1
|
Abdolkhani R, Gray K, Borda A, DeSouza R. Recommendations for the Quality Management of Patient-Generated Health Data in Remote Patient Monitoring: Mixed Methods Study. JMIR Mhealth Uhealth 2023; 11:e35917. [PMID: 36826986 PMCID: PMC10007009 DOI: 10.2196/35917] [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: 12/23/2021] [Revised: 04/01/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patient-generated health data (PGHD) collected from innovative wearables are enabling health care to shift to outside clinical settings through remote patient monitoring (RPM) initiatives. However, PGHD are collected continuously under the patient's responsibility in rapidly changing circumstances during the patient's daily life. This poses risks to the quality of PGHD and, in turn, reduces their trustworthiness and fitness for use in clinical practice. OBJECTIVE Using a sociotechnical health informatics lens, we developed a data quality management (DQM) guideline for PGHD captured from wearable devices used in RPM with the objective of investigating how DQM principles can be applied to ensure that PGHD can reliably inform clinical decision-making in RPM. METHODS First, clinicians, health information specialists, and MedTech industry representatives with experience in RPM were interviewed to identify DQM challenges. Second, these stakeholder groups were joined by patient representatives in a workshop to co-design potential solutions to meet the expectations of all the stakeholders. Third, the findings, along with the literature and policy review results, were interpreted to construct a guideline. Finally, we validated the guideline through a Delphi survey of international health informatics and health information management experts. RESULTS The guideline constructed in this study comprised 19 recommendations across 7 aspects of DQM. It explicitly addressed the needs of patients and clinicians but implied that there must be collaboration among all stakeholders to meet these needs. CONCLUSIONS The increasing proliferation of PGHD from wearables in RPM requires a systematic approach to DQM so that these data can be reliably used in clinical care. The developed guideline is an important next step toward safe RPM.
Collapse
Affiliation(s)
- Robab Abdolkhani
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
- Department of General Practice, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Kathleen Gray
- Centre for Digital Transformation of Health, The University of Melbourne, Melbourne, Australia
| | - Ann Borda
- Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Ruth DeSouza
- School of Art, Royal Melbourne Institue of Technology University, Melbourne, Australia
| |
Collapse
|
2
|
Koehle H, Kronk C, Lee YJ. Digital Health Equity: Addressing Power, Usability, and Trust to Strengthen Health Systems. Yearb Med Inform 2022; 31:20-32. [PMID: 36463865 PMCID: PMC9719765 DOI: 10.1055/s-0042-1742512] [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: 12/05/2022] Open
Abstract
BACKGROUND Without specific attention to health equity considerations in design, implementation, and evaluation, the rapid expansion of digital health approaches threatens to exacerbate rather than ameliorate existing health disparities. METHODS We explored known factors that increase digital health inequity to contextualize the need for equity-centered informatics. This work used a narrative review method to summarize issues about inequities in digital health and to discuss future directions for researchers and clinicians. We searched literature using a combination of relevant keywords (e.g., "digital health", "health equity", etc.) using PubMed and Google Scholar. RESULTS We have highlighted strategies for addressing medical marginalization in informatics according to vectors of power such as race and ethnicity, gender identity and modality, sexuality, disability, housing status, citizenship status, and criminalization status. CONCLUSIONS We have emphasized collaboration with user and patient groups to define priorities, ensure accessibility and localization, and consider risks in development and utilization of digital health tools. Additionally, we encourage consideration of potential pitfalls in adopting these diversity, equity, and inclusion (DEI)-related strategies.
Collapse
Affiliation(s)
- Han Koehle
- Student Affairs Health Equity Initiative, University of California Santa Barbara, Santa Barbara, California, USA
| | - Clair Kronk
- Center for Medical Informatics, Yale University School of Medicine, Connecticut, USA,Correspondence to: Clair Kronk Center for Medical Informatics, Yale School of Medicine300 George Street, PO Box 208009 New Haven, CT 06520USA
| | - Young Ji Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Rajamani G, Rodriguez Espinosa P, Rosas LG. Intersection of Health Informatics Tools and Community Engagement in Health-Related Research to Reduce Health Inequities: Scoping Review. J Particip Med 2021; 13:e30062. [PMID: 34797214 PMCID: PMC8663666 DOI: 10.2196/30062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The exponential growth of health information technology has the potential to facilitate community engagement in research. However, little is known about the use of health information technology in community-engaged research, such as which types of health information technology are used, which populations are engaged, and what are the research outcomes. OBJECTIVE The objectives of this scoping review were to examine studies that used health information technology for community engagement and to assess (1) the types of populations, (2) community engagement strategies, (3) types of health information technology tools, and (4) outcomes of interest. METHODS We searched PubMed and PCORI Literature Explorer using terms related to health information technology, health informatics, community engagement, and stakeholder involvement. This search process yielded 967 papers for screening. After inclusion and exclusion criteria were applied, a total of 37 papers were analyzed for key themes and for approaches relevant to health information technology and community engagement research. RESULTS This analysis revealed that the communities engaged were generally underrepresented populations in health-related research, including racial or ethnic minority communities such as Black/African American, American Indian/Alaska Native, Latino ethnicity, and communities from low socioeconomic backgrounds. The studies focused on various age groups, ranging from preschoolers to older adults. The studies were also geographically spread across the United States and the world. Community engagement strategies included collaborative development of health information technology tools and partnerships to promote use (encompassing collaborative development, use of community advisory boards, and focus groups for eliciting information needs) and use of health information technology to engage communities in research (eg, through citizen science). The types of technology varied across studies, with mobile or tablet-based apps being the most common platform. Outcomes measured included eliciting user needs and requirements, assessing health information technology tools and prototypes with participants, measuring knowledge, and advocating for community change. CONCLUSIONS This study illustrates the current landscape at the intersection of health information technology tools and community-engaged research approaches. It highlights studies in which various community-engaged research approaches were used to design culturally centered health information technology tools, to promote health information technology uptake, or for engagement in health research and advocacy. Our findings can serve as a platform for generating future research upon which to expand the scope of health information technology tools and their use for meaningful stakeholder engagement. Studies that incorporate community context and needs have a greater chance of cocreating culturally centered health information technology tools and better knowledge to promote action and improve health outcomes.
Collapse
Affiliation(s)
- Geetanjali Rajamani
- Department of Human Biology, Stanford University, Stanford, CA, United States
| | - Patricia Rodriguez Espinosa
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, School of Medicine, Stanford University, Stanford, CA, United States
| |
Collapse
|
4
|
McGraw D, Petersen C. From Commercialization to Accountability: Responsible Health Data Collection, Use, and Disclosure for the 21st Century. Appl Clin Inform 2020; 11:366-373. [PMID: 32434225 DOI: 10.1055/s-0040-1710392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Deven McGraw
- Ciitizen Corp., Palo Alto, California, United States
| | - Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| |
Collapse
|
5
|
Petersen C, Austin RR, Backonja U, Campos H, Chung AE, Hekler EB, Hsueh PYS, Kim KK, Pho A, Salmi L, Solomonides A, Valdez RS. Citizen science to further precision medicine: from vision to implementation. JAMIA Open 2020; 3:2-8. [PMID: 32607481 PMCID: PMC7309265 DOI: 10.1093/jamiaopen/ooz060] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/04/2019] [Accepted: 10/25/2019] [Indexed: 12/12/2022] Open
Abstract
The active involvement of citizen scientists in setting research agendas, partnering with academic investigators to conduct research, analyzing and disseminating results, and implementing learnings from research can improve both processes and outcomes. Adopting a citizen science approach to the practice of precision medicine in clinical care and research will require healthcare providers, researchers, and institutions to address a number of technical, organizational, and citizen scientist collaboration issues. Some changes can be made with relative ease, while others will necessitate cultural shifts, redistribution of power, recommitment to shared goals, and improved communication. This perspective, based on a workshop held at the 2018 AMIA Annual Symposium, identifies current barriers and needed changes to facilitate broad adoption of a citizen science-based approach in healthcare.
Collapse
Affiliation(s)
- Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Robin R Austin
- School of Nursing, University of Minnesota, Minneapolis, Minnesota, USA
| | - Uba Backonja
- Nursing & Healthcare Leadership, University of Washington Tacoma, Tacoma, Washington, USA
- Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hugo Campos
- Kaiser Permanente, Kaiser Permanente Innovation, Oakland, California, USA
| | - Arlene E Chung
- Departments of Internal Medicine and Pediatrics & the Program on Health & Clinical Informatics, UNC School of Medicine, Chapel Hill, North Carolina, USA
| | - Eric B Hekler
- Department of Family Medicine & Public Health, Center for Wireless & Population Health Systems, Design Lab, Qualcomm Institute, University of California-San Diego, San Diego, California, USA
| | - Pei-Yun S Hsueh
- Center for Computational Health, IBM TJ Watson Research Center, Yorktown Heights, New York, USA
| | - Katherine K Kim
- Betty Irene Moore School of Nursing, Department of Public Health Sciences-School of Medicine, University of California-Davis, Sacramento, California, USA
| | - Anthony Pho
- School of Nursing, Columbia University, New York, New York, USA
| | - Liz Salmi
- OpenNotes/Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Anthony Solomonides
- Family Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
| | - Rupa S Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| |
Collapse
|
6
|
Leung K, Lu-McLean D, Kuziemsky C, Booth RG, Collins Rossetti S, Borycki E, Strudwick G. Using Patient and Family Engagement Strategies to Improve Outcomes of Health Information Technology Initiatives: Scoping Review. J Med Internet Res 2019; 21:e14683. [PMID: 31596241 PMCID: PMC6806121 DOI: 10.2196/14683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/14/2019] [Accepted: 07/30/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use, and evaluation of these technologies. Despite knowing this, there is a lack of health care organizations using patient and family engagement strategies to enhance the use and adoption of health ITs, specifically. OBJECTIVE This study aimed to answer the following three research questions (RQs): (1) what current frameworks or theories have been used to guide patient and family engagement in health IT adoption, use, implementation, selection, and evaluation?, (2) what studies have been done on patient and family engagement strategies in health IT adoption, use, implementation, selection, and evaluation?, and (3) what patient and family engagement frameworks, studies, or resources identified in the literature can be applied to health IT adoption, use, implementation, selection, and evaluation? METHODS This scoping review used a five-step framework developed by Arksey and O'Malley and adapted by Levac et al. These steps include the following: (1) identifying the RQ, (2) identifying relevant studies, (3) selecting studies, (4) charting relevant data, and (5) summarizing and reporting the result. Retrieved academic and grey literature records were evaluated using a literature review software based on inclusion and exclusion criteria by two independent reviewers. If consensus was not achieved, two reviewers would resolve conflicts by discussion. Research findings and strategies were extracted from the studies and summarized in data tables. RESULTS A total of 35 academic articles and 23 gray literature documents met the inclusion criteria. In total, 20 of the 35 included studies have been published since 2017. Frameworks found include the patient engagement framework developed by Healthcare Information and Management Systems Society and the patient and family engagement framework proposed by Carman et al. Effective strategies include providing patients with clear expectations and responsibilities and providing reimbursement for time and travel. The gray literature sources outlined key considerations for planning and supporting engagement initiatives such as providing patients with professional development opportunities, and embedding patients in existing governance structures. CONCLUSIONS Several studies have reported their findings regarding successful strategies to engage patients and family members in health IT initiatives and the positive impact that can emerge when patients and family members are engaged in such initiatives in an effective manner. Currently, no framework has consolidated all of the key strategies and considerations that were found in this review to guide health care organizations when engaging patients and family members in a health IT-specific project or initiative. Further research to evaluate and validate the existing strategies would be of value.
Collapse
Affiliation(s)
- Kevin Leung
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | | | | | | | | |
Collapse
|
7
|
NØHR C, KUZIEMSKY CE, ELKIN PL, MARCILLY R, PELAYO S. Sustainable Health Informatics: Health Informaticians as Alchemists. Stud Health Technol Inform 2019; 265:3-11. [PMID: 31431570 PMCID: PMC7323624 DOI: 10.3233/shti190129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The digital transformation of health care delivery remains an elusive work in progress. Contextual variation continues to be a significant barrier to the development of sustainable health information systems. In this paper we characterize health informaticians as modern alchemists and use this characterization to describe informatics progress in addressing four key healthcare challenges. We highlight the need for informaticians to be diligent and loyal to basic methodological principles while also appreciating the role that contextual variation plays in informatics research. We also emphasize that meaningful health systems transformation takes time. The insight presented in this paper helps informaticians in our quest to develop sustainable health information systems.
Collapse
Affiliation(s)
- Christian NØHR
- Maersk Mc-Kinney Moller Institute, University of Southern Denmark
| | | | - Peter L. ELKIN
- Department of Biomedical Informatics, Jacobs School of Medicine, University at Buffalo, The State University of New York
| | - Romaric MARCILLY
- Univ. Lille, INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d’Investigation clinique, EA 2694, F-59000 Lille, France
| | - Sylvia PELAYO
- Univ. Lille, INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d’Investigation clinique, EA 2694, F-59000 Lille, France
| |
Collapse
|
8
|
Cahan EM, Frick SL. Orthopaedic phenotyping of NGLY1 deficiency using an international, family-led disease registry. Orphanet J Rare Dis 2019; 14:148. [PMID: 31217022 PMCID: PMC6584998 DOI: 10.1186/s13023-019-1131-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/12/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND NGLY1 deficiency is a rare autosomal recessive disorder caused by loss in enzymatic function of NGLY1, a peptide N-glycanase that has been shown to play a role in endoplasmic reticulum associated degradation (ERAD). ERAD dysfunction has been implicated in other well-described proteinopathies, such as Alzheimer's disease, Parkinson's disease, and Huntington's disease. The classical clinical tetrad includes developmental delay, hypolacrima, transiently elevated transaminases, and hyperkinetic movement disorders. The musculoskeletal system is also commonly affected, but the orthopaedic phenotype has been incompletely characterized. Best practices for orthopaedic clinical care have not been elucidated and considerable variability has resulted from this lack of evidence base. Our study surveyed patients enrolled in an international registry for NGLY1 deficiency in order to characterize the orthopaedic manifestations, sequelae, and management. RESULTS Our findings, encompassing the largest cohort for NGLY1 deficiency to date, detail levels of motor milestone achievement; physical exam findings; fracture rates/distribution; frequency of motor skill regression; non-pharmacologic and non-procedural interventions; pharmacologic therapies; and procedural interventions experienced by 29 participants. Regarding the orthopaedic phenotype, at time of survey response, we found that over 40% of patients experienced motor skill regression from their peak. Over 80% of patients had at least one orthopaedic diagnosis, and nearly two-thirds of the total had two or more. More than half of patients older than 6 years had sustained a fracture. Related to orthopaedic non-medical management, we found that 93 and 79% of patients had utilized physical therapy and non-operative orthoses, respectively. In turn, the vast majority took at least one medication (including for bone health and antispasmodic therapy). Finally, nearly half of patients had undergone an invasive procedure. Of those older than 6 years, two-thirds had one or more procedures. Stratification of these analyses by sex revealed distinctive differences in disease natural history and clinical management course. CONCLUSIONS These findings describing the orthopaedic natural history and standard of care in patients with NGLY1 deficiency can facilitate diagnosis, inform prognosis, and guide treatment recommendations in an evidence-based manner. Furthermore, the methodology is notable for its partnership with a disease-specific advocacy organization and may be generalizable to other rare disease populations. This study fills a void in the existing literature for this population and this methodology offers a precedent upon which future studies for rare diseases can build.
Collapse
Affiliation(s)
- Eli M Cahan
- New York University School of Medicine, New York, NY, 10010, USA.
- Department of Pediatric Orthopaedics, Stanford University, 300 Pasteur Drive, R107, Palo Alto, CA, 94305, USA.
| | - Steven L Frick
- Department of Pediatric Orthopaedics, Stanford University, 300 Pasteur Drive, R107, Palo Alto, CA, 94305, USA
| |
Collapse
|