Digital Health Transition in Rheumatology: A Qualitative Study

The global COVID-19 pandemic has led to drastic changes in the management of patients with rheumatic diseases. Due to the imminent risk of infection, monitoring intervals of rheumatic patients have prolonged. The aim of this study is to present insights from patients, rheumatologists, and digital product developers on the ongoing digital health transition in rheumatology. A qualitative and participatory semi-structured fishbowl approach was conducted to gain detailed insights from a total of 476 participants. The main findings show that digital health and remote care are generally welcomed by the participants. Five key themes emerged from the qualitative content analysis: (1) digital rheumatology use cases, (2) user descriptions, (3) adaptation to different environments of rheumatology care, and (4) potentials of and (5) barriers to digital rheumatology implementation. Codes were scaled by positive and negative ratings as well as on micro, meso, and macro levels. A main recommendation resulting from the insights is that both patients and rheumatologists need more information and education to successfully implement digital health tools into clinical routine.

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Determinants of and barriers to adoption of digital therapeutics for mental health at scale in the NHS

BMJ Innovations ◽

10.1136/bmjinnov-2019-000384 ◽

2020 ◽

Vol 6 (3) ◽

pp. 92-98

Author(s):

Matt G Williams ◽

Richard Stott ◽

Nicki Bromwich ◽

Susie K Oblak ◽

Colin A Espie ◽

...

Keyword(s):

Mental Health ◽

Digital Literacy ◽

Market Access ◽

Qualitative Content Analysis ◽

Digital Health ◽

Decision Makers ◽

Structured Interviews ◽

Barriers To Adoption ◽

Information Governance ◽

Further Development

ObjectivesAlthough it is widely acknowledged that digital therapeutics will play a significant role in the future delivery of healthcare, the method by which these innovations may be commissioned by the National Health Service, at scale, remains unclear. This study explores English health commissioners’ experiences of, and attitudes towards, adopting digital healthcare innovations.Methods37 commissioners and decision-makers from a range of sectors within the health profession were invited to participate in structured interviews to gather relevant examples of experience and opinions. 14 commissioners participated and the notes from the resulting interviews were interpreted using qualitative content analysis. Controlled interpretation was applied to the categorised responses, paraphrasing and classifying into themes.ResultsCommon determinants and barriers to adoption of digital mental health expressed during the interview process included commissioners’ lack of familiarity with technology, information governance, digital literacy of users and decision-makers.ConclusionsRecognition of identified barriers may be helpful for innovators when developing engagement and market access strategies and suggest areas for focus and further development within the commissioning process to accommodate digital health solutions.

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Impact of the COVID-19 Pandemic on Cancer Researchers in 2020: A Qualitative Study of Events to Inform Mitigation Strategies

Frontiers in Public Health ◽

10.3389/fpubh.2021.741223 ◽

2021 ◽

Vol 9 ◽

Author(s):

Louis Fox ◽

Katharina Beyer ◽

Elke Rammant ◽

Esme Morcom ◽

Mieke Van Hemelrijck ◽

...

Keyword(s):

Cancer Research ◽

English Language ◽

Qualitative Content Analysis ◽

Digital Health ◽

Research Priorities ◽

Economic Effects ◽

Mitigation Strategies ◽

Future Research ◽

Research Strategies ◽

Research Activity

Introduction: The COVID-19 pandemic has had an unprecedented impact on global health systems and economies. With ongoing and future challenges posed to the field due to the pandemic, re-examining research priorities has emerged as a concern. As part of a wider project aiming to examine research priorities, here we aimed to qualitatively examine the documented impacts of the COVID-19 pandemic on cancer researchers.Materials and Methods: We conducted a literature review with the aim of identifying non-peer-reviewed journalistic sources and institutional blog posts which qualitatively documented the effects of the COVID-19 pandemic on cancer researchers. We searched on 12th January 2021 using the LexisNexis database and Google, using terms and filters to identify English-language media reports and blogs, containing references to both COVID-19 and cancer research. The targeted search returned 751 results, of which 215 articles met the inclusion criteria. These 215 articles were subjected to a conventional qualitative content analysis, to document the impacts of the pandemic on the field of cancer research.Results: Our analysis yielded a high plurality of qualitatively documented impacts, from which seven categories of direct impacts emerged: (1) COVID measures halting cancer research activity entirely; (2) COVID measures limiting cancer research activity; (3) forced adaptation of research protocols; (4) impacts on cancer diagnosis, cases, and services; (5) availability of resources for cancer research; (6) disruption to the private sector; and (7) disruption to supply chains. Three categories of consequences from these impacts also emerged: (1) potential changes to future research practice; (2) delays to the progression of the field; and (3) potential new areas of research interest.Discussion: The COVID-19 pandemic had extensive practical and economic effects on the field of cancer research in 2020 that were highly plural in nature. Appraisal of cancer research strategies in a post-COVID world should acknowledge the potential for substantial limitations (such as on financial resources, limited access to patients for research, decreased patient access to cancer care, staffing issues, administrative delays, or supply chain issues), exacerbated cancer disparities, advances in digital health, and new areas of research related to the intersection of cancer and COVID-19.

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Digital health in the age of The Infinite Network

APSIPA Transactions on Signal and Information Processing ◽

10.1017/atsip.2016.6 ◽

2016 ◽

Vol 5 ◽

Cited By ~ 1

Author(s):

Nikhil Balram ◽

Ivana Tošić ◽

Harsha Binnamangalam

Keyword(s):

Large Scale ◽

Digital Health ◽

Wearable Sensors ◽

Embedded Sensors ◽

Individual Level ◽

Continuous Approach ◽

Infinite Network ◽

Remote Care ◽

The Impact

The exponential growth in digital technology is leading us to a future in which all things and all people are connected all the time, something we refer to as The Infinite Network (TIN), which will cause profound changes in every industry. Here, we focus on the impact it will have in healthcare. TIN will change the essence of healthcare to a data-driven continuous approach as opposed to the event-driven discrete approach used today. At a micro or individual level, smart sensing will play a key role, in the form of embedded sensors, wearable sensors, and sensing from smart medical devices. At a macro or aggregate level, healthcare will be provided by Intelligent Telehealth Networks that evolve from the telehealth networks that are available today. Traditional telemedicine has delivered remote care to patients in the area where doctors are not readily available, but has not achieved at large scale. New advanced networks will deliver care at a much larger scale. The long-term future requires intelligent hybrid networks that combine artificial intelligence with human intelligence to provide continuity of care at higher quality and lower cost than is possible today.

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POS1114 INFECTION RISK AMONG RHEUMATIC PATIENTS RECEIVING DENOSUMAB THERAPY: SINGLE CENTRE EXPERIENCE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3038 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 837.1-837

Author(s):

K. L. Ng ◽

M. Mohd Zain ◽

I. S. Lau

Keyword(s):

Postmenopausal Women ◽

Treatment Duration ◽

Infection Risk ◽

Director General ◽

Risk Of Infection ◽

Steroid Use ◽

Dmard Therapy ◽

Chronic Lung Diseases ◽

Biologic Dmard ◽

Rheumatic Patients

Background:Osteoporosis (OS) is common in rheumatic diseasas (RMD). OS fracture leads to morbidity and premature mortality. The treatment for OS is well established with good long term safety profile. Oral bisphosphonate (BIS) is recommended as initial treatment option for both postmenopausal and glucocorticoid induced OS. Denosumab (DSB), is the noninferior alternative option. Despite its efficacy, DSB was linked with elevated infection risk in non RMD. Yet, data in RMD is lacking.Objectives:To determine the infection risk and associated factors in RMD patients receiving DSB.Methods:This is retrospective cohort study. Data was extracted from medical database (between Jan 2010 & Dec 2018) at Selayang Hospital, Malaysia. Descriptive statistical analysis, logistic regression (LR) and cox (proportional hazard) regression [CPHR] were the analysis methods.Results:50 cases were analysed. 96% were female. The median age was 72.5 ± 12.7 years. The primary rheumatological disorders were rheumatoid arthritis (48%), OS (24%) and systemic lupus erythematosus (10%). 92% had ≥ 1 comorbidity including metabolic/cardiovascular diseases (74%), chronic lung diseases (CLD) (40%) and diabetes mellitus (DM) (22%). 54% had disease modifying anti rheumatic drug (DMARD) therapy; majority (59.2%) received single conventional synthetic DMARD. Only 7.4% received combination biologic DMARD therapy. 28% had received prednisolone therapy, with dose < 7.5mg OD in 78.6%.The median age at DSB initiation was 71 ± 12.4 years. 38% had fracture history and 88% had received previous OS treatment.In total, 13 infection episodes were recorded. The infection risk was 26% & incidence rate was 134 cases per 1000 person-years. 84.6% required hospitalisation and 38.5% were severe cases. The mortality rate was 23.1%. The mean DSB treatment duration to first infection was 15.46 ± 11.9 months.Univariate LR showed infection risk and hospitalisation were higher with longer DSB treatment duration, OR 1.062 (95% CI: 1.010 - 1.117), p = 0.018) & OR 1.057 (95% CI: 1.003 - 1.114, p = 0.037), respectively. These risks were lower in absence of steroid use, OR 0.2 (95% CI: 0.051 - 0.784, p = 0.021) and OR 0.215 (95% CI: 0.052 - 0.889, p = 0.034), respectively. Additionally, infection risk was lower in absence of CLD, OR 0.188 (95% CI: 0.048 - 0.742, p = 0.017) and hospitalisation was lower without concomitant DM, OR 0.050 (95% CI: 0.050 — 0.950, p = 0.043). Yet, multivariate LR did not infer the above predictions, after adjustment made for age, gender, rheumatological diseases, comorbidity, DMARD therapy and steroid dosing. For severe infection and case fatality, no predictive factors were identified.CPHR showed patients without steroid use had lower fatality risk, HR 0.077 (95% CI: 0.007 - 0.864, p = 0.038). With confounding factors (age, gender, previous infection and comorbidity), the observed difference was insignificant.Conclusion:Risk of infection and hospitalisation could be higher in rheumatic patients receiving longer DSB treatment duration. Concomitant comorbidities (CLD and DM) might increase the risk of infection and/or hospitalisation.References:[1]Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361:756–65.[2]Watts NB, Roux C, Modlin JF, Brown JP, Daniels A, Jackson S, Smith S, Zack DJ, Zhou L, Grauer A, Ferrari S. Infections in postmenopausal women with osteoporosis treated with denosumab or placebo: coincidence or causal association? Osteoporos Int. 2012;23(1):327–337.[3]Prabhakaran S, Pritchard C. Comparison of infection rates in patients receiving denosumab, denosumab and biologics and biologics alone in a suburban rheumatology clinic [abstract]. Arthritis Rheumatol 2014;66 Suppl 10:S409.[4]Bray V, Bagley A, West S, Etzel C, Kremer J, Kolfenbach J. Infection risk among patients receiving concurrent denosumab and biologic or non-biologic DMARD therapy: An analysis of the ConsortiumAcknowledgements:We would like to thank the Director General of Health Malaysia for his permission for this poster presentation.Disclosure of Interests:None declared.

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Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers (Preprint)

10.2196/preprints.19284 ◽

2020 ◽

Cited By ~ 4

Author(s):

Guy Fagherazzi ◽

Catherine Goetzinger ◽

Mohammed Ally Rashid ◽

Gloria A Aguayo ◽

Laetitia Huiart

Keyword(s):

Public Health ◽

Digital Health ◽

Digital Tools ◽

Risk Of Infection ◽

Care Model ◽

Health Initiatives ◽

Social Media Platforms ◽

Health Social Media ◽

Public Reaction

UNSTRUCTURED The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients’ symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users’ cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis.

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Characteristics and Symptoms of App Users Seeking COVID-19–Related Digital Health Information and Remote Services: Retrospective Cohort Study

Journal of Medical Internet Research ◽

10.2196/23197 ◽

2020 ◽

Vol 22 (10) ◽

pp. e23197

Author(s):

Amichai Perlman ◽

Alina Vodonos Zilberg ◽

Peter Bak ◽

Michael Dreyfuss ◽

Maya Leventer-Roberts ◽

...

Keyword(s):

Health Information ◽

Clinical Characteristics ◽

Digital Health ◽

Relative Rate ◽

Limited Information ◽

Self Assessment ◽

Ocular Symptoms ◽

Medical Evaluation ◽

Predominantly Female ◽

Remote Care

Background Patient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice. Objective The aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19–related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools. Methods This study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)–driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19–related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician. Results During the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department. Conclusions Our results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19.

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Can We Enable Digital Transition in Healthcare Delivery?

Research Anthology on Telemedicine Efficacy, Adoption, and Impact on Healthcare Delivery ◽

10.4018/978-1-7998-8052-3.ch005 ◽

2021 ◽

pp. 65-88

Author(s):

Sylvie Occelli ◽

Bibiana Scelfo

Keyword(s):

Health Knowledge ◽

Digital Health ◽

Healthcare Delivery ◽

Health Department ◽

Local Context ◽

Maturity Model ◽

Health Transition ◽

Conceptual Approach ◽

Collaborative Environment ◽

Ehealth Service

Implementing digital health transition is challenging. Whilst technology progresses rapidly, the appropriation of innovation in healthcare is slower and has to deal with the local context. This is the case with Piedmont, an Italian region where in the last decade a number of telemedicine projects have been launched. In order to assess their implementation a survey has been recently conducted by the regional Health Department. This work builds upon the results of this investigation. The conceptual approach underlying the survey is illustrated and the main findings of the investigation discussed. To examine the regional situation, a notion of telemedicine maturity model is used. By making it explicit the main dimensions entailed in developing an ehealth service, its application can facilitate the digital health transition in the region. A core argument is that to handle the complexity of ehealth projects a collaborative environment for exchanging health knowledge should be implemented.

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Standards of hygiene for ultrasound-guided core cut biopsies of the breast

Ultraschall in der Medizin - European Journal of Ultrasound ◽

10.1055/a-0667-7898 ◽

2018 ◽

Vol 39 (06) ◽

pp. 636-642

Author(s):

Jörg Heil ◽

Sarah Hug ◽

Heike Martiny ◽

Michael Golatta ◽

Manuel Feisst ◽

...

Keyword(s):

German Society ◽

Breast Ultrasound ◽

Evidence Based ◽

Risk Of Infection ◽

Ultrasound Guided ◽

Clinical Routine ◽

Biopsy Needle ◽

Skin Disinfection ◽

Hygiene Measures ◽

Evidence Based Guidelines

Abstract Purpose The aim was to obtain an overview of the hygiene measures undertaken during ultrasound guided core cut biopsies of the breast by experts certified by the German Society for Ultrasound in Medicine in order to derive recommendations for clinical routine, taking into account the available literature and the lack of evidence based guidelines. Materials and Methods A survey was conducted with all members of the levels I to III of the breast ultrasound working group of the German Society for Ultrasound in Medicine. The estimation of the risk of infection after a core cut biopsy of the breast was asked for as well as the hygiene measures undertaken in practice to avoid infection. Results The risk of infection after a core cut biopsy of the breast was estimated to be one per thousand (median value). The most commonly performed hygiene measures were a spray, wipe, spray desinfection (98.1 %) and the use of sterile gloves (54.7 %). Conclusion Due to the very low risk of infection we recommend the routine use of gloves and an adequate skin disinfection. Contact of the transducer or of an unsterile contact medium with the biopsy needle is considered highly unlikely und should be avoided.

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Structuring Clinical Workflows for Diabetes Care

Applied Clinical Informatics ◽

10.4338/aci-2014-04-ra-0039 ◽

2014 ◽

Vol 05 (02) ◽

pp. 512-526 ◽

Cited By ~ 2

Author(s):

N. Lasierra ◽

S. Oberbichler ◽

I. Toma ◽

A. Fensel ◽

A. Hoerbst ◽

...

Keyword(s):

Best Practices ◽

Diabetes Care ◽

Qualitative Content Analysis ◽

Building Blocks ◽

Task Execution ◽

Clinical Routine ◽

Health Records ◽

Workflow Patterns ◽

Data Elements ◽

Categorization Model

SummaryBackground: Electronic health records (EHRs) play an important role in the treatment of chronic diseases such as diabetes mellitus. Although the interoperability and selected functionality of EHRs are already addressed by a number of standards and best practices, such as IHE or HL7, the majority of these systems are still monolithic from a user-functionality perspective. The purpose of the OntoHealth project is to foster a functionally flexible, standards-based use of EHRs to support clinical routine task execution by means of workflow patterns and to shift the present EHR usage to a more comprehensive integration concerning complete clinical workflows.Objectives: The goal of this paper is, first, to introduce the basic architecture of the proposed OntoHealth project and, second, to present selected functional needs and a functional categorization regarding workflow-based interactions with EHRs in the domain of diabetes.Methods: A systematic literature review regarding attributes of workflows in the domain of diabetes was conducted. Eligible references were gathered and analyzed using a qualitative content analysis. Subsequently, a functional workflow categorization was derived from diabetes-specific raw data together with existing general workflow patterns.Results: This paper presents the design of the architecture as well as a categorization model which makes it possible to describe the components or building blocks within clinical workflows. The results of our study lead us to identify basic building blocks, named as actions, decisions, and data elements, which allow the composition of clinical workflows within five identified contexts.Conclusions: The categorization model allows for a description of the components or building blocks of clinical workflows from a functional view.Citation: Schweitzer M, Lasierra N, Oberbichler S, Toma I, Fensel A, Hoerbst A. Structuring clinical workflows for diabetes care: An overview of the OntoHealth approach. Appl Clin Inf 2014; 5: 512–526 http://dx.doi.org/10.4338/ACI-2014-04-RA-0039

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Building MedVenture – A mobile health application to improve adolescent medication adherence – Using a multidisciplinary approach and academic–industry collaboration

Digital Health ◽

10.1177/20552076211019877 ◽

2021 ◽

Vol 7 ◽

pp. 205520762110198

Author(s):

Pooja Mehta ◽

Susan L Moore ◽

Sheana Bull ◽

Bethany M Kwan

Keyword(s):

Content Analysis ◽

Medication Adherence ◽

Mobile Health ◽

Research Team ◽

Qualitative Content Analysis ◽

Digital Health ◽

Healthcare Providers ◽

User Engagement ◽

Engagement Strategies ◽

Industry Collaboration

Objective Mobile health (mHealth) tools are increasingly used to support medication adherence yet few have been designed specifically for the pediatric population. This paper describes the development of a medication adherence application ( MedVenture) using the integration of patient and healthcare provider input, health behavior theory, and user engagement strategies for adolescents with chronic gastrointestinal disease. Methods MedVenture was created by a multidisciplinary research team consisting of a gastroenterologist, a social health psychologist, software developers, and digital health researchers. Healthcare providers and adolescent patients were interviewed to identify barriers to medication adherence, explore ways that technologies could best support medication adherence for both patients and providers, and determine user requirements and core design features for a digital health tool. Intervention mapping was used to match themes from qualitative content analysis to known efficacious adherence strategies, according to a conceptual framework based on self-determination theory. Iterative design with review by the research team and two rounds of user testing informed the final prototype. Results Three themes were identified from content analysis: 1) lack of routine contributes to nonadherence, 2) adolescents sometimes purposefully forgo medications, and 3) healthcare providers would prefer a tool that promotes patient self-management rather than one that involves patient-provider interaction. These findings, combined with evidence-based adherence and user engagement strategies, resulted in the development of MedVenture – a game-based application to improve planning and habit formation. Conclusions Academic-industry collaboration incorporating stakeholders can facilitate the development of mobile health tools designed specifically for adolescents with chronic disease.

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