scholarly journals Digital Health Divide in South Asia: Ethical Concerns, Challenges, and Recommendations

2020 ◽  
Author(s):  
Md Mahbub Hossain ◽  
Wenting Weng ◽  
Sudip Bhattacharya ◽  
Hoimonty Mazumder ◽  
Farah Faizah
Keyword(s):  
Health Services ◽  
South Asia ◽  
Digital Divide ◽  
Digital Health ◽  
Healthcare Providers ◽  
Optimal Growth ◽  
Digital Platforms ◽  
Health Technologies ◽  
Ethical Concerns ◽  
Key Stakeholders

The continued development of digital health technologies is reforming health systems and services globally; however, the South Asian countries are experiencing a sub-optimal growth and use of such technologies. Thus, a digital divide in healthcare is affecting the potential transformations in health services and outcomes in this region. This implies inadequate access to the best possible health technologies for a majority of the population, raising ethical concerns for healthcare practice. We discuss such concerns and the underlying socio-ecological challenges at individual, community, society, and systems levels pertinent to the digital divide in healthcare and highlight the strategic recommendations to bridge the existing gaps. These challenges should be addressed through engaging key stakeholders in healthcare including patients, informal caregivers, healthcare providers, health services organizations, technological providers, local and regional regulatory organizations, and other entities who may inform the development and implementation of digital platforms for equitable health across populations in South Asia.

Foundations for Meaningful Consent in Canada’s Digital Health Ecosystem: Findings from a Pan-Canadian Survey (Preprint)

2021 ◽  
Author(s):  
Nelson Shen ◽  
Iman Kassam ◽  
Haoyu Zhao ◽  
Wei Wang ◽  
Sarah Wickham ◽  
...  
Keyword(s):  
Health Services ◽  
Information Needs ◽  
Digital Health ◽  
Healthcare Providers ◽  
Data Access ◽  
Patient Access ◽  
Access Channel ◽  
Patient Consent ◽  
Data Source ◽  
Healthcare Privacy

BACKGROUND Patients are increasingly gaining online access to digital health services and expect to access their data from various sources through a central patient access channel. For digital health services to connect and mutually share data, it is critical to understand patient consent preferences to meet the privacy needs of Canadians. Understanding user consent requirements and information needs is necessary in developing a trustworthy and transparent consent management system to support patient access channels. OBJECTIVE The objective of this study was to understand (1) data control preferences, (2) information needs for consent, and (3) how preferences and needs may vary by different user characteristics. METHODS A secondary analysis of a national survey was completed using a retrospective descriptive study design. The cross-sectional survey, conducted in October 2019, used a series of vignettes and consent scenarios to develop a deeper understanding of Canadians’ privacy perspectives and preferences for consent management. Non-parametric tests, and logistic regression analyses were conducted to identify differences and associations between the various factors. RESULTS Of the 1017 total responses, 70.4% (716/1017) of participants self-identified as potential users. Almost all (672/716, 93.8%) felt the ability to control their data was important, while 53.8% (385/716) believed an “all or none” control at data source level was adequate. Most users prefer new data sources to be accessible by healthcare providers (546/716, 76.3%) and delegated parties (389/716, 54.3%) by default. Users with positive healthcare privacy experiences were more likely than users with poor experiences to grant default access to healthcare providers (OR 2.78, 95%CI 1.34-5.74) and less likely to grant access to no-one (OR 0.31, 95%CI 0.14-0.72). From a list of nine information elements found in consent forms, users selected an average of 5.70 (SD 2.66) and 5.63 (SD 2.84) items to feel informed in consenting to data access by care partners, and commercial digital health service providers respectively. There were significant differences (p<0.05) in information needs between the scenarios. CONCLUSIONS Many survey participants would register and use a patient access channel and believe the ability to control data access is important, especially as it pertains to access by those outside their care. Positive healthcare experiences were a significant factor in this decision, signaling the importance of providing positive healthcare privacy experiences in both physical and digital environments. These findings suggest broad “all-or-none” approach by data source may be accepted; however, approximately one-fifth of users were unable to decide. Although vignettes were used to introduce the questions, this study showed that more context is required for users to make an informed decision. Understanding their information needs will be critical, as these needs varied with use case, highlighting the importance of prioritizing and tailoring information to enable meaningful consent.

scholarly journals Establishing a digital health platform in an academic medical center supporting rural communities

2020 ◽  
Vol 4 (5) ◽  
pp. 384-388
Author(s):  
Anita Walden ◽  
Aaron S. Kemp ◽  
Linda J. Larson-Prior ◽  
Thomas Kim ◽  
Jennifer Gan ◽  
...  
Keyword(s):  
Rural Communities ◽  
Mobile Health ◽  
Medical Center ◽  
Digital Health ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
Training Models ◽  
Health Technologies ◽  
Regional Conference ◽  
Patient Advocates

AbstractThe University of Arkansas for Medical Sciences (UAMS), like many rural states, faces clinical and research obstacles to which digital innovation is seen as a promising solution. To implement digital technology, a mobile health interest group was established to lay the foundation for an enterprise-wide digital health innovation platform. To create a foundation, an interprofessional team was established, and a series of formal networking events was conducted. Three online digital health training models were developed, and a full-day regional conference was held featuring nationally recognized speakers and panel discussions with clinicians, researchers, and patient advocates involved in digital health programs at UAMS. Finally, an institution-wide survey exploring the interest in and knowledge of digital health technologies was distributed. The networking events averaged 35–45 attendees. About 100 individuals attended the regional conference with positive feedback from participants. To evaluate mHealth knowledge at the institution, a survey was completed by 257 UAMS clinicians, researchers, and staff. It revealed that there are opportunities to increase training, communication, and collaboration for digital health implementation. The inclusion of the mobile health working group in the newly formed Institute for Digital Health and Innovation provides a nexus for healthcare providers and researches to facilitate translational research.

scholarly journals ‘We are very individual’: anticipated effects on stroke survivors of using their person-generated health data

2020 ◽  
Vol 27 (3) ◽  
pp. e100149
Author(s):  
Gerardo Luis Dimaguila ◽  
Frances Batchelor ◽  
Mark Merolli ◽  
Kathleen Gray
Keyword(s):  
Health Services ◽  
Information Technologies ◽  
Digital Health ◽  
Healthcare Providers ◽  
Health Behaviours ◽  
Stroke Care ◽  
Health Data ◽  
Care Process ◽  
Stroke Survivors ◽  
Patient Reported

BackgroundPerson-generated health data (PGHD) are produced by people when they use health information technologies. People who use PGHD may experience changes in their health and care process, such as engagement with their own healthcare, and their sense of social support and connectedness. Research into evaluating those reported effects has not kept up; thus, a method for measuring PGHD outcomes was previously designed and applied to the exemplar case of Kinect-based stroke rehabilitation systems. A key step of the method ensures that the patient’s voice is included. Allowing stroke survivors to participate in the development and evaluation of health services and treatment can inform healthcare providers on decisions about stroke care, and thereby improve health outcomes.ObjectiveThis paper presents the perspectives of stroke survivors and clinicians on the anticipated effects of stroke survivors’ use of PGHD from a poststroke simulated rehabilitation technology.MethodsThis study gathered the perspectives of stroke survivors and clinicians through three focus groups and three interviews, recruited for convenience. Participants were also asked questions intended to encourage them to comment on the initial items of the patient-reported outcome measure-PGHD. Deductive thematic analysis was performed.ResultsThis paper has further demonstrated that outcomes of using PGHD can be measured. For instance, stroke survivors described that using PGHD could result in positive, negative and nil effects on their health behaviours. Survivors and clinicians had varying perspectives in three of the six themes presented, and emphasise the importance of allowing stroke survivors to participate in the evaluation of digital health services.

scholarly journals EUROSCAN INTERNATIONAL NETWORK MEMBER AGENCIES: THEIR STRUCTURE, PROCESSES, AND OUTPUTS

2015 ◽  
Vol 31 (1-2) ◽  
pp. 78-85 ◽  
Author(s):  
Claire Packer ◽  
Sue Simpson ◽  
Rosimary Terezinha de Almeida
Keyword(s):  
Health Services ◽  
Healthcare Providers ◽  
Global Network ◽  
Network Member ◽  
International Network ◽  
Health Technologies ◽  
Additional Information ◽  
Telephone Interviews ◽  
Technology Life Cycle ◽  
Barriers To Collaboration

Objectives: The EuroScan International Network is a global network of publicly funded early awareness and alert (EAA) systems for health technologies. We describe the EuroScan member agency systems and methods, and highlight the potential for increased collaboration.Methods: EuroScan members completed postal questionnaires supplemented with telephone interviews in 2012 to elicit additional information and check equivalence of responses. Information was updated between March and May 2013.Results: Fifteen of the seventeen member agencies responded. The principal purpose of agencies is to inform decisions on coverage or reimbursement of health services and decisions on undertaking secondary research. The main users of information are national governments; health professionals; health services purchasers, commissioners, and decision makers; and healthcare providers. Most EuroScan agencies are small with almost half having fewer than two whole time equivalent staff. Ten agencies use both active and passive identification approaches, four use only active approaches. Most start identification in the experimental or investigational stages of the technology life cycle. All agencies assessed technologies when they are between the investigational and established, but under diffusion stages. Barriers to collaboration revolve around different system aims, purposes, and requirements; a lack of staff, finance, or opportunity; language differences; and restrictions on dissemination.Conclusions: Although many barriers to collaboration were identified, the majority of agencies were supportive of increased collaboration either involving the whole EuroScan Network or between individual agencies. Despite differences in the detailed identification processes, members thought that this was the most feasible phase to develop additional collaboration.

scholarly journals Crossing the Digital Divide in Online Self-Management Support: Analysis of Usage Data From HeLP-Diabetes (Preprint)

2018 ◽  
Author(s):  
Shoba Poduval ◽  
Saddif Ahmed ◽  
Louise Marston ◽  
Fiona Hamilton ◽  
Elizabeth Murray
Keyword(s):  
Type 2 Diabetes ◽  
Health Services ◽  
Digital Divide ◽  
Digital Health ◽  
Target Population ◽  
Health Interventions ◽  
Self Management ◽  
Weak Evidence ◽  
Minority Ethnic

BACKGROUND Digital health is increasingly recognized as a cost-effective means to support patient self-care. However, there are concerns about whether the “digital divide,” defined as the gap between those who do and do not make regular use of digital technologies, will lead to increased health inequalities. Access to the internet, computer literacy, motivation to use digital health interventions, and fears about internet security are barriers to use of digital health interventions. Some of these barriers disproportionately affect people of older age, black or minority ethnic background, and low socioeconomic status. HeLP-Diabetes (Healthy Living for People with type 2 Diabetes), a theoretically informed online self-management program for adults with type 2 diabetes, was developed to meet the needs of people from a broad demographic background. OBJECTIVE This study aimed to determine whether there was evidence of a digital divide when HeLP-Diabetes was integrated into routine care. This was achieved by (1) comparing the characteristics of people who registered for the program against the target population (people with type 2 diabetes in inner London), (2) comparing the characteristics of people who registered for the program and used it with those who did not use it, and (3) comparing sections of the website visited by different demographic groups. METHODS A retrospective analysis of data on the use of HeLP-Diabetes in routine clinical practice in 4 inner London clinical commissioning groups was undertaken. Data were collected from patients who registered for the program as part of routine health services.. Data on gender, age, ethnicity, and educational attainment were collected at registration, and data on webpage visits (user identification number, date, time, and page visited) were collected automatically by software on the server side of the website. RESULTS The characteristics of people who registered for the program were found to reflect those of the target population. The mean age was 58.4 years (SD=28.0), over 50.0% were from black and minority ethnic backgrounds, and nearly a third (29.8%) had no qualifications beyond school leaving age. There was no association between demographic characteristics and use of the program, apart from weak evidence of less use by the mixed ethnicity group. There was no evidence of the differential use of the program by any demographic group, apart from weak evidence for people with degrees and school leavers being more likely to use the “Living and working with diabetes” (P=.03) and “Treating diabetes” (P=.04) sections of the website. CONCLUSIONS This study is one of the first to provide evidence that a digital health intervention can be integrated into routine health services without widening health inequalities. The relative success of the intervention may be attributed to integration into routine health care, and careful design with extensive user input and consideration of literacy levels. Developers of digital health interventions need to acknowledge barriers to access and use, and collect data on the demographic profile of users, to address inequalities.

Digital Health Innovation Enhancing Patient Experience in Medical Travel

2021 ◽  
pp. 199-223
Author(s):  
Anita Medhekar
Keyword(s):  
Instant Messaging ◽  
Digital Health ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Health Records ◽  
Health Technologies ◽  
Medical Travel ◽  
Travel Decision ◽  
Health Data Analytics ◽  
The Relationship

Digital health technological innovations are disrupting every sector of the economy, including medical travel/tourism. Global patients as medical tourists are using patient-centric digital health technologies, enhancing patient/medical tourists experience and making it more transparent and engaging with healthcare providers and medical tourists. Digital communication tools such as e-mail, online appointments, smartphones, instant messaging applications, social media tools, user-generated content by online patient communities, tele-medicine, tele-radiology, my-Health records, Skype consultation, WhatsApp, health video, electronic health records, health data analytics tools, and artificial intelligence-enabled health technologies enhance the medical travel decision-making process, reduce cost, improve patient care and transparency of communication, and engage the relationship between the patient and the healthcare provider with positive outcomes, medical tourist experience, and empowerment.

Application of a health technology assessment framework to digital health technologies that manage chronic disease: a systematic review

2021 ◽  
Vol 38 (1) ◽  
Author(s):  
Amy von Huben ◽  
Martin Howell ◽  
Joseph Carrello ◽  
Sarah Norris ◽  
Sally Wortley ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health Services ◽  
Health Technology Assessment ◽  
Technology Assessment ◽  
Digital Health ◽  
Investment Decisions ◽  
Health Technology ◽  
Cochrane Library ◽  
Primary Research ◽  
Health Technologies

Abstract Background As health services increasingly make investment decisions in digital health technologies (DHTs), a DHT-specific and comprehensive health technology assessment (HTA) process is crucial in assessing value-for-money. Research in DHTs is ever-increasing, but whether it covers the content required for HTA is unknown. Objectives To summarize current trends in primary research on DHTs that manage chronic disease at home, particularly the coverage of content recommended for DHT-specific and comprehensive HTA. Methods Medline, Embase, Econlit, CINAHL, and The Cochrane Library (1 January 2015 to 20 March 2020) were searched for primary research studies using keywords related to DHT and HTA domains. Studies were assessed for coverage of the most frequently recommended content to be considered in a nine domain DHT-specific HTA previously developed. Results A total of 178 DHT interventions were identified, predominantly randomized controlled trials targeting cardiovascular disease/diabetes in high- to middle-income countries. A coverage assessment of the cardiovascular and diabetes DHT studies (112) revealed less than half covered DHT-specific content in all but the health problem domain. Content common to all technologies but essential for DHTs was covered by more than half the studies in all domains except for the effectiveness and ethical analysis domains. Conclusions Although DHT research is increasing, it is not covering all the content recommended for a DHT-specific and comprehensive HTA. The inability to conduct such an HTA may lead to health services making suboptimal investment decisions. Measures to increase the quality of trial design and reporting are required in DHT primary research.

scholarly journals “Sometimes I don’t have a pulse, and I’m still alive!” Healthcare providers on digital health techs

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
F Tomasella ◽  
H M Morgan
Keyword(s):  
Digital Health ◽  
Healthcare Providers ◽  
Future Research ◽  
Structured Interviews ◽  
Clinical Value ◽  
Health Technologies ◽  
Advantages And Disadvantages ◽  
Health Related ◽  
Potential Benefits ◽  
Change Promotion

Abstract Background Digital health technologies (DHTs) are increasingly becoming an integral part of our lives, healthcare field included. The WHO recently has even released the first digital health guidelines for worldwide intervention. Commercially available DHTs (e.g. smartphones, smartwatches, apps) may hold significant potential in healthcare, upon successful and constructive integration. Literature on the topic is split between enthusiasm for the potential benefits, and concerns about reliability and effectiveness. Little is known about what healthcare professionals (HCPs) have experienced so far with patients and what they believe the main issues for implementation may be. This study aims to investigate current perceptions of HCPs towards self-tracked health-related outputs from devices and apps available to the public. Methods Nine HCPs volunteered to take part in semi-structured interviews. Data were thematically analysed adopting a pre-constructed framework (deductive approach) based on current (April 2019) literature and the findings from the first two interviews. Results The following main themes were identified and explored in detail: HCPs' experience, perceived knowledge and views on DHTs; advantages and disadvantages; barriers towards healthcare implementation and solutions; future perspectives. While most participants were adopters of DHTs and held positive views about them, their overall experience with patients and the technology was limited. Potential reasons for this included factors such as time/resources availability; colleagues' mindset; lack of evidence of effectiveness for practice; privacy/data security concerns. Conclusions The potential advantages of DHTs' adoption in healthcare are substantial - e.g. patient autonomy, time/resources saving, health and behaviour change promotion. However, future research is warranted focussing on addressing barriers, minimising disadvantages, and assessing the clinical value of commercially available DHTs. Key messages We explored healthcare providers’ views on the role of commercial digital health techs in clinical practice. Despite some privacy and reliability concerns, commercial digital health techs show promise.

Selecting digital health technologies for validation and piloting by healthcare providers: a decision-making perspective from ontario

2019 ◽  
Vol 35 (1) ◽  
pp. 1-4
Author(s):  
Amarjit Chahal ◽  
Abraham Rudnick
Keyword(s):  
Decision Making ◽  
Digital Health ◽  
Healthcare Providers ◽  
Healthcare Organizations ◽  
Health Technologies ◽  
Health Apps ◽  
Strategic Direction ◽  
Academic Hospitals ◽  
Health Related ◽  
Alternative Approaches

AbstractDigital health technologies (DHTs) such as health apps are rapidly emerging as a major disruptor of health care. Yet there is no well-established process of decision making for selecting DHTs that are worthy of investing resources in their validation to determine whether they are ready (safe, effective, and not too costly) for health related use. We report here on an Ontario-based initiative to support such decision making. Specifically, we developed a decision-making algorithm that uses approved criteria including the strategic direction of the health research institute and the hospital, and availability of resources. The Council of Academic Hospitals of Ontario has adapted our approach for other hospitals. We hope that other healthcare organizations, in and beyond Ontario, will consider this and alternative approaches, and that research will be conducted to evaluate such approaches.

Digital Health Innovation Enhancing Patient Experience in Medical Travel

2020 ◽  
pp. 13-35 ◽  
Author(s):  
Anita Medhekar
Keyword(s):  
Instant Messaging ◽  
Digital Health ◽  
Healthcare Providers ◽  
Improve Patient Care ◽  
Health Records ◽  
Health Technologies ◽  
Medical Travel ◽  
Travel Decision ◽  
Health Data Analytics ◽  
The Relationship

Digital health technological innovations are disrupting every sector of the economy, including medical travel/tourism. Global patients as medical tourists are using patient-centric digital health technologies, enhancing patient/medical tourists experience and making it more transparent and engaging with healthcare providers and medical tourists. Digital communication tools such as e-mail, online appointments, smartphones, instant messaging applications, social media tools, user-generated content by online patient communities, tele-medicine, tele-radiology, my-Health records, Skype consultation, WhatsApp, health video, electronic health records, health data analytics tools, and artificial intelligence-enabled health technologies enhance the medical travel decision-making process, reduce cost, improve patient care and transparency of communication, and engage the relationship between the patient and the healthcare provider with positive outcomes, medical tourist experience, and empowerment.

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