scholarly journals Teaching Digital Health Ethics – Considerations and Lessons in Hands on Learning.

2020 ◽  
Author(s):  
Arthi Kumaravel ◽  
Philip Henson ◽  
John Torous
Keyword(s):  
Mental Health ◽  
Care Delivery ◽  
Digital Health ◽  
Clinical Care ◽  
Ethical Principles ◽  
Privacy Policy ◽  
Assessment Framework ◽  
Patient Privacy ◽  
Smartphone Applications ◽  
General Data Protection Regulation

Abstract Background Educators need new tools to teach resident learners how to evaluate the privacy risks of and utilize the benefits of smartphone applications with their patients. To address this need for education addressing the changing landscape of mental health care delivery, we sought to create a simple tool that can be used in the clinic. Through this 10-point assessment framework for screening health apps based from ethical principles of the General Data Protection Regulation (GDPR), we propose a method that educators can utilize to teach residents about the privacy concerns of utilizing smartphone applications as part of clinical care with their patients. Methods We utilized an ethical-educational framework we developed from ethical principles of the GDPR with a group of 27 psychiatry residents from two academic centers for a simulation exercise to assess harms of using smartphone apps with a patient. Results All 27 raters completed the evaluations, but only 24 reported a time record for completion of the evaluation. The mean time to evaluate the privacy policy of the sample app’s privacy policy was 434.2 seconds (just over five minutes). Percentage agreement of each question on the survey ranged from a high of 81.5% to a low of 48.1%. Conclusions In this study, we developed an assessment framework based on the ethical principles contained within the GDPR to utilize for education of resident learners around digital health privacy. This is the first framework developed for resident learners to help them understand the potential risks to patient privacy with the use of smartphone applications for mental health. The discussion prompted by an examination of a privacy policy through this framework highlights the need for further educational tools built into the residency education curriculum regarding these risks as use of these applications become more wide spread.

Managing the Digital Disruption Associated with COVID-19-Driven Rapid Digital Transformation in Brisbane, Australia

2021 ◽  
Vol 12 (05) ◽  
pp. 1135-1143
Author(s):  
Amalie Dyda ◽  
Magid Fahim ◽  
Jon Fraser ◽  
Marianne Kirrane ◽  
Ides Wong ◽  
...  
Keyword(s):  
Care Delivery ◽  
Digital Health ◽  
Clinical Care ◽  
Models Of Care ◽  
Digital Transformation ◽  
Lessons Learned ◽  
Digital Data ◽  
Routine Practice ◽  
Action Research Project ◽  
Digital Disruption

Abstract Background The COVID-19 pandemic has forced rapid digital transformation of many health systems. These innovations are now entering the literature, but there is little focus on the resulting disruption. Objective We describe the implementation of digital innovations during the COVID-19 response of Australia's largest health service, Metro North (in Brisbane, Queensland), the challenges of the subsequent digital disruption, how these were managed, and lessons learned. Methods Prior to the COVID-19 pandemic, the Australian state of Queensland created the Queensland Digital Clinical Charter, which provides guidance for the development of digital health programs. The guidelines utilize three horizons: digitizing workflows, leveraging digital data to transform clinical care, and reimagining new and innovative models of care. The technical response to COVID-19 in Metro North is described across these horizons. The rapid digital response caused significant disruption to health care delivery; management of the disruption and the outcomes are detailed. This is a participatory action research project, with members of the research team assisting with leading the implementation project informing the case report content. Results Several digital innovations were introduced across Metro North during the COVID-19 response. This resulted in significant disruption creating digital hypervigilance, digital deceleration, data discordance, and postdigital “depression.” Successful management of the digital disruption minimized the negative effects of rapid digital transformation, and contributed to the effective management of the pandemic in Queensland. Conclusion The rapid digital transformation in Metro North during COVID-19 was successful in several aspects; however, ongoing challenges remain. These include the need to improve data sharing and increase interoperability. Importantly, the innovations need to be evaluated to ensure that Metro North can capitalize on these changes and incorporate them into long-term routine practice. Moving forward, it will be essential to manage not only the pandemic, but increasingly, the resultant digital disruption.

scholarly journals Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review (Preprint)

2019 ◽  
Author(s):  
Brian Lo ◽  
Jenny Shi ◽  
Elisa Hollenberg ◽  
Alexxa Abi-Jaoudé ◽  
Andrew Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Care Delivery ◽  
Digital Health ◽  
Controlled Trial ◽  
Health Interventions ◽  
Health Apps ◽  
Mental Health Interventions ◽  
Usage Data

BACKGROUND Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. OBJECTIVE This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). METHODS A scoping review was conducted using the Arksey and O’Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. RESULTS Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. CONCLUSIONS This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.

scholarly journals Protecting patient privacy in digital health technology: the Dutch m-Health infrastructure of Hartwacht as a learning case

2020 ◽  
Vol 6 (4) ◽  
pp. 170-176
Author(s):  
Eric Wierda ◽  
Sebastiaan Blok ◽  
G Aernout Somsen ◽  
Enno T van der Velde ◽  
Igor I Tulevski ◽  
...  
Keyword(s):  
Digital Health ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Legal Framework ◽  
Patient Privacy ◽  
General Data Protection Regulation ◽  
Explicit Consent ◽  
Practice Of Medicine ◽  
General Data

Innovative ways of healthcare delivery like m-Health, the practice of medicine by mobile devices and wearable devices are the promising new technique that may lead to improvement in quality of care at lower costs. While fully acknowledging the importance of m-Health development, there are challenges on privacy legislation. We address the legal framework, especially the General Data Protection Regulation, applied to m-Health and its implications for m-Health developments in Europe. We discuss how these rules are applied using a representative example of an m-Health programme with remote monitoring in the Netherlands. We consider informing patients about the data processing and obtaining their explicit consent as main responsibilities of healthcare providers introducing m-Health in their practice.

scholarly journals Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review

10.2196/15942 ◽  
2020 ◽  
Vol 7 (6) ◽  
pp. e15942
Author(s):  
Brian Lo ◽  
Jenny Shi ◽  
Elisa Hollenberg ◽  
Alexxa Abi-Jaoudé ◽  
Andrew Johnson ◽  
...  
Keyword(s):  
Mental Health ◽  
Scoping Review ◽  
Care Delivery ◽  
Digital Health ◽  
Controlled Trial ◽  
Health Interventions ◽  
Health Apps ◽  
Mental Health Interventions ◽  
Usage Data

Background Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. Objective This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). Methods A scoping review was conducted using the Arksey and O’Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. Results Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. Conclusions This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.

scholarly journals Early Psychosis Service User Views on Digital Technology: Qualitative Analysis (Preprint)

2018 ◽  
Author(s):  
Sandra Bucci ◽  
Rohan Morris ◽  
Katherine Berry ◽  
Natalie Berry ◽  
Gillian Haddock ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Digital Technology ◽  
Service User ◽  
Care Delivery ◽  
Digital Health ◽  
Early Psychosis ◽  
Treatment Modalities ◽  
Future Research ◽  
Service Users

BACKGROUND Digital technology has the potential to improve outcomes for people with psychosis. However, to date, research has largely ignored service user views on digital health interventions (DHIs). OBJECTIVE The objective of our study was to explore early psychosis service users’ subjective views on DHIs. METHODS Framework analysis was undertaken with data obtained from 21 semistructured interviews with people registered with early intervention for psychosis services. Robust measures were used to develop a stable framework, including member checking, triangulation, independent verification of themes, and consensus meetings. RESULTS The following 4 themes were established a priori: acceptability of technology in psychosis and mental health; technology increasing access to and augmenting mental health support; barriers to adopting DHIs; and concerns about management of data protection, privacy, risk, and security of information. The following 2 themes were generated a posteriori: blending DHIs with face-to-face treatment and empowerment, control, and choice. DHIs were also viewed as potentially destigmatizing, overcoming barriers faced in traditional service settings, facilitating communication, and empowering service users to take active control of their health care. CONCLUSIONS In the first study of its kind, early psychosis service users’ were largely positive about the potential use of DHIs supporting and managing mental health. Overall, service users felt that DHIs were a progressive, modern, and relevant platform for health care delivery. Concerns were expressed around privacy and data security and practical barriers inherent within DHIs, all of which require further attention. Future research should explore whether findings transfer to other service user groups, other technology delivery formats, and across a range of treatment modalities.

Measurement in an on-demand virtual mental health system: a review and viewpoint (Preprint)

2020 ◽  
Author(s):  
Sarah Kunkle ◽  
John A Naslund ◽  
Justin Hunt ◽  
Dana Udall ◽  
Erica Hayes ◽  
...  
Keyword(s):  
Mental Health ◽  
Data Science ◽  
New Technologies ◽  
Digital Health ◽  
Clinical Care ◽  
The United States ◽  
On Demand ◽  
Measurement Based Care ◽  
Multidisciplinary Perspective ◽  
Development And Management

UNSTRUCTURED Mental health is a growing public health priority in the United States and globally. Measurement-based care (MBC) has been shown to improve outcomes in clinical care, yet there are significant challenges to implementation. New technologies offer opportunities to address these obstacles and to measure new and existing constructs at a scale that was previously not possible. This paper aims to summarize existing literature on MBC, focusing on mental health and digital health. Specifically, we describe a case example called Ginger, a novel on-demand virtual system for delivering mental health services, and demonstrate how this platform aligns with core principles of MBC in mental health based on existing frameworks and findings from the literature. Additionally, we integrate feedback from multidisciplinary stakeholders (clinical practitioners, data science, product development and management, and research) to develop a perspective on key tenets of measurement in this system. To navigate the challenges of translating traditional measurement tools into new technologies in addition to developing new measurements, this multidisciplinary perspective is required. Ultimately, this will enhance our understanding of mental health and ability to develop interventions to improve outcomes.

Managed Mental Health Care: Implications for Administrators and Managers of Community-Based Agencies

1993 ◽  
Vol 74 (3) ◽  
pp. 171-177 ◽  
Author(s):  
Norman Winegar
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Care Delivery ◽  
Clinical Care ◽  
The United States ◽  
Health Care Delivery System ◽  
Community Based ◽  
Early Management ◽  
Financial Arrangements

A revolution is occurring in the private mental health care delivery system in the United States, marked by increased employer interest in how health care dollars are spent, new financial arrangements between payers and providers, and a reshaping of clinical practice to focus on efficacy and efficiency according to objective clinical care guidelines. Managed mental health care (MMHC) evolved from early management processes such as retroactive review into networks of providers in partnership with MMHC firms whose goal is to pursue effective management of benefits and care. Areas of cooperation and potential pitfalls of relationships between community' based agencies and MMHC entities are discussed.

scholarly journals Early Psychosis Service User Views on Digital Technology: Qualitative Analysis

10.2196/10091 ◽  
2018 ◽  
Vol 5 (4) ◽  
pp. e10091 ◽  
Author(s):  
Sandra Bucci ◽  
Rohan Morris ◽  
Katherine Berry ◽  
Natalie Berry ◽  
Gillian Haddock ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Digital Technology ◽  
Service User ◽  
Care Delivery ◽  
Digital Health ◽  
Early Psychosis ◽  
Treatment Modalities ◽  
Future Research ◽  
Service Users

Background Digital technology has the potential to improve outcomes for people with psychosis. However, to date, research has largely ignored service user views on digital health interventions (DHIs). Objective The objective of our study was to explore early psychosis service users’ subjective views on DHIs. Methods Framework analysis was undertaken with data obtained from 21 semistructured interviews with people registered with early intervention for psychosis services. Robust measures were used to develop a stable framework, including member checking, triangulation, independent verification of themes, and consensus meetings. Results The following 4 themes were established a priori: acceptability of technology in psychosis and mental health; technology increasing access to and augmenting mental health support; barriers to adopting DHIs; and concerns about management of data protection, privacy, risk, and security of information. The following 2 themes were generated a posteriori: blending DHIs with face-to-face treatment and empowerment, control, and choice. DHIs were also viewed as potentially destigmatizing, overcoming barriers faced in traditional service settings, facilitating communication, and empowering service users to take active control of their health care. Conclusions In the first study of its kind, early psychosis service users’ were largely positive about the potential use of DHIs supporting and managing mental health. Overall, service users felt that DHIs were a progressive, modern, and relevant platform for health care delivery. Concerns were expressed around privacy and data security and practical barriers inherent within DHIs, all of which require further attention. Future research should explore whether findings transfer to other service user groups, other technology delivery formats, and across a range of treatment modalities.

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