Lack of Acceptance of Digital Healthcare in the Medical Market: Addressing Old Problems Raised by Various Clinical Professionals and Developing Possible Solutions

Various digital healthcare devices and apps, such as blood glucose meters, blood pressure monitors, and step-trackers are commonly used by patients; however, digital healthcare devices have not been widely accepted in the medical market as of yet. Despite the various legal and privacy issues involved in their use, the main reason for its poor acceptance is that users do not use such devices voluntarily and continuously. Digital healthcare devices generally do not provide valuable information to users except for tracking self-checked glucose or walking. To increase the use of these devices, users must first understand the health data produced in the context of their personal health, and the devices must be easy to use and integrated into everyday life. Thus, users need to know how to manage their own data. Medical staff must teach and encourage users to analyze and manage their patient-generated healthcare data, and users should be able to find medical values from these digital devices. Eventually, a single customized service that can comprehensively analyze various medical data to provide valuable customized services to users, and which can be linked to various heterogeneous digital healthcare devices based on the integration of various health data should be developed. Digital healthcare professionals should have detailed knowledge about a variety of digital healthcare devices and fully understand the advantages and disadvantages of digital healthcare to help patients understand and embrace the use of such devices.     

Applying information and communications technologies to collect health data from remote settings: A systematic assessment of current technologies

Modern information and communications technologies (ICTs) are now so feature-rich and widely available that they can be used to “capture,” or collect and transmit, health data from remote settings. Electronic data capture can reduce the time necessary to notify public health authorities, and provide important baseline information. A number of electronic health data capture systems based on specific ICTs have been developed for remote areas. We expand on that body of work by defining and applying an assessment process to characterize ICTs for remote-area health data capture. The process is based on technical criteria, and assesses the feasibility and effectiveness of specific technologies according to the resources and constraints of a given setting. Our characterization of current ICTs compares different system architectures for remote-area health data capture systems. Ultimately, we believe that our criteria-based assessment process will remain useful for characterizing future ICTs.     

Protecting the patient by promoting end-user competence in health informatics systems-moves towards a generic health computer user "driving license"

The effectiveness and quality of health informatics systems' support to healthcare delivery are largely determined by two factors-the suitability of the system installed, and the competence of the users. However, the profile of users of large-scale clinical health systems is significantly different from the profile of end-users in other enterprises such as the finance sector, insurance, travel or retail sales. Work with a mental health provider in Ireland, who was introducing a customized electronic patient record (EPR) system, identified the strong legal and ethical importance of adequately skills for the health professionals and others, who would be the system users. The experience identified the need for a clear and comprehensive generic user qualification at a basic but robust level. The European computer driving license (ECDL) has gained wide recognition as a basic generic qualification for users of computer systems. However, health systems and data have a series of characteristics that differentiate them from other data systems. The logical conclusion was the recognition of a need for an additional domain-specific qualification-an "ECDL Health Supplement". Development of this is now being progressed.     

Distributed clinical data sharing via dynamic access-control policy transformation

BackgroundData sharing in electronic health record (EHR) systems is important for improving the quality of healthcare delivery. Data sharing, however, has raised some security and privacy concerns because healthcare data could be potentially accessible by a variety of users, which could lead to privacy exposure of patients. Without addressing this issue, large-scale adoption and sharing of EHR data are impractical. The traditional solution to the problem is via encryption. Although encryption can be applied to access control, it is not applicable for complex EHR systems that require multiple domains (e.g. public and private clouds) with various access requirements.ObjectivesThis study was carried out to address the security and privacy issues of EHR data sharing with our novel access-control mechanism, which captures the scenario of the hybrid clouds and need of access-control policy transformation, to provide secure and privacy-preserving data sharing among different healthcare enterprises.MethodsWe introduce an access-control mechanism with some cryptographic building blocks and present a novel approach for secure EHR data sharing and access-control policy transformation in EHR systems for hybrid clouds.ResultsWe propose a useful data sharing system for healthcare providers to handle various EHR users who have various access privileges in different cloud environments. A systematic study has been conducted on data sharing in EHR systems to provide a solution to the security and privacy issues.ConclusionsIn conclusion, we introduce an access-control method for privacy protection of EHRs and EHR policy transformation that allows an EHR access-control policy to be transformed from a private cloud to a public cloud. This method has never been studied previously in the literature. Furthermore, we provide a protocol to demonstrate policy transformation as an application scenario.     

Redesigning electronic health record systems to support public health

Current electronic health record systems are primarily clinical in focus, designed to provide patient-level data and provider-level decision support. Adapting EHR systems to serve public health needs provides the possibility of enormous advances for public health practice and policy. In this review, we evaluate EHR functionality and map it to the three core functions of public health: assessment, policy development, and assurance. In doing so, we identify and discuss important design, implementation, and methodological issues with current systems. For example, in order to support public health's traditional focus on preventive health and socio-behavioral factors, EHR data models would need to be expanded to incorporate environmental, psychosocial, and other non-medical data elements, and workflow would have to be examined to determine the optimal way of collecting these data. We also argue that redesigning EHR systems to support public health offers benefits not only to the public health system but also to consumers, health-care institutions, and individual providers.     

Understanding the information needs of public health practitioners: a literature review to inform design of an interactive digital knowledge management system

The need for rapid access to information to support critical decisions in public health cannot be disputed; however, development of such systems requires an understanding of the actual information needs of public health professionals. This paper reports the results of a literature review focused on the information needs of public health professionals. The authors reviewed the public health literature to answer the following questions: (1) What are the information needs of public health professionals? (2) In what ways are those needs being met? (3) What are the barriers to meeting those needs? (4) What is the role of the Internet in meeting information needs? The review was undertaken in order to develop system requirements to inform the design and development of an interactive digital knowledge management system. The goal of the system is to support the collection, management, and retrieval of public health documents, data, learning objects, and tools.Method:The search method extended beyond traditional information resources, such as bibliographic databases, tables of contents (TOC), and bibliographies, to include information resources public health practitioners routinely use or have need to use—for example, grey literature, government reports, Internet-based publications, and meeting abstracts.Results:Although few formal studies of information needs and information-seeking behaviors of public health professionals have been reported, the literature consistently indicated a critical need for comprehensive, coordinated, and accessible information to meet the needs of the public health workforce. Major barriers to information access include time, resource reliability, trustworthiness/credibility of information, and “information overload”.Conclusions:Utilizing a novel search method that included the diversity of information resources public health practitioners use, has produced a richer and more useful picture of the information needs of the public health workforce than other literature reviews. There is a critical need for public health digital knowledge management systems designed to reflect the diversity of public health activities, to enable human communications, and to provide multiple access points to critical information resources. Public health librarians and other information specialists can serve a significant role in helping public health professionals meet their information needs through the development of evidence-based decision support systems, human-mediated expert searching and training in the use information retrieval systems.     

Commentary: Health systems and health policy: a curriculum for all medical students.

A companion article in this issue of Academic Medicine provides an example of a method for electively integrating health systems and health policy issues into medical education. However, a curriculum in health systems and health policy is crucial to the education of all future physicians and other health professionals. The Clinical Prevention and Population Health Curriculum Framework of the Healthy People Curriculum Task Force has recently recommended a health systems and health policy curriculum that includes the domains of organization of clinical and public health systems; health services financing; health workforce; and health policy process. The curriculum should commence prior to year three and continue in years three and four so that students have a framework for integrating and subsequently sharing their experiences. Current Liaison Committee on Medical Education data indicate that on average less than 70% of medical schools require any curriculum in these four domains and only 40% of medical schools include all four of these domains in their required curriculum. Incorporation all of these domains into well-defined, required curricula that are broad in scope has the potential to change the attitudes of future clinicians toward efforts to control costs, collaborate with other health professions, and influence health policies.     

Efficacy of public health surveillance systems

Public health surveillance system (PHSS) serves for continuous and systematic data collection, analysis and interpretation, in order to enable planning, implementation and evaluation of public health practice. PHSS should alert to events (usually unwanted), assist to create public health policy and strategies, document effects and achieving the goals as well as setting public health priorities. Surveillance systems monitor communicable and non-communicable diseases, health resources and public health programs and interventions. The main drawback of the existing PHSS is fragmentation and delay of information, usually not up-to-date. Modern information and communication technology enables getting data from hospitals and other health information systems directly, and use them for surveillance. Our model of surveillance system appeared as not standalone but an integrated system getting data that are by-product of frontline workers. Therefore, the electronic health records should be the source of data for disease surveillance. Medical, nurse and similar schools as well as the Ministry of Health and health institutions could be data sources for health personnel surveillance. Medical devices can be monitored by data coming from institutions and bodies dealing with such devices. Public health programs defined by institutions and bodies can be monitored by them and others taking part in implementation. Therefore, they all can be the source of data for surveillance of public health programs and interventions. Without such systems, any rationalization in health care and better quality is not possible. Therefore, the present public health surveillance system should be improved, as we have suggested, by using current information and communication technology and integrating the data that are by-product of the frontline worker, and by including the end users in system development at the very beginning.     

Bringing Health and Fitness Data Together for Connected Health Care: Mobile Apps as Enablers of Interoperability

Background

A transformation is underway regarding how we deal with our health. Mobile devices make it possible to have continuous access to personal health information. Wearable devices, such as Fitbit and Apple’s smartwatch, can collect data continuously and provide insights into our health and fitness. However, lack of interoperability and the presence of data silos prevent users and health professionals from getting an integrated view of health and fitness data. To provide better health outcomes, a complete picture is needed which combines informal health and fitness data collected by the user together with official health records collected by health professionals. Mobile apps are well positioned to play an important role in the aggregation since they can tap into these official and informal health and data silos.

Objective

The objective of this paper is to demonstrate that a mobile app can be used to aggregate health and fitness data and can enable interoperability. It discusses various technical interoperability challenges encountered while integrating data into one place.

Methods

For 8 years, we have worked with third-party partners, including wearable device manufacturers, electronic health record providers, and app developers, to connect an Android app to their (wearable) devices, back-end servers, and systems.

Results

The result of this research is a health and fitness app called myFitnessCompanion, which enables users to aggregate their data in one place. Over 6000 users use the app worldwide to aggregate their health and fitness data. It demonstrates that mobile apps can be used to enable interoperability. Challenges encountered in the research process included the different wireless protocols and standards used to communicate with wireless devices, the diversity of security and authorization protocols used to be able to exchange data with servers, and lack of standards usage, such as Health Level Seven, for medical information exchange.

Conclusions

By limiting the negative effects of health data silos, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care.     

Patient data confidentiality and patient rights

There has been a recent trend to gather and record more comprehensive and more detailed personal medical information in computerized databases. Retrieval and access are much easier from electronic records than from hard copies stored in the archives of care-providing institutions. The Institute of Medicine voiced concern that these developments raised numerous problematic issues, the most disturbing of which is a much more widespread and systematic violation of privacy via what they called 'authorized abuse', i.e. authorized users abusing their access privileges. Other worries stemmed from the sharing of patient information among different entities. Multitudes of organizations receive information about patients' health records, often without their knowledge or consent. These include care providers, insurers, pharmacists, employers, life insurance companies and marketing firms. This article addresses the issues of medical data ownership and some health data-recording problems to which we propose co-ownership and co-documentation as part of the solution. We believe that a cooperative approach will help to maintain greater accuracy of personal medical data, written in language that can be shared and understood by the consumers and not one couched in terminology understandable only to professional personnel and to delegate the power to the patient to decide when and to whom to give authorization for its use by a third party and for research.     

Privacy-preserving screen capture: Towards closing the loop for health IT usability

As information technology permeates healthcare (particularly provider-facing systems), maximizing system effectiveness requires the ability to document and analyze tricky or troublesome usage scenarios. However, real-world health IT systems are typically replete with privacy-sensitive data regarding patients, diagnoses, clinicians, and EMR user interface details; instrumentation for screen capture (capturing and recording the scenario depicted on the screen) needs to respect these privacy constraints. Furthermore, real-world health IT systems are typically composed of modules from many sources, mission-critical and often closed-source; any instrumentation for screen capture can rely neither on access to structured output nor access to software internals.In this paper, we present a tool to help solve this problem: a system that combines keyboard video mouse (KVM) capture with automatic text redaction (and interactively selectable unredaction) to produce precise technical content that can enrich stakeholder communications and improve end-user influence on system evolution. KVM-based capture makes our system both application-independent and OS-independent because it eliminates software-interface dependencies on capture targets. Using a corpus of EMR screenshots, we present empirical measurements of redaction effectiveness and processing latency to demonstrate system performances. We discuss how these techniques can translate into instrumentation systems that improve real-world health IT deployments.     

Securing interoperability between chip card based medical information systems and health networks.

Health information systems supporting shared care are going to be distributed and interoperable. Dealing with sensitive personal medical information, such information systems have to provide appropriate security services, allowing only authorised users restricted access rights to the patients' data according to the 'need to know' principle. Especially in healthcare, chip card based information systems occur in the shape of patient data cards providing informational self determination and mobility of the users as well as quality, integrity, accountability, and availability of the data stored on the card, thus improving the shared care of patients. The DIABCARD project aims at the implementation and evaluation of a chip card based medical information system (CCMIS) for facilitating communication and co-operation between health professionals in different organisations or departments caring the same patient with diabetes as an example. In co-operation with the EC-funded TrustHealth(2) project, communication and application security services needed are provided like strong authentication as well as the derived services such as authorisation, access control, accountability, confidentiality, etc. The solution is based on Health Professional Cards and Trusted Third Party services. In addition to the secure handling of the patient's chip card and data in DIABCARD workstations, the secure communication between these workstations and related departmental systems has been implemented. Based on the results of this feasibility study, an enhanced security services specification for the DIABCARD example of a CCMIS is provided which will be implemented in the framework of a health network being established in the German federal state Bavaria. Beside the preferred solution of a combination of Patient Identification Card and Patient Data Card, lower level alternatives using card-verifiable certificates are explained in some details. Finally, a few legal issues, future trends like the XML standard set and their implications for the solution presented as well as for distributed health information systems in general are shortly discussed.     

A course on the transition to adult care of patients with childhood-onset chronic illnesses.

Children with special health care needs born today have a 90% chance of surviving into adulthood, making their transition to adult systems of care an issue that will affect almost all physicians. However, many adult generalists and specialists are not familiar with the management of chronic diseases that begin in childhood. While the public health system has made transition to appropriate adult care a priority, and many specialty organizations have endorsed this concept, there are no published studies addressing how the concept of transition can be taught to medical students or residents. The authors describe a one-week course for medical students, begun in 2001 at their institution, that addresses the transition for youth with special health care needs, emphasizing patient and family-centered care, cultural competence, and decision making in end-of-life issues. Cystic fibrosis, a common genetic disease with increasing life expectancy, is used as the model for the course. Involvement of interdisciplinary faculty, interviews with youth with special health care needs and family caregivers, readings from academic and nonacademic literature, and group discussions are presented as teaching methods. Key insights based on experience with the course are the need to include the voices of patients and families, the use of faculty from various professions and specialties to model interdisciplinary care, and the insight that problems specific to transition offer into contemporary health care financing. Future studies should measure the impact of such courses on students' knowledge of transition issues, and determine essential information required for physicians in practice.     

Promoting Health in Virtual Worlds: Lessons From Second Life

Background

Social media services can help empower people to take greater responsibility for their health. For example, virtual worlds are media-rich environments that have many technically advantageous characteristics that can be used for Health 2.0 purposes. Second Life has been used to build environments where people can obtain information and interact with other users for peer support and advice from health care professionals.

Objective

The intent of the study was to find out whether Second Life is a working and functional platform supporting the empowerment of people in health-related issues.

Methods

We conducted a review of the current health-related activity in Second Life, coupled with an extensive series of observations and interactions with the respective resources inside Second Life.

Results

A total of 24 operative health resources were found in Second Life, indicating that health-related activity is rather limited in Second Life, though at first glance it appears to contain very rich health-related content. The other main shortcomings of Second Life relate to a lack of activity, a low number of resource users, problems with Second Life’s search features, and the difficulty of finding trustworthy information.

Conclusions

For the average user, Second Life offers very little unique value compared to other online health resources.     

Examining the evidence of the impact of health information technology in primary care: An argument for participatory research with health professionals and patients

PurposeHealth information technology represents a promising avenue to improve health care delivery. How can we use lessons learnt from existing health information technologies in primary care to inform the optimal design of newer developments such as personal health records?MethodsThe results of systematic literature reviews about the impact of different information systems on health outcomes in primary care are critically discussed in a narrative synthesis, with a focus on their implications for the development of personal health records.ResultsGiven the proliferation of systematic reviews and randomized controlled trials, high quality evidence for health information technology in primary care is accumulating with mixed results. The heterogeneity of systems being compared and the quality of research can no longer account for these findings. One potential explanation may be that systems originally designed for acute care settings are being implemented in primary care. Early studies evaluating personal health records suggest that targeting patient outcomes directly and adapting systems to patients’ needs may be part of the solution.ConclusionIn order to develop personal health records for primary care, studies are needed that involve the users, namely patients and primary care health professionals, in the design and evaluation of these systems from their inception. Participatory research is a recommended methodological approach.     

Communication practices in conversations about sexual health in medical healthcare settings: A systematic review

ObjectiveMany healthcare professionals experience difficulties in discussing sexual health with their patients. The aim of this review was to synthesize results of studies on communication practices in interactions about sexual health in medical settings, to offer healthcare professionals suggestions on how to communicate about this topic.MethodsWe searched for studies using five databases. Reference lists and specialist bibliographies were searched to identify additional studies. We included discourse analytic studies that used recordings of medical consultations.ResultsWe identified five studies that met the inclusion criteria. Findings were synthesized into seven categories of practices deployed by patients and healthcare professionals when talking about sexual health: avoiding delicate terms (1), delaying potentially delicate words and issues (2), using assumptive talk (3), generalized advice-giving (4), deploying patients’ talk (5), depersonalization (6), and patient-initiated advice (7).ConclusionPractices indicate the delicacy associated with discussing sexual health issues, but results also shed light on practices that can help professionals to deal with this delicacy, and to be responsive to patients’ needs and concerns.Practice implicationsFindings will assist healthcare professionals in broaching topics related to sexual health so they can help patients deal with challenges that affect their sexual health and overall well-being.     

Ethical issues in public health informatics: implications for system design when sharing geographic information

Public health programs today constitute a multi-professional inter-organizational environment, where both health service and other organizations are involved. Developing information systems, including the IT security measures needed to suit this complex context, is a challenge. To ensure that all involved organizations work together towards a common goal, i.e., promotion of health, an intuitive strategy would be to share information freely in these programs. However, in practice it is seldom possible to realize this ideal scenario. One reason may be that ethical issues are often ignored in the system development process. This investigation uses case study methods to explore ethical obstacles originating in the shared use of geographic health information in public health programs and how this affects the design of information systems. Concerns involving confidentiality caused by geographically referenced health information and influences of professional and organizational codes are discussed. The experience presented shows that disregard of ethical issues can result in a prolonged development process for public health information systems. Finally, a theoretical model of design issues based on the case study results is presented.     

A review of postnatal mental health websites: help for healthcare professionals and patients

The internet offers an accessible and cost-effective way to help women suffering with various types of postnatal mental illness and also can provide resources for healthcare professionals. Many websites on postnatal mental illness are available, but there is little information on the range or quality of information and resources offered. The current study therefore aimed to review postnatal health websites and evaluate their quality on a variety of dimensions. A systematic review of postnatal health websites was conducted. Searches were carried out on four search engines (Google, Yahoo, Ask Jeeves and Bing) which are used by 98% of web users. The first 25 websites found for each key word and their hyperlinks were assessed for inclusion in the review. Websites had to be exclusively dedicated to postnatal mental health or have substantial information on postnatal mental illness. Eligible websites (n = 114) were evaluated for accuracy of information, available resources and quality. Results showed that information was largely incomplete and difficult to read; available help was limited and website quality was variable. The top five postnatal mental illness websites were identified for (1) postnatal mental illness sufferers and (2) healthcare professionals. It is hoped these top websites can be used by healthcare professionals both for their own information and to advise patients on quality online resources.