scholarly journals Viewpoint: digital paediatrics—so close yet so far away

2021 ◽  
pp. archdischild-2021-322719
Author(s):  
Kai O Hensel ◽  
John Powell
Keyword(s):  
Mobile Apps ◽  
Outcome Measurement ◽  
Digital Health ◽  
Routine Data ◽  
Evidence Base ◽  
Care Needs ◽  
Health Records ◽  
Human Contact ◽  
Medical Education And Training ◽  
Fast Pace

Technology is driving a revolution in healthcare, but paediatric services have not fully harnessed the potential. Digital health solutions yet to achieve their promise in paediatrics include electronic health records, decision support systems, telemedicine and remote consultations, despite the accelerated uptake during the COVID-19 pandemic. There are also significant potential benefits in digitally enabled research, including systems to identify and recruit participants online or through health records, tools to extract data points from routine data sets rather than new data collection, and remote approaches to outcome measurement. Children and their families are increasingly becoming digital health citizens, able to manage their own health and use of health services through mobile apps and wearables such as fitness trackers. Ironically, one barrier to the uptake of these technologies is that the fast pace of change in this area means the evidence base behind many of these tools remains underdeveloped. Clinicians are often sceptical of innovations which appear largely driven by enthusiasts rather than science. Rigorous studies are needed to demonstrate safety and effectiveness. Regulators need to be agile and responsive. Implementation needs adequate resource and time, and needs to minimise risks and address concerns, such as worries over losing human contact. Digital health care needs to be embedded in medical education and training so that clinicians are trained in the use of innovations and can understand how to embed within services. In this way, digital paediatrics can deliver benefits to the profession, to services and to our patients.

scholarly journals Effective and Collegial Governance of Digital Tools in Health Care

ACI Open ◽  
2021 ◽  
Vol 05 (01) ◽  
pp. e13-e16
Author(s):  
Andrew Auerbach ◽  
Kay Burke ◽  
Raman Khanna
Keyword(s):  
Health Care ◽  
Mobile Apps ◽  
Digital Health ◽  
Strategic Thinking ◽  
Digital Transformation ◽  
Digital Tools ◽  
Health Records ◽  
Governance Strategy ◽  
Effective Use ◽  
Management Priorities

AbstractDigital transformation of health care has provided an opportunity for broad-based innovation using tools and platforms implemented either through electronic health records (EHRs), adding software to EHRs or prescribing the software to patients directly (e.g., mobile apps). Effective use and management of digital health tools requires a coherent governance strategy that incorporates strategic thinking and clear management priorities. This manuscript reviews nine of the authors’ recommendations for achieving this challenging but critical overall goal for digital health.

scholarly journals PARE0008 MOBILE APPLICATION “MOJRA” FOR MONITORING PATIENTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1290.1-1290 ◽  
Author(s):  
N. Teodorovic ◽  
S. Djordjevic ◽  
L. Vranic
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Best Practice ◽  
Mobile Apps ◽  
Digital Health ◽  
Work Capacity ◽  
Learning Center ◽  
Approval Procedure ◽  
The Republic

Background:In Serbia, regular examinations with a rheumatologist are scheduled on average every 3 to 4 months. With this in mind, there is a real possibility that many patient data during this period may not be presented to the doctor during the examination, either because the patient forgets them or because they may focus on other issues and may not highlight key factsObjectives:To overcome this problem, the Association of Patients with Rheumatic Diseases of Serbia-ORS in cooperation with an IT firm developed the application “MojRA”, which was presented at the annual rheumatology congress of Serbia held in September 2019. The application “MojRA” is intended for patients suffering from rheumatoid arthritis - RA. The application enables efficient storage and systematization of data, allows doctors to monitor the condition of their patients between two examinations and have a medical history. “MojRA” is available for now from smartphones running the android operating system on the google play store. The privacy of patient information is guaranteed.Methods:Patients with RA will be able to record and store information about important moments during treatment in a simple and transparent way. At each subsequent visit they will be able to describe what happened to their illness in the meantime. The application can create different types of reports and views.At the same time, the doctor can use the app to inform the patient about her/his condition in real time, which will contribute to better and more meaningful communication. All this would improve the quality of health care, preserving work capacity and improving the quality of life.Results:In order to simplify biotherapy committee approval procedure for patients of RA, the “Charger” has been developed in association with ORS and URes. The “Charger” will connect data collected by MojRa to the registry of RA patients, making the whole approval procedure more efficient and transparent.Testing of the second version of this application is underway, meetings are held between the patients using the application and the IT company that created it.Plans are to expand the app to other types of arthritis in the near future, too, and will soon be completed for devices running Apple operating systems.Conclusion:In addition to being of great benefit to patients and doctors, it can in the future be of immeasurable importance for the savings in the overall health care system of the Republic of Serbia.References:[1]Mobile Apps for Rheumatoid Arthritis: Opportunities and Challenges, Mollard E, Michaud K, Rheum Dis Clin, May 2019, Volume 45, Issue 2, Pages 197–209[2]Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality, Rebecca Grainger, Hutt Hospital, JMIR Publications, Advancing Digital Health Research, Feb 27, 2017.[3]ACR Mobile Apps,https://www.rheumatology.org/Learning-Center/Apps,American College of Reumatology.Disclosure of Interests:None declared

scholarly journals Delivering healthcare remotely to cardiovascular patients during COVID-19

2020 ◽  
Vol 19 (6) ◽  
pp. 486-494 ◽  
Author(s):  
Lis Neubeck ◽  
Tina Hansen ◽  
Tiny Jaarsma ◽  
Leonie Klompstra ◽  
Robyn Gallagher
Keyword(s):  
Cardiovascular Disease ◽  
Usual Care ◽  
Mobile Apps ◽  
Digital Health ◽  
Well Being ◽  
Search Terms ◽  
Cardiovascular Patients ◽  
Cardiovascular Morbidity And Mortality ◽  
Remote Healthcare ◽  
Healthcare Interventions

Background Although attention is focused on addressing the acute situation created by the COVID-19 illness, it is imperative to continue our efforts to prevent cardiovascular morbidity and mortality, particularly during a period of prolonged social isolation which may limit physical activity, adversely affect mental health and reduce access to usual care. One option may be to deliver healthcare interventions remotely through digital healthcare solutions. Therefore, the aim of this paper is to bring together the evidence for remote healthcare during a quarantine situation period to support people living with cardiovascular disease during COVID-19 isolation. Methods The PubMed, CINAHL and Google Scholar were searched using telehealth OR digital health OR mHealth OR eHealth OR mobile apps AND COVID-19 OR quarantine search terms. We also searched for literature relating to cardiovascular disease AND quarantine. Results The literature search identified 45 potentially relevant publications, out of which nine articles were included. Three overarching themes emerged from this review: (1) preparing the workforce and ensuring reimbursement for remote healthcare, (2) supporting mental and physical health and (3) supporting usual care. Conclusion To support people living with cardiovascular disease during COVID-19 isolation and to mitigate the effects of quarantine and adverse effect on mental and physical well-being, we should offer remote healthcare and provide access to their usual care.

Exclusion by Design: Lack of Information about Community Participation in COVID-19-related Mobile Apps and its Relationship to Digital Health Disparities (Preprint)

2021 ◽  
Author(s):  
Muhammed Yassin Idris ◽  
Maya Korin ◽  
Faven Araya ◽  
Sayeeda Chowdhury ◽  
Humberto Brown ◽  
...  
Keyword(s):  
Community Participation ◽  
Mobile Health ◽  
Medical Information ◽  
Mobile Apps ◽  
Digital Health ◽  
Community Based ◽  
Health Technologies ◽  
Community Needs ◽  
App Development ◽  
Communities Of Color

UNSTRUCTURED The rate and scale of transmission of COVID-19 overwhelmed healthcare systems worldwide, particularly in under-resourced communities of color that already faced a high prevalence of pre-existing health conditions. One way the health ecosystem has tried to address the pandemic is by creating mobile apps for telemedicine, dissemination of medical information, and disease tracking. As these new mobile health tools continue to be a primary format for healthcare, more attention needs to be given to their equitable distribution, usage, and accessibility. In this viewpoint collaboratively written by a community-based organization and a health app development research team, we present results of our systematic search and analysis of community engagement in mobile apps released between February and December 2020 to address the COVID-19 pandemic. We provide an overview of apps’ features and functionalities but could not find any publicly available information regarding whether these apps incorporated participation from communities of color disproportionately impacted by the pandemic. We argue that while mobile health technologies are a form of intellectual property, app developers should make public the steps taken to include community participation in app development. These steps could include community needs assessment, community feedback solicited and incorporated, and community participation in evaluation. These are factors that community-based organizations look for when assessing whether to promote digital health tools among the communities they serve. Transparency about the participation of community organizations in the process of app development would increase buy-in, trust, and usage of mobile health apps in communities where they are needed most.

Who is allowed to read and write?

2020 ◽  
Vol 19 (3) ◽  
pp. 116-117
Author(s):  
Christian P Subbe ◽  
Keyword(s):  
Information Needs ◽  
Healthcare Professionals ◽  
Personal Health Records ◽  
High Rate ◽  
Personal Health ◽  
Care Needs ◽  
Serious Adverse Events ◽  
Health Records ◽  
Clinical Records ◽  
The Way

What makes us human? In 2015 Jeremy Vine asked this question to a selection of leading British thinkers and writers. The answers were as diverse as the people he interviewed. While you might have your own views about the complexity of being human I would suggest that being able to articulate thoughts and communicate them to others might be one of the characteristics that distinguishes us from other life forms. And if we think more about the achievements of human culture then being able to communicate thoughts in writing and reading other people’s thoughts is one of the unique abilities that humanity has acquired during its evolution: Young humans spend extensive time to learn how to read and write. They write on paper, they read books and they do the same on computers. They become adults. They read and write most days: they e-mail their telephone company, file online forms to the tax office and or write romantic notes to their partner. Then they get older and become unwell and enter large modern building full of the most state-of-the-art technology. But here, in hospitals, none of them are allowed to read or write. They are being asked questions by someone who is often younger and in a rush. That person usually speaks a different language called jargon and try their best to translate their jargon to normal language.1 Patients are not allowed to write their own records and access to read the records is cumbersome. And if this is how we structure communication in our clinical practice then why are we surprised about the hierarchical relationship between patients and healthcare professionals and the high rate of error due to miscommunication? There might be good reasons for the way we document in healthcare: historically only the educated few like doctors were able to read and write and therefore the way to record patient histories had to be by those who were educated to do so. Additionally professions have always defined themselves by their own professional language and jargon that allows their members to describe matters precisely and at the same time create a sense of identity. Things have however changed in the last 100 years and a large proportion of our patients is able to read and write and might be perfectly capable to document their own information (and subsequently read all information that relates to them). The paper from Renggli et al in this issue of Acute Medicine explores the feasibility of documentation by patients on admission to hospital in Switzerland by using a web-based platform: at least half of the patients who were admitted with an emergency to hospital could document important parts their own medical history. The study demonstrated that documentation by patients added additional new information over and beyond of that collected by doctors and improved completeness of records, especially for the increasingly important social history. The paper has three important implications: Good information needs time: Patients can add more information if given the questions and their own time – rushing through an unprepared face-to-face consultation is unlikely to bring out the most relevant information in a reliable fashion. Sharing with patients might improve work-efficiency. Up to 25% of the time of doctors and nurses working in hospitals is taken up by documentation2,3: at a time when so many employed in healthcare are overworked and burnt out it would be reckless not to consider changes in information flow through the lens of work-load and efficiency. Quality care needs joint ownership with patients: Patients participation in the co-design and delivery of new services and shared decision of patients and clinicians in making of complex decision has been challenging to say the least. Co-ownership of clinical records is potentially a key strategic lever to achieve better decisions and services. Patient organisations and policy makers are expecting for patients to access medical records. Personal health records are now compulsory in some countries with roll-out of access for all citizens completed in countries like Estonia since 20084 and Sweden since 2018.5 It is National Health Service (NHS) policy to make a “personalized healthcare” available to everybody by 2020.6 That is now. Despite this there is virtually no evidence for the usage of personal health records in hospital.7,8 There are significant caveats to the current study: Half of the patients approached declined to take part and it is unclear why this was the case. Maybe they did not want to take part in any research. Maybe they felt too unwell to write. And maybe they were unable to read and write. While most people reaching adulthood in European countries have gone to school there is also evidence that up to 7 million adults in England are functionally illiterate and not able to read and write beyond the most basic level9 and relying on friends and family members, signs and symbols to travel through modern life. There is also an increasing body of work about digital exclusion and concerns that those who are unable to navigate the online world are at risk of being left behind by society.10 There are additional questions about ownership: do patients own all data that relates to their care or is documentation by healthcare professionals their intellectual property. There are strong arguments for both perspectives. From a patient safety point of view their would seem to be a strong imperative to come to pragmatic agreements. Research suggests that the majority of serious adverse events was flagged by patients and relatives at a time when they could have been predicted and potentially prevented by clinical teams.11 But safety critical information is often hidden from those who are most affected by it, the patients. The paper by Renggli et all does therefore provide important evidence for the development of a more co-operative and democratic way of providing acute care by using something that is a key part of being human: the ability to read and write.

scholarly journals Designing Decentralized Ledger Technology for Electronic Health Records

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
Vikram Dhillon
Keyword(s):  
Electronic Health Records ◽  
Open Source ◽  
Digital Health ◽  
Health Records ◽  
Distributed Ledger ◽  
Distributed Ledger Technology ◽  
Electronic Health

No abstract available. Editor’s note: A proposal to implement distributed ledger technology for electronic health records is outlined here. The rationale for integration of distributed ledgers in the healthcare domain is introduced, followed by a discussion of the features enabled by the use of a blockchain. An open source implementation of a distributed ledger is then presented. The article concludes with an examination of opportunities and challenges ahead in deploying blockchains for digital health.

scholarly journals Electronic health records in ambulances: the ERA multiple-methods study

2020 ◽  
Vol 8 (10) ◽  
pp. 1-140
Author(s):  
Alison Porter ◽  
Anisha Badshah ◽  
Sarah Black ◽  
David Fitzpatrick ◽  
Robert Harris-Mayes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Services ◽  
Electronic Health Records ◽  
Case Studies ◽  
Routine Data ◽  
Health Economy ◽  
Multiple Methods ◽  
Health Records ◽  
Electronic Health ◽  
Future Work

Background Ambulance services have a vital role in the shift towards the delivery of health care outside hospitals, when this is better for patients, by offering alternatives to transfer to the emergency department. The introduction of information technology in ambulance services to electronically capture, interpret, store and transfer patient data can support out-of-hospital care. Objective We aimed to understand how electronic health records can be most effectively implemented in a pre-hospital context in order to support a safe and effective shift from acute to community-based care, and how their potential benefits can be maximised. Design and setting We carried out a study using multiple methods and with four work packages: (1) a rapid literature review; (2) a telephone survey of all 13 freestanding UK ambulance services; (3) detailed case studies examining electronic health record use through qualitative methods and analysis of routine data in four selected sites consisting of UK ambulance services and their associated health economies; and (4) a knowledge-sharing workshop. Results We found limited literature on electronic health records. Only half of the UK ambulance services had electronic health records in use at the time of data collection, with considerable variation in hardware and software and some reversion to use of paper records as services transitioned between systems. The case studies found that the ambulance services’ electronic health records were in a state of change. Not all patient contacts resulted in the generation of electronic health records. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the electronic health records. Ambulance clinicians continued to use indirect data input approaches (such as first writing on a glove) even when using electronic health records. The primary function of electronic health records in all services seemed to be as a store for patient data. There was, as yet, limited evidence of electronic health records’ full potential being realised to transfer information, support decision-making or change patient care. Limitations Limitations included the difficulty of obtaining sets of matching routine data for analysis, difficulties of attributing any change in practice to electronic health records within a complex system and the rapidly changing environment, which means that some of our observations may no longer reflect reality. Conclusions Realising all the benefits of electronic health records requires engagement with other parts of the local health economy and dealing with variations between providers and the challenges of interoperability. Clinicians and data managers, and those working in different parts of the health economy, are likely to want very different things from a data set and need to be presented with only the information that they need. Future work There is scope for future work analysing ambulance service routine data sets, qualitative work to examine transfer of information at the emergency department and patients’ perspectives on record-keeping, and to develop and evaluate feedback to clinicians based on patient records. Study registration This study is registered as Health and Care Research Wales Clinical Research Portfolio 34166. Funding This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 10. See the NIHR Journals Library website for further project information.

Patient-Centered Palliative Care for Patients With Advanced Lung Cancer

2022 ◽  
Author(s):  
Jennifer S. Temel ◽  
Laura A. Petrillo ◽  
Joseph A. Greer
Keyword(s):  
Lung Cancer ◽  
Palliative Care ◽  
Checkpoint Inhibitors ◽  
Care Delivery ◽  
Cancer Therapeutics ◽  
Evidence Base ◽  
Advanced Lung Cancer ◽  
Care Needs ◽  
Patient Centered ◽  
Patient Reported

The evidence base demonstrating the benefits of an early focus on palliative care for patients with serious cancers, including advanced lung cancer, is substantial. Early involvement of specialty-trained palliative care clinicians in the care of patients with advanced lung cancer improves patient-reported outcomes, such as quality of life, and health care delivery, including hospice utilization. Since the time that many of these palliative care trials were conducted, the paradigm of cancer care for many cancers, including lung cancer, has changed dramatically. The majority of patients with advanced lung cancer are now treated with immune checkpoint inhibitors or targeted therapies, both of which have had a significant impact on patient's experience and outcomes. With this changing landscape of lung cancer therapeutics, patients are facing new and different challenges, including dealing with novel side effect profiles and coping with greater uncertainty regarding their prognosis. Patients who are living longer with their advanced cancer also struggle with how to address survivorship issues, such as sexual health and exercise, and decision making about end-of-life care. Although palliative care clinicians remain well-suited to address these care needs, they may need to learn new skills to support patients treated with novel therapies. Additionally, as the experience of patients with advanced lung cancer is becoming more varied and individualized, palliative care research interventions and clinical programs should also be delivered in a patient-centered manner to best meet patient's needs and improve their outcomes. Tailored and technology-based palliative care interventions are promising strategies for delivering patient-centered palliative care.

Depression Reduction for Patients With Type 2 Diabetes via E-Health Interventions

2021 ◽  
pp. 62-70
Author(s):  
Cynthia Wong
Keyword(s):  
Type Ii Diabetes ◽  
Mobile Apps ◽  
Personal Health Records ◽  
Health Interventions ◽  
Type Ii ◽  
Patient Portals ◽  
Health Records ◽  
Research Findings ◽  
Poor Outcomes

Diabetes is one of the most significant global health emergencies affecting populations in the 21st century, where one out of 15 adults has type II diabetes. Impaired glucose tolerance contributes to more than half of all causes of diabetes. Further, depression has adverse economic and health outcomes. The condition also contributes to poor outcomes in screening efforts among type II diabetes patients. E-health intervention is one of the means for reducing depression. There is, therefore, a need to investigate whether the strategy effectively reduces depression among patients with type II diabetes. The research examined the e-health interventions, which include personal health records (PHRs), diabetes mobile apps, patient portals, information repositories, telehealth, and electronic health records (EHRs). The research findings indicated that e-health would significantly help in reducing depression among people with type II diabetes.

A Viewpoint of Security for Digital Health Care in the United States

2014 ◽  
Vol 2 (1) ◽  
pp. 1-21 ◽  
Author(s):  
Steven A. Demurjian ◽  
Alberto De la Rosa Algarín ◽  
Jinbo Bi ◽  
Solomon Berhe ◽  
Thomas Agresta ◽  
...  
Keyword(s):  
United States ◽  
Health Care ◽  
Health Information ◽  
Information Exchange ◽  
Digital Health ◽  
The United States ◽  
Hard Copy ◽  
Health Providers ◽  
Patient Portals ◽  
Health Records

In health care, patient information of interest to health providers, researchers, public health researchers, insurers, patients, etc., is stored in different locations via electronic media and/or hard-copy formats. All potential users need electronic access to health information technology systems such as: electronic health records, personal health records, patient portals, and ancillary systems such as imaging, laboratory, pharmacy, etc. Controlling access to information from multiple systems requires granularity levels of privileges ranging from one patient to a cohort to an entire population. In this paper, we present a viewpoint of the state of secure digital health care in the United States, focusing on the resources that need to be protected as dictated by legal entities and regulations, the available approaches in the present state-of-the art, and, the potential needs for the future of security for digital health care. By utilizing a real world scenario, the authors explore the limitations of health information exchange in the United States, and present one possible architecture for secure digital health care that builds on existing technology alternatives.

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