One Digital Health: A Unified Framework for Future Health Ecosystems

Empowering healthcare education: A multilingual ontology for medical informatics and digital health (MIMO) integrated to artificial intelligence powered training in smart hospitals

Objective: A comprehensive understanding of professional and technical terms is essential to achieving practical results in multidisciplinary projects dealing with health informatics and digital health. The medical informatics multilingual ontology (MIMO) initiative has been created through international cooperation. MIMO is continuously updated and comprises over 3700 concepts in 37 languages on the Health Terminology/Ontology Portal (HeTOP). Methods: We conducted case studies to assess the feasibility and impact of integrating MIMO into real-world healthcare projects. In HosmartAI, MIMO is used to index technological tools in a dedicated marketplace and improve partners' communication. Then, in SaNuRN, MIMO supports the development of a "Catalog and Index of Digital Health Teaching Resources" (CIDHR) backing digital health resources retrieval for health and allied health students. Results: In HosmartAI, MIMO facilitates the indexation of technological tools and smooths partners' interactions. In SaNuRN within CIDHR, MIMO ensures that students and practitioners access up-to-date, multilingual, and high-quality resources to enhance their learning endeavors. Conclusion: Integrating MIMO into training in smart hospital projects allows healthcare students and experts worldwide with different mother tongues and knowledge to tackle challenges facing the health informatics and digital health landscape to find innovative solutions improving initial and continuous education.

The impact of digital literacy on personal health: Evidence from the China family panel study

BACKGROUND

In the digital era, digital literacy is a fundamental indicator of a nation's quality and plays a crucial role in public health. Exploring the theoretical mechanisms and effects of digital literacy on individuals' health is of great practical importance, advancing the initiatives of 'Digital China' and 'Healthy China'.

METHODS

The study utilised three-period survey panel data from the China Family Panel Study spanning 2016, 2018, and 2020 to measure and evaluate levels of digital literacy, physical health, mental health, healthy lifestyle, and integrated health among the participants. Subsequently, a series of empirical analyses were conducted to examine the general impact, heterogeneous effects and transmission pathways of digital literacy on various types of health levels.

RESULTS

Digital literacy significantly enhances all aspects of respondents' health, and this conclusion remains valid even after conducting robustness tests and addressing endogeneity through variable substitution and selecting instrumental variables using the 2SLS method. Furthermore, examining heterogeneity by considering individual traits and the makeup of digital literacy reveals that the impact of digital literacy on individuals' health varies according to age, cultural background, personal income, and the components of digital literacy. Pathway analyses also demonstrate that medical accessibility, information access, social network, and planned behaviour are key routes through which digital literacy enhances the health of the population.

CONCLUSIONS

It is imperative for the government to actively promote the advancement of the digital healthcare industry, while individuals should strive to enhance their digital literacy. By collectively focussing on these efforts, national health can be significantly improved.

Essential competencies of nurses for climate change response in Saudi Arabia: A rapid literature review

AIM

Amidst the mounting challenges posed by climate change, the healthcare sector emerges as a vital frontliner, with nurses standing as its linchpins. This review delves into the pivotal role of nurses in combatting the health consequences of climatic alterations, particularly within the nuanced environment of Saudi Arabia.

DESIGN

A rapid literature review.

METHOD

Drawing from a rigorous analysis of 53 studies, our exploration revolves around the preparedness strategies formulated in response to Saudi Arabia's changing climate. The variables analysed included study design, sample size, focus area, geographical coverage and key findings related to nurse competencies. Data were collected using a structured data extraction form and analysed using thematic content analysis. Employing content analysis, we discerned essential domains: from grasping the health impacts of climate change to customizing care for the most susceptible populations and championing advocacy initiatives.

FINDINGS

Salient findings highlight nurses' profound understanding of both direct and secondary health implications of climate shifts. Additionally, the results emphasize the tailored interventions needed for vulnerable groups, capacity building and disaster readiness. Crucially, our findings spotlight the significance of weaving cultural, ethical and regional threads into nursing strategies. By painting a comprehensive picture, we showcase the delicate balance of environmental evolution, healthcare dynamics and the unique socio-cultural tapestry of Saudi Arabia.

CONCLUSION

The results of our analysis revealed key competencies required for nurses, including the ability to address immediate health impacts, provide tailored care for vulnerable populations and engage in advocacy and policy formulation. In summation, nurses' multifaceted roles-from immediate medical care to research, advocacy and strategizing-underscore their invaluable contribution to confronting the health adversities sparked by climate change. Our review accentuates the essential contributions of nurses in tackling climate-related health hurdles and calls for more nuanced research, policy adjustments and proactive measures attuned to Saudi Arabia's distinct backdrop.

Spatiotemporal models of dengue epidemiology in the Philippines: Integrating remote sensing and interpretable machine learning

Previous dengue epidemiological analyses have been limited in spatiotemporal extent or covariate dimensions, the latter neglecting the multifactorial nature of dengue. These constraints, caused by rigid and traditional statistical tools which collapse amidst 'Big Data', prompt interpretable machine-learning (iML) approaches. Predicting dengue incidence and mortality in the Philippines, a data-limited yet high-burden country, the mlr3 universe of R packages was used to build and optimize ML models based on remotely sensed provincial and dekadal 3 NDVI and 9 rainfall features from 2016 to 2020. Between two tasks, models differ across four random forest-based learners and two clustering strategies. Among 16 candidates, rfsrc-year-case and ranger-year-death significantly perform best for predicting dengue incidence and mortality, respectively. Therefore, temporal clustering yields the best models, reflective of dengue seasonality. The two best models were subjected to tripartite global exploratory model analyses, which encompass model-agnostic post-hoc methods such as Permutation Feature Importance (PFI) and Accumulated Local Effects (ALE). PFI reveals that the models differ in their important explanatory aspect, rainfall for rfsrc-year-case and NDVI for ranger-year-death, among which long-term average (lta) features are most relevant. Trend-wise, ALE reveals that average incidence predictions are positively associated with 'Rain.lta', reflective of dengue cases peaking during the wet season. In contrast, those for mortality are negatively associated with 'NDVI.lta', reflective of urban spaces driving dengue-related deaths. By technologically addressing the challenges of the human-animal-ecosystem interface, this study adheres to the One Digital Health paradigm operationalized under Sustainable Development Goals (SDGs). Leveraging data digitization and predictive modeling for epidemiological research paves SDG 3, which prioritizes holistic health and well-being.

Digital Health Education for the Future: The SaNuRN (Santé Numérique Rouen-Nice) Consortium's Journey

SaNuRN is a five-year project by the University of Rouen Normandy (URN) and the Côte d’Azur University (CAU) consortium to optimize digital health education for medical and paramedical students, professionals, and administrators. The project includes a skills framework, training modules, and teaching resources. In 2027, SaNuRN is expected to train a significant portion of the 400,000 health and paramedical professions students at the French national level. Our purpose is to give a synopsis of the SaNuRN initiative, emphasizing its novel educational methods and how they will enhance the delivery of digital health education. Our goals include showcasing SaNuRN as a comprehensive program consisting of a proficiency framework, instructional modules, and educational materials and explaining how SaNuRN is implemented in the participating academic institutions. SaNuRN is a project aimed at educating and training health-related and paramedics students in digital health. The project results from a cooperative effort between URN and CAU, covering four French departments. The project is based on the French National Referential on Digital Health (FNRDH), which defines the skills and competencies to be acquired and validated by every student in the health, paramedical, and social professions curricula. The SaNuRN team is currently adapting the existing URN and CAU syllabi to FNRDH and developing short-duration video capsules of 20 to 30 minutes to teach all the relevant material. The project aims to ensure that the largest student population earns the necessary skills, and it has developed a two-tier system involving facilitators who will enable the efficient expansion of the project’s educational outreach and support the students in learning the needed material efficiently. With a focus on real-world scenarios and innovative teaching activities integrating telemedicine devices and virtual professionals, SaNuRN is committed to enabling continuous learning for healthcare professionals in clinical practice. The SaNuRN team introduced new ways of evaluating healthcare professionals by shifting from a knowledge-based to a competencies-based evaluation, aligning with the Miller teaching pyramid and using the Objective Structured Clinical Examination and Script Concordance Test in digital health education. Drawing on the expertise of URN, CAU, and their public health and digital research laboratories and partners, the SaNuRN project represents a platform for continuous innovation, including telemedicine training and living labs with virtual and interactive professional activities. The SaNuRN project provides a comprehensive, personalized 30-hour training package for health and paramedical students, addressing all 70 FNRDH competencies. The program is enhanced using AI and NLP to create virtual patients and professionals for digital healthcare simulation. SaNuRN teaching materials are open-access. The project collaborates with academic institutions worldwide to develop educational material in digital health in English and multilingual formats. SaNuRN offers a practical and persuasive training approach to meet the current digital health education requirements.

Enhancing Healthcare through Sensor-Enabled Digital Twins in Smart Environments: A Comprehensive Analysis

This comprehensive review investigates the transformative potential of sensor-driven digital twin technology in enhancing healthcare delivery within smart environments. We explore the integration of smart environments with sensor technologies, digital health capabilities, and location-based services, focusing on their impacts on healthcare objectives and outcomes. This work analyzes the foundational technologies, encompassing the Internet of Things (IoT), Internet of Medical Things (IoMT), machine learning (ML), and artificial intelligence (AI), that underpin the functionalities within smart environments. We also examine the unique characteristics of smart homes and smart hospitals, highlighting their potential to revolutionize healthcare delivery through remote patient monitoring, telemedicine, and real-time data sharing. The review presents a novel solution framework leveraging sensor-driven digital twins to address both healthcare needs and user requirements. This framework incorporates wearable health devices, AI-driven health analytics, and a proof-of-concept digital twin application. Furthermore, we explore the role of location-based services (LBS) in smart environments, emphasizing their potential to enhance personalized healthcare interventions and emergency response capabilities. By analyzing the technical advancements in sensor technologies and digital twin applications, this review contributes valuable insights to the evolving landscape of smart environments for healthcare. We identify the opportunities and challenges associated with this emerging field and highlight the need for further research to fully realize its potential to improve healthcare delivery and patient well-being.

The application of innovative ecosystems to build resilient communities in response to major public health events

In recent years, major public health events have had a significant and far-reaching impact on communities. As a response, there has been an increasing interest in enhancing community resilience through innovative ecosystems that involve diverse stakeholders with varying needs and demands. This study investigates the application of innovative ecosystems to improve community resilience in the face of major public health events by utilizing a sequential game approach to balance the interests of government, community, and residents. Subsequently, a comprehensive questionnaire survey was conducted among key stakeholders to ascertain their objectives, requirements and concerns for the innovation ecosystem based on the analysis results of the game model. The reliability and effectiveness of the proposed research method were verified through the analysis and verification of the sequence game model and questionnaire survey results. Finally, according to our analysis results, we propose countermeasures for promoting innovative ecosystems to improve community resilience. The research results indicate that the successful implementation of innovative ecosystems requires consideration of the different needs of stakeholders such as government officials, community members, and residents. Combining these perspectives can effectively promote such systems while enhancing the community's resilience to major public health events.

Sharing Digital Health Educational Resources in a One-Stop Shop Portal: Tutorial on the Catalog and Index of Digital Health Teaching Resources (CIDHR) Semantic Search Engine

BACKGROUND

Access to reliable and accurate digital health web-based resources is crucial. However, the lack of dedicated search engines for non-English languages, such as French, is a significant obstacle in this field. Thus, we developed and implemented a multilingual, multiterminology semantic search engine called Catalog and Index of Digital Health Teaching Resources (CIDHR). CIDHR is freely accessible to everyone, with a focus on French-speaking resources. CIDHR has been initiated to provide validated, high-quality content tailored to the specific needs of each user profile, be it students or professionals.

OBJECTIVE

This study's primary aim in developing and implementing the CIDHR is to improve knowledge sharing and spreading in digital health and health informatics and expand the health-related educational community, primarily French speaking but also in other languages. We intend to support the continuous development of initial (ie, bachelor level), advanced (ie, master and doctoral levels), and continuing training (ie, professionals and postgraduate levels) in digital health for health and social work fields. The main objective is to describe the development and implementation of CIDHR. The hypothesis guiding this research is that controlled vocabularies dedicated to medical informatics and digital health, such as the Medical Informatics Multilingual Ontology (MIMO) and the concepts structuring the French National Referential on Digital Health (FNRDH), to index digital health teaching and learning resources, are effectively increasing the availability and accessibility of these resources to medical students and other health care professionals.

METHODS

First, resource identification is processed by medical librarians from websites and scientific sources preselected and validated by domain experts and surveyed every week. Then, based on MIMO and FNRDH, the educational resources are indexed for each related knowledge domain. The same resources are also tagged with relevant academic and professional experience levels. Afterward, the indexed resources are shared with the digital health teaching and learning community. The last step consists of assessing CIDHR by obtaining informal feedback from users.

RESULTS

Resource identification and evaluation processes were executed by a dedicated team of medical librarians, aiming to collect and curate an extensive collection of digital health teaching and learning resources. The resources that successfully passed the evaluation process were promptly included in CIDHR. These resources were diligently indexed (with MIMO and FNRDH) and tagged for the study field and degree level. By October 2023, a total of 371 indexed resources were available on a dedicated portal.

CONCLUSIONS

CIDHR is a multilingual digital health education semantic search engine and platform that aims to increase the accessibility of educational resources to the broader health care-related community. It focuses on making resources "findable," "accessible," "interoperable," and "reusable" by using a one-stop shop portal approach. CIDHR has and will have an essential role in increasing digital health literacy.

How to establish digital health ecosystems from the perspective of health service-organizations: A taxonomy developed based on expert interviews conducted as modified Delphi approach

Objective

Digital health ecosystems may be the next revolution in improving citizens' well-being, health delivery, data management, and health system processes, but solutions have not yet been broadly established. Reasons could be that health service-organizations have misaligned interests or lack capabilities. This study investigates reasons from a multi-health-service-organization perspective, differentiating between payers, insurers, healthcare providers, and innovators, detailing the expected value-adds, preferred participation roles, and required capabilities including a rating assessment.

Methods

Findings are based on a taxonomy development methodology, which combines a literature review with semi-structured qualitative expert interviews, conducted using a modified Delphi approach. Interviews were thematically analysed.

Results

In total, 21 experts across the four health service-organization groups were interviewed. The capability taxonomy includes a total of 16 capabilities, categorized in three themes: 'Health market', 'organizational', and 'technology and informatic'. Providers expect a value-add from strengthening their health process economics through efficiency gains but reveal the largest capability gaps, especially in 'interoperability' and 'platform'. Innovators' 'technology and informatic' capabilities complement well with those of payers for the 'health market'.

Conclusions

We present a health service-organization-specific three-stage approach for establishing digital health ecosystems. Payers and insurers should address their 'technology and informatic' capability gaps, using technical enablers or forming new entities to reduce dependencies from legacy information technology systems. Innovators should clarify their monetization models and create positive awareness for their services, possibly entering the market directly. Providers must address interoperability issues and may require incentives to encourage their participation. Findings suggest governmental policymakers to prioritize three health policy initiatives.

Identification of required capabilities of digital health ecosystems when preventing and managing non-communicable diseases

Objective

Non-communicable diseases cause annual mortality for 41 million people worldwide. These diseases include coronary heart disease, cancer, stroke, diabetes, and musculoskeletal as well as mental disorders. Innovation ecosystems in healthcare are multifactor networks in which different stakeholders interact together to create socio-economic (patient and cost) value via research, co-creation, and traditional market activities. Although there is much evidence about the impact of digital health interventions and the capabilities needed to support individual actors and specific diseases in non-communicable disease prevention and management, the current understanding of the concept of innovation ecosystems associated with theories is not well understood. There is also a lack of research about innovation ecosystems in the healthcare context. Or understanding of the holistic perspective of the capabilities needed in innovation ecosystems to support future digital health. The objective of this study was to answer this research gap by identifying what capabilities are needed in future digital health ecosystems related to people with non-communicable diseases or at risk of non-communicable diseases. By doing this, the study will help different organisations and policies address this very challenging situation.

Methods

To answer this objective, a qualitative interview-based study including 34 semi-structured interviews was conducted in Finland. Complex adaptive systems theory was used as a theoretical lens to analyse empirical data.

Results and conclusion

Several new capabilities were identified for digital health innovation ecosystems to make organisation managers and policymakers aware of how to deal with future health system demands. From the organisational perspective, capabilities are needed to use non-medical and heterogeneous data to support better treatments and clinical decision-making and provide better and safer data access. From the management perspective, hospitals need capabilities to allow critical experts to participate in innovation work, and overall, all ecosystem actors need capabilities to orchestrate research and innovation actions in the area of digital health.

The Internet of Animals: what it is, what it could be

One of the biggest trends in ecology over the past decade has been the creation of standardized databases. Recently, this has included live data, formal linkages between disparate databases, and automated analytics, a synergy that we recognize as the Internet of Animals (IoA). Early IoA systems relate animal locations to remote-sensing data to predict species distributions and detect disease outbreaks, and use live data to inform management of endangered species. However, meeting the future potential of the IoA concept will require solving challenges of taxonomy, data security, and data sharing. By linking data sets, integrating live data, and automating workflows, the IoA has the potential to enable discoveries and predictions relevant to human societies and the conservation of animals.

The Role of Human and Organizational Factors in the Pursuit of One Digital Health

OBJECTIVE

This paper surveys a subset of the 2022 human and organizational factor (HOF) literature to provide guidance on building a One Digital Health ecosystem.

METHODS

We searched a subset of journals in PubMed/Medline for studies with "human factors" or "organization" in the title or abstract. Papers published in 2022 were eligible for inclusion in the survey. Selected papers were categorized into structural and behavioural aspects to understand digital health enabled interactions across micro, meso, and macro systems.

RESULTS

Our survey of the 2022 HOF literature showed that while we continue to make meaningful progress at digital health enabled interactions across systems levels, there are still challenges that must be overcome. For example, we must continue to grow the breadth of HOF research beyond individual users and systems to assist with the scale up of digital health systems across and beyond organizations. We summarize the findings by providing five HOF considerations to help build a One Digital Health ecosystem.

CONCLUSION

One Digital Health challenges us to improve coordination, communication, and collaboration between the health, environmental and veterinary sectors. Doing so requires us to develop both the structural and behavioural capacity of digital health systems at the organizational level and beyond so that we can develop more robust and integrated systems across health, environmental and veterinary sectors. The HOF community has much to offer and must play a leading role in designing a One Digital Health ecosystem.

One Health in a Digital World: Technology, Data, Information and Knowledge

OBJECTIVES

To describe the origins and growth of the One Health concept and its recent application in One Digital Health.

METHODS

Bibliometric review and critical discussion of emergent themes derived from co-occurrence of MeSH keywords.

RESULTS

The fundamental interrelationship between human health, animal health and the wider environment has been recognized since ancient times. One Health as a distinct term originated in 2004 and has been a rapidly growing concept of interest in the biomedical literature since 2017. One Digital Health has quickly established itself as a unifying construct that highlights the critical role of technology, data, information and knowledge to facilitate the interdisciplinary collaboration that One Health requires. The principal application domains of One Digital Health to date are in FAIR data integration and analysis, disease surveillance, antimicrobial stewardship and environmental monitoring.

CONCLUSIONS

One Health and One Digital Health offer powerful lenses to examine and address crises in our living world. We propose thinking in terms of Learning One Health Systems that can dynamically capture, integrate, analyse and monitor application of data across the biosphere.

Automation in Contemporary Clinical Information Systems: a Survey of AI in Healthcare Settings

AIMS AND OBJECTIVES

To examine the nature and use of automation in contemporary clinical information systems by reviewing studies reporting the implementation and evaluation of artificial intelligence (AI) technologies in healthcare settings.

METHOD

PubMed/MEDLINE, Web of Science, EMBASE, the tables of contents of major informatics journals, and the bibliographies of articles were searched for studies reporting evaluation of AI in clinical settings from January 2021 to December 2022. We documented the clinical application areas and tasks supported, and the level of system autonomy. Reported effects on user experience, decision-making, care delivery and outcomes were summarised.

RESULTS

AI technologies are being applied in a wide variety of clinical areas. Most contemporary systems utilise deep learning, use routinely collected data, support diagnosis and triage, are assistive (requiring users to confirm or approve AI provided information or decisions), and are used by doctors in acute care settings in high-income nations. AI systems are integrated and used within existing clinical information systems including electronic medical records. There is limited support for One Health goals. Evaluation is largely based on quantitative methods measuring effects on decision-making.

CONCLUSION

AI systems are being implemented and evaluated in many clinical areas. There remain many opportunities to understand patterns of routine use and evaluate effects on decision-making, care delivery and patient outcomes using mixed-methods. Support for One Health including integrating data about environmental factors and social determinants needs further exploration.

Consumer Informatics and One Health: Shifting the Focus from the Individual to the Globe. Findings from the Yearbook 2023 Section on Education and Consumer Health Informatics

OBJECTIVE

To summarise the state of the art during the year 2022 in consumer health informatics and education, with a special emphasis on "One Health".

METHODS

We conducted a systematic search of articles published in PubMed. We build queries to merge terms related to "consumer health informatics", "one health", and "digital". We retrieved 94 potential articles for review. These articles were screened according to topic relevance and 12 were selected for consideration of best paper candidates, which were then presented to a panel of international experts for full paper review and scoring. The top five papers were discussed in a consensus meeting. Three papers received the highest score from the expert panel, and these papers were selected to be representative papers on consumer informatics for exploring one health from consumer perspective in the year 2022.

RESULTS

Bibliometrics analysis conducted on words found in abstracts of the 12 candidate papers revealed four clusters of articles, where clustering outcomes explained 96.91% of the dispersion. The first cluster composes three papers related to patient engagement in primary care practices, using digital-delivered diabetes prevention programmes, or exploring citizen involvement in co-designing environmental projects (such as air pollution exposure and health). The second cluster represents four papers related to digital health literacy and consumer behavior, such as digital vaccine literacy, and food labelling influences and whether displaying Nutri- and Eco-Score at food product level led to improved consumer choices. The third cluster consists of two papers exploring strategies to involve citizens in various science projects while analyzing the quality of citizen-collected data (e.g., mosquito bites or gastropod community dataset). The last cluster contains three papers related to the relationships between human behavior with their environment and their contribution to citizen science projects (e.g., biological water quality in the Netherlands distribution, composition, abundance of debris across sandy beaches in Australia and its regions, urbanization and reptile biodiversity across Florida).

CONCLUSION

Traditionally, consumer health informatics focuses on providing individuals with tools and resources to actively manage their own health. By incorporating a global health (or one health) perspective, our field is now at a crossroad, demanding us to think beyond the individual and challenging us to instill the thinking that our actions not only have consequences on the individual but also on the population and the environment. Perhaps this is also a reflective time for the consumer informatics field, to consider shifting the focus from the individual to one that is more aligned with one health, helping consumers gain awareness of how their actions impact on the individual, the population and the environment, and providing them with tools to work collectively to help decide how their actions may bring benefits (as well as harms) across these levels.

Leveraging Data and Technology to Enhance Interdisciplinary Collaboration and Health Outcomes

OBJECTIVE

To give an overview of recent research and propose a selection of best papers published in 2022 in Informatics for One Health.

METHODS

An extensive search using PubMed and Web of Science was conducted to identify peer-reviewed articles published between December 2021 and December 2022, in order to find relevant publications in the 'Informatics for One Health' field. The selection process comprised three steps: (i) eight candidate best papers were first selected by the two section editors; (ii) external reviewers from internationally renowned research teams reviewed each candidate best paper; and (iii) the editorial committee of the Yearbook conducted the final best paper selection.

RESULTS

The candidate best papers represent studies that characterized significant challenges facing Informatics for One Health. Other trends of interest related to the deployment of medical artificial intelligence tools and the implementation of the FAIR principles within the One Health broad scenario. In general, papers identified in the search fell into one of the following categories: 1) Health improvement via digital technology; 2) Climate change/Environment/Biodiversity; and 3) Maturity of healthcare services.

CONCLUSION

The topic turns extremely important in the next future for what concerns the need to understand complex interactions in order to safeguard the health of populations and ecosystems.

Integrated Management Systems (IMS) to Support and Sustain Quality One Health Services: International Lessons from the COVID-19 Pandemic by the IMIA Primary Care Working Group

OBJECTIVES

One Health considers human, animal and environment health as a continuum. The COVID-19 pandemic started with the leap of a virus from animals to humans. Integrated management systems (IMS) should provide a coherent management framework, to meet reporting requirements and support care delivery. We report IMS deployment during, and retention post the COVID-19 pandemic, and exemplar One Health use cases.

METHODS

Six volunteer members of the International Medical Association's (IMIA) Primary Care Working Group provided data about any IMS and One Health use to support the COVID-19 pandemic initiatives. We explored how IMS were: (1) Integrated with organisational strategy; (2) Utilised standardised processes, and (3) Met reporting requirements, including public health. Selected contributors provided Unified Modelling Language (UML) use case diagram for a One Health exemplar.

RESULTS

There was weak evidence of synergy between IMS and health system strategy to the COVID-19 pandemic. However, there were rapid pragmatic responses to COVID-19, not citing IMS. All health systems implemented IMS to link COVID test results, vaccine uptake and outcomes, particularly mortality and to provide patients access to test results and vaccination certification. Neither proportion of gross domestic product alone, nor vaccine uptake determined outcome. One Health exemplars demonstrated that animal, human and environmental specialists could collaborate.

CONCLUSIONS

IMS use improved the pandemic response. However, IMS use was pragmatic rather than utilising an international standard, with some of their benefits lost post-pandemic. Health systems should incorporate IMS that enables One Health approaches as part of their post COVID-19 pandemic preparedness.

Telehealth as a Component of One Health: a Position Paper

INTRODUCTION

One Health (OH) refers to the integration of human, animal, and ecosystem health within one framework in the context of zoonoses, antimicrobial resistance and stewardship, and food security. Telehealth refers to distance delivery of healthcare. A systems approach is central to both One Health and telehealth, and telehealth can be a core component of One Health. Here we explain how telehealth might be integrated into One Health.

METHODS

We have considered antimicrobial resistance (AMR) as a use case where both One Health and telehealth can be used for coordination among the farming sector, the veterinary services, and human health providers to mitigate the risk of AMR. We conducted a narrative review of the literature to develop a position on the inter-relationships between telehealth and One Health. We have summarised how telehealth can be incorporated within One Health.

RESULTS

Clinicians have used telehealth to address antimicrobial resistance, zoonoses, food borne infection, improvement of food security and antimicrobial stewardship. We identified little existing evidence in support of the usage of telehealth within a One Health paradigm, although in isolation, both are useful for the same purpose, i.e., mitigation of the significant public health risks posed by zoonoses, food borne infections, and antimicrobial resistance.

CONCLUSIONS

It is possible to integrate telehealth within a One Health framework to develop effective inter-sectoral communication essential for the mitigation and addressing of zoonoses, food security, food borne infection containment and antimicrobial stewardship. More research is needed to substantiate and investigate this model of healthcare.

Digital Emergency Management for a Complex One Health Landscape: the Need for Standardization, Integration, and Interoperability

OBJECTIVE

Planning reliable long-term planning actions to handle disruptive events requires a timely development of technological infrastructures, as well as the set-up of focused strategies for emergency management. The paper aims to highlight the needs for standardization, integration, and interoperability between Accident & Emergency Informatics (A&EI) and One Digital Health (ODH), as fields capable of dealing with peculiar dynamics for a technology-boosted management of emergencies under an overarching One Health panorama.

METHODS

An integrative analysis of the literature was conducted to draw attention to specific foci on the correlation between ODH and A&EI, in particular: (i) the management of disruptive events from private smart spaces to diseases spreading, and (ii) the concepts of (health-related) quality of life and well-being.

RESULTS

A digitally-focused management of emergency events that tackles the inextricable interconnectedness between humans, animals, and surrounding environment, demands standardization, integration, and systems interoperability. A consistent and finalized process of adoption and implementation of methods and tools from the International Standard Accident Number (ISAN), via findability, accessibility, interoperability, and reusability (FAIR) data principles, to Medical Informatics and Digital Health Multilingual Ontology (MIMO) - capable of looking at different approaches to encourage the integration between the ODH framework and the A&EI vision, provides a first answer to these needs.

CONCLUSIONS

ODH and A&EI look at different scales but with similar goals for converging health and environmental-related data management standards to enable multi-sources, interdisciplinary, and real-time data integration and interoperability. This allows holistic digital health both in routine and emergency events.

One Health: Insights from Organizational & Social, Technology Assessment and Human Factors Perspectives

OBJECTIVES

To offer diverse but complementary perspectives on how biomedical and health informatics can be informed by and help to achieve the vision of One Health.

METHODS

Overview of key considerations and critical discussion of common themes, barriers and opportunities, based on collaborative review by International Medical Informatics Association (IMIA) working group members active in related fields.

RESULTS

Health and care systems are complex sociotechnical systems that need explicit design and implementation strategies to align with the goals of One Health. The evidence-based health informatics paradigm and associated frameworks for evaluation of digital health technologies need to broaden their scope to take full account of the One Health approach. Informatics has specific contributions to make to One Health, for example by improved user experience reducing energy consumption and effective app design enhancing medication adherence.

CONCLUSIONS

One Health is inherently intertwined with ergonomic, sociotechnical and evaluation perspectives in biomedical and health informatics. Health is a planetary issue that requires interdisciplinary collaborative action. The theories and principles of biomedical and health informatics offer many opportunities to transform digital health technology to better serve the One Health agenda.

How Participatory Health Informatics Catalyzes One Digital Health

OBJECTIVE

To identify links between Participatory Health Informatics (PHI) and the One Digital Health framework (ODH) and to show how PHI could be used as a catalyst or contributor to ODH.

METHODS

We have analyzed the addressed topics within the ODH framework in previous IMIA Yearbook contributions from our working group during the last 10 years. We have matched main themes with the ODH's framework three perspectives (individual health and wellbeing, population and society, and ecosystem).

RESULTS

PHI catalysts ODH individual health and wellbeing perspective by providing a more comprehensive view on human health, attitudes, and relations between human health and animal health. Integration of specific behavior change techniques or gamification strategies in digital solutions are effective to change behaviors which address the P5 paradigm. PHI supports the population and society perspective through the engagement of the various stakeholders in healthcare. At the same time, PHI might increase a risk for health inequities due to technologies inaccessible to all equally and challenges associated with this. PHI is a catalyst for the ecosystem perspective by contributing data into the digital health data ecosystem allowing for analysis of interrelations between the various data which in turn might provide links among all components of the healthcare ecosystem.

CONCLUSION

Our results suggest that PHI can and will involve topics relating to ODH. As the ODH concept crystalizes and becomes increasingly influential, its themes will permeate and become embedded in PHI even more. We look forward to these developments and co-evolution of the two frameworks.

Nursing Informatics' Contribution to One Health

OBJECTIVES

To summarise contemporary knowledge in nursing informatics related to education, practice, governance and research in advancing One Health.

METHODS

This descriptive study combined a theoretical and an empirical approach. Published literature on recent advancements and areas of interest in nursing informatics was explored. In addition, empirical data from International Medical Informatics Association (IMIA) Nursing Informatics (NI) society reports were extracted and categorised into key areas regarding needs, established activities, issues under development and items not current.

RESULTS

A total of 1,772 references were identified through bibliographic database searches. After screening and assessment for eligibility, 146 articles were included in the review. Three topics were identified for each key area: 1) education: "building basic nursing informatics competence", "interdisciplinary and interprofessional competence" and "supporting educators competence"; 2) practice: "digital nursing and patient care", "evidence for timely issues in practice" and "patient-centred safe care"; 3) governance: "information systems in healthcare", "standardised documentation in clinical context" and "concepts and interoperability", and 4) research: "informatics literacy and competence", "leadership and management", and "electronic documentation of care". 17 reports from society members were included. The data showed overlap with the literature, but also highlighted needs for further work, including more strategies, methods and competence in nursing informatics to support One Health.

CONCLUSIONS

Considering the results of this study, from the literature nursing informatics would appear to have a significant contribution to make to One Health across settings. Future work is needed for international guidelines on roles and policies as well as knowledge sharing.

The Need for Green and Responsible Medical Informatics and Digital Health: Looking Forward with One Digital Health

One Health is an important initiative to view the world in a more integrative sense of our health and environment. Digital Health provides essential support to all of us as healthcare professionals and customers. One Digital Health (ODH) combines both One Health and Digital Health to provide a technologically integrative view. ODH gives an essential place to the environment and ecosystems. Thus, health technologies and digital health must be "green" and eco-friendly as much as possible. We suggest in this position paper examples of developing and implementing ODH-related concepts, systems, and products with a respectful consideration of the environment. For humans and animals, developing cutting-edge technologies to improve wellness and healthcare is critical. Nevertheless, we can learn from One Health that digitalization and so One Digital Health must be built to implement green, eco-friendly, and responsible thinking.

Nursing in a posthuman era: Towards a technology-integrated ecosystem of care

The healthcare sector has undergone significant transformation due to the rapid advancements in artificial intelligence and biotechnologies, presenting both opportunities and threats to the nursing profession. Posthumanism, as a critical perspective challenging anthropocentrism and emphasizing the increasingly blurred boundaries between humans and nonhumans, provides a novel lens to comprehend these technological advancements. In this commentary paper, I draw on the posthuman discourse to argue that in light of these technological forces, we need to contemplate the core values and fundamental patterns of knowing within the nursing discipline, reconfigure nursing scope, redefine its relations with other agents, and embrace a technology-integrated ecosystem of care.

Changing the paradigm in health and care services: modern value chains using open innovation for the creation of new digital health solutions

Digital Health is a subject of extensive discourse when considering its current and future significance. This significance arises from a convergence of various factors, including the escalating capabilities and cost-effectiveness of computing and communication technology, coupled with the mounting demands and challenges faced by healthcare systems. The integration of health and technology, when studied collectively with the purpose of addressing tangible real-world issues, holds the potential to generate substantial outcomes that greatly influence the provision of clinical and social care, thereby enhancing the overall well-being of both individuals and populations. In this sense, in this paper we propose a collaborative approach, using Open Innovation, where the most relevant stakeholders-health and care professionals, citizens and companies-work together to develop and validate innovative digital solutions for health and care. We have called this approach of value co-creation the Collaborative Ecosystem, and we focus specifically on the potential development of the Regional Ecosystem for Collaborative Innovation in Digital Health and Care, and the envisioned implications of its implementation in economic and social dimensions.

Development of an Evidence-Based Conceptual Model of the Health Care Sector Under Digital Transformation: Integrative Review

BACKGROUND

Digital transformation is currently one of the most influential developments. It is fundamentally changing consumers' expectations and behaviors, challenging traditional firms, and disrupting numerous markets. Recent discussions in the health care sector tend to assess the influence of technological implications but neglect other factors needed for a holistic view on the digital transformation. This calls for a reevaluation of the current state of digital transformation in health care. Consequently, there is a need for a holistic view on the complex interdependencies of digital transformation in the health care sector.

OBJECTIVE

This study aimed to examine the effects of digital transformation on the health care sector. This is accomplished by providing a conceptual model of the health care sector under digital transformation.

METHODS

First, the most essential stakeholders in the health care sector were identified by a scoping review and grounded theory approach. Second, the effects on these stakeholders were assessed. PubMed, Web of Science, and Dimensions were searched for relevant studies. On the basis of an integrative review and grounded theory methodology, the relevant academic literature was systematized and quantitatively and qualitatively analyzed to evaluate the impact on the value creation of, and the relationships among, the stakeholders. Third, the findings were synthesized into a conceptual model of the health care sector under digital transformation.

RESULTS

A total of 2505 records were identified from the database search; of these, 140 (5.59%) were included and analyzed. The results revealed that providers of medical treatments, patients, governing institutions, and payers are the most essential stakeholders in the health care sector. As for the individual stakeholders, patients are experiencing a technology-enabled growth of influence in the sector. Providers are becoming increasingly dependent on intermediaries for essential parts of the value creation and patient interaction. Payers are expected to try to increase their influence on intermediaries to exploit the enormous amounts of data while seeing their business models be challenged by emerging technologies. Governing institutions regulating the health care sector are increasingly facing challenges from new entrants in the sector. Intermediaries increasingly interconnect all these stakeholders, which in turn drives new ways of value creation. These collaborative efforts have led to the establishment of a virtually integrated health care ecosystem.

CONCLUSIONS

The conceptual model provides a novel and evidence-based perspective on the interrelations among actors in the health care sector, indicating that individual stakeholders need to recognize their role in the system. The model can be the basis of further evaluations of strategic actions of actors and their effects on other actors or the health care ecosystem itself.

One Digital Health Intervention for Monitoring Human and Animal Welfare in Smart Cities: Viewpoint and Use Case

Smart cities and digital public health are closely related. Managing digital transformation in urbanization and living spaces is challenging. It is critical to prioritize the emotional and physical health and well-being of humans and their animals in the dynamic and ever-changing environment they share. Human-animal bonds are continuous as they live together or share urban spaces and have a mutual impact on each other's health as well as the surrounding environment. In addition, sensors embedded in the Internet of Things are everywhere in smart cities. They monitor events and provide appropriate responses. In this regard, accident and emergency informatics (A&EI) offers tools to identify and manage overtime hazards and disruptive events. Such manifold focuses fit with One Digital Health (ODH), which aims to transform health ecosystems with digital technology by proposing a comprehensive framework to manage data and support health-oriented policies. We showed and discussed how, by developing the concept of ODH intervention, the ODH framework can support the comprehensive monitoring and analysis of daily life events of humans and animals in technologically integrated environments such as smart homes and smart cities. We developed an ODH intervention use case in which A&EI mechanisms run in the background. The ODH framework structures the related data collection and analysis to enhance the understanding of human, animal, and environment interactions and associated outcomes. The use case looks at the daily journey of Tracy, a healthy woman aged 27 years, and her dog Mego. Using medical Internet of Things, their activities are continuously monitored and analyzed to prevent or manage any kind of health-related abnormality. We reported and commented on an ODH intervention as an example of a real-life ODH implementation. We gave the reader examples of a "how-to" analysis of Tracy and Mego's daily life activities as part of a timely implementation of the ODH framework. For each activity, relationships to the ODH dimensions were scored, and relevant technical fields were evaluated in light of the Findable, Accessible, Interoperable, and Reusable principles. This "how-to" can be used as a template for further analyses. An ODH intervention is based on Findable, Accessible, Interoperable, and Reusable data and real-time processing for global health monitoring, emergency management, and research. The data should be collected and analyzed continuously in a spatial-temporal domain to detect changes in behavior, trends, and emergencies. The information periodically gathered should serve human, animal, and environmental health interventions by providing professionals and caregivers with inputs and "how-to's" to improve health, welfare, and risk prevention at the individual and population levels. Thus, ODH complementarily combined with A&EI is meant to enhance policies and systems and modernize emergency management.

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.

Telemedicine Use and the Perceived Risk of COVID-19: Patient Experience

INTRODUCTION

The COVID-19 outbreak resulted in an increased demand for telemedicine worldwide. Telemedicine is a technology-based virtual platform that allows the exchange of clinical data and images over remote distances. This study aims to examine the impact of the perceived risk of COVID-19 on telemedicine use in Bangladesh.

METHODS

This explanatory study was conducted in hospital settings across Dhaka city in Bangladesh. Patients were eligible to participate if they were aged 18 years or over and had used telemedicine in a hospital at least once since the COVID-19 outbreak. Outcome variables included sociodemographic, the perceived risk of COVID-19, and telehealth use. Study data were collected using an online and paper-based survey.

RESULTS

A total of 550 patients participated in this study, mostly male (66.4%), single (58.2%), and highly educated (74.2%). The means of the different domains of telemedicine use reflected a high degree of perceived benefit, accessibility, and satisfaction but a lower degree of privacy and discomfort, care personnel expertise, and usability. COVID 19 perceived risk predicted between 13.0% and 26.6% of variance in telemedicine domains, while the effects of demographic variables were controlled or removed. The perceived risk of COVID-19 was negatively correlated with privacy and discomfort, as well as care personnel concerns. Low and high levels of perceived COVID-19 risk were less likely to encourage the use of telemedicine as a risk reduction tool.

DISCUSSION

The participants were mainly satisfied with telemedicine, finding it beneficial and accessible; however, many were concerned about privacy, care personnel expertise, and its usability. The perceived risk of COVID-19 was a strong predictor (contributor) of telemedicine use, suggesting that risk perception can be used to encourage telemedicine use as a risk reduction strategy during pandemics; however, a medium level of risk was more promising.

One Digital Health for more FAIRness

BACKGROUND

 One Digital Health (ODH) aims to propose a framework that merges One Health's and Digital Health's specific features into an innovative landscape. FAIR (Findable, Accessible, Interoperable, and Reusable) principles consider applications and computational agents (or, in other terms, data, metadata, and infrastructures) as stakeholders with the capacity to find, access, interoperate, and reuse data with none or minimal human intervention.

OBJECTIVES

 This paper aims to elicit how the ODH framework is compliant with FAIR principles and metrics, providing some thinking guide to investigate and define whether adapted metrics need to be figured out for an effective ODH Intervention setup.

METHODS

 An integrative analysis of the literature was conducted to extract instances of the need-or of the eventual already existing deployment-of FAIR principles, for each of the three layers (keys, perspectives and dimensions) of the ODH framework. The scope was to assess the extent of scatteredness in pursuing the many facets of FAIRness, descending from the lack of a unifying and balanced framework.

RESULTS

 A first attempt to interpret the different technological components existing in the different layers of the ODH framework, in the light of the FAIR principles, was conducted. Although the mature and working examples of workflows for data FAIRification processes currently retrievable in the literature provided a robust ground to work on, a nonsuitable capacity to fully assess FAIR aspects for highly interconnected scenarios, which the ODH-based ones are, has emerged. Rooms for improvement are anyway possible to timely deal with all the underlying features of topics like the delivery of health care in a syndemic scenario, the digital transformation of human and animal health data, or the digital nature conservation through digital technology-based intervention.

CONCLUSIONS

 ODH pillars account for the availability (findability, accessibility) of human, animal, and environmental data allowing a unified understanding of complex interactions (interoperability) over time (reusability). A vision of integration between these two worlds, under the vest of ODH Interventions featuring FAIRness characteristics, toward the development of a systemic lookup of health and ecology in a digitalized way, is therefore auspicable.

eHealth Platforms to Promote Autonomous Life and Active Aging: A Scoping Review

New technologies, namely eHealth platforms, are being used more than ever before. These platforms enable older people to have a more independent lifestyle, enhance their participation, and improve their well-being. Information and communication technologies are expected to be linked to the triad of aging, social inclusion, and active participation, which is in line with the implementation of Smart Healthy and Age-Friendly Environments. This scoping review aimed to map eHealth platforms designed to promote autonomous life and active aging. The Joanna Briggs Institute methodology and the PRISMA-ScR checklist were used. A search was conducted on MEDLINE (via PubMed), CINAHL Complete (via EBSCOhost), Scopus, Cochrane Database of Systematic Reviews (via EBSCOhost), SciELO, DART-Europe, CAPES, and MedNar databases. Fourteen studies were included. This scoping review synthesized information on eHealth platforms designed to promote active living, their domains of intervention, and the outcomes assessed in those studies that have implemented and evaluated these eHealth platforms.

Accident & Emergency Informatics and One Digital Health

OBJECTIVES

Climate changes are the major challenge in public and individual health, as they modify the ecosystem and yield contagious diseases from animal to human. Furthermore, we notice the rapid development of elderly, changing the population demographic. These critical measures have imposed economical costs, require trained personnel, and reduce the healthcare systems' performances.

METHODS

COVID-19 pandemic showed that digital health paradigms such as m-health, telemedicine, and Internet of medical things (IoMT) should be further developed for such disasters. Quarantine was experienced frequently at different levels, which indicates the urgent need to develop smart medical homes for continuous monitoring of the patients. Human health, environment, and animals are the three interwoven aspects of public health that should be formulated under a conceptual and unified framework. Accident and Emergency Informatics (A&EI) considers the prediction and prevention of an individual's health in the long term and detects instant accidents and emergencies for further processes linking to hospital and rescue services for lowering the impact. One Digital Health (ODH) considers the health of the human, the animal, and the environment as a whole.

RESULTS & CONCLUSION

In this position paper, we discuss the mutual benefits of A&EI and ODH in disaster management. We outline the mission, current status of A&EI in healthcare, and summarize the most important development of A&EI-related scope in the other fields of science. We discuss developing smart environments to monitor environmental and animal aspects. Then we examine the use of the ODH framework for enhancing the A&EI capacities to deal with complex disasters. Moreover, we discuss the further development of the international standard accident number (ISAN) to include and link environmental and animal event related data. Besides, ODH will cope with the A&EI protocols and technical specifications to be part of A&EI in the application layer.

Medical Informatics and Digital Health Multilingual Ontology (MIMO): a tool to improve international collaborations

Background

Even if English is the leading language for international communication, it is essential to keep in mind that research runs at the local level by local teams generally communicating in their local/national language, especially in Europe among European projects.

Objective

Therefore, the European Federation for Medical Informatics - Working Group on Health Informatics for Inter-regional Cooperation” has one objective: To develop a multilingual ontology focusing on Health Informatics and Digital Health as a collaboration tool that improves international and, in particular, European collaborations.

Results

We have developed the Medical Informatics and Digital Health Multilingual Ontology (MIMO). Hosted on the Health Terminology/Ontology Portal (HeTOP), MIMO contains around 1,000 concepts, 460 MeSH Descriptors, 220 MeSH Concepts, and more than 300 newly created concepts. MIMO is continuously updated to comprise as recent as possible concepts and their translations in more than 30 languages. Moreover, the MIMO’s development team constantly improves MIMO content and supporting information. Thus, during workshop discussions and one-on-one exchanges, the MIMO team has collected domain experts’ opinions about the community’s interests and suggestions for future enhancements. Moreover, MIMO will be integrated to support the annotation and categorization of research products into the HosmartAI European project involving more than 20 countries around Europe and worldwide.

Conclusion

MIMO is hosted by HeTOP (Health Terminology/Ontology Portal), which integrates 100 terminologies and ontologies in 55 languages. MIMO is freely available online. MIMO is portable to other knowledge platforms as part of MIMO’s main aims to facilitate communication between medical librarians, translators, and researchers as well as to support students’ self-learning.

The Impact of Digital Transformation on Inpatient Care: A Mixed Design Study (Preprint)

BACKGROUND

In the context of the digital transformation of all areas of society, health care providers are also under pressure to change. New technologies and a change in patients' self-perception and health awareness require rethinking the provision of health care services. New technologies and the extensive use of data can change provision processes, optimize them, or replace them with new services. The inpatient sector, which accounts for a particularly large share of health care spending, plays a major role in this regard.

OBJECTIVE

This study examined the influences of current trends in digitization on inpatient service delivery.

METHODS

We conducted a scoping review. This was applied to identify the international trends in digital transformation as they relate to hospitals. Future trends were considered from different perspectives. Using the defined inclusion criteria, international peer-reviewed articles published between 2016 and 2021 were selected. The extracted core trends were then contextualized for the German hospital sector with 12 experts.

RESULTS

We included 44 articles in the literature analysis. From these, 8 core trends could be deduced. A heuristic impact model of the trends was derived from the data obtained and the experts' assessments. This model provides a development corridor for the interaction of the trends with regard to technological intensity and supply quality. Trend accelerators and barriers were identified.

CONCLUSIONS

The impact analysis showed the dependencies of a successful digital transformation in the hospital sector. Although data interoperability is of particular importance for technological intensity, the changed self-image of patients was shown to be decisive with regard to the quality of care. We show that hospitals must find their role in new digitally driven ecosystems, adapt their business models to customer expectations, and use up-to-date information and communications technologies.

Beyond Pathogen Filtration: Possibility of Smart Masks as Wearable Devices for Personal and Group Health and Safety Management

Face masks are an important way to combat the COVID-19 pandemic. However, the prolonged pandemic has revealed confounding problems with the current face masks, including not only the spread of the disease but also concurrent psychological, social, and economic complications. As face masks have been worn for a long time, people have been interested in expanding the purpose of masks from protection to comfort and health, leading to the release of various "smart" mask products around the world. To envision how the smart masks will be extended, this paper reviewed 25 smart masks (12 from commercial products and 13 from academic prototypes) that emerged after the pandemic. While most smart masks presented in the market focus on resolving problems with user breathing discomfort, which arise from prolonged use, academic prototypes were designed for not only sensing COVID-19 but also general health monitoring aspects. Further, we investigated several specific sensors that can be incorporated into the mask for expanding biophysical features. On a larger scale, we discussed the architecture and possible applications with the help of connected smart masks. Namely, beyond a personal sensing application, a group or community sensing application may share an aggregate version of information with the broader population. In addition, this kind of collaborative sensing will also address the challenges of individual sensing, such as reliability and coverage. Lastly, we identified possible service application fields and further considerations for actual use. Along with daily-life health monitoring, smart masks may function as a general respiratory health tool for sports training, in an emergency room or ambulatory setting, as protection for industry workers and firefighters, and for soldier safety and survivability. For further considerations, we investigated design aspects in terms of sensor reliability and reproducibility, ergonomic design for user acceptance, and privacy-aware data-handling. Overall, we aim to explore new possibilities by examining the latest research, sensor technologies, and application platform perspectives for smart masks as one of the promising wearable devices. By integrating biomarkers of respiration symptoms, a smart mask can be a truly cutting-edge device that expands further knowledge on health monitoring to reach the next level of wearables.

Operationalizing "One Health" as "One Digital Health" Through a Global Framework That Emphasizes Fair and Equitable Sharing of Benefits From the Use of Artificial Intelligence and Related Digital Technologies

The operationalization of One Health (OH) through digitalization is a means to deploy digital technologies (including Artificial Intelligence (AI), big data and related digital technologies) to better capacitate us to deal with growing climate exigency and related threats to human, animal and plant health. With reference to the concept of One Digital Health (ODH), this paper considers how digital capabilities can help to overcome ‘operational brakes’ in OH through new and deeper insights, better predictions, and more targeted or precise preventive strategies and public health countermeasures. However, the data landscape is fragmented and access to certain types of data is increasingly restrictive as individuals, communities and countries seek to assert greater control over data taken from them. This paper proposes for a dedicated global ODH framework—centered on fairness and equity—to be established to promote data-sharing across all the key knowledge domains of OH and to devise data-driven solutions to challenges in the human-animal-ecosystems interface. It first considers the data landscape in relation to: (1) Human and population health; (2) Pathogens; (3) Animal and plant health; and (4) Ecosystems and biodiversity. The complexification from the application of advance genetic sequencing technology is then considered, with focus on current debates over whether certain types of data like digital (genetic) sequencing information (DSI) should remain openly and freely accessible. The proposed ODH framework must augment the existing access and benefit sharing (ABS) framework currently prescribed under the Nagoya Protocol to the Convention on Biological Diversity (CBD) in at least three different ways. First, the ODH framework should apply to all genetic resources and data, including DSI, whether from humans or non-humans. Second, the FAIRER principles should be implemented, with focus on fair and equitable benefit-sharing. Third, the ODH framework should adopt multilateral approaches to data sharing (such as through federated data systems) and to ABS. By operationalizing OH as ODH, we are more likely to be able to protect and restore natural habitats, secure the health and well-being of all living things, and thereby realize the goals set out in the post-2020 Global Biodiversity Framework under the CBD.

Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study

BACKGROUND

The rapid development of digital health has reduced the time and cost of medical treatment, bringing efficient and economical benefits. However, older adults all over the world are deficient in digital health knowledge and skills to varying degrees. This study intends to investigate the current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China, so as to provide theoretical reference for global digital health researches and the construction of gerontological digital health service models.

METHODS

A cross-sectional survey was conducted from September 2020 to April 2021 in Chongqing, China. 572 community-dwelling older adults (≥ 65 years) were surveyed by stratified sampling. Data on sociodemographic characteristics, Internet usage, attitude towards Internet health information and digital health literacy were collected. Wherein, the digital health literacy assessment adopted the Digital Health Literacy Assessment Scale for community-dwelling older adults, which was developed by the research group, proven to be with good internal consistency (0.941), split-half reliability (0.889), test-retest reliability (0.941), content validity (0.967), criterion validity (0.938) and construct validity. The influencing factors were explored by univariate analysis and multiple linear regression analysis.

RESULTS

The average score of digital health literacy was 37.10 (SD 18.65). Univariate analysis showed that there were statistically significant differences in the comparison of digital health literacy according to 16 variables, such as different age and education levels. Multiple linear regression analysis showed that education level, marital status, self-rated health status, degree of health concerns, duration of Internet usage, time spent using the Internet per day, frequency of Internet usage, frequency of receiving guidance passively from family members, perceived usefulness, perceived ease of use and perceived reliability were positively correlated with digital health literacy, while age and perceived risk were negatively correlated with digital health literacy.

CONCLUSION

The overall digital health literacy of community-dwelling older adults in Southwest China is relatively low. In the future, health professionals should fully consider the diverse influencing factors of digital health literacy, assess individual differences and provide targeted intervention programs. Meanwhile, global public health authorities should integrate health resources effectively, and seek health service models for older adults in line with the development of the digital age to narrow the digital divide.

Smart mask - Wearable IoT solution for improved protection and personal health

The use of face masks is an important way to fight the COVID-19 pandemic. In this paper, we envision the Smart Mask, an IoT supported platform and ecosystem aiming to prevent and control the spreading of COVID-19 and other respiratory viruses. The integration of sensing, materials, AI, wireless, IoT, and software will help the gathering of health data and health-related event detection in real time from the user as well as from their environment. In the larger scale, with the help of AI-based analysis for health data it is possible to predict and decrease medical costs with accurate diagnoses and treatment plans, where the comparison of personal data to large-scale public data enables drawing up a personal health trajectory, for example. Key research problems for smart respiratory protective equipment are identified in addition to future research directions. A Smart Mask prototype was developed with accompanying user application, backend and heath AI to study the concept.

Climate Change, Human Health, and Health Informatics: A New View of Connected and Sustainable Digital Health

The connection between human health and climate change has had a scientific basis for many decades. However, little attention has been directed to applying the science of health informatics to this aspect of health and healthcare until recently. This paper briefly reviews examples of recent international work on two fronts: to consider how health informatics can reduce the carbon footprint of healthcare, and to consider how it can integrate new kinds of data for insights into the human health impacts of climate change. Health informatics has two principles of fundamental relevance to this work - connectedness, in other words linking and integrating health data from multiple sources; and sustainability, in other words making healthcare overall more efficient and effective. Deepening its commitment to these principles will position health informatics as a discipline and a profession to support and guide technological advances that respond to the world's climate health challenges.

Industry 4.0 and Digitalisation in Healthcare

Industry 4.0 in healthcare involves use of a wide range of modern technologies including digitisation, artificial intelligence, user response data (ergonomics), human psychology, the Internet of Things, machine learning, big data mining, and augmented reality to name a few. The healthcare industry is undergoing a paradigm shift thanks to Industry 4.0, which provides better user comfort through proactive intervention in early detection and treatment of various diseases. The sector is now ready to make its next move towards Industry 5.0, but certain aspects that motivated this review paper need further consideration. As a fruitful outcome of this review, we surveyed modern trends in this arena of research and summarised the intricacies of new features to guide and prepare the sector for an Industry 5.0-ready healthcare system.

Capacity and Readiness Assessment of Healthcare Facilities for Digital Health Interventions Against Tuberculosis and HIV in Addis Ababa, Ethiopia

Background

There is a high level of concern that low-income countries lack the capacity and readiness to effectively adopt, implement, and scale up digital health interventions (DHIs). We aimed to assess the infrastructure and human resource capacity and readiness of healthcare facilities to adopt and implement any new DHI for tuberculosis (TB) and HIV care and treatment in Addis Ababa, Ethiopia.

Method

We carried out a cross-sectional, mixed-methods study in 14 public healthcare facilities that provide TB and HIV care and treatment services. Providers' perceived readiness to adopt and implement digital health was assessed using a self-administered questionnaire designed based on an adapted eHealth readiness assessment model that covers six domains: core readiness, organizational cultural readiness, value proposition readiness, technological readiness, regulatory policy readiness, and operational resource readiness. The infrastructure and human resource capacity were assessed on-site using a tool adapted from the Technology Infrastructure Checklist. Internal consistency was assessed using Cronbach's alpha, and the significant relationship between the composite variables was assessed using Pearson's correlation coefficients (r).

Result

We assessed 14 facilities on-site and surveyed 60 TB and HIV healthcare providers. According to Cronbach's alpha test, all the six technology acceptance domains had a value of >0.8, suggesting a strong interrelatedness between the measuring items. The correlation between technological readiness and operational resource readiness was significant (r = 0.8). The providers perceived their work environment as good enough in electronic data protection, while more efforts are needed in planning, training, adapting, and implementing digital health. Of the 14 facilities, 64.3% lack the plan to establish a functional local area network, and 43% lack skilled staff on payroll to provide maintenance of computers and other digital technologies.

Conclusion

Like many developing countries, there was a modest infrastructure and human resource capacity and readiness of public healthcare facilities in Addis Ababa, Ethiopia, to nurture and strengthen DHIs across the TB and HIV cascades of care. Technological and operational resource readiness, including funding and a Well-trained workforce, are essential for successful implementation and use of digital health against the two infectious diseases of global importance in such settings.

Challenges in the development of digital public health interventions and mapped solutions: Findings from a scoping review

Background

“Digital public health” has emerged from an interest in integrating digital technologies into public health. However, significant challenges which limit the scale and extent of this digital integration in various public health domains have been described. We summarized the literature about these challenges and identified strategies to overcome them.

Methods

We adopted Arksey and O’Malley's framework (2005) integrating adaptations by Levac et al. (2010). OVID Medline, Embase, Google Scholar, and 14 government and intergovernmental agency websites were searched using terms related to “digital” and “public health.” We included conceptual and explicit descriptions of digital technologies in public health published in English between 2000 and June 2020. We excluded primary research articles about digital health interventions. Data were extracted using a codebook created using the European Public Health Association's conceptual framework for digital public health.

Results and analysis

Overall, 163 publications were included from 6953 retrieved articles with the majority (64%, n = 105) published between 2015 and June 2020. Nontechnical challenges to digital integration in public health concerned ethics, policy and governance, health equity, resource gaps, and quality of evidence. Technical challenges included fragmented and unsustainable systems, lack of clear standards, unreliability of available data, infrastructure gaps, and workforce capacity gaps. Identified strategies included securing political commitment, intersectoral collaboration, economic investments, standardized ethical, legal, and regulatory frameworks, adaptive research and evaluation, health workforce capacity building, and transparent communication and public engagement.

Conclusion

Developing and implementing digital public health interventions requires efforts that leverage identified strategies to overcome diverse challenges encountered in integrating digital technologies in public health.

A critical review of the role of technology and context in digital health research

Digital health represents a research field dedicated to realising digital technologies’ potential and developing knowledge about their feasibility and impacts. Yet, drawing on a critical review of the articles in the most prominent multidisciplinary digital health journals, this paper argues that the digital health field has not profoundly engaged with its core subject, namely technology. The features of digital technologies remain in the background, and research is disconnected from the complexities of healthcare settings, including multiple technologies, established practices and people. Instead, the overarching focus in the digital health literature is the processing capabilities of digital technologies and their posited impacts. This paper proposes a research direction in digital health where technology and the context of use take a more prominent role. It argues that realising the potential of digital health requires intensive investigation drawing on different disciplines, grounded on understanding healthcare processes, related informational needs and the concrete features of digital technologies.

Reasons for Utilizing Telemedicine during and after the COVID-19 Pandemic: An Internet-Based International Study

The COVID-19 pandemic challenges healthcare services. Concomitantly, this pandemic had a stimulating effect on technological expansions related to telehealth and telemedicine. We sought to elucidate the principal patients' reasons for using telemedicine during the COVID-19 pandemic and the propensity to use it thereafter. Our primary objective was to identify the reasons of the survey participants' disparate attitudes toward the use of telemedicine. We performed an online, multilingual 30-question survey for 14 days during March-April 2021, focusing on the perception and usage of telemedicine and their intent to use it after the pandemic. We analyzed the data to identify the attributes influencing the intent to use telemedicine and built decision trees to highlight the most important related variables. We examined 473 answers: 272 from Israel, 87 from Uruguay, and 114 worldwide. Most participants were women (64.6%), married (63.8%) with 1-2 children (52.9%), and living in urban areas (84.6%). Only a third of the participants intended to continue using telemedicine after the COVID-19 pandemic. Our main findings are that an expected substitution effect, technical proficiency, reduced queueing times, and peer experience are the four major factors in the overall adoption of telemedicine. Specifically, (1) for most participants, the major factor influencing their telemedicine usage is the implicit expectation that such a visit will be a full substitute for an in-person appointment; (2) another factor affecting telemedicine usage by patients is their overall technical proficiency and comfort level in the use of common web-based tools, such as social media, while seeking relevant medical information; (3) time saving as telemedicine can allow for asynchronous communications, thereby reducing physical travel and queuing times at the clinic; and finally (4) some participants have also indicated that telemedicine seems more attractive to them after watching family and friends (peer experience) use it successfully.

Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence-Based Infodemiology Study

Background

Discussions of health issues on social media are a crucial information source reflecting real-world responses regarding events and opinions. They are often important in public health care, since these are influencing pathways that affect vaccination decision-making by hesitant individuals. Artificial intelligence methodologies based on internet search engine queries have been suggested to detect disease outbreaks and population behavior. Among social media, Twitter is a common platform of choice to search and share opinions and (mis)information about health care issues, including vaccination and vaccines.

Objective

Our primary objective was to support the design and implementation of future eHealth strategies and interventions on social media to increase the quality of targeted communication campaigns and therefore increase influenza vaccination rates. Our goal was to define an artificial intelligence–based approach to elucidate how threads in Twitter on influenza vaccination changed during the COVID-19 pandemic. Such findings may support adapted vaccination campaigns and could be generalized to other health-related mass communications.

Methods

The study comprised the following 5 stages: (1) collecting tweets from Twitter related to influenza, vaccines, and vaccination in the United States; (2) data cleansing and storage using machine learning techniques; (3) identifying terms, hashtags, and topics related to influenza, vaccines, and vaccination; (4) building a dynamic folksonomy of the previously defined vocabulary (terms and topics) to support the understanding of its trends; and (5) labeling and evaluating the folksonomy.

Results

We collected and analyzed 2,782,720 tweets of 420,617 unique users between December 30, 2019, and April 30, 2021. These tweets were in English, were from the United States, and included at least one of the following terms: “flu,” “influenza,” “vaccination,” “vaccine,” and “vaxx.” We noticed that the prevalence of the terms vaccine and vaccination increased over 2020, and that “flu” and “covid” occurrences were inversely correlated as “flu” disappeared over time from the tweets. By combining word embedding and clustering, we then identified a folksonomy built around the following 3 topics dominating the content of the collected tweets: “health and medicine (biological and clinical aspects),” “protection and responsibility,” and “politics.” By analyzing terms frequently appearing together, we noticed that the tweets were related mainly to COVID-19 pandemic events.

Conclusions

This study focused initially on vaccination against influenza and moved to vaccination against COVID-19. Infoveillance supported by machine learning on Twitter and other social media about topics related to vaccines and vaccination against communicable diseases and their trends can lead to the design of personalized messages encouraging targeted subpopulations’ engagement in vaccination. A greater likelihood that a targeted population receives a personalized message is associated with higher response, engagement, and proactiveness of the target population for the vaccination process.

Defining the Scope of Digital Public Health and Its Implications for Policy, Practice, and Research: Protocol for a Scoping Review

Background

There has been rapid development and application of digital technologies in public health domains, which are considered to have the potential to transform public health. However, this growing interest in digital technologies in public health has not been accompanied by a clarity of scope to guide policy, practice, and research in this rapidly emergent field.

Objective

This scoping review seeks to determine the scope of digital health as described by public health researchers and practitioners and to consolidate a conceptual framework of digital public health.

Methods

The review follows Arksey and O’Malley’s framework for conducting scoping reviews with improvements as suggested by Levac et al. The search strategy will be applied to Embase, Medline, and Google Scholar. A grey literature search will be conducted on intergovernmental agency websites and country-specific websites. Titles and abstracts will be reviewed by independent reviewers, while full-text reviews will be conducted by 2 reviewers to determine eligibility based on prespecified inclusion and exclusion criteria. The data will be coded in an iterative approach using the best-fit framework analysis methodology.

Results

This research project received funding from the British Columbia Centre for Disease Control Foundation for Population and Public Health on January 1, 2020. The initial search was conducted on June 1, 2020 and returned 6953 articles in total. After deduplication, 4523 abstracts were reviewed, and 227 articles have been included in the review. Ethical approval is not required for this review as it uses publicly available data.

Conclusions

We anticipate that the findings of the scoping review will contribute relevant evidence to health policy makers and public health practitioners involved in planning, funding, and delivering health services that leverage digital technologies. Results of the review will be strategically disseminated through publications in scientific journals, conferences, and engagement with relevant stakeholders.

International Registered Report Identifier (IRRID)

DERR1-10.2196/27686

Training the Next Industrial Engineers and Managers about Industry 4.0: A Case Study about Challenges and Opportunities in the COVID-19 Era

Training the next generation of industrial engineers and managers is a constant challenge for academia, given the fast changes of industrial technology. The current and predicted development trends in applied technologies affecting industry worldwide as formulated in the Industry 4.0 initiative have clearly emphasized the needs for constantly adapting curricula. The sensible socioeconomic changes generated by the COVID-19 pandemic have induced significant challenges to society in general and industry. Higher education, specifically when dealing with Industry 4.0, must take these new challenges rapidly into account. Modernization of the industrial engineering curriculum combined with its migration to a blended teaching landscape must be updated in real-time with real-world cases. The COVID-19 crisis provides, paradoxically, an opportunity for dealing with the challenges of training industrial engineers to confront a virtual dematerialized work model which has accelerated during and will remain for the foreseeable future after the pandemic. The paper describes the methodology used for adapting, enhancing, and evaluating the learning and teaching experience under the urgent and unexpected challenges to move from face-to-face university courses distant and online teaching. The methodology we describe is built on a process that started before the onset of the pandemic, hence in the paper we start by describing the pre-COVID-19 status in comparison to published initiatives followed by the real time modifications we introduced in the faculty to adapt to the post-COVID-19 teaching/learning era. The focus presented is on Industry 4.0. subjects at the leading edge of the technology changes affecting the industrial engineering and technology management field. The manuscript addresses the flow from system design subjects to implementation areas of the curriculum, including practical examples and the rapid decisions and changes made to encompass the effects of the COVID-19 pandemic on content and teaching methods including feedback received from participants.

Management Models Applied to the Human-Wolf Conflict in Agro-Forestry-Pastoral Territories of Two Italian Protected Areas and One Spanish Game Area

Simple Summary

Conservation practices in the nature of some animal species are very difficult when they are in conflict with anthropogenic activities. In order to make possible the coexistence of a predator such as the wolf with animal breeding activities in the wild, the EU has produced solid and structured legislation through the Natura 2000 network. The application of the Habitats Directive allows the various member countries to choose biodiversity management actions as long as they maintain their resilience. Our work compares two different management methods developed in Spain and Italy with the aim of evaluating a possible difference in the conservation of wolf packs present in their respective territories. The results obtained show that both in Spain and Italy, the presence of the wolf causes damage to livestock. The economic damage is quite substantial and affects, in different ways, sheep, goat, bovine, and equine breeding. Nevertheless, wolf populations are stable in Spain, where hunting is allowed, and slightly increasing in Italy, where the species is particularly protected.

Abstract

Our work shows that, despite the persistence of persecutory actions, conservation activity has proved successful for the return of numerous wild mammals to different habitats, including the wolf. The human-wolf conflict is still described in all countries where the wolf is present. This is evidenced by the high number of damages on livestock, and the corpses of wolves found both in protected areas and in those where hunting is permitted. The diagnosis of road accidents, together with poisoning and poaching, are major causes of mortality. Although hunting records the highest percentage of kills in Spain, the demographic stability reported by the censuses suggests that this activity does not have a consistent influence on the Iberian wolf population’s survival. In Italy, where wolf hunting is prohibited, wolf populations are to be increasing. In some Italian situations, wolf attacks on horses seem to cause unwanted damage to foals, but they represent a very precious source of information about the habits of carnivores. A simple management plan would be sufficient to help the coexistence between the productive parts and the ecosystem services ensured by the presence of the wolf. The presence of hybrids is a negative factor.