Digital health technologies and health-care privatisation

Digital health has been touted as a true transformation of health care, but all medical interventions have associated risks that must be understood and quantified. The Internet has brought many advancements, which quickly jumped from our computers into our pockets via powerful and completely connected mobile devices that are now being envisioned as devices for medical diagnostics and care delivery. As health care struggles with cost, inequity, value, and rapid virtualization, solid models of benefit-risk determination, new regulatory approaches for biomedical products, and clear risk-based conversations with all stakeholders are essential. Detailed examination of emerging digital health technologies has revealed 10 categories of digital side effects or “toxicities” that must be understood, prevented when possible, and managed when not. These toxicities include cyberthreat, loss of privacy, cyberchondria and cyber addiction, threats to physical security, charlatanism, overdiagnosis and overtreatment, medical/user error, and the plague of medical misinformation. For digital health to realize its promise, these toxicities must be understood, measured, warned against, and managed as concurrent side effects, in the same fashion as any other medical side effect.

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Clinical Integration of Digital Solutions in Health Care: An Overview of the Current Landscape of Digital Technologies in Cancer Care

JCO Clinical Cancer Informatics ◽

10.1200/cci.17.00159 ◽

2018 ◽

pp. 1-9 ◽

Cited By ~ 24

Author(s):

Shivank Garg ◽

Noelle L. Williams ◽

Andrew Ip ◽

Adam P. Dicker

Keyword(s):

Quality Of Life ◽

Artificial Intelligence ◽

Health Care ◽

Data Collection ◽

Patient Outcomes ◽

Cancer Care ◽

Digital Health ◽

Health Technologies ◽

Health Care Value

Digital health constitutes a merger of both software and hardware technology with health care delivery and management, and encompasses a number of domains, from wearable devices to artificial intelligence, each associated with widely disparate interaction and data collection models. In this review, we focus on the landscape of the current integration of digital health technology in cancer care by subdividing digital health technologies into the following sections: connected devices, digital patient information collection, telehealth, and digital assistants. In these sections, we give an overview of the potential clinical impact of such technologies as they pertain to key domains, including patient education, patient outcomes, quality of life, and health care value. We performed a search of PubMed ( www.ncbi.nlm.nih.gov/pubmed ) and www.ClinicalTrials.gov for numerous terms related to digital health technologies, including digital health, connected devices, smart devices, wearables, activity trackers, connected sensors, remote monitoring, electronic surveys, electronic patient-reported outcomes, telehealth, telemedicine, artificial intelligence, chatbot, and digital assistants. The terms health care and cancer were appended to the previously mentioned terms to filter results for cancer-specific applications. From these results, studies were included that exemplified use of the various domains of digital health technologies in oncologic care. Digital health encompasses the integration of a vast array of technologies with health care, each associated with varied methods of data collection and information flow. Integration of these technologies into clinical practice has seen applications throughout the spectrum of care, including cancer screening, on-treatment patient management, acute post-treatment follow-up, and survivorship. Implementation of these systems may serve to reduce costs and workflow inefficiencies, as well as to improve overall health care value, patient outcomes, and quality of life.

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Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study (Preprint)

10.2196/preprints.20579 ◽

2020 ◽

Author(s):

Leah Taylor Kelley ◽

Jamie Fujioka ◽

Kyle Liang ◽

Madeline Cooper ◽

Trevor Jamieson ◽

...

Keyword(s):

Health Care ◽

Health System ◽

Health Systems ◽

Business Models ◽

Digital Health ◽

Digital Technologies ◽

Economic Incentives ◽

Barriers To Entry ◽

Health Innovation ◽

Health Technologies

BACKGROUND Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging. OBJECTIVE This study aims to identify areas for health system improvement to promote the integration of innovative digital health technologies developed by SMEs. METHODS This paper qualitatively analyzes a series of case studies to identify health system barriers faced by SMEs developing digital health technologies in Canada and proposed solutions to encourage a more innovative ecosystem. The Women’s College Hospital Institute for Health System Solutions and Virtual Care established a consultation program for SMEs to help them increase their innovation capacity and take their ideas to market. The consultation involved the SME filling out an onboarding form and review of this information by an expert advisory committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzed their recommendation reports to identify common barriers to digital health innovation. RESULTS A total of 2 central themes were identified, each with 3 subthemes. First, a common barrier to system integration was the lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation. Second, the health system’s current structure does not create incentives for clinicians to use digital technologies, which threatens the sustainability of SMEs’ business models. SMEs faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals. CONCLUSIONS There is a significant disconnect between the economic incentives that drive clinical behaviors and the use of digital technologies that would benefit patients’ well-being. To encourage the use of digital health technologies, publicly funded health systems need to dedicate funding for the evaluation of digital solutions and streamlined pathways for clinical integration.

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Elements of Trust in Digital Health Systems: Scoping Review (Preprint)

10.2196/preprints.11254 ◽

2018 ◽

Author(s):

Afua Adjekum ◽

Alessandro Blasimme ◽

Effy Vayena

Keyword(s):

Health Care ◽

Health Systems ◽

Scoping Review ◽

Service Provider ◽

Digital Health ◽

Digital Technologies ◽

Data Access ◽

Building Blocks ◽

Sociodemographic Factors ◽

Health Technologies

BACKGROUND Information and communication technologies have long become prominent components of health systems. Rapid advances in digital technologies and data science over the last few years are predicted to have a vast impact on health care services, configuring a paradigm shift into what is now commonly referred to as digital health. Forecasted to curb rising health costs as well as to improve health system efficiency and safety, digital health success heavily relies on trust from professional end users, administrators, and patients. Yet, what counts as the building blocks of trust in digital health systems has so far remained underexplored. OBJECTIVE The objective of this study was to analyze what relevant stakeholders consider as enablers and impediments of trust in digital health. METHODS We performed a scoping review to map out trust in digital health. To identify relevant digital health studies, we searched 5 electronic databases. Using keywords and Medical Subject Headings, we targeted all relevant studies and set no boundaries for publication year to allow a broad range of studies to be identified. The studies were screened by 2 reviewers after which a predefined data extraction strategy was employed and relevant themes documented. RESULTS Overall, 278 qualitative, quantitative, mixed-methods, and intervention studies in English, published between 1998 and 2017 and conducted in 40 countries were included in this review. Patients and health care professionals were the two most prominent stakeholders of trust in digital health; a third—health administrators—was substantially less prominent. Our analysis identified cross-cutting personal, institutional, and technological elements of trust that broadly cluster into 16 enablers (altruism, fair data access, ease of use, self-efficacy, sociodemographic factors, recommendation by other users, usefulness, customizable design features, interoperability, privacy, initial face-to-face contact, guidelines for standardized use, stakeholder engagement, improved communication, decreased workloads, and service provider reputation) and 10 impediments (excessive costs, limited accessibility, sociodemographic factors, fear of data exploitation, insufficient training, defective technology, poor information quality, inadequate publicity, time-consuming, and service provider reputation) to trust in digital health. CONCLUSIONS Trust in digital health technologies and services depends on the interplay of a complex set of enablers and impediments. This study is a contribution to ongoing efforts to understand what determines trust in digital health according to different stakeholders. Therefore, it offers valuable points of reference for the implementation of innovative digital health services. Building on insights from this study, actionable metrics can be developed to assess the trustworthiness of digital technologies in health care.

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Exploring digital health care: eHealth, mHealth, and librarian opportunities

Journal of the Medical Library Association JMLA ◽

10.5195/jmla.2021.1180 ◽

2021 ◽

Vol 109 (3) ◽

Author(s):

Janet Chan

Keyword(s):

Health Care ◽

Health Literacy ◽

Health Information ◽

Digital Health ◽

The United States ◽

Security And Privacy ◽

Care Providers ◽

Vast Number ◽

Health Technologies ◽

Technology Advances

Technology advances in eHealth and mHealth are changing the way that health care consumers and providers communicate, receive and deliver care, and access health information. As electronic health records and smartphones have become ubiquitous in the United States, opportunities and applications for the integration of eHealth and mHealth have increased. In addition to technology advances, the changing health care model is simultaneously adapting to and driving initiatives in digital health care. With these digital initiatives have come challenges, including data overload, security and privacy concerns, deficits in technological and health literacy skills, and sorting through the vast number of choices of digital applications. Navigating this changing landscape can be overwhelming and time consuming for both health care providers and consumers. Librarians are uniquely positioned to assist providers and consumers to break down barriers within the digital health care landscape through data management initiatives, technology and health literacy instruction, and finding and evaluating health information and digital health technologies.

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Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters (Preprint)

10.2196/preprints.21815 ◽

2020 ◽

Author(s):

Francesco Petracca ◽

Oriana Ciani ◽

Maria Cucciniello ◽

Rosanna Tarricone

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Health Care Services ◽

Organizational Context ◽

Digital Health ◽

Health Care Systems ◽

Health Technologies ◽

Digital Reconstruction ◽

Depth Analysis ◽

Care Systems

UNSTRUCTURED A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after.

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Digital Health Technologies Respond to the COVID-19 Pandemic In a Tertiary Hospital in China: Development and Usability Study

Journal of Medical Internet Research ◽

10.2196/24505 ◽

2020 ◽

Vol 22 (11) ◽

pp. e24505 ◽

Cited By ~ 1

Author(s):

Wanmin Lian ◽

Li Wen ◽

Qiru Zhou ◽

Weijie Zhu ◽

Wenzhou Duan ◽

...

Keyword(s):

Health Care ◽

Digital Health ◽

Tertiary Hospital ◽

Service Platform ◽

Web Based ◽

Symptom Monitoring ◽

Health Technologies ◽

Epidemic Period ◽

Control And Prevention ◽

The Web

Background The outbreak of COVID-19 has caused a continuing global pandemic. Hospitals are integral to the control and prevention of COVID-19; however, they are facing numerous challenges during the epidemic. Objective Our study aimed to introduce the practical experience of the design and implementation of a web-based COVID-19 service platform at a tertiary hospital in China as well as the preliminary results of the implementation. Methods The web-based COVID-19 service platform was deployed within the health care system of the Guangdong Second Provincial General Hospital and Internet Hospital; the function of the platform was to provide web-based medical services for both members of the public and lay health care workers. The focal functions of this system included automated COVID-19 screening, related symptom monitoring, web-based consultation, and psychological support; it also served as a COVID-19 knowledge hub. The design and process of each function are introduced. The usage data for the platform service were collected and are represented by three periods: the pre-epidemic period (December 22, 2019, to January 22, 2020, 32 days), the controlled period (January 23 to March 31, 2020, 69 days), and the postepidemic period (April 1 to June 30, 2020, 91 days). Results By the end of June 2020, 96,642 people had used the automated COVID-19 screening and symptom monitoring systems 161,884 and 7,795,194 times, respectively. The number of general web-based consultation services per day increased from 30 visits in the pre-epidemic period to 122 visits during the controlled period, then dropped to 73 visits in the postepidemic period. The psychological counseling program served 636 clients during the epidemic period. For people who used the automated COVID-19 screening service, 160,916 (99.40%) of the total users were classified in the no risk category. 464 (0.29%) of the people were categorized as medium to high risk, and 12 people (0.01%) were recommended for further COVID-19 testing and treatment. Among the 96,642 individuals who used the COVID-19 related symptoms monitoring service, 6696 (6.93%) were symptomatic at some point during the monitoring period. Fever was the most frequently reported symptom, with 2684/6696 symptomatic people (40.1%) having had this symptom. Cough and sore throat were also relatively frequently reported by the 6696 symptomatic users (1657 people, 24.7%, and 1622 people, 24.2%, respectively). Conclusions The web-based COVID-19 service platform implemented at a tertiary hospital in China is exhibited to be a role model for using digital health technologies to respond to the COVID-19 pandemic. The digital solutions of automated COVID-19 screening, daily symptom monitoring, web-based care, and knowledge propagation have plausible acceptability and feasibility for complementing offline hospital services and facilitating disease control and prevention.

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Remote Monitoring of Patient- and Family-Generated Health Data in Pediatrics

PEDIATRICS ◽

10.1542/peds.2021-054137 ◽

2022 ◽

Author(s):

Carolyn Foster ◽

Dana Schinasi ◽

Kristin Kan ◽

Michelle Macy ◽

Derek Wheeler ◽

...

Keyword(s):

Health Care ◽

Digital Literacy ◽

Care Delivery ◽

Digital Health ◽

Health Care Team ◽

Models Of Care ◽

Health Data ◽

Care Needs ◽

Case Examples ◽

Health Technologies

Remote patient monitoring (RPM) is a form of telemedicine that involves the collection and transmission of health data from a patient to their health care team by using digital health technologies. RPM can be leveraged to aggregate and visualize longitudinal patient-generated health data for proactive clinical management and engagement of the patient and family in a child’s health care. Collection of remote data has been considered standard of care for years in some chronic pediatric conditions. However, software limitations, gaps in access to the Internet and technology devices, digital literacy, insufficient reimbursement, and other challenges have prevented expansion of RPM in pediatric medicine on a wide scale. Recent technological advances in remote devices and software, coupled with a shift toward virtual models of care, have created a need to better understand how RPM can be leveraged in pediatrics to improve the health of more children, especially for children with special health care needs who are reliant on high-quality chronic disease management. In this article, we define RPM for the general pediatric health care provider audience, provide case examples of existing RPM models, discuss advantages of and limitations to RPM (including how data are collected, evaluated, and managed), and provide a list of current RPM resources for clinical practitioners. Finally, we propose considerations for expansion of this health care delivery approach for children, including clinical infrastructure, equitable access to digital health care, and necessary reimbursement. The overarching goal is to advance health for children by adapting RPM technologies as appropriate and beneficial for patients, families, and providers alike.

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Photovoice as a research, advocacy, and harmonization tool for refugee and local youth in Turkey

European Journal of Public Health ◽

10.1093/eurpub/ckab164.864 ◽

2021 ◽

Vol 31 (Supplement_3) ◽

Author(s):

O Karadag Caman ◽

DI Ceyhan ◽

I Sumbuloglu ◽

S Karabey ◽

Y Ben Amor

Keyword(s):

Health Care ◽

Young People ◽

Health Information ◽

Digital Health ◽

Health Problems ◽

Youth Health ◽

Health Technologies ◽

Access To Health ◽

Youth Friendly ◽

Youth Friendly Services

Abstract Background Turkey has millions of refugee and local youth, who share common youth health problems. As part of the REACH Project, this study aimed to assess youth's access to health information, health care, and healthy environments, in addition to their perspectives on using digital health technologies. Methods We used photovoice, a community based participatory research approach, and worked with 4 mixed (refugee and local) youth groups between the ages of 15 to 24 in Istanbul. Each youth group met with the research team and a professional photographer before data collection. Young people then took photos of barriers and facilitators regarding their access to health information, health care, and digital health technologies, in addition to their health problems. This was followed by focus group-like discussions, where young people discussed the photos and their meanings for them. Content analysis was used for data analysis and findings were shared with stakeholders via photo exhibits, panels, and policy briefs for advocacy purposes. The study was funded by TaiwanICDF and Columbia University. Results Findings showed that youth had a wide range of physical, social and mental health problems coupled with problems in accessing health information and youth-friendly services. Problems with social determinants of health were more prominent for refugees. Although youth often used the internet to access information, their experiences with digital health technologies were very limited. Conclusions Our study findings indicated that despite legal rights to access health care for all youth, refugee youth faced more barriers in accessing information and services. On the other hand, refugee and local youth showed similarities regarding common youth health problems and access to youth-friendly services. The photovoice approach enabled active participation and created a shared environment for refugee and local youth to discuss their mutual problems and understand each other. Key messages Photography is a communication tool that acts as a bridge between participants, researchers, and decision makers. Photovoice, as a participatory approach, creates a learning environment for both participants and researchers.

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Hackathons as Stepping Stones in Health Care Innovation: Case Study With Systematic Recommendations

Journal of Medical Internet Research ◽

10.2196/17004 ◽

2020 ◽

Vol 22 (3) ◽

pp. e17004 ◽

Cited By ~ 4

Author(s):

Akira-Sebastian Poncette ◽

Pablo-David Rojas ◽

Joscha Hofferbert ◽

Alvaro Valera Sosa ◽

Felix Balzer ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Digital Health ◽

Participation Rate ◽

Multidisciplinary Teams ◽

Stepping Stones ◽

Health Technologies ◽

Health Community ◽

Cost Efficient

Background Until recently, developing health technologies was time-consuming and expensive, and often involved patients, doctors, and other health care professionals only as passive recipients of the end product. So far, users have been minimally involved in the ideation and creation stages of digital health technologies. In order to best address users’ unmet needs, a transdisciplinary and user-led approach, involving cocreation and direct user feedback, is required. In this context, hackathon events have become increasingly popular in generating enthusiasm for user-centered innovation. Objective This case study describes preparatory steps and the performance of a health hackathon directly involving patients and health care professionals at all stages. Feasibility and outcomes were assessed, leading to the development of systematic recommendations for future hackathons as a vehicle for bottom-up innovation in health care. Methods A 2-day hackathon was conducted in February 2017 in Berlin, Germany. Data were collected through a field study. Collected field notes were subsequently discussed in 15 informal meetings among the research team. Experiences of conducting two further hackathons in December 2017 and November 2018 were included. Results In total, 30 participants took part, with 63% (19/30) of participants between 25 and 34 years of age, 30% (9/30) between 35 and 44 years of age, and 7% (2/30) younger than 25 years of age. A total of 43% (13/30) of the participants were female. The participation rate of medical experts, including patients and health care professionals, was 30% (9/30). Five multidisciplinary teams were formed and each tackled a specific health care problem. All presented projects were apps: a chatbot for skin cancer recognition, an augmented reality exposure-based therapy (eg, for arachnophobia), an app for medical neighborhood connectivity, a doctor appointment platform, and a self-care app for people suffering from depression. Patients and health care professionals initiated all of the projects. Conducting the hackathon resulted in significant growth of the digital health community of Berlin and was followed up by larger hackathons. Systematic recommendations for conducting cost-efficient hackathons (n≤30) were developed, including aspects of community building, stakeholder engagement, mentoring, themes, announcements, follow-up, and timing for each step. Conclusions This study shows that hackathons are effective in bringing innovation to health care and are more cost- and time-efficient and potentially more sustainable than traditional medical device and digital product development. Our systematic recommendations can be useful to other individuals and organizations that want to establish user-led innovation in academic hospitals by conducting transdisciplinary hackathons.

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