Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study

Cloud Horizons: Strengthening Rural Healthcare Through Telemedicine's Digital Canopy

Introduction

Cloud-based telemedicine holds promise for improving healthcare accessibility and delivery, particularly in rural areas of developing countries like Tanzania. However, little is known about its determinants and benefits in such contexts. This study investigates the factors influencing the usage of telemedicine in Mvomero district, Morogoro region, Tanzania, focusing on both supply and demand sides.

Method

Using structured interviews and key informant interviews, the study examines various cloud-based telemedicine platforms, including remote monitoring, electronic health records, cloud-based storage, and machine learning algorithms. The study used descriptive statistics to analyze quantitative data, while thematic analysis was used to analyze qualitative data.

Results

Results reveal several factors influencing telemedicine usage. On the demand side, perceived benefits (53.96%), technology cost (62.79%), legal practices (62.79%), and resource availability and affordability (49.77%) are crucial. On the supply side, technological innovation (35%) and access to financial resources (43%) play pivotal roles. Environmental and institutional factors such as political willingness (38%) and regulatory support (34%) also impact telemedicine usage. Moreover, results reveal that cloud-based telemedicine platforms in rural healthcare facilities have several benefits including improved access (32.74% to 57.44%), cost efficiency (37.88% to 54.82%), timely consultations (56.83% to 65.21%), health monitoring, and prescription management (43.89% to 75.90%). Private facilities particularly emphasize health monitoring.

Conclusion

Adopting telemedicine technologies can revolutionize rural healthcare by providing customized and easily accessible services. Policymakers can use these findings to develop targeted strategies, including subsidized infrastructure, innovative financing models, and clear regulatory frameworks. Clear guidelines on data transfer and privacy are essential to ensure legal compliance and equitable access to telemedicine benefits. Simplifying registration requirements and implementing explicit consent mechanisms are recommended to address data privacy concerns. These measures aim to promote operational efficiency, data safety, and enhanced health outcomes in resource-limited settings.

The Transformative Power of Virtual Hospitals for Revolutionising Healthcare Delivery

Objectives: The objective of this narrative review is to explore the advantages and limitations of VHs in delivering healthcare, including access to specialized professionals, streamlined communication, efficient scheduling, integration of electronic health records, ongoing monitoring, and support, transcending geographical boundaries, and resource optimization. Methods: Review of literature. Results: The national healthcare systems are facing an alarming rise in pressure due to global shifts. Virtual hospitals (VH) offer a practical solution to numerous systemic challenges, including rising costs and increased workloads for healthcare providers. VH also facilitate the delivery of personalized services and enable the monitoring of patients beyond the conventional confines of healthcare settings, reducing the reliance on waiting medicine carried out in doctors' offices or hospitals. Conclusion: VH can mirror the conventional healthcare referral system.

Effect of timing of enteral nutrition initiation on poor prognosis in patients after cardiopulmonary bypass: A prospective observational study

OBJECTIVES

Current guidelines recommend that enteral nutrition (EN) be implemented as early as possible in patients after cardiopulmonary bypass (CPB), but the optimal time to initiate EN remains controversial. Therefore, the aim of this study was to investigate the effect of timing of EN initiation on poor prognosis in patients after CPB.

METHODS

This was a prospective observational study with patients who underwent CPB in a tertiary hospital from September 1, 2021, to January 31, 2022. The patients were divided into three groups according to the timing of EN initiation: <24 h, 24 to 48 h, and >48 h. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals to identify independent risk factors for poor prognosis.

RESULTS

The study included 579 patients, of whom 255 patients had EN initiated at <24 h (44%), 226 at 24 to 48 h (39%), and at >48 h (17%). With EN <24 h as a reference, multivariate logistic analysis showed that EN 24 to 48 h (OR, 1.854, P = 0.008) and EN >48 h (OR, 7.486, P <0.001) were independent risk factors for poor prognosis after CPB. Age (OR, 1.032, P = 0.001), emergency surgery (OR, 10.051; P <0.001), surgical time (OR, 1.006; P <0.001), and sequential organ failure assessment score (OR, 1.269; P = 0.001) also increased the risk for poor prognosis after CPB.

CONCLUSIONS

Compared with early EN <24 h, EN 24 to 48 h and EN >48 h increased the risk for poor prognosis in patients after CPB.

How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021

Background

Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services.

Methods

We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission.

Results

Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission.

Conclusion

The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.

Patient Satisfaction With a Multisite, Multiregional Remote Patient Monitoring Program for Acute and Chronic Condition Management: Survey-Based Analysis

BACKGROUND

Remote patient monitoring (RPM) is an option for continuously managing the care of patients in the comfort of their homes or locations outside hospitals and clinics. Patient engagement with RPM programs is essential for achieving successful outcomes and high quality of care. When relying on technology to facilitate monitoring and shifting disease management to the home environment, it is important to understand the patients' experiences to enable quality improvement.

OBJECTIVE

This study aimed to describe patients' experiences and overall satisfaction with an RPM program for acute and chronic conditions in a multisite, multiregional health care system.

METHODS

Between January 1, 2021, and August 31, 2022, a patient experience survey was delivered via email to all patients enrolled in the RPM program. The survey encompassed 19 questions across 4 categories regarding comfort, equipment, communication, and overall experience, as well as 2 open-ended questions. Descriptive analysis of the survey response data was performed using frequency distribution and percentages.

RESULTS

Surveys were sent to 8535 patients. The survey response rate was 37.16% (3172/8535) and the completion rate was 95.23% (3172/3331). Survey results indicated that 88.97% (2783/3128) of participants agreed or strongly agreed that the program helped them feel comfortable managing their health from home. Furthermore, 93.58% (2873/3070) were satisfied with the RPM program and ready to graduate when meeting the program goals. In addition, patient confidence in this model of care was confirmed by 92.76% (2846/3068) of the participants who would recommend RPM to people with similar conditions. There were no differences in ease of technology use according to age. Those with high school or less education were more likely to agree that the equipment and educational materials helped them feel more informed about their care plans than those with higher education levels.

CONCLUSIONS

This multisite, multiregional RPM program has become a reliable health care delivery model for the management of acute and chronic conditions outside hospitals and clinics. Program participants reported an excellent overall experience and a high level of satisfaction in managing their health from the comfort of their home environment.

A Novel Hospital-to-Home System for Children With Medical Complexities: Usability Testing Study

Background

Children with medical complexity (CMC) are a group of young people who have severe complex chronic conditions, substantial family-identified service needs, functional limitations, and high health care resource use. Technology-enabled hospital-to-home interventions designed to deliver comprehensive care in the home setting are needed to ease CMC family stress, provide proactive and comprehensive care to this fragile population, and avoid hospital admissions, where possible.

Objective

In this usability testing study, we aimed to assess areas of strength and opportunity within the DigiComp Kids system, a hospital-to-home intervention for CMC and their families and care providers.

Methods

Hospital-based clinicians, family members of medically complex children, and home-based clinicians participated in DigiComp Kids usability testing. Participants were recorded and tasked to think aloud while completing usability testing tasks. Participants were scored on the metrics of effectiveness, efficiency, and satisfaction, and the total usability score was calculated using the Single Usability Metric. Participants also provided insights into user experiences during the postusability testing interviews.

Results

A total of 15 participants (5 hospital-based clinicians, 6 family members, and 4 home-based clinicians) participated in DigiComp Kids usability testing. The participants were able to complete all assigned tasks independently. Error-free rates for tasks ranged from 58% to 100%; the average satisfaction rating across groups was ≥80%, as measured by the Single Ease Question. Task times of participants were variable compared with the task times of an expert DigiComp Kids user. Single Usability Metric scores ranged from 80.5% to 89.5%. In qualitative interviews, participants stressed the need to find the right fit between user needs and the effort required to use the system. Interviews also revealed that the value of the DigiComp Kids system was in its ability to create a digital bridge between hospital and home, enabling participants to foster and maintain connections across boundaries.

Conclusions

Usability testing revealed strong scores across the groups. Insights gained include the importance of tailoring the implementation of the system to match individual user needs, streamlining key system features, and consideration of the meaning attached to system use by participants to allow for insight into system adoption and sustainment.

Educational approaches for patients with heart surgery: a systematic review of main features and effects

Introduction

Patients who undergo heart surgery are exposed to mental and physical difficulties after discharge from hospital. They often need support and follow-up after discharge. The use of educational approaches or solutions before or after heart surgery can increase patients' knowledge on the post-operative complications and self-care. The main purpose of this systematic review is to determine the applications of educational approaches and investigate the effects of these approaches on patients with heart surgery.

Method and materiel

A thorough search was conducted in Medline (through PubMed), Scopus, ISI web of science to select related articles published between 2011 and May 2022. All of the retrieved papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

Results

A total of 29 articles were obtained from the search, which included in this systematic review after being assessed based on inclusion and exclusion criteria. Most of the articles (n = 10, 34.48%) had been conducted in Canada and Iran, with the most significant number published in 2016. Out of 29 studies, 23 were experimental studies, and six were observational-analytical studies. The number of participants in the studies ranged from 11 to 600 (IQR1: 57.5, median: 88, IQR3: 190). In 28 (96.55%) studies, the educational approaches had a significant effect on clinical, economic or patient-reported outcomes. The greatest effect reported by the studies was related to clinical outcomes such as patient care improvement or change in clinical practice. The most effects in the patient-reported outcomes were related to improving patient satisfaction and patient knowledge. In terms of global rating scores, 17.24% of the included studies were considered as weak, 20.68% as moderate, and 62.06% as strong.

Conclusion

The results of systematic review showed that the use of educational approaches by patients before and after heart surgery can have significant effects on reducing stress and financial burden, and increasing the quality of care and level of knowledge in patients.

A Smarter Health through the Internet of Surgical Things

(1) Background: In the last few years, technological developments in the surgical field have been rapid and are continuously evolving. One of the most revolutionizing breakthroughs was the introduction of the IoT concept within surgical practice. Our systematic review aims to summarize the most important studies evaluating the IoT concept within surgical practice, focusing on Telesurgery and surgical Telementoring. (2) Methods: We conducted a systematic review of the current literature, focusing on the Internet of Surgical Things in Telesurgery and Telementoring. Forty-eight (48) studies were included in this review. As secondary research questions, we also included brief overviews of the use of IoT in image-guided surgery, and patient Telemonitoring, by systematically analyzing fourteen (14) and nineteen (19) studies, respectively. (3) Results: Data from 219 patients and 757 healthcare professionals were quantitively analyzed. Study designs were primarily observational or based on model development. Palpable advantages from the IoT incorporation mainly include less surgical hours, accessibility to high quality treatment, and safer and more effective surgical education. Despite the described technological advances, and proposed benefits of the systems presented, there are still identifiable gaps in the literature that need to be further explored in a systematic manner. (4) Conclusions: The use of the IoT concept within the surgery domain is a widely incorporated but less investigated concept. Advantages have become palpable over the past decade, yet further research is warranted.

Mobile internet-based mixed-reality interactive telecollaboration system for neurosurgical procedures: technical feasibility and clinical implementation

OBJECTIVE

To increase access to health interventions and healthcare services for patients in resource-constrained settings, strategies such as telemedicine must be implemented for the allocation of medical resources across geographic boundaries. Telecollaboration is the dominant form of surgical telemedicine. In this study, the authors report and evaluate a novel mobile internet-based mixed-reality interactive telecollaboration (MIMIT) system as a new paradigm for telemedicine and validate its clinical feasibility.

METHODS

The application of this system was demonstrated for long-distance, real-time collaboration of neuroendoscopic procedures. The system consists of a local video processing workstation, a head-mounted mixed-reality display device, and a mobile remote device, connected over mobile internet (4G or 5G), allowing global point-to-point communication. Using this system, 20 cases of neuroendoscopic surgery were performed and evaluated. The system setup, composite video latency, technical feasibility, clinical implementation, and future potential business model were analyzed and evaluated.

RESULTS

The MIMIT system allows two surgeons to perform complex visual and verbal communication during the operation. The average video delay time is 184.25 msec (range 160–230 msec) with 4G mobile internet, and 23.25 msec (range 20–26 msec) with 5G mobile internet. Excellent image resolution enabled remote neurosurgeons to visualize all critical anatomical structures intraoperatively. Remote instructors could easily make marks on the surgical view; then the composite image, as well as the audio conversation, was transferred to the local surgeon. In this way, a real-time, long-distance collaboration can occur. This system was used for 20 neuroendoscopic surgeries in various cities in China and even across countries (Boston, Massachusetts, to Jingzhou, China). Its simplicity and practicality have been recognized by both parties, and there were no technically related complications recorded.

CONCLUSIONS

The MIMIT system allows for real-time, long-distance telecollaborative neuroendoscopic procedures and surgical training through a commercially available and inexpensive system. It enables remote experts to implement real-time, long-distance intraoperative interaction to guide inexperienced local surgeons, thus integrating the best medical resources and possibly promoting both diagnosis and treatment. Moreover, it can popularize and improve neurosurgical endoscopy technology in more hospitals to benefit more patients, as well as more neurosurgeons.

Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review

Background

Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions.

Objective

To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions.

Methods

This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1.

Results

In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions.

Conclusions

This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes.

International Registered Report Identifier (IRRID)

RR2-10.1136/bmjopen-2020-045596

Patient and clinician use characteristics and perceptions of pulse oximeter use: A scoping review

BACKGROUND AND OBJECTIVES

The need to monitor patients outside of a formal clinical setting, such as a hospital or ambulatory care facility, has become increasingly important since COVID-19. It introduces significant challenges to ensure accurate and timely measurements, maintain strong patient engagement, and operationalise data for clinical decision-making. Remote Patient Monitoring (RPM) devices like the pulse oximeter help mitigate these difficulties, however, practical approaches to successfully integrate this technology into existing patient-clinician interactions that ensure the delivery of safe and effective care are vital. The objective of this scoping review was to synthesise existing literature to provide an overview of the variety of user perceptions associated with pulse oximeter devices, which may impact patients' and clinicians' acceptance of the devices in a RPM context.

METHODS

A search over three databases was conducted between April 2021 - June 2021 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Review (PRISMA-ScR) guidelines. A total of 16 articles were included in this scoping review.

RESULTS

Results indicate there has been an increase in use of pulse oximeters across hospital and community settings for continuous vital signs monitoring and remote monitoring of patients over time. Research in this area is shifting towards increasing accessibility of care through the development and implementation of telehealth systems and phone oximeters. Aspects of pulse oximeter UX most frequently investigated are usability and acceptability, however, these terms are often undefined, or definitions vary across studies. Perceived effectiveness, opportunity costs, and attitude towards use remain unexplored areas of UX. Overall, patients and clinicians view the pulse oximeter positively and find it user-friendly. A high level of learnability was found for the device and additional benefits included increasing patient self-efficacy and clinician motivation to work. However, issues getting an accurate reading due to device usability are still experienced by some patients and clinicians.

CONCLUSION

This scoping review is the first to summarise user perceptions of the pulse oximeter in a healthcare context. It showed that both patients and clinicians hold positive perceptions of the pulse oximeter and important factors to consider in designing user-focused services include ease-of-use and wearability of devices; context of use including user's prior health and IT knowledge; attitude towards use and perceived effectiveness; impact on user motivation and self-efficacy; and finally, potential user costs like inconvenience or increased anxiety. With the rapid increase in research studies examining pulse oximeter use for RPM since COVID-19, a systematic review is warranted as the next step to consolidate evidence and investigate the impact of these factors on pulse oximeter acceptance and effectiveness.

Machine Learning and Internet of Things Enabled Monitoring of Post-Surgery Patients: A Pilot Study

Artificial Intelligence (AI) and Internet of Things (IoT) offer immense potential to transform conventional healthcare systems. The IoT and AI enabled smart systems can play a key role in driving the future of smart healthcare. Remote monitoring of critical and non-critical patients is one such field which can leverage the benefits of IoT and machine learning techniques. While some work has been done in developing paradigms to establish effective and reliable communications, there is still great potential to utilize optimized IoT network and machine learning technique to improve the overall performance of the communication systems, thus enabling fool-proof systems. This study develops a novel IoT framework to offer ultra-reliable low latency communications to monitor post-surgery patients. The work considers both critical and non-critical patients and is balanced between these to offer optimal performance for the desired outcomes. In addition, machine learning based regression analysis of patients' sensory data is performed to obtain highly accurate predictions of the patients' sensory data (patients' vitals), which enables highly accurate virtual observers to predict the data in case of communication failures. The performance analysis of the proposed IoT based vital signs monitoring system for the post-surgery patients offers reduced delay and packet loss in comparison to IEEE low latency deterministic networks. The gradient boosting regression analysis also gives a highly accurate prediction for slow as well as rapidly varying sensors for vital sign monitoring.

Systematic Review of Telemedicine and eHealth Systems Applied to Vascular Surgery

OBJECTIVE

The objective of this paper is to review and analyze the current state of telemedicine and ehealth in the field of vascular surgery.

METHODS

This paper collects the relevant information obtained after reviewing the articles related to telemedicine in vascular surgery, published from 2012 to 2022 contained in scientific databases. In addition, the results obtained are statistically studied based on various factors, such as the year of publication or the search engine. In this way, we obtain a complete vision of the current state of telemedicine in the field of vascular surgery.

RESULTS

After performing this search and applying selection criteria, 29 articles were obtained for subsequent study and discussion, of which 20 were published in the second half of the decade, representing 70% of the results. In the analysis carried out according to the search criteria used, it can be seen that using the word telemedicine we obtained 69% of the articles while with the criteria mHealth and eHealth we only obtained 22% and 9% of the results, respectively. It can be seen that the filter with the most potential content articles was "vascular surgery AND telemedicine". In the analysis performed according to the search engine, it was observed that the Google Scholar database contains 93% of the articles found in the massive search and the relevant articles contained therein represent 52% of the total.

CONCLUSION

An upward trend has been observed in recent years, with a clear increase in the number of publications and much lower figures in the first years. One aspect to highlight is that 47.8% of the articles analyzed focus only on postoperative treatment, which may be due to the help provided by telemedicine in detecting surgical site infections by sending images and videos, this being one of the most common postoperative complications. The analyzed works show the importance of telemedicine in vascular surgery and identify possible future lines of research. In the analysis carried out on the origin of the selected relevant papers, an important interest of the US in this topic is demonstrated since more than 50% of the research contains authors from this country, it is also observed that there is no research from Spain, so this research would be an initial step to determine the weaknesses of telemedicine in this field of medicine and a good opportunity to open a research gap in this branch.

Perioperative Tablet-Based Telemonitoring After Abdominal Wall Hernia Surgery: Pilot Prospective Observational Cohort Study

BACKGROUND

Hernia repairs account for millions of general surgical procedures performed each year worldwide, with a notable shift to outpatient settings over the last decades. As technical possibilities such as smartphones, tablets, and different kinds of probes are becoming more and more available, such systems have been evaluated for applications in various clinical settings. However, there have been few studies conducted in the surgical field, especially in general surgery.

OBJECTIVE

We aimed to assess the feasibility of a tablet-based follow up to monitor activity levels after repair of abdominal wall hernias and to evaluate a possible reduction of adverse events by their earlier recognition.

METHODS

Patients scheduled for elective surgical repair of minor abdominal wall hernias (eg, inguinal, umbilical, or trocar hernias) were equipped with a telemonitoring system, including a tablet, pulse oximeter, and actimeter, for a monitoring phase of 7 days before and 30 days after surgery. Descriptive statistical analyses were performed.

RESULTS

We enrolled 16 patients with a mean overall age of 48.75 (SD 16.27) years. Preoperative activity levels were reached on postoperative day 12 with a median of 2242 (IQR 0-4578) steps after plunging on the day of surgery. The median proportion of available activity measurements over the entire study period of 38 days was 69% (IQR 56%-81%). We observed a gradual decrease in the proportion of available data for all parameters during the postoperative course. Six out of ten patients (60%) regained preoperative activity levels within 3 weeks after surgery. Overall, patients rated the usability of the system as relatively easy.

CONCLUSIONS

Tablet-based follow up is feasible after surgical repair of minor abdominal wall hernias, with good adherence rates during the first couple of weeks after surgery. Thus, such a system could be a useful tool to supplement or even replace traditional outpatient follow up in selected general surgical patients.

User Perceptions of Virtual Hospital Apps in China: Systematic Search

BACKGROUND

Virtual hospital apps are mobile apps that offer functionalities of online consultation, medical guidance, health community forums, referrals, outpatient appointments or virtual hospital-to-home care services. With an increasing number of online medical and health care consulting services, virtual hospital apps have made health care more accessible and fairer for all, especially in China. However, they have occurred without control or regulation. User evaluation can provide directions to help apps optimize identification, lower risks, and guarantee service quality.

OBJECTIVE

We aimed to conduct a systematic search for virtual hospital apps in China. To get a global view, virtual hospital apps were assessed and characterized by means of quantitative analysis. To get a local view, we conducted a content feedback analysis to explore user requirements, expectations, and preferences.

METHODS

A search was conducted of the most popular Apple and Android app stores in China. We characterized and verified virtual hospital apps and grouped apps according to quantification analysis. We then crawled apps and paid attention to corresponding reviews to incorporate users' involvement, and then performed aspect-based content labeling and analysis using an inductive approach.

RESULTS

A total of 239 apps were identified in the virtual hospital app markets in China, and 2686 informative corresponding reviews were analyzed. The evidence showed that usefulness and ease of use were vital facts for engagement. Users were likely to trust a consulting service with a high number of downloads. Furthermore, users expected frequently used apps with more optimization to improve virtual service. We characterized apps according to 4 key features: (1) app functionalities, including online doctor consultation, in-app purchases, tailored education, and community forums; (2) security and privacy, including user data management and user privacy; (3) health management, including health tracking, reminders, and notifications; and (4) technical aspects, including user interface and equipment connection.

CONCLUSIONS

Virtual hospitals relying on the mobile internet are growing rapidly. A large number of virtual hospital apps are available and accessible to a growing number of people. Evidence from this systematic search can help various types of virtual hospital models enhance virtual health care experiences, go beyond offline hospitals, and continuously meet the needs of individual end users.