Health Policy and Privacy Challenges Associated With Digital Technology

Importance

Digital technology is part of everyday life. Digital interactions generate large amounts of data that can reveal information about the health of individual consumers (the digital health footprint).

Objective

Τo describe health privacy challenges associated with digital technology.

Design, Setting, and Participants

For this qualitative study, In-depth, semistructured, qualitative interviews were conducted with 26 key experts from diverse fields in the US between January 1 and July 31, 2018. Open-ended questions and hypothetical scenarios were used to identify sources of digital information that contribute to consumers' health-relevant digital footprints and challenges for health privacy. Participants also completed a survey instrument on which they rated the health relatedness of digital data sources.

Main Outcomes and Measures

Health policy challenges associated with digital technology based on qualitative responses to expert interviews.

Results

Although experts' ratings of digital data sources suggested a possible distinction between health and nonhealth data, qualitative interviews uniformly indicated that all data can be health data, particularly when aggregated across sources and time. Five key characteristics of the digital health footprint were associated with health privacy policy challenges: invisibility (people are unaware of how their data are tracked), inaccuracy (data in the digital health footprint can be inaccurate), immortality (data have no expiration date and are aggregated over time), marketability (data have immense commercial value and are frequently bought and sold), and identifiability (individuals can be readily reidentified and anonymity is nearly impossible to achieve). There are virtually no regulatory structures in the US to protect health privacy in the context of the digital health footprint.

Conclusions and Relevance

The findings suggest that a sector-specific approach to digital technology privacy in the US may be associated with inadequate health privacy protections.

Twelve tips for medical students to conduct a systematic review

Background: Medical students engaged in research develop general skills that are instrumental to clinical practice. The systematic review, a cornerstone of evidence-based medicine, represents an ideal starting point for student researchers. Aim and methods: To outline twelve tips on conducting a systematic review for medical students with limited research experience. Results: The tips in this article are practical, comprehensive, and informed by the authors experience as medical students. Conclusion: The twelve tips can help medical students contribute to the literature and build a valuable skillset for future research and clinical practice.

The project vita: A dynamic knowledge management tool

A project vita is a comprehensive index of factual information about a project's activities and achievements. Like an individual's professional curriculum vita or resume, it serves as evidence of past performance and capacity for future endeavors. This article situates the project vita as a knowledge management tool for use by large-scale research and development projects or coalitions. In such complex endeavors, the variety and scope of the knowledge generated can quickly outpace project staff attempts to collect, classify, disseminate, and support the effective use of the constant stream of information being produced. We describe how to develop a project vita and utilize it to support several essential project functions, including communication, evaluation, management, and as a portal to products.

MOSAIC – A Modular Approach to Data Management in Epidemiological Studies

Introduction: In the context of an increasing number of multi-centric studies providing data from different sites and sources the necessity for central data management (CDM) becomes undeniable. This is exacerbated by a multiplicity of featured data types, formats and interfaces. In relation to methodological medical research the definition of central data management needs to be broadened beyond the simple storage and archiving of research data.

Objectives: This paper highlights typical requirements of CDM for cohort studies and registries and illustrates how orientation for CDM can be provided by addressing selected data management challenges.

Methods: Therefore in the first part of this paper a short review summarises technical, organisational and legal challenges for CDM in cohort studies and registries. A deduced set of typical requirements of CDM in epidemiological research follows.

Results: In the second part the MOSAIC project is introduced (a modular systematic approach to implement CDM). The modular nature of MOSAIC contributes to manage both technical and organisational challenges efficiently by providing practical tools. A short presentation of a first set of tools, aiming for selected CDM requirements in cohort studies and registries, comprises a template for comprehensive documentation of data protection measures, an interactive reference portal for gaining insights and sharing experiences, supplemented by modular software tools for generation and management of generic pseudonyms, for participant management and for sophisticated consent management.

Conclusions: Altogether, work within MOSAIC addresses existing challenges in epidemiological research in the context of CDM and facilitates the standardized collection of data with pre-programmed modules and provided document templates. The necessary effort for in-house programming is reduced, which accelerates the start of data collection.

Supporting information technology across health boards in New Zealand: themes emerging from the development of a shared services organization

Shared services organizations are ascribed with adding value to business in several ways but especially by sharing resources and leading to economies of scale. However, these gains are not automatic and in some instances, particularly healthcare, they are difficult to achieve. This article describes a project to develop a shared services information technology infrastructure across two district health boards in New Zealand. The study reveals valuable insight into the crisis issues that accompany change management and identifies emergent themes that can be used to reduce negative impact.

Comprehensive Child Welfare Information System. Final rule

This final rule replaces the Statewide and Tribal Automated Child Welfare Information Systems (S/TACWIS) rule with the Comprehensive Child Welfare Information System (CCWIS) rule. The rule also makes conforming amendments in rules in related requirements. This rule will assist title IV-E agencies in developing information management systems that leverage new innovations and technology in order to better serve children and families. More specifically, this final rule supports the use of cost-effective, innovative technologies to automate the collection of high-quality case management data and to promote its analysis, distribution, and use by workers, supervisors, administrators, researchers, and policy makers.

A Practical Method for Data Handling in Multi-Method Usability Research Studies

BACKGROUND

Analyses of large, complex data sets are common in health informatics and usability research. Researchers need feasible ways of streamlining data handling and analyses. We offer a useful approach across qualitative and digitalized data.

METHODS

Illustrated by a usability evaluation study on a mHealth system, we present methods for managing a large set of usability data using qualitative data analysis software (QDAS). Three different data collection methods were used (usability testing, in-depth interviews, and open-ended questionnaire responses).

RESULTS

The process began at initial transcription and all data were imported into the system. Content analysis was used throughout - from problem identification to assigning problem classifications and severity ratings to linkages with system views.

CONCLUSION

This approach was practical and useful as it allowed the capture and synthesis of a large number of multifaceted usability problems. We recommend this approach to other researchers performing usability evaluations on large data sets.

Enhancing Patient Safety Using Clinical Nursing Data: A Pilot Study

To enhance patient safety from falls, many hospital information systems have been implemented to collect clinical data from the bedside and have used the information to improve fall prevention care. However, most of them use administrative data not clinical nursing data. This necessitated the development of a web-based Nursing Practice and Research Information Management System (NPRIMS) that processes clinical nursing data to measure nurses' delivery of fall prevention care and its impact on patient outcomes. This pilot study developed computer algorithms based on a falls prevention protocol and programmed the prototype NPRIMS. It successfully measured the performance of nursing care delivered and its impact on patient outcomes using clinical nursing data from the study site. Results of the study revealed that NPRIMS has the potential to pinpoint components of nursing processes that are in need of improvement for preventing patient from falls.

IT Infrastructure for Merging Data from Different Clinical Trials and Across Independent Research Networks

Opsoclonus Myoclonus Syndrome (OMS) is a rare disease in children which is often associated with neuroblastoma and, therefore, requires treatment by pediatric neurologists and oncologists. The ongoing OMS trial investigates questions related to OMS and potentially underlying neuroblastomas. To support this trial with an adequate IT infrastructure, linkage of neuroblastoma research databases with the OMS electronic data capture (EDC) system was required. Therefore, an EDC system for the OMS trial was developed and integrated into the research infrastructure of the European Network for Cancer Research in Children and Adolescents (ENCCA) project. Application of ENNCA's pseudonymization concept enabled linkage of the OMS trial with neuroblastoma trials from two different scientific societies, while being compliant with current data protection regulations. Linkage of the neurological and the oncological domain could successfully be demonstrated and a promising concept for secondary use of the data of both domains has been developed, proofing the broad potential of the concepts for cross-domain research as promoted in the ENCCA project.

A Strategy for Reusing the Data of Electronic Medical Record Systems for Clinical Research

There is a great need to reuse data stored in electronic medical records (EMR) databases for clinical research. We previously reported the development of a system in which progress notes and case report forms (CRFs) were simultaneously recorded using a template in the EMR in order to exclude redundant data entry. To make the data collection process more efficient, we are developing a system in which the data originally stored in the EMR database can be populated within a frame in a template. We developed interface plugin modules that retrieve data from the databases of other EMR applications. A universal keyword written in a template master is converted to a local code using a data conversion table, then the objective data is retrieved from the corresponding database. The template element data, which are entered by a template, are stored in the template element database. To retrieve the data entered by other templates, the objective data is designated by the template element code with the template code, or by the concept code if it is written for the element. When the application systems in the EMR generate documents, they also generate a PDF file and a corresponding document profile XML, which includes important data, and send them to the document archive server and the data sharing saver, respectively. In the data sharing server, the data are represented by an item with an item code with a document class code and its value. By linking a concept code to an item identifier, an objective data can be retrieved by designating a concept code. We employed a flexible strategy in which a unique identifier for a hospital is initially attached to all of the data that the hospital generates. The identifier is secondarily linked with concept codes. The data that are not linked with a concept code can also be retrieved using the unique identifier of the hospital. This strategy makes it possible to reuse any of a hospital's data.

[Eleven thesis on the archive of scientific research, for a new patrimonial and scientific policy]

Abstracting the main content of a recent report on the bad state of the archives of scientific research, this paper puts forward eleven thesis likely to feed, in this time of numeric transition to a new documentary regime and to a new patrimonial policy. The recent numeric conditions impose to set new archival pratices, more proactive, anticipative and prospective. Archives of scientific research must be thought in a double memorial and scientific dimension, and not only as a patrimonial or historical one.

'Pop-Up' Governance: developing internal governance frameworks for consortia: the example of UK10K

Innovations in information technologies have facilitated the development of new styles of research networks and forms of governance. This is evident in genomics where increasingly, research is carried out by large, interdisciplinary consortia focussing on a specific research endeavour. The UK10K project is an example of a human genomics consortium funded to provide insights into the genomics of rare conditions, and establish a community resource from generated sequence data. To achieve its objectives according to the agreed timetable, the UK10K project established an internal governance system to expedite the research and to deal with the complex issues that arose. The project's governance structure exemplifies a new form of network governance called 'pop-up' governance. 'Pop-up' because: it was put together quickly, existed for a specific period, was designed for a specific purpose, and was dismantled easily on project completion. In this paper, we use UK10K to describe how 'pop-up' governance works on the ground and how relational, hierarchical and contractual governance mechanisms are used in this new form of network governance.

A Framework for Global Collaborative Data Management for Malaria Research

Data generated during the course of research activities carried out by the International Centers of Excellence for Malaria Research (ICEMR) is heterogeneous, large, and multi-scaled. The complexity of federated and global data operations and the diverse uses planned for the data pose tremendous challenges and opportunities for collaborative research. In this article, we present the foundational principles for data management across the ICEMR Program, the logistics associated with multiple aspects of the data life cycle, and describe a pilot centralized web information system created in PlasmoDB to query a subset of this data. The paradigm proposed as a solution for the data operations in the ICEMR Program is widely applicable to large, multifaceted research projects, and could be reproduced in other contexts that require sophisticated data management.

Development and testing of indicators to measure coordination of clinical information and management across levels of care

BACKGROUND

Coordination across levels of care is becoming increasingly important due to rapid advances in technology, high specialisation and changes in the organization of healthcare services; to date, however, the development of indicators to evaluate coordination has been limited. The aim of this study is to develop and test a set of indicators to comprehensively evaluate clinical coordination across levels of care.

METHODS

A systematic review of literature was conducted to identify indicators of clinical coordination across levels of care. These indicators were analysed to identify attributes of coordination and classified accordingly. They were then discussed within an expert team and adapted or newly developed, and their relevance, scientific soundness and feasibility were examined. The indicators were tested in three healthcare areas of the Catalan health system.

RESULTS

52 indicators were identified addressing 11 attributes of clinical coordination across levels of care. The final set consisted of 21 output indicators. Clinical information transfer is evaluated based on information flow (4) and the adequacy of shared information (3). Clinical management coordination indicators evaluate care coherence through diagnostic testing (2) and medication (1), provision of care at the most appropriate level (2), completion of diagnostic process (1), follow-up after hospital discharge (4) and accessibility across levels of care (4). The application of indicators showed differences in the degree of clinical coordination depending on the attribute and area.

CONCLUSION

A set of rigorous and scientifically sound measures of clinical coordination across levels of care were developed based on a literature review and discussion with experts. This set of indicators comprehensively address the different attributes of clinical coordination in main transitions across levels of care. It could be employed to identify areas in which health services can be improved, as well as to measure the effect of efforts to improve clinical coordination in healthcare organizations.

Characterizing the Networks of Digital Information that Support Collaborative Adaptive Forest Management in Sierra Nevada Forests

Some of the factors that can contribute to the success of collaborative adaptive management--such as social learning, open communication, and trust--are built upon a foundation of the open exchange of information about science and management between participants and the public. Despite the importance of information transparency, the use and flow of information in collaborative adaptive management has not been characterized in detail in the literature, and currently there exist opportunities to develop strategies for increasing the exchange of information, as well as to track information flow in such contexts. As digital information channels and networks have been increased over the last decade, powerful new information monitoring tools have also been evolved allowing for the complete characterization of information products through their production, transport, use, and monitoring. This study uses these tools to investigate the use of various science and management information products in a case study--the Sierra Nevada Adaptive Management Project--using a mixed method (citation analysis, web analytics, and content analysis) research approach borrowed from the information processing and management field. The results from our case study show that information technologies greatly facilitate the flow and use of digital information, leading to multiparty collaborations such as knowledge transfer and public participation in science research. We conclude with recommendations for expanding information exchange in collaborative adaptive management by taking advantage of available information technologies and networks.

HIEs and the gateway to better care

Health information exchanges (HIEs) are becoming a more widely used method for physicians to share valuable patient information. A proposed health service enterprise gateway would connect to local health information exchanges and give physicians a single place to exchange data with all state health agencies.

Achieving interoperability for accountable care

Based on findings of a recent survey, accountable care organizations should keep eight points in mind as they seek to establish interoperability among their provider constituents: Create a shared governance structure to make IT decisions. Conduct a readiness assessment and gap analysis. Reconfigure the technology infrastructure and processes to support new value-based care delivery protocols. Consider targeting programs around high-risk groups. Develop real-time data-sharing systems. Ensure privacy and security policies and procedures are in place. Assess and address workforce issues expeditiously. Participate in broader interoperability efforts.

The Good, the Bad, the Ugly…and the Even Better of Rapid Abstracting

With the ever increasing and welcome demand for our cancer registry data at Moffitt Cancer Center (an National Cancer Institute-designated Comprehensive Cancer Center), the traditional cancer registry model of abstracting 4 to 6 months after date of first contact became more and more of a hindrance to the mutual goals and vision for use of our data. We set a goal of utilizing the American College of Surgeon's Rapid Quality Reporting System and we knew that, to use the functionality of that system to improve patient timelines for treatment, we would need to rapidly abstract all our analytic breast and colorectal cases. Rapid abstracting is the method whereby all diagnostic, surgical, and staging information must be gathered in order to complete the first half of the abstract 4 to 6 weeks from date of first contact.

16. Information

Effective disaster management requires systems for data acquisition and information management that enable responders to rapidly collect, process, interpret, distribute, and access the data and information required for disaster management. Effective information sharing depends on the types of users, the type of damage, alterations of the functional status of the affected society, and how the information is structured. Those in need of information should be provided with the information necessary for their tasks and not be overloaded with unnecessary information that could serve as a distraction. Such information systems must be designed and exercised. To disseminate and share data with the relevant users, all disaster responses must include effective and reliable information systems. This information includes that acquired from repeated assessments in terms of available and needed human and material resources, which resources no longer are needed, and the status of the relief and recovery workers. It is through this information system that vital decisions are made that are congruent with the overall picture as perceived by the most relevant coordination and control centre. It is essential that information systems be designed and tested regularly as part of preparedness. Such systems must have the capacity to acquire, classify, and present information in an organised and useful manner.

Challenges in humanitarian information management and exchange: evidence from Haiti

There is a growing recognition of the critical role information management can play in shaping effective humanitarian response, coordination and decision-making. Quality information, reaching more humanitarian actors, will result in better coordination and better decision-making, thus improving the response to beneficiaries as well as accountability to donors. The humanitarian response to the 2010 Haiti earthquake marked a watershed moment for humanitarian information management. Yet the fragmented nature of the response and the use of hierarchical models of information management, along with other factors, have led some observers to label the Haiti response a failure. Using an analytical framework often found in humanitarian emergencies, this study analyses challenges to information flow in the Haiti case and the implications for effective humanitarian response. It concludes by offering possible paths for overcoming such challenges, and for restoring the value and utility of humanitarian information management and exchange in humanitarian relief settings.

Digging deeper into data

Data analysts can help organizations identify opportunities to improve clinical and financial performance. Hospitals should seek data analysts who possess: Knowledge of multiple data sets A math, science, computer science, or clinical background Healthcare industry experience Critical and systems thinking skills

Description and analysis of design and intended use for Epidemiologic Dynamic Data Collection Platform in China

Disease surveillance systems can be extremely valuable tools and a critical step in system implementation is data collection. In order to obtain quality data efficiently and align the public health business process, Epidemiologic Dynamic Data Collection platform (EDDC) was developed and applied in China. We describe the design of EDDC and assess the platform from six dimensions (service, system, information, use, users and benefit) under the DeLone and McLean Information System Success Model. Objective indicators were extracted from each dimension with the aim of describing the system in detail. The characteristics of functions, performances, usages and benefits of EDDC were reflected under the analysis framework. The limitations and future directions of EDDC are offered for wide use in public health data collection.

Management of scientific information with Google Drive

BACKGROUND

The amount and diversity of scientific publications requires a modern management system. By "management" we mean the process of gathering interesting information for the purpose of reading and archiving for quick access in future clinical practice and research activity. In the past, such system required physical existence of a library, either institutional or private. Nowadays in an era dominated by electronic information, it is natural to migrate entire systems to a digital form.

AIM OF THE STUDY

In the following paper we describe the structure and functions of an individual electronic library system (IELiS) for the management of scientific publications based on the Google Drive service.

MATERIAL AND METHODS

Architecture of the system. Architecture system consists of a central element and peripheral devices. Central element of the system is virtual Google Drive provided by Google Inc. Physical elements of the system include: tablet with Android operating system and a personal computer, both with internet access. Required software includes a program to view and edit files in PDF format for mobile devices and another to synchronize the files.

RESULTS

Functioning of the system. The first step in creating a system is collection of scientific papers in PDF format and their analysis. This step is performed most frequently on a tablet. At this stage, after being read, the papers are cataloged in a system of folders and subfolders, according to individual demands. During this stage, but not exclusively, the PDF files are annotated by the reader. This allows the user to quickly track down interesting information in review or research process. Modification of the document title is performed at this stage, as well. Second element of the system is creation of a mirror database in the Google Drive virtual memory. Modified and cataloged papers are synchronized with Google Drive. At this stage, a fully functional scientific information electronic library becomes available online. The third element of the system is a periodic two-way synchronization of data between Google Drive and tablet, as occasional modification of the files with annotation or recataloging may be performed at both locations.

CONCLUSIONS

The system architecture is designed to gather, catalog and analyze scientific publications. All steps are electronic, eliminating paper forms. Indexed files are available for re-reading and modification. The system allows for fast access to full-text search with additional features making research easier. Team collaboration is also possible with full control of user privileges. Particularly important is the safety of collected data. In our opinion, the system exceeds many commercially available applications in terms of functionality and versatility.

Developing a data governance model in health care

When building a data governance model, finance leaders should: Establish a leadership team and define the program's scope. Calculate the return using the confidence in data-dependent assumptions metric. Identify specific areas of deficiency and create a budget to address these areas.

Requirement analysis for an electronic laboratory notebook for sustainable data management in biomedical research

Sustainable data management in biomedical research requires documentation of metadata for all experiments and results. Scientists usually document research data and metadata in laboratory paper notebooks. An electronic laboratory notebook (ELN) can keep metadata linked to research data resulting in a better understanding of the research results, meaning a scientific benefit [1]. Besides other challenges [2], the biggest hurdles for introducing an ELN seem to be usability, file formats, and data entry mechanisms [3] and that many ELNs are assigned to specific research fields such as biology, chemistry, or physics [4]. We aimed to identify requirements for the introduction of ELN software in a biomedical collaborative research center [5] consisting of different scientific fields and to find software fulfilling most of these requirements.

Close the clinical communications loop in 4 steps

The ability to actively, effectively and securely engage in four elements of communication has a positive impact on patient care. Learn how some organizational structures, such as accountable care organizations and patient-centered medical homes, are implementing new techniques.