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Journal Description

The Journal of Medical Internet Research (JMIR), now in its 20th year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2017: 4.671, ranked #1 out of 22 journals) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals. 

As open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.

Be a widely cited leader in the digitial health revolution and submit your paper today!


Recent Articles:

  • Source: The Authors; Copyright: Anne Helen Hansen; URL:; License: Licensed by JMIR.

    Associations Between the Use of eHealth and Out-of-Hours Services in People With Type 1 Diabetes: Cross-Sectional Study


    Background: Despite the increasing prevalence of diabetes and the increasing use of eHealth, little is known about the association between provider-based health services and eHealth among people with diabetes. This is the second study in a project exploring the associations between the use of eHealth and the use of provider-based health services. Objective: The objective of this study was to investigate which eHealth services are used among out-of-hours (OOH) visitors with type 1 diabetes (T1D), and whether the use of eHealth (eg, apps, search engines, video services, and social media) was associated with the use of OOH services. We also wanted to investigate associations between anxiety, reassurance, and change in doctor-seeking behavior because of health information acquired from the Internet, and the use of OOH services. Methods: We used data from a 2018 email survey of members of the Norwegian Diabetes Association (18-89 years old). Respondents with T1D were eligible for analyses. Using descriptive statistics, we estimated the use of OOH services and eHealth. Using logistic regressions, we studied the associations between the use of OOH services and the use of eHealth, as well as associations between the use of OOH services and reported consequences of using Internet-based health information. Results: In the sample of 523 people with T1D (mean age 47 years), 26.7% (129/484) visited OOH services once or more during the previous year. Among the OOH visitors, search engines were used for health purposes by 86.7% (111/128), apps (health apps in general) by 63.6% (82/129), social media by 45.3% (58/128), and video services by 28.4% (36/127). The use of OOH services was positively associated with self-reported anxiety/depression (odds ratio [OR] 4.53, 95% CI 1.43-14.32) and with the use of apps (OR 1.73, 95% CI 1.05-2.85), but not with other types of eHealth. Those who had felt anxious based on information from the Internet were more likely to visit OOH services compared with those who had not felt anxious (OR 2.38, 95% CI 1.50-3.78). People who had decided to consult a doctor based on information from the Internet were more likely to visit OOH services (OR 2.76, 95% CI 1.64-4.66), compared to those who had not made such an Internet-based decision. Conclusions: People with T1D were frequent users of OOH services, and the OOH visitors were frequent users of eHealth. The use of OOH services was positively associated with the use of health apps, with self-reported anxiety/depression, and with feeling anxious based on information from the Internet. Likewise, deciding to consult a doctor based on information from the Internet was positively associated with OOH visits. The use of eHealth seems to have a significant impact on people with T1D.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Experiences With Video Consultations in Specialized Palliative Home-Care: Qualitative Study of Patient and Relative Perspectives


    Background: The work of specialized palliative care (SPC) teams is often challenged by substantial amounts of time spent driving to and from patients’ homes and long distances between the patients and the hospitals. Objective: Video consultations may be a solution for real-time SPC at home. The aim of this study was to explore the use of video consultations, experienced by patients and their relatives, as part of SPC at home. Methods: This explorative and qualitative study included palliative care patients in different stages and relatives to use video consultations as a part of their SPC between October 2016 and March 2017. Data collection took place in the patients’ homes and consisted of participant observations followed by semistructured interviews. Inclusion criteria consisted of patients with the need for SPC, aged more than 18 years, who agreed to participate, and relatives wanting to participate in the video consultations. Data were analyzed with Giorgi’s descriptive phenomenological methodology. Results: A number of patients (n=11) and relatives (n=3) were included and, in total, 86 video consultations were conducted. Patients participating varied in time from 1 month to 6 months, and the number of video consultations per patient varied from 3 to 18. The use of video consultations led to a situation where patients, despite life-threatening illnesses and technical difficulties, took an active role. In addition, relatives were able to join on equal terms, which increased active involvement. The patients had different opinions on when to initiate the use of video consultations in SPC; it was experienced as optional at the initiating stage as well as the final stage of illness. If the video consultations included multiple participants from the SPC team, the use of video consultations could be difficult to complete without interruptions. Conclusions: Video consultations in SPC for home-based patients are feasible and facilitate a strengthened involvement and communication between patients, relatives, and SPC team members.

  • Source: iStock by Getty Images; Copyright: DNY59; URL:; License: Licensed by the authors.

    The Association Between Medication Adherence for Chronic Conditions and Digital Health Activity Tracking: Retrospective Analysis


    Background: Chronic diseases have a widespread impact on health outcomes and costs in the United States. Heart disease and diabetes are among the biggest cost burdens on the health care system. Adherence to medication is associated with better health outcomes and lower total health care costs for individuals with these conditions, but the relationship between medication adherence and health activity behavior has not been explored extensively. Objective: The aim of this study was to examine the relationship between medication adherence and health behaviors among a large population of insured individuals with hypertension, diabetes, and dyslipidemia. Methods: We conducted a retrospective analysis of health status, behaviors, and medication adherence from medical and pharmacy claims and health behavior data. Adherence was measured in terms of proportion of days covered (PDC), calculated from pharmacy claims using both a fixed and variable denominator methodology. Individuals were considered adherent if their PDC was at least 0.80. We used step counts, sleep, weight, and food log data that were transmitted through devices that individuals linked. We computed metrics on the frequency of tracking and the extent to which individuals engaged in each tracking activity. Finally, we used logistic regression to model the relationship between adherent status and the activity-tracking metrics, including age and sex as fixed effects. Results: We identified 117,765 cases with diabetes, 317,340 with dyslipidemia, and 673,428 with hypertension between January 1, 2015 and June 1, 2016 in available data sources. Average fixed and variable PDC for all individuals ranged from 0.673 to 0.917 for diabetes, 0.756 to 0.921 for dyslipidemia, and 0.756 to 0.929 for hypertension. A subgroup of 8553 cases also had health behavior data (eg, activity-tracker data). On the basis of these data, individuals who tracked steps, sleep, weight, or diet were significantly more likely to be adherent to medication than those who did not track any activities in both the fixed methodology (odds ratio, OR 1.33, 95% CI 1.29-1.36) and variable methodology (OR 1.37, 95% CI 1.32-1.43), with age and sex as fixed effects. Furthermore, there was a positive association between frequency of activity tracking and medication adherence. In the logistic regression model, increasing the adjusted tracking ratio by 0.5 increased the fixed adherent status OR by a factor of 1.11 (95% CI 1.06-1.16). Finally, we found a positive association between number of steps and adherent status when controlling for age and sex. Conclusions: Adopters of digital health activity trackers tend to be more adherent to hypertension, diabetes, and dyslipidemia medications, and adherence increases with tracking frequency. This suggests that there may be value in examining new ways to further promote medication adherence through programs that incentivize health tracking and leveraging insights derived from connected devices to improve health outcomes.

  • Source: Flickr; Copyright: ibmphoto24; URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Artificial Intelligence and the Future of Primary Care: Exploratory Qualitative Study of UK General Practitioners’ Views


    Background: The potential for machine learning to disrupt the medical profession is the subject of ongoing debate within biomedical informatics and related fields. Objective: This study aimed to explore general practitioners’ (GPs’) opinions about the potential impact of future technology on key tasks in primary care. Methods: In June 2018, we conducted a Web-based survey of 720 UK GPs’ opinions about the likelihood of future technology to fully replace GPs in performing 6 key primary care tasks, and, if respondents considered replacement for a particular task likely, to estimate how soon the technological capacity might emerge. This study involved qualitative descriptive analysis of written responses (“comments”) to an open-ended question in the survey. Results: Comments were classified into 3 major categories in relation to primary care: (1) limitations of future technology, (2) potential benefits of future technology, and (3) social and ethical concerns. Perceived limitations included the beliefs that communication and empathy are exclusively human competencies; many GPs also considered clinical reasoning and the ability to provide value-based care as necessitating physicians’ judgments. Perceived benefits of technology included expectations about improved efficiencies, in particular with respect to the reduction of administrative burdens on physicians. Social and ethical concerns encompassed multiple, divergent themes including the need to train more doctors to overcome workforce shortfalls and misgivings about the acceptability of future technology to patients. However, some GPs believed that the failure to adopt technological innovations could incur harms to both patients and physicians. Conclusions: This study presents timely information on physicians’ views about the scope of artificial intelligence (AI) in primary care. Overwhelmingly, GPs considered the potential of AI to be limited. These views differ from the predictions of biomedical informaticians. More extensive, stand-alone qualitative work would provide a more in-depth understanding of GPs’ views.

  • Source: Shutterstock; Copyright: rawpixel; URL:; License: Licensed by the authors.

    Can Smartphone Apps Increase Physical Activity? Systematic Review and Meta-Analysis


    Background: Smartphone apps are a promising tool for delivering accessible and appealing physical activity interventions. Given the large growth of research in this field, there are now enough studies using the “gold standard” of experimental design—the randomized controlled trial design—and employing objective measurements of physical activity, to support a meta-analysis of these scientifically rigorous studies. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of smartphone apps for increasing objectively measured physical activity in adults. Methods: A total of 7 electronic databases (EMBASE, EmCare, MEDLINE, Scopus, Sport Discus, The Cochrane Library, and Web of Science) were searched from 2007 to January 2018. Following the Population, Intervention, Comparator, Outcome and Study Design format, studies were eligible if they were randomized controlled trials involving adults, used a smartphone app as the primary or sole component of the physical activity intervention, used a no- or minimal-intervention control condition, and measured objective physical activity either in the form of moderate-to-vigorous physical activity minutes or steps. Study quality was assessed using a 25-item tool based on the Consolidated Standards of Reporting Trials checklist. A meta-analysis of study effects was conducted using a random effects model approach. Sensitivity analyses were conducted to examine whether intervention effectiveness differed on the basis of intervention length, target behavior (physical activity alone vs physical activity in combination with other health behaviors), or target population (general adult population vs specific health populations). Results: Following removal of duplicates, a total of 6170 studies were identified from the original database searches. Of these, 9 studies, involving a total of 1740 participants, met eligibility criteria. Of these, 6 studies could be included in a meta-analysis of the effects of physical activity apps on steps per day. In comparison with the control conditions, smartphone apps produced a nonsignificant (P=.19) increase in participants’ average steps per day, with a mean difference of 476.75 steps per day (95% CI −229.57 to 1183.07) between groups. Sensitivity analyses suggested that physical activity programs with a duration of less than 3 months were more effective than apps evaluated across more than 3 months (P=.01), and that physical activity apps that targeted physical activity in isolation were more effective than apps that targeted physical activity in combination with diet (P=.04). Physical activity app effectiveness did not appear to differ on the basis of target population. Conclusions: This meta-analysis provides modest evidence supporting the effectiveness of smartphone apps to increase physical activity. To date, apps have been most effective in the short term (eg, up to 3 months). Future research is needed to understand the time course of intervention effects and to investigate strategies to sustain intervention effects over time.

  • The Case for a Hippocratic Oath for Connected Medical Devices: Viewpoint


    Prior to graduating from medical school, soon-to-be physicians take the Hippocratic Oath, a symbolic declaration to provide care in the best interest of patients. As the medical community increasingly deploys connected devices to deliver patient care, a critical question emerges: should the manufacturers and adopters of these connected technologies be governed by the symbolic spirit of the Hippocratic Oath? In 2016, I Am The Cavalry, a grassroots initiative from the cybersecurity research community, published the first Hippocratic Oath for Connected Medical Devices (HOCMD), containing 5 principles. Over the past three years, the HOCMD has gained broad support and influenced regulatory policy. We introduce 5 case studies of the HOCMD in practice, illustrating how the 5 principles can lead to a safer and more effective adoption of connected medical technologies.

  • Source: Flickr; Copyright: Army Medicine; URL:; License: Creative Commons Attribution (CC-BY).

    A Human(e) Factor in Clinical Decision Support Systems


    The overwhelming amount, production speed, multidimensionality, and potential value of data currently available—often simplified and referred to as big data —exceed the limits of understanding of the human brain. At the same time, developments in data analytics and computational power provide the opportunity to obtain new insights and transfer data-provided added value to clinical practice in real time. What is the role of the health care professional in collaboration with the data scientist in the changing landscape of modern care? We discuss how health care professionals should provide expert knowledge in each of the stages of clinical decision support design: data level, algorithm level, and decision support level. Including various ethical considerations, we advocate for health care professionals to responsibly initiate and guide interprofessional teams, including patients, and embrace novel analytic technologies to translate big data into patient benefit driven by human(e) values.

  • The function of video conferencing in WeChat is used to perform the PBL. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    WeChat as a Platform for Problem-Based Learning in a Dental Practical Clerkship: Feasibility Study


    Background: Problem-Based-Learning (PBL) has been widely accepted in student-centered medical education. Since WeChat is the most popular communication app in China, we have chosen to use WeChat as new platform for online PBL in order to reduce the limitations of traditional PBL in dental practical clerkships. Objective: This study aims to demonstrate the feasibility and acceptability of online PBL using WeChat (WeChat-PBL) in a dental practical clerkship. Methods: A total of 72 students in a dental practical clerkship and 10 tutors participated in this study from June to August 2017. We created 10 WeChat groups to provide a communication platform for the PBL teaching, in which the students selected the PBL cases themselves from their practical clerkship. After each individual PBL case, group members were required to complete an evaluation on the PBL process itself. A final questionnaire survey was completed by the participants to summarize the long-term evaluation of the whole WeChat-PBL experience after the 3-month clerkship. Data from the PBL cases, WeChat messages, periodic evaluations, and long-term evaluations were collected for analysis. Results: There were 45 cases presented in the WeChat-PBL within the 3-month clerkship. All students had positive reactions to the communication within the PBL groups. The results of the periodic evaluation showed that the students and tutors were quite satisfied with the process of WeChat-PBL and appreciated the group members’ contributions and performance. The final questionnaire results indicated that the WeChat-PBL had achieved positive effects. Conclusions: The results of this study indicate the feasibility and acceptability of the app, WeChat, for problem-based learning in a dental practical clerkship.

  • Students of the Nursing School of Porto using Body Interact for virtual simulation in nursing education. Source: The Authors; Copyright: Nursing School of Porto; URL:; License: Creative Commons Attribution (CC-BY).

    Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial


    Background: In the field of health care, knowledge and clinical reasoning are key with regard to quality and confidence in decision making. The development of knowledge and clinical reasoning is influenced not only by students’ intrinsic factors but also by extrinsic factors such as satisfaction with taught content, pedagogic resources and pedagogic methods, and the nature of the objectives and challenges proposed. Nowadays, professors play the role of learning facilitators rather than simple “lecturers” and face students as active learners who are capable of attributing individual meanings to their personal goals, challenges, and experiences to build their own knowledge over time. Innovations in health simulation technologies have led to clinical virtual simulation. Clinical virtual simulation is the recreation of reality depicted on a computer screen and involves real people operating simulated systems. It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings. Clinical virtual simulation can provide a pedagogical strategy and can act as a facilitator of knowledge retention, clinical reasoning, improved satisfaction with learning, and finally, improved self-efficacy. However, little is known about its effectiveness with regard to satisfaction, self-efficacy, knowledge retention, and clinical reasoning. Objective: This study aimed to evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students. Methods: A randomized controlled trial with a pretest and 2 posttests was carried out with Portuguese nursing students (N=42). The participants, split into 2 groups, had a lesson with the same objectives and timing. The experimental group (n=21) used a case-based learning approach, with clinical virtual simulator as a resource, whereas the control group (n=21) used the same case-based learning approach, with recourse to a low-fidelity simulator and a realistic environment. The classes were conducted by the usual course lecturers. We assessed knowledge and clinical reasoning before the intervention, after the intervention, and 2 months later, with a true or false and multiple-choice knowledge test. The students’ levels of learning satisfaction and self-efficacy were assessed with a Likert scale after the intervention. Results: The experimental group made more significant improvements in knowledge after the intervention (P=.001; d=1.13) and 2 months later (P=.02; d=0.75), and it also showed higher levels of learning satisfaction (P<.001; d=1.33). We did not find statistical differences in self-efficacy perceptions (P=.9; d=0.054). Conclusions: The introduction of clinical virtual simulation in nursing education has the potential to improve knowledge retention and clinical reasoning in an initial stage and over time, and it increases the satisfaction with the learning experience among nursing students.

  • Source: Shutterstock Inc; Copyright:; URL:; License: Licensed by the authors.

    Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women


    Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers’ health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4%) and women (211/500, 42.2%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8%), women (408/479, 85.2%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9%), and to receive printed materials by mail (215/500, 43.4%). Men preferred to receive information in a video game format (156/511, 30.7%). Younger men (46/73, 63%) and younger women (49/60, 81%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use.

  • Combined hormonal contraceptives. Source: Flickr; Copyright: Annabelle Shemer; URL:; License: Creative Commons Attribution + Noncommercial + NoDerivatives (CC-BY-NC-ND).

    Searching for Information on the Risks of Combined Hormonal Contraceptives on the Internet: A Qualitative Study Across Six European Countries


    Background: Searching for health information online is increasingly common and is an obvious source of information about oral combined hormonal contraceptives (CHCs) and their risks. However, little is known about how publicly available websites address the risks of CHCs, particularly venous thromboembolism (VTE). Objective: The aim was to explore the information available to women about VTE and other risks of CHCs on websites available through commonly used search engines. Methods: A qualitative study was conducted to explore whether and how websites about CHCs in Denmark, Germany, Netherlands, Slovakia, Spain, and the United Kingdom make reference to VTE and other CHC risks. A systematic search procedure was adopted across the six countries, based on relevant keywords. The search was carried out using the Google search engine by fluent/native speakers of each language. A content analysis approach was conducted to extract information from the selected websites. Results: A total of 357 websites were reviewed. Nearly all (343/357, 96.1%) the websites mentioned VTE as a risk of CHCs, with approximately half referring to other side effects as well. One-fifth (92/357, 25.8%) of the websites provided suggestions about the best contraceptive method to use, and only a minority (23/357, 6.4%) recommended women discuss CHCs with their health professionals. Sites were generally run by the media (110/357 30.8%) or medical services from nongovernmental organizations (140/357, 39.2%). Only a minority of websites referred to organizations such as the European Medicines Agency (11/357, 3.1%). Conclusions: Despite the large number of websites containing information about oral CHCs and their risks, particularly VTE, only a limited number referred to information from accredited health agency sources. We argue this is a missed opportunity for accredited health agencies to share high-quality information to assist women using CHCs to make informed decisions about contraception.

  • Source: Pexels; Copyright: Christina Morillo; URL:; License: Licensed by JMIR.

    Improving the Quality of Consumer Health Information on Wikipedia: Case Series


    Background: Wikipedia is one of the most consulted health resources in the world. Since the public is using health information from Wikipedia to make health care decisions, improving the quality of that health information is in the public interest. The open editable content design of Wikipedia and quality control processes in place provide an opportunity to add high-value, evidence-based information and take an active role in improving the health care information infrastructure. Objective: The aim of this project was to enhance Wikipedia health pages using high-quality, current research findings and track the persistence of those edits and number of page views after the changes to assess the reach of this initiative. Methods: We conducted Wikipedia Editathons with 3 different cohorts of Physical Therapy (PT) students to add high-quality health information to existing Wikipedia pages. Students synthesized best evidence information and updated and/or corrected existing Wikipedia entries on specific health pages. To evaluate the impact of these contributions, we examined two factors: (1) response to our contributions from the Wikipedia editing community, including number and type of subsequent edits as well as persistence of the student contributions and (2) number of page views by the public from the time of the page edits. Results: A total of 98 PT students in 3 different cohorts engaged in Editathons, editing 24 health pages. Of the 24 edits, 22 persisted at the end of the observation period (from time of entry to May 31, 2018) and received nearly 8 million page views. Each health page had an average of 354,724 page views. Conclusions: The Wikipedia Editathon is an effective way to continuously enhance the quality of health information available on Wikipedia. It is also an excellent way of bridging health technology with best-evidence medical facts and disseminating accurate, useful information to the public.

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  • Mapping how future doctors are trained on Health Information Technologies in the European Union: Descriptive study

    Date Submitted: Mar 21, 2019

    Open Peer Review Period: Mar 21, 2019 - Mar 28, 2019

    Background: Health information technologies (HIT) are being used by healthcare institutions to assist clinicians provide care with tools like electronic health records (EHR), telemedicine services and...

    Background: Health information technologies (HIT) are being used by healthcare institutions to assist clinicians provide care with tools like electronic health records (EHR), telemedicine services and others. There are still many barriers to HIT adoption, including mismatches between investments and benefits, disruptions in the workflow, and concerns about privacy and confidentiality. The lack of training of health professionals as a workforce regarding HIT is an increasingly recognized and under studied barrier. Objective: The purpose of this study is to assess the current state of the EU in regards to what courses are available in the graduate level for future health professionals to create foundational knowledge of HIT, and to explore possible determining factors for their exposure to said contents. Methods: A cross-sectional descriptive study of the EU medical education was performed to explore the prevalence of specific HIT training offered to future physicians. The curricula of all identified higher learning institutions that offer the Medical Degree (MD), were explored looking for graduate level courses that offer training on HIT topics. HIT topics were defined as any graduate level course or subject that specifically trained students on issues regarding the design, development, use and/or implementation of HIT. The different courses names and descriptions (where available) were revised for mentions of HIT topics. Potential factors such as population, yearly medical graduates, total number of physicians, EHR presence and GDP as were explored for associations. Results: A total of 302 Medical schools were explored from the 28 member states of the EU. Only a third (29.80%, n=90/302) of all MD curricula offered any kind of HIT course on the graduate level, and of the courses that were offered almost two thirds were presented as required courses (64.44%, n=58/90). Most EU countries offer HIT courses in less than half of their medical schools, regardless of their GDP per capita. Countries with the highest percentages of HIT course offer are amongst the ones with the lowest GDP per capita in EU. There seems to be a weak inverse correlation (-0,49) between the two variables (GDP per capita and HIT course offer). There is a trend between the availability of medical human resources and an increase in the presence of HIT courses, with Romania, Croatia and Greece as outliers in this respect. Conclusions: The current state of medical training in the European Union in this regard leaves much room for improvement, further studies are called for in-depth analysis on the type of contents and manner of instruction that would fit present and future needs concerning HIT.

  • Internet-based asthma education program in combination with presence education increases asthma knowledge more than conventional presence education: results of a randomized controlled trial

    Date Submitted: Mar 18, 2019

    Open Peer Review Period: Mar 21, 2019 - May 16, 2019

    Background: Asthma education programs (AEP) in combination with keeping an asthma diary and usage of an asthma action plan to foster self-management is associated with reduced hospitalization, disabil...

    Background: Asthma education programs (AEP) in combination with keeping an asthma diary and usage of an asthma action plan to foster self-management is associated with reduced hospitalization, disability and mortality. However, only few patients are participating in presence educational programs which might be due to time constraints, organizational reasons, and low physiological or psychological strains. Internet-based educational programs might help to increase participation rates. Objective: We developed an electronic AEP (eAEP) conform with accreditation criteria for presence AEPs (pAEPs) and compared the effectiveness of eAEP and pAEP for knowledge gain regarding asthma self-management. Methods: The study was a two-armed, single-centre, randomized controlled trial performed between 17th July and 11th October 2018 in a pulmonary rehabilitation in-patient clinic. Due to safety reasons, patients of the eAEP group were obliged to participate in the presence education after finalization of the eAEP. Asthma knowledge was determined with the Asthma Knowledge Test (AKT) comprising 54 items. The total sum score ranges from 0 to 54 points, with higher scoring indicating better knowledge. Group differences were calculated with linear regression adjusting for age, gender, years since asthma diagnosis and AKT baseline values. Results: In the intervention group, AKT scores increased from 41.57 (standard deviation 5.63) at baseline to 45.82 (3.84) after completion of the eAEP, and again after completion of the pAEP to 47.20 (3.78) (both increases p<0.001). In the control group the scores increased from 41.73 (4.74) at baseline to 45.72 (3.65) after completion of the pAEP (p<0.001). The knowledge gain was similar between the eAEP and pAEP group after completion of the corresponding educational sessions (p=0.881). However, knowledge gain was significantly higher in the eAEP group after participating in the obligatory pAEP group compared to the patients solely participating in the pAEP group (p=0.020). Personal comments highlighted the possibility to use the eAEP for looking up facts about asthma medication and management, or to use it for in-depth learning after pAEP. Conclusions: eAEP might lead to similar knowledge gain as pAEP. Thus, an internet-based approach to reach patients for asthma education might be valuable to compensate for the educational deficits of a large amount of patients with asthma. Future studies have to examine optimal ways how to implement eAEPs within clinical settings or primary care, under consideration of the necessity to combine it with regular review, active engagement and training of patients. Clinical Trial: German Register of Clinical Trials; number DRKS00015078.

  • The impacts of perceived transparency of privacy policy and trust in providers on building trust in Health Information Exchange (HIE)

    Date Submitted: Mar 18, 2019

    Open Peer Review Period: Mar 21, 2019 - May 16, 2019

    Background: In the context of exchange technologies, such as Health Information Exchanges (HIEs), existing technology acceptance theories should be expanded to consider not only the cognitive beliefs...

    Background: In the context of exchange technologies, such as Health Information Exchanges (HIEs), existing technology acceptance theories should be expanded to consider not only the cognitive beliefs resulting in adoption behavior, but also the affect provoked by the sharing nature of the technology. Objective: This work uses a trust-centered model to study HIEs adoption. Based on the Theory of Reasoned Action (TRA), the technology adoption literature, and the trust transfer mechanism, we theoretically explain and empirically test the impacts of perceived transparency of privacy policy and trust in healthcare providers on cognitive trust and emotional trust in an HIE. Moreover, we analyze the effects of cognitive trust and emotional trust on the intention to opt in to the HIE and willingness to disclose health information. Methods: An online survey was conducted using data from individuals who were aware of HIE through experiences with a (or multiple) provider participating in a HIE network. Results: SEM analysis results provide empirical support for the proposed model. Our findings indicate that when patients trust in healthcare providers and they know more about HIE security measures, HIE sharing procedures, and privacy terms, then they feel more in control, more assured, and less at risk. Moreover, trust in providers has a significant moderating effect on building trust in HIE efforts. Results also show that patient trust in HIE may take the forms of opt-in intentions to HIE and patients’ willingness to disclose health information which are exchanged through the HIE. Conclusions: The results of this research should be of interest to both academics and practitioners. The findings provide an in-depth dimensions of HIE privacy policy that should be addressed by healthcare organizations to exchange personal health information in a secure and private manner.This work can contribute to trust transfer theory and enrich the literature on HIE efforts. Practitioners can also identify how to leverage the benefit of patients’ trust and trust transfer process to promote HIE initiatives nationwide.

  • A hybrid depressive mood analysis model to detect blogger depression tendency from web posts

    Date Submitted: Mar 18, 2019

    Open Peer Review Period: Mar 21, 2019 - May 16, 2019

    n recent years, reports of suicide have continuously increased because of people suffering from tremendous pressure or depression. Depression is listed as the third highest health issue from the World...

    n recent years, reports of suicide have continuously increased because of people suffering from tremendous pressure or depression. Depression is listed as the third highest health issue from the World Health Organization. They also predict that depression will become the second highest issue by 2020. This kind of mental illness is difficult to diagnose and detect. In our previous works, we proposed a Negative Emotion Evaluation (NEE) model and an Event-Driven Depression Tendency Warning (EDDTW) model to early detect depressive moods. In this work, we combine the previous models to propose a Hybrid Depressive Mood Analysis (HDMA) model to predict the depression from web posts. The experimental results show that our proposed hybrid depressive mood analysis model obtains over 70% precision.

  • The Adoption of Electronic Patient Record Sharing Pilot Project: A Cross-Sectional Survey

    Date Submitted: Mar 18, 2019

    Open Peer Review Period: Mar 21, 2019 - May 16, 2019

    Background: The Public Private Interface-electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in H...

    Background: The Public Private Interface-electronic Patient Record (PPI-ePR) system was implemented as a new electronic platform to facilitate collaboration between the public and private sectors in Hong Kong. However, its barriers to participate and benefits have not hitherto been comprehensively assessed. Objective: This study aims to evaluate the awareness, acceptance, perceived benefits, and obstacles to participation among private doctors and general public. Methods: From December 2012 to January 2013, 2,435 telephone interviews were performed by trained interviewers to survey random-selected patients who were enrolled or not enrolled in the PPI-ePR system. At the meantime, self-administered surveys were sent by post to 10,285 registered doctors in Hong Kong. The questionnaires for both patients and doctors contain questions on subjects’ awareness, acceptance and perceptions to PPI-ePR, perceived benefits and obstacles of participating in the programme, reasons for not using the system after enrolling, as well as perceived areas for service improvement of the system. Results: Over 53% of enrolled patients believed that the PPI-ePR system would improve healthcare quality by “reducing duplicate tests and treatments”, while over 76% of enrolled doctors emphasized “timely access to patients’ medical records” as the biggest benefit of their enrolment. Among non-enrolled patients, unawareness of the project was among the most popular obstacle of enrolling the PPI-ePR system (40%). Regarding non-enrolled doctors, the complicated registration process hinder them from participating in the programme the most (48%). Establishing of user-friendly interface (71.5%), and open rights for patients to access their own medical records (63.7%) were among the most widely underlined factors to attract non-enrollees’ participation of the programme. Conclusions: This study comprehensively assessed the popularity, perceived benefits and hindering factors of enrolling the PPI-ePR system in Hong Kong. Lack of awareness, as well as fear of the complex registration procedures, was the most common reason of individuals’ absence in the program, calling for more frequent and effective promotions of the program. Even for enrolled users, simplified and user-friendly interface with more functions must be developed to improve their activity.

  • Differential Diagnosis Assessment in Ambulatory Care with an Automated Medical History-Taking Device: A Pilot Randomized Study

    Date Submitted: Mar 17, 2019

    Open Peer Review Period: Mar 20, 2019 - May 15, 2019

    Background: Automated medical history-taking devices (AMHTD) are emerging tools with the potential to increase the quality of medical consultations by providing physicians with an exhaustive, high-qua...

    Background: Automated medical history-taking devices (AMHTD) are emerging tools with the potential to increase the quality of medical consultations by providing physicians with an exhaustive, high-quality, standardized anamnesis and differential diagnosis (DD). Objective: This study aims to assess the effectiveness of an AMHTD to obtain an accurate DD in an outpatient service. Methods: We conducted a pilot, randomized controlled trial including 59 patients presenting to an emergency outpatient unit and suffering from various conditions affecting the limbs, the back and the chest wall. Resident physicians were randomized into two groups, one assisted by the AMHTD and one without access to the device. For each patient, physicians were asked to establish an exhaustive DD based on the anamnesis and clinical examination. In the intervention group, residents read the AMHTD report before performing the anamnesis. In both groups, the senior physician had to establish a DD, considered as the gold standard, independent of the resident’s opinion and the AMHTD report. Results: Physicians in the intervention group (n=29) had more years of clinical practice compared to the control group (n=30) (mean: 4.3 ± 2 vs. 5.5 ± 2, respectively; P=.03). There were also 16.1% more DDs in the intervention group (mean: 75.3 ± 26% vs. 59.2 ± 31%, respectively; P=.01). Subgroup analysis showed a between-group difference of 3.3% for low complexity cases (1-2 DDs possible) in favor of the AHMTD, 31.1% for intermediate complexity (3 DDs), and 23.7% for high complexity (4-5 DDs). The AMHTD was able to determine 72.6 ± 30% of the correct DDs. Patient satisfaction was good (4.3/5) and 26/29 patients (90%) estimated being able to accurately describe their symptomatology. In eight of 29 cases (28%), the residents considered that the AMHTD helped DD establishment. Conclusions: The AMHTD allowed physicians to make more accurate DD, particularly in complex cases where the diagnosis is not evident. This could be explained not only by the ability of the AMHTD to make the right diagnoses, but also by the exhaustive anamnesis provideApproved by the Medical Ethics Committee of Geneva University Hospitals (REQ-2017-00878).d. Clinical Trial: Approved by the Medical Ethics Committee of Geneva University Hospitals (REQ-2017-00878).