Open Peer-Review: The Effects of Self-Feedback Function on Continued Use of Mobile Personal Health Record Application, and other submissions


 

JMIR has been a leader in applying openness, participation, collaboration and other "2.0" ideas to scholarly publishing, and since December 2009 offers open peer review articles, allowing JMIR users to sign themselves up as peer reviewers for specific articles currently considered by the Journal (in addition to author- and editor-selected reviewers). Note that this is a not a complete list of submissions as authors can opt-out. The list below shows recently submitted articles where submitting authors have not opted-out of open peer-review and where the editor has not made a decision yet. (Note that this feature is for reviewing specific articles - if you just want to sign up as reviewer (and wait for the editor to contact you if articles match your interests), please sign up as reviewer using your profile).
To assign yourself to an article as reviewer, you must have a user account on this site (if you don't have one, register for a free account here) and be logged in (please verify that your email address in your profile is correct). Add yourself as a peer reviewer to any article by clicking the '+Peer-review Me!+' link under each article. Full instructions on how to complete your review will be sent to you via email shortly after. Do not sign up as peer-reviewer if you have any conflicts of interest (note that we will treat any attempts by authors to sign up as reviewer under a false identity as scientific misconduct and reserve the right to promptly reject the article and inform the host institution).
The standard turnaround time for reviews is currently 2 weeks, and the general aim is to give constructive feedback to the authors and/or to prevent publication of uninteresting or fatally flawed articles. Reviewers will be acknowledged by name if the article is published, but remain anonymous if the article is declined.

The abstracts on this page are unpublished studies - please do not cite them (yet). If you wish to cite them/wish to see them published, write your opinion in the form of a peer-review!

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review


The Effects of Self-Feedback Function on Continued Use of Mobile Personal Health Record Application

Background: With dramatic growth in the healthcare industry, innovation and development in information technology (IT) have driven patient-centric care service. Especially, the advent of smartphones brought health information much closer to patients. In spite of all of the effort and attention to implement mobile personal health record (mPHR) applications (apps), little is known about the adoption of mobile technology in the healthcare realm. Objective: The main goal of this study is to determine which aspects of mPHR apps attract patients and how such aspects alter their application usage patterns. Methods: We collected 1,727 patients’ individual log data of an mPHR application provided by the Asan Medical Center in Korea and their demographic and hospital records. This app provides four types of functions; Health management, Chart, Medication, and Outpatient support. Exploiting the function usage data, we measured the effectiveness of these functions to successfully hold patients’ use of the app in two different settings; panel analysis and survival analysis. Results: The results of the panel analysis using 20,872 samples suggest that all of the function types increase the amount of use. However, only the patient’s own health management features enabling them to measure and store personal health information positively influences patients to sustain the use of the mPHR app. Moreover, the results of the survival analysis show that the likelihood to sustain the use of mPHR app is associative with the intensive use of this self-feedback features. Conclusions: Developing personal IT devices and services to promote health supports is still at an immature stage. There are gaps between as-is and to-be models of the devices, thus various attempts have been made to fill this gap. The efficacy of the self-feedback validated in this study may enlighten a way to encourage patients’ behavior change through mobile devices and move one step ahead toward the future model.
 
Date Submitted: Aug 11, 2014
Open Peer Review Period: Aug 26, 2014 - Oct 21, 2014
 
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The use of Chinese-language Internet information about cancer by Chinese health consumers

Background: There is evidence that Internet health information is able to empower consumers and has a positive impact on the outcome of cancer patients. However, there is little research on Chinese-language Internet cancer information. Due to the differences in the information content and cultural background of Chinese and English Internet, research in Chinese-language settings may reveal different usage patterns and issues as compared to the more widely studied English-language Internet. Objective: This study investigates the use of Chinese-language Internet information about cancer by Chinese health consumers, as well as its impact on their cancer care. Methods: This study applied a grounded theory approach in data collection and analysis to construct a theoretical framework for understanding the pattern of use and impact of cancer information from the Chinese-language Internet. Semi-structured interviews were carried out with 20 participants in the People’s Republic of China (PRC) to learn their experience of using the Internet for cancer information as a patient themselves or, more typically, for a family member with cancer or possible cancer. Thematic analysis was undertaken on the interview data applying methods such as open coding, axial coding and constant comparison. Results: Three major themes were identified from the analysis process: (1) information needs evolve during the treatment journey; (2) Traditional Chinese Medicine (TCM) and adverse effects of treatment are the topics of greatest interest for participants; and (3) most participants have encountered Internet health information with questionable quality. Conclusions: The Internet has great potential to empower Chinese cancer patients and their family members through the cancer care journey. However, the quality issues around Internet cancer information, cultural considerations and current health care paradigm constrain this potential. Efforts should be done in order to improve cancer care in China, including establishing online support groups for Chinese cancer patients and care givers, educating consumers to raise awareness of side effects of TCM and to identify high quality Internet information, Engaging customers into decision making.
 
Date Submitted: Aug 23, 2014
Open Peer Review Period: Aug 25, 2014 - Oct 20, 2014
 
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Acute Medical Exacerbations and Engagement with Web-based Health Informatio

Background: The internet is an increasingly important resource for individuals, who seek information from both health professionals and peers. While the demographic and health characteristics of persons who use health information technology has been well described, less is known about the relationship between these health characteristics and level of engagement with health information technology. Even less is known about whether persons who produce web-based health information differ in health status from persons who consume such content. Objective: We explored the health characteristics of persons who engage with the internet for the purposes of consuming or producing web-based health information, and specifically, whether healthier versus sicker persons engage with health information technology in different ways. Methods: We analyzed data from the 2012 Pew Health survey, a landline and cellphone survey of 3,104 adults in the United States. Using multiple logistic regression with sampling weights, we examined the association between sociodemographic and health characteristics and the consumption or production of web-based health information. Sociodemographic variables included age, sex, race and education. Health characteristics included self-reported health status, presence of chronic condition(s), and having an acute medical exacerbation. Acute medical exacerbations were defined as an Emergency Department visit, hospitalization, or other serious medical emergency in the last 12 months. Results: The majority of the sample reported good or excellent health (80%), although 50% reported having at least one chronic condition. Approximately 20% of the sample experienced an acute medical exacerbation in the past year. Education was the sociodemographic characteristic most strongly associated with consuming web-based health information. The strongest health-related predictors of consuming web-based health information were an acute medical exacerbation (OR 2.39, p < .0001) and having a chronic condition (OR 1.54, p = .007). Having an acute medical exacerbation was the only predictor of producing web-based health information (OR 1.97, p = .003). All respondents, regardless of health status, were most interested in web-based health information regarding diseases or medical problems. However, persons with acute medical exacerbations were more likely to seek web-based health information regarding medical tests, procedures and drugs compared to persons without acute medical exacerbations. Conclusions: Producers of web-based health information differ from consumers of this information in important health characteristics that could skew the content of peer-generated web-based health information and over-represent the experiences of persons with acute medical exacerbations. Having an acute medical exacerbation may represent a “window of opportunity” during which patient engagement with health information technology changes. The health care visit for the acute medical exacerbation may represent an opportune time for providers to point patients towards high-quality, easy-to-understand web-based information, especially regarding treatments and procedures.
 
Date Submitted: Aug 21, 2014
Open Peer Review Period: Aug 21, 2014 - Oct 16, 2014
 
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Prioritization of free-text clinical documents: a novel use of a Bayesian classifier

Background: The amount of incoming data into physicians’ offices is increasing, thereby making it difficult to process information efficiently and accurately to maximize positive patient outcomes. Current manual processes of screening for individual terms within long free-text documents are tedious and error-prone. This paper explores the use of statistical methods and computer systems to assist clinical data management. Objective: To verify and validate the use of a naive Bayesian classifier as a means of properly prioritizing important clinical data, specifically that of free text radiology reports. Methods: Fifty reports were first used to train the algorithm based on physicians’ categorization of clinical reports as high-priority or low-priority. Then, the algorithm was used to evaluate 354 reports. Additional beautification procedures such as section extractors, text pre-processors, and negation detection were performed. Results: The algorithm evaluated the 354 reports with discrimination between high-priority and low-priority reports, resulting in a bimodal probability distribution. In all scenarios tested, the false negative rates were below 1.1% and the recall rates ranged from 95.65% to 98.91%. In the case of 50% prior probability and 80% threshold probability, the accuracy of this Bayesian was 93.50%, with a positive predictive value (precision) of 80.54%. It also showed a sensitivity (recall) of 98.91% and a F-measure of 88.78%. Conclusions: The results showed that the algorithm was able to be trained to detect abnormal radiology results by accurately screening clinical reports. Such a technique can potentially be used to enable automatic flagging of critical results. In addition to accuracy, the algorithm was able to minimize false negatives, which is important for clinical applications. We conclude that a Bayesian statistical classifier, by flagging reports with abnormal findings, can assist a physician in reviewing radiology reports more efficiently. This higher level of prioritization allows physicians to address important radiologic findings in a timelier manner and may also aid in minimizing errors of omission.
 
Date Submitted: Aug 19, 2014
Open Peer Review Period: Aug 21, 2014 - Oct 16, 2014
 
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Developing a healthy online cookbook for pediatric cancer patients and survivors

Background: Obesity has been a growing problem among children and adolescents in the United States for a number of decades. Childhood cancer survivors (CCS) are more susceptible to the downstream health consequences of obesity such as cardiovascular disease, endocrine issues and risk of cancer recurrence due to late effects of treatment and suboptimal dietary and physical activity habits. Objective: To document the development of an online cookbook of healthy recipes and nutrition resources to help enable pediatric cancer patients and survivors to lead healthier lifestyles. Methods: At the Table was created by a committee of staff members, community leaders, donors, patients and family members. Recipes were collected from several sources and through contests on social media. We incorporated advice from MDACCH’s Family Advisory and Adolescent/Young Adult Advisory Council members, which included current patients, parents and CCS. Results: Over 400 recipes, searchable by several categories and with accompanying nutritional information, are currently available on the At The Table site. In addition to healthy recipes, social media functionality and cooking videos are built into the site. At the Table is also a nutrition information resource with nutrition and cooking tip sheets available on several subjects. Conclusions: At the Table is a unique resource for promoting healthy lifestyles spanning pediatric oncology prevention, treatment and survivorship. Through evaluations of At the Table’s current and future use, as well as incorporation of the website into interventions designed to promote energy balance, we will continue to adapt and build this unique resource to serve cancer patients, survivors and the general public.
 
Date Submitted: Aug 19, 2014
Open Peer Review Period: Aug 21, 2014 - Oct 16, 2014
 
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Are Parents Getting it Right? A Survey of Parents’ Internet Use for Children’s Healthcare Information.

Background: The use of the Internet to search for medical and health related information is increasing and associated with concerns around quality and safety. We investigated the current use and perceptions of reliable websites for children’s health information by parents. Methods: Following institutional ethics approval we conducted a survey of parents/guardians of children presenting for day surgery. A 20-item survey instrument developed and tested by the investigators was administered. Results: Ninety-eight percent of respondents reported that they used the Internet to search for information around their child’s health. Eighty percent reported using public began their search using public search engines while less than 20% reported starting their search by using university/hospital-based websites. Common conditions such as colds/flu, skin conditions and fever were the most frequently searched and unique conditions directly affecting the child were second. Despite low usage levels of university/hospital-based websites for health information, the majority of respondents (74%) regarded these as providing safe, accurate and reliable information. In contrast, only 24% of respondents regarded public search engines as providing safe and reliable information. Fifty percent of respondents reported that they cross-checked information found on the internet with a family physician. Conclusions: An unprecedented majority of parents/guardians is using the Internet for their child’s health information. Of concern is that parents/guardians are currently not using reliable and safe sources of information. Health care providers should begin to focus on improving access to safe, accurate and reliable information for parents/guardians through various modalities including education, design for multiplatform, and better search engine optimization.
 
Date Submitted: Aug 18, 2014
Open Peer Review Period: Aug 18, 2014 - Oct 13, 2014
 
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E-health, participatory medicine and ethical care: A focus group study of patients and health care providers use of health technologies

Background: The rapid explosion in ehealth is claimed as transformational, accelerating the shift from traditional passive patient to patients as partners and altering the patient-clinician relationship. Epatients are engaged, equipped, enabled and empowered to take part in shared decision-making, and take responsibility for self-managing their illness. In this paper we use e-health and e-health technologies to refer to information and communication technologies used for health and wellness purposes. This includes a vast range of resources such as online applications, tools, information sources and social media. The widespread and rapid adoption of e-health technologies can enable immediacy and convenience in patient-clinician communications, provide patients with extensive and up-to-date information and connect people with similar conditions and have the potential to improve health outcomes. Objective: The objective of our study is to examine how people with chronic illness use ehealth in their daily lives, investigate how it affects patient-provider relationships, and explore the ethical and practical ramifications for patients, providers, and service provision. We apply a relational ethics approach to make explicit the implications and emerging ethical issues of ehealth and associated shifts in terms of patient-clinician relationships, self-management and shared decision-making. Methods: We purposively sampled participants in British Columbia, Canada to participate in focus groups. To be eligible, patient participants self-reported a diagnosis of arthritis and at least one other chronic health condition; health care providers (HCPs) reported a caseload of patients with arthritis and multi-morbidity (>25%). Results: We recruited 32 participants (18 patients, 14 HCPs) for focus group discussions. The participants attended 7 focus groups (FGs), 4 with patients and 3 with rehabilitation professionals and physicians. We used a semi-structured, but flexible, discussion guide. All discussions were audiotaped and transcribed verbatim. Elements of grounded theory guided our constant comparison thematic analytic approach. A relational ethics conceptual lens was applied to the data to identify emergent ethical issues. Predominant themes to emerge were how ehealth use influenced: 1) Changing roles; 2) Partnerships; 3) Tensions and burdens. Conclusions: The knowledge gained through e-health resources supports self-management and changes the medical encounter, supporting pertinent discussion and shared decision-making for patients and clinicians. Our findings emphasize the interactive process of making medical decisions; the negotiations that take place in clinical encounters; the patient work in terms of preparation; and the associated importance of trust, in order to feel able to share and negotiate in a more equitable partnership model. We also revealed the vulnerabilities of both patients and clinicians when facing the tensions and burdens around Internet use, in particular regarding negotiations, of time and evolving roles which nurture shared and informed discussions. Relational ethics brings attention to the moral space of medical encounters in which e-health care occurs.
 
Date Submitted: Aug 17, 2014
Open Peer Review Period: Aug 18, 2014 - Oct 13, 2014
 
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Smartphone-Connected Wearable Motion Sensors to Assess Post-operative Mobilization

Background: Early mobilization after surgery reduces the incidence of a wide range of complications. Wearable motion sensors measure movements over time and transmit this data wirelessly, which has the potential to monitor patient recovery and encourages patients to engage in their own rehabilitation. Objective: We sought to determine the ability of off-the-shelf activity sensors to remotely monitor patient postoperative mobility. Methods: Consecutive subjects were recruited under the Department of Neurosurgery at Columbia University. Patients were enrolled during physical therapy sessions. The total number of steps counted by the two blinded researchers was compared to the steps recorded on 4 activity sensors positioned at different body locations. Results: A total of 148 motion data points were generated. The start time, end time, and duration of each walking session were accurately recoded by the devices and were remotely available for the investigator to analyze. Our multivariate analysis showed that step length was an independent predictor of sensor accuracy. On linear regression, there was a modest positive correlation between increasing step length and increased ankle sensor accuracy (R=.640, r2=.397) that reached statistical significance on the multivariate model (p=.034). Although increased gait speed also correlated with increased ankle sensor accuracy (r2=.197). Accuracy was also affected by several specific measures of a patient’s level of physical assistance, for which we generated a model to mathematically adjust for systematic under-estimation as well as disease severity. Conclusions: For the first time, we assessed the accuracy and utility of widely-available and wirelessly-connected activity sensors in a postoperative patient population. Our results show that activity sensors are able to provide invaluable information about a patient’s mobility status and can transmit this data wirelessly, although there is a systematic underestimation bias in more debilitated patients.
 
Date Submitted: Aug 14, 2014
Open Peer Review Period: Aug 18, 2014 - Oct 13, 2014
 
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Barriers to meaningful use of personal health records by patients: A structured review

Background: An increasing focus on personal electronic health records (PHRs) offers healthcare benefits for patients, particularly those in undeserved and marginalised populations, at risk of receiving less effective healthcare and worse health outcomes. However, PHRs are likely to favour text, technical and health literate users, and be less suitable for disadvantaged patients. These individuals may be less likely to access an online record or contribute to the EHR Incentive Programs ‘meaningful use’ Measure #2 (5% of patients accessing their record). These concerns have prompted this review of the literature, which seeks evidence about barriers to the adoption and continued use of PHRs, the nature of the evidence for those barriers, and the stage of PHR implementation where particular barriers apply. Methods: Searches in PubMed, Embase, CINAHL and ProQuest databases were used to retrieve articles published in English after 2003 in a refereed journal or presented in a refereed conference or scientific meeting. After screening to remove items which were out of scope, the phase of the PHR implementation, the type of investigation, and PHR barriers were categorised using thematic coding. Results: The search retrieved 439 items; screening identified 40 in-scope publications, which provided evidence of 21 barriers to patient adoption and continued use of PHRs, categorised here as Individual, Demographic, Capability, Health-related, PHR or Attitudinal factors. Barriers were identified in most phases of PHR implementation, and in most types of study. A secondary outcome identified that eleven of the publications may have introduced a bias by excluding participants who were less affluent, less capable, or marginalised. Conclusions: PHR barriers can interfere with the decision to start using a PHR, with the adoption process, and with continued use, and the impact of particular barriers may vary at different phases of PHR adoption. The complex interrelationships which exist between many of the barriers is suggested in some publications, and emerges more clearly from this review. Many PHR barriers appear to be related to low socioeconomic status. The 5% meaningful use criterion will measure the activities of more capable PHR users, for whom the barriers are not insurmountable, but is less likely to include online activity by disadvantaged patients. A better understanding is needed of how the effect of barriers is manifested, how that that effect can be countered, and how planning and implementation of PHR initiatives can make allowance for patient level barriers to PHR adoption and use, with appropriate actions to mitigate the effect of those barriers for more disadvantaged patients.
 
Date Submitted: Aug 14, 2014
Open Peer Review Period: Aug 14, 2014 - Oct 9, 2014
 
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The essential evil! A viewpoint of family physicians on educational email alerts

Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians (FPs) become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search online resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: To understand participants’ knowledge, attitudes, and behaviour in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the ‘Knowledge Attitude Behaviour’ model. Participants and data collection: Semi-structured face-to-face interviews with 15 FPs. Analysis: Inductive-deductive thematic qualitative data analysis. Results: As expressed by one FP, email is “the essential evil”. All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (i) advantages of educational email alerts such as saving time, convenience and valid information, and (ii) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by FPs can help to improve educational email alerts.
 
Date Submitted: Aug 11, 2014
Open Peer Review Period: Aug 12, 2014 - Oct 7, 2014
 
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An Observational Study of Social/Emotional Support in Smoking Cessation Twitter Accounts

Background: Smoking continues to remain the number one preventable cause of premature death in the United States. While evidence for the effectiveness of smoking cessation interventions has increased rapidly, questions remain on how to effectively disseminate these findings. Twitter, the second largest online social network, provides a natural way of disseminating information. Health communicators can use Twitter to inform smokers, provide social support, and attract them to other interventions. A key challenge for health researchers is how to frame their communications to maximize the engagement of smokers. Objective: To examine current Twitter activity for smoking cessation. Methods: Active smoking cessation related Twitter accounts (N=18) were identified. Their 50 most recent tweets were content coded using a schema adapted from the Roter Interaction Analysis System (RIAS), a theory-based, validated coding method. Using negative binomial regression, the association of number of followers and frequency of individual tweet content at baseline was assessed. The difference in followership at six-months (compared to baseline) to the frequency of tweet content was compared using linear regression. Both analyses were adjusted by account type (organizational or not organizational). Results: The 18 accounts had 60,609 followers at baseline and 68,167 at six months. Twenty four percent of tweets were socio-emotional support (mean 11.8, SD 9.8), 14% (mean 7, SD=8.4) were encouraging/engagement, and 62% (mean 31.2, SD 15.2) were informational. At baseline, higher frequency of socio-emotional support and encouraging/engaging tweets was significantly associated with higher number of followers (socio-emotional: IRR 1.09, 95% CI=1.02, 1.20; encouraging/engaging: IRR 1.06, 95% CI=1.00, 1.12). Conversely, higher frequency of informational tweets was significantly associated with lower number of followers (IRR 0.95, 95% CI=0.92, 0.98). At six months, for every increase by 1 in socio-emotional tweets, the change in followership significantly increased by 43.94 (P=0.027); the association was slightly attenuated after adjusting by account type and not significant (P=0.064)). Conclusions: Smoking cessation activity exists on Twitter. Preliminary findings suggest that certain content strategies can be used to encourage followership, and this needs to be further investigated.
 
Date Submitted: Aug 8, 2014
Open Peer Review Period: Aug 11, 2014 - Oct 6, 2014
 
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Personal experiences and emotionality in health-related knowledge exchange: A randomized controlled field experiment in Internet forums

Background: On the Internet people share personal experiences as well as facts and objective information. This holds true also for the exchange of health-related information in a variety of Internet forums. In online discussions about health topics both fact-oriented and strongly personally affected contributions occur on a regular basis. Objective: In the present field experiment we examined in what way the particular type of contribution (i.e., factual information vs. personal experiences) has an impact on the subsequent communication in health-related Internet forums. Methods: For this purpose we posted parallelized queries to 28 comparable Internet forums; queries were identical with regard to the information contained but included either fact-oriented descriptions or personal experiences. Results: We found no evidence that personal contributions (3.79, SD 3.91) evoked more responses from other members of the Internet forums than fact-oriented contributions (2.14, SD 2.93, t(26)=0.126, P=.219). But personal experiences (3.17, SD 1.29) elicited emotional replies from other users to a greater extent than fact-oriented contributions (2.13, SD 1.29, t(81)=3.659, P<.001). Conclusions: We suggest explaining the finding that personal contributions elicited more emotional replies by processes of emotional anchoring of people’s own style of communication. We recommend future studies that should aim at testing the hypotheses with more general topics, constructing different fact-oriented posts, and examining additional potential factors of influence such as personality factors or particular communication situations.
 
Date Submitted: Aug 7, 2014
Open Peer Review Period: Aug 8, 2014 - Oct 3, 2014
 
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Telepathology Impacts and Implementation Challenges: A Scoping Review

Background: Telepathology is a particular form of telemedicine which fundamentally alters the way pathology services are delivered. The global digital pathology market is expected to grow at a compound annual growth rate of 15% from $2.2 billion in 2013 to nearly $4.5 billion in 2018. Prior telepathology research has mostly focused on two themes, namely, technical feasibility issues and diagnosis accuracy. Objective: As a complement to prior research conducted in this domain, we aim to synthesize the extant literature on telepathology implementation challenges and broader organizational/societal impacts and to propose a research agenda to guide future efforts in this domain. Methods: To achieve our goals, a scoping review was conducted.Two complementary databases were systematically searched: MEDLINE (Pubmed) and ABI/INFORM (ProQuest). Only peer-reviewed articles and conference proceedings were considered. The final sample consisted of 159 papers published between 1992 and 2013. Results: Our review highlights the diversity of telepathology networks and the importance of considering these distinctions when interpreting findings. For one thing, various network structures are associated with different benefits. While the dominant rationale in single site projects is financial, with telepathology being considered as an equal quality substitute to more costly solutions such as having a resident or roaming pathologist, larger centralized and decentralized networks are targeting a more diverse set of benefits, including extending access to pathology to a whole region, achieving substantial economies of scale in workforce and equipment and improving quality by standardizing care. Overall, our findings reveals that solid and rigorous evaluation studies remain rare as of today. As potential benefits are a key motivator leading to individual and organizational adoption, rigorously evaluating their nature and extent represents an important endeavor for future research. Further, our synthesis of the extant literature reveals that the nature and scale of encountered implementation challenges vary depending on the project structure. In smaller telepathology networks, organizational concerns are less prominent, and implementers are more focused on usability issues. As the project scope widens, organizational and legal issues gain prominence. Conclusions: Researchers should strive to assess telepathology impacts through more rigorous methodologies, leverage more existing theories and frameworks to explain telepathology implementation challenges and success, and ponder the form of telepathology networks when investigating these issues.
 
Date Submitted: Aug 6, 2014
Open Peer Review Period: Aug 8, 2014 - Oct 3, 2014
 
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Personal Health Record Reach in the Veterans Health Administration

Background: My HealtheVet (MHV) is the personal health record (PHR) and patient portal developed by the Veterans Health Administration (VA). While millions of Veterans have registered for MHV, little is known about how reach of MHV varies across clinical conditions. Objective: To characterize PHR reach by specific clinical conditions. Methods: This was a cross-sectional analysis of all Veterans nationwide with at least one inpatient admission or two outpatient visits between April 2010 and March 2012. We compared adoption (registration, authentication, opt-in to use secure messaging) and use (prescription refill and secure messaging) of MHV in April 2012 across 18 specific clinical conditions prevalent in and high priority to the VA. Results: Among 6,012,875 Veterans, 6.2% were women, 61.4% were Caucasian, 47% were over 65 years of age, and 26.3% resided in rural areas. Nationwide, 18.6% had registered for MHV, 11.1% refilled prescriptions via MHV, and 1.9% used secure messaging with their clinical providers. Veterans with trauma-related conditions (spinal cord injury and traumatic brain injury) had the highest relative use of refill (18.0%) and secure messaging functions (3.2%), followed by those with certain mental health conditions (on average, 17.2% and 3.2% of patients with depression, anxiety or post-traumatic stress disorder used refills and secure messaging, respectively). Patients with certain medical conditions had lower rates of use, including coronary artery disease (11.1% and 1.9% medication refills and secure messaging, respectively) and congestive heart failure (10.4% and 1.7%, respectively). Some, but not all, variation was explained by differences in patients’ sociodemographic characteristics by diagnosis. Conclusions: In this phase of early adoption, opportunities are being missed for those with specific medical conditions that require intensive treatment and self-management which could be greatly supported by functions of a tethered personal health record.
 
Date Submitted: Aug 4, 2014
Open Peer Review Period: Aug 5, 2014 - Sep 30, 2014
 
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Health information-seeking behavior of seniors in the Netherlands who use the internet

Background: The internet is viewed as an important source for health information and a medium for patient empowerment. However, little is known about how seniors use the internet in relation to other sources for health information. Objective: To determine which information resources seniors use and trust for health information, which sources are preferred, and which sources are used by seniors for different information needs. Methods: Questions from published surveys were selected based on their relevance to the study objectives. The autonomy preference index was used to assess information needs and preferences for involvement in health decisions. Invitation to participate in this online survey was sent to the email list of a local senior organization (298 addresses). Results: We had 118 respondents with a median age of 72 years. Health professionals, pharmacists, and the internet were the most commonly used and trusted sources of health information. Leaflets, television, newspapers, and health magazines were also important sources. Respondents who reported higher use of the internet also reported higher use of other sources (p < 0.001). Use of health professionals, pharmacists, leaflets, telephone, television and radio were not significantly different; use of all other resources was significantly higher in internet users. Preferred information sources were the internet (44%), other sources (e.g. magazines, 36%), health professionals (17%), and no information seeking (3%). Of those who sought health information in the last 12 months, 41% sought it after an appointment, 22% were preparing for an appointment, and 19% were deciding if an appointment was needed. The source used varied by the type of information sought. The internet was used most often for symptoms (64%), prognosis (68%), and treatment options (62%), while health professionals were asked for additional information on medications (56%), side effects (47%), coping (55%), practical care (86%), and nutrition/exercise (60%). Information on paper was rarely used. One third reported that they often need additional information but cannot find it, 93% reported difficulty finding information in their own language, and 95% reported that they expect health professionals to provide all needed information. Conclusions: In this population of seniors who use the internet, the internet was a preferred source of health information. Seniors who report higher use of the internet also report higher use of other information resources, and were also the main consumers of paper-based resources. Respondents most frequently searched for health information after an appointment rather than to prepare for an appointment. Resources used varied by health topic. Future research should investigate how seniors seek and understand information on the internet, whether seniors who seek information from all sources tend to be internet users, and how to reach seniors who prefer not to use the internet for health information. Clinical Trial: n/a
 
Date Submitted: Aug 4, 2014
Open Peer Review Period: Aug 5, 2014 - Sep 30, 2014
 
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Randomized controlled trial of web-based mindfulness training for mental health promotion: Enhancements with the Health Action Process Approach

Background: With increasing evidence demonstrating the effectiveness of web-based interventions and mindfulness-based training in improving health, delivering mindfulness training online is an attractive proposition. Objective: This study evaluated the efficacy of two internet-based interventions (basic mindfulness and Health Action Process Approach (HAPA)-enhanced mindfulness) with waitlist control. HAPA principles were used to enhance participants’ efficacy and planning. Methods: Participants were recruited online and offline among local universities. Three hundred and twenty-one university students and staff were randomly assigned to three conditions. The basic and HAPA-enhanced groups completed the 8-week fully automated mindfulness training online. All participants (including control) were asked to complete an online questionnaire pre-program, post-program, and at 3-month follow-up. Results: Significant group by time interaction effect was found. The HAPA-enhanced group showed significantly higher levels of mindfulness from pre- to post-, and such improvement was sustained at follow-up. Both the basic and HAPA-enhanced mindfulness groups showed better mental well-being from pre- to post-, and improvement was sustained at 3-month follow-up. Conclusions: Online mindfulness training can improve mental health. Online platform is a viable medium to implement and disseminate evidence-based interventions and is a highly scalable approach to reach the general public. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR) ChiCTR-TRC-12002954
 
Date Submitted: Aug 1, 2014
Open Peer Review Period: Aug 1, 2014 - Sep 26, 2014
 
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Top-down or bottom-up? Building information systems for healthcare

In this study we compare a large scale top-down project with a small scale bottom-up project within Norwegian healthcare. Both projects aimed to establish inter-organizational services with integration to the installed bases in the involved organizations. The aim of the paper is to explore how inter-organizational information system projects can be organized and run. In particular the paper discusses bottom-up and top-down approaches to project organization and development models including conditions for user participation. The paper concludes by outlining a possible middle position on organization and development: an approach resembling networked governance.
 
Date Submitted: Aug 1, 2014
Open Peer Review Period: Aug 1, 2014 - Sep 26, 2014
 
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Quality of Websites of Obstetrics and Gynecology Departments: Cross-sectional Study

Background: The internet has become an easily accessible and widely used source of healthcare information. There are, however, no standardized or commonly accepted criteria for the quality of Obstetrics and Gynecology websites. Objective: To evaluate the quality of websites of Obstetrics and Gynecology departments and to compare websites nationally and internationally. Methods: We scored 672 websites from Germany (n=566), Austria (n=57), and Switzerland (n=49) using the objective criteria: Google presentation (2 items), technical aspects (11 items), navigation (8 items), and content (6 items) for a 26 point score. Scores were compared nationally and internationally. A multivariable regression model assessed good quality score (≥50% of maximum) as the dependent variable and country, Google presentation, technical aspect, navigation and content scores as independent variables. Results: The mean score of websites was 13.8±3.3. 4.2% were rated as excellent (≥75% of maximum), 61.8% as fair (≥50% of maximum). German (14.0±3.2) and Swiss (13.8±4.0) websites scored significantly higher compared to Austrian websites (11.6±2.5) (P<.001 and P=.005, respectively). Academic had higher scores than non-academic departments (14.9±3.2 vs. 13.7±3.1, P<.001). Single institutions had higher scores compared to healthcare consortium institutions (14.1±3.2 vs. 13.2±2.6, P=.003). Departments in Northern and Southern states had higher scores compared to Eastern states (14.4±3.2 and 14.2±3.2 vs. 13.0±3.0, P<.001). In a multivariable logistic regression model, Google presentation, technical aspects, navigation, and content (all: P<.001) independently predicted a website’s reaching a good quality score. Conclusions: The quality of websites of Obstetrics and Gynecology departments varies widely. We found marked differences depending on country, affiliation, and region.
 
Date Submitted: Aug 1, 2014
Open Peer Review Period: Aug 1, 2014 - Sep 26, 2014
 
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Integrating mHealth in oncology: experience in the province of Trento

Background: Over the last 15 years, we have developed various integrated eHealth solutions aimed at healthcare professionals, citizens and patients. Objective: We have developed two mobile health applications: for the home monitoring of cancer patients receiving oral chemotherapy or targeted therapies, such as capecitabine or sunitinib, and for the safe delivery of infusion chemotherapy. Methods: Using mobile communication technology, information from patient-held diaries may be conveyed to a specific database and made available to health professionals in real time. Moreover, a specific rule-based alarm system may alert doctors and nurses of critical events so that they can promptly contact the patient to give him proper indications. Safe Therapy Mobile system The system is based on a Radio-Frequency Identification (RFID)/barcode reader which checks the patient, the nurse and the infusion bag before each drug administration and communicates via Bluetooth with a tablet. This in turn communicates via Wi-Fi with the server of the Oncologic Patient Record (OPR), in order to import the detailed prescription of chemotherapy and ancillary therapy. All drug administrations are tracked and recorded in the patient’s digital OPR. Results: Home monitoring of cancer patients In the diary application, deployed on the patient tablet, the prescribed therapy is converted in the number and type of pills that the patient has to take day by day. In the case of toxicity, the patient is helped by a scale of predefined drug-specific symptoms in which each grade is defined in simple language and, for skin toxicities, illustrated by pictures. All data appear in the patient diary and in the doctor/nurse dashboard. This allows professionals to check the condition of the patient at a glance. A rule-based alarm system, alerts doctors or nurses in the case of potentially “critical” situations. The preliminary results of the more advanced pilot studies on chronic patients, have confirmed that this approach appears useful and reliable to clinicians and patients. Safe Therapy Mobile system At the patient’s bedside, the system identifies and matches the patient, the drug infusion bag and the nurse, to verify the right drug administration, and tracks the entire infusion process. In a proper testing, the system never failed to match the patient-drug-nurse association correctly and didn’t impact on the duration of chemotherapy. It was well accepted by nurses and patients and is presently adopted for routine activity. Conclusions: Although the mobile health applications that we have developed have yet to prove their role in the validation trials, we are confident that they may result beneficial to our patients, because they have been tightly integrated with our complex and composite information system, which guarantees privacy, security, architecture, interoperability and particularly a true and real time patient-health professional communication.
 
Date Submitted: Jul 31, 2014
Open Peer Review Period: Jul 31, 2014 - Sep 25, 2014
 
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Analysis of PubMed User Sessions Using a Full-Day PubMed Query Log: A Comparison of Experienced and Non-Experienced PubMed Users

Background: PubMed is the largest biomedical bibliographic information source in the Internet. PubMed has been considered as one of the most important and reliable source of up-to-date healthcare evidence. Previous studies targeted to learn about the effects of domain expertise/knowledge on the search performance using PubMed. However, very little is known about PubMed users’ knowledge of information retrieval (IR) functions and their usage in query formulation. Objective: The purpose of the study was to shed light on how experienced/non-experienced PubMed users perform their search queries by analyzing a full-day query log. Our hypothesis is that (1) experienced PubMed users who use system functions quickly retrieve relevant documents and (2) non-experienced PubMed users who do not use them take longer search sessions than experienced users. Methods: To test the hypothesis we analyzed PubMed query log data containing nearly 3 million queries. User sessions are categorized into two categories: experienced and non-experienced user sessions. We compared the experienced and non-experienced users per number of sessions, and the experienced and non-experienced user sessions per session length with the focus on how fast they complete their sessions. Results: To test the hypothesis, we measured how much the information retrieval session is successful (retrieving relevant documents), that is represented as the decrease rates of the experienced and non-experienced users from the session length of 1 to 2, 3, 4, and 5. The decrease rate (from the session length of 1 to 2) of the experienced users is significantly larger than those of the non-experienced groups. Conclusions: The experienced PubMed users quickly retrieve relevant documents than the non-experienced PubMed users.
 
Date Submitted: Jul 30, 2014
Open Peer Review Period: Jul 31, 2014 - Sep 25, 2014
 
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VALIDITY OF ELECTRONIC DIET RECORDING NUTRIENT ESTIMATES COMPARED TO DIETITIAN ANALYSIS OF DIET RECORDS: A RANDOMIZED CONTROLLED TRIAL

Background: Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation. Objective: To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track™ software for the Apple iPod touch™ and records kept on the Nutrihand® website to DR coded and analyzed by a research dietitian into a customized USDA nutrient analysis program. Methods: Adult participants (n=19) enrolled in a cross-over designed clinical trial [1]. During each of two wash-out periods participants kept written 3-day DR. In addition they were randomly assigned to enter their DR in an online dietary analysis program (Nutrihand®) or a hand-held electronic device (Tap & Track™). They completed an additional 3-day DR and the alternate electronic diet recording methods during the second wash-out. Entries resulted in 228 daily diet records; or 12 for each of 19 participants. Means and standard deviations of nutrient intake were calculated for each method. Concordance of the intake estimates were determined by Bland-Altman plots. Coefficients of determination (R2) were calculated for each comparison to assess the strength of the linear relationship between methods. Results: No significant differences were observed between the mean nutrient values for energy, carbohydrate, protein, fat, saturated fatty acids, total fiber or sodium between the recorded DR analyzed in GRAND and either Nutrihand® or Tap & Track™, or for total sugars comparing GRAND and Tap & Track™. Reported values for total sugars were significantly reduced (p<.05) comparing Nutrihand® to GRAND. Coefficients of determination (R2) for Nutrihand® and Tap & Track™ compared to DR entries into GRAND, respectively, were energy 0.56, 0.01; carbohydrate 0.58, 0.08; total fiber 0.65, 0.37; sugar 0.78, 0.41; protein 0.44, 0.03; fat 0.36, 0.03; saturated fatty acids 0.23, 0.03; sodium 0.20, 0.00; and for Nutrihand® only for cholesterol 0.88; vitamin A 0.02; vitamin C 0.37; calcium 0.05; and iron 0.77. Bland-Altman analysis demonstrates high variability in individual responses for both electronic capture programs with higher 95% limits of agreement for dietary intake recorded on Tan & Track™. Conclusions: In comparison to dietitian entered 3-day DR, electronic methods resulted in no significant difference in mean nutrient estimates but exhibited larger variability, particularly the Tap & Track™ program. However, electronic DR provided mean estimates of energy, macronutrients, and some micronutrients which approximated those of the dietitian analyzed DR and may be appropriate for dietary monitoring of groups. Electronic diet assessment methods have the potential to reduce the cost and burden of DR analysis for nutrition research and clinical practice. Clinical Trial: This study was registered at clinicaltrials.gov (NCT01183520).
 
Date Submitted: Jul 30, 2014
Open Peer Review Period: Jul 31, 2014 - Sep 25, 2014
 
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Familial, Associational & Incidental Relationship initiative [FAIR]

Background: The widespread development of medical data warehouses has occurred over the last several years. Current data warehouses focus on individual cases, but lack the ability to identify family members that could be used for dyadic or familial research. Currently, the patient’s family history in the medical record is the only documentation we have to understand the health status and social habits of family members of the patient. Identifying familial linkages in a phenotypic data warehouse can be valuable in cohort identification, and beginning to understand interactions of diseases among families. Objective: The goal of the Familial, Associational, & Incidental Relationships (FAIR) system is to identify an index set of patients’ relationships through elements in a data warehouse. Methods: Using a test set of 500 children, we measured the sensitivity and specificity of available linkage algorithm (e.g: insurance id and phone numbers) and validated this tool/algorithm through a manual chart audit. Results: The average age of children in the sample was 8 years of age (SD=5). The cohort was 52% male. Fifty-two percent of these children were identified as white in Race. The identifiers used for FAIR were available on the majority of patients insurance number 97%, phone number 100%, and address 99%. When utilizing the FAIR tool, sensitivity varied from 16% to 87%, and specificity from 70% to 100% using various combinations of identifiers. Using the “i2b2” warehouse infrastructure, we have now developed a web app that facilitates FAIR for any index population. Conclusions: FAIR is a valuable research and clinical resource that extends the capabilities of existing data warehouses and lays the groundwork for family-based research. FAIR will expedite studies that would otherwise require registry or manual chart abstraction data sources.
 
Date Submitted: Jul 29, 2014
Open Peer Review Period: Jul 30, 2014 - Sep 24, 2014
 
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Veteran, Primary Care Provider, and Specialist Satisfaction with Electronic Consultation

Background: Access to specialty care is challenging for Veterans in rural locations. To address this challenge, in December 2009, the VA implemented an electronic consultation (e-consult) program to provide primary care providers (PCPs) and patients enhanced specialty care access. Objective: This quality improvement (QI) project evaluation was designed to: (1) assess satisfaction with the e-consult process and (2) identify perceived facilitators and barriers to using the e-consult program. Methods: We conducted semi-structured telephone interviews with Veteran patients (N=15), Community Based Outpatient Clinic (CBOC) PCPs (N=15), and VA Pittsburgh specialty physicians (N=4) who used the e-consult program December 2009-August 2010. Participants answered questions regarding satisfaction in 8 domains and identified factors contributing to their responses. Results: Most participants were white (patients=87%; PCPs=80%; specialists=75%) and male (patients=93%; PCPs=67%; specialists=75%). On average, patients had one e-consult (SD=0), PCPs initiated 6 e-consults (SD=6), and VAPHS specialists performed 17 e-consults (SD=11). Patients, PCPs, and specialty physicians were satisfied with e-consults (mean+SD of 4.6+0.5 on 1-5 Likert-scale, 4.1+0.8, and 3.8+1.0 respectively). The most common reason why patients and specialists reported increased overall satisfaction with e-consults was improved communication, whereas improved timeliness of care was the most common reason for PCPs. Interestingly, communication was the most reported perceived barrier and facilitator to e-consult use. Conclusions: Veterans and VA healthcare providers were satisfied with the e-consult process. Our findings suggest that while reasons for satisfaction with e-consult differ somewhat for patients and physicians, e-consult may be a useful tool to improve VA Healthcare System access for rural patients.
 
Date Submitted: Jul 23, 2014
Open Peer Review Period: Jul 25, 2014 - Sep 19, 2014
 
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Development of patient-centered mhealth living donor education programs for African Americans

Background: There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant waitlist due to the disproportionally lower availability of deceased donor kidneys compared to other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mobile health (mHealth) strategies may be a way to deliver educational and supportive services to African American transplant eligible patients and improve reach to those living in remote areas or unable to attend traditional group session based programs . Prior to program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective: The objectives of this study was to investigate African American transplant eligible patients’ attitudes and perceptions toward mobile technology and its viability in a mHealth program aimed at educating patients about the process of living kidney donation. Methods: Using frameworks from the Technology Acceptance Model and Self-Determination Theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center which included deceased/living donor kidney recipients and living donors/caregivers. After a demo of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members’ perceptions about how education messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results: Qualitative findings found five major themes that were common among all participants. These included: (1) strong support for use of mobile technology, (2) different media formats would be nice to have, (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred, (4) media needs to work quickly and be easy to use, (5) high prevalence of access to technology help within their immediate circles. Differences showed that recipients were willing to spend more time on education topics than the living donors/caregivers, that they wanted to build skills on how to have conversations with others, and preferred getting information from many sources where the living donors/caregivers predominantly wanted to hear from other living donors and wanted the facts to make their decisions. The questionnaires showed a high amount of acceptability and interest to use the proposed program with 80% of responses scored 4 or 5 out of a 5-point Likert scale. Also, high utilization of mobile technology with 71.9% of the participants having a smartphone and 43.9% already had a tablet computer in their household. Conclusions: Our study supports the use a mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs and programs should be tailored to each target audience.
 
Date Submitted: Jul 21, 2014
Open Peer Review Period: Jul 21, 2014 - Sep 15, 2014
 
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Public perception of telemedicine and mobile health in China

Background: In recent years, telemedicine and mobile health (“mhealth”) technology have emerged as a viable solution to reduce unmet demands of health care services in the People’s Republic of China (“China” hereafter). Yet, the adoption of telemedicine and mhealth depends heavily on whether Chinese stakeholders believe that the new technology can actually work. It is therefore important to examine the public perception of this new technology in China. Objective: This paper seeks to reveal the perception towards telemedicine and mhealth among stakeholders in the Chinese health sector. We are interested in identifying the issues that have attracted attention from these stakeholders, particularly how they perceive and articulate the opportunities and barriers of this technology. Methods: In this paper, we collect data from a social media platform by adopting techniques from informatics. We focus attention on a social media site called Hc3i.cn, particularly its “telemedicine/mhealth” forum that began operation in November, 2009. We examine all the conversation threads (“threads”) in this forum, extracting both quantitative and qualitative information from these threads. We identify a number of keywords that have been used frequently as the first post to initiate a new thread, and analyze a selected list of these threads in depth. Results: The forum has produced 571 threads as of the research cut-off date in May, 2014. These threads consist of 2811 posts, so each thread has 2811/571 = 4.92 participation posts on average. Among other things, a relatively large number of forum participants initiated a new thread (32.57% of all first posts) to discuss the connections between telemedicine, mhealth and existing health information technology (HIT). Forum participants have put a great emphasis on the local relevance of telemedicine and mhealth to China but they also expressed interest in learning how other countries had utilized telemedicine and mhealth. Qualitative analysis shows that Chinese stakeholders see large organizational entities such as hospitals and multinational companies to be catalysts for telemedicine and mhealth development. Conclusions: This research has several significant observations: As mentioned, Chinese stakeholders have seen hospitals and multinational companies as significant entities in fostering telemedicine and mhealth in that country. Hospitals are seen to possess the capacity to absorb the costs of learning and facilitating large-scale change; whereas multinational companies are able to bring in enormous economic opportunities in association with telemedicine and mhealth technology. In addition, the participation of multinational companies is believed to increase acceptance among health stakeholders towards telemedicine and mhealth, as well as contribute useful capitals and knowledge to the new technology’s further development. Clinical Trial: N/A
 
Date Submitted: Jul 8, 2014
Open Peer Review Period: Jul 9, 2014 - Sep 3, 2014
 
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Exploring the Far Side of Mobile Health – Information Security and Privacy of Mobile Health Applications on iOS and Android

Background: Mobile health (mHealth) applications (apps) aim at providing seamless access to tailored health information technology (IT) and have the potential to alleviate global health burdens. Yet, they bear risks to information security and privacy because users need to reveal private, sensitive medical information to redeem certain benefits. Due to the plethora and diversity of available mHealth apps, implications for information security and privacy are unclear and complex. Objective: The objective of this research is to establish an overview of mHealth apps offered on iOS and Android with a special focus on potential damage to users through information security and privacy infringements. Methods: We assessed apps available in English and offered in the categories Medical and Health & Fitness in the iOS and Android app stores. Based on the information retrievable from the app stores, we developed a market overview, tagged apps to make offered information machine-readable, and clustered discovered apps to identify and group similar apps. Subsequently, information security and privacy implications were assessed based on health specificity of information available to apps, potential damage through information leaks, potential damage through information manipulation, potential damage through information loss, and potential value of information to third parties. Results: We discovered 24,405 health-related apps (iOS: 21,953; Android: 2,452). Absence or scarceness of ratings for 81.36% of iOS and 76.14% of Android apps indicates that less than a quarter of mHealth apps are in more or less widespread use. Clustering resulted in 245 distinct clusters, which were consolidated into 12 app archetypes grouping clusters with similar assessments of potential damage through information security and privacy infringements. The majority of apps (95.63% of apps) pose at least some potential damage through information security and privacy infringements. 11.67% of apps scored the highest assessments of potential damages. Conclusions: Various kinds of mHealth apps collect and offer critical, sensitive, private medical information calling for a special focus on information security and privacy of mHealth apps. In order to foster user acceptance and trust, appropriate security measures and processes need to be devised and employed so that users can benefit from seamlessly accessible, tailored mHealth apps without exposing themselves to the serious repercussions of information security and privacy infringements.
 
Date Submitted: Jul 6, 2014
Open Peer Review Period: Jul 7, 2014 - Sep 1, 2014
 
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