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Rathbone A, Stumpf S, Claisse C, Sillence E, Coventry L, Brown RD, Durrant AC. People with long-term conditions sharing personal health data via digital health technologies: A scoping review to inform design. PLOS DIGITAL HEALTH 2023; 2:e0000264. [PMID: 37224154 DOI: 10.1371/journal.pdig.0000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
The use of digital technology amongst people living with a range of long-term health conditions to support self-management has increased dramatically. More recently, digital health technologies to share and exchange personal health data with others have been investigated. Sharing personal health data with others is not without its risks: sharing data creates threats to the privacy and security of personal data and plays a role in trust, adoption and continued use of digital health technology. Our work aims to inform the design of these digital health technologies by investigating the reported intentions of sharing health data with others, the associated user experiences when using these digital health technologies and the trust, identity, privacy and security (TIPS) considerations for designing digital health technologies that support the trusted sharing of personal health data to support the self-management of long-term health conditions. To address these aims, we conducted a scoping review, analysing over 12,000 papers in the area of digital health technologies. We conducted a reflexive thematic analysis of 17 papers that described digital health technologies that support sharing of personal health data, and extracted design implications that could enhance the future development of trusted, private and secure digital health technologies.
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Affiliation(s)
- Amy Rathbone
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Simone Stumpf
- School of Computing Science, University of Glasgow, Glasgow, United Kingdom
| | - Caroline Claisse
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Elizabeth Sillence
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Lynne Coventry
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - Richard D Brown
- Department of Psychology, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Abigail C Durrant
- Open Lab, School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
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Testa S, Mayora-Ibarra O, Piras EM, Balagna O, Micocci S, Zanutto A, Forti S, Conforti D, Nicolini A, Malfatti G, Moz M, Gios L, Benetollo PP, Turra E, Orrasch M, Zambotti F, Del Greco M, Maines M, Filippi L, Ghezzi M, Romanelli F, Racano E, Marin M, Betta M, Bertagnolli E. Implementation of tele visit healthcare services triggered by the COVID-19 emergency: the Trentino Province experience. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:77-92. [PMID: 34150467 PMCID: PMC8203489 DOI: 10.1007/s10389-021-01609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 05/27/2021] [Indexed: 12/05/2022]
Abstract
Aim In response to the SARS-CoV-2 emergency, the Competence Centre on digital health ‘TrentinoSalute4.0’ has developed TreC_Televisita, a tele visit solution that meets the needs of the Trentino healthcare system and maintains high-quality patient–doctor interactions while respecting social distancing. This paper highlights how ‘TreC_Televisita’ was integrated into the Trentino healthcare system and its potential to become a structural and durable solution for the future local healthcare service provisioning. Subject and methods This paper presents the multifactorial context that TreC_Televisita has faced for its implementation and the strategies adopted for its structural integration into the healthcare system. The analysis focuses on the main issues faced for the integration of the tele visits (e.g. privacy, payments) and how the context of TrentinoSalute4.0 permitted responding quickly to its implementation during the pandemic. It also describes how TreC_Televisita fits into the healthcare continuum from the organisational and technological standpoint, the end-user perspective and the barriers that could hamper the solution scalability. Results TreC_Televisita has demonstrated to be a technological solution that can be contextualised for different clinical domains beyond SARS-CoV-2. Moreover, it has shown its potential to scale up the solution beyond the COVID-19 emergency to the whole healthcare provisioning system in the long term. Conclusion Being a positive experience in the first months of its implementation, the long-term goal is to transform TreC_Televisita into a structural pillar of the Trentino healthcare system, setting the bases for a sustainable, win–win situation for all the stakeholders involved in healthcare service provisioning.
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Affiliation(s)
- Sara Testa
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | | | | | - Olivia Balagna
- Provincia Autonoma di Trento, Piazza Dante 15, 38122 Trento, Italy
| | - Stefano Micocci
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Alberto Zanutto
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Stefano Forti
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Diego Conforti
- Provincia Autonoma di Trento, Piazza Dante 15, 38122 Trento, Italy
| | - Andrea Nicolini
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Giulia Malfatti
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Monica Moz
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Lorenzo Gios
- Fondazione Bruno Kessler, Via Santa Croce 77, 38122 Trento, Italy
| | - Pier Paolo Benetollo
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Ettore Turra
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Massimo Orrasch
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Francesca Zambotti
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Maurizio Del Greco
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Massimiliano Maines
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Lorena Filippi
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Monica Ghezzi
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Federica Romanelli
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Elisabetta Racano
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Mauro Marin
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Marta Betta
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
| | - Elisabetta Bertagnolli
- Azienda Provinciale per i Servizi Sanitari, Via Alcide Degasperi 79, 38123 Trento, Italy
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Eccher C, Gios L, Zanutto A, Bizzarri G, Conforti D, Forti S. TreC platform. An integrated and evolving care model for patients' empowerment and data repository. J Biomed Inform 2020; 102:103359. [PMID: 31917253 DOI: 10.1016/j.jbi.2019.103359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 11/12/2019] [Accepted: 12/15/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Health care has been deeply revolutionized by the new wave of information and communication technology (ICT) development, particularly related to the electronic/personal health record (PHR). The present paper describes the original design and implementation approach followed in the Trentino Province (Italy) to promote an Integrated Care Model for patients' empowerment and data repository, by means of an evolving Personal Health Record - PHR platform, named TreC (Trentino Citizens Clinical Record). MATERIALS AND METHODS The TreC Platform is conceived as a communication hub among different stakeholders. The core assumption of the TreC platform strategy is to consider the citizen/patient as main manager and owner of both his/her own health and his/her contacts with the health care systems. RESULTS Over the years, the TreC platform has represented the core pillar in the digitalization process promoted at Province level. This has been strategically embedded in the multi-faceted e-government strategy endorsed by the Province of Trento. So far (October 2018), more than 89,000 citizens within the Province of Trento are using TreC platform as a way to communicate with the health care system and access their own personal health records. CONCLUSIONS The experience gained through the TreC platform implementation and its results are promising, supporting the idea that a PHR platform can represent a key driving factor in improving health care quality and efficiency, both from a patient and a health care staff perspective.
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Affiliation(s)
- Claudio Eccher
- Center for Information and Communication Technology, Fondazione Bruno Kessler, Trento, Italy.
| | - Lorenzo Gios
- TrentinoSalute 4.0, Competence Center for Digital Health, Trento, Italy
| | - Alberto Zanutto
- Center for Information and Communication Technology, Fondazione Bruno Kessler, Trento, Italy
| | | | | | - Stefano Forti
- Center for Information and Communication Technology, Fondazione Bruno Kessler, Trento, Italy
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Piras EM, Miele F. On digital intimacy: redefining provider-patient relationships in remote monitoring. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41 Suppl 1:116-131. [PMID: 31599992 DOI: 10.1111/1467-9566.12947] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Remote monitoring has often been thought to lead to a highly structured and standardised care process. Several studies have stressed that patient-provider communication could be hindered if mediated by technologies, leading to an impoverished relationship. We argue that while remote monitoring leads to a redefinition of the patient-provider relationship, it could also offer the opportunity to develop a more intimate acquaintance not possible via only routine visits. The study is part of a clinical trial aimed at assessing the acceptability of a remote monitoring platform for type 1 diabetes. Drawing on practice-based studies, we focused our analysis on the practice of text message exchange between patients and providers. The 396 conversations were coded with a template analysis, leading to the identification of two main categories: 'knowing the patient' and 'knowing about the patient'. The analysis reveals that the practice of messaging led to the development of a 'digital intimacy', a relationship characterised by a thorough familiarity made possible by electronic devices that extends to face-to-face encounters. Drawing on our case, we argue that remote monitoring can foster greater intimacy between patients and providers, which is made possible by the overall increase in the quantity and quality of communication between patients and providers.
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Affiliation(s)
- Enrico Maria Piras
- Centre for Information and Communication Technology, Bruno Kessler Foundation, Trento, Italy
| | - Francesco Miele
- Centre for Information and Communication Technology, Bruno Kessler Foundation, Trento, Italy
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Koskinen JSS. The concept of Datenherrschaft of patient information from a Heideggerian perspective. JOURNAL OF INFORMATION COMMUNICATION & ETHICS IN SOCIETY 2019. [DOI: 10.1108/jices-04-2018-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PurposeIn this paper, patient information is approached from a Heideggerian perspective with the intention to gather an understanding about the personal nature of the information. The purpose of this paper is to analyse the ownership of patient information and then present Datenherrschaft (German for “mastery over information”) as a suitable model for patient ownership of patient information.Design/methodology/approachThis paper is theoretical in approach. It is based on arguments derived from Heidegger’s work in the Being and Time.FindingsBased on this Heideggerian approcah, a proposal for using the special definition of ownership of patient information – Datenherrschaft – given to a patient is suggested. From a Heideggerian perspective, it can be stated that the patient has the strongest rights towards patient information because this information is crucial for a patient to have an understanding about their Dasein (being-in-the-world).Research limitations/implicationsDatenherrschaft is used as an example of an ethically justified way of regulating the patient information ownership and should be analysed further. Especially the practical implications of implementing Datenherrschaft need more research.Originality/valuePatient information ownership is an issue that is neither unambiguously solved in many countries, nor has it, in our view, been ethically justified. The potential solution – Datenherrschaft – presented in this paper is clear and has strong philosophical justifications.
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Bruni A, Miele F, Piras EM. 'Homemade': Building, mending, and coordinating a care network. Soc Sci Med 2019; 237:112449. [PMID: 31394398 DOI: 10.1016/j.socscimed.2019.112449] [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: 10/23/2018] [Revised: 07/24/2019] [Accepted: 07/25/2019] [Indexed: 11/30/2022]
Abstract
In recent decades, longer life expectancy, the consequent greater number of patients with often concurrent diseases, and the need of healthcare institutions to reduce the costs of services, have engendered changes in all European healthcare systems. On one side, healthcare systems increasingly rely on the self-management skills of patients, who undertake a growing amount of 'sickness work' from which they are relieved only in the case of severe illness. On the other, the inability of public healthcare systems to satisfy the increased demand for care has led to the growth of private healthcare organizations as well as cooperatives of health professionals who offer their services privately. The care of citizens, therefore, is increasingly distributed across networks of actors with very different objectives, logics of action and professional backgrounds (public and private healthcare organizations, community medical services, voluntary organizations). Despite the attention devoted by social studies of medicine to the work done by citizens in supporting the work of clinicians and nurses, the work performed in connection to the management of care networks have been only marginally investigated. Drawing on a qualitative research carried out in the Province of Trento (Italy) and focused on the different ways in which elderly people with chronic conditions manage their conditions outside the healthcare and welfare institutions, in this paper we are interested in deepening the understanding of the invisible work citizens perform in connection to the management of care services and professionals. That is, the work needed in order to activate, mend and coordinate complex networks of care.
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Piras EM, Cabitza F, Lewkowicz M, Bannon L. Personal Health Records and Patient-Oriented Infrastructures: Building Technology, Shaping (New) Patients, and Healthcare Practitioners. Comput Support Coop Work 2019. [DOI: 10.1007/s10606-019-09364-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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I’m Trying to Find my Way of Staying Organized: the Socio-Technical Assemblages of Personal Health Information Management. Comput Support Coop Work 2019. [DOI: 10.1007/s10606-019-09346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Miele F, Clementi S, Gennaro R, Nicolao I, Romanelli T, Speese K, Piras EM. Text Messaging and Type 1 Diabetes Management: Qualitative Study Exploring Interactions Among Patients and Health Care Professionals. JMIR Diabetes 2019; 4:e11343. [PMID: 31094332 PMCID: PMC6533872 DOI: 10.2196/11343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/16/2018] [Accepted: 03/30/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The diffusion of information and communication technologies (ICTs) in type 1 diabetes (T1D) management has generated a debate on the ways in which ICTs can support the patient-provider relationship. Several studies have focused on text messages. Most of the literature proposes quantitative analysis of the impact of text messaging on the clinical conditions of patients and/or their satisfaction with the technology, while the qualitative studies have focused mainly on patients' perceptions about strengths and weaknesses of this technology. OBJECTIVE In contrast to past studies, we adopted a qualitative approach for the in-depth examination of patient-health care professionals' interactions in text messaging. METHODS The study focused on the use of the Trento Cartella Clinica del Cittadino Diabetes System (TreC-DS), a digital platform with a built-in messaging system, in two diabetes centers, integrating message analysis with interviews with patients and health care professionals. Each center focused on a specific patient profile: the first one focused on pregnant women with T1D and the second one focused on adult patients with poorly controlled diabetes. RESULTS The main results of the study were as follows: (1) Health care professionals and patients perceived the messaging system as useful for sharing information (ie, pregnant women for prescriptions and adults with poorly controlled diabetes for advice); (2) The content and communication styles of the two centers differed: in the case of pregnant women, interactions via text messaging were markedly prescriptive, while in the case of adult patients with poorly controlled diabetes, they were conceived as open dialogues; and (3) Conversations were initiated mainly by professionals; in the cases considered, it was mainly the diabetes center that decided whether a messaging conversation was needed. CONCLUSIONS The results show how the features of interactions of text messaging changed based on the patient profiles in two different centers. In addition, in both diabetes centers that were involved, the system seems to have laid a foundation for a closer relationship between patients and health care professionals.
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Affiliation(s)
- Francesco Miele
- e-Health Research Unit, Bruno Kessler Foundation, Trento, Italy
| | - Silvia Clementi
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Trento, Italy
| | - Renzo Gennaro
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Rovereto, Italy
| | - Ilaria Nicolao
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Trento, Italy
| | - Tiziana Romanelli
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Trento, Italy
| | - Katja Speese
- Azienda Provinciale per i Servizi Sanitari, Diabetes Center, Rovereto, Italy
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Diffin J, Byrne B, Kerr H, Price J, Abbott A, McLaughlin D, O'Halloran P. The usefulness and acceptability of a personal health record to children and young people living with a complex health condition: A realist review of the literature. Child Care Health Dev 2019; 45:313-332. [PMID: 30817012 PMCID: PMC6519173 DOI: 10.1111/cch.12652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/15/2019] [Accepted: 02/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are a growing number of children and young people (CYP) with chronic health needs or complex disabilities. Increasingly, CYP with life-limiting or life-threatening conditions are surviving into adulthood. Communication between CYP, their family, and health professionals can be challenging. The use of a personal health record (PHR) is one potential strategy for improving communication by promoting CYP's health advocacy skills. However, PHR implementation has proved difficult due to technical, organisational, and professional barriers. The aim of this realist review is to identify the factors, which help or hinder the use of PHRs with CYP living with a complex health condition. METHODS Systematic realist review. Literature was sourced from six databases: Medline, Embase, CINAHL, PsychInfo, The Cochrane Library, and Science Direct (from 1946 to August Week 3 2018). The web was searched to identify grey literature. Articles were sourced from reference lists of included studies. Data were extracted using a standardised data extraction form. Two reviewers completed data extraction and synthesis. Methodological rigor was assessed using the relevant Critical Appraisal Skills Programme tool. RESULTS Nine articles were included. Contextual factors, which helped implementation, included the CYP having a high perception of need for a PHR and a high level of desire for self-management. Service providers and CYP need knowledge about the purpose and benefits of the PHR, and organisations need a dedicated person to facilitate PHR use. Mechanisms triggered by the PHR included improved understanding and knowledge of health care condition(s) for CYP, an increased feeling of control over condition(s), and more active engagement in their health care. Outcomes for CYP included improved self-advocacy and communication. CONCLUSION Clearer definitions of which young people would benefit from using a PHR must be established to inform which organisations and service providers would be best suited to PHR implementation.
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Affiliation(s)
- Janet Diffin
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Bronagh Byrne
- School of Sociology, Social Policy and Social WorkQueen's University BelfastBelfastUK
| | - Helen Kerr
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Jayne Price
- School of NursingKingston University LondonLondonUK
| | - Aine Abbott
- Aberfoyle Medical Practice Derry, Specialty Dr Palliative Medicine Foyle Hospice DerryLondonderryUK
| | - Dorry McLaughlin
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
| | - Peter O'Halloran
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
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Marchant C, O’Donohoe S. Homo prostheticus? Intercorporeality and the emerging adult-smartphone assemblage. INFORMATION TECHNOLOGY & PEOPLE 2019. [DOI: 10.1108/itp-07-2017-0209] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeYoung people’s attachment to their smartphones is well-documented, with smartphones often described as prostheses. While prior studies typically assume a clear human/machine divide, this paper aims to build on posthuman perspectives, exploring intercorporeality, the blurring of human/technology boundaries, between emerging adults and their smartphones. The paper aims to discuss these issues.Design/methodology/approachDrawing on assemblage theory, this interpretive study uses smartphone diaries and friendship pair/small group discussions with 27 British emerging adults.FindingsParticipants in this study are characterized ashomo prostheticus, living with and through their phones, treating them as extensions of their mind and part of their selves as they navigated between their online and offline, private and social lives.Homo prostheticuswas part of a broader assemblage or amalgamation of human and non-human components. As these components interacted with each other, the assemblage could be strengthened or weakened by various technological, personal and social factors.Research limitations/implicationsThese qualitative findings are based on a particular sample at a particular point in time, within a particular culture. Further research could explore intercorporeality in human–smartphone relationships among other groups, in other cultures.Originality/valueAlthough other studies have used prosthetic metaphors, this paper contributes to understanding of smartphones as aprosthesesin the lives of emerging adults, highlighting intercorporeality as a key feature ofhomo prostheticus. It also uses assemblage theory to contextualizehomo prostheticusand explores factors strengthening or weakening the broader human–smartphone assemblage.
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Piras EM. Beyond self-tracking: Exploring and unpacking four emerging labels of patient data work. Health Informatics J 2019; 25:598-607. [DOI: 10.1177/1460458219833121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the growing attention of researchers, healthcare managers and policy makers, data gathering and information management practices are largely untheorized areas. In this work are presented and discussed some early-stage conceptualizations: patient-generated health data, observations of daily living, quantified self and personal health information management. As I shall try to demonstrate, these labels are not neutral; rather, they underpin quite different perspectives with respect to health, patient–doctor relationship and the status of data.
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13
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Aligning Concerns in Telecare: Three Concepts to Guide the Design of Patient-Centred E-Health. Comput Support Coop Work 2018. [DOI: 10.1007/s10606-018-9309-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Piras EM. Kairotic and chronological knowing: diabetes logbooks in-and-out of the hospital. DATA TECHNOLOGIES AND APPLICATIONS 2018. [DOI: 10.1108/dta-03-2017-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The paper reflects on the role of knowledge artefacts in the patient-provider relationship across the organisational boundaries of the clinical setting. Drawing on the analysis of the diabetes logbook, the purpose of this paper is to illustrate the role of knowledge artefacts in a fragmented system of knowledge through the study of two distinct practices: “logbook compiling” and “consultation in the surgery”.
Design/methodology/approach
The theoretical framework of analysis is rooted in the tradition of practice-based studies which envisions knowledge as the emerging, precarious and socially constructed product of being involved in a practice. The paper follows a designed qualitative research, conducting semi-structured interviews, participant observation and artefact analysis.
Findings
The knowledge artefacts support different and partially irreducible forms of knowledge. Knowing-in-practice is accomplished by means of different activities which contribute to the reshaping of the knowledge artefact itself. The analysis of the “knowledge artefact-in-use” reveals that different actors (doctors and patients) adopt two different perspectives when investigating the chronic condition. Clinicians are interested in a chronological representation of patient data while patients and families are interested in making sense of specific situations, adopting a kairotic perspective (Kairos: the right moment) that emphasises the instant in which something significant for someone happens.
Originality/value
The analysis of the knowledge artefacts-in-use has a twofold outcome. On one hand, it illustrates the mutual shaping of knowing, artefacts and practices. On the other hand, it shows how knowledge artefact can become pivotal resources in a fragmented system of knowledge.
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Rantanen MM, Koskinen J. PHR, We’ve Had a Problem Here. THIS CHANGES EVERYTHING – ICT AND CLIMATE CHANGE: WHAT CAN WE DO? 2018. [DOI: 10.1007/978-3-319-99605-9_28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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The agency of patients and carers in medical care and self-care technologies for interacting with doctors. Health Informatics J 2017; 25:330-349. [DOI: 10.1177/1460458217712054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Zanutto A. 'Two clicks and I'm in!' Patients as co-actors in managing health data through a personal health record infrastructure. Health Informatics J 2017; 25:389-400. [PMID: 28612642 DOI: 10.1177/1460458217712056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
One of the most significant changes in the healthcare field in the past 10 years has been the large-scale digitalization of patients' healthcare data, and an increasing emphasis on the importance of patients' roles in cooperating with healthcare professionals through digital infrastructures. A project carried out in the North of Italy with the aim of creating a personal health record has been evaluated over the course of 5 years by means of mixed method fieldwork. Two years after the infrastructure was put into regular service, the way in which patients are represented in the system and patient practices have been studied using surveys and qualitative interviews. The data show that, first, patients have become co-actors in describing their clinical histories; second, that they have become co-actors in the diagnosis process; and finally, they have become co-actors in the management of time and space as regards their specific state of health.
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Digitalization as institutional work: a case of designing a tool for changing diabetes care. INFORMATION TECHNOLOGY & PEOPLE 2017. [DOI: 10.1108/itp-07-2015-0155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose
E-health tools for patients aim to change current care practices. However the role of IT in transforming health care is not straightforward. The purpose of this paper is to understand how this change process unfolds and what characterizes the process by which visions of new care practices become inscribed into digital tools.
Design/methodology/approach
The study adopted a qualitative research design and it is based on an interpretive case study on the digitalization of a tool for diabetes care used in a hospital in Norway. Data have been collected via interviews and observations. Digitalization activities are understood as institutional work in order to examine the relation between the decisions taken in the design process and the intended change of the practices of diabetes care.
Findings
The study identifies three types of activities of institutional work: inscription of self-reflection, inscription of legitimation and inscription of new usage. The analysis of these activities shows how the vision of patients’ more active, learning and reflection-oriented role is inscribed into digital technology; how institutional work strives both for change and for legitimation thus smoothing the transition to a new institutional arrangement; and how institutional work relates to digital materiality.
Originality/value
The study contributes to the institutional theory literature by conceptualizing digitalization as institutional work toward changing institutions. It also contributes to the IS literature on digitalization by providing an analysis of how the affordances of digital materials support the work toward new institutions.
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Gagnon MP, Payne-Gagnon J, Breton E, Fortin JP, Khoury L, Dolovich L, Price D, Wiljer D, Bartlett G, Archer N. Adoption of Electronic Personal Health Records in Canada: Perceptions of Stakeholders. Int J Health Policy Manag 2016; 5:425-433. [PMID: 27694670 PMCID: PMC4930348 DOI: 10.15171/ijhpm.2016.36] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/02/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Healthcare stakeholders have a great interest in the adoption and use of electronic personal health records (ePHRs) because of the potential benefits associated with them. Little is known, however, about the level of adoption of ePHRs in Canada and there is limited evidence concerning their benefits and implications for the healthcare system. This study aimed to describe the current situation of ePHRs in Canada and explore stakeholder perceptions regarding barriers and facilitators to their adoption. METHODS Using a qualitative descriptive study design, we conducted semi-structured phone interviews between October 2013 and February 2014 with 35 individuals from seven Canadian provinces. The participants represented six stakeholder groups (patients, ePHR administrators, healthcare professionals, organizations interested in health technology development, government agencies, and researchers). A detailed summary of each interview was created and thematic analysis was conducted. RESULTS We observed that there was no consensual definition of ePHR in Canada. Factors that could influence ePHR adoption were related to knowledge (confusion with other electronic medical records [EMRs] and lack of awareness), system design (usability and relevance), user capacities and attitudes (patient health literacy, education and interest, support for professionals), environmental factors (government commitment, targeted populations) and legal and ethical issues (information control and custody, confidentiality, privacy and security). CONCLUSION ePHRs are slowly entering the Canadian healthcare landscape but provinces do not seem well-prepared for the implementation of this type of record. Guidance is needed on critical issues regarding ePHRs, such as ePHR definition, data ownership, access to information and interoperability with other electronic health records (EHRs). Better guidance on these issues would provide a greater awareness of ePHRs and inform stakeholders including clinicians, decision-makers, patients and the public. In turn, it may facilitate their adoption in the country.
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Affiliation(s)
- Marie-Pierre Gagnon
- Faculty of Nursing Science, Université Laval, Quebec City, QC, Canada
- Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
- Centre de recherche sur les soins et les services de première ligne, Centre intégré de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Julie Payne-Gagnon
- Research Centre of the CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Erik Breton
- Faculty of Medicine, Université Laval, Quebec City, QC, Canada
| | - Jean-Paul Fortin
- Centre de recherche sur les soins et les services de première ligne, Centre intégré de santé et services sociaux de la Capitale-Nationale, Quebec City, QC, Canada
| | - Lara Khoury
- Faculty of Law, McGill University, Montreal, QC, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Norman Archer
- DeGroote School of Business, McMaster University, Hamilton, ON, Canada
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Forbes D, Wongthongtham P. Ontology based intercultural patient practitioner assistive communications from qualitative gap analysis. INFORMATION TECHNOLOGY & PEOPLE 2016. [DOI: 10.1108/itp-08-2014-0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– There is an increasing interest in using information and communication technologies to support health services. But the adoption and development of even basic ICT communications services in many health services is limited, leaving enormous gaps in the broad understanding of its role in health care delivery. The purpose of this paper is to address a specific (intercultural) area of healthcare communications consumer disadvantage; and it examines the potential for ICT exploitation through the lens of a conceptual framework. The opportunity to pursue a new solutions pathway has been amplified in recent times through the development of computer-based ontologies and the resultant knowledge from ontologist activity and consequential research publishing.
Design/methodology/approach
– A specific intercultural area of patient disadvantage arises from variations in meaning and understanding of patient and clinician words, phrases and non-verbal expression. Collection and localization of data concepts, their attributes and individual instances were gathered from an Aboriginal trainee nurse focus group and from a qualitative gap analysis (QGA) of 130 criteria-selected sources of literature. These concepts, their relationships and semantic interpretations populate the computer ontology. The ontology mapping involves two domains, namely, Aboriginal English (AE) and Type II diabetes care guidelines. This is preparatory to development of the Patient Practitioner Assistive Communications (PPAC) system for Aboriginal rural and remote patient primary care.
Findings
– The combined QGA and focus group output reported has served to illustrate the call for three important drivers of change. First, there is no evidence to contradict the hypothesis that patient-practitioner interview encounters for many Australian Aboriginal patients and wellbeing outcomes are unsatisfactory at best. Second, there is a potent need for cultural competence knowledge and practice uptake on the part of health care providers; and third, the key contributory component to determine success or failures within healthcare for ethnic minorities is communication. Communication, however, can only be of value in health care if in practice it supports shared cognition; and mutual cognition is rarely achievable when biopsychosocial and other cultural worldview differences go unchallenged.
Research limitations/implications
– There has been no direct engagement with remote Aboriginal communities in this work to date. The authors have initially been able to rely upon a cohort of both Indigenous and non-Indigenous people with relevant cultural expertise and extended family relationships. Among these advisers are health care practitioners, academics, trainers, Aboriginal education researchers and workshop attendees. It must therefore be acknowledged that as is the case with the QGA, the majority of the concept data is from third parties. The authors have also discovered that urban influences and cultural sensitivities tend to reduce the extent of, and opportunity to, witness AE usage, thereby limiting the ability to capture more examples of code-switching. Although the PPAC system concept is qualitatively well developed, pending future work planned for rural and remote community engagement the authors presently regard the work as mostly allied to a hypothesis on ontology-driven communications. The concept data population of the AE home talk/health talk ontology has not yet reached a quantitative critical mass to justify application design model engineering and real-world testing.
Originality/value
– Computer ontologies avail us of the opportunity to use assistive communications technology applications as a dynamic support system to elevate the pragmatic experience of health care consultations for both patients and practitioners. The human-machine interactive development and use of such applications is required just to keep pace with increasing demand for healthcare and the growing health knowledge transfer environment. In an age when the worldwide web, communications devices and social media avail us of opportunities to confront the barriers described the authors have begun the first construction of a merged schema for two domains that already have a seemingly intractable negative connection. Through the ontology discipline of building syntactically and semantically robust and accessible concepts; explicit conceptual relationships; and annotative context-oriented guidance; the authors are working towards addressing health literacy and wellbeing outcome deficiencies of benefit to the broader communities of disadvantage patients.
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Galligioni E, Piras EM, Galvagni M, Eccher C, Caramatti S, Zanolli D, Santi J, Berloffa F, Dianti M, Maines F, Sannicolò M, Sandri M, Bragantini L, Ferro A, Forti S. Integrating mHealth in Oncology: Experience in the Province of Trento. J Med Internet Res 2015; 17:e114. [PMID: 25972226 PMCID: PMC4468599 DOI: 10.2196/jmir.3743] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/23/2014] [Accepted: 02/16/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The potential benefits of the introduction of electronic and mobile health (mHealth) information technologies, to support the safe delivery of intravenous chemotherapy or oral anticancer therapies, could be exponential in the context of a highly integrated computerized system. OBJECTIVE Here we describe a safe therapy mobile (STM) system for the safe delivery of intravenous chemotherapy, and a home monitoring system for monitoring and managing toxicity and improving adherence in patients receiving oral anticancer therapies at home. METHODS The STM system is fully integrated with the electronic oncological patient record. After the prescription of chemotherapy, specific barcodes are automatically associated with the patient and each drug, and a bedside barcode reader checks the patient, nurse, infusion bag, and drug sequence in order to trace the entire administration process, which is then entered in the patient's record. The usability and acceptability of the system was investigated by means of a modified questionnaire administered to nurses. The home monitoring system consists of a mobile phone or tablet diary app, which allows patients to record their state of health, the medications taken, their side effects, and a Web dashboard that allows health professionals to check the patient data and monitor toxicity and treatment adherence. A built-in rule-based alarm module notifies health care professionals of critical conditions. Initially developed for chronic patients, the system has been subsequently customized in order to monitor home treatments with capecitabine or sunitinib in cancer patients (Onco-TreC). RESULTS The STM system never failed to match the patient/nurse/drug sequence association correctly, and proved to be accurate and reliable in tracing and recording the entire administration process. The questionnaires revealed that the users were generally satisfied and had a positive perception of the system's usefulness and ease of use, and the quality of their working lives. The pilot studies with the home monitoring system with 43 chronic patients have shown that the approach is reliable and useful for clinicians and patients, but it is also necessary to pay attention to the expectations that mHealth solutions may raise in users. The Onco-TreC version has been successfully laboratory tested, and is now ready for validation. CONCLUSIONS The STM and Onco-TreC systems are fully integrated with our complex and composite information system, which guarantees privacy, security, interoperability, and real-time communications between patients and health professionals. They need to be validated in order to confirm their positive contribution to the safer administration of anticancer drugs.
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Affiliation(s)
- Enzo Galligioni
- Medical Oncology Department, Azienda Provinciale per i Servizi Sanitari, Trento, Italy.
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