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Ramamoorthi K, Stamenova V, Liu RH, Bhattacharyya O. The Implementation of Federated Digital Identifiers in Health Care: Rapid Review. J Med Internet Res 2024; 26:e45751. [PMID: 38329799 PMCID: PMC10884916 DOI: 10.2196/45751] [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: 01/16/2023] [Revised: 08/04/2023] [Accepted: 12/19/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Federated digital identifiers (FDIs) have been cited to improve the interoperability of data and information management while enhancing the privacy of individuals verifying their identity on the web. Many countries around the world have implemented FDIs in various sectors, such as banking and government. Similarly, FDIs could improve the experience for those wanting to access their health care information; however, they have only been introduced in a few jurisdictions around the world, and their impact remains unclear. OBJECTIVE The main objective of this environmental scan was to describe how FDIs have been established and implemented to enable patients' access to health care. METHODS We conducted this study in 2 stages, with the primary stage being a rapid review, which was supplemented by a targeted gray literature search. Specifically, the rapid review was conducted through a database search of MEDLINE and Embase, which generated a list of countries and their services that use FDIs in health care. This list was then used to conduct a targeted gray literature search using the Google search engine. RESULTS A total of 93 references from the database and targeted Google searches were included in this rapid review. FDIs were implemented in health care in 11 countries (Australia, Belgium, Canada, Denmark, Estonia, Finland, Iceland, Norway, Singapore, Sweden, and Taiwan) and exclusively used with a patient-accessible electronic health record system through a single sign-on interface. The most common FDIs were implemented nationally or provincially, and establishing them usually required individuals to visit a bank or government office in person. In contrast, some countries, such as Australia, allow individuals to verify their identities entirely on the web. We found that despite the potential of FDIs for use in health care to facilitate the amalgamation of health information from different data sources into one platform, the adoption of most health care services that use FDIs remained below 30%. The exception to this was Australia, which had an adoption rate of 90%, which could be correlated with the fact that it leveraged an opt-out consent model. CONCLUSIONS This rapid review highlights key features of FDIs across regions and elements associated with higher adoption of the patient-accessible electronic health record systems that use them, like opt-out registration. Although FDIs have been reported to facilitate the collation of data from multiple sources through a single sign-on interface, there is little information on their impact on care or patient experience. If FDIs are used to their fullest potential and implemented across sectors, adoption rates within health care may also improve.
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Affiliation(s)
- Karishini Ramamoorthi
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Vess Stamenova
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Rebecca H Liu
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Onil Bhattacharyya
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Goff AJ, Barton CJ, Merolli M, Zhang Quah AS, Ki-Cheong Hoe C, De Oliveira Silva D. Comprehensiveness, accuracy, quality, credibility and readability of online information about knee osteoarthritis. HEALTH INF MANAG J 2023; 52:185-193. [PMID: 35613496 DOI: 10.1177/18333583221090579] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND People are increasingly using the Internet to retrieve health information about chronic musculoskeletal conditions, yet content can be inaccurate and of variable quality. OBJECTIVE To summarise (i) comprehensiveness, (ii) accuracy and clarity, iii) quality of information about treatment choices, (iv) credibility and (v) readability of online information about knee osteoarthritis. METHOD Systematic appraisal of website content. Searches for "knee osteoarthritis" and "knee arthritis" were performed using Google and Bing (October 2020). The top 20 URLs of each search were screened for eligibility. Comprehensiveness, accuracy and clarity of content were matched against 14 pre-defined topic descriptors. DISCERN and HONcode were used to measure quality of information about treatment choices and website credibility, respectively. Flesch Reading Ease and Flesch-Kincaid Grade Level tests were used to assess readability. RESULTS Thirty-five websites were included. Websites were generally comprehensive (median, range = 12, 0-14/14) with descriptors available for 67% (n = 330/490) of topics across all websites, but only 35% (n = 116/330) were accurate and clear. Quality of information about treatment choices was generally low (median DISCERN score, range = 40, 16-56/80). Credibility descriptors were present for 65% (n = 181/280) of items, with 81% (n = 146/181) of descriptors being clear. Median Flesch reading ease was 53 (range = 21-74), and Flesch-Kincaid grade level was 8 (range = 5-11). CONCLUSION Few websites provide accurate and clear content aligned to key research evidence. Quality of information about treatment choices was poor, with large variation in comprehensiveness, credibility and readability. IMPLICATIONS Careful consideration is required by clinicians to identify what online information people with knee osteoarthritis have accessed and to address misinformed beliefs.
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Affiliation(s)
- Anthony J Goff
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic, Australia
- Health and Social Sciences, Singapore Institute of Technology, Singapore
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic, Australia
| | - Mark Merolli
- Centre for Health Exercise, and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Vic, Australia
| | | | | | - Danilo De Oliveira Silva
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Vic, Australia
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Given F, Allan M, McCarthy S, Hemsley B. Digital health autonomy for people with communication or swallowing disability and the Sustainable Development Goal 10 of reducing inequalities and Goal 3 of good health and well-being. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:72-76. [PMID: 35848621 DOI: 10.1080/17549507.2022.2092212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
PURPOSE The purpose of this article is to explore the Sustainable Development Goal of reduced inequalities (SDG 10) in relation to the experiences of people with communication disability with lived experiences and their access to self-determined healthcare. As such, the article also informs the goal of good health and well-being (SDG 3). METHOD In preparing this article the authors reviewed recent literature on digital health records and digital autonomy as a means to improving equity of access and explored the experiences of two of the authors as people with severe communication disability who use a wide range of digital health technologies in pursuing safe and quality health care. The literature and their experiences highlight a need for improved co-design and usage across disability and health service systems management if e-health records are to be used to reduce inequalities in accessing healthcare. RESULT Recent research and the lived experiences of the first two authors reflect that e-health information systems, designed to improve the consumer's ability to access and share their own health information, are not used to full advantage in disability and healthcare environments. CONCLUSION Increased access to multimodal communication strategies and communication technologies, along with user-centred co-design that enables digital health autonomy will further progress towards reduced inequalities (SDG 10) and good health and well-being (SDG 3) and for people with communication or swallowing disability.
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Affiliation(s)
- Fiona Given
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Meredith Allan
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Shaun McCarthy
- Newcastle Law School, University of Newcastle, Newcastle, Australia
| | - Bronwyn Hemsley
- Faculty of Health, University of Technology Sydney, Sydney, Australia
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Loggie C, Davis J. The emergence of health information in aged care. HEALTH INF MANAG J 2022; 52:59-63. [PMID: 36314717 DOI: 10.1177/18333583221128339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cheng C, Gearon E, Hawkins M, McPhee C, Hanna L, Batterham R, Osborne RH. Digital Health Literacy as a Predictor of Awareness, Engagement, and Use of a National Web-Based Personal Health Record: Population-Based Survey Study. J Med Internet Res 2022; 24:e35772. [PMID: 36112404 PMCID: PMC9526109 DOI: 10.2196/35772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/16/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Web-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.
Objective
With limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).
Methods
A population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.
Results
A total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.
Conclusions
This study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.
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Affiliation(s)
- Christina Cheng
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Emma Gearon
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Melanie Hawkins
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
| | | | - Lisa Hanna
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Roy Batterham
- Faculty of Public Health, Thammasat University, Bangkok, Thailand
| | - Richard H Osborne
- Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia
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Healthcare providers’ perspectives on using smart home systems to improve self-management and care in people with heart failure: A qualitative study. Int J Med Inform 2022; 167:104837. [DOI: 10.1016/j.ijmedinf.2022.104837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/24/2022] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
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“Dietitians May Only Have One Chance”—The Realities of Treating Obesity in Private Practice in Australia. Healthcare (Basel) 2022; 10:healthcare10020404. [PMID: 35207016 PMCID: PMC8872301 DOI: 10.3390/healthcare10020404] [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: 01/21/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Overweight and obesity are the leading contributors to non-fatal burden of disease in Australia. Very low energy diets (VLEDs) comprising of meal replacement products (MRP) effectively induce substantial weight loss in people with obesity, yet they are rarely used as a first line treatment. Dietitians in private practice are perfectly placed to administer treatments for obesity; however, little is known about the preferred interventions used or their attitudes to incorporating VLEDs and MRPs into their treatments for overweight and obesity. Methods: This study used descriptive qualitative methods to explore accredited practicing dietitians’ (APDs’) perspectives and practices regarding obesity and obesity interventions, including the use of VLEDs and MRPs. Qualitative in-depth semi-structured interviews were conducted with 20 dietitians who had experience in private practice and in treating obesity. Transcribed interviews were analysed thematically using the technique of template analysis. Results: In the context within which dietitians’ practice was found to be a barrier to using evidence-based practice (EBP) for obesity treatment, four overarching themes were found. These were: (1) patient-centred care is the dietitians’ preferred intervention model; (2) VLEDs promote weight loss in specific situations; (3) systemic barriers constrain effective dietetic practice and equitable access to all, and (4) successful outcomes are predicated on working outside of systemic barriers. Conclusion: Dietitians in private practice are well placed and able to provide life-enhancing and evidence-based treatments for overweight and obesity and associated chronic disease in the community. However, systemic barriers need to be addressed to provide equitable access to effective care irrespective of socio-economic status.
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Hemsley B, Debono D. Recognising complexity: Foregrounding vulnerable and diverse populations for inclusive health information management research. HEALTH INF MANAG J 2021; 51:113-117. [PMID: 34822259 DOI: 10.1177/18333583211052708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Deborah Debono
- Faculty of Health, 1994University of Technology Sydney, Ultimo, NSW, Australia
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Harahap NC, Handayani PW, Hidayanto AN. Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review. J Med Internet Res 2021; 23:e26236. [PMID: 34287210 PMCID: PMC8339989 DOI: 10.2196/26236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/07/2021] [Accepted: 05/24/2021] [Indexed: 12/28/2022] Open
Abstract
Background Functionalities of personal health record (PHR) are evolving, and continued discussions about PHR functionalities need to be performed to keep it up-to-date. Technological issues such as nonfunctional requirements should also be discussed in the implementation of PHR. Objective This study systematically reviewed the main functionalities and issues in implementing the PHR. Methods This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search is performed using the online databases Scopus, ScienceDirect, IEEE, MEDLINE, CINAHL, and PubMed for English journal articles and conference proceedings published between 2015 and 2020. Results A total of 105 articles were selected in the review. Seven function categories were identified in this review, which is grouped into basic and advanced functions. Health records and administrative records were grouped into basic functions. Medication management, communication, appointment management, education, and self-health monitoring were grouped into advanced functions. The issues found in this study include interoperability, security and privacy, usability, data quality, and personalization. Conclusions In addition to PHR basic and advanced functions, other supporting functionalities may also need to be developed based on the issues identified in this study. This paper provides an integrated PHR architectural model that describes the functional requirements and data sources of PHRs.
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Yadav L, Gill TK, Taylor A, deYoung J, Visvanathan R, Chehade MJ. "Context, content, and system" supporting digital health hub (DHH)-enabled models of care (MoCs) for fragility hip fractures: perspectives of diverse multidisciplinary stakeholders in South Australia from qualitative in-depth interviews. Arch Osteoporos 2021; 16:167. [PMID: 34741200 PMCID: PMC8571011 DOI: 10.1007/s11657-021-01031-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 10/19/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Combining thematic analysis and a human-computer persuasive systems framework suggests that hip fracture recovery among older people can be enhanced through person-centered digital health hub models of care focused on behavior change education and integrated care. The findings intend to guide settings involving comorbid conditions and low- and middle-income countries in developing innovative digital health solutions. PURPOSE The purpose of this study was to understand stakeholders' perspectives on the development of a digital health-enabled model of care for fragility hip fractures and to map out factors that could influence the design and implementation of such a model. METHODS Qualitative in-depth interviews were conducted with stakeholders from various clinical disciplines, allied health, and computer science. A hybrid process involving thematic analysis of the raw data using inductive coding was the first step. In the second step, the tenets of a theoretical framework (health behavior change supporting systems) were deductively applied to the thematic constructs generated as part of the first step of the analysis. RESULTS In total, 24 in-depth interviews were conducted with stakeholders. We identified 18 thematic constructs presented under the categories of context, content, and system. Context covered patient characteristics such as frailty, digital literacy, and patient or carer participation, whereas healthcare delivery aspects included the structure and culture of existing practice and the need for innovative holistic models of care. Content outlines the active ingredients and approach in developing a digital health hub, and it highlights the importance of targeted education and behavior change. The system is a complicated matrix crossing different aspects of healthcare and offering a value proposition design through personalization across modes of content delivery. This must foster trust, ensure adequate financing, and support ownership and privacy by establishing appropriate mechanisms for embedding change. CONCLUSION The findings from this study provide insights around potential factors related to patients, community support, and healthcare delivery influencing the design and next-stage implementation of a digital health hub model of care for fragility hip fractures.
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Affiliation(s)
- Lalit Yadav
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, the University of Adelaide, Adelaide, Australia
- Discipline of Orthopaedics & Trauma, Royal Adelaide Hospital, Level 5G, 581, North Terrace, Adelaide, SA 5000 Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, Australia
| | - Tiffany K. Gill
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, Australia
| | - Anita Taylor
- Discipline of Orthopaedics & Trauma, Royal Adelaide Hospital, Level 5G, 581, North Terrace, Adelaide, SA 5000 Australia
| | - Jennifer deYoung
- Discipline of Orthopaedics & Trauma, Royal Adelaide Hospital, Level 5G, 581, North Terrace, Adelaide, SA 5000 Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, the University of Adelaide, Adelaide, Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, Australia
- Aged and Extended Care, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, Australia
| | - Mellick J. Chehade
- National Health and Medical Research Council Centre for Research Excellence in Frailty and Healthy Ageing, Adelaide Medical School, the University of Adelaide, Adelaide, Australia
- Discipline of Orthopaedics & Trauma, Royal Adelaide Hospital, Level 5G, 581, North Terrace, Adelaide, SA 5000 Australia
- Adelaide Medical School, Faculty of Health and Medical Sciences, the University of Adelaide, Adelaide, Australia
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