Importance-Performance Analysis of Personal Health Records in Taiwan: A Web-Based Survey

Gender-Specific Determinants of eHealth Literacy: Results from an Adolescent Internet Behavior Survey in Taiwan

Adolescents' Internet health information usage has rarely been investigated. Adolescents seek all kinds of information from the Internet, including health information, which affects their Health Literacy that eHealth Literacy (eHL). This study is a retrospective observational study, we have total of 500 questionnaires were distributed, 87% of which were recovered, and we explored the channels that adolescents use to search for health information, their ability to identify false information, and factors affecting the type and content of health information queried. Adolescents believe that the Internet is a good means to seek health information because of its instant accessibility, frequent updating, convenience, and lack of time limits. More boys use the Internet to seek health information than girls in junior high schools (p = 0.009). The Internet is an important source of health information for adolescents but contains extensive misinformation that adolescents cannot identify. Additionally, adolescent boys and girls are interested in different health issues. Therefore, the government should implement measures to minimize misinformation on the Internet and create a healthy, educational online environment to promote Adolescents' eHealth Literacy (eHL).

Comparison of Health Awareness in South Korean Middle School Students According to Type of Online Physical Education Classes during the COVID-19 Pandemic

Coronavirus disease 2019 popularized online classes to prevent educational deficits affected by the pandemic. This study aimed to assess the differences in the importance and performance of health awareness in Korean middle school students according to the types of online physical education classes they attended during the coronavirus disease 2019 pandemic. Overall, 583 participants were selected using a convenience sampling method; the data were obtained through an online survey using Google forms. Frequency analysis, reliability analysis, independent sample t-test, and importance–performance analysis were performed. First, the differences between importance and performance were found to be the most for sleep and physical activity management, and the least for disease and hygiene management. In addition, both groups demonstrated higher importance and performance for hygiene and disease management. There were significant differences in the importance and performance of all the sub-factors. Second, hygiene, disease management, and mental health management were found in quadrant I in both groups, while physical activity, sleep, and dietary habit management were in quadrant III. No factors were in quadrants II and IV. Correspondingly, there was no significant difference in adolescents’ health awareness between the assignment-based online group and interactive online group.

Functionalities and Issues in the Implementation of Personal Health Records: Systematic Review

Background

Functionalities of personal health record (PHR) are evolving, and continued discussions about PHR functionalities need to be performed to keep it up-to-date. Technological issues such as nonfunctional requirements should also be discussed in the implementation of PHR.

Objective

This study systematically reviewed the main functionalities and issues in implementing the PHR.

Methods

This systematic review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The search is performed using the online databases Scopus, ScienceDirect, IEEE, MEDLINE, CINAHL, and PubMed for English journal articles and conference proceedings published between 2015 and 2020.

Results

A total of 105 articles were selected in the review. Seven function categories were identified in this review, which is grouped into basic and advanced functions. Health records and administrative records were grouped into basic functions. Medication management, communication, appointment management, education, and self-health monitoring were grouped into advanced functions. The issues found in this study include interoperability, security and privacy, usability, data quality, and personalization.

Conclusions

In addition to PHR basic and advanced functions, other supporting functionalities may also need to be developed based on the issues identified in this study. This paper provides an integrated PHR architectural model that describes the functional requirements and data sources of PHRs.

A Technology Acceptance Model for Deploying Masks to Combat the COVID-19 Pandemic in Taiwan (My Health Bank): Web-Based Cross-sectional Survey Study

BACKGROUND

The successful completion of medical practices often relies on information collection and analysis. Government agencies and medical institutions have encouraged people to use medical information technology (MIT) to manage their conditions and promote personal health. In 2014, Taiwan established the first electronic personal health record (PHR) platform, My Health Bank (MHB), which allows people to access and manage their PHRs at any time. In the face of the COVID-19 pandemic in 2020, Taiwan has used MIT to effectively prevent the spread of COVID-19 and undertaken various prevention measures before the onset of the outbreak. Using MHB to purchase masks in an efficient and orderly way and thoroughly implementing personal protection efforts is highly important to contain disease spread.

OBJECTIVE

This study aims to understand people's intention to use the electronic PHR platform MHB and to investigate the factors affecting their intention to use this platform.

METHODS

From March 31 to April 9, 2014, in a promotion via email and Facebook, participants were asked to fill out a structured questionnaire after watching an introductory video about MHB on YouTube. The questionnaire included seven dimensions: perceived usefulness, perceived ease of use, health literacy, privacy and security, computer self-efficacy, attitude toward use, and behavioral intention to use. Each question was measured on a 5-point Likert scale ranging from "strongly disagree" (1 point) to "strongly agree" (5 points). Descriptive statistics and structural equation analysis were performed using SPSS 21 and AMOS 21 software.

RESULTS

A total of 350 valid questionnaire responses were collected (female: 219/350, 62.6%; age: 21-30 years: 238/350, 68.0%; university-level education: 228/350, 65.1%; occupation as student: 195/350, 56.6%; average monthly income

CONCLUSIONS

From the perspective of the populace, this study explored the factors affecting the use of MHB and constructed an interpretation model with a strong goodness of fit. The results of our analysis are consistent with the technology acceptance model. Through the diverse value-added services of MHB, Taiwan's experience in pandemic prevention with smart technology can facilitate future responses to unknown, emerging infectious diseases.

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Key Words

• COVID-19
• electronic health record
• electronic medical record
• intention
• literacy
• model
• my health bank
• personal health record
• privacy
• protection
• security
• structural equation model
• survey
• technology acceptance model
• usage

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MESH Headings

• Adult
• COVID-19/epidemiology
• COVID-19/prevention & control
• COVID-19/transmission
• Cross-Sectional Studies
• Disease Transmission, Infectious/prevention & control
• Female
• Humans
• Internet
• Male
• Masks
• Pandemics
• SARS-CoV-2
• Surveys and Questionnaires
• Taiwan/epidemiology
• Technology
• Young Adult

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Affiliation(s)

Wen-Hsun Tsai Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan Medical Administration Office, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
Yi-Syuan Wu Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
Chia-Shiang Cheng Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
Ming-Hao Kuo Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
Yu-Tien Chang School of Public Health, National Defense Medical Center, Taipei, Taiwan
Fu-Kang Hu Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan Medical Informatics Office, Tri-Service General Hospital, Taipei, Taiwan
Chien-An Sun Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
Chi-Wen Chang School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
Ta-Chien Chan Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
Chao-Wen Chen Trauma and Critical Care Service Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
Chia-Cheng Lee Medical Informatics Office, Tri-Service General Hospital, Taipei, Taiwan Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan
Chi-Ming Chu Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan School of Public Health, National Defense Medical Center, Taipei, Taiwan Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan Department of Public Health, China Medical University, Taichung, Taiwan Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

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Existing Data Sources in Clinical Epidemiology: The Taiwan National Health Insurance Laboratory Databases

This paper provides an introduction to laboratory databases established by Taiwan National Health Insurance Administration (NHIA) since 2015 and released for research since June 2017. The National Health Insurance (NHI) is a government-run single-payer program introduced in 1995 that now covers more than 99% of 23 million Taiwanese citizens. To prevent duplication of medication prescriptions and laboratory test and examination prescriptions, contracted health care providers are required to upload the results of laboratory tests and reports of examinations to the NHIA. The cumulative number of laboratory test results was 5.64 billion from January 2015 to the end of August 2020 for 602 types of test. There are 35 variables for each laboratory test result stored in the databases that can be used for research. However, different hospitals might use different format in reporting the results. The researchers therefore have to develop algorithms to include and exclude incompatible records and to determine whether the results are positive or negative (normal or abnormal). The NHIA suggests that researchers release their source codes of algorithms so that other researchers can modify the codes to improve inter-study comparability. Through the unique personal identification number, the laboratory data can be linked to NHI inpatient and outpatient claims data for further value-added analyses. Non-Taiwanese researchers can collaborate with Taiwan researchers to access the NHI laboratory databases.

Importance-Performance Analysis of Health Perception among Korean Adolescents during the COVID-19 Pandemic

This study assessed the health perceptions of 333 Korean adolescents during the coronavirus disease (COVID-19) pandemic via an online questionnaire administered in October 2020, which queried the perceived importance and actual performance of health behaviors. The health perception scales used in the survey consists of the six dimensions of mental health, disease, physical activity, sleep, diet, and sanitary health. The data were primarily analyzed using paired sample t-test for analysis of difference and importance-performance analysis (IPA). The IPA results were presented in four quadrants-"keep up the good work," "concentrate here," "low priority," and "possible overkill." The results indicated that first, there was a positive relationship between the importance and performance of all the subdimensions of health perception. Second, sanitary healthcare was rated as being of the greatest importance and was performed most, while physical activity management was rated least important and performed least. Third, statistically significant differences were found between importance and performance for all items of mental health, disease, physical activity, sleep, and diet dimensions, and some differences were found for items assessing the hygiene control dimension. Fourth, in the two-dimensional IPA model, "sanitary health" and "disease" are in Quadrant I (keep up the good work); "mental health," in Quadrant II (concentrate here); and "physical activity," "sleep," and "diet," in Quadrant III (low priority). No components of healthcare were in Quadrant IV (possible overkill). Based on these results, we emphasize the importance of adolescent health education and discuss solutions to enhance the performance of healthcare activities.

Identification of quality gaps in healthcare services using the SERVQUAL instrument and importance-performance analysis in medical intensive care: a prospective study at a medical center in Taiwan

Background

Assessing patients’ expectations and perceptions of health service delivery is challenging. To understand the service quality in intensive care units (ICUs), we investigated the expected and perceived service quality of ICU care.

Methods

We conducted this study at an ICU of a university-affiliated medical center in Taiwan from April to September 2019. Admitted patients or their family members responded to a questionnaire survey adopted from the SERVQUAL instrument consisting of 22 items in five dimensions. The questionnaire was provided on ICU admission for expectation and before ICU discharge for perception. We analyzed the quality gaps between the surveys and applied important-performance analysis (IPA).

Results

A total of 117 patients were included (62.4% males, average age: 65.9 years, average length of stay: 10.1 days, and 76.9% survival to ICU discharge). The overall weighted mean scores for the surveys were similar (4.57 ± 0.81 and 4.58 ± 0.52, respectively). The ‘tangibles’ dimension had a higher perception than expectation (3.99 ± 0.55 and 4.31 ± 0.63 for expectation and perception, respectively, p < 0.001). IPA showed that most of the items in ‘reliability,’ ‘responsiveness’ and ‘assurance’ were located in the quadrant of high expectation and high perception, whereas most of the items in ‘tangibles’ and ‘empathy’ were located in the quadrant of low expectation and low perception. One item (item 1 for ‘tangibles’) was found in the quadrant of high expectation and low perception.

Conclusions

The SERVQUAL approach and IPA might provide useful information regarding the feedback by patients and their families for ICU service quality. In most aspects, the performance of the ICU satisfactorily matched the needs perceived by the patients and their families.

Requirements of Health Data Management Systems for Biomedical Care and Research: Scoping Review

BACKGROUND

Over the last century, disruptive incidents in the fields of clinical and biomedical research have yielded a tremendous change in health data management systems. This is due to a number of breakthroughs in the medical field and the need for big data analytics and the Internet of Things (IoT) to be incorporated in a real-time smart health information management system. In addition, the requirements of patient care have evolved over time, allowing for more accurate prognoses and diagnoses. In this paper, we discuss the temporal evolution of health data management systems and capture the requirements that led to the development of a given system over a certain period of time. Consequently, we provide insights into those systems and give suggestions and research directions on how they can be improved for a better health care system.

OBJECTIVE

This study aimed to show that there is a need for a secure and efficient health data management system that will allow physicians and patients to update decentralized medical records and to analyze the medical data for supporting more precise diagnoses, prognoses, and public insights. Limitations of existing health data management systems were analyzed.

METHODS

To study the evolution and requirements of health data management systems over the years, a search was conducted to obtain research articles and information on medical lawsuits, health regulations, and acts. These materials were obtained from the Institute of Electrical and Electronics Engineers, the Association for Computing Machinery, Elsevier, MEDLINE, PubMed, Scopus, and Web of Science databases.

RESULTS

Health data management systems have undergone a disruptive transformation over the years from paper to computer, web, cloud, IoT, big data analytics, and finally to blockchain. The requirements of a health data management system revealed from the evolving definitions of medical records and their management are (1) medical record data, (2) real-time data access, (3) patient participation, (4) data sharing, (5) data security, (6) patient identity privacy, and (7) public insights. This paper reviewed health data management systems based on these 7 requirements across studies conducted over the years. To our knowledge, this is the first analysis of the temporal evolution of health data management systems giving insights into the system requirements for better health care.

CONCLUSIONS

There is a need for a comprehensive real-time health data management system that allows physicians, patients, and external users to input their medical and lifestyle data into the system. The incorporation of big data analytics will aid in better prognosis or diagnosis of the diseases and the prediction of diseases. The prediction results will help in the development of an effective prevention plan.

Personal electronic healthcare records: What influences consumers to engage with their clinical data online? A literature review

Background:

Online electronic records such as patient portals and personally controlled electronic health records (PEHRs) have been widely viewed as a key component to modernising the delivery of healthcare but the uptake of such systems has been slow.

Objective:

The purpose of this literature review was to determine what influences consumers to engage and interact with their clinical data online.

Method:

A scoping literature review following PRISMA guidelines was completed. Electronic patient record research published between January 2009 and December 2018 was included. Following screening and full-text reviews, a total of 64 records were included in this review.

Results:

Three key areas of influence on consumer engagement with their clinical data online emerged: demographic factors affecting consumer interaction with PEHRs; consumers’ perceived benefits and detriments of PEHR use; and the influence of PEHR use on consumer empowerment and responsibility.

Discussion:

Consumer motivation and readiness for engaging with their clinical data online and their long-term ongoing use of these systems requires further exploration.

Conclusion:

As worldwide rates of consumer interactions with individual online clinical data remain low, what influences consumer engagement with a PEHR remains unknown. Further research into the consumer perspective of, and interaction with, a PEHR, needs to be undertaken to determine if factors such as frequent usage of the system by consumers leads to improved clinical outcomes.

Findings from 2017 on Consumer Health Informatics and Education: Health Data Access and Sharing

OBJECTIVE

 To summarize the state of the art during the year 2017 in consumer health informatics and education, with a special emphasis on sharing health data and accessing personal health information (PHI) from patients' and consumers' perspective.

METHODS

 We conducted a systematic search of articles published in PubMed using a predefined set of queries which identified 228 potential articles for review. The section editors then screened these articles according to topic relevance and selected 15 candidate best papers for full review and scoring by a panel of international experts. Based on the scores and the reviews, four papers received the highest score and were selected in a consensus meeting as the best papers on health data access and sharing from consumers' and patients' perspective.

RESULTS

 These four papers were categorised into the following topics: 1) data sharing for research and governance in privacy protection; 2) use of personal health information and individual privacy concerns; and 3) consumers' views and demographic characteristics regarding health data sharing and the use of digital health portals. Overall, it was surprising to see only a small number of papers reporting original research in this area.

CONCLUSIONS

 Patients understand the need for sharing information to facilitate best care and to enrich biomedical knowledge. When confronted with the reality of accessing information systems for their own information, patients are concerned about usability as well as privacy. Overall, there is a need for more emphasis on: 1) considering privacy as a feature defined by design; 2) using specific consent approaches and data sharing mechanisms for recruiting clinical trial participants; 3) taking into account socio-demographic characteristics when promoting consumer access to personal health information; and 4) defining indicators of high-quality care to incorporate healthcare professionals' level of caution when accessing patients' medical information and fostering patient trust in data exchange. Ultimately, privacy mechanisms should be part of the design process and not only be implemented when security has been breached and violated.