eHealth and telemedicine: Practices and beliefs among healthcare professionals and medical students at a medical university

Telemedicine's Hesitant Reception Among Digital Natives: A Cluster Analysis of Polish Students' Attitudes

Objective: As digital natives appear to be the most suitable target group for technological innovations, we tested this notion by analyzing their attitude toward the implementation of telemedicine in Poland. Methods: An online survey was conducted from April to October 2021, yielding responses from 475 university students on their experience with teleconsultations, which are an essential part of telemedicine. Satisfaction-related questions were used to perform cluster analysis, and subsequently, clusters were compared based on significant differences in responses including sociodemographic and utilization patterns. Open-ended questions were analyzed to further gauge the rationale behind the demonstrated attitude. Results: The responses were polarized. In the cluster analysis, on one side were the "Skeptics" and "Enemies," who shared negative opinions on professionalism and convenience, differing only in their assessment of intangible skills. On the other side were the "Enthusiasts," who were satisfied in all categories; the "Indifferent," who lacked strong opinions; and the "Time-pressed," who, while openly admitting its drawbacks, were highly likely to continue using it due to its time-saving potential. Recurring concerns in open-ended questions focused on unreliable diagnoses and uncooperative administrative personnel. Conclusions: The reception was polarized. The split in answers suggests that administrative problems were limited to some providers, indicating they should be possible to overcome. There is a clear pattern that telemedicine is seen as an incomplete service. However, many would happily continue to use it due to its convenience and time-saving benefits.

Personalized dose selection for the first Waldenström macroglobulinemia patient on the PRECISE CURATE.AI trial

The digital revolution in healthcare, amplified by the COVID-19 pandemic and artificial intelligence (AI) advances, has led to a surge in the development of digital technologies. However, integrating digital health solutions, especially AI-based ones, in rare diseases like Waldenström macroglobulinemia (WM) remains challenging due to limited data, among other factors. CURATE.AI, a clinical decision support system, offers an alternative to big data approaches by calibrating individual treatment profiles based on that individual's data alone. We present a case study from the PRECISE CURATE.AI trial with a WM patient, where, over two years, CURATE.AI provided dynamic Ibrutinib dose recommendations to clinicians (users) aimed at achieving optimal IgM levels. An 80-year-old male with newly diagnosed WM requiring treatment due to anemia was recruited to the trial for CURATE.AI-based dosing of the Bruton tyrosine kinase inhibitor Ibrutinib. The primary and secondary outcome measures were focused on scientific and logistical feasibility. Preliminary results underscore the platform's potential in enhancing user and patient engagement, in addition to clinical efficacy. Based on a two-year-long patient enrollment into the CURATE.AI-augmented treatment, this study showcases how AI-enabled tools can support the management of rare diseases, emphasizing the integration of AI to enhance personalized therapy.

Factors influencing use of eHealth services during and after the COVID-19 pandemic

OBJECTIVES

The rapid advancement of information and communication technologies has made eHealth applications increasingly available and accessible. The COVID-19 pandemic has accelerated the need for remote health service provision. This research aims to explore the usage, perceptions, and knowledge of eHealth interventions during and after the COVID-19 pandemic.

METHODS

A cross-sectional survey was conducted in 2021 (during the pandemic) and 2023 (post-pandemic) using a structured questionnaire based on the Technology Acceptance Model (TAM) and the eHealth Literacy Scale (eHEALS). The survey, conducted in Greece, included 638 participants in total (277 in 2021 and 361 in 2023). Structural equation modeling was employed to assess the factors influencing eHealth adoption.

RESULTS

The findings indicate a slight increase in positive perceptions of eHealth usefulness, intention to use, and actual usage over the 2 years. However, concerns remain regarding the ease of use and eHealth literacy. eHealth literacy significantly predicts the perceived usefulness and ease of use of eHealth services, both of which predict the intention to use them. Additionally, higher education levels are positively associated with eHealth literacy, while older age is negatively associated with ease of use. Gender did not significantly impact these factors. These findings were consistent across both surveys.

CONCLUSIONS

Policy-makers should focus on simplifying eHealth services, removing technical barriers, and enhancing the population's eHealth literacy to promote wider adoption of eHealth services.

The digital readiness of future physicians: nurturing the post-pandemic medical education

BACKGROUND

The COVID-19 pandemic has accelerated the integration of digital technologies in the healthcare sector. Telemedicine has notably emerged as a significant tool, offering a range of benefits. However, various barriers, such as healthcare professionals' insufficient technological skills and competencies, can hinder its effective implementation. Scholars have examined the readiness of future physicians, with some studies exploring their readiness before or during the COVID-19 crisis. There is, however, a noteable gap in the literature concerning the post-pandemic period. This study aims to identify gaps in current medical education programs by examining two primary aspects: (1) technical readiness (encompassing general and health-related digital competencies) and (2) behavioural readiness, which includes prior experiences and future intentions related to telemedicine education and implementation among medical students and residents.

METHODS

A cross-sectional study was conducted using a web-based questionnaire administered to medical students and residents at a major Northern Italian university. The survey responses were analyzed to ascertain whether their distributions varied across demographic variables such as gender and level of education.

RESULTS

The most commonly owned technologies were laptops and smartphones, with smartphones perceived as the easiest to use, while desktop computers presented more challenges. Approximately 38% of respondents expressed apprehension about applying digital health information in decision-making processes. There was a significant lack of both personal and academic experience, with only 16% of students and residents having used telemedicine in a university setting. Despite this, 83% of participants expressed a desire for training in telemedicine, and 81% were open to experimenting with it during their academic journey. Moreover, 76% of respondents expressed interest in incorporating telemedicine into their future clinical practice.

CONCLUSIONS

This study highlights the need for medical students and residents to receive specific education in digital health and telemedicine. Introducing curricula and courses in this domain is critical to addressing the challenges of digital healthcare.

Staff and students' perceptions about using telehealth technology in a medical university: A qualitative study

INTRODUCTION

The use of telehealth technology is a way to promote the health status of the community. The purpose of this study was to investigate staff and students' perceptions about using telehealth technology in a medical university.

METHODS

This was a qualitative study completed in 2020. The research participants were 26 university staff and students who took part in semi-structured interviews. To analyze the data, the thematic analysis method was used.

RESULTS

The findings of the present study included five themes, 20 subthemes and 58 categories. The main themes were the current status of providing healthcare services at the university, and the strengths, weaknesses, opportunities and threats of using telehealth technology for the university staff and students.

CONCLUSION

According to the results, there are many opportunities for using telehealth technology in the medical university. The experiences of other institutes can be used to implement the technology successfully.

Needs, expectations, facilitators, and barriers among insurance physicians related to the use of eHealth in their work: results of a survey

PURPOSE

To determine needs, expectations, facilitators, and barriers of insurance physicians (IPs) for using eHealth in their work. Also, we investigated differences between age groups.

MATERIALS AND METHODS

All insurance physicians employed at the Dutch Social Security Institute (SSI) received an online anonymous survey in July 2020.

RESULTS

Three hundred and fifteen IPs (31%) responded. According to these IPs, the most important need for using eHealth was to collect medical information more effectively and efficiently (71%).Main facilitators were that eHealth could make IPs' work more effectively and efficiently (61%) and more future-proof (60%). Main barriers were losing human interaction (54%) and security issues (51%). Younger IPs saw more options for using eHealth, compared to older IPs.

CONCLUSIONS

The majority of IPs (in particular younger IPs) had a positive view towards using eHealth in their daily work. Nevertheless, differences in needs, expectations, facilitators and barriers between the age groups should be taken into account for the successful development and implementation of interventions using eHealth in insurance medicine.

A 360 Evaluation of Neonatal Care Quality at a Level II Neonatal Intensive Care Unit when Delivered Using a Hybrid Telemedicine Service

OBJECTIVE

In 2013, the Section of Neonatal and Perinatal Medicine at the University of Oklahoma's Children's Hospital began providing advanced care to a regional level II neonatal intensive care unit (NICU), using a hybrid telemedicine program. This project compares health care providers' and parents' assessments of health care quality using this program.

STUDY DESIGN

This is a prospective, anonymous, nonrandomized survey of health care providers and parents of neonates using our hybrid telemedicine services. Physicians, neonatal nurse practitioners (NNPs), nurses, and parents completed pencil-and-paper surveys based on their participatory roles. Institutional Review Board approval was obtained at OU Medical Center and Comanche County Memorial Hospital. Surveys consisted of 5-point Likert's scale questions. Descriptive statistics compared the level of agreement with each question across participant groups. A service quality (SQ) composite score was created by summing responses from six SQ questions. Between-group analysis was done on the SQ score using the Mann-Whitney U-test.

RESULTS

Nine physicians, 10 NNPs, 12 nurses, and 40 parents completed the survey. Providers agreed (90%) that telemedicine can effectively deliver advanced neonatal care; the care patients receive is comparable to direct patient care (87%); telemedicine enhanced overall patient care quality (90%); providers can effectively interact with each other and families using telemedicine (90.3%), and overall telemedicine experience was good (90%). In total, 61% of providers reported telemedicine improves physician-patient interaction. Parents of newborns agreed that they were well informed about telemedicine use for their child's care (88%), were able to communicate routinely with neonatologists (85%), and were comfortable with their child's physical examinations (93%). Provider's versus family's (SQ) score was not significantly different.

CONCLUSION

All survey participants, including neonatologists, NNPs, nurses, and patient families, reported high levels of satisfaction with the hybrid telemedicine model developed and implemented at this institution which may be comparable to in-person direct patient care.

KEY POINTS

· Implementation of a hybrid telemedicine system provides an alternative to the transfer of newborns needing advanced care to tertiary care facilities.. · In this study, both health care providers and patient family members were satisfied with the quality of care using hybrid telemedicine.. · In this study, families of newborns could fully participate in their child's care using the hybrid telemedicine system..

Facilitators and barriers in acceptance of telemedicine among healthcare providers in Pakistan: A cross-sectional survey

Objectives

This study aimed to assess healthcare professionals' awareness and acceptance of telemedicine residing in Pakistan.

Materials and Methods

A cross-sectional study was conducted across Pakistan from November 2021 to March 2022. Data entry was done through a self-administered questionnaire. In this survey, the non-probability purposive sampling method was adopted. Medical doctors from all specialties that fall into the age category of 20-60 years were included in this study. Statistical Package for Social Sciences (SPSS) version 22.0 was used for univariate data analysis.

Results

Among the 860 healthcare professionals who received the survey, 198 responded (23.0% response rate). The mean ± SD age of the participants was 31.16 ± 8.56. The results were found to be statistically significant for knowledge about telemedicine among healthcare professionals workplace, that is, healthcare professionals working in the private sector indicated a high level of awareness regarding telemedicine as compared to those in the public sector (p = 0.03). A significant difference (p-value ⩽ 0.05) in knowledge was seen among doctors working in the public sector and those working in a private setup. Results indicate significant positive associations between telemedicine utilization and perceived benefits over disadvantages (β = 1.03, p = 0.017), reliance among healthcare professionals (β = 1.22, p = 0.008), and enhancement in healthcare quality (β = 1.42, p = 0.001). Moreover, familiarity with telemedicine correlates strongly with its usage (β = 2.56, p < 0.000).

Conclusion

Overall, healthcare professionals exhibited satisfactory knowledge regarding telemedicine and showed an accepting attitude toward telemedicine. Our study recommends enhancing the importance of Telemedicine training at the Healthcare professionals' level to produce quality service delivery in healthcare organizations.

Digital health in perinatal care: Exploring usage, attitudes, and needs among Swiss women in urban and rural settings

Background

Switzerland's healthcare system is known for its quality but faces challenges such as slow digitalization and fragmentation, especially in perinatal care. This study investigates Swiss women's use, needs, and attitudes in respect of digital health tools during pregnancy and postpartum, focusing on any differences between rural and urban populations.

Methods

A web-based cross-sectional survey targeted pregnant women and those who had given birth in the last 12 months. Participants were recruited through social media, and the data were analyzed using principal component analysis and multivariable regressions to explore factors affecting the use of digital tools and attitudes toward eHealth.

Results

A total of 1160 participants completed the survey. Healthcare professionals (92%) and private networks (77%) were the primary sources of information. Women expressed a strong preference for app features such as data access (73%), prescription management (73%), and scheduling appointments with healthcare professionals (71%). However, they also raised concerns about the impersonal nature of digital healthcare interactions (71%). Overall, rural women had more negative attitudes toward online health information seeking, which can be attributed to differences in education levels.

Conclusion

The findings indicate that while Swiss women in the perinatal period do utilize digital tools, they focus more on nonmedical topics such as tracking physiological development. The study underscores the importance of adapting digital health solutions to the specific needs of women in the perinatal period. Emphasis should be placed on developing applications that are not only informative but also empower women on their healthcare journey while ensuring data privacy and supporting personal interactions with healthcare providers.

Virtual Healthcare Revolution: Understanding Nurse Competencies and Roles

Introduction

Digital healthcare, especially virtual health, has changed nurses' jobs and skills. In the evolving healthcare landscape, nurses healthcare landscape is increasingly required to have diverse competencies to navigate the world of virtual health effectively.

Objective

This study aims to qualitatively explore the role of nurses in virtual health and the competencies required to work in virtual health in Saudi Arabia, with a specific focus on SEHA virtual hospital.

Methods

An online open survey with nursing experts was employed as the qualitative method approach during the initial phase of an online Delphi study design.

Results

Twelve core competencies were identified: digital technology proficiency, professionalism, clinical expertise, leadership, legal and ethical considerations, care coordination, documentation, effective communication, patient assessment and diagnosis, patient safety, patient-centered care, and remote patient monitoring.

Conclusions

The research emphasizes the crucial role of nurses in virtual hospitals and clinics, contributing to the expansion of the virtual healthcare environment. It presents a thorough competency framework that can guide the development of training programs and policies, enhancing the effectiveness of virtual healthcare delivery.

Impact

The study provides a foundational competencies list that can guide the development of comprehensive training programs for nurses in virtual healthcare. Policymakers and educational leaders are encouraged to use these findings to create standardized practices and policies, enhancing the effectiveness and efficiency of virtual healthcare delivery.

Knowledge and Perception of Telemedicine among Medical Students of the University of Jos, Plateau State, Nigeria

Background

Telemedicine has promising potential to address the challenges faced by healthcare systems in developing countries, in providing equitable access to quality care. However, the practice of telemedicine is generally poor in these countries. The success of telemedicine like any technology depends on numerous factors including users' knowledge and perceptions. Hence, this study aimed to examine the knowledge and perceptions of telemedicine among medical students at the University of Jos.

Methodology

This was a cross-sectional study among 305 clinical medical students selected through a stratified sampling technique. A self-administered questionnaire consisting of a 28-item 5-point Likert response scale was used to collect data, comprising 13 items for knowledge, 8 for the perception of benefits, and 7 for the perception of ease of use of telemedicine. Data was analyzed using IBM-SPSS.

Results

One hundred and eleven (36.4%) participants had good knowledge of telemedicine, while 113 (37.1%) had a good perception of the benefits and 103 (33.8%) had a good perception of the ease of use. Respondents with a good knowledge of telemedicine were about five times more likely (OR = 5.24, 95% CI = 3.15 - 8.69) to have a good perception of the benefits and about eight times more likely (OR = 8.33, 95% CI = 4.57 - 14.26) to have a good perception of ease of use.

Conclusions

Few medical students possess desirable levels of knowledge and perceptions of telemedicine which portrays a gap in the medical education curriculum. Therefore, training, and educational opportunities are recommended to improve their knowledge and perception of telemedicine.

Assessing the Awareness and Perception of Telemedicine Among the General Population in the Al-Baha Region, Saudi Arabia

Telemedicine plays an important role in healthcare by improving the quality of the healthcare system. However, various challenges associated with the effective implementation of telemedicine have been reported. This study aimed to explore the awareness and utilization of telemedicine services among the general population in the Al-Baha region of Saudi Arabia and the factors affecting it. Using a cross-sectional design for the study, the quantitative approach was employed through a questionnaire-based survey. Data from 359 participants from the Al-Baha general population were collected, including both males and females over the age of 18. The analysis of the collected data shows a low level of familiarity within the general population; indeed, 54.9% (197) of participants have experienced using telemedicine services. Moreover, the study reveals that the major concerns influencing the use of telemedicine services are limited availability, privacy and security, and quality of care. Almost half of the participants have used telemedicine, and they expressed concerns related to quality of care, privacy and security, limited availability, and technical difficulties. However, telemedicine was positively perceived among the participants. There is a need to raise public awareness about the importance and effectiveness of telemedicine.

Graduate and postgraduate educational challenges during the COVID-19 pandemic period: its impact and innovations-a scoping review

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has transformed the global view of education, including graduate and postgraduate education making the development of an alternative approach in times of social isolation an academic imperative. The present review aims to investigate the challenges experienced among undergraduate and postgraduate education and the strategies adopted to address these challenges during the pandemic.

METHOD

The preferred reporting items for the systematic review and meta-analyses extension for Scoping Reviews (PRISMA-ScR) were followed. The aim was to include journal articles published in the English language that discussed the influence of the pandemic on educational processes and applied innovative approaches as a solution to educational challenges. From January to August 2020, PubMed, EMBASE, and Google Scholar were searched for articles, yielding 10,019 articles. Two groups of authors examined the retrieved articles separately to avoid any risk of bias. The title and abstract of the articles were used for scrutiny, followed by full-text screening based on the established inclusion and exclusion criteria. The facts and findings of the studies were also discussed based on per capita income, literacy rate, and Internet accessibility.

RESULTS

Thirty of the obtained articles were included in the study. The selected articles were from North and South/Latin America, Asia & Pacific, South Africa, and Europe regions. Nineteen of the selected articles dealt with undergraduate education, ten with postgraduate, and one with both groups. The affordability of digital devices and the availability of Internet services were the major challenges for low- and middle-income economies. The ZOOM platform has been adopted by more than 90% of the education systems.

CONCLUSION

Means of communication, including visual media, digitized content, and other web-based platforms, have been recognized as efficient learning and training tools, but have not been fully accessible for mass application and use due to the lack of availability of resources, their cost, and insufficient training among the users. In light of this review, it is suggested that harmonized and collaborative efforts should be made to develop cost-effective and user-friendly tools to overcome the current challenges and prevent future educational crises.

SYSTEMIC REVIEW REGISTRATION

The review was not registered.

Use of telemonitoring in patient self-management of chronic disease: a qualitative meta-synthesis

BACKGROUND

Telemonitoring for the remote patient self-management of chronic conditions can be a cost-effective method for delivering care in chronic disease; nonetheless, its implementation in clinical practice remains low. The aim of this meta-synthesis is to explore barriers and facilitators associated with the use of remote patient monitoring of chronic disease, drawing on qualitative research, and assessing participant interactions with this technology.

METHOD

A meta-synthesis of qualitative studies was performed. MEDLINE, SCOPUS and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from database date of inception to 5 February 2021. The Critical Appraisal Skills Programme (CASP) was used to critically appraise each study. Thematic synthesis was performed to identify user (patients, carers and healthcare professionals) perspectives and experiences of patient remote monitoring of chronic disease (Type 2 diabetes mellitus, chronic obstructive pulmonary disease, and cardiovascular disease).

RESULTS

Searches returned 10,401 studies and following independent screening by two reviewers, nine studies were included in this meta-synthesis. Data were synthesised and categorised into four key themes: (1) Improved care; (2) Communication; (3) Technology feasibility & acceptability; and (4) Intervention concerns. Most patients using patient remote devices felt motivated in managing their own lifestyles and felt reassured by the close monitoring and increased communication. Barriers identified involved generational differences and difficulties with the technology used.

CONCLUSION

Most studies showed a positive attitude to telemonitoring, with patients preferring the convenience of telemonitoring in comparison to attending regular clinics. Further research is required to assess the most effective technology for chronic disease management, how to maintain long-term patient adherence, and identify effective approaches to address generational variation in telemonitoring up-take.

Perception towards the implementation of telemedicine during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The COVID-19 pandemic has led to a surge in the use of telemedicine as a means of delivering healthcare services remotely. Healthcare providers play a key role in the adoption and implementation of telemedicine for its effectiveness. Despite its benefits, there have been unclear concerns about its effectiveness and acceptance in the process of implementing telemedicine. The objective of the study was to assess health professionals' perceptions towards the implementation of telemedicine during the COVID-19 pandemic.

METHODS

A cross-sectional study design was conducted among eight hundred forty-five study participants from December 2020 to February 2021. A pre-test was performed on 5% of the total sample size, and the quality of the data was ensured by checking its completeness and consistency. Descriptive statistics and bivariable and multivariable logistic regression were used. The Variables with a P-value equal to or less than 0.25 in bivariable logistic regression were entered into a multivariable logistic regression, and model fitness was assessed.

RESULT

The study revealed that 60.9% of professionals had a good perception toward telemedicine implementation, with an 87.2% response rate. Health professionals with IT support staff, ICT training, who use social media platforms regularly, and availability of computer or smartphone within/outside their health facility were 4.7, 3.3, 3.7, and 13.2 times more likely to have a positive association towards telemedicine implementation respectively.

CONCLUSION

More than half of the health professionals had a good perception of telemedicine. Social media use, ICT training, computer accessibility, and the presence of IT support staff were all found to have positive associations with the telemedicine perception. In the era of the COVID-19 pandemic, the government should take the initiative to strengthen opportunities for health professionals to learn and apply telemedicine in their medical practice by providing ICT training, IT infrastructure and support staff, improving computer access, and recommending health professionals' positive use of social media in the health facility.

Perception of Saudi undergraduate medical students on telemedicine training and its implementation

BACKGROUND

The use of telemedicine has increased considerably in healthcare delivery, especially during this time of the coronavirus disease 2019 (COVID-19) pandemic. It has, therefore, become necessary to train medical students to better equip them for this new means of healthcare delivery. The aim of the present study was to assess the perception of undergraduate medical students on telemedicine training.

MATERIALS AND METHODS

A cross-sectional study was conducted on a total of 521 undergraduate medical students studying in the Eastern Region of Saudi Arabia. Data were collected via a self-administered pretested questionnaire comprising two main sections: demographics and knowledge and opinions regarding telemedicine training.

RESULTS

About 73% students think that the use of telemedicine for patient care will increase in the future, and 59.3% think that the medical students should be trained in telemedicine. Majority of the students (78%) opined that telemedicine training should be optional and 58% said it should be taught during the clinical phase of the undergraduate curriculum. The best telemedicine training course learning objectives medical students opined to be included were: telemedicine practical skills (70.2%), legal aspects of telemedicine practice (68.3%), and potential positive and/or negative use of telemedicine tools and methods (67.6%). Telemedicine skills students would like to learn how to effectively engage patients, knowledge about telemedicine regulations and the consequences of breaching them.

CONCLUSION

Medical students are aware of the importance of incorporating telemedicine training into the medical curriculum. Training these students is vital to ensure their competence as physicians in their future clinical careers, that is make them a digitally health-literate future workforce.

Perceptions of medical students toward teledermatology as an educational tool: a cross-sectional study

Introduction

Teledermatology consultations have recently been on the rise, especially due to the SARS-CoV-2 pandemic. The role of teledermatology has been extensively discussed as a mean for the education of dermatology residents. Nevertheless, little has been explored on its use as a pedagogical tool for medical students. The objectives of this study were to assess the level of satisfaction of medical students with teledermatology and to evaluate their opinion about its use as an educational tool.

Methods

A cross-sectional study was carried out at the Dermatology Department, Hospital Universitario Virgen de las Nieves, Granada (Spain). Participants were fourth-year medical students. Every student would spend half of their internship in face-to-face consultations and the other half in teledermatology consultations. Data was collected via self-administered questionnaires.

Results

Eighty one students were finally surveyed, being 66.67% (73/81) female. A majority of students considered a mixed clinical internship model (face-to-face consultations combined with teledermatology) more suitable for obtaining higher marks in the subject of dermatology and in the Medical Intern Resident exam (p = 0.04). Nevertheless, face-to-face practice was considered more useful for their training as general practitioners (p = 0.04).

Conclusion

Despite the fact that students highly value doctor-patient relationship, teledermatology is considered a powerful educational tool.

"More" work for nurses: the ironies of eHealth

BACKGROUND

eHealth applications are considered a technological fix that can potentially address some of the grand challenges in healthcare, including burnout among healthcare professionals, the growing burden of patients with chronic conditions, and retaining and recruiting healthcare professionals. However, as the deployment of eHealth applications in healthcare is relatively novel, there is a lack of research on how they affect the work environment of healthcare professionals. This study explores how work evolves-particularly for nurses-during the utilisation of three eHealth applications.

METHODS

The study is a qualitative case study with an interpretive approach. The utilisation of three different eHealth applications was studied. Seventy-five healthcare professionals were interviewed, most of whom were nurses (n = 47). Interviews were transcribed verbatim and qualitative content analysis was used to analyse the text.

RESULTS

Three main themes were identified: work that is ignored and overlooked; actions needed to complete visible work; and more sedentary work activities. The findings suggest that work surrounding the utilisation of eHealth applications in care practices is mostly performed by nurses. While the promise of more efficient workflows resulting from healthcare's digital transformation may be realised to different degrees, the utilisation of eHealth applications creates additional invisible labour for nurses.

CONCLUSION

We identified through our analysis that the extra work created by eHealth applications is invisible at the organisational level. Most of the invisible labour was performed by nurses, who were engaged in utilising the eHealth applications. This needs to be recognised when implementing eHealth applications in care practices.

'It increases my ability to influence my ways of working': A qualitative study on digitally mediated patient management in primary healthcare

BACKGROUND

Digitally mediated primary healthcare is increasingly influencing working conditions, raising questions about how digitally mediated patient management is experienced.

AIM

The aim of this study was to generate insights, through the lens of postphenomenology, into how digitally mediated primary healthcare affects the work and working environment, by gathering perspectives from primary healthcare professionals who regularly manage patient errands through a digital platform.

METHODS

Two rounds of interviews were conducted with a diversified sample of primary healthcare professionals at a primary healthcare centre. The first round of interviews was conducted during the initial phase of the deployment of a digital platform for patient management, with the second round conducted a year later (n = 24). The interview transcripts were analysed using reflexive thematic analysis.

RESULTS

Four themes relating to digitally mediated care work were identified: 'positive feelings towards digitally mediated primary healthcare', 'seeing a positive work atmosphere as a prerequisite for change', 'experiencing increased control over the pace of workflow' and 'reconfiguration of previous problems'.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

Building on postphenomenology, our study adds to the understanding of how material and symbolic aspects mutually affect the mediating role of a digital platform for patient management. Thus, the results indicate that the experience of using digitally mediated care processes is conditioned by the discourse towards digitalisation at the workplace and the management's approach to and inclusion of employees in the digital transition of primary healthcare, as well as the usefulness and usability of the digital platform. The findings can inform both practice and policy.

Factors associated with the perceptions of eHealth technology of Chinese nurses and nursing students

AIM

The current study sought to assess the perceptions of eHealth technology of nurses and nursing students in China and to examine the association between these perceptions and demographic factors.

BACKGROUND

Despite the increasing use of eHealth technologies in China and across the globe, the perceptions of practicing and student nurses remain minimally explored. Findings from such an inquiry can potentially inform actions and policies to improve the uptake of eHealth technologies among Chinese nurses.

DESIGN

This was a cross-sectional study with a real-time online survey.

METHODS

A convenience sample of 1338 nurses and nursing students from Mainland China participated in the study. Their perceptions of eHealth technology were collected using the Chinese version of the Perceptions of eHealth Technology Scale. The Kruskal-Wallis test and multiple linear regression analysis were used to examine the relationship between demographic variables (age group, gender, occupation, education level, position and clinical experience) and perceptions of eHealth technology. All study procedures adhered to the STROBE guidelines.

RESULTS

Most participants were aged between 20 and 29 (55.8%). Nearly half (42.5%) were frontline clinical nursing staff, some were nursing students (36.2%), academic nursing staff (12.3%) and clinical nursing management staff (9.0%). Regardless of the differences in their demographic characteristics, the participants had higher mean scores in "Perception of eHealth applications" and lower mean scores in "Knowledge of eHealth technology". Participants with doctoral degree had a higher mean total score and higher sub-scale scores in knowledge of eHealth technology, perception of the advantages of eHealth technology and perception of eHealth applications; and the lowest scores in perception of the disadvantages of eHealth technology and perception of eHealth applications. Occupation, position and clinical experience were found to be the demographic characteristics associated with eHealth perceptions, before adjusting for age and gender. Education level was associated with eHealth perceptions regardless of adjustment.

CONCLUSION

Overall, participants had higher scores on perceptions of eHealth applications but lower scores on knowledge of eHealth technology. Considering the association between education and all subscales and overall scores, it may be essential to implement continuing professional education for nurses to improve their knowledge of eHealth applications. Encouragement to use available eHealth digital technologies may also be helpful to improve perceptions of eHealth.

Information and Training on the Use of Telemedicine in Pediatric Population: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP), and of the Syndicate of Family Pediatrician Doctors (SIMPeF)

Telemedicine has entered the daily lives of doctors, although the digital skills of healthcare professionals still remain a goal to be achieved. For the purpose of a large-scale development of telemedicine, it is necessary to create trust in the services it can offer and to favor their acceptance by healthcare professionals and patients. In this context, information for the patient regarding the use of telemedicine, the benefits that can be derived from it, and the training of healthcare professionals and patients for the use of new technologies are fundamental aspects. This consensus document is a commentary that has the aim of defining the information on and training aspects of telemedicine for pediatric patients and their caregivers, as well as pediatricians and other health professionals who deal with minors. For the present and the future of digital healthcare, there is a need for a growth in the skills of professionals and a lifelong learning approach throughout the professional life. Therefore, information and training actions are important to guarantee the necessary professionalism and knowledge of the tools, as well as a good understanding of the interactive context in which they are used. Furthermore, medical skills can also be integrated with the skills of various professionals (engineers, physicists, statisticians, and mathematicians) to birth a new category of health professionals responsible for building new semiotics, identifying criteria for predictive models to be integrated into clinical practice, standardizing clinical and research databases, and defining the boundaries of social networks and new communication technologies within health services.

Self-reported perceptions and knowledge of telemedicine in medical students and professionals who enrolled in an online course in Peru

BACKGROUND

Telemedicine has become more relevant during the COVID-19 pandemic. However, medical students and professionals do not acquire competences in telemedicine during their training. Our objective was to describe the self-reported perception and baseline knowledge of telemedicine among medical students and professionals enrolled in a virtual course.

METHODS

Cross-sectional study that included physicians or medical students aged 18 years or older who were interested in a free virtual telemedicine course and who completed the data collection questionnaire. We used a Likert scale to assess the self-reported perceptions of four domains related to telemedicine. The participants were grouped into three levels for each domain: low, medium and high. We also objectively assessed telemedicine knowledge by means of 10 questions, with a cut-off point of 50% of correct answers. The Fisher's exact test, the Chi-square test, and the Mann-Whitney U test were used for the comparison of categorical data. A p-value < 0.05 was considered statistically significant.

RESULTS

We included 161 participants: 118 medical students and 43 physicians. We observed no significant differences between medical students and physicians in self-reported perceptions of knowledge, security, or utility of telemedicine. However, students had a high self-reported perception of the disadvantages of telemedicine especially related to patient security (p = 0.018), efficiency of care (p = 0.040), and the possibility of medical malpractice (p = 0.010) compared to physicians. Nearly half of the students (n = 53,44.9%) and physicians (n = 22,51.7%) answered 50% or more of the questions related to telemedicine knowledge correctly.

CONCLUSION

Among the physicians and medical students enrolled in the course, the students perceived the disadvantages of telemedicine more frequently. Although physicians and students have limited knowledge of telemedicine, there appears to be no influence of experience and prior training in telemedicine.

eHealth competence building for future doctors and nurses - Attitudes and capabilities

BACKGROUND

Digitalisation is rapidly changing health care processes and the health care sector, thus increasing the need to improve the digital competence of future health care professionals.

PURPOSE

The aim of this study was to describe the attitudes of medical and nursing students towards digital health based on self-evaluation as well as to compare the differences in perceptions between the two student groups.

METHODS

A cross-sectional study was conducted as an online survey using the Webropol in April 2021 at the University of Oulu and Oulu University of Applied Sciences in Finland. The survey questionnaire consisted of seven background questions and 16 statements on a five-point Likert scale (fully disagree to fully agree) to survey student attitudes towards eHealth, and their digital capabilities.

RESULTS

A total of 250 medical and nursing students were invited to participate in the study and 170 of them took the survey (response rate 68 %). Of those answered, 38 % (n = 64) were nursing and 32 % (n = 106) medical students. Students generally had a positive attitude towards eHealth and health care digitalisation. The differences in perceptions and preparedness between medical and nursing students were surprisingly small in the two student groups. There was a statistically significant difference between the two groups in three out of 16 statements: these were related to changes in the roles of health care professionals and patients as well as the students' knowledge of information contained in the national patient portal.

CONCLUSIONS

The results of this study provide a good starting point for further harmonisation of the curriculum for both health professional groups regarding the teaching of eHealth and telemedicine.

Professional Competence and Its Effect on the Implementation of Healthcare 4.0 Technologies: Scoping Review and Future Research Directions

BACKGROUND

The implementation of Healthcare 4.0 technologies faces a number of barriers that have been increasingly discussed in the literature. One of the barriers presented is the lack of professionals trained in the required competencies. Such competencies can be technical, methodological, social, and personal, contributing to healthcare professionals managing and adapting to technological changes. This study aims to analyse the previous research related to the competence requirements when adopting Healthcare 4.0 technologies.

METHODS

To achieve our goal, we followed the standard procedure for scoping reviews. We performed a search in the most important databases and retrieved 4976 (2011-present) publications from all the databases. After removing duplicates and performing further screening processes, we ended up with 121 articles, from which 51 were selected following an in-depth analysis to compose the final publication portfolio.

RESULTS

Our results show that the competence requirements for adopting Healthcare 4.0 are widely discussed in non-clinical implementations of Industry 4.0 (I4.0) applications. Based on the citation frequency and overall relevance score, the competence requirement for adopting applications of the Internet of Things (IoT) along with technical competence is a prominent contributor to the literature.

CONCLUSIONS

Healthcare organisations are in a technological transition stage and widely incorporate various technologies. Organisations seem to prioritise technologies for 'sensing' and 'communication' applications. The requirements for competence to handle the technologies used for 'processing' and 'actuation' are not prevalent in the literature portfolio.

Digital health understanding and preparedness of medical students: a cross-sectional study

Digitalisation is changing all areas of our daily life. This changing environment requires new competences from physicians in all specialities. This study systematically surveyed the knowledge, attitude, and interests of medical students. These results will help further develop the medical curriculum, as well as increase our understanding of future physicians by other healthcare market players. A web-based survey consisting of four sections was developed: Section one queried demographic data, section two assessed the current digital health knowledge of medical students, section three queried their attitudes about the future impact of digital health in medicine and section four assessed the recommendations medical students have for the medical curriculum in terms of digital health. This survey was distributed to all (11,978) student at all public Austrian medical schools. A total of 8.4% of the medical student population started the survey. At the knowledge self-assessment section, the medical students reached mean of 11.74 points (SD 4.42) out of a possible maximum of 32 (female mean 10.66/ SD 3.87, male mean 13.34/SD 4.50). The attitude section showed that students see digitalisation as a threat, especially with respect to the patient-physician relationship. The curriculum recommendation section showed a high interest for topics related to AI, a per study year increasing interest in impact of digital health in communication, as well as a decreasing interest in robotic related topics. The attitude towards digital health can be described as sceptical. To ensure that future physicians keep pace with this development and fulfil their responsibility towards the society, medical schools need to be more proactive to foster the understanding of medical students that digital health will persistently alter the medical practice.

My Real Avatar has a Doctor Appointment in the Wepital: A System for Persistent, Efficient, and Ubiquitous Medical Care

COVID-19 created a great deal of personal, social, and economic anxiety in the USA and across the globe and exposed the inadequacy of traditional medical systems in handling large-scale emergencies. While telemedicine and virtual visits have become popular as a result, they end once a visit is over, hence lacking data persistence and continuity in caring for patients. Using the design science research approach with support from the theory of affordances, this paper proposes the design of a medical system (called wepital) in which patients receive care through their real avatars, enabling hospitals and other medical centers to provide immediate care that can continue for as long as a patient needs it. Real avatars are digital representations of patients that embody their real-time vital signs and health information. We have created a functional prototype to demonstrate how the proposed design can work. To assess the usability of the design, we have used the prototype in an experiment to provide medical advice to patient volunteers. Based on a theory-based conceptual model, we collected survey data after the experiment to identify factors contributing to the success of such a system, as measured by patient satisfaction. We report the factors that significantly contribute to the patients’ satisfaction. As part of the application and policy implications of our work, we propose a nationwide system that could supplement and expand the capacity of medical systems at the national or even global level.

Reaping the benefits of digital transformation through Public-Private Partnership: A service ecosystem view applied to healthcare

The ongoing digital transformation ushers unprecedented challenges for publicly owned healthcare organizations. Collaborative governance models, such as Public Private Partnerships (PPPs), advance their readiness to address such challenges, paving the way for the establishment of a viable service ecosystem. However, little is known about how PPPs enhance the publicly owned healthcare organizations’ ability to thrive amidst the digital transformation. The article investigates this issue, drawing on the exploratory case of “Lab@AOR”, a PPP established between Loccioni and the University Hospital of Marche (Italy) which focused on the robotization of a critical component of healthcare services’ delivery. Three ingredients have been found to nurture the PPP’s cohesiveness and success: (1) the alignment between the public partner’s needs and the private partner’s competences, (2) knowledge contamination, and (3) the adoption of patient-centeredness as the inspiring principle of the collaboration. The PPP represents an initial step of the transition towards a service ecosystem, entailing a fully-fledged partners’ integration for value co-generation.

The Perception of Health Professionals in Bangladesh toward the Digitalization of the Health Sector

Bangladesh is undertaking a major transformation towards digitalization in every sector, and healthcare is no exception. Digitalization of the health sector is expected to improve healthcare services while reducing human effort and ensuring the satisfaction of patients and health professionals. However, for practical and successful digitalization, it is necessary to understand the perceptions of health professionals. Therefore, we conducted a cross-sectional survey in Bangladesh to investigate health professionals' perceptions in relation to various socio-demographic variables such as age, gender, location, profession and institution. We also evaluated their competencies, as digital health-related competencies are required for digitalization. Additionally, we identified major digitalization challenges. Quantitative survey data were analyzed with Python Pandas, and qualitative data were classified using Valence-Aware Dictionary and Sentiment Reasoner (VADER). This study found significant relationships between age χ2(12,N=701)=82.02,p<0.001; location χ2(4,N=701)=18.78,p<0.001; and profession χ2(16,N=701)=71.02,p<0.001; with technical competency. These variables also have similar influences on psychological competency. According to VADER, 88.1% (583/701) of respondents have a positive outlook toward digitalization. The internal consistency of the survey was confirmed by Cronbach's alpha score (0.746). This study assisted in developing a better understanding of how professionals perceive digitalization, categorizes professionals based on competency, and prioritizes the major digitalization challenges.

Medical Students and Their Perceptions of Digital Medicine: a Question of Gender?

Digital technologies play an essential role in the medical sector of today and the future. In a cross-sectional online survey at a German medical university, male students more frequently reported keeping themselves informed about digital medicine outside of their studies across all clinical years of study. While female students self-assessed their knowledge in different fields of digital medicine as worse than their male peers in the first clinical years of study, no more gender differences could be found towards the final year. However, students of both genders showed a strong desire for further education on the topic of digital medicine.

Practices, Perceived Benefits, and Barriers Among Medical Students and Health Care Professionals Regarding the Adoption of eHealth in Clinical Settings: Cross-sectional Survey Study

BACKGROUND

eHealth is increasingly becoming an indispensable part of health practice and policy-making strategies. However, the use of eHealth tools in clinical practice and the perceptions of eHealth among medical students and health care professionals in Vietnam are not well understood.

OBJECTIVE

This study aims to investigate perceptions and practices regarding eHealth and their associated factors among medical students and health care professionals.

METHODS

A web-based cross-sectional study was conducted on 523 medical students and health care professionals. Information about the practices for, perceived barriers to, and benefits of eHealth application in clinical practices was collected. Multivariate Tobit and logistic regression models were used to determine factors associated with perceptions and practices.

RESULTS

In total, 61.6% (322/523) of participants used eHealth tools in clinical practices, with moderate levels of eHealth literacy. The score for the perceived benefits of eHealth tools was low. The most common barrier for eHealth utilization was human resources for IT (240/523, 45.9%), followed by security and risk control capacity (226/523, 43.2%) and no training in eHealth application (223/523, 42.6%). Age, eHealth literacy, and the use of the internet for updating medical knowledge were positively associated with using eHealth tools in clinical practices.

CONCLUSIONS

eHealth tools were moderately used in clinical practices, and the benefits of eHealth were underestimated among health care professionals and medical students in Vietnam. Renovating the current medical education curriculum to integrate eHealth principles should be required to equip health care professionals and medical students with essential skills for rapid digital transformation.

Usage and perceptions of telemedicine among health care professionals in China

OBJECTIVE

To explore health care professionals' usage and perceptions of telemedicine, including their experience, evaluation and attitude towards telemedicine, and the factors affecting their satisfaction, using intention, and willingness to recommend telemedicine.

METHODS

A nationwide and web-based survey was conducted. Statistical charts were used to describe the usage and perceptions of telemedicine by health care professionals. And the ordinal logistic regression was applied to analyze the influencing factors.

RESULTS

A total of 1349 valid questionnaires were collected. In the survey, 74.0 % of Chinese health care professionals used telemedicine once a week. The average duration of participating in telemedicine services lasted mainly 11-30 min (64.0 %). More than half (52.5 %) of participants' hospitals adopted fee subsidy measures, followed by the award for excellent evaluation (36.4 %). The majority (92.5 %) believed that telemedicine could reduce patient referral rates. More than 95 % were satisfied with telemedicine, were willing to continue, and would recommend telemedicine for patients, respectively. The main problems existing were: incomplete system equipment, insufficient timeliness, high costs, inability to reimburse medical insurance, non-standardized medical records, inadequate publicity, cumbersome processes and long waiting time. Ordinal logistic regression showed that too short service duration (≤10 min) could significantly reduce medical professionals' overall satisfaction, using intention and willingness to recommend (P = 0.026, P = 0.017 and P = 0.040 respectively), while the convenience of the operating system had a significant positive impact (P = 0.005, P = 0.003 and P = 0.001 respectively). And cost subsidy incentive and the promotion of professional titles could significantly enhance their overall satisfaction(P = 0.006, P = 0.030), using intention (P = 0.011, P = 0.001), and willingness to recommend (P = 0.040, P = 0.004).

CONCLUSIONS

The usage of telemedicine is relatively insufficient. Most health care professionals have fairly positive opinions toward telemedicine. The most mentioned issues and expectations for telemedicine can be roughly divided into four categories: infrastructure, service process, charge and cost, and popularity. It is possible to improve their evaluation by improving system convenience, enhancing service punctuality, avoiding excessively short service duration and adopting incentive measures.

The Chain Mediating Effect of the Public's Online Health Information-Seeking Behavior on Doctor-Patient Interaction

Objective

This paper aims to explore the influence mechanisms of online health information-seeking behavior (OHISB) on doctor-patient interactions from a psychological perspective, using theory as a guide, which can effectively guide the mode of doctor-patient interaction after search behavior in China.

Methods

We conducted a convenient web-based survey among members of the public who engage in searching behavior in China using a pretested structured questionnaire. Structural equation modeling was performed for path analysis and mediating effect testing.

Results

The findings of the study show that (1) 4 control variables (education level, occupation, income, and diagnosed disease) had significant differences in online health information-seeking behavior; 7 control variables (age, gender, living area, education level, occupation, income, medical insurance) were significantly different in doctor-patient interaction behaviors. (2) perceived disease severity (95% CI: 0.003, 0.04, P < 0.001), perceived action benefits (95% CI: 0.059, 0.138, P < 0.001), and e-health literacy (95% CI: 0.061, 0.155, P < 0.001) were positive predictors between OHISB and doctor-patient interactions. (2) E-health literacy and perceived disease severity (95% CI: 0.001, 0.013, P < 0.05), and e-health literacy and perceived action benefits (95% CI: 0.082, 0.166, P < 0.001) play chain mediating roles between OHISB and doctor-patient interactions.

Conclusions

E-health literacy, perceived disease severity, and perceived action benefits act as chain mediators between OHISB and doctor-patient interactions.

Teachers' Value Consonance and Employee-Based Brand Equity: The Mediating Role of Belongingness and Self-Efficacy

This study investigated the impact of value consonance on employee-based brand equity through the mediating role of teachers' self-efficacy and belongingness. For this purpose, a deductive approach was followed, and data were collected under a cross-sectional research design from academia through a questionnaire. Prior approval from the administration was sought before administrating the questionnaire on a large scale and a sample of 520 teachers was approached in the first phase. At this stage, 418 answered questionnaires were received, while in the second wave, questions related to the teacher's self-efficacy and employee-based brand equity were asked from the respondents. Out of these 418 re-distributed questionnaires, 387 were received back and after discarding the partially filled and incomplete questionnaires, the useable sample size was left as 372. Data have been analyzed by using the structural equation modeling technique, which was assessed through measurement and structural model. Results indicate that value consonance can promote positive behaviors in the workplace. Moreover, teachers with high self-efficacy can develop based on brand equity. Similarly, employees with high-value consonance develop a sense of belongingness with their academic institutes. Limitations and future directions are also discussed.

How far has the digitization of medical teaching progressed in times of COVID-19? A multinational survey among medical students and lecturers in German-speaking central Europe

BACKGROUND

To ensure successful medical education despite the COVID-19 pandemic, the demand for online instruction has substantially increased. Fast and efficient teaching in a digital format poses a great challenge for medical students and lecturers as well as the universities.

OBJECTIVE

The aim of this study is to capture the readiness of medical students and faculty members to participate in rapidly- evolving online education.

METHODS

This cross-sectional study is based on two questionnaires distributed among medical students and associate deans for education in Germany, Austria and Switzerland. Questions included decision- making questions, categorical questions, and open-ended questions, all addressing the frequency and format of the digital education offered, the perceived quality of digital education, and medical student satisfaction with digital education. Questions about missing content and areas for improvement from the perspectives of medical students were included. The associate deans were asked for their opinions about the impact of the pandemic on teaching, the organizational setup and implementation of digital education by universities, and plans for future initiatives.

RESULTS

Three thousand and thirty medical students (m = 752 and f = 2245) from 53 universities participated in the study. The study showed that 92% of students were affected by the pandemic, and 19% of the students viewed the changes as entirely negative. 97% of the medical students were able to participate in digital courses, but only 4% were able to learn exclusively online. For 77% of the medical students, digital offerings accounted for over 80% of the education offered. In terms of content, medical students complained about a lack of practical teaching, such as contact with patients, lecturers, fellow medical students, and a poor perceived quality of teaching due to dubbing, frequent changeover of seminars, problem-oriented learning groups and in-person teaching, a lack of interaction possibilities and a lack of technical equipment, such as lecturers' knowledge and server capacities, at the universities. Overall, almost half of the medical students (42%) rated the implementation of digital teaching at their universities as good or very good. Forty-one of the 53 associate deans responded to the questionnaire, and 35 felt medical education was influenced by the pandemic. The associate deans (80%; 33/41) felt that the digitalization of medical education was negatively influenced by the pandemic. Only 44% (18/41) felt that their universities were well or very well positioned for digital teaching. All the associate deans believe that digital teaching in medicine will continue after the pandemic.

CONCLUSIONS

In the German-speaking world, the rapid conversion of medical teaching to a digital format has been well implemented in many cases. The perceived quality of the implementation of digital education still lacks practical relevance and the use of new digital media, such as learning games, VR, and online question time. The digital format of medical education will likely continue beyond the COVID-19 pandemic.

Nationwide Assessment of Knowledge and Perception in Reinforcing Telemedicine in the Age of COVID-19 Among Medical Students From Pakistan

The urgency for telemedicine is felt during the COVID-19 pandemic which has rendered the world shut by enforcing quarantines and lockdowns. Many developing countries including Pakistan have inadequate telehealth care services that limited access to rural and remote areas. A cross-sectional survey was carried out among medical students i.e., both preclinical and clinical enrolled in various medical colleges from all provinces of Pakistan to determine their Knowledge, Attitude and Perception regarding the use of Telemedicine during the COVID-19 Pandemic. A total of 398 respondents were included in this preliminary survey. Knowledgeable scores were calculated, from a maximum obtainable score of 7. The mean knowledge was found to be significantly associated with age, province, and year of study (p-value < 0.05). Attitude scores were calculated from a maximum obtainable score of 10. All the independent variables failed to reach a significant (p < 0.05) association with the mean attitude of respondents about telemedicine. Perception scores were calculated from a maximum obtainable score of 8. Residents of Khyber Pakhtunkhwa are more likely to know about telemedicine than Balochistan (p = 0.022) on univariate regression. We identified, lack of knowledge and training for telemedicine in medical institutes. It is crucial to assess the knowledge of medical students regarding telemedicine to comprehend, and evaluate their attitude as future doctors who can play a significant role in establishing telemedicine services in the health care system.

Attitudes and Expectations of Clinical Research Participants Toward Digital Health and Mobile Dietary Assessment Tools: Cross-Sectional Survey Study

Background

The adoption of health technologies is key to empower research participants and collect quality data. However, the acceptance of health technologies is usually evaluated in patients or healthcare practitioners, but not in clinical research participants.

Methods

A 27-item online questionnaire was provided to the 11,695 members of a nutrition clinical research participant database from the Nantes area (France), to assess (1) participants' social and demography parameters, (2) equipment and usage of health apps and devices, (3) expectations in research setting and (4) opinion about the future of clinical research. Each item was described using frequency and percentage overall and by age classes. A global proportion comparison was performed using chi-square or Fisher-exact tests.

Results

A total of 1529 respondents (81.0% women, 19.0% men) completed the survey. Main uses of health apps included physical activity tracking (54.7%, age-related group difference, p < 0.001) and food quality assessment (45.7%, unrelated to age groups). Overall, 20.4% of respondents declared owning a connected wristband or watch. Most participants (93.8%) expected the use of connected devices in research. However, protection of personal data (37.5%), reliability (35.5%) and skilled use of devices (28.5%) were perceived as the main barriers. Most participants (93.3%) would agree to track their food intake using a mobile app, and 80.5% would complete it for at least a week while taking part in a clinical study. Only 13.2% would devote more than 10 min per meal to such record. A majority (60.4%) of respondents would accept to share their social media posts in an anonymous way and most (82.2%) of them would accept to interact with a chatbot for research purposes.

Conclusions

Our cross-sectional study suggests that clinical study participants are enthusiastic about all forms of digital health technologies and participant-centered studies but remain concerned about the use of personal data. Repeated assessments are suggested to evaluate the research participant's interest in technologies following the increase in use and demand for innovative health services during the pandemic of COVID-19.

Healthcare Providers’ Perspective about the Use of Telemedicine in Egypt: A National Survey

Incorporation of telemedicine in general clinical practice is becoming a compelling need nowadays in the context of COVID-19 pandemic and its consequent burdens on the healthcare systems. Though telemedicine appears to be appealing and carries a lot of advantages, yet it is still faced by many challenges and barriers especially in developing countries. Our aim was to explore the impression of healthcare providers about telemedicine and its applicability in clinical practice in Egypt. A cross-sectional study was conducted among healthcare providers from different Egyptian governorates through a web-based survey. The survey gathered information about demographic, socioeconomic features of the enrolled healthcare participants; their knowledge, previous experience, impression about telemedicine, advantages of telemedicine over traditional medical services, barriers that may face telemedicine, and additional services that can be provided by telemedicine were also explored. Our study enrolled 642 healthcare providers from all over Egypt, 43.77% were females, of which 55.5% were physicians, 27.3% were nurses, 6.1% were technicians, 7.6% were administrative clerks, and 3.6% were medical directors. Sixty-four percent of participants reported that they have never used telemedicine. Smartphones were the most commonly used mean in the group who used telemedicine (65%), and smartphone applications were the favorable telemedicine service for about 50% of participants. Participants assumed that the use of telemedicine might not have a negative effect on the doctor-patient relationship but raised some concerns regarding the privacy and security of patients' data. Despite the fact that telemedicine appears to be appealing and widely accepted by healthcare providers, yet still, its implementation is confronted by some obstacles. Precise organizational guidelines need to be developed to clearly figure out the exact role of each healthcare provider to minimize their doubtfulness about telemedicine and to facilitate its adoption.

Cross-sectional study on knowledge and attitude of telemedicine in medical students of Nepal

BACKGROUND AND AIMS

Telemedicine is the delivery of healthcare services from distance using information and communication technology. It helps in overcoming the geographical physical barrier, increasing access to the healthcare services. Telemedicine has been growing in Nepal, with several hospitals and medical organizations providing services since 2006. COVID-19 pandemic ignited significant interests in it, which previously remained unnoticed, realizing its importance for the present and future. The objective of this study was to evaluate the knowledge and attitude toward telemedicine among medical students in Nepal.

METHODS

An observational study among medical students in 19 medical colleges in Nepal was performed from May to June using Google forms. The survey consisted of 27 questions including information on demography and telemedicine exposure, its status in Nepal, interest, and plans for its future utilization.

RESULTS

Of 146 total surveyed students, 77.4% (n = 113) provided their views regarding telemedicine. Among students with knowledge of telemedicine, only 8.8% (n = 10) had attended some training. Only 6% (n = 4) of those who had previously consulted through telemedicine labeled their experience as poor. Exactly 88.5% (n = 100) were not satisfied with present telemedicine practices and coverage and 43.4% (n = 49) were optimistic about using telemedicine in future. Irrespective of location of medical colleges (Kathmandu Valley or outside) or levels of study (preclinical or clinical), students had similar knowledge and attitude regarding telemedicine.

CONCLUSION

The participants have good knowledge regarding the importance of telemedicine but only few of them are educated regarding its usage. Despite limited exposure to telemedicine, participants advocate for expansion and wide use of telemedicine due to economy, technological advancement, and topographic diversities. Internet, sense of reliability, privacy issue, and lack of proper curriculum seem to have raised question on their positive attitude. Formal and structured education may enable optimistic aspirants to integrate telemedicine skills with medical care delivery with ease.

The Perceptions of Telehealth Physiotherapy for People with Bronchiectasis during a Global Pandemic-A Qualitative Study

Physiotherapy is a core component of management for people with bronchiectasis and has predominantly been delivered in an in-person consultative format. With the global pandemic, a telehealth physiotherapy model of service evolved, but the perceptions and experiences from the consumer perspective of this service have not been evaluated. Participants who had a diagnosis of bronchiectasis and received a minimum of two telehealth physiotherapy sessions during the months of March 2020 to December 2020 at a private hospital were invited to take part in a semistructured interview. Interview transcripts were coded independently, with themes established by consensus from two researchers. In total, nine participants completed interviews (age range 44 to 83 years, 67% male), with four themes identified. Themes were initial mixed opinions and acceptance of telehealth physiotherapy as an alternate model, ease of use and limitations to the telehealth platform, enablers and barriers to physiotherapy service provision, and preferences for future models of telehealth physiotherapy beyond a pandemic. In the event of the continuation of telehealth physiotherapy services for people with bronchiectasis, the perceptions and experiences outlined by consumers could be applied to inform future modification of this model of service.

Enhancing the security of E-Health services in Bangladesh using blockchain technology

The telemedicine service concept was mainly established to benefit the underprivileged people from rural areas of a country. However, due to the low literacy and awareness rates among rural population of Bangladesh, the service is not much effective. This paper represents a study on the awareness of the rural population of telemedicine service in Bangladesh and few key findings indicate how the awareness could be increased. The research also suggests that utilizing blockchain technology can enhance the data security and privacy. The research reveals some of the findings which can raise the awareness and popularity of telemedicine service among rural population. We have proposed implementation of blockchain technology which can vastly improve the security issue.

Modifying UTAUT2 for a cross-country comparison of telemedicine adoption

The ongoing COVID19 pandemic has put digital health technologies in the spotlight. To gain a deeper understanding of patients’ usage intentions of virtual doctor appointments, the present research adapts the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) by integrating perceived security and perceived product advantage, two known barriers to successful telemedicine adoption. Applying age-stratified sampling, an online survey was distributed to 800 citizens in Germany and the United States of America. 710 completed and valid questionnaires were subsequently analyzed using SPSS and AMOS (versions 24).

Significant, direct, and positive effects of performance expectancy, hedonic motivation, perceived security, and perceived product advantage on the behavioral intention to use virtual doctor appointments were found. The analysis of the moderating variables, age and gender, showed significant differences in user's performance expectancy and effort expectancy, and perceived product advantage, respectively. With virtual health care models on the rise, these results are important for stakeholders such as policymakers, governments, employers, but also physicians, and insurance companies as they offer clear recommendations to design telemedicine adoption strategies to ensure successful patient engagement.

Knowledge and awareness of health professionals towards telemedicine services in Northwest, Ethiopia

Background

Understanding telemedicine technology is significantly important for the implementation of a telemedicine system in resource-limited areas. Specifically, in Ethiopia, the doctor-to-patient ratio was 0.003. This has made it difficult to access healthcare services remotely. Therefore, to maximize and facilitate telemedicine adoption, it is critical to have information about health professionals’ knowledge and awareness of telemedicine services. This study aimed to determine the Knowledge and Awareness of Health Professionals towards Telemedicine Services in Northwest, Ethiopia.

Methods

An institution-based cross-sectional study design was conducted among 423 health professionals working at referral hospitals from 12 February to 20 March 2020. Descriptive statistics, bivariable and multivariable logistic regression analysis were done. To identify associated factors, an odds ratio with a 95% confidence interval (CI) was used.

Result

With a response rate of 411 (97.2%), approximately 56.4% of professionals had good knowledge and 57.4% had high awareness of telemedicine services. Information sharing culture [AOR = 3.01, 95% CI: 1.89, 4.80], IT support staff [AOR = 1.87, 95% CI: 1.06, 3.29], internet as a source of information [AOR = 1.80, 95% CI: 1.1, 2.94], awareness [AOR = 1.35, 95% CI: 1.03, 2.40], and being male [AOR = 1.73, 95% CI:1.06], telemedicine training [AOR = 2.33, 95% CI: 1.15, 4.72] and computer accessibility in their hospitals [AOR = 1.54,95% CI: 1.01, 2.35] were significantly associated with respondents’ awareness of telemedicine services.

Conclusion

More than half of the participants were well-versed in and aware of telemedicine applications. Information sources, having IT support staff, information sharing culture, gender, and awareness were significant for telemedicine service knowledge, and telemedicine training and computer access were significant factors for health professionals’ awareness of telemedicine services. As a result, health professionals should receive appropriate and ongoing awareness-raising training on telemedicine systems.

A proposed learning environment framework for virtual care

The way in which health care is delivered has rapidly changed since the onset of the COVID-19 pandemic, with a rapid increase in virtual delivery of clinical care. As a result, the learning environment (LE) in health professions education, which has traditionally been situated in the bricks-and-mortar clinical context, now also requires attention to the virtual space. As a frequently examined topic in the health professions literature, the LE is a critical component in the development and training of future healthcare professionals. Based on a published conceptual framework for the LE from Gruppen et al. in 2019, a conceptual framework for how the LE can manifest through virtual care space is presented here. The four components of personal, social, organizational, physical/virtual spaces are explored, with a discussion of how they can be integrated into virtual care. The authors provide suggestions that health professions educators can consider when adapting their LE to the virtual environment and highlight aspects of its integration that require further research and investigation.

Telemedicine for healthcare: Capabilities, features, barriers, and applications

Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.

Transition to telehealth : Engaging medical students in telemedicine healthcare delivery

In recent years, telemedicine has been increasingly incorporated into medical practice, a process which has now been accelerated by the COVID-19 pandemic. As telemedicine continues to progress, it is necessary for medical institutions to incorporate telemedicine into their curricula, and to provide students with the necessary skills and experience to effectively carry out telemedicine consultations. The purposes of this study are to review the involvement of medical students with telemedicine and to determine both the benefits and the challenges experienced. A literature review on the MEDLINE; CINAHL Plus; APA PsychInfo; Library, Information Science and Technology Abstracts; and Health Business Elite databases was performed on September 7, 2020, yielding 561 results. 33 manuscripts were analysed, with the main benefits and challenges experienced by medical students summarized. In addition to increasing their understanding of the importance of telemedicine and the acquisition of telemedicine-specific skills, students may use telemedicine to act as a valuable workforce during the COVID-19 pandemic. Challenges that students face, such as discomfort with carrying out telemedicine consults and building rapport with patients, may be addressed through the incorporation of telemedicine teaching into the medical curricula through experiential learning. However, other more systemic challenges, such as technical difficulties and cost, need to be examined for the full benefits of telemedicine to be realized. Telemedicine is here to stay and has proven its worth during the COVID-19 pandemic, with medical students embracing its potential in assisting in medical clinics, simulation of clinical placements, and online classrooms.

Evidence-Based Practices and Use among Employees and Students at an Austrian Medical University

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees (n = 638) and students (n = 609). In line with Bandura's self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice.

Facilitators and barriers for the implementation of telemedicine from a local government point of view - a cross-sectional survey in Germany

BACKGROUND

Telemedicine offers additional ways of delivering medical care, e.g., in primary care in rural areas. During the last decades, projects including telemedicine are being implemented worldwide. However, implementation of telemedicine is in some countries, e.g., Germany somewhat slower compared to northern European countries. One important part of successful implementation is to include the citizen perspective. The aims of this study were to explore the perception of representatives of the local government regarding telemedicine in the context of a perceived GP shortage and to tailor future telemedicine offers according to these perceived needs.

METHODS

Considering the multidisciplinary assessment suggested by the Model for Assessment of Telemedicine a questionnaire with 19 questions was developed by identifying determinants of telemedicine out the literature. After pre-testing, the questionnaire was sent to all 2199 mayors from the federal states of Schleswig-Holstein (North Germany) and Baden-Württemberg (South Germany) as representatives of the citizens (cross- sectional study; full population survey). The final questionnaire contained sections for socio-demographic data, telemedicine and perceived GP shortage. All responses from November 2018 until 2019 were included and analyzed descriptively.

RESULTS

The response rate was 32% (N = 699), of which 605 were included in the analysis. A majority of the participants stated they live in a rural area and 46% were in the office for up to 8 years. The mayors had predominantly a positive perception about telemedicine (60%) and 76% of them stated, their community would benefit from telemedicine. A GP shortage was reported by 39% of the participants. The highest risk of telemedicine was seen in misdiagnosing. In case of an emergency situation 291 (45%) of the participants considered data privacy as not as relevant. Mayors from a community with a perceived GP shortage had a more negative perception regarding telemedicine.

CONCLUSION

The acceptance of telemedicine is rapidly rising compared to former studies. Communities with a perceived GP shortage had a more negative perception. Barriers like data security concerns were seen as less important in case of an emergency. The highest risk of telemedicine was seen in misdiagnosing. These findings need to be considered in designing future telemedicine offers.

Telemedicine in the management of patients with chronic respiratory failure

Patients with chronic respiratory failure are often required to attend multiple hospital appointments, which may be difficult due to their physical disabilities and the amount of equipment they are required to bring. Their caregivers often struggle with the lack of immediate care available when the patient suffers difficulties at home. Telemedicine is an opportunity to bridge the gap between home and healthcare professionals by allowing the healthcare team to reach into patients' homes to provide more frequent support. The evidence for the use of telemedicine in patients with chronic respiratory failure remains equivocal. Although the uptake of telemedicine has been slow, the SARS-CoV-2 pandemic has resulted in the rapid dissemination of telemedicine to allow the delivery of care to vulnerable patients while reducing the need for their attendance in hospital. Logistical and legal challenges to the delivery of telemedicine remain, but the pandemic may serve as a driver to ameliorate these challenges and facilitate wider use of this technology to improve the experience of patients with chronic respiratory failure.

Educational aims

To provide an overview of the rationale for delivering care via telemedicine for patients with chronic respiratory failure.To provide the evidence base for establishing a telemedicine service.To highlight the potential opportunities and challenges in delivering a telemedicine service for patients with chronic respiratory failure.