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Šlapáková Losová V, Dvouletý O. The role of open innovation in addressing resource constraints in healthcare: a systematic literature review. J Health Organ Manag 2024; ahead-of-print. [PMID: 38270394 DOI: 10.1108/jhom-06-2023-0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
PURPOSE The resource crisis in healthcare can be alleviated by engaging external stakeholders and resources in healthcare delivery. The authors use value and open innovation concepts to understand what motivates the stakeholders to join the healthcare innovation ecosystem and what value such an ecosystem brings to healthcare. DESIGN/METHODOLOGY/APPROACH A systematic literature review following the PRISMA framework method was applied to reach the research objective. Out of a total of 509 identified articles published till 2021, 25 were selected as relevant for this review. FINDINGS Six categories of actors were identified, including innovation intermediaries, which were so far neglected in the healthcare innovation literature. Furthermore, patients, healthcare providers, innovation suppliers, investors and influencers were described. The authors also distinguished internal and external stakeholders. The authors show why and how open innovation projects contribute to involving external stakeholders and resources in healthcare delivery by contributing to patient autonomy, relationship building, knowledge transfer, improving collaborative mindset and culture, advancing know-how and bringing additional finances. ORIGINALITY/VALUE This article is the first one to systematically describe the value of open innovation in healthcare. The authors challenge the positivist approach in value presented by value-based healthcare. The authors show how openness contributes to addressing the resource crisis by involving new stakeholders and resources in the care delivery process.
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Affiliation(s)
| | - Ondřej Dvouletý
- Department of Entrepreneurship, Prague University of Economics and Business, Prague, Czech Republic
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Stanimirovic D. Failures and fallacies of eHealth initiatives: Are we finally able to overcome the underlying theoretical and practical orthodoxies? Digit Health 2024; 10:20552076241254019. [PMID: 38766362 PMCID: PMC11100379 DOI: 10.1177/20552076241254019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 03/29/2024] [Indexed: 05/22/2024] Open
Abstract
The growing and ubiquitous digitalization trends embodied in eHealth initiatives have led to the widespread adoption of digital solutions in the healthcare sector. These initiatives have been heralded as a potent transformative force aiming to improve healthcare delivery, enhance patient outcomes and increase the efficiency of healthcare systems. However, despite the significant potential and possibilities offered by eHealth initiatives, the article highlights the importance of critically examining their implications and cautions against the misconception that technology alone can solve complex public health concerns and healthcare challenges. It emphasizes the need to critically consider the sociocultural context, education and training, organizational and institutional aspects, regulatory frameworks, user involvement and other important factors when implementing eHealth initiatives. Disregarding these crucial elements can render eHealth initiatives inefficient or even counterproductive. In view of that, the article identifies failures and fallacies that can hinder the success of eHealth initiatives and highlights areas where they often fall short of meeting rising and unjustified expectations. To address these challenges, the article recommends a more realistic and evidence-based approach to planning and implementing eHealth initiatives. It calls for consistent research agendas, appropriate evaluation methodologies and strategic orientations within eHealth initiatives. By adopting this approach, eHealth initiatives can contribute to the achievement of societal goals and the realization of the key health priorities and development imperatives of healthcare systems on a global scale.
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Scarbrough H, Sanfilippo KRM, Ziemann A, Stavropoulou C. Mobilizing pilot-based evidence for the spread and sustainability of innovations in healthcare: The role of innovation intermediaries. Soc Sci Med 2024; 340:116394. [PMID: 38000177 DOI: 10.1016/j.socscimed.2023.116394] [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: 07/26/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/26/2023]
Abstract
An endemic challenge facing healthcare systems around the world is how to spread innovation more widely and sustainably. A common response to this challenge involves conducting pilot implementation studies to generate evidence of the innovation's benefits. However, despite the key role that such studies play in the local adoption of innovation, their contribution to the wider spread and sustainability of innovation is relatively under-researched and under-theorized. In this paper we examine this contribution through an empirical examination of the experiences of an innovation intermediary organization in the English NHS (National Health Service). We find that their work in mobilizing pilot-based evidence involves three main strands; configuring to context; transitioning evidence; and managing the transition. Through this analysis we contribute to theory by showing how the agency afforded by intermediary roles can support the effective transitioning of pilot-based evidence across different phases in the innovation journey, and across different occupational groups, and can thus help to create a positive feedback loop from localized early implementers of an innovation to later more widespread adoption and sustainability. Based on these findings, we develop insights on the reasons for the unnecessary repetition of pilots - so-called 'pilotitis'- and offer policy recommendations on how to enhance the role of pilots in the wider spread and sustainability of innovation.
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Affiliation(s)
- Harry Scarbrough
- Centre for Healthcare Innovation Research (CHIR), Bayes Business School, City, University of London, 106 Bunhill Row, London, EC1Y 8TZ, UK.
| | - Katie Rose M Sanfilippo
- Centre for Healthcare Innovation Research (CHIR), School of Health and Psychological Sciences, City, University of London, UK
| | - Alexandra Ziemann
- Global Public Health, Department of Social & Policy Sciences, Bath University, UK
| | - Charitini Stavropoulou
- Centre for Healthcare Innovation Research (CHIR), School of Health and Psychological Sciences, City, University of London, UK
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Msosa YJ, Grauslys A, Zhou Y, Wang T, Buchan I, Langan P, Foster S, Walker M, Pearson M, Folarin A, Roberts A, Maskell S, Dobson R, Kullu C, Kehoe D. Trustworthy Data and AI Environments for Clinical Prediction: Application to Crisis-Risk in People With Depression. IEEE J Biomed Health Inform 2023; 27:5588-5598. [PMID: 37669205 DOI: 10.1109/jbhi.2023.3312011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Depression is a common mental health condition that often occurs in association with other chronic illnesses, and varies considerably in severity. Electronic Health Records (EHRs) contain rich information about a patient's medical history and can be used to train, test and maintain predictive models to support and improve patient care. This work evaluated the feasibility of implementing an environment for predicting mental health crisis among people living with depression based on both structured and unstructured EHRs. A large EHR from a mental health provider, Mersey Care, was pseudonymised and ingested into the Natural Language Processing (NLP) platform CogStack, allowing text content in binary clinical notes to be extracted. All unstructured clinical notes and summaries were semantically annotated by MedCAT and BioYODIE NLP services. Cases of crisis in patients with depression were then identified. Random forest models, gradient boosting trees, and Long Short-Term Memory (LSTM) networks, with varying feature arrangement, were trained to predict the occurrence of crisis. The results showed that all the prediction models can use a combination of structured and unstructured EHR information to predict crisis in patients with depression with good and useful accuracy. The LSTM network that was trained on a modified dataset with only 1000 most-important features from the random forest model with temporality showed the best performance with a mean AUC of 0.901 and a standard deviation of 0.006 using a training dataset and a mean AUC of 0.810 and 0.01 using a hold-out test dataset. Comparing the results from the technical evaluation with the views of psychiatrists shows that there are now opportunities to refine and integrate such prediction models into pragmatic point-of-care clinical decision support tools for supporting mental healthcare delivery.
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Goldstein SP, Tovar A, Espel-Huynh HM, Cooksey Stowers K. Applying a Social Determinants of Health Framework to Guide Digital Innovations That Reduce Disparities in Chronic Disease. Psychosom Med 2023; 85:659-669. [PMID: 36800264 PMCID: PMC10439976 DOI: 10.1097/psy.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
ABSTRACT Chronic diseases are among the top causes of global death, disability, and health care expenditure. Digital health interventions (e.g., patient support delivered via technologies such as smartphones, wearables, videoconferencing, social media, and virtual reality) may prevent and mitigate chronic disease by facilitating accessible, personalized care. Although these tools have promise to reach historically marginalized groups, who are disproportionately affected by chronic disease, evidence suggests that digital health interventions could unintentionally exacerbate health inequities. This commentary outlines opportunities to harness recent advancements in technology and research design to drive equitable digital health intervention development and implementation. We apply "calls to action" from the World Health Organization Commission on Social Determinants of Health conceptual framework to the development of new, and refinement of existing, digital health interventions that aim to prevent or treat chronic disease by targeting intermediary, social, and/or structural determinants of health. Three mirrored "calls to action" are thus proposed for digital health research: a) develop, implement, and evaluate multilevel, context-specific digital health interventions; b) engage in intersectoral partnerships to advance digital health equity and social equity more broadly; and c) include and empower historically marginalized groups to develop, implement, and access digital health interventions. Using these "action items," we review several technological and methodological innovations for designing, evaluating, and implementing digital health interventions that have greater potential to reduce health inequities. We also enumerate possible challenges to conducting this work, including leading interdisciplinary collaborations, diversifying the scientific workforce, building trustworthy community relationships, and evolving health care and digital infrastructures.
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Affiliation(s)
- Stephanie P. Goldstein
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
| | - Alison Tovar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI 02912, USA
| | - Hallie M. Espel-Huynh
- Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, 222 Richmond St., Providence, RI, 02903, USA
| | - Kristen Cooksey Stowers
- Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT 06269
- Rudd Center for Food Policy and Health, University of Connecticut, 1 Constitution Plaza, Hartford, CT 06103
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Asthana S, Prime S. The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers. FRONTIERS IN HEALTH SERVICES 2023; 3:1225757. [PMID: 37711604 PMCID: PMC10498291 DOI: 10.3389/frhs.2023.1225757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 09/16/2023]
Abstract
Healthcare systems worldwide are striving for the "quadruple aim" of better population health and well-being, improved experience of care, healthcare team well-being (including that of carers) and lower system costs. By shifting the balance of care from reactive to preventive by facilitating the integration of data between patients and clinicians to support prevention, early diagnosis and care at home, many technological solutions exist to support this ambition. Yet few have been mainstreamed in the NHS. This is particularly the case in English coastal areas which, despite having a substantially higher burden of physical and mental health conditions and poorer health outcomes, also experience inequalities with respect to digital maturity. In this paper, we suggest ways in which digital health technologies (DHTs) can support a greater shift towards prevention; discuss barriers to digital transformation in coastal communities; and highlight ways in which central, regional and local bodes can enable transformation. Given a real risk that variations in digital maturity may be exacerbating coastal health inequalities, we call on health and care policy leaders and service managers to understands the potential benefits of a digital future and the risks of failing to address the digital divide.
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Affiliation(s)
- Sheena Asthana
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
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van Kessel R, Roman-Urrestarazu A, Anderson M, Kyriopoulos I, Field S, Monti G, Reed SD, Pavlova M, Wharton G, Mossialos E. Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review. J Med Internet Res 2023; 25:e48000. [PMID: 37490322 PMCID: PMC10410406 DOI: 10.2196/48000] [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] [Received: 04/07/2023] [Revised: 05/31/2023] [Accepted: 06/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Department of International Health, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Andres Roman-Urrestarazu
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Ilias Kyriopoulos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Samantha Field
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giovanni Monti
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Shelby D Reed
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, United States
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, Netherlands
| | - George Wharton
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Fulop NJ, Walton H, Crellin N, Georghiou T, Herlitz L, Litchfield I, Massou E, Sherlaw-Johnson C, Sidhu M, Tomini SM, Vindrola-Padros C, Ellins J, Morris S, Ng PL. A rapid mixed-methods evaluation of remote home monitoring models during the COVID-19 pandemic in England. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-151. [PMID: 37800997 DOI: 10.3310/fvqw4410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Background Remote home monitoring services were developed and implemented for patients with COVID-19 during the pandemic. Patients monitored blood oxygen saturation and other readings (e.g. temperature) at home and were escalated as necessary. Objective To evaluate effectiveness, costs, implementation, and staff and patient experiences (including disparities and mode) of COVID-19 remote home monitoring services in England during the COVID-19 pandemic (waves 1 and 2). Methods A rapid mixed-methods evaluation, conducted in two phases. Phase 1 (July-August 2020) comprised a rapid systematic review, implementation and economic analysis study (in eight sites). Phase 2 (January-June 2021) comprised a large-scale, multisite, mixed-methods study of effectiveness, costs, implementation and patient/staff experience, using national data sets, surveys (28 sites) and interviews (17 sites). Results Phase 1 Findings from the review and empirical study indicated that these services have been implemented worldwide and vary substantially. Empirical findings highlighted that communication, appropriate information and multiple modes of monitoring facilitated implementation; barriers included unclear referral processes, workforce availability and lack of administrative support. Phase 2 We received surveys from 292 staff (39% response rate) and 1069 patients/carers (18% response rate). We conducted interviews with 58 staff, 62 patients/carers and 5 national leads. Despite national roll-out, enrolment to services was lower than expected (average enrolment across 37 clinical commissioning groups judged to have completed data was 8.7%). There was large variability in implementation of services, influenced by patient (e.g. local population needs), workforce (e.g. workload), organisational (e.g. collaboration) and resource (e.g. software) factors. We found that for every 10% increase in enrolment to the programme, mortality was reduced by 2% (95% confidence interval: 4% reduction to 1% increase), admissions increased by 3% (-1% to 7%), in-hospital mortality fell by 3% (-8% to 3%) and lengths of stay increased by 1.8% (-1.2% to 4.9%). None of these results are statistically significant. We found slightly longer hospital lengths of stay associated with virtual ward services (adjusted incidence rate ratio 1.05, 95% confidence interval 1.01 to 1.09), and no statistically significant impact on subsequent COVID-19 readmissions (adjusted odds ratio 0.95, 95% confidence interval 0.89 to 1.02). Low patient enrolment rates and incomplete data may have affected chances of detecting possible impact. The mean running cost per patient varied for different types of service and mode; and was driven by the number and grade of staff. Staff, patients and carers generally reported positive experiences of services. Services were easy to deliver but staff needed additional training. Staff knowledge/confidence, NHS resources/workload, dynamics between multidisciplinary team members and patients' engagement with the service (e.g. using the oximeter to record and submit readings) influenced delivery. Patients and carers felt services and human contact received reassured them and were easy to engage with. Engagement was conditional on patient, support, resource and service factors. Many sites designed services to suit the needs of their local population. Despite adaptations, disparities were reported across some patient groups. For example, older adults and patients from ethnic minorities reported more difficulties engaging with the service. Tech-enabled models helped to manage large patient groups but did not completely replace phone calls. Limitations Limitations included data completeness, inability to link data on service use to outcomes at a patient level, low survey response rates and under-representation of some patient groups. Future work Further research should consider the long-term impact and cost-effectiveness of these services and the appropriateness of different models for different groups of patients. Conclusions We were not able to find quantitative evidence that COVID-19 remote home monitoring services have been effective. However, low enrolment rates, incomplete data and varied implementation reduced our chances of detecting any impact that may have existed. While services were viewed positively by staff and patients, barriers to implementation, delivery and engagement should be considered. Study registration This study is registered with the ISRCTN (14962466). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (RSET: 16/138/17; BRACE: 16/138/31) and NHSEI and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 13. See the NIHR Journals Library website for further project information. The views expressed in this publication are those of the authors and not necessarily those of the National Institute for Health and Care Research or the Department of Health and Social Care.
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Affiliation(s)
- Naomi J Fulop
- Department of Applied Health Research, University College London, UK
| | - Holly Walton
- Department of Applied Health Research, University College London, UK
| | | | | | - Lauren Herlitz
- Department of Applied Health Research, University College London, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, UK
| | - Efthalia Massou
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Manbinder Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Sonila M Tomini
- Department of Applied Health Research, University College London, UK
| | | | - Jo Ellins
- Health Services Management Centre, School of Social Policy, University of Birmingham, UK
| | - Stephen Morris
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Pei Li Ng
- Department of Applied Health Research, University College London, UK
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Konopik J, Blunck D. Development of an Evidence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review. J Med Internet Res 2023; 25:e41512. [PMID: 37289482 PMCID: PMC10288351 DOI: 10.2196/41512] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/14/2022] [Accepted: 04/07/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers' expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector. OBJECTIVE This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation. METHODS First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation. RESULTS A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem. CONCLUSIONS The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself.
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Affiliation(s)
- Jens Konopik
- Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
| | - Dominik Blunck
- Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
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Ganapathi S, Duggal S. Exploring the experiences and views of doctors working with Artificial Intelligence in English healthcare; a qualitative study. PLoS One 2023; 18:e0282415. [PMID: 36862694 PMCID: PMC9980725 DOI: 10.1371/journal.pone.0282415] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The National Health Service (NHS) aspires to be a world leader of Artificial Intelligence (AI) in healthcare, however, there are several barriers facing translation and implementation. A key enabler of AI within the NHS is the education and engagement of doctors, however evidence suggests that there is an overall lack of awareness of and engagement with AI. RESEARCH AIM This qualitative study explores the experiences and views of doctor developers working with AI within the NHS exploring; their role within medical AI discourse, their views on the implementation of AI more widely and how they consider the engagement of doctors with AI technologies may increase in the future. METHODS This study involved eleven semi-structured, one-to-one interviews conducted with doctors working with AI in English healthcare. Data was subjected to thematic analysis. RESULTS The findings demonstrate that there is an unstructured pathway for doctors to enter the field of AI. The doctors described the various challenges they had experienced during their career, with many arising from the differing demands of operating in a commercial and technological environment. The perceived awareness and engagement among frontline doctors was low, with two prominent barriers being the hype surrounding AI and a lack of protected time. The engagement of doctors is vital for both the development and adoption of AI. CONCLUSIONS AI offers big potential within the medical field but is still in its infancy. For the NHS to leverage the benefits of AI, it must educate and empower current and future doctors. This can be achieved through; informative education within the medical undergraduate curriculum, protecting time for current doctors to develop understanding and providing flexible opportunities for NHS doctors to explore this field.
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Affiliation(s)
- Shaswath Ganapathi
- University of Birmingham Medical School, Birmingham, United Kingdom
- * E-mail:
| | - Sandhya Duggal
- University of Birmingham Medical School, Birmingham, United Kingdom
- The Strategy Unit, Midlands Lancashire Commissioning Support Unit, Leyland, United Kingdom
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Stoumpos AI, Kitsios F, Talias MA. Digital Transformation in Healthcare: Technology Acceptance and Its Applications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3407. [PMID: 36834105 PMCID: PMC9963556 DOI: 10.3390/ijerph20043407] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 02/08/2023] [Accepted: 02/10/2023] [Indexed: 05/27/2023]
Abstract
Technological innovation has become an integral aspect of our daily life, such as wearable and information technology, virtual reality and the Internet of Things which have contributed to transforming healthcare business and operations. Patients will now have a broader range and more mindful healthcare choices and experience a new era of healthcare with a patient-centric culture. Digital transformation determines personal and institutional health care. This paper aims to analyse the changes taking place in the field of healthcare due to digital transformation. For this purpose, a systematic bibliographic review is performed, utilising Scopus, Science Direct and PubMed databases from 2008 to 2021. Our methodology is based on the approach by Wester and Watson, which classify the related articles based on a concept-centric method and an ad hoc classification system which identify the categories used to describe areas of literature. The search was made during August 2022 and identified 5847 papers, of which 321 fulfilled the inclusion criteria for further process. Finally, by removing and adding additional studies, we ended with 287 articles grouped into five themes: information technology in health, the educational impact of e-health, the acceptance of e-health, telemedicine and security issues.
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Affiliation(s)
- Angelos I. Stoumpos
- Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus
| | - Fotis Kitsios
- Department of Applied Informatics, University of Macedonia, 156 Egnatia Street, GR54636 Thessaloniki, Greece
| | - Michael A. Talias
- Healthcare Management Postgraduate Program, Open University Cyprus, P.O. Box 12794, Nicosia 2252, Cyprus
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12
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Usher-Smith JA, Hindmarch S, French DP, Tischkowitz M, Moorthie S, Walter FM, Dennison RA, Stutzin Donoso F, Archer S, Taylor L, Emery J, Morris S, Easton DF, Antoniou AC. Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. Br J Cancer 2023; 128:1636-1646. [PMID: 36737659 PMCID: PMC9897164 DOI: 10.1038/s41416-023-02145-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.
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Affiliation(s)
- Juliet A. Usher-Smith
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Hindmarch
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marc Tischkowitz
- grid.5335.00000000121885934Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Sowmiya Moorthie
- grid.5335.00000000121885934PHG Foundation, University of Cambridge, Cambridge, UK
| | - Fiona M. Walter
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca A. Dennison
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francisca Stutzin Donoso
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Lily Taylor
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- grid.1008.90000 0001 2179 088XCentre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Stephen Morris
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Antonis C. Antoniou
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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13
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Eysenbach G, Cavalini H, Shetty S, Delanerolle G. Digital Maturity Consulting and Strategizing to Optimize Services: Overview. J Med Internet Res 2023; 25:e37545. [PMID: 36649060 PMCID: PMC9890346 DOI: 10.2196/37545] [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: 02/27/2022] [Revised: 10/19/2022] [Accepted: 11/16/2022] [Indexed: 11/18/2022] Open
Abstract
The National Health Service (NHS), the health care system of the United Kingdom, is one of the largest health care entities in the world and has been successfully serving the UK population for decades. The NHS is also the fourth-largest employer globally. True to its reputation, some of the most modern and technically advanced medical services are available in the United Kingdom. However, between the acute, primary, secondary, and tertiary care providers of the NHS, there needs to be seamless integration and interoperability to provide timely holistic care to patients at a national level. Various efforts have been taken and programs launched since 2002 to achieve digital transformation in the NHS but with partial success rates. As it is important to understand a problem before trying to solve it, in this paper, we focus on tools used to assess the digital maturity of NHS trusts and organizations. Additionally, we aim to present the impact of ongoing transformation attempts on secondary services, particularly mental health. This paper considered the literature on digital maturity and performed a rapid review of currently available tools to measure digital maturity. We have performed a multivocal literature review that included white papers and web-based documents in addition to peer-reviewed literature. Further, the paper also provides a perspective of the ground reality from a mental health service provider's point of view. Assessment tools adopted from the global market, later modified and tailor-made to suit local preferences, are currently being used. However, there is a need for a robust framework that assesses status, allows target setting, and tracks progress across diverse providers.
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Affiliation(s)
| | - Heitor Cavalini
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Suchith Shetty
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom
| | - Gayathri Delanerolle
- Research & Innovation Department, Southern Health NHS Foundation Trust, Southampton, United Kingdom.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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‘The plural of silo is not ecosystem’: Qualitative study on the role of innovation ecosystems in supporting ‘Internet of Things’ applications in health and care. Digit Health 2023. [DOI: 10.1177/20552076221147114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Background Internet of Things (IoT) innovations such as wearables and sensors promise improved health outcomes and service efficiencies. Yet, most applications remain experimental with little routine use in health and care settings. We sought to examine the multiple interacting influences on IoT implementation, spread and scale-up, including the role of regional innovation ‘ecosystems’ and the impact of the COVID-19 context. Methods Qualitative study involving 20 participants with clinical, entrepreneurial and broader innovation experience in 18 in-depth interviews, focusing primarily on heart monitoring and assistive technology applications. Data analysis was informed by the NASSS (non-adoption, abandonment, scale-up, spread, sustainability) framework. Results Interviewees discussed multiple tensions and trade-offs, including lack of organisational capacity for routine IoT use, limited ability to receive and interpret data, complex procurement and governance processes, and risk of health disparities and inequalities without system support and funding. Although the pandemic highlighted opportunities for IoT use, it was unclear whether these would be sustained, with framings of innovation as ‘disruption’ coming at odds with immediate needs in healthcare settings. Even in an ‘ecosystem’ with strong presence of academic and research institutions, support was viewed as limited, with impressions of siloed working, conflicting agendas, fragmentation and lack of collaboration opportunities. Conclusions IoT development, implementation and roll-out require support from multiple ecosystem actors to be able to articulate a value proposition beyond experimental or small-scale applications. In contexts where clinical, academic and commercial worlds collide, sustained effort is needed to align needs, priorities and motives, and to strengthen potential for good value IoT innovation.
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15
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Njoku C, Green Hofer S, Sathyamoorthy G, Patel N, Potts HWW. The role of accelerator programmes in supporting the adoption of digital health technologies: A qualitative study of the perspectives of small- and medium-sized enterprises. Digit Health 2023; 9:20552076231173303. [PMID: 37256012 PMCID: PMC10226171 DOI: 10.1177/20552076231173303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 04/14/2023] [Indexed: 06/01/2023] Open
Abstract
Objective Evidence-based digital health technologies are increasingly important in delivering care to an ageing population with constrained resources. In the United Kingdom, accelerator programmes (APs) have been developed to support the adoption of digital health technologies within the National Health Service. This study aims to explore the perspectives of stakeholders using APs. Methods Stakeholders representing nine small -and medium-sized enterprises (SMEs) that were engaged with three different APs (n = 9). Semi-structured interviews were conducted with key informants between April and September 2018. Framework analysis of the data was performed to explore their perspectives on APs. Results Four key themes were generated. Informants reported the need to generate evidence before and during the programme, appreciating different types of evidence and their importance. Informants identified several key factors that were a catalyst for success, including involvement in the programme and access to individuals and organisations that were crucial for support. However, several barriers were identified at the programme and system levels. Finally, informants identified key supporting processes that enhanced the adoption of their innovations. Conclusion SMEs that develop digital health technologies report that, while APs are useful in supporting the adoption of these technologies, some issues remain. These relate to the emphasis on traditional research evidence that remains a challenge for SMEs to generate. Also, several system-level barriers to innovation in healthcare persist. As APs and SMEs continue to create an entrepreneurial ecosystem, there is increased potential for the development of supporting processes and infrastructure to accelerate the efficient and timely adoption of new digital health technologies.
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Affiliation(s)
- Chidi Njoku
- Department of Primary Care and Public
Health, Imperial College London, London, UK
| | - Stuart Green Hofer
- Department of Primary Care and Public
Health, Imperial College London, London, UK
| | - Ganesh Sathyamoorthy
- Department of Primary Care and Public
Health, Imperial College London, London, UK
| | | | - Henry WW Potts
- Institute of Health Informatics,
University College London, UCL Institute of Health Informatics, London, UK
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16
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Fagerström M, Löf M, Müssener U, Thomas K. The importance of trusting conditions for organizations' readiness to implement mHealth to support healthy lifestyle behaviors: An interview study within Swedish child and school healthcare. Digit Health 2023; 9:20552076231181476. [PMID: 37361431 PMCID: PMC10286530 DOI: 10.1177/20552076231181476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To explore perceptions among nurses, managers, and policymakers regarding organizational readiness to implement mHealth for the promotion of healthy lifestyle behaviors in child and school healthcare. Methods Individual semi-structured interviews with nurses (n = 10), managers (n = 10), and policymakers (n = 8) within child and school healthcare in Sweden. Inductive content analysis was used for data analysis. Results Data showed that various trust-building aspects in health care organizations may contribute to readiness to implement mHealth. Several aspects were perceived to contribute trusting conditions: (a) how health-related data could be stored and managed; (b) how mHealth aligned with current organizational ways of working; (c) how implementation of mHealth was governed; and (d) camaraderie within a healthcare team to facilitate use of mHealth in practice. Poor capability to manage health-related data, as well as lack of governance of mHealth implementation were described as dealbreakers for readiness to implement mHealth in healthcare organizations. Conclusions Healthcare professionals and policymakers perceived that trusting conditions for mHealth implementation within organizations were central for readiness. Specifically, governance of mHealth implementation and the ability to manage health-data produced by mHealth were perceived critical for readiness.
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Affiliation(s)
- Maria Fagerström
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Marie Löf
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden
| | - Ulrika Müssener
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Kristin Thomas
- Department of Health, Medicine, and Caring Sciences, Linköping University, Linkoping, Sweden
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17
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Gardner J, Herron D, McNally N, Williams B. Advancing the digital and computational capabilities of healthcare providers: A qualitative study of a hospital organisation in the NHS. Digit Health 2023; 9:20552076231186513. [PMID: 37456124 PMCID: PMC10345922 DOI: 10.1177/20552076231186513] [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: 11/24/2022] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Objective Healthcare systems require transformation to meet societal challenges and projected health demands. Digital and computational tools and approaches are fundamental to this transformation, and hospitals have a key role to play in their development and implementation. This paper reports on a study with the objective of exploring the challenges encountered by hospital leaders and innovators as they implement a strategy to become a data-driven hospital organisation. In doing so, this paper provides guidance to future leaders and innovators seeking to build computational and digital capabilities in complex clinical settings. Methods Interviews were undertaken with 42 participants associated with a large public hospital organisation within England's National Health Service. Using the concept of institutional readiness as an analytical framework, the paper explores participants' perspectives on the organisation's capacity to support the development of, and benefit from, digital and computational approaches. Results Participants' accounts reveal a range of specific institutional readiness criteria relating to organisational vision, technical capability, organisational agility, and talent and skills that, when met, enhance the organisations' capacity to support the development and implementation of digital and computational tools. Participant accounts also reveal challenges relating to these criteria, such as unrealistic expectations and the necessary prioritisation of clinical work in resource-constrained settings. Conclusions The paper identifies a general set of institutional readiness criteria that can guide future hospital leaders and innovators aiming to improve their organisation's digital and computational capability. The paper also illustrates the challenges of pursuing digital and computational innovation in resource-constrained hospital environments.
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Affiliation(s)
- John Gardner
- School of Social Sciences, Monash University, Melbourne, Australia
| | | | | | - Bryan Williams
- Institute of Cardiovascular Sciences, University College London, London, UK
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18
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Dunham M, Bacon L, Cottom S, McCrone P, Mehrpouya H, Spyridonis F, Thompson T, Schofield P. Chronic pain through COVID. FRONTIERS IN PAIN RESEARCH 2022; 3:937652. [PMID: 36341152 PMCID: PMC9629777 DOI: 10.3389/fpain.2022.937652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To identify good practice in the community management of chronic pain, and to understand the perspective of a group of healthcare service users towards the management of chronic pain using technology during the COVID-19 pandemic. Methods Forty-five people, recruited via social media and Pain Association Scotland, participated in three focus groups hosted over Zoom. Focus groups were conducted using semi-structured questions to guide the conversation. Data were analysed using Ritchie / Spencer's Framework Analysis. Results The participants shared observations of their experiences of remotely supported chronic pain services and insights into the potential for future chronic pain care provision. Experiences were in the majority positive with some describing their rapid engagement with technology during the COVID pandemic. Conclusion Results suggest there is strong potential for telehealth to complement and support existing provision of pain management services.
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Affiliation(s)
- M. Dunham
- School of Health / Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- Correspondence: M. Dunham
| | - L. Bacon
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - S. Cottom
- Pain Association Scotland, Perth, United Kingdom
| | - P. McCrone
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - H. Mehrpouya
- School of Design and Informatics, Abertay University, Dundee, United Kingdom
| | - F. Spyridonis
- Department of Computer Science, Brunel University London, Uxbridge, United Kingdom
| | - T. Thompson
- School of Human Sciences, University of Greenwich, London, United Kingdom
| | - P. Schofield
- University of Plymouth, Plymouth, United Kingdom
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19
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Mielke J, Leppla L, Valenta S, Zullig LL, Zúñiga F, Staudacher S, Teynor A, De Geest S. Unraveling implementation context: the Basel Approach for coNtextual ANAlysis (BANANA) in implementation science and its application in the SMILe project. Implement Sci Commun 2022; 3:102. [PMID: 36183141 PMCID: PMC9526967 DOI: 10.1186/s43058-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Designing intervention and implementation strategies with careful consideration of context is essential for successful implementation science projects. Although the importance of context has been emphasized and methodology for its analysis is emerging, researchers have little guidance on how to plan, perform, and report contextual analysis. Therefore, our aim was to describe the Basel Approach for coNtextual ANAlysis (BANANA) and to demonstrate its application on an ongoing multi-site, multiphase implementation science project to develop/adapt, implement, and evaluate an integrated care model in allogeneic SteM cell transplantatIon facILitated by eHealth (the SMILe project). METHODS BANANA builds on guidance for assessing context by Stange and Glasgow (Contextual factors: the importance of considering and reporting on context in research on the patient-centered medical home, 2013). Based on a literature review, BANANA was developed in ten discussion sessions with implementation science experts and a medical anthropologist to guide the SMILe project's contextual analysis. BANANA's theoretical basis is the Context and Implementation of Complex Interventions (CICI) framework. Working from an ecological perspective, CICI acknowledges contextual dynamics and distinguishes between context and setting (the implementation's physical location). RESULTS BANANA entails six components: (1) choose a theory, model, or framework (TMF) to guide the contextual analysis; (2) use empirical evidence derived from primary and/or secondary data to identify relevant contextual factors; (3) involve stakeholders throughout contextual analysis; (4) choose a study design to assess context; (5) determine contextual factors' relevance to implementation strategies/outcomes and intervention co-design; and (6) report findings of contextual analysis following appropriate reporting guidelines. Partly run simultaneously, the first three components form a basis both for the identification of relevant contextual factors and for the next components of the BANANA approach. DISCUSSION Understanding of context is indispensable for a successful implementation science project. BANANA provides much-needed methodological guidance for contextual analysis. In subsequent phases, it helps researchers apply the results to intervention development/adaption and choices of contextually tailored implementation strategies. For future implementation science projects, BANANA's principles will guide researchers first to gather relevant information on their target context, then to inform all subsequent phases of their implementation science project to strengthen every part of their work and fulfill their implementation goals.
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Affiliation(s)
- Juliane Mielke
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Lynn Leppla
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.7708.80000 0000 9428 7911Department of Medicine I, Faculty of Medicine, Medical Center University of Freiburg, Freiburg im Breisgau, Germany
| | - Sabine Valenta
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.410567.1Department of Hematology, University Hospital Basel, Basel, Switzerland
| | - Leah L. Zullig
- grid.26009.3d0000 0004 1936 7961Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care & System, and Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC USA
| | - Franziska Zúñiga
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Sandra Staudacher
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Alexandra Teynor
- grid.440970.e0000 0000 9922 6093University of Applied Sciences Augsburg, Faculty of Computer Science, Augsburg, Germany
| | - Sabina De Geest
- grid.6612.30000 0004 1937 0642Institute of Nursing Science (INS), Department Public Health (DPH), Faculty of Medicine, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland ,grid.5596.f0000 0001 0668 7884Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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20
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Carter B, Saron H, Blake L, Eyton-Chong CK, Dee S, Evans L, Harris J, Hughes H, Jones D, Lambert C, Lane S, Mehta F, Peak M, Preston J, Siner S, Sefton G, Carrol ED. Clinical utility and acceptability of a whole-hospital, pro-active electronic paediatric early warning system (the DETECT study): A prospective e-survey of parents and health professionals. PLoS One 2022; 17:e0273666. [PMID: 36107953 PMCID: PMC9477367 DOI: 10.1371/journal.pone.0273666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 08/11/2022] [Indexed: 11/18/2022] Open
Abstract
Background Paediatric early warning systems (PEWS) are a means of tracking physiological state and alerting healthcare professionals about signs of deterioration, triggering a clinical review and/or escalation of care of children. A proactive end-to-end deterioration solution (the DETECT surveillance system) with an embedded e-PEWS that included sepsis screening was introduced across a tertiary children’s hospital. One component of the implementation programme was a sub-study to determine an understanding of the DETECT e-PEWS in terms of its clinical utility and its acceptability. Aim This study aimed to examine how parents and health professionals view and engage with the DETECT e-PEWS apps, with a particular focus on its clinical utility and its acceptability. Method A prospective, closed (tick box or sliding scale) and open (text based) question, e-survey of parents (n = 137) and health professionals (n = 151) with experience of DETECT e-PEWS. Data were collected between February 2020 and February 2021. Results Quantitative data were analysed using descriptive and inferential statistics and qualitative data with generic thematic analysis. Overall, both clinical utility and acceptability (across seven constructs) were high across both stakeholder groups although some challenges to utility (e.g., sensitivity of triggers within specific patient populations) and acceptability (e.g., burden related to having to carry extra technology) were identified. Conclusion Despite the multifaceted nature of the intervention and the complexity of implementation across a hospital, the system demonstrated clinical utility and acceptability across two key groups of stakeholders: parents and health professionals.
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Affiliation(s)
- Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
- * E-mail:
| | - Holly Saron
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Lucy Blake
- Department of Social Sciences, University of West of England, Bristol, United Kingdom
| | - Chin-Kien Eyton-Chong
- Department of General Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Sarah Dee
- High Dependency Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Leah Evans
- High Dependency Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Jane Harris
- Faculty of Health, Public Health Institute, Liverpool John Moores University, United Kingdom
| | - Hannah Hughes
- Oncology Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Dawn Jones
- Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Caroline Lambert
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Fulya Mehta
- Department of General Paediatrics, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Matthew Peak
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Jennifer Preston
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sarah Siner
- Clinical Research Division, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Gerri Sefton
- Paediatric Intensive Care Unit, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
| | - Enitan D. Carrol
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Infectious Diseases, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
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21
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Valentijn PP, Tymchenko L, Jacobson T, Kromann J, Biermann CW, AlMoslemany MA, Arends RY. Digital Health Interventions for Musculoskeletal Pain Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2022; 24:e37869. [PMID: 36066943 PMCID: PMC9490534 DOI: 10.2196/37869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/17/2022] [Accepted: 07/25/2022] [Indexed: 11/24/2022] Open
Abstract
Background Digital health solutions can provide populations with musculoskeletal pain with high-reach, low-cost, easily accessible, and scalable patient education and self-management interventions that meet the time and resource restrictions. Objective The main objective of this study was to determine the effectiveness of digital health interventions for people with musculoskeletal pain conditions (ie, low back pain, neck pain, shoulder pain, knee pain, elbow pain, ankle pain, and whiplash). Methods A systematic review and meta-analysis was conducted. We searched PubMed and Cochrane Central Register of Controlled Trials (from 1974 to August 2021) and selected randomized controlled trials of digital health interventions in the target population of patients with musculoskeletal pain with a minimum follow-up of 1 month. A total of 2 researchers independently screened and extracted the data. Results A total of 56 eligible studies were included covering 9359 participants, with a mean follow-up of 25 (SD 15.48) weeks. In moderate-quality evidence, digital health interventions had a small effect on pain (standardized mean difference [SMD] 0.19, 95% CI 0.06-0.32), disability (SMD 0.14, 95% CI 0.03-0.25), quality of life (SMD 0.22, 95% CI 0.07-0.36), emotional functioning (SMD 0.24, 95% CI 0.12-0.35), and self-management (SMD 0.14, 95% CI 0.05-0.24). Conclusions Moderate-quality evidence supports the conclusion that digital health interventions are effective in reducing pain and improving functioning and self-management of musculoskeletal pain conditions. Low-quality evidence indicates that digital health interventions can improve the quality of life and global treatment. Little research has been conducted on the influence of digital health on expenses, knowledge, overall improvement, range of motion, muscle strength, and implementation fidelity. Trial Registration PROSPERO CRD42022307504; https://tinyurl.com/2cd25hus
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Affiliation(s)
- Pim Peter Valentijn
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,Department of Health Services Research, School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Liza Tymchenko
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands
| | | | | | | | | | - Rosa Ymkje Arends
- Essenburgh Research & Consultancy, Essenburgh Group, Harderwijk, Netherlands.,University of Applied Sciences Utrecht, Utrecht, Netherlands
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22
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Fang ML, Walker M, Wong KLY, Sixsmith J, Remend L, Sixsmith A. Future of digital health and community care: Exploring intended positive impacts and unintended negative consequences of COVID-19. Healthc Manage Forum 2022; 35:279-285. [PMID: 35775162 PMCID: PMC9253718 DOI: 10.1177/08404704221107362] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Response to COVID-19 has both intentionally and unintentionally progressed the digitization of health and community care, which can be viewed as a human rights issue considering that access to health and community care is a human right. In this article, we reviewed two cases of digitization of health and community care during the pandemic; one in Scotland, United Kingdom and another in British Columbia, Canada. An integrated analysis revealed that digitization of health and community care has intended positive and unintended negative consequences. Based on the analysis, we suggest five areas of improvement for equity in care: building on the momentum of technology advantages; education and digital literacy; information management and security; development of policy and regulatory frameworks; and the future of digital health and community care. This article sheds light on how health practitioners and leaders can work to enhance equity in care experiences amid the changing digital landscape.
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Affiliation(s)
| | | | - Karen Lok Yi Wong
- 8166University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Leslie Remend
- 411 Seniors Centre Society, Vancouver, British Columbia, Canada
| | - Andrew Sixsmith
- 411 Seniors Centre Society, Vancouver, British Columbia, Canada
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23
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Lynch M, Yoo J, Mukami D, Arian W, Bashford T, Hobden P, Luthra P, Patel M, Ralph N, Winters N, McGrath L, Simms B. Principles to guide the effective use of technology to support capacity development in global health partnerships. BMJ Glob Health 2022; 6:bmjgh-2021-006783. [PMID: 35840176 PMCID: PMC9296875 DOI: 10.1136/bmjgh-2021-006783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/13/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Jihoon Yoo
- Tropical Health and Education Trust, London, UK
| | - Diana Mukami
- Institute of Local Capacity Development, Amref Health Africa, Nairobi, Kenya
| | | | - Tom Bashford
- NIHR Global Health Research Group for Neurotrauma, University of Cambridge, Cambridge, UK
| | - Paul Hobden
- Chief Executive Office, Gateway, Cape Town, South Africa
| | - Pramod Luthra
- Associate Postgraduate Dean, Health Education England North West, Manchester, UK
| | - Mumtaz Patel
- Postgraduate Associate Dean, Health Education England North West, Manchester, UK
| | - Neil Ralph
- Technology Enhanced Learning, Health Education England, Leeds, UK
| | - Niall Winters
- Department of Education, University of Oxford, Oxford, UK
| | - Louise McGrath
- Programmes, Tropical Health and Education Trust, London, UK
| | - Ben Simms
- Chief Executive, Tropical Health and Education Trust, London, UK
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24
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Han JED, Ibrahim H, Aiyegbusi OL, Liu X, Marston E, Denniston AK, Calvert MJ. Opportunities and Risks of UK Medical Device Reform. Ther Innov Regul Sci 2022; 56:596-606. [PMID: 35416614 PMCID: PMC9007047 DOI: 10.1007/s43441-022-00394-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/14/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To identify the potential opportunities and risks around future UK regulatory reform of medical devices. DESIGN A mixed methods approach, comprising a rapid literature review, one-to-one, semi-structured interviews with key stakeholders, a multidisciplinary stakeholder workshop, and a post-workshop survey. SETTING United Kingdom. PARTICIPANTS 32 key stakeholders across the medical device sector were identified both from the public and private sectors. RESULTS Opportunities relating to regulatory independence were identified, including the potential to create and implement a regulatory framework that ensures availability of medical devices; innovation and investment potential; and safety to the citizens of the UK. The most significant risks identified included threats to the safety of individual patients and the wider health system arising from the delay in awaiting regulatory approval due to the shortage of approved bodies; and reduced competitiveness of UK market and device manufacturers. Recommendations were identified to mitigate risks, centred on harnessing broader cross-sector collaborations, promoting patient and public partnership, and maximizing international engagement. CONCLUSIONS The UK's medical device sector is at a time-critical juncture to construct a regulatory framework to navigate its exit of Europe and respond to Europe's transition to new medical device regulations whilst also addressing the ongoing demand for rapid approval for new devices in response to the global pandemic. Investment, capacity-building, and international engagement will play a central role in mitigating risks and maximizing opportunities for medical device regulation.
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Affiliation(s)
- Ji Eun Diana Han
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Hussein Ibrahim
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK.,National Institute for Health Research (NIHR) Applied Research Collaborative West Midlands, University of Birmingham, Birmingham, UK
| | - Xiaoxuan Liu
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK.,Health Data Research UK, London, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Eliot Marston
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Alastair K Denniston
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK.,Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Health Data Research UK, London, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Regulatory Horizons Council, London, UK
| | - Melanie J Calvert
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK. .,Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK. .,Centre for Patient Reported Outcomes Research, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. .,National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham, Birmingham, UK. .,NIHR Surgical Reconstruction and Microbiology Research Centre University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK. .,National Institute for Health Research (NIHR) Applied Research Collaborative West Midlands, University of Birmingham, Birmingham, UK.
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25
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Buivydaite R, Reen G, Kovalevica T, Dodd H, Hicks I, Vincent C, Maughan D. Improving usability of Electronic Health Records in a UK Mental Health setting: a feasibility study. J Med Syst 2022; 46:50. [PMID: 35674989 PMCID: PMC9177469 DOI: 10.1007/s10916-022-01832-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 11/15/2022]
Abstract
Background Electronic Health Records (EHRs) can help clinicians to plan, document and deliver care for patients in healthcare services. When used consistently, EHRs can advance patient safety and quality, and reduce clinician’s workload. However, usability problems can make it difficult for clinicians to use EHRs effectively, which can negatively impact both healthcare professionals and patients. Objective To improve usability of EHRs within a mental health service in the UK. Methods This was a feasibility study conducted with two mental health teams. A mixed-methods approach was employed. Focus group discussions with clinicians identified existing usability problems in EHRs and changes were made to address these problems. Updated EHR assessment forms were evaluated by comparing the following measures pre and post changes: (1) usability testing to monitor time spent completing and duplicating patient information in EHRs, (2) clinician’s experience of using EHRs, and (3) proportion of completed EHR assessment forms. Results Usability testing with clinicians (n = 3) showed that the time taken to complete EHR assessment forms and time spent duplicating patient information decreased. Clinician’s experience of completing EHR assessment forms also significantly improved post changes compared to baseline (n = 71; p < 0.005). There was a significant increase in completion of most EHR forms by both teams after EHR usability improvements (all at p < 0.01). Conclusions Usability improvements to EHRs can reduce the time taken to complete forms, advance clinician’s experience and increase usage of EHRs. It is important to engage healthcare professionals in the usability improvement process of EHRs in mental health services. Supplementary information The online version contains supplementary material available at 10.1007/s10916-022-01832-0.
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Affiliation(s)
- Ruta Buivydaite
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - Gurpreet Reen
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Harry Dodd
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ian Hicks
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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26
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Hammerton M, Benson T, Sibley A. Readiness for five digital technologies in general practice: perceptions of staff in one part of southern England. BMJ Open Qual 2022; 11:bmjoq-2022-001865. [PMID: 35768171 PMCID: PMC9244720 DOI: 10.1136/bmjoq-2022-001865] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Our aim was to understand how digital readiness within general practice varies between different technologies and to identify how demographic, workplace and external factors affect this. The technologies considered include electronic patient records, telehealth (text messaging and video consultations), patient online access, patient clinical apps and wearables, and social media. Method A digital readiness survey tool was developed and used in one area of southern England during Spring 2020. Semistructured qualitative interviews were also carried out with some practice staff and digital technology company representatives. Results GPs, nurses and non-clinical staff submitted 287 responses from 27 general practices (out of 33 invited). Staff digital readiness differs significantly between technologies. The mean perceived digital competency scores on 0–100 scale (high is good) were electronic patient records (75.7), telehealth (64.2), patient online access (65.8), patient clinical apps and wearables (50.8), and social media (51.2). Younger general practice staff, those in post for 5 or less years are more digitally competent and confident than older staff. This applies to both clinical and non-clinical staff. Older patient population, rurality and smaller practice size are associated with lower digital readiness. Readiness to use digital technology may have improved since the start of the COVID-19 pandemic but barriers remain in poor IT and mobile infrastructure, software usability and interoperability, and concerns about information governance. Conclusions Improving digital readiness in general practice is complex and multifactorial. Issues may be alleviated by using dedicated digital implementation teams and closer collaboration between stakeholders (GPs and their staff, patients, funders, technology companies and government).
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Affiliation(s)
| | - Tim Benson
- R-Outcomes Ltd, Newbury, UK
- Institute of Health Informatics, UCL, London, UK
| | - Andrew Sibley
- Wessex Academic Health Science Network, Southampton, UK
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27
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Fjellså HMH, Husebø AML, Storm M. eHealth in Care Coordination for Older Adults Living at Home: A Scoping Review (Preprint). J Med Internet Res 2022; 24:e39584. [DOI: 10.2196/39584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
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28
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Oberschmidt K, van Velsen L, Grünloh C, Fiorini L, Rovini E, Melero Muñoz FJ. International eHealth ecosystems and the quest for the winning value proposition: findings from a survey study. OPEN RESEARCH EUROPE 2022; 2:56. [PMID: 37645272 PMCID: PMC10445862 DOI: 10.12688/openreseurope.14655.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 08/31/2023]
Abstract
BACKGROUND eHealth ecosystems are becoming increasingly important for national and international healthcare. In such ecosystems, different actors are connected and work together to create mutual value. However, it is important to be aware of the goals that each actor pursues within the ecosystem. METHOD This study describes the outcomes of a workshop (30 participants) and two surveys (completed by 54 and 100 participants), which investigated how different types of industry stakeholders, namely social services, healthcare, technology developers and researchers, rated potential value propositions for an eHealth ecosystem. Both the feasibility and the importance of each proposition was taken into account. RESULTS Interoperability between services was highly valued across industry types but there were also vast differences concerning other propositions. CONCLUSION Jointly reflecting on the different perceived values of an ehealth ecosystem can help actors working together to form an ecosystem.
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Affiliation(s)
- Kira Oberschmidt
- Biomedical Signals and Systems Group, University of Twente, Enschede, 7500AE, The Netherlands
- eHealth department, Roessingh Research and Development, Enschede, 7500 AH, The Netherlands
| | - Lex van Velsen
- Biomedical Signals and Systems Group, University of Twente, Enschede, 7500AE, The Netherlands
- eHealth department, Roessingh Research and Development, Enschede, 7500 AH, The Netherlands
| | - Christiane Grünloh
- Biomedical Signals and Systems Group, University of Twente, Enschede, 7500AE, The Netherlands
- eHealth department, Roessingh Research and Development, Enschede, 7500 AH, The Netherlands
| | - Laura Fiorini
- Department of Industrial Engineering, University of Florence, Florence, 50139, Italy
| | - Erika Rovini
- Department of Industrial Engineering, University of Florence, Florence, 50139, Italy
| | - Francisco José Melero Muñoz
- Telecommunication Networks Engineering Group, Technical University of Cartagena, Cartagena, 30202, Spain
- Technical Research Centre of Furniture and Wood of the Region of Murcia (CETEM), Yecla, 30510, Spain
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29
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Acharya A, Black RC, Smithies A, Darzi A. Evaluating the impact of a digital leadership programme on national digital priorities: a mixed methods study. BMJ Open 2022; 12:e056369. [PMID: 35487747 PMCID: PMC9058758 DOI: 10.1136/bmjopen-2021-056369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aimed to determine the impact of the United Kingdom's National Health Service Digital Academy (NHSDA) Digital Health Leadership course on high-level recommendations in digital preparedness and the development of a proficient leadership to oversee digital transformation, which has been a longstanding priority within the NHS. DESIGN A mixed methods study incorporating an online questionnaire, in-depth interviews and focus groups that were then analysed through a thematic analysis, underpinned by a constructivist approach. SETTINGS An online mixed methods study of a defined cohort of participants who had completed the NHSDA course. PARTICIPANTS 26 participants were recruited to the study, of whom 50% were clinicians, 26.9% in management and 19.2% in data science. All had completed the 2-year NHSDA programme in Digital Health Leadership more than 6 months prior. RESULTS Interviews and focus groups elicited two key areas of impact of the course: loco-regional digitisation and the development of a network of change agents. The dissertation project had direct effects on local digital transformation efforts. Most of these projects focused on clinician (11.7%) or service user (10.3%) engagement, as oppose to de novo digital processes (9.4%). The development of a network of digital leaders has facilitated communication between organisations and improved the efficiency of the national digital infrastructure. CONCLUSIONS A bespoke course incorporating a dissertation of practice model for digital health leaders can have broader impact for the attainment of digital priorities. This includes helping trusts to successfully adopt digital solutions, as well as fostering shared organisational learning. These influences, however, are mediated by resource and cultural barriers, which continue to hinder transformation efforts.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ruth Claire Black
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Alisdair Smithies
- Institute of Global Health Innovation, Imperial College London, London, UK
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, UK
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30
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Kim SY, Moon JY, Shin J, Sim JY, Kim M, Jang J. Survey for Government Policies Regarding Strategies for the Commercialization and Globalization of Digital Therapeutics. Yonsei Med J 2022; 63:S56-S62. [PMID: 35040606 PMCID: PMC8790580 DOI: 10.3349/ymj.2022.63.s56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/25/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study was conducted to build a direction for government policies regarding strategies for the commercialization of digital therapeutics in Korea, as well as its globalization. MATERIALS AND METHODS The study included 37 participants from the Korea Digital Health Industry Association (KODHIA). The data was based on a survey conducted in 2020 targeting employees of companies engaged in the digital health industry in Korea. Participants were asked about their involvement in product development of digital therapeutics and their opinion about the growing motivator for digital therapeutics in Korea and the global market. RESULTS According to our data, among subjects not involved in making digital therapeutics products, the main reason for not being involved was the lack of experts (73.9%) and difficulty in licensing (73.9%). Responses concerning the priority area in need of national support were R&D funding (43.2%), and the next was licensing guidance and simplifying regulations (24.3%). Possible difficulties of overseas market expansion were the unfamiliarity in digital therapeutics technology verification and licensing structures of foreign countries (73%), and concerns regarding the level of recognition of clinical trials and technology in Korea from overseas (70.3%). Overall, respondents were hesitant in starting a related business due to the lack of government support and the complexity of the regulation process. Moreover, concerns about global market entry were similar. Being unfamiliar with the novel process and worrying about the achievement despite existing challenges were the biggest drawback. CONCLUSION For the digital therapeutics industry to evolve domestically and internationally, government support and guidance are essential.
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Affiliation(s)
- Soo Young Kim
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Jong Youn Moon
- Department of Preventive Medicine, Gachon University College of Medicine, Incheon, Korea
- Center for Public Healthcare, Gachon University Gil Medical Center, Incheon, Korea.
| | - Jaeyong Shin
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
- Institute of Health Services Research, Yonsei University, Seoul, Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Jung Yeon Sim
- Department of Medical Device Engineering and Management, Yonsei University Graduate School, Seoul, Korea
| | - Meelim Kim
- Health IT Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jieun Jang
- Department of Public Health, Yonsei University Graduate School, Seoul, Korea
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31
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Rauwerdink A, Kasteleyn MJ, Chavannes NH, Schijven MP. Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study. J Med Internet Res 2021. [PMID: 34842536 DOI: 10.1016/j.ceh.2020.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. OBJECTIVE The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. METHODS To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. RESULTS The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. CONCLUSIONS The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.ceh.2020.12.002.
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Affiliation(s)
- Anneloek Rauwerdink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
- Citrien Fund program eHealth, Amsterdam, Netherlands
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32
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Rauwerdink A, Kasteleyn MJ, Chavannes NH, Schijven MP. Successes of and Lessons From the First Joint eHealth Program of the Dutch University Hospitals: Evaluation Study. J Med Internet Res 2021; 23:e25170. [PMID: 34842536 PMCID: PMC8663485 DOI: 10.2196/25170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/23/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A total of 8 Dutch university hospitals are at the forefront of contributing meaningfully to a future-proof health care system. To stimulate nationwide collaboration and knowledge-sharing on the topic of evidence-based eHealth, the Dutch university hospitals joined forces from 2016 to 2019 with the first Citrien Fund (CF) program eHealth; 29 eHealth projects with various subjects and themes were selected, supported, and evaluated. To determine the accomplishment of the 10 deliverables for the CF program eHealth and to contribute to the theory and practice of formative evaluation of eHealth in general, a comprehensive evaluation was deemed essential. OBJECTIVE The first aim of this study is to evaluate whether the 10 deliverables of the CF program eHealth were accomplished. The second aim is to evaluate the progress of the 29 eHealth projects to determine the barriers to and facilitators of the development of the CF program eHealth projects. METHODS To achieve the first aim of this study, an evaluation study was carried out using an adapted version of the Commonwealth Scientific and Industrial Research Organization framework. A mixed methods study, consisting of a 2-part questionnaire and semistructured interviews, was conducted to analyze the second aim of the study. RESULTS The 10 deliverables of the CF program eHealth were successfully achieved. The program yielded 22 tangible eHealth solutions, and significant knowledge on the development and use of eHealth solutions. We have learned that the patient is enthusiastic about accessing and downloading their own medical data but the physicians are more cautious. It was not always possible to implement the Dutch set of standards for interoperability, owing to a lack of information technology (IT) capacities. In addition, more attention needed to be paid to patients with low eHealth skills, and education in such cases is important. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the success of the 29 projects. The in-depth interviews illustrated that a novel eHealth solution should fulfill a need, that partners already having the knowledge and means to accelerate development should be involved, that clear communication with IT developers and other stakeholders is crucial, and that having a dedicated project leader with sufficient time is of utmost importance for the success of a project. CONCLUSIONS The 8 Dutch university hospitals were able to collaborate successfully and stimulate through a bottom-up approach, nationwide eHealth development and knowledge-sharing. In total, 22 tangible eHealth solutions were developed, and significant eHealth knowledge about their development and use was shared. The eHealth projects' progress aspects such as planning, IT services, and legal played an important role in the successful progress of the projects and should therefore be closely monitored when developing novel eHealth solutions. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.ceh.2020.12.002.
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Affiliation(s)
- Anneloek Rauwerdink
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
| | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden, Netherlands
| | - Marlies P Schijven
- Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, Amsterdam, Netherlands
- Citrien Fund program eHealth, Amsterdam, Netherlands
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Arora A, Wright A, Cheng TKM, Khwaja Z, Seah M. Innovation Pathways in the NHS: An Introductory Review. Ther Innov Regul Sci 2021; 55:1045-1058. [PMID: 34009551 PMCID: PMC8132486 DOI: 10.1007/s43441-021-00304-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/05/2021] [Indexed: 01/02/2023]
Abstract
Healthcare as an industry is recognised as one of the most innovative. Despite heavy regulation, there is substantial scope for new technologies and care models to not only boost patient outcomes but to do so at reduced cost to healthcare systems and consumers. Promoting innovation within national health systems such as the National Health Service (NHS) in the United Kingdom (UK) has been set as a key target for health care professionals and policy makers. However, while the UK has a world-class biomedical research industry, several reports in the last twenty years have highlighted the difficulties faced by the NHS in encouraging and adopting innovations, with the journey from idea to implementation of health technology often taking years and being very expensive, with a high failure rate. This has led to the establishment of several innovation pathways within and around the NHS, to encourage the invention, development and implementation of cost-effective technologies that improve health care delivery. These pathways span local, regional and national health infrastructure. They operate at different stages of the innovation pipeline, with their scope and work defined by location, technology area or industry sector, based on the specific problem identified when they were set up. In this introductory review, we outline each of the major innovation pathways operating at local, regional and national levels across the NHS, including their history, governance, operating procedures and areas of expertise. The extent to which innovation pathways address current challenges faced by innovators is discussed, as well as areas for improvement and future study.
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Affiliation(s)
- Anmol Arora
- School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 0SP, UK.
| | - Andrew Wright
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Tsz Kin Mark Cheng
- Department of Medical Sciences, Faculty of Biology, University of Cambridge, Cambridge, UK
| | - Zahra Khwaja
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Matthew Seah
- Department of Surgery, University of Cambridge, Cambridge, UK
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Chen Y, Stavropoulou C, Narasinkan R, Baker A, Scarbrough H. Professionals' responses to the introduction of AI innovations in radiology and their implications for future adoption: a qualitative study. BMC Health Serv Res 2021; 21:813. [PMID: 34389014 PMCID: PMC8364018 DOI: 10.1186/s12913-021-06861-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 08/05/2021] [Indexed: 12/13/2022] Open
Abstract
Background Artificial Intelligence (AI) innovations in radiology offer a potential solution to the increasing demand for imaging tests and the ongoing workforce crisis. Crucial to their adoption is the involvement of different professional groups, namely radiologists and radiographers, who work interdependently but whose perceptions and responses towards AI may differ. We aim to explore the knowledge, awareness and attitudes towards AI amongst professional groups in radiology, and to analyse the implications for the future adoption of these technologies into practice. Methods We conducted 18 semi-structured interviews with 12 radiologists and 6 radiographers from four breast units in National Health Services (NHS) organisations and one focus group with 8 radiographers from a fifth NHS breast unit, between 2018 and 2020. Results We found that radiographers and radiologists vary with respect to their awareness and knowledge around AI. Through their professional networks, conference attendance, and contacts with industry developers, radiologists receive more information and acquire more knowledge of the potential applications of AI. Radiographers instead rely more on localized personal networks for information. Our results also show that although both groups believe AI innovations offer a potential solution to workforce shortages, they differ significantly regarding the impact they believe it will have on their professional roles. Radiologists believe AI has the potential to take on more repetitive tasks and allow them to focus on more interesting and challenging work. They are less concerned that AI technology might constrain their professional role and autonomy. Radiographers showed greater concern about the potential impact that AI technology could have on their roles and skills development. They were less confident of their ability to respond positively to the potential risks and opportunities posed by AI technology. Conclusions In summary, our findings suggest that professional responses to AI are linked to existing work roles, but are also mediated by differences in knowledge and attitudes attributable to inter-professional differences in status and identity. These findings question broad-brush assertions about the future deskilling impact of AI which neglect the need for AI innovations in healthcare to be integrated into existing work processes subject to high levels of professional autonomy.
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Affiliation(s)
- Yaru Chen
- Centre for Healthcare Innovation Research, City, University of London, London, UK
| | - Charitini Stavropoulou
- Centre for Healthcare Innovation Research, City, University of London, London, UK.,School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Radhika Narasinkan
- Centre for Healthcare Innovation Research, City, University of London, London, UK
| | - Adrian Baker
- Centre for Healthcare Innovation Research, City, University of London, London, UK
| | - Harry Scarbrough
- Centre for Healthcare Innovation Research, City, University of London, London, UK. .,Bayes Business School, City, University of London, 106 Bunhill Row, London, EC1Y 8TZ, UK.
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Tinsel I, Metzner G, Schlett C, Sehlbrede M, Bischoff M, Anger R, Brame J, König D, Wurst R, Fuchs R, Lindinger P, Bredenkamp R, Farin-Glattacker E. Effectiveness of an interactive web-based health program for adults: a study protocol for three concurrent controlled-randomized trials (EVA-TK-Coach). Trials 2021; 22:526. [PMID: 34376228 PMCID: PMC8353439 DOI: 10.1186/s13063-021-05470-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 07/20/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND A healthy lifestyle can help prevent diseases that impair quality of life and lead to premature death. The Techniker health insurance fund offers a comprehensive online health program to support users in achieving their health goals of Increasing Fitness, Losing and Maintaining Weight, or Smoking Cessation. METHODS The aim of this study is to test the long-term effectiveness of the web-based TK-HealthCoach with regard to the primary outcomes of increased physical activity, sustainable weight reduction, and smoking abstinence. We are conducting three interconnected, randomized controlled trials (RCT), one for each health goal, within which participants are allocated to an intervention group (interactive online health program) or a control group (non-interactive online health program). The effects of the intervention groups compared to the control groups will be analyzed by multi-level models for change. Participants' data are captured via online questionnaires before the program starts (baseline t0), again when it ends (t1), and later at two follow-up surveys (t2 and t3); the latter 12 months after t1. We are documenting socio-demographic, health-related, and psychological variables as well as usage behavior data of the programs. According to our sample size calculation, we have to enroll 1114 participants in each Losing and Maintaining Weight and Increasing Fitness RCT and 339 participants in the Smoking Cessation RCT. Additionally, 15-20 participants in the interactive smoking-cessation program will be invited to qualitative telephone interviews with the aim to obtain detailed information concerning utilization, compliance, and satisfaction. The online RCTs' inclusion criteria are: adults of each gender regardless of whether they are insured with Techniker health insurance fund. Persons with impairments or pre-existing conditions require a medical assessment as to whether the program is suitable for them. Specific exclusion criteria apply to each program/RCT. DISCUSSION We assume that study participants will improve their health behavior by using the offered online health programs and that each health goal's intervention group will reveal advantages regarding the outcome variables compared to the control groups. Study enrollment started on January 1, 2020. TRIAL REGISTRATION German Clinical Trials Register, Universal Trial Number (UTN): U1111-1245-0273 . Registered on 11 December 2019.
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Affiliation(s)
- Iris Tinsel
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany.
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Christian Schlett
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Matthias Sehlbrede
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Martina Bischoff
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Robin Anger
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
| | - Judith Brame
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Daniel König
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Ramona Wurst
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Reinhard Fuchs
- Department of Sport and Sport Science (IfSS), University of Freiburg, Freiburg, Germany
| | - Peter Lindinger
- Scientific Working Group in Smoking Cessation (WAT), Tübingen, Germany
| | - Rainer Bredenkamp
- Clinical Trials Unit UMG, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 49, 79106, Freiburg, Germany
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Disrupting 3D printing of medicines with machine learning. Trends Pharmacol Sci 2021; 42:745-757. [PMID: 34238624 DOI: 10.1016/j.tips.2021.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 06/03/2021] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
3D printing (3DP) is a progressive technology capable of transforming pharmaceutical development. However, despite its promising advantages, its transition into clinical settings remains slow. To make the vital leap to mainstream clinical practice and improve patient care, 3DP must harness modern technologies. Machine learning (ML), an influential branch of artificial intelligence, may be a key partner for 3DP. Together, 3DP and ML can utilise intelligence based on human learning to accelerate drug product development, ensure stringent quality control (QC), and inspire innovative dosage-form design. With ML's capabilities, streamlined 3DP drug delivery could mark the next era of personalised medicine. This review details how ML can be applied to elevate the 3DP of pharmaceuticals and importantly, how it can expedite 3DP's integration into mainstream healthcare.
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Betmouni S. Diagnostic digital pathology implementation: Learning from the digital health experience. Digit Health 2021; 7:20552076211020240. [PMID: 34211723 PMCID: PMC8216403 DOI: 10.1177/20552076211020240] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/04/2021] [Indexed: 01/18/2023] Open
Abstract
Digital Pathology (also referred to as Telepathology and Whole Slide Imaging) is the process of producing high resolution digital images from tissue sections on glass slides. These glass slides are normally examined under a microscope by a pathologist as part of the diagnostic process. The emergence of digital pathology now means that digital images are stored on secure servers and can be viewed on computer monitors; enabling pathologists to work remotely and to collaborate with other colleagues when second opinions are needed. The implementation of digital pathology into clinical practice has many potential benefits. Although this has been long recognised, its adoption as a diagnostic tool remains low and pathologists’ projections about its future deployment are cautious. Notable early digital pathology adopters have led the way. The challenge now is to scale-up digital pathology beyond the relatively few large networks and centres of excellence. Many other areas of healthcare have accumulated experience about optimising approaches to digital health/healthcare technology deployment and sustainability. This has been done in a multi-disciplinary context and has applied theoretical/conceptual frameworks. Thus far there has been little use of similar frameworks in the planning of digital pathology deployment in clinical practice. In this essay, I will explore the scope of digital pathology implementation approaches that have been deployed in clinical practice and examine what can be learned from the wider healthcare experience of adopting, scaling-up and sustaining innovative healthcare solutions.
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Affiliation(s)
- Samar Betmouni
- Digital Health Enterprise Zone, University of Bradford, Bradford, UK.,Digital Health Enterprise Zone, University of Bradford, Bradford, UK
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Esdar M, Hübner U, Thye J, Babitsch B, Liebe JD. The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data. JMIR Med Inform 2021; 9:e23306. [PMID: 33720029 PMCID: PMC8077601 DOI: 10.2196/23306] [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: 08/08/2020] [Revised: 12/13/2020] [Accepted: 02/07/2021] [Indexed: 01/12/2023] Open
Abstract
Background Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. Objective The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. Methods We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. Results The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. Conclusions The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT.
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Affiliation(s)
- Moritz Esdar
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Ursula Hübner
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Johannes Thye
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany
| | - Birgit Babitsch
- Institute of Health and Education, New Public Health, Osnabrück University, Osnabrueck, Germany
| | - Jan-David Liebe
- Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Osnabrueck, Germany.,Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
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Jimenez G, Matchar D, Koh CHG, van der Kleij R, Chavannes NH, Car J. The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review. J Med Internet Res 2021; 23:e20195. [PMID: 33427676 PMCID: PMC7834942 DOI: 10.2196/20195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 11/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background Several countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging chronically ill population and rising costs. Some of these efforts have included technology-based enhancements as one of the features to support the overall intervention, but their details and impacts have not been explored. Objective This study aimed to identify the role of digital/health technologies within wider multifeature interventions that are aimed at enhancing primary care, and to describe their aims and stakeholders, types of technologies used, and potential impacts. Methods A systematic review was performed following Cochrane guidelines. An electronic search, conducted on May 30, 2019, was supplemented with manual and grey literature searches in December 2019, to identify multicomponent interventions that included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive narrative synthesis was used for analysis and presentation of the results. Results Of 37 articles, 14 (38%) described the inclusion of a technology-based innovation as part of their multicomponent interventions to enhance primary care. The most commonly identified technologies were the use of electronic health records, data monitoring technologies, and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased primary care visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. Conclusions Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing primary care, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving primary care. Stronger policy and financial support, and advocacy of key stakeholders are needed to encourage the introduction of efficient technological innovations, which are backed by evidence-based research, so that digital technologies can fulfill the promise of supporting strong sustainable primary care.
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Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - David Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Choon Huat Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Evans L, Mohamed B, Thomas EC. Using telemedicine and wearable technology to establish a virtual clinic for people with Parkinson's disease. BMJ Open Qual 2020; 9:bmjoq-2020-001000. [PMID: 32958473 PMCID: PMC7507852 DOI: 10.1136/bmjoq-2020-001000] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/20/2020] [Accepted: 07/31/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To develop an effective, patient-centred and sustainable service, we set up a virtual clinic (VC) for patients with Parkinson's disease, combining phone consultations and reports from wearable technology. The Parkinson's Kinetigraph (PKG) is a wrist-worn device providing objective motor assessment, generating a report used by clinicians to optimise medication regimens. INTERVENTIONS A pilot study of VC was designed using quality improvement methodology. For a VC appointment, patients were phoned by a clinician. After discussing symptoms and reviewing the PKG report, the clinician could decide on any medication changes or other interventions and relay this to the patient's general practitioner in a clinic letter. Patient feedback was gathered via questionnaires and data collected on the outcomes and timings of the consultations. RESULTS Over 12 clinics, 61 patients had VC appointments. Of questionnaire respondents, 89% were satisfied with VC (n=41). At VC, the clinician was able to make a treatment decision comparable to a face-to-face clinic in 79% of cases (n=48). Reasons appointments were deemed unsuccessful included issues with the PKG, speech or hearing problems and complex phase of disease. VC appointments, including administration time, last on average 22 min. This compares to 20 min face-to-face appointments but these do not include administration time. CONCLUSIONS We have demonstrated a safe and effective VC template. Most VC appointments are equivalent to face-to-face clinic in terms of treatment outcome. Success could be further improved by appropriate patient selection. Using VC is time saving and can result in releasing face-to-face appointment slots for those in urgent need or newly referred patients. Further cost analysis is required; the cost of the PKG alone is more expensive than a face-to-face appointment, but this does not take into account other value added, such as patient convenience and satisfaction, and reduced need for ambulance transport.
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Affiliation(s)
- Lauren Evans
- Geriatric Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Biju Mohamed
- Geriatric Medicine, Cardiff and Vale University Health Board, Cardiff, UK
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Kelly JT, Collins PF, McCamley J, Ball L, Roberts S, Campbell KL. Digital disruption of dietetics: are we ready? J Hum Nutr Diet 2020; 34:134-146. [DOI: 10.1111/jhn.12827] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/03/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023]
Affiliation(s)
- J. T. Kelly
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
| | - P. F. Collins
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- School of Allied Health Sciences Griffith University Southport QLD Australia
| | - J. McCamley
- Metro North Hospital and Health Service Herston QLD Australia
| | - L. Ball
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
| | - S. Roberts
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- School of Allied Health Sciences Griffith University Southport QLD Australia
- Gold Coast Hospital and Health Service Southport QLD Australia
| | - K. L. Campbell
- Menzies Health Institute Queensland Griffith University Southport QLD Australia
- Centre of Applied Health Economics School of Medicine Griffith University Southport QLD Australia
- Metro North Hospital and Health Service Herston QLD Australia
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Szczepura A, Holliday N, Neville C, Johnson K, Khan AJK, Oxford SW, Nduka C. Raising the Digital Profile of Facial Palsy: National Surveys of Patients' and Clinicians' Experiences of Changing UK Treatment Pathways and Views on the Future Role of Digital Technology. J Med Internet Res 2020; 22:e20406. [PMID: 32763890 PMCID: PMC7573702 DOI: 10.2196/20406] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/18/2020] [Accepted: 06/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Facial nerve palsy leaves people unable to move muscles on the affected side of their face. Challenges exist in patients accessing facial neuromuscular retraining (NMR), a therapy used to strengthen muscle and improve nerve function. Access to therapy could potentially be improved through the use of digital technology. However, there is limited research available on patients' and clinicians' views about the potential benefits of such telerehabilitation based on their lived experiences of treatment pathways. OBJECTIVE This study aims to gather information about facial palsy treatment pathways in the United Kingdom, barriers to accessing NMR, factors influencing patient adherence, measures used to monitor recovery, and the potential value of emerging wearable digital technology. METHODS Separate surveys of patients with facial palsy and facial therapy specialists were conducted. Questionnaires explored treatment pathways and views on telerehabilitation, were co-designed with users, and followed a similar format to enable cross-referencing of responses. A follow-up survey of national specialists investigated methods used to monitor recovery in greater detail. Analysis of quantitative data was conducted allowing for data distribution. Open-text responses were analyzed using thematic content analysis. RESULTS A total of 216 patients with facial palsy and 25 specialist therapists completed the national surveys. Significant variations were observed in individual treatment pathways. Patients reported an average of 3.27 (SD 1.60) different treatments provided by various specialists, but multidisciplinary team reviews were rare. For patients diagnosed most recently, there was evidence of more rapid initial prescribing of corticosteroids (prednisolone) and earlier referral for NMR therapy. Barriers to NMR referral included difficulties accessing funding, shortage of specialist therapists, and limited awareness of NMR among general practitioners. Patients traveled long distances to reach an NMR specialist center; 9% (8/93) of adults reported traveling ≥115 miles. The thematic content analysis demonstrates positive attitudes to the introduction of digital technology, with similar incentives and barriers identified by both patients and clinicians. The follow-up survey of 28 specialists uncovered variations in the measures currently used to monitor recovery and no agreed definitions of a clinically significant change for any of these. The main barriers to NMR adherence identified by patients and therapists could all be addressed by using suitable real-time digital technology. CONCLUSIONS The study findings provide valuable information on facial palsy treatment pathways and views on the future introduction of digital technology. Possible ways in which emerging sensor-based digital technology can improve rehabilitation and provide more rigorous evidence on effectiveness are described. It is suggested that one legacy of the COVID-19 pandemic will be lower organizational barriers to this introduction of digital technology to assist NMR delivery, especially if cost-effectiveness can be demonstrated.
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Affiliation(s)
- Ala Szczepura
- Faculty Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Nikki Holliday
- Health & Life Sciences, Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
| | - Karen Johnson
- Facial Palsy UK (Charity), Peterborough, United Kingdom
| | - Amir Jahan Khan Khan
- Department of Economics,, Institute of Business Administration (IBA), Karachi, Pakistan
| | - Samuel W Oxford
- Exercise & Life Sciences, Faculty Health & Life Sciences, Centre for Sport, Coventry University, Coventry, United Kingdom
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, West Sussex, United Kingdom
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Capozzo R, Zoccolella S, Musio M, Barone R, Accogli M, Logroscino G. Telemedicine is a useful tool to deliver care to patients with Amyotrophic Lateral Sclerosis during COVID-19 pandemic: results from Southern Italy. Amyotroph Lateral Scler Frontotemporal Degener 2020; 21:542-548. [DOI: 10.1080/21678421.2020.1773502] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Rosa Capozzo
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | | | - Marco Musio
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | - Roberta Barone
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | - Miriam Accogli
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Disease and The Aging Brain at the Hospital “C. Panico” Tricase (Lecce), University of Bari, Tricase, Italy
- Department of Basic Medicine, Neuroscience and Sense Organs, University of Bari, Italy
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