Innovation process of mHealth: An overview of FDA-approved mobile medical applications

MedTech start-ups: A comprehensive scoping review of current research trends and future directions

Medical start-ups (MedTech) significantly contribute to the development and commercialization of innovative healthcare solutions, driving advancements in technology, enhancing treatment effectiveness, and supporting public health. This study explores the main themes and concepts related to MedTech start-ups, examines the research methods used, and identifies major gaps in the literature. A scoping literature review was performed by searching the Scopus, PubMed, and Web of Science databases for publications from 2012 to 2023, focusing on MedTech start-ups in titles, abstracts, and keywords. References were analyzed using the Bibliometrix package in R, and a coupling network analysis was conducted, visualizing results on a Coupling Map to identify key research themes and gaps. The research identified 480 unique articles on MedTech start-ups. After removing duplicates and following a PRISMA-based assessment, 79 articles were included in the review. The studies predominantly focused on organizations, including start-ups and Venture Capital funds (46%). Most articles (60%) used qualitative methods, 25% employed mixed methods, and 15% used quantitative methods. Geographically, 63% of articles focused on a single country, primarily the USA (35%), followed by Iran, Sweden, Switzerland, China, and Japan (2-4% each). Coupling analysis identified five topic clusters: crowdfunding for medical research, innovation in medical technology, new product development, digital start-ups, and the venture capital industry. This review highlights the significant role of MedTech start-ups in advancing healthcare innovations despite challenges like regulatory hurdles and high capital requirements. The literature emphasizes the importance of collaboration among universities, industry, and government for successful commercialization. The geographic concentration in the USA indicates a need for more inclusive research. Crowdfunding and venture capital emerge as crucial funding sources, suggesting strategies to mitigate risks and enhance innovation success.

Shifting From Active to Passive Monitoring of Alzheimer Disease: The State of the Research

Most research using digital technologies builds on existing methods for staff-administered evaluation, requiring a large investment of time, effort, and resources. Widespread use of personal mobile devices provides opportunities for continuous health monitoring without active participant engagement. Home-based sensors show promise in evaluating behavioral features in near real time. Digital technologies across these methodologies can detect precise measures of cognition, mood, sleep, gait, speech, motor activity, behavior patterns, and additional features relevant to health. As a neurodegenerative condition with insidious onset, Alzheimer disease and other dementias (AD/D) represent a key target for advances in monitoring disease symptoms. Studies to date evaluating the predictive power of digital measures use inconsistent approaches to characterize these measures. Comparison between different digital collection methods supports the use of passive collection methods in settings in which active participant engagement approaches are not feasible. Additional studies that analyze how digital measures across multiple data streams can together improve prediction of cognitive impairment and early-stage AD are needed. Given the long timeline of progression from normal to diagnosis, digital monitoring will more easily make extended longitudinal follow-up possible. Through the American Heart Association-funded Strategically Focused Research Network, the Boston University investigative team deployed a platform involving a wide range of technologies to address these gaps in research practice. Much more research is needed to thoroughly evaluate limitations of passive monitoring. Multidisciplinary collaborations are needed to establish legal and ethical frameworks for ensuring passive monitoring can be conducted at scale while protecting privacy and security, especially in vulnerable populations.

Innovation Process and Industrial System of US Food and Drug Administration-Approved Software as a Medical Device: Review and Content Analysis

BACKGROUND

There has been a surge in academic and business interest in software as a medical device (SaMD). SaMD enables medical professionals to streamline existing medical practices and make innovative medical processes such as digital therapeutics a reality. Furthermore, SaMD is a billion-dollar market. However, SaMD is not clearly understood as a technological change and emerging industry.

OBJECTIVE

This study aims to review the landscape of SaMD in response to increasing interest in SaMD within health systems and regulation. The objectives of the study are to (1) clarify the innovation process of SaMD, (2) identify the prevailing typology of such innovation, and (3) elucidate the underlying mechanisms driving the SaMD innovation process.

METHODS

We collected product information on 581 US Food and Drug Administration-approved SaMDs from the OpenFDA website and 268 company profiles of the corresponding manufacturers from Crunchbase, Bloomberg, PichBook.com, and other company websites. In addition to assessing the metadata of SaMD, we used correspondence and business process analysis to assess the distribution of intended use and how SaMDs interact with other devices in the medical process.

RESULTS

The current SaMD industry is highly concentrated in medical image processing and radiological analysis. Incumbents in the medical device industry currently lead the market and focus on incremental innovation, whereas new entrants, particularly startups, produce more disruptive innovation. We found that hardware medical device functions as a complementary asset for SaMD, whereas how SaMD interacts with the complementary asset differs according to its intended use. Based on these findings, we propose a regime map that illustrates the SaMD innovation process.

CONCLUSIONS

SaMD, as an industry, is nascent and dominated by incremental innovation. The innovation process of the present SaMD industry is shaped by data accessibility, which is key to building disruptive innovation.

Healthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: A systematic review

Communicable diseases remain a leading cause of death and disability in low- and middle-income countries (LMICs). mHealth technologies carry considerable promise for managing these disorders within resource-poor settings, but many existing applications exclusively represent digital versions of existing guidelines or clinical calculators, communication facilitators, or patient self-management tools. We thus systematically searched PubMed, Web of Science, and Cochrane Central for studies published between January 2007 and October 2019 involving technologies that were mobile phone- or tablet-based; able to screen for, diagnose, or monitor a communicable disease of importance in LMICs; and targeted health professionals as primary users. We excluded technologies that digitized existing paper-based tools or facilitated communication (i.e., knowledge-based algorithms). Extracted data included disease category, pathogen type, diagnostic method, intervention purpose, study/target population, sample size, study methodology, development stage, accessory requirement, country of development, operating system, and cost. Given the search timeline, studies involving COVID-19 were not included in the analysis. Of 13,262 studies identified by the screen, 33 met inclusion criteria. 12% were randomized clinical trials (RCTs), with 58% of publications representing technical descriptions. 62% of studies had 100 or fewer subjects. All studied technologies involved diagnosis or screening steps; none addressed the monitoring of infections. 52% focused on priority diseases (HIV, malaria, tuberculosis), but only 12% addressed a neglected tropical disease. Although most reported studies were priced under 20USD at time of publication, two thirds of the records did not yet specify a cost for the study technology. We conclude that there are only a small number of mHealth technologies focusing on innovative methods of screening and diagnosing communicable diseases potentially of use in LMICs. Rigorous RCTs, analyses with large sample size, and technologies assisting in the monitoring of diseases are needed.

Optimizing the Relationship between Regulation and Innovation in Dietary Supplements: A Case Study of Food with Function Claims in Japan

Regulation has long been a counterpart of innovation in the health care industry, and recent cases have demonstrated that appropriately designed regulations can both coexist with and promote innovation. This study is the first study to explore how the regulatory environment affected the innovation process during the transition of the regulations for functional foods in Japan by examining quantitatively the impact of the foods with function claims (FFC) system on industry, companies, and products. Based on a dataset of Japanese dietary supplement manufacturing companies (n = 169) and their products (n = 731) in 2019, we found that companies that have newly entered the FFC system are smaller in scale than existing companies (p < 0.01, Wilcoxon rank sum test). We also found that companies with FFC products have larger revenue growth (p = 0.01). A multiple regression analysis revealed that FFC product sales increased with in-house clinical testing (coefficient: 26.8, p < 0.0001), diverse active ingredients (coefficient: 7.6, p < 0.001), and the claim of new functions (coefficient: 10.2, p < 0.05). These results suggested that the FFC system facilitated the market entry of small and mid-size enterprises and promoted the creation of high-value products through innovative company efforts.

Social Acceptance of Mobile Health among Young Adults in Japan: An Extension of the UTAUT Model

The unprecedented development of information and communication technologies has opened up immense possibilities in the field of health care. Mobile health (mHealth) is gaining increasing attention as an important technology for solving health-related problems. Although a high rate of smartphone usage among young people in Japan has been identified, smartphone usage for health management is not high. As Japanese youth are important potential users of mHealth, it is necessary to explore theories that influence the behavioral intention of Japanese youth to adopt mHealth. This study conducted a questionnaire survey in a Japanese university and collected 233 valuable responses. This study was adapted and extended from the unified theory of acceptance and use of technology (UTAUT) model to measure eight constructs: health consciousness, social influence, facilitation conditions, perceived risk, trust, performance expectancy, effort expectancy, and behavioral intention. Structural equation modeling was used for hypothesis testing. We found that trust, performance expectancy, and effort expectancy directly influenced the behavioral intention to use mHealth. Health consciousness and social influence indirectly influence behavioral intention through trust and performance expectancy. Facilitation conditions indirectly influenced behavioral intention through effort expectancy. This study makes a vital theoretical contribution to policymakers and product developers for the further diffusion of mHealth among young people in Japan.

Digitalized transcranial electrical stimulation: A consensus statement

OBJECTIVE

Although relatively costly and non-scalable, non-invasive neuromodulation interventions are treatment alternatives for neuropsychiatric disorders. The recent developments of highly-deployable transcranial electric stimulation (tES) systems, combined with mobile-Health technologies, could be incorporated in digital trials to overcome methodological barriers and increase equity of access. The study aims are to discuss the implementation of tES digital trials by performing a systematic scoping review and strategic process mapping, evaluate methodological aspects of tES digital trial designs, and provide Delphi-based recommendations for implementing digital trials using tES.

METHODS

We convened 61 highly-productive specialists and contacted 8 tES companies to assess 71 issues related to tES digitalization readiness, and processes, barriers, advantages, and opportunities for implementing tES digital trials. Delphi-based recommendations (>60% agreement) were provided.

RESULTS

The main strengths/opportunities of tES were: (i) non-pharmacological nature (92% of agreement), safety of these techniques (80%), affordability (88%), and potential scalability (78%). As for weaknesses/threats, we listed insufficient supervision (76%) and unclear regulatory status (69%). Many issues related to methodological biases did not reach consensus. Device appraisal showed moderate digitalization readiness, with high safety and potential for trial implementation, but low connectivity.

CONCLUSIONS

Panelists recognized the potential of tES for scalability, generalizability, and leverage of digital trials processes; with no consensus about aspects regarding methodological biases.

SIGNIFICANCE

We further propose and discuss a conceptual framework for exploiting shared aspects between mobile-Health tES technologies with digital trials methodology to drive future efforts for digitizing tES trials.

A Layered Adopter-Structure Model for the Download of COVID-19 Contact Tracing Apps: A System Dynamics Study for mHealth Penetration

(1) Background: Contact tracing and notification apps for coronavirus disease 2019 (COVID-19) are installed on smartphones and are intended to detect contact with another person's device. A high installation rate is important for these apps to enable them to be effective countermeasures against the silent transmission of diseases. However, the installation rate varies among apps and regions and the penetration dynamics of these applications are unclear. (2) Methods: The download behavior of contact tracing applications was investigated using publicly available datasets. The increase in downloads was modeled using a system dynamics model derived from the product growth model. (3) Results: The imitation effects present in the traditional product growth model were not observed in COVID-19 contact tracing apps. The system dynamics model, without the imitation effect, identified the downloads of the Australian COVIDSafe app. The system dynamics model, with a layered adopter, identified the downloads of the Japanese tracing app COCOA. The spread of COVID-19 and overall anti-COVID-19 government intervention measures in response to the spread of infection seemed to result in an increase in downloads. (4) Discussion: The suggested layered structure of users implied that individualized promotion for each layer was important. Addressing the issues among users who are skeptical about adoption is pertinent for optimal penetration of the apps.

Open-source electronic health record systems: A systematic review of most recent advances

Open-source Electronic Health Records (OS-EHRs) are of pivotal importance in the management, operations, and administration of any healthcare organization. With the advancement of health informatics, researchers and healthcare practitioners have proposed various frameworks to assess the maturation of Open-source EHRs. The significance of OS-EHRs stems from the fact that vendor-based EHR implementations are becoming financially burdensome, with some vendors raking in more than $1 billion with one contract. Contrarily, the adoption of OS-EHRs suffers from a lack of systematic evaluation from the standpoint of a standard reference model. To this end, the Healthcare Information and Management Systems Society (HIMSS) has presented a strategic road map called EMR Adoption and Maturity (EMRAM). The HIMSS-EMRAM model proposes a stage-wise model approach that is globally recognized and can be essentially applied as a benchmark evaluation criteria for open-source EHRs. This paper offers an applied descriptive methodology over the frequently studied open-source EHRs currently operational worldwide or has the potential of adoption in healthcare settings. Besides, we also present profiling (User Support, Developer' Support, Customization Support, Technical details, and Diagnostic help) of studied OS-EHRs from developer's and user's perspectives using updated standard metrics. We carried out multi-aspect objective analysis of studied systems covering EHR functions, software based features and implementation. This review portrays systematic aspects of electronic medical record standards for open-source software implementations. As we observed in the literature, prevalent research and working prototypes lack systematic review of the HIMSS-EMRAM model and do not present evolving software features. Therefore, after the application of our assessment measures, the results obtained indicate that OS-EHRs are yet to acquire standard compliance and implementation. The findings in this paper can be beneficial in the planning and implementation of OS-EHRs projects in the future.

A Dynamic Equilibrium Mechanism of Core Layer Interests in the Mobile Medical Platform Ecosystem

In recent years, with the development of the mobile Internet, big data, and cloud computing, the mobile medical platforms such as Ding Xiang Yuan aggregating platform ecological resources have played an irreplaceable role in improving efficiency, optimizing resource allocation, and even promoting the transformation and upgrading of the medical industry. Despite all this, most mobile medical platforms in China still face many problems, including the immature business model, the stagnation of the interaction of knowledge and information among platform members, and the weak platform competitiveness. Based on a review of the platform and commercial ecosystems, this paper adopts the evolutionary game method and simulation to analyze the evolutionary stability strategy of operators, partners, and users in the core layer of the platform during preflow and postflow periods of a mobile medical platform, hence, to construct a beneficial dynamic equilibrium model of a platform business ecosystem under the optimal decisions made by all parties involved in the platform: the goal in the early stage (preflow period) is to increase platform user flow. Hence, the knowledge/information sharing of platform users is needed to enhance platform's visibility. While in the late period (postflow period), when the platform user flow reaches a certain scale, platform's goal is to promote revenue, which relies mainly on the pricing strategy. It is critical to promote the stability of the platform and the dynamic balance of interests at the core layer in the pricing process. This paper applies the platform business ecosystem theory and the evolutionary game theory to mobile medical platform development, contributing theoretically and practically in the following: (1) providing a more solid theoretical support for the mobile medical platform research and enriching the theoretical framework of the platform business ecosystem; (2) proposing the dynamic equilibrium model based on the optimal decisions of the platform core layers, which help to reveal the inherent law of the evolution of the mobile medical platform; (3) providing policy suggestions and management implications in constructing an appropriate business ecosystem and achieving sustainable development in mobile medical platforms.

Creating an innovation infrastructure in academic nursing

As interest in nurse-led health and health care innovation grows, we must prepare nurses with the skills, knowledge, and experiences necessary to lead in these areas. In this article we describe how schools of nursing can integrate innovation in their mission, describe actionable steps to position nurses as leaders in this space, and provide a case study example of how to infuse innovation into a school of nursing. CLINICAL RELEVANCE: In order for nurses to lead in health and healthcare innovation, schools of nursing and nursing programs must think strategically about the knowledge and skills the next generation of nurses will need and then support those innovation needs at all levels of research, education, and practice.

Critical Factors and Economic Methods for Regulatory Impact Assessment in the Medical Device Industry

Introduction

Methods

Results

Discussion

Effects of Patient-Generated Health Data: Comparison of Two Versions of Long-Term Mobile Personal Health Record Usage Logs

Patient-generated health data (PGHD) can be managed easily by a mobile personal health record (mPHR) and can increase patient engagement. This study investigated the effect of PGHD functions on mPHR usage. We collected usage log data from an mPHR app, My Chart in My Hand (MCMH), for seven years. We analyzed the number of accesses and trends for each menu by age and sex according to the version-up. Generalized estimating equation (GEE) analysis was used to determine the likelihood of continuous app usage according to the menus and version-up. The total number of users of each version were 15,357 and 51,553, respectively. Adult females under 50 years were the most prevalent user group (30.0%). The “My Chart” menu was the most accessed menu, and the total access count increased by ~10 times after the version-up. The “Health Management” menu designed for PGHD showed the largest degree of increase in its likelihood of continuous usage after the version-up (1.245; p < 0.0001) across menus (range: 0.925–1.050). Notably, improvement of PGHD management in adult females over 50 years is needed.

Analysis of the Regulatory, Legal, and Medical Conditions for the Prescription of Mobile Health Applications in the United States, The European Union, and France

INTRODUCTION

Mobile health (mHealth) is now considered an important approach to extend traditional health services and to meet the growing medical needs. The prescribability of mHealth applications is a complex problem because it depends on a large number of factors and concerns a wide range of disciplines and actors in the industrial, health, normative, and regulatory domains.

OBJECTIVE

Our study correlated data from the scientific literature with data on regulatory developments in the United States, the European Union, and France with the aim of identifying the conditions for the prescription of mHealth applications.

METHODS

The search method adopted was the systematic literature review process by Brereton et al. All empirical evidence from the relevant fields of study was gathered and then evaluated to answer our predefined research questions. The WoS and PubMed databases were queried for the period between 1 January 1975 and 30 November 2020. A total of 165 articles (15 with a direct focus and 150 with an indirect focus on mHealth prescribing) were analyzed/cross-referenced. The ScienceDirect database was consulted to complement the collected data when needed. Data published by international and national regulatory bodies were analyzed in light of the scientific data obtained from the WoS, PubMed, and ScienceDirect databases.

RESULTS

The International Medical Device Regulators Forum has ensured the international structuring of the regulatory field in collaboration with participating countries. The creation and updating of databases have allowed the tracking of medical device versions/upgrades and incidents. The regulatory organizations of the United States, the European Union, and France are currently consulting healthcare personnel, manufacturers, and patients to establish evaluation criteria for usability and quality of instructions for use that take into consideration patients' level of literacy. These organizations are also providing support to manufacturers who wish to file marketing applications. Marketing, privacy, and cybersecurity measures are evolving with developments in technology and state cooperation policies. The prescription of mHealth applications will gain social acceptance only if consistency and coordination are ensured at all stages of the process: from pre-design, through verification of medical effectiveness, to ethical consideration during data collection and use, and on to marketing.

CONCLUSION

The conditions for mHealth prescribability include the adaptation of international regulation by the different states, the state provision of marketing support, and the evaluation of mHealth applications. For mHealth to gain social acceptance, increased collaboration among physicians, manufacturers, and "information technology stakeholders" is needed. Once this is achieved, MHealth can become the cornerstone of successful health care reform.

The Significance of Alliance Networks in Research and Development of Digital Health Products for Diabetes: Observational Study

Background

Digital health has been advancing owing to technological progress by means of smart devices and artificial intelligence, among other developments. In the field of diabetes especially, there are many active use cases of digital technology supporting the treatment of diabetes and improving lifestyle. In the innovation ecosystem, new alliance networks are formed not only by medical device companies and pharmaceutical companies, but also by information and communications technology companies and start-ups. While understanding and utilizing the network structure is important to increase the competitive advantage of companies, there is a lack of previous research describing the structure of alliance networks and the factors that lead to their formation in digital health.

Objective

The aim of this study was to explore the significance of alliance networks, focusing on digital health for diabetes, in effectively implementing processes, from the research and development of products or services to their launch and market penetration.

Methods

First, we listed the companies and contracts related to digital health for diabetes, visualized the change in the number of companies and the connections between companies in each industry, and analyzed the overview of the network. Second, we calculated the degree, betweenness centrality, and eigenvector centrality of each company in each year. Next, we analyzed the relationship between network centrality and market competitiveness by using annual sales as a parameter of company competitiveness. We also compared the network centrality of each company by industry or headquarters location (or both) and analyzed the characteristics of companies with higher centrality. Finally, we analyzed the relationship between network centrality and the number of products certified or approved by the US Food and Drug Administration.

Results

We found the degree centrality of companies was correlated with an increase in their sales. The betweenness and eigenvector centralities of medical devices companies located in the United States were significantly higher than those outside the United States (P=.04 and .005, respectively). Finally, the degree, betweenness, and eigenvector centralities were correlated with an increase in the number of Class III, but not of Class I nor II, medical device products.

Conclusions

These findings give rise to new insights into industry ecosystem for digital health and its requirement and expect a contribution to research and development practices in the field of digital health.

Exploring the Shift in International Trends in Mobile Health Research From 2000 to 2020: Bibliometric Analysis

BACKGROUND

Smartphones have become an integral part of our lives with unprecedented popularity and a diverse selection of apps. The continuous upgrading of information technology has also enabled smartphones to display great potential in the field of health care.

OBJECTIVE

We aimed to determine the future research direction of mobile health (mHealth) by analyzing its research trends and latest research hotspots.

METHODS

This study collected mHealth-related literature published between 2000 and 2020 from the Web of Science database. Descriptive statistics of publication trends of mHealth research were determined by analyzing the annual number of publications in the literature and annual number of publications by country. We constructed visualization network maps of country (or regional) collaborations and author-provided keyword co-occurrences, as well as overlay visualization maps of the average publication year of author-provided keywords to analyze the hotspots and research trends in mHealth research.

RESULTS

In total, 12,593 mHealth-related research papers published between 2000 and 2020 were found. The results showed an exponential growth trend in the number of annual publications in mHealth literature. JMIR mHealth and uHealth, the Journal of Medical Internet Research, and JMIR Research Protocols were the 3 top journals with respect to number of publications. The United States remained the leading contributor to the literature in this area (5294/12,593, 42.0%), well ahead of other countries and regions. Other countries and regions also showed a clear trend of annual increases in the number of mHealth publications. The 4 countries with the largest number of publications-the United States, the United Kingdom, Canada, and Australia-were found to cooperate more closely. The rest of the countries and regions showed a clear geographic pattern of cooperation. The keyword co-occurrence analysis of the top 100 authors demonstrated 5 clusters, namely, development of mHealth medical technology and its application to various diseases, use of mHealth technology to improve basic public health and health policy, mHealth self-health testing and management in daily life, adolescent use of mHealth, and mHealth in mental health. The research trends revealed a gradual shift in mHealth research from health policy and improving public health care to the development and social application of mHealth technologies.

CONCLUSIONS

To the best of our knowledge, the most current bibliometric analysis dates back to 2016. However, the number of mHealth research published between 2017 and 2020 exceeds the previous total. The results of this study shed light on the latest hotspots and trends in mHealth research. These findings provide a useful overview of the development of the field; they may also serve as a valuable reference and provide guidance for researchers in the digital health field.

Regulations, Open Data and Healthcare Innovation: A Case of MSK-IMPACT and Its Implications for Better Cancer Care

Simple Summary

The advancement in both science and technology has contributed to the development of novel diagnostic technologies; such technologies enable medical practitioners to diagnose diseases that could not be previously detected. However, in order to translate new technologies into practical applications, various types of challenges need to be overcome. To address these challenges, including those in clinical management and regulatory science, healthcare policies have been constantly implemented to promote the practical application of outcomes generated by healthcare innovation. This study conducted comparative analyses of three tumor profiling tests approved by the U.S. Food and Drug Administration (FDA) in 2017, hypothesizing that the FDA’s regulatory reforms, early application of new technologies to both research and clinical settings, and open data accumulated as a result of large-scale research programs have promoted new drug development in oncology. The study then discussed the implications potentially suggested by the outcomes and challenges of the three tests.

Abstract

This study investigated a case of Memorial Sloan Kettering-Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT), a tumor profiling test approved by the U.S. Food and Drug Administration (FDA) in 2017, to examine what factors would contribute to healthcare innovation. First, we set the following three parameters to observe cases: (i) the FDA regulatory reforms, (ii) early application of new technologies, such as next-generation sequencing (NGS), to both research and clinical settings, and (iii) accumulation of open data. Then, we performed a comparative analysis of MSK-IMPACT with FoundationOne CDx and Oncomine Dx Target Test, both of which were FDA-approved tumor profiling tests launched in 2017. As a result, we found that MSK-IMPACT secures neutrality as a non-profit organization, achieves the active incorporation of basic research results, and performs superiorly in clinical operations, such as patient enrollment. On the contrary, we confirmed that FoundationOne CDx was the most prominent case in terms of the number of new drugs and expanded indications approved in which the FDA’s expedited approval programs were considerably utilized. Consequently, to uncover the full potential of MSK-IMPACT, it is suggested that more intersectoral collaborative activities between various healthcare stakeholders, in particular, pharmaceutical companies, for driving clinical development must be carried out based on an organizational framework that facilitates collaboration.

A Mobile App and Dashboard for Early Detection of Infectious Disease Outbreaks: Development Study

BACKGROUND

Outbreaks of infectious diseases pose great risks, including hospitalization and death, to public health. Therefore, improving the management of outbreaks is important for preventing widespread infection and mitigating associated risks. Mobile health technology provides new capabilities that can help better capture, monitor, and manage infectious diseases, including the ability to quickly identify potential outbreaks.

OBJECTIVE

This study aims to develop a new infectious disease surveillance (IDS) system comprising a mobile app for accurate data capturing and dashboard for better health care planning and decision making.

METHODS

We developed the IDS system using a 2-pronged approach: a literature review on available and similar disease surveillance systems to understand the fundamental requirements and face-to-face interviews to collect specific user requirements from the local public health unit team at the Nepean Hospital, Nepean Blue Mountains Local Health District, New South Wales, Australia.

RESULTS

We identified 3 fundamental requirements when designing an electronic IDS system, which are the ability to capture and report outbreak data accurately, completely, and in a timely fashion. We then developed our IDS system based on the workflow, scope, and specific requirements of the public health unit team. We also produced detailed design and requirement guidelines. In our system, the outbreak data are captured and sent from anywhere using a mobile device or a desktop PC (web interface). The data are processed using a client-server architecture and, therefore, can be analyzed in real time. Our dashboard is designed to provide a daily, weekly, monthly, and historical summary of outbreak information, which can be potentially used to develop a future intervention plan. Specific information about certain outbreaks can also be visualized interactively to understand the unique characteristics of emerging infectious diseases.

CONCLUSIONS

We demonstrated the design and development of our IDS system. We suggest that the use of a mobile app and dashboard will simplify the overall data collection, reporting, and analysis processes, thereby improving the public health responses and providing accurate registration of outbreak information. Accurate data reporting and collection are a major step forward in creating a better intervention plan for future outbreaks of infectious diseases.

Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review

PROPOSE

Advancements in mobile technology, primarily through the use of applications, may support the process of monitoring adherence to oral therapies, controlling toxicities, or providing self-care guidelines to patients undergoing chemotherapy treatment. This study aims to assemble the available knowledge regarding the use of mobile applications by cancer patients undergoing chemotherapy treatment.

METHODS

A literature review based on the Joanna Briggs Institute model(s) for Scoping Review was conducted. All articles published until 30 May 2019, were identified in the MEDLINE®, CINAHL®, and PsycINFO® electronic databases using the related Boolean logical operators and key terms. Extracted data included research aims, methodological design, application name, the functionalities of the applications, and major results.

RESULTS

A total of 26 articles were included in this study. The search identified 16 different mobile applications, some of which were addressed in various publications, demonstrating different characteristics in design, use, and development.

CONCLUSION

The use of mobile applications can be seen as an important and effective way to monitor adherence and support in the self-management of complications associated with chemotherapy treatments. Notwithstanding, these applications should be tested outside the academic environment, outreaching this group of people to effectively investigate its applicability, allowing the assessment of the impact of this "new" technological intervention process.

Uncertain Multiplicative Language Decision Method Based on Group Compromise Framework for Evaluation of Mobile Medical APPs in China

The mobile medical application (M-medical APP) can optimize medical service process and reduce health management costs for users, which has become an important complementary form of traditional medical services. To assist users including patients choose the ideal M-medical APP, we proposed a novel multiple attribute group decision making algorithm based on group compromise framework, which need not determine the weight of decision-maker. The algorithm utilized an uncertain multiplicative linguistic variable to measure the individual original preference to express the real evaluation information as much as possible. The attribute weight was calculated by maximizing the differences among alternatives. It determined the individual alternatives ranking according to the net flow of each alternative. By solved the 0–1 optimal model with the objective of minimizing the differences between individual ranking, the ultimate group compromise ranking was obtained. Then we took 10 well-known M-medical APPs in Chinese as an example, we summarized service categories provided for users and constructed the assessment system consisting of 8 indexes considering the service quality users are concerned with. Finally, the effectiveness and superiority of the proposed method and the consistency of ranking results were verified, through comparing the group ranking results of 3 similar algorithms. The experiments show that group compromise ranking is sensitive to attribute weight.

Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users

Background

Injury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan.

Objective

This study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users.

Methods

A cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment.

Results

A total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6% (338/361) of participants had no experience using mHealth technology for wound care.

Conclusions

Our study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes.

Cancer Prevention Using Machine Learning, Nudge Theory and Social Impact Bond

There have been prior attempts to utilize machine learning to address issues in the medical field, particularly in diagnoses using medical images and developing therapeutic regimens. However, few cases have demonstrated the usefulness of machine learning for enhancing health consciousness of patients or the public in general, which is necessary to cause behavioral changes. This paper describes a novel case wherein the uptake rate for colorectal cancer examinations has significantly increased due to the application of machine learning and nudge theory. The paper also discusses the effectiveness of social impact bonds (SIBs) as a scheme for realizing these applications. During a healthcare SIB project conducted in the city of Hachioji, Tokyo, machine learning, based on historical data obtained from designated periodical health examinations, digitalized medical insurance receipts, and medical examination records for colorectal cancer, was used to deduce segments for whom the examination was recommended. The result revealed that out of the 12,162 people for whom the examination was recommended, 3264 (26.8%) received it, which exceeded the upper expectation limit of the initial plan (19.0%). We conclude that this was a successful case that stimulated discussion on potential further applications of this approach to wider regions and more diseases.

"MySweetGestation": A novel smartphone application for women with or at risk of diabetes during pregnancy

Mobile health (mHealth) applications (apps) have been recently introduced as an easily accessible tool for providing information to pregnant women with diabetes. Despite the growing number of apps on the topic "diabetes & pregnancy", a smartphone app offering comprehensive and individualized information to both women (before and during gestation) and their healthcare professionals was still missing. To overcome this lack, the Italian Diabetes and Pregnancy Study Group conceived and realized in 2016 a novel mobile app called "MySweetGestation". It is designed to be an interactive educational tool for both patients and physicians not expert in the field. Through an interactive way of learning, it provides validated information to the user, focusing on different area of interest: from prevention and risk factors for developing diabetes during pregnancy to treatment and follow-up strategies after gestation. Three years since its publication, MySweetGestation has been downloaded in different western and eastern countries worldwide, suggesting a widespread social impact. Easily accessible personalized information made available via mHealth technology may be of great importance to spread controlled information among the pregnant population. MySweetGestation, being an interactive educational device for both patients and healthcare professionals, may contribute to improve the management of pregnant women with diabetes.

Cognitive impairment screening using m-health: an android implementation of the mini-mental state examination (MMSE) using speech recognition

PURPOSE

This paper describes an implementation of an Android application that allows cognitive functions to be tested.

METHODS

The application consists of a slightly modified Mini Mental state Examination (MMSE) test that provides examiner assistance in diagnosing cognitive impairments. The application deploys speech recognition techniques to allow easy and automated scoring of the test. The test results and test-related information are stored in a database providing easy access to data for follow-up and analysis, resulting in overall benefits to the examiner workflow. A small-scale pilot study of 5 months duration was conducted in a nursing home where 15 residents were tested with the MMSE app test and with the (paper) MMSE test with the aim of determining the agreement between the two test methods.

RESULTS

The final MMSE test scores, with a maximum score of 30, agree; the differences have a mean of 0.1, a standard deviation of 2.1 and fall in a [- 4, + 4] range as is illustrated in a Bland-Altman analysis. From examiner reflections, the motoric skills of the participant are indicated to contribute strongly to the time benefit of the assessment itself.

CONCLUSIONS

The findings of this study suggest that the mobile digital version of the slightly modified MMSE test has the potential to be used as an attractive alternative for the conventional paper version of the test.