Cell phone e-mail as a means to collect information on pregnancy and delivery: a pilot study in Japan.

BACKGROUND: The diffusion of cell phones is 91.9% in Japan. Especially, cell phone e-mail is now widely used as a media source in Japan. The authors of this research have been engaged in collecting basic data to establish a system for providing improved health information on pregnancy and delivery through cell phones for pregnant women and their family members. OBJECTIVE: In this study, we classified the trends of health information of pregnancy and delivery in which people desire to obtain through cell phone based on the characteristics of the information and, of each classification we revealed the generic characteristic (age, gender, gestational weeks and any other children), any social support, the types of cell phones or/and computers and their related use. METHODS: Anonymous questionnaires were distributed to the participants of delivery preparation workshops held at two places in the northern parts of Kyushu Area to collect data. The cell phone e-mail usage trends were measured by four-rated scales. To classify the characteristics of the information, a Principal Factor Analysis was conducted. To find out correlation between the information classified and the generic characteristics, Mann-Whitney's U-test was conducted. RESULTS: Out of two hundred and fifteen (215) respondents including 117 pregnant women and 98 husbands, 208 respondents possessed cell phones. Regarding the health information of pregnancy and delivery desired to obtain through cell phone e-mail, two factors, namely "medical information" and "non-medical information" have derived. Those who did not possess computers tended to use their cell phone e-mail to obtain both "medical information" (P = .002) and "non-medical information" (P = .02). While those who use cell phone e-mail almost everyday tended to use cell phone e-mail for obtaining "non-medical information" (P = .02). CONCLUSION: This study indicated that providing medical information and non-medical information through cell phone e-mail is an essential service, especially in Japan, where the diffusion of cell phones is far higher than that of computers.     

A Mixed-Methods Study on the Acceptability of Using eHealth for HIV Prevention and Sexual Health Care Among Men Who Have Sex With Men in China

Background

Human immunodeficiency virus (HIV) infection disproportionately affects men who have sex with men (MSM). Over half of all HIV-positive MSM in China may not know their HIV status. Mobile phones and Web interventions (eHealth) are underutilized resources that show promise for supporting HIV education, testing, and linkage to care.

Objective

This mixed-methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care.

Methods

We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the Internet survey, which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care.

Results

The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the Internet as the primary source of information about sexual health, HIV and other sexually transmitted diseases (STDs), use of the Internet to enable HIV testing opportunities by facilitating connections with both the gay community and health care providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the Internet sample (N=1342), the average age was 30.6 years old, 82.81% (1098/1342) were single, and 53.42% (711/1331) had completed college. In the past 3 months, 38.66% (382/988) had condomless sex and 60.53% (805/1330) self-reported having ever tested for HIV. The majority of men owned computers (94.14%, 1220/1296) and mobile phones (92.32%, 1239/1342), which many had used to search for HIV/STD information and testing sites. In multivariate analysis, interest in using computers or mobile phones to support their sexual health care was associated with being a student, prior use of computers or mobile phones to search for general health information, prior use of computers or mobile phones to search for HIV/STD information, and confidentiality concerns.

Conclusions

MSM in this sample had high utilization of technology and interest in eHealth despite confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.     

Recent Advances (2011-2012) in Technology-Delivered Interventions for People Living with HIV

Technology is rapidly advancing and becoming a cost effective option for intervention delivery particularly for isolated and hard to reach populations, such as people living with HIV/AIDS. A systematic review was conducted to identify recent technology based interventions for people living with HIV. The review yielded 12 studies that were grouped by the health behavior that it addressed and then the type of technology utilized. The majority of studies reviewed focused on medication adherence and used several different technologies to deliver the intervention including SMS/text messaging, cell phones and computers. This review identified several gaps in the literature particularly the lack of technology-based interventions focusing on engagement and retention to care as well as sexual risk reduction. Suggestions for future research based on these findings are provided.     

Sociotechnical analysis of nurses’ use of personal mobile phones at work

BackgroundNurses’ use of personal mobiles phones at work is a growing trend in healthcare organizations. Although recent studies have explored the positive and negative implications of nurses using personal mobile phones at work, none has yet analyzed the interactions of sociotechnical components (users, technology and policy) on nurses’ use of personal mobile phones at work.ObjectivesIdentify sociotechnical interactions by analyzing each sociotechnical component (users, technology and policy) that affects nurses’ use of personal mobile phones at work.MethodsIn-depth interviews were conducted with 30 nurses employed in 13 hospitals in the Philippines. The respondents include staff nurses (n = 23), charge nurses (n = 4), and nurse managers (n = 3). Staff nurses were asked on their use of personal mobile phones at work, while charge and nurse managers were asked on their observations regarding staff nurses’ use of personal mobile phones at work. Responses were analyzed qualitatively using sociotechnical analysis.ResultsSociotechnical analysis indicated that staff nurses used their personal mobile phones at work in various ways because its use helped in their nursing work, but inevitably altered a few of their routines. Although most hospitals had policies that prohibit the use of mobile phones, staff nurses justified their use of personal mobile phones by using it for work purposes and for the benefit of their patients. Staff nurses highlighted the absence of hospital-provided mobile phones as a key reason for using personal mobile phones at work. Charge nurses and nurse managers also influenced staff nurses’ use of personal mobile phones at work.ConclusionsNurses could use their personal mobile phones at work for work purposes to enhance their clinical performance and improve patient care. Hospital administrators can leverage on nurses’ use of personal mobile phones at work by formulating policies that consider both the benefits and potential drawbacks of mobile phone usage. Recommendations are made for the formulation of hospital policies to optimize the use of personal mobile phones of nurses at work.     

Clinical information technology in hospitals: a comparison between the state of Iowa and two provinces in Canada

Despite the growing interest in adopting information technology (IT) in healthcare, the degree of technology sophistication varies among healthcare organizations. Changes in the health care sector and continuous pressure to improve the quality of care have driven the evolution of IT in hospitals. This paper provides an overview of clinical IT sophistication in a sample of U.S. hospitals, and compares clinical IT capacities in this sample with a sample of Canadian hospitals. The instrument used for the comparison measures three clinical dimensions of IT sophistication: functional sophistication, technological sophistication and integration level. Clinical areas that were considered include patient management, patient care activities and clinical support activities. The comparison between hospitals in Iowa and Canada shows differences in clinical IT sophistication between the two settings. Hospitals in Iowa appear to have more technologies but fewer computerized processes and integration of patient management activities. Technological sophistication however, was low in both samples. Our findings confirm the construct validity of the measurement instrument and show initial evidence of its generalizability. More initiatives using the instrument would lead to enhancement in IT assessment tools that can be used for evaluation of IT in relation to patient management and quality outcomes.     

A Mobile Phone Integrated Health Care Delivery System of Medical Images

With the growing computing capability of mobile phones, a handy mobile controller is developed for accessing the picture archiving and communication system (PACS) to enhance image management for clinicians with nearly no restriction in time and location using various wireless communication modes. The PACS is an integrated system for the distribution and archival of medical images that are acquired by different imaging modalities such as CT (computed tomography) scanners, CR (computed radiography) units, DR (digital radiography) units, US (ultrasonography) scanners, and MR (magnetic resonance) scanners. The mobile controller allows image management of the PACS including display, worklisting, query and retrieval of medical images in DICOM format. In this mobile system, a server program is developed in a PACS Web server which serves as an interface for client programs in the mobile phone and the enterprise PACS for image distribution in hospitals. The application processing is performed on the server side to reduce computational loading in the mobile device. The communication method of mobile phones can be adapted to multiple wireless environments in Hong Kong. This allows greater feasibility to accommodate the rapidly changing communication technology. No complicated computer hardware or software is necessary. Using a mobile phone embedded with the mobile controller client program, this system would serve as a tool for heath care and medical professionals to improve the efficiency of the health care services by speedy delivery of image information. This is particularly important in case of urgent consultation, and it allows health care workers better use of the time for patient care.     

The Department of Veterans Affairs’ (VA) implementation of the Virtual Lifetime Electronic Record (VLER): Findings and lessons learned from Health Information Exchange at 12 sites

PurposeWe describe the Department of Veterans Affairs’ (VA) Virtual Lifetime Health Electronic Record (VLER) pilot phase in 12 communities to exchange health information with private sector health care organizations and the Department of Defense (DoD), key findings, lessons, and implications for advancing Health Information Exchanges (HIE), nationally.MethodsA mixed methods approach was used to monitor and evaluate the status of VLER Health Exchange pilot phase implementation from December 2009 through October 2012. Selected accomplishments, contributions, challenges, and early lessons that are relevant to the growth of nationwide HIE are discussed.ResultsVeteran patient and provider acceptance, trust, and perceived value of VLER Health Exchange are found to be high, and usage by providers is steadily growing. Challenges and opportunities to improve provider use are identified, such as better data quality and integration with workflow. Key findings and lessons for advancing HIE are identified.ConclusionsVLER Health Exchange has made great strides in advancing HIE nationally by addressing important technical and policy issues that have impeded scalability, and by increasing trust and confidence in the value and accuracy of HIE among users. VLER Health Exchange has advanced HIE interoperability standards and patient consent policies nationally. Policy, programmatic, technology, and health Information Technology (IT) standards implications to advance HIE for improved delivery and coordination of health care are discussed. The pilot phase success led to VA-wide deployment of this data sharing capability in 2013.     

Improving information technology adoption and implementation through the identification of appropriate benefits: creating IMPROVE-IT

This paper describes the objectives of a collaborative initiative that attempts to provide the evidence that increased information technology (IT) capabilities, availability, and use lead directly to improved clinical quality, safety, and effectiveness within the inpatient hospital setting. This collaborative network has defined specific measurement indicators in an attempt to examine the existence, timing, and level of improvements in health outcomes that can be derived from IT investment. These indicators are in three areas: (1) IT costs (which includes both initial and ongoing investment), (2) IT infusion (ie, system availability, adoption, and deployment), and (3) health performance (eg, clinical efficacy, efficiency, quality, and effectiveness). Herein, we outline the theoretical framework, the methodology employed to create the metrics, and the benefits that can be obtained.     

How to deal with information in transfusion medicine?

Still today the role of information in most organizations is underestimated or considered not adequate in regards to the use we make. Its impact in transfusion medicine needs to be controlled and understood in order to estimate the real value brought to the organization. This paper proposes a way to organize activities in managing information end the required information technology. It is based on activities related to information classification, to IT (Information Technology). Infrastructure classification and, moat important, to best practices needed for Information management and related IT infrastructures. Considerations presented in this paper are mostly based on results provided by the ISBT Working Party on Information Technology.     

A national survey of health service infrastructure and policy impacts on access to computerised CBT in Scotland

ABSTRACT: BACKGROUND: NICE recommends computerised cognitive behavioural therapy (cCBT) for the treatment of several mental health problems such as anxiety and depression. cCBT may be one way that services can reduce waiting lists and improve capacity and efficiency. However, there is some doubt about the extent to which the National Health Service (NHS) in the UK is embracing this new health technology in practice. This study aimed to investigate Scottish health service infrastructure and policies that promote or impede the implementation of cCBT in the NHS. METHODS: A telephone survey of lead IT staff at all health board areas across Scotland to systematically enquire about the ability of local IT infrastructure and IT policies to support delivery of cCBT. RESULTS: Overall, most of the health boards possess the required software to use cCBT programmes. However, the majority of NHS health boards reported that they lack dedicated computers for patient use, hence access to cCBT at NHS sites is limited. Additionally, local policy in the majority of boards prevent staff from routinely contacting patients via email, skype or instant messenger, making the delivery of short, efficient support sessions difficult. CONCLUSIONS: Conclusions: Overall most of the infrastructure is in place but is not utilised in ways that allow effective delivery. For cCBT to be successfully delivered within a guided support model, as recommended by national guidelines, dedicated patient computers should be provided to allow access to online interventions. Additionally, policy should allow staff to support patients in convenient ways such as via email or live chat. These measures would increase the likelihood of achieving Scottish health service targets to reduce waiting time for psychological therapies to 18 weeks.     

Telemedicine: experience at SGPGIMS, Lucknow

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) located in Lucknow, capital of Uttar Pradesh, a state in Northern India, is a tertiary level referral academic medical center involved in teaching and training of super specialist medical professionals with 22 academic departments. It is the first tertiary care hospital in public healthcare sector in India to adopt Information Technology (IT) for healthcare delivery. The Hospital Information System (HIS) was implemented in 1998 to record, store, process and retrieve health data of all the patients. This software was developed in-house in collaboration with Center for Development of Advanced Computing (C- DAC), Pune. Later in the year 1999, telemedicine activities were initiated in the form of testing the concept and technology. The first research grant was availed of in the year 2001, which helped in creating an infrastructure for telemedicine. Regular tele-healthcare and tele-educational services were introduced for the postgraduate students of medical colleges of Orissa. These services have now been extended to educate the doctors of other medical colleges and community centers in other states. Besides, the Institute is associated with organizational activities and in policy initiatives of the government. All the activities are in project mode and are being financially supported by government agencies such as Indian Space Research Organisation (ISRO) and Department of Information Technology. Looking at the need of skilled manpower in the field of telemedicine and e-health, a school of telemedicine is coming up in the campus, which will also provide core infrastructure for research and development.     

Creating a histology-embryology free digital image database using high-end microscopy and computer techniques for on-line biomedical education

The development of new technology and the possibility of fast information delivery by either Internet or Intranet connections are changing education. Microanatomy education depends basically on the correct interpretation of microscopy images by students. Modern microscopes coupled to computers enable the presentation of these images in a digital form by creating image databases. However, the access to this new technology is restricted entirely to those living in cities and towns with an Information Technology (IT) infrastructure. This study describes the creation of a free Internet histology database composed by high-quality images and also presents an inexpensive way to supply it to a greater number of students through Internet/Intranet connections. By using state-of-the-art scientific instruments, we developed a Web page (http://www2.uerj.br/~micron/atlas/atlasenglish/index.htm) that, in association with a multimedia microscopy laboratory, intends to help in the reduction of the IT educational gap between developed and underdeveloped regions.     

Interpretive Flexibility in Mobile Health: Lessons From a Government-Sponsored Home Care Program

Background

Mobile technologies have emerged as important tools that health care personnel can use to gain easy access to client data anywhere. This is particularly useful for nurses and care workers in home health care as they provide services to clients in many different settings. Although a growing body of evidence supports the use of mobile technologies, the diverse implications of mobile health have yet to be fully documented.

Objective

Our objective was to examine a large-scale government-sponsored mobile health implementation program in the Danish home care sector and to understand how the technology was used differently across home care agencies.

Methods

We chose to perform a longitudinal case study with embedded units of analysis. We included multiple data sources, such as written materials, a survey to managers across all 98 Danish municipalities, and semistructured interviews with managers, care workers, and nurses in three selected home care agencies. We used process models of change to help analyze the overall implementation process from a longitudinal perspective and to identify antecedent conditions, key events, and practical outcomes.

Results

Strong collaboration between major stakeholders in the Danish home care sector (government bodies, vendors, consultants, interest organizations, and managers) helped initiate and energize the change process, and government funding supported quick and widespread technology adoption. However, although supported by the same government-sponsored program, mobile technology proved to have considerable interpretive flexibility with variation in perceived nature of technology, technology strategy, and technology use between agencies. What was first seen as a very promising innovation across the Danish home care sector subsequently became the topic of debate as technology use arrangements ran counter to existing norms and values in individual agencies.

Conclusions

Government-sponsored programs can have both positive and negative results, and managers need to be aware of this and the interpretive flexibility of mobile technology. Mobile technology implementation is a complex process that is best studied by combining organization-level analysis with features of the wider sociopolitical and interorganizational environment.     

Basic Health Services in Nigeria: models for primary care in America.

The basic problems in delivery of health care in the United States and in Nigeria are similar; the major differences are in magnitude. Nigeria''s Basic Health Services Scheme, now being implemented, is a bold effort to make quality health care accessible to the entire population. American health planners should look to such developing countries for concepts adaptable to our own health care delivery system. In developing primary care programs in particular, they should consider three basic components of the Nigerian scheme: (1) delegation of appropriate responsibilities to non-physician health providers in order to augment physician manpower in underserved areas; (2) location of training centers in environments similar to those where the trainees will serve; and (3) use of home-based care records to increase patient participation in health care.     

Healthcare in the pocket: mapping the space of mobile-phone health interventions

Mobile phones are becoming an increasingly important platform for the delivery of health interventions. In recent years, researchers have used mobile phones as tools for encouraging physical activity and healthy diets, for symptom monitoring in asthma and heart disease, for sending patients reminders about upcoming appointments, for supporting smoking cessation, and for a range of other health problems. This paper provides an overview of this rapidly growing body of work. We describe the features of mobile phones that make them a particularly promising platform for health interventions, and we identify five basic intervention strategies that have been used in mobile-phone health applications across different health conditions. Finally, we outline the directions for future research that could increase our understanding of functional and design requirements for the development of highly effective mobile-phone health interventions.     

Assessment of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating mobile health (mHealth) technology

BackgroundOver two decades of research has been conducted using mobile devices for health related behaviors yet many of these studies lack rigor. There are few evaluation frameworks for assessing the usability of mHealth, which is critical as the use of this technology proliferates. As the development of interventions using mobile technology increase, future work in this domain necessitates the use of a rigorous usability evaluation framework.MethodsWe used two exemplars to assess the appropriateness of the Health IT Usability Evaluation Model (Health-ITUEM) for evaluating the usability of mHealth technology. In the first exemplar, we conducted 6 focus group sessions to explore adolescents’ use of mobile technology for meeting their health Information needs. In the second exemplar, we conducted 4 focus group sessions following an Ecological Momentary Assessment study in which 60 adolescents were given a smartphone with pre-installed health-related applications (apps).Data analysisWe coded the focus group data using the 9 concepts of the Health-ITUEM: Error prevention, Completeness, Memorability, Information needs, Flexibility/Customizability, Learnability, Performance speed, Competency, Other outcomes. To develop a finer granularity of analysis, the nine concepts were broken into positive, negative, and neutral codes. A total of 27 codes were created. Two raters (R1 and R2) initially coded all text and a third rater (R3) reconciled coding discordance between raters R1 and R2.ResultsA total of 133 codes were applied to Exemplar 1. In Exemplar 2 there were a total of 286 codes applied to 195 excerpts. Performance speed, Other outcomes, and Information needs were among the most frequently occurring codes.ConclusionOur two exemplars demonstrated the appropriateness and usefulness of the Health-ITUEM in evaluating mobile health technology. Further assessment of this framework with other study populations should consider whether Memorability and Error prevention are necessary to include when evaluating mHealth technology.     

E-health progresses in Romania

The paper is presenting the recent evolution of e-health aspects in Romania. Data presented are based on governmental reports. Surveys organized by the "Lucian Blaga" University of Sibiu and studies carried on by the national Institute for Research and Development in Informatics (I.C.I.) have shown that Romania has important health problems, from cardio vascular diseases (CVD) to cancer and infectious diseases, a high score on mortality and morbidity and a low one on natality. Poor management of the health sector did not help to solve all these problems. In the last 14 years there were several attempts to reform healthcare but none succeeded until now. The health insurance system is operational but needs still to be improved. Acknowledging the deep crisis of the health system the Prime Minister nominated a new minister of health and important changes in the health management approach are to be envisaged. One of this is the introduction of the e-procurement system for all health related goods. In spite of the crisis of the health system, e-health applications are flourishing. We can distinguish applications at national and local level and also punctual applications. The main applications refer to hospital information systems (HIS), electronic health records (EHR), e-procurement, image processing, diagnosis and treatment aids, telediagnosis, teleconsultation, education, research and domain oriented web support services. Most academic clinical hospital is now members of a web community "mednet". Unfortunately a lot of medical web sites have disappeared for lack of funds. As the health sector is in general funded from the public budget and the health crisis is deepened in the last years, the driving force in implementing e-health concepts and technologies is not the Ministry of Health but the Information Technology (IT) community, with a strong support from the Ministry of Information Technology and Communications and also from the Ministry of Education and Research, the Romanian Academy and professional non-governmental organizations. Our government has established the strategy for achieving the e-society for almost all domains but healthcare is still the Cinderella. It is expected that IT will play the role of the Fair Godmother by improving the general health status of the population through a better management of health services and better access to information and knowledge, for both major actors: the health professionals and the citizens.     

Lassa virus infection in Nigeria: clinical perspective overview

Lassa fever is a severe, often fatal, hemorrhagic fever caused by Lassa virus, an Arenavirus that can be transmitted to humans from asymptomatically infected multimammate rats. The speculation is that Lassa viral infection may affect between 2 to 3 million people each year in certain portions of the West African region, causing a mortality of about 10000 during the same period. Lassa fever is one of the endemic zoonosis in Nigeria with a high probability for nosocomial transmission due to several health care sector challenges. Although treatment is available for Lassa fever, early diagnosis is still difficult in almost all Nigerian health care institutions. The intention of this clinical overview is to: (1) summarize the pertinent literature for clinicians in primary, secondary, and tertiary health care centers; and (2) suggest a need to use the information from basic research and laboratory diagnosis to incorporate international best practices into public health and clinical practice guidelines.     

Mobile phone technology and hospitalized patients: a cross-sectional surveillance study of bacterial colonization,and patient opinions and behaviours

Healthcare workers’ mobile phones provide a reservoir of bacteria known to cause nosocomial infections. UK National Health Service restrictions on the utilization of mobile phones within hospitals have been relaxed; however, utilization of these devices by inpatients and the risk of cross-contamination are currently unknown. Here, we examine demographics and characteristics of mobile phone utilization by inpatients and phone surface microbial contamination. One hundred and two out of 145 (70.3%) inpatients who completed a questionnaire detailing their opinions and utilization of mobile phones, also provided their mobile phones for bacteriological analysis and comparative bacteriological swabs from their nasal cavities; 92.4% of patients support utilization of mobile phones by inpatients; indeed, 24.5% of patients stated that mobile phones were vital to their inpatient stay. Patients in younger age categories were more likely to possess a mobile phone both inside and outside hospital (p <0.01) but there was no gender association. Eighty-six out of 102 (84.3%) patients’ mobile phone swabs were positive for microbial contamination. Twelve (11.8%) phones grew bacteria known to cause nosocomial infection. Seven (6.9%) phones and 32 (31.4%) nasal swabs demonstrated Staphylococcus aureus contamination. MSSA/MRSA contamination of phones was associated with concomitant nasal colonization. Patient utilization of mobile phones in the clinical setting is popular and common; however, we recommend that patients are educated by clear guidelines and advice on inpatient mobile phone etiquette, power charging safety, regular cleaning of phones and hand hygiene, and advised not to share phones or related equipment with other inpatients in order to prevent transmission of bacteria.