two clinician focus groups were conducted. Multiple methods were utilized, such as grounded theory coding to develop themes and content analysis to classify responses according to the U&G framework. RESULTS Four main categories emerged that users desire to be included in health portals: integration with technology (27%), coordination of care (27%), incorporation of lifestyle (26%), and increased control (20%). Additional analysis revealed that health portals are mainly utilized to fulfill cognitive and affective needs, with over 80% of recommendations related to the U&G categories of cognitive and affective needs. Cognitive (60%), affective (21%), social integrative (10%), personal integrative (9%), and tension release (0%). CONCLUSIONS Portals will continue to evolve and become important health communication tools if they address the user's perspective and are inclusive of new technological advances. Specifically, portals must become more user centric and incorporate aspects of the patients' lifestyle and integrate health information technology.
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Affiliation(s)
- Jordan M Alpert
- 1 Department of Health Behavior and Policy, Virginia Commonwealth University , Richmond, Virginia
| | - Alex H Krist
- 2 Department of Family Medicine and Population Health, Virginia Commonwealth University , Richmond, Virginia
| | - Rebecca A Aycock
- 2 Department of Family Medicine and Population Health, Virginia Commonwealth University , Richmond, Virginia
| | - Gary L Kreps
- 3 Department of Communication, George Mason University , Fairfax, Virginia
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Fuji KT, Abbott AA, Galt KA. A qualitative study of how patients with type 2 diabetes use an electronic stand-alone personal health record. Telemed J E Health 2015; 21:296-300. [PMID: 25614996 DOI: 10.1089/tmj.2014.0084] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient use of personal health records (PHRs) to manage their health information has been proposed to enhance patient knowledge and empower patients to make changes in their self-care behaviors. However, there remains a gap in understanding about patients' actual PHR use behaviors. The purpose of this qualitative study was to explore how patients with type 2 diabetes used a PHR to manage their diabetes-related health information for self-care. MATERIALS AND METHODS Fifty-nine patients with type 2 diabetes were interviewed 3-6 months after receiving initial training on a free-of-charge, Web-based PHR. Interviews were audio-recorded, transcribed, and analyzed using an iterative process of in vivo coding, categorization, and theme development. RESULTS Nine themes emerged, three of which expressed positive experiences: complete and accessible record; increased awareness; and behavioral changes. The remaining six themes expressed negative experiences: out of sight, out of mind; I would have used it if I were sicker; economic, infrastructure, and computer literacy barriers; lack of patient-provider engagement; double tracking; and privacy and security concerns. CONCLUSIONS Despite some potential positive benefits resulting from PHR use, several barriers inhibited sustained and effective use over time. Provider and patient education about the benefits of PHR use and about the potential for filling in information gaps in the provider-based record is key to engage patients and stimulate PHR adoption and use.
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Affiliation(s)
- Kevin T Fuji
- 1 Center for Health Services Research and Patient Safety, Creighton University , Omaha, Nebraska
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Fuji KT, Abbott AA, Galt KA. Personal health record design: qualitative exploration of issues inhibiting optimal use. Diabetes Care 2014; 37:e13-4. [PMID: 24356602 PMCID: PMC3968449 DOI: 10.2337/dc13-1630] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Chrischilles EA, Hourcade JP, Doucette W, Eichmann D, Gryzlak B, Lorentzen R, Wright K, Letuchy E, Mueller M, Farris K, Levy B. Personal health records: a randomized trial of effects on elder medication safety. J Am Med Inform Assoc 2013; 21:679-86. [PMID: 24326536 DOI: 10.1136/amiajnl-2013-002284] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To examine the impact of a personal health record (PHR) on medication-use safety among older adults. BACKGROUND Online PHRs have potential as tools to manage health information. We know little about how to make PHRs accessible for older adults and what effects this will have. METHODS A PHR was designed and pretested with older adults and tested in a 6-month randomized controlled trial. After completing mailed baseline questionnaires, eligible computer users aged 65 and over were randomized 3:1 to be given access to a PHR (n=802) or serve as a standard care control group (n=273). Follow-up questionnaires measured change from baseline medication use, medication reconciliation behaviors, and medication management problems. RESULTS Older adults were interested in keeping track of their health and medication information. A majority (55.2%) logged into the PHR and used it, but only 16.1% used it frequently. At follow-up, those randomized to the PHR group were significantly less likely to use multiple non-steroidal anti-inflammatory drugs-the most common warning generated by the system (viewed by 23% of participants). Compared with low/non-users, high users reported significantly more changes in medication use and improved medication reconciliation behaviors, and recognized significantly more side effects, but there was no difference in use of inappropriate medications or adherence measures. CONCLUSIONS PHRs can engage older adults for better medication self-management; however, features that motivate continued use will be needed. Longer-term studies of continued users will be required to evaluate the impact of these changes in behavior on patient health outcomes.
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Affiliation(s)
- Elizabeth A Chrischilles
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
| | - Juan Pablo Hourcade
- Department of Computer Science, College of Liberal Arts, The University of Iowa, Iowa City, Iowa, USA
| | - William Doucette
- College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - David Eichmann
- School of Library and Information Science, The University of Iowa, Iowa City, Iowa, USA
| | - Brian Gryzlak
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Ryan Lorentzen
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
| | - Kara Wright
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Elena Letuchy
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Michael Mueller
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA
| | - Karen Farris
- College of Pharmacy, The University of Michigan, Ann Arbor, Michigan, USA
| | - Barcey Levy
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa, USA Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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