The role of health kiosks in 2009: literature and informant review

Evaluation of the Suitability of Smart Health Products for Aging Based on the IIVAHP-CRITIC Model: A Case Study of Smart Health Kiosk

In the global situation of an aging population, the evaluation of the suitability of smart health products for aging is very important in order to achieve sustainable development goals. However, few evaluation methods have been adopted for smart health products for older individuals. An objective and comprehensive evaluation system and evaluation methods need to be established to guide the design of smart health products. In this study, a Smart Health Kiosk (SHK) was used as an example, and an index system was established for the evaluation of the suitability for aging based on the influencing factors from four dimensions. To address the problem that it is difficult to quantify the subjective and objective weights in the evaluation, this study proposes a method of evaluating suitability for aging based on the combination of the Improved Interval-Valued Analytic Hierarchy Process and the Criteria Importance Though Intercrieria Correlation (IIVAHP-CRITIC) method. The results show that the method integrates the influence of subjective and objective weights on the evaluation and avoids the limitations of a single evaluation. It takes into account the relationship between the various levels of indicators and the subjective and objective indicators. Weights calculated by the IIVAHP-CRITIC method help to better assess the objectivity and validity of the design solutions. This evaluation method can effectively reflect the related attributes of each element in the aging-suitability design stage of smart health products. The evaluation results help to improve the quality and ergonomic comfort of aging products, and can effectively reduce the occurrence of design problems.

COVID-19 and beyond: development of a comprehensive telemedical diagnostic framework

Purpose

During the COVID-19 pandemic, a threatening bottleneck of medical staff arose due to a shortage of trained caregivers, who became infected while working with infectious patients. While telemedicine is rapidly evolving in the fields of teleconsultation and telesurgery, proper telediagnostic systems are not yet available, although the demand for contactless patient–doctor interaction is increasing.

Methods

In this project, the current limitations were addressed by developing a comprehensive telediagnostic system. Therefore, medical examinations have been assessed in collaboration with medical experts. Subsequently, a framework was developed, satisfying the relevant constraints of medical-, technical-, and hygienic- aspects in order to transform in-person examinations into a contactless procedure. Diagnostic steps were classified into three groups: assisted procedures carried out by the patient, teleoperated examination methods, and adoptions of conventional methods.

Results

The Telemedical Diagnostic Framework was implemented, resulting in a functional proof of concept, where potentially infectious patients could undergo a full medical examination. The system comprises, e.g., a naso-pharyngeal swab, an inspection of the oral cavity, auscultation, percussion, and palpation, based on robotic end-effectors. The physician is thereby connected using a newly developed user-interface and a lead robot, with force feedback control, that enables precise movements with the follower robot on the patient’s side.

Conclusion

Our concept proves the feasibility of a fully telediagnostic system, that consolidates available technology and new developments to an efficient solution enabling safe patient-doctor interaction. Besides infectious situations, this solution can also be applied to remote areas.

The Role of Health Kiosks: A Scoping Review (Preprint)

Background

Health kiosks are publicly accessible computing devices that provide access to services, including health information provision, clinical measurement collection, patient self–check-in, telemonitoring, and teleconsultation. Although the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow.

Objective

We seek to clarify the current and future roles of health kiosks by investigating the settings, roles, and clinical domains in which kiosks are used; whether usability evaluations of health kiosks are being reported, and if so, what methods are being used; and what the barriers and facilitators are for the deployment of kiosks.

Methods

We conducted a scoping review using a bibliographic search of Google Scholar, PubMed, and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers described the implementation as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and querying the key informants. For each article, we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and whether the kiosk included usability testing. We then summarized the data in frequency tables.

Results

A total of 141 articles were included, of which 134 (95%) were primary studies, and 7 (5%) were reviews. Approximately 47% (63/134) of the primary studies described kiosks in secondary care settings. Other settings included community (32/134, 23.9%), primary care (24/134, 17.9%), and pharmacies (8/134, 6%). The most common roles of the health kiosks were providing health information (47/134, 35.1%), taking clinical measurements (28/134, 20.9%), screening (17/134, 12.7%), telehealth (11/134, 8.2%), and patient registration (8/134, 6.0%). The 5 most frequent health domains were multiple conditions (33/134, 24.6%), HIV (10/134, 7.5%), hypertension (10/134, 7.5%), pediatric injuries (7/134, 5.2%), health and well-being (6/134, 4.5%), and drug monitoring (6/134, 4.5%). Kiosks were integrated into the clinical pathway in 70.1% (94/134) of studies, opportunistic kiosks accounted for 23.9% (32/134) of studies, and in 6% (8/134) of studies, kiosks were used in both. Usability evaluations of kiosks were reported in 20.1% (27/134) of papers. Barriers (e.g., use of expensive proprietary software) and enablers (e.g., handling of on-demand consultations) of deploying health kiosks were identified.

Conclusions

Health kiosks still play a vital role in the health care system, including collecting clinical measurements and providing access to web-based health services and information to those with little or no digital literacy skills and others without personal internet access. We identified research gaps, such as training needs for teleconsultations and scant reporting on usability evaluation methods.

Utilization of integrated health kiosks: A systematic review

Background: In some countries, integrated health kiosks are used to provide some services and information. However; it is still not officially included in many countries' health systems. The purpose of this study was to gather and summarize different aspects of using health kiosks in countries. Methods: Five English databases, including Web of Science, Cochrane Library, PubMed / Medline, Embase and Scopus, were explored from 2001 to 2018, using words related to three concepts: health, design and development, and kiosk. Different dimensions of health kiosks utilization in the world were identified and analyzed thematically. Results: Out of 918 search results, 37 articles were included in the study and analyzed. Most of them were conducted in the United States and addressed the development, implementation, design, or feasibility of utilizing integrated health kiosks. The different aspects of kiosk utilization were categorized into 6 dimensions: services provided, deployment location, user characteristics and variables of accepting kiosks, notable design and construction points, their benefits and effectiveness, and finally, the challenges of using kiosks. Conclusion: This study found that health kiosks are promising, cost-effective and multifunctional tools; if included in the formal health system of countries, they may improve health indicators in countries. However, before deploying, their challenges and concerns need to be investigated and addressed.

The Demographic Representativeness and Health Outcomes of Digital Health Station Users: Longitudinal Study

Background

Digital health stations offer an affordable and accessible platform for people to monitor their health; however, there is limited information regarding the demographic profile of users and the health benefits of this technology.

Objective

This study aimed to assess the demographic representativeness of health station users, identify the factors associated with repeat utilization of stations, and determine if the health status of repeat users changed between baseline and final health check.

Methods

Data from 180,442 health station users in Australia, including 8441 repeat users, were compared with 2014-2015 Australian National Health Survey (NHS) participants on key demographic and health characteristics. Binary logistic regression analyses were used to compare demographic and health characteristics of repeat and one-time users. Baseline and final health checks of repeat users were compared using McNemar tests and Wilcoxon signed rank tests. The relationship between the number of checks and final health scores was investigated using generalized linear models.

Results

The demographic profile of SiSU health station users differs from that of the general population. A larger proportion of SiSU users were female (100,814/180,442, 55.87% vs 7807/15,393, 50.72%), younger (86,387/180,442, 47.88% vs 5309/15,393, 34.49% aged less than 35 years), and socioeconomically advantaged (64,388/180,442, 35.68% vs 3117/15,393, 20.25%). Compared with NHS participants, a smaller proportion of SiSU health station users were overweight or obese, were smokers, had high blood pressure (BP), or had diabetes. When data were weighted for demographic differences, only rates of high BP were found to be lower for SiSU users compared with the NHS participants (odds ratio [OR] 1.26; P<.001). Repeat users were more likely to be female (OR 1.37; P<.001), younger (OR 0.99; P<.001), and from high socioeconomic status areas—those residing in socioeconomic index for areas quintiles 4 and 5 were significantly more likely to be repeat users compared with those residing in quintile 1 (OR 1.243; P<.001 and OR 1.151; P<.001, respectively). Repeat users were more likely to have a higher BMI (OR 1.02; P<.001), high BP (OR 1.15; P<.001), and less likely to be smokers (OR 0.77; P<.001). Significant improvements in health status were observed for repeat users. Mean BMI decreased by 0.97 kg/m2 from baseline to final check (z=−14.24; P<.001), whereas the proportion of people with high BP decreased from 15.77% (1080/6848) to 12.90% (885/6860; χ²₁=38.2; P<.001). The proportion of smokers decreased from 11.91% (1005/8438) to 10.13% (853/8421; χ²₁=48.4; P<.001). Number of repeat health checks was significantly associated with smoking status (OR 0.96; P<.048) but not with higher BP (P=.14) or BMI (P=.23).

Conclusions

These findings provide valuable insight into the benefits of health stations for self-monitoring and partially support previous research regarding the effect of demographics and health status on self-management of health.

Barriers and facilitators of deploying health kiosk in Iran: A qualitative study

INTRODUCTION

It is less than a decade in Iran that integrated health kiosks have been limitedly provided to public by private sector. Considering the significant benefits of them, this study aimed to identify the barriers and facilitators for deploying kiosks in Iran's formal health system in three phases, "design and construct, implement, and use."

MATERIALS AND METHODS

This was a qualitative study in Iran, and the data were collected through 20 semi-structured interviews with experts in 2019. Participants were selected by purposeful method with the most diversity in terms of background and work experience; the interview texts were coded in MAXQDA10 software and analyzed through framework analysis. Participants' viewpoint was used to verify the data and observers' review to confirm them.

RESULTS

The barriers for designing and constructing kiosks were identified in the form of two main themes: the overall structure of the country and the structure of the health system; the obstacles for implementing were categorized in one main theme, lack of sources; and the barriers to use were also fall into four themes related to people, policymakers, service providers, and designers of kiosks. The facilitators at construction and implementation phases included the overall structure of the country and the structure of health system. At the use stage, the facilitators related to people, health and insurance policymakers, and owners and constructers were identified.

CONCLUSION

It is possible to deploy health kiosks in the Iranian formal health system, although there are some time-consuming and costly barriers which can be overcome by the strengths and opportunities of the system.

Non-targeted HIV testing in the emergency department: not just how but where

INTRODUCTION

The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location. While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing. Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the 'where' can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.

Data Requirements and the Basis for Designing Health Information Kiosks

Introduction

Health kiosks are an innovative and cost-effective solution that organizations can easily implement to help educate people.

Aim

To determine the data requirements and basis for designing health information kiosks as a new technology to maintain the health of society.

Methods

By reviewing the literature, a list of information requirements was provided in 4 sections (demographic information, general information, diagnostic information and medical history), and questions related to the objectives, data elements, stakeholders, requirements, infrastructures and the applications of health information kiosks were provided. In order to determine the content validity of the designed set, the opinions of 2 physicians and 2 specialists in medical informatics were obtained. The test-retest method was used to measure its reliability. Data were analyzed using SPSS software.

Results

In the proposed model for Iran, 170 data elements in 6 sections were presented for experts' opinion, which ultimately, on 106 elements, a collective agreement was reached.

Conclusion

To provide a model of health information kiosk, creating a standard data set is a critical point. According to a survey conducted on the various literature review studies related to the health information kiosk, the most important components of a health information kiosk include six categories; information needs, data elements, applications, stakeholders, requirements and infrastructure of health information kiosks that need to be considered when designing a health information kiosk.

Informed consent for opt-in HIV testing via tablet kiosk: an assessment of patient comprehension and acceptability

Although implementation of HIV testing in the emergency department has met with some success, one commonly cited challenge is the consent process. Kiosks offer one potential strategy to overcome this barrier. This pilot cross-sectional survey study examined patient comprehension of opt-in HIV testing consent and acceptability of using a kiosk to provide consent. Subjects were guided through a simulated consent process using a kiosk and then completed a survey of consent comprehension and acceptability of kiosk use. Subjects were 50.3% female, Black (74.4%), and had an education level of high school or less (61.3%). Subjects found the kiosk very easy or easy to use (83.9%) and reported they were very or mostly comfortable using the kiosk to consent to HIV testing (89.4%). Subjects understood the required aspects of consent: HIV testing was voluntary (93.0%, n = 185) and that refusal would not impact their care (98.5%, n = 196; 99.0%, n = 197). Following a simulated consent process, subjects demonstrated a high rate of comprehension about the vital components of HIV testing consent. Subjects reported they were comfortable using the kiosk, found the kiosk easy to use, and reported a positive experience using the kiosk to provide consent for HIV testing.

Patient education and follow-up as an intervention for hypertensive patients discharged from an emergency department: a randomized control trial study protocol

Background

Persistently elevated blood pressure (BP) is a leading risk factor for cardiovascular disease development, making effective hypertension management an issue of considerable public health importance. Hypertension is particularly prominent among African Americans, who have higher disease prevalence and consistently lower BP control than Whites and Hispanics. Emergency departments (ED) have limited resources for chronic disease management, especially for under-served patients dependent upon the ED for primary care, and are not equipped to conduct follow-up. Kiosk-based patient education has been found to be effective in primary care settings, but little research has been done on the effectiveness of interactive patient education modules as ED enhanced discharge for an under-served urban minority population.

Methods/Design

Achieving Blood Pressure Control Through Enhanced Discharge (AchieveBP) is a behavioral RCT patient education intervention for patients with a history of hypertension who have uncontrolled BP at ED discharge. The project will recruit up to 200 eligible participants at the ED, primarily African-American, who will be asked to return to a nearby clinical research center for seven, thirty and ninety day visits, with a 180 day follow-up. Consenting participants will be randomized to either an attention-control or kiosk-based interactive patient education intervention. To control for potential medication effects, all participants will be prescribed similar, evidenced-based anti-hypertensive regimens and have their prescription filled onsite at the ED and during visits to the clinic. The primary target endpoint will be success in achieving BP control assessed at 180 days follow-up post-ED discharge. The secondary aim will be to assess the relationship between patient activation and self-care management.

Discussion

The AchieveBP trial will determine whether using interactive patient education delivered through health information technology as ED enhanced discharge with subsequent education sessions at a clinic is an effective strategy for achieving short-term patient management of BP. The project is innovative in that it uses the ED as an initial point of service for kiosk-based health education designed to increase BP self-management. It is anticipated findings from this translational research could also be used as a resource for patient education and follow-up with hypertensive patients in primary care settings.

Trial registration

ClinicalTrials.gov Registration Number: NCT02069015. Registered February 19, 2014.

Use of a Tablet-Based Risk Assessment Program to Improve Health Counseling and Patient-Provider Relationships in a Federally Qualified Health Center

This study evaluates the impact of an interactive, tablet-based lifestyle behavior questionnaire prior to a patient's primary care visit on counseling for health behaviors and patient-provider relationships. Using a quasi-experimental design at 2 federally qualified health centers, adults aged 18 to 35 years were asked to complete a tablet-based assessment about nutrition, physical activity, weight, smoking status, and alcohol use to identify unhealthy behaviors and their desire to discuss them with their provider. In the intervention group, participants were more likely to trust their providers (83% vs 71%, P = .0427) and feel that their provider cared about their health (80% vs 68%, P = .0468). Overweight/obese individuals were more likely to discuss weight loss with their doctor (59% vs 33%, P = .0088). Integrating information technology into primary care to encourage providers to discuss lifestyle issues and promote a positive patient-provider relationship may help improve the health promotion in primary care practices.

Acceptability of health information technology aimed at environmental health education in a prenatal clinic

OBJECTIVE

To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients.

METHODS

A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game.

RESULTS

The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (p<0.01). Qualitative data revealed: (1) benefit of exposure to computer use; (2) reinforcing strategy of health education; and (3) popularity of the interactive game.

CONCLUSION

The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic.

PRACTICE IMPLICATIONS

This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures.

An emergency department registration kiosk can increase HIV screening in high risk patients

We evaluated the feasibility and the patient acceptability of integrating a kiosk into routine emergency department (ED) practice for offering HIV testing. The work was conducted in four phases: phase 1 was a baseline, in which external testing staff offered testing at the bedside; phase 2 was a pilot assessment of a prototype kiosk; phase 3 was a pilot implementation and phase 4 was the full implementation with automated login. Feasibility was assessed by the proportion of offering HIV tests, acceptance, completion and result reporting. During the study period, the number of ED patients and eligible patients for screening were similar in the three main phases. However, the number and proportion of patients offered testing of those eligible for screening increased significantly from phase 1 (32%) to phase 3 (37%) and phase 4 (40%). There were slightly higher prevalences of newly diagnosed HIV with kiosk versus bedside testing (phase 1, 0%; phase 3, 0.2%; phase 4, 0.5%). Compared to patients tested at the bedside, patients tested via the kiosk were significantly younger, more likely to be female, to be black, and to report high risk behaviours. ED-based HIV screening via a registration-based kiosk was feasible, yielded similar proportions of testing, and increased the proportion of engagement of higher-risk patients in testing.

The role of health information kiosks in diverse settings: a systematic review

BACKGROUND

Public access computing through computer kiosks placed in clinical and community settings may help bridge the digital health information divide.

OBJECTIVE

The objective was to examine the current utilisation of computer based health information kiosks in diverse settings. Further, the objective was to examine the locations for health kiosks, kiosk features, application of theoretical framework in the design and development of health kiosks and the outcomes assessed.

METHODS

A search was conducted using Pubmed and CINAHL with articles published from January 2005 to January 2012. The articles that focused on the use of computer based health information kiosks in community and clinical settings.

RESULTS

The majority of the 31 articles included in this study were conducted in urban settings (90%; n = 28), clinical settings (58%; n = 18) and focused on child safety (19%; n = 6). Computer-based tailoring was utilised in majority of the studies (77%; n = 24). However, limited studies described the theoretical frameworks to facilitate this tailoring (42%; n = 13).

CONCLUSIONS

The results suggest that health information kiosks are a feasible medium to disseminate health information among various users in clinical and community settings, with high acceptance and satisfaction by users. Theoretical driven interventions are needed to examine long term impacts of health information kiosks especially in rural and underserved populations.

Well-child care clinical practice redesign at a community health center: provider and staff perspectives

BACKGROUND

Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery.

OBJECTIVE

To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years.

METHODS

Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions.

RESULTS

The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non-face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non-face-to-face (eg, phone) parent communication, and group visits.

CONCLUSION

CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.

Consumer health information technology in an adult public health primary care clinic: a heart health education feasibility study

OBJECTIVE

To explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic.

METHODS

Fifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up.

RESULTS

Participants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p=.02), and decreased systolic (p=.01) and diastolic BP (p<.001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant.

CONCLUSION

Using a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults.

PRACTICE IMPLICATIONS

A kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas.

Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities

BACKGROUND

Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users.

OBJECTIVE

The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities.

METHODS

Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system.

RESULTS

the patient ehealth readiness questionnaire (perq) includes questions used to calculate four subscores: patients' perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities.

CONCLUSIONS

PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further.

Maximizing the healthcare environment: a systematic review exploring the potential of computer technology to promote self-management of chronic illness in healthcare settings

OBJECTIVE

The aim of this systematic review is to investigate the effectiveness of using computers to deliver patient self-management programs (PSMPs) to patients with chronic illness in health supported settings.

METHODS

We included randomized controlled trials (RCTs), where the experimental intervention was compared either with an equivalent 'standard' PSMP delivered by staff, usual care or no intervention and reported data either on clinical or behavioral outcomes. We conducted a narrative synthesis, incorporating a small quantitative analysis to enable comparisons across studies.

RESULTS

A total of 11 studies met the inclusion criteria. There was insufficient evidence to determine whether computer-based PSMPs were superior to standard programs. However, it appeared that these interventions were effective when compared to no intervention. Interventions incorporating behavior change techniques beyond the provision of information appeared more effective than those that did not.

CONCLUSION

Evidence from the current review, whilst limited, suggests that computer-based PSMPs, delivered in health-supported settings, show potential for changing health behaviors and improving clinical outcomes in patients with chronic illness.

PRACTICE IMPLICATIONS

Although the approach shows promise, it is premature to recommend the integration of these interventions into clinical practice. However, more well designed trials are warranted to test their efficacy and cost-benefit.

Factors that promote or inhibit the implementation of e-health systems: an explanatory systematic review

OBJECTIVE

To systematically review the literature on the implementation of e-health to identify: (i) barriers and facilitators to e-health implementation, and (ii) outstanding gaps in research on the subject.

METHODS

MEDLINE, EMBASE, CINAHL, PSYCINFO and the Cochrane Library were searched for reviews published between 1 January 1995 and 17 March 2009. Studies had to be systematic reviews, narrative reviews, qualitative metasyntheses or meta-ethnographies of e-health implementation. Abstracts and papers were double screened and data were extracted on country of origin; e-health domain; publication date; aims and methods; databases searched; inclusion and exclusion criteria and number of papers included. Data were analysed qualitatively using normalization process theory as an explanatory coding framework.

FINDINGS

Inclusion criteria were met by 37 papers; 20 had been published between 1995 and 2007 and 17 between 2008 and 2009. Methodological quality was poor: 19 papers did not specify the inclusion and exclusion criteria and 13 did not indicate the precise number of articles screened. The use of normalization process theory as a conceptual framework revealed that relatively little attention was paid to: (i) work directed at making sense of e-health systems, specifying their purposes and benefits, establishing their value to users and planning their implementation; (ii) factors promoting or inhibiting engagement and participation; (iii) effects on roles and responsibilities; (iv) risk management, and (v) ways in which implementation processes might be reconfigured by user-produced knowledge.

CONCLUSION

The published literature focused on organizational issues, neglecting the wider social framework that must be considered when introducing new technologies.

Consumer empowerment in health care amid the internet and social media

OBJECTIVES

Consumer empowerment in health and rapid change in health information and communication technologies have their roots in broader social trends. This article reviews the activities at the intersection of consumer empowerment and technology.

DATA SOURCES

Technical reports, white papers, books, journal articles, and Web sites.

CONCLUSION

Social trends are visible in the integration of information and communication technologies into health care, in both searching for and sharing information on the Internet, in the use of social media to create new types of interactions with family, providers, and peers, and in the e-patient, who integrates these new roles and new technologies.

IMPLICATIONS FOR NURSING PRACTICE

Changes in both patients and technology will impact oncology nursing practice as new, patient-centered, interactions emerge.

Management of cardiovascular risk factors is leaving the office: potential impact of telemedicine

Effective control of hypertension and the other cardiovascular risk factors has been dependent on primary medical care as provided by family practitioners and internists. The progressive reduction in availability of primary care for adult populations in the United States threatens the likelihood of better control of the risk factors and potential loss of opportunity for prevention of cardiovascular disease. Recent progress has been made in the use of home blood pressure monitoring for improvement in classification of risk for hypertensive patients. Several studies establish the feasibility of home pressure monitoring combined with telemedicine for improving control of hypertension. Some studies have explored the role of self-care for adjustment of medication, as well. The potential growth of this strategy for effective control of hypertension with reduced need for face-to-face encounter time in primary care is a promising solution to the reduction in primary care providers. Management of hyperlipidemia and diabetes by telemedicine is also being explored, particularly for rural areas, but may also be effective in urban settings. Development of technology for home monitoring together with electronic communication to providers and mechanisms for education, feedback, and warnings offers a promising solution to the possible crisis in prevention of cardiovascular disease due to the loss of traditional primary care.

Method for technology-delivered healthcare measures

Current healthcare literature lacks development and evaluation methods for research and practice measures administered by technology. Researchers with varying levels of informatics experience are developing technology-delivered measures because of the numerous advantages they offer. Hasty development of technology-delivered measures can present issues that negatively influence administration and psychometric properties. The Method for Technology-delivered Healthcare Measures is designed to systematically guide the development and evaluation of technology-delivered measures. The five-step Method for Technology-delivered Healthcare Measures includes establishment of content, e-Health literacy, technology delivery, expert usability, and participant usability. Background information and Method for Technology-delivered Healthcare Measures steps are detailed.

Characterizing Patient-Friendly "Micro-Explanations" of Medical Events

Patients' basic understanding of clinical events has been shown to dramatically improve patient care. We propose that the automatic generation of very short micro-explanations, suitable for real-time delivery in clinical settings, can transform patient care by giving patients greater awareness of key events in their electronic medical record. We present results of a survey study indicating that it may be possible to automatically generate such explanations by extracting individual sentences from consumer-facing Web pages. We further inform future work by characterizing physician and non-physician responses to a variety of Web-extracted explanations of medical lab tests.

Physician Attitudes about Patient-Facing Information Displays at an Urban Emergency Department

Hospital information systems have primarily been designed to support physicians and administrators, though recent research has explored the value of patient-facing information displays. Electronic systems can be designed to provide tailored information to patients on their health, their care teams, the status of their hospital stays, and their expected care plans. However, this direct delivery of information from database to patient represents a fundamental change to the traditional flow of clinical information. We therefore explore physician attitudes toward a proposed patient-facing display of information abstracted from a hospital EHR, in the context of an urban emergency department. We find that physicians generally support direct delivery of electronic information to patients, and uncover important concerns to consider in the design of patient-facing information systems.

Designing Patient-Centric Information Displays for Hospitals

Electronic medical records are increasingly comprehensive, and this vast repository of information has already contributed to medical efficiency and hospital procedure. However, this information is not typically accessible to patients, who are frequently under-informed and unclear about their own hospital courses. In this paper, we propose a design for in-room, patient-centric information displays, based on iterative design with physicians. We use this as the basis for a Wizard-of-Oz study in an emergency department, to assess patient and provider responses to in-room information displays. 18 patients were presented with real-time information displays based on their medical records. Semi-structured interviews with patients, family members, and hospital staff reveal that subjective response to in-room displays was overwhelmingly positive, and through these interviews we elicited guidelines regarding specific information types, privacy, use cases, and information presentation techniques. We describe these findings, and we discuss the feasibility of a fully-automatic implementation of our design.