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Bouhouita-Guermech S, Haidar H. Scoping Review Shows the Dynamics and Complexities Inherent to the Notion of "Responsibility" in Artificial Intelligence within the Healthcare Context. Asian Bioeth Rev 2024; 16:315-344. [PMID: 39022380 PMCID: PMC11250714 DOI: 10.1007/s41649-024-00292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 07/20/2024] Open
Abstract
The increasing integration of artificial intelligence (AI) in healthcare presents a host of ethical, legal, social, and political challenges involving various stakeholders. These challenges prompt various studies proposing frameworks and guidelines to tackle these issues, emphasizing distinct phases of AI development, deployment, and oversight. As a result, the notion of responsible AI has become widespread, incorporating ethical principles such as transparency, fairness, responsibility, and privacy. This paper explores the existing literature on AI use in healthcare to examine how it addresses, defines, and discusses the concept of responsibility. We conducted a scoping review of literature related to AI responsibility in healthcare, searching databases and reference lists between January 2017 and January 2022 for terms related to "responsibility" and "AI in healthcare", and their derivatives. Following screening, 136 articles were included. Data were grouped into four thematic categories: (1) the variety of terminology used to describe and address responsibility; (2) principles and concepts associated with responsibility; (3) stakeholders' responsibilities in AI clinical development, use, and deployment; and (4) recommendations for addressing responsibility concerns. The results show the lack of a clear definition of AI responsibility in healthcare and highlight the importance of ensuring responsible development and implementation of AI in healthcare. Further research is necessary to clarify this notion to contribute to developing frameworks regarding the type of responsibility (ethical/moral/professional, legal, and causal) of various stakeholders involved in the AI lifecycle.
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Affiliation(s)
| | - Hazar Haidar
- Ethics Programs, Department of Letters and Humanities, University of Quebec at Rimouski, Rimouski, Québec Canada
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2
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Nassehi D, Gripsrud BH, Ramvi E. Theoretical Perspectives Underpinning Research on the Physician-Patient Relationship in a Digital Health Practice: Scoping Review. Interact J Med Res 2024; 13:e47280. [PMID: 38748465 PMCID: PMC11137420 DOI: 10.2196/47280] [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: 03/14/2023] [Revised: 08/26/2023] [Accepted: 02/27/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The advent of digital health technologies has transformed the landscape of health care, influencing the dynamics of the physician-patient relationship. Although these technologies offer potential benefits, they also introduce challenges and complexities that require ethical consideration. OBJECTIVE This scoping review aims to investigate the effects of digital health technologies, such as digital messaging, telemedicine, and electronic health records, on the physician-patient relationship. To understand the complex consequences of these tools within health care, it contrasts the findings of studies that use various theoretical frameworks and concepts with studies grounded in relational ethics. METHODS Using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we conducted a scoping review. Data were retrieved through keyword searches on MEDLINE/PubMed, Embase, IEEE Xplore, and Cochrane. We screened 427 original peer-reviewed research papers published in English-language journals between 2010 and 2021. A total of 73 papers were assessed for eligibility, and 10 of these were included in the review. The data were summarized through a narrative synthesis of the findings. RESULTS Digital health technologies enhance communication, improve health care delivery efficiency, and empower patients, leading to shifts in power dynamics in the physician-patient relationship. They also potentially reinforce inequities in health care access due to variations in technology literacy among patients and lead to decreases in patient satisfaction due to the impersonal nature of digital interactions. Studies applying a relational ethics framework have revealed the nuanced impacts of digital health technologies on the physician-patient relationship, highlighting shifts toward more collaborative and reciprocal care. These studies have also explored transitions from traditional hierarchical relationships to mutual engagement, capturing the complexities of power dynamics and vulnerabilities. Other theoretical frameworks, such as patient-centered care, and concepts, such as patient empowerment, were also valuable for understanding these interactions in the context of digital health. CONCLUSIONS The shift from hierarchical to collaborative models in the physician-patient relationship not only underscores the empowering potential of digital tools but also presents new challenges and reinforces existing ones. Along with applications for various theoretical frameworks and concepts, this review highlights the unique comprehensiveness of a relational ethics perspective, which could provide a more nuanced understanding of trust, empathy, and power dynamics in the context of digital health. The adoption of relational ethics in empirical research may offer richer insights into the real-life complexities of the physician-patient relationship, as mediated by digital technologies.
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Affiliation(s)
- Damoun Nassehi
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Birgitta Haga Gripsrud
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Ellen Ramvi
- Department of Caring and Ethics, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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Rakers M, van de Vijver S, Bossio P, Moens N, Rauws M, Orera M, Shen H, Hallensleben C, Brakema E, Guldemond N, Chavannes NH, Villalobos-Quesada M. SERIES: eHealth in primary care. Part 6: Global perspectives: Learning from eHealth for low-resource primary care settings and across high-, middle- and low-income countries. Eur J Gen Pract 2023; 29:2241987. [PMID: 37615720 PMCID: PMC10453992 DOI: 10.1080/13814788.2023.2241987] [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: 11/17/2022] [Revised: 07/13/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND eHealth offers opportunities to improve health and healthcare systems and overcome primary care challenges in low-resource settings (LRS). LRS has been typically associated with low- and middle-income countries (LMIC), but they can be found in high-income countries (HIC) when human, physical or financial resources are constrained. Adopting a concept of LRS that applies to LMIC and HIC can facilitate knowledge interchange between eHealth initiatives while improving healthcare provision for socioeconomically disadvantaged groups across the globe. OBJECTIVES To outline the contributions and challenges of eHealth in low-resource primary care settings. STRATEGY We adopt a socio-ecological understanding of LRS, making LRS relevant to LMIC and HIC. To assess the potential of eHealth in primary care settings, we discuss four case studies according to the WHO 'building blocks for strengthening healthcare systems'. RESULTS AND DISCUSSION The case studies illustrate eHealth's potential to improve the provision of healthcare by i) improving the delivery of healthcare (using AI-generated chats); ii) supporting the workforce (using telemedicine platforms); iii) strengthening the healthcare information system (through patient-centred healthcare information systems), and iv) improving system-related elements of healthcare (through a mobile health financing platform). Nevertheless, we found that development and implementation are hindered by user-related, technical, financial, regulatory and evaluation challenges. We formulated six recommendations to help anticipate or overcome these challenges: 1) evaluate eHealth's appropriateness, 2) know the end users, 3) establish evaluation methods, 4) prioritise the human component, 5) profit from collaborations, ensure sustainable financing and local ownership, 6) and contextualise and evaluate the implementation strategies.
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Affiliation(s)
- Margot Rakers
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | | | - Paz Bossio
- Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
| | - Nic Moens
- Africa eHealth Foundation, Veenendaal, the Netherlands
| | | | | | - Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- School of Nursing Guangzhou, Guangzhou Medical University, Guangdong, China
| | - Cynthia Hallensleben
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | | | - Niels H. Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
| | - María Villalobos-Quesada
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands
- National eHealth Living Lab (NELL), Leiden, the Netherlands
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Chen Z, Liang N, Zhang H, Li H, Yang Y, Zong X, Chen Y, Wang Y, Shi N. Harnessing the power of clinical decision support systems: challenges and opportunities. Open Heart 2023; 10:e002432. [PMID: 38016787 PMCID: PMC10685930 DOI: 10.1136/openhrt-2023-002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
Clinical decision support systems (CDSSs) are increasingly integrated into healthcare settings to improve patient outcomes, reduce medical errors and enhance clinical efficiency by providing clinicians with evidence-based recommendations at the point of care. However, the adoption and optimisation of these systems remain a challenge. This review aims to provide an overview of the current state of CDSS, discussing their development, implementation, benefits, limitations and future directions. We also explore the potential for enhancing their effectiveness and provide an outlook for future developments in this field. There are several challenges in CDSS implementation, including data privacy concerns, system integration and clinician acceptance. While CDSS have demonstrated significant potential, their adoption and optimisation remain a challenge.
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Affiliation(s)
- Zhao Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ning Liang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Haili Zhang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huizhen Li
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yijiu Yang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xingyu Zong
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yaxin Chen
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanping Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Nannan Shi
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Erku D, Khatri R, Endalamaw A, Wolka E, Nigatu F, Zewdie A, Assefa Y. Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6854. [PMID: 37835125 PMCID: PMC10572344 DOI: 10.3390/ijerph20196854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023]
Abstract
Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem-featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments-is pivotal for eHealth interventions' success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth's potential is often restricted by existing socio-cultural norms, geographical inequities in technology access, and digital literacy disparities. Our review underscores the importance of considering the digital ecosystem's readiness, user behavior, broader health system requirements, and PHC capacity for adopting digital solutions while assessing digital health interventions' impact.
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Affiliation(s)
- Daniel Erku
- Centre for Applied Health Economics, School of Medicine, Griffith University, Nathan, QLD 4111, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, QLD 4111, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Resham Khatri
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
| | - Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia; (E.W.); (F.N.); (A.Z.)
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD 4072, Australia; (R.K.); (A.E.); (Y.A.)
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Pinnock H, Hui CY, van Boven JF. Implementation of digital home monitoring and management of respiratory disease. Curr Opin Pulm Med 2023; 29:302-312. [PMID: 37132298 PMCID: PMC10241431 DOI: 10.1097/mcp.0000000000000965] [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] [Indexed: 05/04/2023]
Abstract
PURPOSE OF REVIEW Digital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the over-arching societal themes of equity, trust and communication. RECENT FINDINGS Technological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data. SUMMARY Understanding and addressing the implementation challenges posed by gaps in policy, regulatory, financial, and technical infrastructure is essential to support delivery of equitable respiratory care that is acceptable to patients and professionals.
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Affiliation(s)
| | - Chi Yan Hui
- Usher Institute, The University of Edinburgh, UK
| | - Job F.M. van Boven
- Department of Clinical Pharmacy and Pharmacology, Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, The Netherlands
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van Lingen MN, Giesbertz NAA, van Tintelen JP, Jongsma KR. Why We Should Understand Conversational AI as a Tool. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2023; 23:22-24. [PMID: 37130401 DOI: 10.1080/15265161.2023.2191039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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9
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Frennert S, Petersson L, Erlingsdottir G. "More" work for nurses: the ironies of eHealth. BMC Health Serv Res 2023; 23:411. [PMID: 37106404 PMCID: PMC10136406 DOI: 10.1186/s12913-023-09418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND eHealth applications are considered a technological fix that can potentially address some of the grand challenges in healthcare, including burnout among healthcare professionals, the growing burden of patients with chronic conditions, and retaining and recruiting healthcare professionals. However, as the deployment of eHealth applications in healthcare is relatively novel, there is a lack of research on how they affect the work environment of healthcare professionals. This study explores how work evolves-particularly for nurses-during the utilisation of three eHealth applications. METHODS The study is a qualitative case study with an interpretive approach. The utilisation of three different eHealth applications was studied. Seventy-five healthcare professionals were interviewed, most of whom were nurses (n = 47). Interviews were transcribed verbatim and qualitative content analysis was used to analyse the text. RESULTS Three main themes were identified: work that is ignored and overlooked; actions needed to complete visible work; and more sedentary work activities. The findings suggest that work surrounding the utilisation of eHealth applications in care practices is mostly performed by nurses. While the promise of more efficient workflows resulting from healthcare's digital transformation may be realised to different degrees, the utilisation of eHealth applications creates additional invisible labour for nurses. CONCLUSION We identified through our analysis that the extra work created by eHealth applications is invisible at the organisational level. Most of the invisible labour was performed by nurses, who were engaged in utilising the eHealth applications. This needs to be recognised when implementing eHealth applications in care practices.
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Affiliation(s)
| | - Lena Petersson
- Department of Health and Welfare, Halmstad University, Halmstad, Sweden
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10
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Norberg BL, Getz LO, Johnsen TM, Austad B, Zanaboni P. General Practitioners' Experiences With Potentials and Pitfalls of Video Consultations in Norway During the COVID-19 Lockdown: Qualitative Analysis of Free-Text Survey Answers. J Med Internet Res 2023; 25:e45812. [PMID: 36939814 PMCID: PMC10131921 DOI: 10.2196/45812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The use of video consultations (VCs) in Norwegian general practice rapidly increased during the COVID-19 pandemic. During societal lockdowns, VCs were used for nearly all types of clinical problems, as in-person consultations were kept to a minimum. OBJECTIVE This study aimed to explore general practitioners' (GPs') experiences of potentials and pitfalls associated with the use of VCs during the first pandemic lockdown. METHODS Between April 14 and May 3, 2020, all regular Norwegian GPs (N=4858) were invited to answer a web-based survey, which included open-ended questions about their experiences with the advantages and pitfalls of VCs. A total of 2558 free-text answers were provided by 657 of the 1237 GPs who participated in the survey. The material was subjected to reflexive thematic analysis. RESULTS Four main themes were identified. First, VCs are described as being particularly convenient, informative, and effective for consultations with previously known patients. Second, strategically planned VCs may facilitate effective tailoring of clinical trajectories that optimize clinical workflow. VCs allow for an initial overview of the problem (triage), follow-up evaluation after an in-person consultation, provision of advice and information concerning test results and discharge notes, extension of sick leaves, and delivery of other medical certificates. VCs may, in certain situations, enhance the GPs' insight in their patients' relational and socioeconomical resources and vulnerabilities, and even facilitate relationship-building with patients in need of care who might otherwise be reluctant to seek help. Third, VCs are characterized by a demarcated communication style and the "one problem approach," which may entail effectiveness in the short run. However, the web-based communication climate implies degradation of valuable nonverbal signals that are more evidently present in in-person consultations. Finally, overreliance on VCs may, in a longer perspective, undermine the establishment and maintenance of relational trust, with a negative impact on the quality of care and patient safety. Compensatory mechanisms include clarifying with the patient what the next step is, answering any questions and giving further advice on treatment if conditions do not improve or there is a need for follow-up. Participation of family members can also be helpful to improve reciprocal understanding and safety. CONCLUSIONS The findings have relevance for future implementation of VCs and deserve further exploration under less stressful circumstances.
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Affiliation(s)
- Børge Lønnebakke Norberg
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Linn Okkenhaug Getz
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Bjarne Austad
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Transparency in persuasive technology, immersive technology, and online marketing: Facilitating users’ informed decision making and practical implications. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2022.107545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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van de Vijver S, Tensen P, Asiki G, Requena-Méndez A, Heidenrijk M, Stronks K, Cobelens F, Bont J, Agyemang C. Digital health for all: How digital health could reduce inequality and increase universal health coverage. Digit Health 2023; 9:20552076231185434. [PMID: 37434727 PMCID: PMC10331232 DOI: 10.1177/20552076231185434] [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: 10/26/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023] Open
Abstract
Digital transformation in health care has a lot of opportunities to improve access and quality of care. However, in reality not all individuals and communities are benefiting equally from these innovations. People in vulnerable conditions, already in need of more care and support, are often not participating in digital health programs. Fortunately, numerous initiatives worldwide are committed to make digital health accessible to all citizens, stimulating the long-cherished global pursuit of universal health coverage. Unfortunately initiatives are not always familiar with each other and miss connection to jointly make a significant positive impact. To reach universal health coverage via digital health it is necessary to facilitate mutual knowledge exchange, both globally and locally, to link initiatives and apply academic knowledge into practice. This will support policymakers, health care providers and other stakeholders to ensure that digital innovations can increase access to care for everyone, leading towards Digital health for all.
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Affiliation(s)
- Steven van de Vijver
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Family Medicine Department, OLVG Hospital, Amsterdam, The Netherlands
| | - Paulien Tensen
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Ana Requena-Méndez
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Barcelona Institute for Global Health, ISGlobal, University of Barcelona, Barcelona, Spain
| | - Michiel Heidenrijk
- Amsterdam Health & Technology Institute, Amsterdam, The Netherlands
- Joep Lange Institute, Amsterdam, The Netherlands
| | - Karien Stronks
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank Cobelens
- Department of Global Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jettie Bont
- Department of Family Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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13
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Neves AL, Burgers J. Digital technologies in primary care: Implications for patient care and future research. Eur J Gen Pract 2022; 28:203-208. [PMID: 35815445 PMCID: PMC9278419 DOI: 10.1080/13814788.2022.2052041] [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] [Indexed: 11/03/2022] Open
Abstract
Digital health is the convergence of digital technologies with health, healthcare, living, and society. Contrasting with the slow trend during the last decades, in the last few years, we have observed an expansion and widespread adoption and implementation. In this paper, we revisit the potential that digital health presents for the delivery of higher quality, safer and more equitable care. Focussing on three examples - patient access to health records, big data analytics, and virtual care - we discuss the emerging opportunities and challenges of digital health, and how they can change primary care. We also reflect on the implications for research to evaluate digital interventions: the need to evaluate clear outcomes in light of the six dimensions of quality of care (patient-centredness, efficiency, effectiveness, safety, timeliness, and equity); to define clear populations to understand what works and for which patients; and to involve different stakeholders in the formulation and evaluation of the research questions. Finally, we share five wishes for the future of digital care in General Practice: the involvement of primary healthcare professionals and patients in the design and maintenance of digital solutions; improving infrastructure, support, and training; development of clear regulations and best practice standards; ensuring patient safety and privacy; and working towards more equitable digital solutions, that leave no one behind.
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Affiliation(s)
- Ana Luísa Neves
- NIHR Imperial Patient Safety Translational Research Centre, Imperial College London, London, UK.,Centre for Health Technology and Services Research/Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jako Burgers
- Department Family Medicine, Care and Public Health Research Institute, Maastricht, The Netherlands.,Dutch College of General Practitioners, Utrecht, The Netherlands
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14
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d'Elia A, Gabbay M, Rodgers S, Kierans C, Jones E, Durrani I, Thomas A, Frith L. Artificial intelligence and health inequities in primary care: a systematic scoping review and framework. Fam Med Community Health 2022; 10:fmch-2022-001670. [PMID: 36450391 PMCID: PMC9716837 DOI: 10.1136/fmch-2022-001670] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE Artificial intelligence (AI) will have a significant impact on healthcare over the coming decade. At the same time, health inequity remains one of the biggest challenges. Primary care is both a driver and a mitigator of health inequities and with AI gaining traction in primary care, there is a need for a holistic understanding of how AI affect health inequities, through the act of providing care and through potential system effects. This paper presents a systematic scoping review of the ways AI implementation in primary care may impact health inequity. DESIGN Following a systematic scoping review approach, we searched for literature related to AI, health inequity, and implementation challenges of AI in primary care. In addition, articles from primary exploratory searches were added, and through reference screening.The results were thematically summarised and used to produce both a narrative and conceptual model for the mechanisms by which social determinants of health and AI in primary care could interact to either improve or worsen health inequities.Two public advisors were involved in the review process. ELIGIBILITY CRITERIA Peer-reviewed publications and grey literature in English and Scandinavian languages. INFORMATION SOURCES PubMed, SCOPUS and JSTOR. RESULTS A total of 1529 publications were identified, of which 86 met the inclusion criteria. The findings were summarised under six different domains, covering both positive and negative effects: (1) access, (2) trust, (3) dehumanisation, (4) agency for self-care, (5) algorithmic bias and (6) external effects. The five first domains cover aspects of the interface between the patient and the primary care system, while the last domain covers care system-wide and societal effects of AI in primary care. A graphical model has been produced to illustrate this. Community involvement throughout the whole process of designing and implementing of AI in primary care was a common suggestion to mitigate the potential negative effects of AI. CONCLUSION AI has the potential to affect health inequities through a multitude of ways, both directly in the patient consultation and through transformative system effects. This review summarises these effects from a system tive and provides a base for future research into responsible implementation.
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Affiliation(s)
- Alexander d'Elia
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Sarah Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Ciara Kierans
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Elisa Jones
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | | | - Lucy Frith
- Centre for Social Ethics & Policy, The University of Manchester, Manchester, UK
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15
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Pinnock H, Murphie P, Vogiatzis I, Poberezhets V. Telemedicine and virtual respiratory care in the era of COVID-19. ERJ Open Res 2022; 8:00111-2022. [PMID: 35891622 PMCID: PMC9131135 DOI: 10.1183/23120541.00111-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization defines telemedicine as “an interaction between a health care provider and a patient when the two are separated by distance”. The COVID-19 pandemic has forced a dramatic shift to telephone and video consulting for follow up and routine ambulatory care for reasons of infection control. Short Message Service (“text”) messaging has proved a useful adjunct to remote consulting allowing transfer of photographs and documents. Maintaining non-communicable diseases care is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of chronic obstructive pulmonary disease, digital support for asthma self-management, remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic, or to maintain safe routine diagnostic or treatment services.Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer-term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the “digital divide” excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the “new norm”.
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16
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Honkoop P, Usmani O, Bonini M. The Current and Future Role of Technology in Respiratory Care. Pulm Ther 2022; 8:167-179. [PMID: 35471689 PMCID: PMC9039604 DOI: 10.1007/s41030-022-00191-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
Over the past few decades, technology and improvements in artificial intelligence have dramatically changed major sectors of our day-to-day lives, including the field of healthcare. E-health includes a wide range of subdomains, such as wearables, smart-inhalers, portable electronic spirometers, digital stethoscopes, and clinical decision support systems. E-health has been consistently shown to enhance the quality of care, improve adherence to therapy, and allow early detection of worsening in chronic pulmonary diseases. The present review addresses the current and potential future role of major e-health tools and approaches in respiratory medicine, with the aim of providing readers with trustful and updated evidence to increase their awareness of the topic, and to allow them to optimally benefit from the latest innovation technology. Collected literature evidence shows that the potential of technology tools in respiratory medicine mainly relies on three fundamental interactions: between clinicians, between clinician and patient, and between patient and health technology. However, it would be desirable to establish widely agreed and adopted standards for conducting trials and reporting results in this area, as well as to take into proper consideration potentially relevant pitfalls related to privacy protection and compliance with regulatory procedures.
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Affiliation(s)
- Persijn Honkoop
- Dept of Biomedical Data Sciences, Section of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Omar Usmani
- National Heart and Lung Institute (NHLI), Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK.
| | - Matteo Bonini
- National Heart and Lung Institute (NHLI), Imperial College London, Guy Scadding Building, Dovehouse Street, London, SW3 6LY, UK.,Department of Cardiovascular and Thoracic Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.,Department of Clinical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy
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17
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Tossaint-Schoenmakers R, Kasteleyn MJ, Rauwerdink A, Chavannes N, Willems S, Talboom-Kamp EPWA. Development of a quality management model and self-assessment questionnaire for hybrid health care: a concept mapping study (Preprint). JMIR Form Res 2022; 6:e38683. [PMID: 35797097 PMCID: PMC9305399 DOI: 10.2196/38683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/01/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Unilabs Netherlands, Utrecht, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Marise J Kasteleyn
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Anneloek Rauwerdink
- Department of Surgery, Gastroenterology and Metabolism, Amsterdam University Medical Centre, Amsterdam, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Sofie Willems
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther P W A Talboom-Kamp
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- Unilabs Group, Geneve, Switzerland
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18
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Boudewijns E, Gidding-Slok A, Burgers J. Samen sterk door persoonsgerichte en digitale zorg. HUISARTS EN WETENSCHAP 2022; 65:14-18. [PMID: 35309971 PMCID: PMC8920056 DOI: 10.1007/s12445-022-1423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Digitale zorg voor chronische patiënten heeft zich in de huisartsenpraktijk de afgelopen jaren stormachtig ontwikkeld, mede door COVID-19. Past die ontwikkeling wel bij persoonsgerichte zorg? Het NHG-Standpunt E-health voor huisarts en patiënt uit 2015 is positief-kritisch en ook de auteurs van deze beschouwing denken dat het kan. Ze geven nieuwe voorbeelden uit de praktijk die dat bevestigen, maar stippen ook de randvoorwaarden aan: training, toegankelijkheid en verder onderzoek naar de effecten.
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Affiliation(s)
- Esther Boudewijns
- Promovendus huisartsgeneeskunde, Universiteit Maastricht, afdeling Huisartsgeneeskunde, Maastricht, Nederland
| | - Annerika Gidding-Slok
- Onderzoeker, Universiteit Maastricht, afdeling Huisartsgeneeskunde, Maastricht, Nederland
| | - Jako Burgers
- Huisarts, leerstoelhouder Nederlands Huisartsen Genootschap ‘Bevorderen van persoonsgerichte zorg in richtlijnen’., NHG, Utrecht, Nederland
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19
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Silven AV, van Peet PG, Boers SN, Tabak M, de Groot A, Hendriks D, van Os HJA, Bonten TN, Atsma DE, de Graaf TJ, Sombroek MP, Chavannes NH, Villalobos-Quesada M. Clarifying responsibility: professional digital health in the doctor-patient relationship, recommendations for physicians based on a multi-stakeholder dialogue in the Netherlands. BMC Health Serv Res 2022; 22:129. [PMID: 35094713 PMCID: PMC8801038 DOI: 10.1186/s12913-021-07316-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 11/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background Implementation of digital health (eHealth) generally involves adapting pre-established and carefully considered processes or routines, and still raises multiple ethical and legal dilemmas. This study aimed to identify challenges regarding responsibility and liability when prescribing digital health in clinical practice. This was part of an overarching project aiming to explore the most pressing ethical and legal obstacles regarding the implementation and adoption of digital health in the Netherlands, and to propose actionable solutions. Methods A series of multidisciplinary focus groups with stakeholders who have relevant digital health expertise were analysed through thematic analysis. Results The emerging general theme was ‘uncertainty regarding responsibilities’ when adopting digital health. Key dilemmas take place in clinical settings and within the doctor-patient relationship (‘professional digital health’). This context is particularly challenging because different stakeholders interact. In the absence of appropriate legal frameworks and codes of conduct tailored to digital health, physicians’ responsibility is to be found in their general duty of care. In other words: to do what is best for patients (not causing harm and doing good). Professional organisations could take a leading role to provide more clarity with respect to physicians’ responsibility, by developing guidance describing physicians’ duty of care in the context of digital health, and to address the resulting responsibilities. Conclusions Although legal frameworks governing medical practice describe core ethical principles, rights and obligations of physicians, they do not suffice to clarify their responsibilities in the setting of professional digital health. Here we present a series of recommendations to provide more clarity in this respect, offering the opportunity to improve quality of care and patients’ health. The recommendations can be used as a starting point to develop professional guidance and have the potential to be adapted to other healthcare professionals and systems. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07316-0.
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20
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Samal L, Fu HN, Camara DS, Wang J, Bierman AS, Dorr DA. Health information technology to improve care for people with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:1006-1036. [PMID: 34363220 PMCID: PMC8515226 DOI: 10.1111/1475-6773.13860] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. DATA SOURCES We searched MEDLINE, CINAHL, PsycINFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020. STUDY DESIGN We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making. DATA COLLECTION/EXTRACTION METHODS Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers. PRINCIPAL FINDINGS The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality. CONCLUSIONS Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC.
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Affiliation(s)
- Lipika Samal
- Brigham and Women's HospitalBostonMAUSA
- Harvard Medical SchoolBostonMAUSA
| | - Helen N. Fu
- Indiana University Richard M. Fairbanks School of Public HealthIndianapolisINUSA
- Regenstrief InstituteCenter for Biomedical InformaticsIndianapolisINUSA
| | - Djibril S. Camara
- Center for Disease Control and Prevention, Center for Surveillance, Epidemiology, and Laboratory Services (CSELS) Division of Scientific Education and Professional Development, Public Health Informatics Fellowship ProgramAtlantaGeorgiaUSA
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
| | - Jing Wang
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
- Florida State University College of NursingTallahasseeFloridaUSA
- Health and Aging Policy Fellows Program at Columbia UniversityNew YorkNYUSA
| | - Arlene S. Bierman
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and QualityRockvilleMDUSA
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21
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Versluis A, van Luenen S, Meijer E, Honkoop PJ, Pinnock H, Mohr DC, Neves AL, Chavannes NH, van der Kleij RMJJ. SERIES: eHealth in primary care. Part 4: Addressing the challenges of implementation. Eur J Gen Pract 2021; 26:140-145. [PMID: 33025820 PMCID: PMC7580793 DOI: 10.1080/13814788.2020.1826431] [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] [Indexed: 11/12/2022] Open
Abstract
Background The implementation of eHealth applications in primary care remains challenging. Enhancing knowledge and awareness of implementation determinants is critical to build evidence-based implementation strategies and optimise uptake and sustainability. Objectives We consider how evidence-based implementation strategies can be built to support eHealth implementation. Discussion What implementation strategies to consider depends on (potential) barriers and facilitators to eHealth implementation in a given situation. Therefore, we first discuss key barriers and facilitators following the five domains of the Consolidated Framework for Implementation Research (CFIR). Cost is identified as a critical barrier to eHealth implementation. Privacy, security problems, and a lack of recognised standards for eHealth applications also hinder implementation. Engagement of key stakeholders in the implementation process, planning the implementation of the intervention, and the availability of training and support are important facilitators. To support care professionals and researchers, we provide a stepwise approach to develop and apply evidence-based implementation strategies for eHealth in primary care. It includes the following steps: (1) specify the eHealth application, (2) define problem, (3) specify desired implementation behaviour, and (4) choose and (5) evaluate the implementation strategy. To improve the fit of the implementation strategy with the setting, the stepwise approach considers the phase of the implementation process and the specific context. Conclusion Applying an approach, as provided here, may help to improve the implementation of eHealth applications in primary care.
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Affiliation(s)
- Anke Versluis
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands.,Section of Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | | | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Ana Luisa Neves
- Institute of Global Health Innovation, Imperial College London, London, UK.,Center for Health Technology and Services Research (CINTESIS)/Department of Community Medicine, Health Information and Decision (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, the Netherlands.,National eHealth Living Lab (NeLL), Leiden, the Netherlands
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22
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Houwink EJF, Kasteleyn MJ, Alpay L, Pearce C, Butler-Henderson K, Meijer E, van Kampen S, Versluis A, Bonten TN, van Dalfsen JH, van Peet PG, Koster Y, Hierck BP, Jeeninga I, van Luenen S, van der Kleij RMJJ, Chavannes NH, Kramer AWM. SERIES: eHealth in primary care. Part 3: eHealth education in primary care. Eur J Gen Pract 2021; 26:108-118. [PMID: 32757859 PMCID: PMC7470053 DOI: 10.1080/13814788.2020.1797675] [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] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Education is essential to the integration of eHealth into primary care, but eHealth is not yet embedded in medical education. OBJECTIVES In this opinion article, we aim to support organisers of Continuing Professional Development (CPD) and teachers delivering medical vocational training by providing recommendations for eHealth education. First, we describe what is required to help primary care professionals and trainees learn about eHealth. Second, we elaborate on how eHealth education might be provided. DISCUSSION We consider four essential topics. First, an understanding of existing evidence-based eHealth applications and conditions for successful development and implementation. Second, required digital competencies of providers and patients. Third, how eHealth changes patient-provider and provider-provider relationships and finally, understanding the handling of digital data. Educational activities to address these topics include eLearning, blended learning, courses, simulation exercises, real-life practice, supervision and reflection, role modelling and community of practice learning. More specifically, a CanMEDS framework aimed at defining curriculum learning goals can support eHealth education by describing roles and required competencies. Alternatively, Kern's conceptual model can be used to design eHealth training programmes that match the educational needs of the stakeholders using eHealth. CONCLUSION Vocational and CPD training in General Practice needs to build on eHealth capabilities now. We strongly advise the incorporation of eHealth education into vocational training and CPD activities, rather than providing it as a separate single module. How learning goals and activities take shape and how competencies are evaluated clearly requires further practice, evaluation and study.
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Affiliation(s)
- Elisa J F Houwink
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Laurence Alpay
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Christopher Pearce
- Centre for Transformation in Digital Health, University of Melbourne, Melbourne, Australia.,Department of General Practice, Monash University, Melbourne, Australia
| | | | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Sanne van Kampen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Tobias N Bonten
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Jens H van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Petra G van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ybranda Koster
- Medical Technology Research Group, Inholland University of Applied Science, Haarlem, The Netherlands
| | - Beerend P Hierck
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands.,Leiden Teachers' Academy, Leiden University, Leiden, The Netherlands
| | - Ilke Jeeninga
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, The Netherlands
| | - Sanne van Luenen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NELL), Leiden, The Netherlands
| | - Anneke W M Kramer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
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23
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Kasteleyn MJ, Versluis A, van Peet P, Kirk UB, van Dalfsen J, Meijer E, Honkoop P, Ho K, Chavannes NH, Talboom-Kamp EPWA. SERIES: eHealth in primary care. Part 5: A critical appraisal of five widely used eHealth applications for primary care - opportunities and challenges. Eur J Gen Pract 2021; 27:248-256. [PMID: 34432601 PMCID: PMC8405089 DOI: 10.1080/13814788.2021.1962845] [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] [Indexed: 11/21/2022] Open
Abstract
Background Given the pressure on modern healthcare systems, eHealth can offer valuable opportunities. However, understanding the potential and challenges of eHealth in daily practice can be challenging for many general practitioners (GPs) and their staff. Objectives To critically appraise five widely used eHealth applications, in relation to safe, evidence-based and high-quality eHealth. Using these applications as examples, we aim to increase understanding of eHealth among GPs and highlight the opportunities and challenges presented by eHealth. Discussion eHealth applications can support patients while increasing efficiency for GPs. A three-way division (inform, monitor, track; interaction; data utilisation) characterises many eHealth applications, with an increasing degree of complexity depending on the domain. All applications provide information and some have extra functionalities that promote interaction, while data analysis and artificial intelligence may be applied to support or (fully) automate care processes. Applications in the inform domain are relatively easy to use and implement but their impact on clinical outcomes may be limited. More demanding applications, in terms of privacy and ethical aspects, are found in the data utilisation domain and may potentially have a more significant impact on care processes and patient outcomes. When selecting and implementing eHealth applications, we recommend that GPs remain critical regarding preconditions on safe, evidence-based and high-quality eHealth, particularly in the case of more complex applications in the data utilisation domain.
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Affiliation(s)
- Marise J Kasteleyn
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Anke Versluis
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Petra van Peet
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands
| | - Ulrik Bak Kirk
- The Research Unit for General Practice, Aarhus, Denmark.,The European Society for Quality and Safety in Family Practice (EQuiP), Aarhus, Denmark
| | - Jens van Dalfsen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | | | - Kendall Ho
- Faculty of Medicine, eHealth Strategy Office, University of British Columbia, Vancouver, Canada
| | - Niels H Chavannes
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands
| | - Esther P W A Talboom-Kamp
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Centre, Leiden, The Netherlands.,National eHealth Living Lab (NeLL), Leiden, The Netherlands.,Saltro Diagnostic Center, Utrecht, The Netherlands
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24
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Clinical Decision Support Systems for Diagnosis in Primary Care: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168435. [PMID: 34444182 PMCID: PMC8391274 DOI: 10.3390/ijerph18168435] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 01/18/2023]
Abstract
Diagnosis is one of the crucial tasks performed by primary care physicians; however, primary care is at high risk of diagnostic errors due to the characteristics and uncertainties associated with the field. Prevention of diagnostic errors in primary care requires urgent action, and one of the possible methods is the use of health information technology. Its modes such as clinical decision support systems (CDSS) have been demonstrated to improve the quality of care in a variety of medical settings, including hospitals and primary care centers, though its usefulness in the diagnostic domain is still unknown. We conducted a scoping review to confirm the usefulness of the CDSS in the diagnostic domain in primary care and to identify areas that need to be explored. Search terms were chosen to cover the three dimensions of interest: decision support systems, diagnosis, and primary care. A total of 26 studies were included in the review. As a result, we found that the CDSS and reminder tools have significant effects on screening for common chronic diseases; however, the CDSS has not yet been fully validated for the diagnosis of acute and uncommon chronic diseases. Moreover, there were few studies involving non-physicians.
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Wattanapisit A, Amaek W, Wattanapisit S, Tuangratananon T, Wongsiri S, Pengkaew P. Challenges of Implementing an mHealth Application for Personalized Physical Activity Counselling in Primary Health Care: A Qualitative Study. Int J Gen Med 2021; 14:3821-3831. [PMID: 34335048 PMCID: PMC8318008 DOI: 10.2147/ijgm.s317241] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction A mobile health (mHealth) technology has the potential to facilitate personalized physical activity (PA) counselling. We aimed to explore the feasibility and challenges of implementing a newly developed mHealth application (PAC app) for personalized PA counselling. Material and Methods A qualitative design employed a descriptive phenomenology approach. Data were collected through focus group discussions (FGDs) with primary health care (PHC) providers and were analyzed using a deductive thematic approach. Results A total of 16 participants participated in four FGDs. Four major themes were found: application for personalized PA counselling, barriers to the use of the application by providers, patient involvement, and impact on PHC services. Discussion The results showed that the new mHealth application can potentially facilitate PA counselling. However, its use in PHC settings requires an understanding of the context of service delivery; the challenges faced by providers and patients and effects on services must be considered. Conclusion Future research should focus on the long-term use of PAC app and its impact on behavioral and health outcomes.
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Affiliation(s)
- Apichai Wattanapisit
- School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | - Waluka Amaek
- College of Graduate Studies, Walailak University, Nakhon Si Thammarat, Thailand
| | | | | | - Sunton Wongsiri
- Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Prasert Pengkaew
- School of Informatics, Walailak University, Nakhon Si Thammarat, Thailand
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Abstract
This article reflects on the breadth of digital developments seen in primary care over time, as well as the rapid and significant changes prompted by the COVID-19 crisis. Recent research and experience have shone further light on factors influencing the implementation and usefulness of these approaches, as well as unresolved challenges and unintended consequences. These are considered in relation to not only digital technology and infrastructure, but also wider aspects of health systems, the nature of primary care work and culture, patient characteristics and inequalities, and ethical issues around data privacy, inclusion, empowerment, empathy and trust. Implications for the future direction and sustainability of these approaches are discussed, taking account of novel paradigms, such as artificial intelligence, and the growing capture of primary care data for secondary uses. Decision makers are encouraged to think holistically about where value is most likely to be added, or risks being taken away, when judging which innovations to carry forward. It concludes that, while responding to this public health emergency has created something of a digital 'big bang' for primary care, an incremental, adaptive, patient-centered strategy, focused on augmenting rather than replacing existing services, is likely to prove most fruitful in the longer term.
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Affiliation(s)
- Claudia Pagliari
- Global eHealth Group, Usher Institute, Edinburgh Global Health Academy & Centre for Population Health Sciences, The University of Edinburgh Medical School, Edinburgh, UK
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27
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E-healthonderwijs is een nieuwe uitdaging voor de huisartsopleiding. ACTA ACUST UNITED AC 2021; 64:19-22. [PMID: 34092805 PMCID: PMC8169429 DOI: 10.1007/s12445-021-1169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Om goed voorbereid te zijn op de toekomst moeten aiossen zich ook in e-health verdiepen. Bij de huisartsopleiding ligt de nadruk echter meer op praktijkleren, waardoor nieuwe ontwikkelingen als e-health niet altijd voldoende aandacht krijgen. Aiossen moeten ook maar net een opleider treffen die zich met e-health bezighoudt. E-health verdient meer aandacht tijdens de opleiding, wat zowel de aios, de opleider als de docent ten goede zal komen.
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Tossaint-Schoenmakers R, Versluis A, Chavannes N, Talboom-Kamp E, Kasteleyn M. The Challenge of Integrating eHealth Into Health Care: Systematic Literature Review of the Donabedian Model of Structure, Process, and Outcome. J Med Internet Res 2021; 23:e27180. [PMID: 33970123 PMCID: PMC8145079 DOI: 10.2196/27180] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Health care organizations are increasingly working with eHealth. However, the integration of eHealth into regular health care is challenging. It requires organizations to change the way they work and their structure and care processes to be adapted to ensure that eHealth supports the attainment of the desired outcomes. OBJECTIVE The aims of this study are to investigate whether there are identifiable indicators in the structure, process, and outcome categories that are related to the successful integration of eHealth in regular health care, as well as to investigate which indicators of structure and process are related to outcome indicators. METHODS A systematic literature review was conducted using the Donabedian Structure-Process-Outcome (SPO) framework to identify indicators that are related to the integration of eHealth into health care organizations. Data extraction sheets were designed to provide an overview of the study characteristics, eHealth characteristics, and indicators. The extracted indicators were organized into themes and subthemes of the structure, process, and outcome categories. RESULTS Eleven studies were included, covering a variety of study designs, diseases, and eHealth tools. All studies identified structure, process, and outcome indicators that were potentially related to the integration of eHealth. The number of indicators found in the structure, process, and outcome categories was 175, 84, and 88, respectively. The themes with the most-noted indicators and their mutual interaction were inner setting (51 indicators, 16 interactions), care receiver (40 indicators, 11 interactions), and technology (38 indicators, 12 interactions)-all within the structure category; health care actions (38 indicators, 15 interactions) within the process category; and efficiency (30 indicators, 15 interactions) within the outcome category. In-depth examination identified four most-reported indicators, namely "deployment of human resources" (n=11), in the inner setting theme within the structure category; "ease of use" (n=16) and "technical issue" (n=10), both in the technology theme within the structure category; and "health logistics" (n=26), in the efficiency theme within the outcome category. CONCLUSIONS Three principles are important for the successful integration of eHealth into health care. First, the role of the care receiver needs to be incorporated into the organizational structure and daily care process. Second, the technology must be well attuned to the organizational structure and daily care process. Third, the deployment of human resources to the daily care processes needs to be aligned with the desired end results. Not adhering to these points could negatively affect the organization, daily process, or the end results.
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Affiliation(s)
- Rosian Tossaint-Schoenmakers
- Saltro Diagnostic Centre, Utrecht, Netherlands.,National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Anke Versluis
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels Chavannes
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther Talboom-Kamp
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands.,Unilabs Group, Geneva, Switzerland
| | - Marise Kasteleyn
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands.,Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands
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Garattini L, Badinella Martini M, Zanetti M. More room for telemedicine after COVID-19: lessons for primary care? THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:183-186. [PMID: 33231825 PMCID: PMC7683583 DOI: 10.1007/s10198-020-01248-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy.
| | | | - Michele Zanetti
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, Italy
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Wattanapisit A, Wattanapisit S, Tuangratananon T, Amaek W, Wongsiri S, Petchuay P. Primary Health Care Providers' Perspectives on Developing an eHealth Tool for Physical Activity Counselling: A Qualitative Study. J Multidiscip Healthc 2021; 14:321-333. [PMID: 33603391 PMCID: PMC7882433 DOI: 10.2147/jmdh.s298390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose Physical inactivity is a global health concern. Physical activity (PA) counselling is an effective intervention for promoting PA in primary health care (PHC) settings. The use of electronic health (eHealth) technology has the potential to support PA counselling. This study aimed to explore PHC providers’ perspectives on the development of an eHealth tool to aid PA counselling in the resource-limited settings. Methods This qualitative study employed interpretive phenomenology. The study was conducted at hospital-based PHC clinics among physicians and registered nurses. Data collection involved in-depth interviews (IDIs) and focus group discussions (FGDs). An inductive thematic approach was used to analyze the data. Results Three physicians participated in three IDIs and 12 nurses participated in four FGDs at three hospitals. The median age of the participants was 43 years. Participants saw 15–100 patients/day (median 40) and spent 2–20 min with each patient (median 5). Three themes emerged. Theme 1: requirements for PA counselling: the participants reflected the needs and characteristics of eHealth tool that may support PA counselling. Theme 2: enabling an eHealth tool for PA counselling: the eHealth should be easy to use, provide PA prescription function, and support follow-up PA counselling. Theme 3: reducing barriers to PA counselling: the eHealth tool was expected to help reduce service and workforce barriers and patients’ limitations. Conclusion A well-designed and practical eHealth tool has the potential to improve PA counselling practice in PHC settings. The eHealth tool may affect an indirect mechanism to reduce barriers to PA counselling. Future research should focus on the usability and utility as well as the process evaluation of the PA counselling eHealth tool that will be implemented in resource-limited settings.
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Affiliation(s)
- Apichai Wattanapisit
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand.,Family Medicine Clinic, Walailak University Hospital, Nakhon Si Thammarat, Thailand
| | | | | | - Waluka Amaek
- College of Graduate Studies, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sunton Wongsiri
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Prachyapan Petchuay
- Department of Clinical Medicine, School of Medicine, Walailak University, Nakhon Si Thammarat, Thailand
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Using Personal Genomic Data within Primary Care: A Bioinformatics Approach to Pharmacogenomics. Genes (Basel) 2020; 11:genes11121443. [PMID: 33266138 PMCID: PMC7761137 DOI: 10.3390/genes11121443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
One application of personalized medicine is the tailoring of medication to the individual, so that the medication will have the highest chance of success. In order to individualize medication, one must have a complete inventory of all current pharmaceutical compounds (a detailed formulary) combined with pharmacogenetic datasets, the genetic makeup of the patient, their (medical) family history and other health-related data. For healthcare professionals to make the best use of this information, it must be visualized in a way that makes the most medically relevant data accessible for their decision-making. Similarly, to enable bioinformatics analysis of these data, it must be prepared and provided through an interface for controlled computational analysis. Due to the high degree of personal information gathered for such initiatives, privacy-sensitive implementation choices and ethical standards are paramount. The Personal Genetic Locker project provides an approach to enable the use of personal genomic data in primary care. In this paper, we provide a description of the Personal Genetic Locker project and show its utility through a use case based on open standards, which is illustrated by the 4MedBox system.
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Affiliation(s)
- Hans Thulesius
- Swedish National Editor, Editorial Board Scandinavian Journal of Primary Health Care, Adjunct and Associate Professor of General Practice, Linnaeus University Kalmar and Lund University, Sweden
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