scholarly journals Role of the Internet in Solving the Last Mile Problem in Medicine

10.2196/16385 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e16385
Author(s):  
Bradford William Hesse
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Rural Areas ◽  
Task Force ◽  
Digital Health ◽  
The United States ◽  
Good News ◽  
The Internet ◽  
Last Mile ◽  
Last Mile Problem

Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the “last mile problem in health care.” In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission’s (FCC’s) Connect2Health Task Force, is the unanticipated emergence of “double burden counties,” ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at “point-of-need,” (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.

scholarly journals Role of the Internet in Solving the Last Mile Problem in Medicine (Preprint)

2019 ◽  
Author(s):  
Bradford William Hesse
Keyword(s):  
Health Care ◽  
Digital Divide ◽  
Rural Areas ◽  
Task Force ◽  
Digital Health ◽  
The United States ◽  
Good News ◽  
The Internet ◽  
Last Mile ◽  
Last Mile Problem

UNSTRUCTURED Internet-augmented medicine has a strong role to play in ensuring that all populations benefit equally from discoveries in the medical sciences. Yet, data from the Centers for Disease Control and Prevention collected from 1999 to 2014 suggested that during the first phase of internet diffusion, progress against mortality has stalled, and in some cases, receded in rural areas that are traditionally underserved by medical and broadband resources. This problem of failing to extend the benefits of extant medical knowledge equitably to all populations regardless of geography can be framed as the “last mile problem in health care.” In theory, the internet should help solve the last mile problem by making the best knowledge in the world available to everyone worldwide at a low cost and no delay. In practice, the antiquated supply chains of industrial age medicine have been slow to yield to the accelerative forces of evolving internet capacity. This failure is exacerbated by the expanding digital divide, preventing residents of isolated, geographically distant communities from taking full advantage of the digital health revolution. The result, according to the Federal Communications Commission’s (FCC’s) Connect2Health Task Force, is the unanticipated emergence of “double burden counties,” ie, counties for which the mortality burden is high while broadband access is low. The good news is that a convergence of trends in internet-enabled health care is putting medicine within striking distance of solving the last mile problem both in the United States and globally. Specific trends to monitor over the next 25 years include (1) using community-driven approaches to bridge the digital divide, (2) addressing structural disconnects in care through P4 Medicine, (3) meeting patients at “point-of-need,” (4) ensuring that no one is left behind through population management, and (5) self-correcting cybernetically through the learning health care system.

Critical Care in Critical Access Hospitals

2015 ◽  
Vol 35 (5) ◽  
pp. 62-67 ◽  
Author(s):  
Teresa J. Seright ◽  
Charlene A. Winters
Keyword(s):  
Health Care ◽  
Critical Care ◽  
Rural Areas ◽  
Tertiary Care ◽  
Safety Net ◽  
The United States ◽  
Infusion Therapy ◽  
Critical Access Hospitals ◽  
Hospital System ◽  
Critical Access Hospital

What began as a grant-funded demonstration project, as a means of bridging the gap in rural health care, has developed into a critical access hospital system comprising 1328 facilities across 45 states. A critical access hospital is not just a safety net for health care in a rural community. Such hospitals may also provide specialized services such as same-day surgery, infusion therapy, and intensive care. For hospitals located near the required minimum of 35 miles from a tertiary care center, management of critically ill patients may be a matter of stabilization and transfer. Critical access hospitals in more rural areas are often much farther from tertiary care; some of these hospitals are situated within frontier areas of the United States. This article describes the development of critical access hospitals, provision of care and services, challenges to critical care in critical access hospitals, and suggestions to address gaps in research and collaborative care.

A Program to Increase Health Care for Children: The Pediatric Nurse Practitioner Program, by Henry K. Silver, MD, Loretta C. Ford, EdD, and Susan G. Stearly, MS, Pediatrics, 1967;39:756–760

PEDIATRICS ◽  
1998 ◽  
Vol 102 (Supplement_1) ◽  
pp. 245-247
Author(s):  
Robert A. Hoekelman
Keyword(s):  
Health Care ◽  
Nurse Practitioner ◽  
Rural Areas ◽  
The United States ◽  
Optimum Level ◽  
Socioeconomic Groups ◽  
Pediatric Nurse ◽  
Lower Socioeconomic ◽  
Urban And Rural Areas ◽  
Pediatric Nurse Practitioner

The increase in population of the United States is occurring at a much more rapid rate than the increase in medical and nursing personnel available to maintain health services at an optimum level. Unless the pattern of furnishing health care, particularly to lower socioeconomic groups in both urban and rural areas, is drastically improved, these groups will suffer from increasingly inadequate health supervision. This paper describes an educational and training program in pediatrics for professional nurses (the “pediatric nurse practitioner” program), which prepares them to assume an expanded role in providing increased health care for children in areas where there are limited facilities for such care.

scholarly journals Characterizing the Rural Opioid Use Environment in Kentucky Using Google Earth: Virtual Audit

10.2196/14923 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14923 ◽  
Author(s):  
Natalie Danielle Crawford ◽  
Regine Haardöerfer ◽  
Hannah Cooper ◽  
Izraelle McKinnon ◽  
Carla Jones-Harrell ◽  
...  
Keyword(s):  
Health Care ◽  
Land Use ◽  
Substance Use ◽  
Rural Areas ◽  
Physical Environment ◽  
The United States ◽  
Google Earth ◽  
Health Care Facilities ◽  
Opioid Epidemic ◽  
Care Facilities

Background The opioid epidemic has ravaged rural communities in the United States. Despite extensive literature relating the physical environment to substance use in urban areas, little is known about the role of physical environment on the opioid epidemic in rural areas. Objective This study aimed to examine the reliability of Google Earth to collect data on the physical environment related to substance use in rural areas. Methods Systematic virtual audits were performed in 5 rural Kentucky counties using Google Earth between 2017 and 2018 to capture land use, health care facilities, entertainment venues, and businesses. In-person audits were performed for a subset of the census blocks. Results We captured 533 features, most of which were images taken before 2015 (71.8%, 383/533). Reliability between the virtual audits and the gold standard was high for health care facilities (>83%), entertainment venues (>95%), and businesses (>61%) but was poor for land use features (>18%). Reliability between the virtual audit and in-person audit was high for health care facilities (83%) and entertainment venues (62%) but was poor for land use (0%) and businesses (12.5%). Conclusions Poor reliability for land use features may reflect difficulty characterizing features that require judgment or natural changes in the environment that are not reflective of the Google Earth imagery because it was captured several years before the audit was performed. Virtual Google Earth audits were an efficient way to collect rich neighborhood data that are generally not available from other sources. However, these audits should use caution when the images in the observation area are dated.

Digital Health Literacy: A Bibliometric Analysis (Preprint)

2021 ◽  
Author(s):  
Keng Yang ◽  
Yekang Hu ◽  
Hanying Qi
Keyword(s):  
Health Literacy ◽  
Health Outcomes ◽  
Digital Divide ◽  
Bibliometric Analysis ◽  
Digital Health ◽  
The United States ◽  
Research Progress ◽  
Future Research ◽  
Scientific Publications ◽  
Number Of Publications

BACKGROUND Digital health is growing at a rapid pace, and digital health literacy has tremendous potential to promote health outcomes, bridge the digital divide, and improve health inequalities. OBJECTIVE The purposes of this study are to conduct a systematic bibliometric analysis on the field of dig-ital health literacy and to understand the research context and trends in this field. METHODS A total of 1,955 scientific publications were collected from the Web of Science (WoS) core col-lection. Institutional cooperation, journal co-citation, theme bursting, keyword co-occurrence, author cooperation, author co-citation, literature co-citation and references in the field of digi-tal health literacy were analyzed using the VOSviewer and CiteSpace knowledge mapping tools. RESULTS The results demonstrated that the United States was the leader in number of publications and citations in this field. The University of California System was first in terms of institutional contributions. The Journal of Medical Internet Research led in number of publications, cita-tions and co-citations. Research areas in the field of digital health literacy mainly include the definition and scale of health literacy, health literacy and health outcomes, health literacy and the digital divide, and the influencing factors of health literacy. CONCLUSIONS We summarize research progress in the field of digital health literacy and reveal the context, trends, and trending topics of digital health literacy research through statistical analysis and network visualization. Our work can serve as a fundamental reference and directional guide for future research in this field.

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.

DIFFUSION OF INFORMATION COMMUNICATION TECHNOLOGY (ICT) THROUGH THE RURAL INTERNET CENTRE: THE MALAYSIAN EXPERIENCE

2010 ◽  
Vol 07 (02) ◽  
pp. 129-143
Author(s):  
AININ SULAIMAN ◽  
NOOR ISMAWATI JAAFAR ◽  
ROHANA JANI
Keyword(s):  
Rural Communities ◽  
Digital Divide ◽  
Rural Areas ◽  
Communication Channel ◽  
The Internet ◽  
Information Communication ◽  
Community Members ◽  
Diffusion Of Information ◽  
E Mail ◽  
By Products

This paper focuses on examining the ICT diffusion by studying an initiative of the Malaysian government to bridge the digital divide that exists across the country's urban and rural communities. This is achieved through investigating the operation and the experience of a typical Rural Internet Centre. The findings of this study showed that there is keen interest among the community to learn and sharpen their ICT-related skills. The Internet Centre serves to provide an avenue for the realisation of this goal. The study showed that despite some operational snags, the Internet Centre performed well. One of the by-products of the centre was that its activities fostered closer relationships among users; it provided an avenue for disparate community members to interact and share their new skills. Bringing the ICT usage and appreciation to the rural areas was successful. About half of the centre users made weekly visits during which they searched for information on the internet, sent and received e-mail and attended the Internet Centre's regular IT classes. They also saw it as a valuable communication channel and a potential leveller of the technological capability gap.

The Digital Revolution in Behavioral Health

2019 ◽  
Vol 26 (1) ◽  
pp. 102-111 ◽  
Author(s):  
Michael J Hasselberg
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Digital Health ◽  
Behavioral Health Care ◽  
The United States ◽  
Care Providers ◽  
Digital Revolution ◽  
The University

BACKGROUND: Technology is disrupting every modern industry, from supermarkets to car manufacturing, and is now entering the health care space. Technological innovations in psychiatry include the opportunity for conducting therapy via two-way video conferencing, providing electronic consultations, and telementoring and education of community health care providers. Use of mobile health applications is also an expanding area of interest and promise. OBJECTIVE: The purpose of this article is to review the evolution and pros and cons of technology-enabled health care since the digital movement in psychiatry began more than 50 years ago as well as describe the University of Rochester’s innovative digital behavioral health care model. METHODS: A review of the literature and recent reports on innovations in digital behavioral health care was conducted, along with a review of the University of Rochester’s model to describe the current state of digital behavioral health care. RESULTS: Given the lack of access to care and mental health professional shortages in many parts of the United States, particularly rural areas, digital behavioral health care will be an increasingly important strategy for managing mental health care needs. However, there are numerous hurdles to be overcome in adopting digital health care, including provider resistance and knowledge gaps, lack of reimbursement parity, restrictive credentialing and privileging, and overregulation at both the state and federal levels. CONCLUSIONS: Digital health innovations are transforming the delivery of mental health care services and psychiatric mental health nurses can be on the forefront of this important digital revolution.

Taking Care of Business

2017 ◽  
Author(s):  
Dan Schiller
Keyword(s):  
Task Force ◽  
The United States ◽  
Free Flow ◽  
The Internet ◽  
Computing Services ◽  
Internet Policy ◽  
Global Commerce ◽  
Free Flow Of Information ◽  
The Impact ◽  
Flow Of Information

This chapter examines the Commerce Department's free-flow policy as part of its power over internet policy. It first provides an overview of U.S.–centric internet and Commerce's Internet Policy Task Force, established to launch an inquiry into “the global free flow of information on the Internet.” The inquiry's purpose was “to identify and examine the impact that restrictions on the flow of information over the Internet have on American businesses and global commerce.” The chapter also considers Commerce's commodification strategies based in part on data centers and the place of cloud computing services in the department's free-flow inquiry. It shows that the Commerce Department's free-flow policy was a major component of the federal government's overall efforts to keep corporate data flows streaming without restriction as new profit sites emerged around an extraterritorial internet managed by the United States.

Critical Challenges and Impediments Affecting Rural Physicians During a Public Health Emergency

2012 ◽  
Vol 6 (4) ◽  
pp. 342-348 ◽  
Author(s):  
Gavin J. Putzer ◽  
Mirka Koro-Ljungberg ◽  
R. Paul Duncan
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Rural Areas ◽  
Associated Factors ◽  
The United States ◽  
Public Health Emergency ◽  
Care Providers ◽  
Rural Physicians

ABSTRACTObjective: Disaster preparedness has become a health policy priority for the United States in the aftermath of the anthrax attacks, 9/11, and other calamities. It is important for rural health care professionals to be prepared for a bioterrorist attack or other public health emergency. We sought to determine the barriers impeding rural physicians from being prepared for a human-induced disaster such as a bioterrorist attack.Methods: This study employed a qualitative methodology using key informant interviews followed by grounded theory methods for data analysis. Semistructured interviews were conducted with 6 physicians in the state of Florida from federally designated rural areas.Results: The interview participants articulated primary barriers and the associated factors contributing to these barriers that may affect rural physician preparedness for human-induced emergencies. Rural physicians identified 3 primary barriers: accessibility to health care, communication between physicians and patients, and rural infrastructure and resources. Each of these barriers included associated factors and influences. For instance, according to our participants, access to care was affected by a lack of health insurance, a lack of finances for health services, and transportation difficulties.Conclusions: Existing rural organizational infrastructure and resources are insufficient to meet current health needs owing to a number of factors including the paucity of health care providers, particularly medical specialists, and the associated patient-level barriers. These barriers presumably would be exacerbated in the advent of a human-induced public health emergency. Thus, strategically implemented health policies are needed to mitigate the barriers identified in this study.(Disaster Med Public Health Preparedness. 2012;6:342–348)

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