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  JMIR Theme Issue 2020: Covid-19...

  May 26, 2020

  Use of a Real-Time Locating System for Contact Tracing of Health Care Workers During the COVID-19 Pandemic at an Infectious Disease Center in Singapore:...

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  Authors List:

  • Hanley J Ho  
  • Zoe Xiaozhu Zhang  
  • Zhilian Huang  
  • Aung Hein Aung  
  • Wei-Yen Lim  
  • Angela Chow  

  Abstract:

  Background: In early 2020, coronavirus disease (COVID-19) emerged and spread by community and nosocomial transmission. Effective contact tracing of potentially exposed health care workers is crucial for the prevention and control of infectious disease outbreaks in the health care setting. Objective: This study aimed to evaluate the comparative effectiveness of contact tracing during the COVID-19 pandemic through the real-time locating system (RTLS) and review of the electronic medical record (EMR) at the designated hospital for COVID-19 response in Singapore. Methods: Over a 2-day study period, all admitted patients with COVID-19, their ward locations, and the health care workers rostered to each ward were identified to determine the total number of potential contacts between patients with COVID-19 and health care workers. The numbers of staff-patient contacts determined by EMR reviews, RTLS-based contact tracing, and a combination of both methods were evaluated. The use of EMR-based and RTLS-based contact tracing methods was further validated by comparing their sensitivity and specificity against self-reported staff-patient contacts by health care workers. Results: Of 796 potential staff-patient contacts (between 17 patients and 162 staff members), 104 (13.1%) were identified by both the RTLS and EMR, 54 (6.8%) by the RTLS alone, and 99 (12.4%) by the EMR alone; 539 (67.7%) were not identified through either method. Compared to self-reported contacts, EMR reviews had a sensitivity of 47.2% and a specificity of 77.9%, while the RTLS had a sensitivity of 72.2% and a specificity of 87.7%. The highest sensitivity was obtained by including all contacts identified by either the RTLS or the EMR (sensitivity 77.8%, specificity 73.4%). Conclusions: RTLS-based contact tracing showed higher sensitivity and specificity than EMR review. Integration of both methods provided the best performance for rapid contact tracing, although technical adjustments to the RTLS and increasing user compliance with wearing of RTLS tags remain necessary.

  • J Med Internet Res 2020;22(5):e19437

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  Review

  May 25, 2020

  The Effectiveness of Electronic Health Interventions for Promoting HIV-Preventive Behaviors Among Men Who Have Sex With Men: Meta-Analysis Based on an...

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  Authors List:

  • Meiqi Xin  
  • Kasisomayajula Viswanath  
  • Angela Yuen-Chun Li  
  • Wangnan CAO  
  • Yuhong HU  
  • Joseph Tak-Fai Lau  
  • Phoenix Kit-Han Mo  

  Abstract:

  Background: The disproportionately high prevalence of HIV among men who have sex with men (MSM) is a global concern. Despite the increasing utilization of electronic health (eHealth) technology in the delivery of HIV prevention interventions, few studies have systematically explored its effectiveness and association with various intervention characteristics. Objective: This study aimed to conduct a meta-analysis of the effectiveness of eHealth technology–based interventions for promoting HIV-preventive behaviors among MSM and to determine effectiveness predictors within a framework integrating design and implementation features. Methods: A systematic literature search using terms related to eHealth technology, HIV, the MSM population, and an experimental study design was performed using 5 databases (ie, MEDLINE, PsycINFO, EMBASE, Web of Science, and ProQuest Dissertations & Theses) and other sources (eg, bibliographies of relevant reviews and JMIR Publications). First, primary meta-analyses were conducted to estimate the effectiveness of eHealth interventions (d₊) in changing 3 HIV-preventive behaviors among MSM: unprotected anal intercourse (UAI), HIV testing, and multiple sex partnership (MSP). Moderation analyses were then conducted to examine a priori effectiveness predictors including behavioral treatment components (eg, theory use, tailoring strategy use, navigation style, and treatment duration), eHealth technology components (eg, operation mode and modality type), and intervention adherence. Results: A total of 46 studies were included. The overall effect sizes at end point were small but significant for all outcomes (UAI: d₊=−.21, P<.001; HIV testing: d₊=.38, P<.001; MSP: d₊=−.26, P=.02). The intervention effects on UAI were significantly larger when compared with preintervention groups than with concurrent groups. Greater UAI reductions were associated with the increased use of tailoring strategies, provision of feedback, and tunneling navigation in interventions with a concurrent group, whereas reductions were associated with the use of self-paced navigation in interventions with a preintervention group. Greater uptake of HIV testing was associated with longer treatment duration; computer-mediated communication; and the use of messaging, social media, or a combined technology modality. Higher intervention adherence consistently predicted larger effects on UAI and HIV testing. Conclusions: This study provided empirical evidence for the effectiveness of eHealth interventions in promoting HIV-preventive behaviors among MSM. Features of treatment content and eHealth technology might best predict the intervention effects on UAI and HIV testing, respectively. Most importantly, intervention adherence tended to play an important role in achieving better effectiveness. The findings could help inform the development of efficacious interventions for HIV prevention in the future.

  • J Med Internet Res 2020;22(5):e15977

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  Medicine 2.0: Social Media, Open,...

  May 25, 2020

  Exploring Strategies for Using Social Media to Self-Manage Health Care When Living With and Beyond Breast Cancer: In-Depth Qualitative Study

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  Authors List:

  • Cathy Ure  
  • Anna Mary Cooper-Ryan  
  • Jenna Condie  
  • Adam Galpin  

  Abstract:

  Background: As breast cancer survival rates improve and structural health resources are increasingly being stretched, health providers require people living with and beyond breast cancer (LwBBC) to self-manage aspects of their care. Objective: This study aimed to explore how women use and experience social media to self-manage their psychosocial needs and support self-management across the breast cancer continuum. Methods: The experiences of 21 women (age range 27-64 years) were explored using an in-depth qualitative approach. The women varied in the duration of their experiences of LwBBC, which facilitated insights into how they evolve and change their self-management strategies over time. Semistructured interviews were analyzed inductively using a thematic analysis, a polytextual analysis, and voice-centered relational methods. Results: The use of multiple social media platforms, such as YouTube, Facebook, WhatsApp, and Twitter, enabled women to self-manage aspects of their care by satisfying needs for timely, relevant, and appropriate support, by navigating identities disrupted by diagnosis and treatment and by allowing them to (re)gain a sense of control. Women described extending their everyday use of multiple platforms to self-manage their care. However, women experienced social media as both empowering and dislocating, as their engagement was impacted by their everyday experiences of LwBBC. Conclusions: Health care professionals (HCPs) need to be more aware, and open to the possibilities, of women using multiple social media resources as self-management tools. It is important for HCPs to initiate value-free discussions and create the space necessary for women to share how social media resources support a tailored and timely self-managed approach to their unique psychosocial needs.

  • J Med Internet Res 2020;22(5):e16902

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  Clinical Information and Decision Making

  May 22, 2020

  Distinguishing Obstructive Versus Central Apneas in Infrared Video of Sleep Using Deep Learning: Validation Study

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  Authors List:

  • Sina Akbarian  
  • Nasim Montazeri Ghahjaverestan  
  • Azadeh Yadollahi  
  • Babak Taati  

  Abstract:

  Background: Sleep apnea is a respiratory disorder characterized by an intermittent reduction (hypopnea) or cessation (apnea) of breathing during sleep. Depending on the presence of a breathing effort, sleep apnea is divided into obstructive sleep apnea (OSA) and central sleep apnea (CSA) based on the different pathologies involved. If the majority of apneas in a person are obstructive, they will be diagnosed as OSA or otherwise as CSA. In addition, as it is challenging and highly controversial to divide hypopneas into central or obstructive, the decision about sleep apnea type (OSA vs CSA) is made based on apneas only. Choosing the appropriate treatment relies on distinguishing between obstructive apnea (OA) and central apnea (CA). Objective: The objective of this study was to develop a noncontact method to distinguish between OAs and CAs. Methods: Five different computer vision-based algorithms were used to process infrared (IR) video data to track and analyze body movements to differentiate different types of apnea (OA vs CA). In the first two methods, supervised classifiers were trained to process optical flow information. In the remaining three methods, a convolutional neural network (CNN) was designed to extract distinctive features from optical flow and to distinguish OA from CA. Results: Overnight sleeping data of 42 participants (mean age 53, SD 15 years; mean BMI 30, SD 7 kg/m²; 27 men and 15 women; mean number of OA 16, SD 30; mean number of CA 3, SD 7; mean apnea-hypopnea index 27, SD 31 events/hour; mean sleep duration 5 hours, SD 1 hour) were collected for this study. The test and train data were recorded in two separate laboratory rooms. The best-performing model (3D-CNN) obtained 95% accuracy and an F₁ score of 89% in differentiating OA vs CA. Conclusions: In this study, the first vision-based method was developed that differentiates apnea types (OA vs CA). The developed algorithm tracks and analyses chest and abdominal movements captured via an IR video camera. Unlike previously developed approaches, this method does not require any attachment to a user that could potentially alter the sleeping condition.

  • J Med Internet Res 2020;22(5):e17252

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  Electronic/Mobile Data Capture,...

  May 22, 2020

  Paper Versus Digital Data Collection Methods for Road Safety Observations: Comparative Efficiency Analysis of Cost, Timeliness, Reliability, and Results

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  Authors List:

  • Niloufer Taber  
  • Amber Mehmood  
  • Perumal Vedagiri  
  • Shivam Gupta  
  • Rachel Pinto  
  • Abdulgafoor M Bachani  

  Abstract:

  Background: Roadside observational studies play a fundamental role in designing evidence-informed strategies to address the pressing global health problem of road traffic injuries. Paper-based data collection has been the standard method for such studies, although digital methods are gaining popularity in all types of primary data collection. Objective: This study aims to understand the reliability, productivity, and efficiency of paper vs digital data collection based on three different road user behaviors: helmet use, seatbelt use, and speeding. It also aims to understand the cost and time efficiency of each method and to evaluate potential trade-offs among reliability, productivity, and efficiency. Methods: A total of 150 observational sessions were conducted simultaneously for each risk factor in Mumbai, India, across two rounds of data collection. We matched the simultaneous digital and paper observation periods by date, time, and location, and compared the reliability by subgroups and the productivity using Pearson correlations (r). We also conducted logistic regressions separately by method to understand how similar results of inferential analyses would be. The time to complete an observation and the time to obtain a complete dataset were also compared, as were the total costs in US dollars for fieldwork, data entry, management, and cleaning. Results: Productivity was higher in paper than digital methods in each round for each risk factor. However, the sample sizes across both methods provided a precision of 0.7 percentage points or smaller. The gap between digital and paper data collection productivity narrowed across rounds, with correlations improving from r=0.27-0.49 to 0.89-0.96. Reliability in risk factor proportions was between 0.61 and 0.99, improving between the two rounds for each risk factor. The results of the logistic regressions were also largely comparable between the two methods. Differences in regression results were largely attributable to small sample sizes in some variable levels or random error in variables where the prevalence of the outcome was similar among variable levels. Although data collectors were able to complete an observation using paper more quickly, the digital dataset was available approximately 9 days sooner. Although fixed costs were higher for digital data collection, variable costs were much lower, resulting in a 7.73% (US $3011/38,947) lower overall cost. Conclusions: Our study did not face trade-offs among time efficiency, cost efficiency, statistical reliability, and descriptive comparability when deciding between digital and paper, as digital data collection proved equivalent or superior on these domains in the context of our project. As trade-offs among cost, timeliness, and comparability—and the relative importance of each—could be unique to every data collection project, researchers should carefully consider the questionnaire complexity, target sample size, implementation plan, cost and logistical constraints, and geographical contexts when making the decision between digital and paper.

  • J Med Internet Res 2020;22(5):e17129

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  e-Learning and Medical Education

  May 22, 2020

  A Blended Learning System to Improve Motivation, Mood State, and Satisfaction in Undergraduate Students: Randomized Controlled Trial

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  Authors List:

  • Mario Lozano-Lozano  
  • Carolina Fernández-Lao  
  • Irene Cantarero-Villanueva  
  • Ignacio Noguerol  
  • Francisco Álvarez-Salvago  
  • Mayra Cruz-Fernández  
  • Manuel Arroyo-Morales  
  • Noelia Galiano-Castillo  

  Abstract:

  Background: Smartphone-based learning, or mobile learning (m-learning), has become a popular learning-and-teaching strategy in educational environments. Blended learning combines strategies such as m-learning with conventional learning to offer continuous training, anytime and anywhere, via innovative learning activities. Objective: The main aim of this work was to examine the short-term (ie, 2-week) effects of a blended learning method using traditional materials plus a mobile app—the iPOT mobile learning app—on knowledge, motivation, mood state, and satisfaction among undergraduate students enrolled in a health science first-degree program. Methods: The study was designed as a two-armed, prospective, single-blind, randomized controlled trial. Subjects who met the inclusion criteria were randomly assigned to either the intervention group (ie, blended learning involving traditional lectures plus m-learning via the use of the iPOT app) or the control group (ie, traditional on-site learning). For both groups, the educational program involved 13 lessons on basic health science. The iPOT app is a hybrid, multiplatform (ie, iOS and Android) smartphone app with an interactive teacher-student interface. Outcomes were measured via multiple-choice questions (ie, knowledge), the Instructional Materials Motivation Survey (ie, motivation), the Profile of Mood States scale (ie, mood state), and Likert-type questionnaires (ie, satisfaction and linguistic competence). Results: A total of 99 students were enrolled, with 49 (49%) in the intervention group and 50 (51%) in the control group. No difference was seen between the two groups in terms of theoretical knowledge gain (P=.92). However, the intervention group subjects returned significantly higher scores than the control group subjects for all postintervention assessed items via the motivation questionnaire (all P<.001). Analysis of covariance (ANCOVA) revealed a significant difference in the confusion and bewilderment component in favor of the intervention group (P=.01), but only a trend toward significance in anger and hostility as well as total score. The intervention group subjects were more satisfied than the members of the control group with respect to five out of the six items evaluated: general satisfaction (P<.001), clarity of the instructions (P<.01), clarity with the use of the learning method (P<.001), enough time to complete the proposed exercises (P<.01), and improvement in the capacity to learn content (P<.001). Finally, the intervention group subjects who were frequent users of the app showed stronger motivation, as well as increased perception of greater gains in their English-language competence, than did infrequent users. Conclusions: The blended learning method led to significant improvements in motivation, mood state, and satisfaction compared to traditional teaching, and elicited statements of subjective improvement in terms of competence in English. Trial Registration: ClinicalTrials.gov NCT03335397; https://clinicaltrials.gov/ct2/show/NCT03335397

  • J Med Internet Res 2020;22(5):e17101

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  New Methods

  May 22, 2020

  What Medical Crowdfunding Campaigns Can Tell Us About Local Health System Gaps and Deficiencies: Exploratory Analysis of British Columbia, Canada

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  Authors List:

  • Jeremy Snyder  
  • Marco Zenone  
  • Valorie Crooks  
  • Nadine Schuurman  

  Abstract:

  Background: There are a range of perceived gaps and shortcomings in the publicly funded Canadian health system. These include wait times for care, lack of public insurance coverage for dental care and pharmaceuticals, and difficulties accessing specialist care. Medical crowdfunding is a response to these gaps where individuals raise funds from their social networks to address health-related needs. Objective: This study aimed to investigate the potential of crowdfunding data to better understand what health-related needs individuals are using crowdfunding for, how these needs compare with the existing commentary on health system deficiencies, and the advantages and limitations of using crowdfunding campaigns to enhance or augment our understanding of perceived health system deficiencies. Methods: Crowdfunding campaigns were scraped from the GoFundMe website. These campaigns were then limited to those originating in the metropolitan Vancouver region of two health authorities during 2018. These campaigns were then further limited to those raising funds to allow the treatment of a medical problem or related to needs arising from ill health. These campaigns were then reviewed to identify the underlying health issue and motivation for pursuing crowdfunding. Results: We identified 423 campaigns for health-related needs. These campaigns requested CAD $8,715,806 (US $6,088,078) in funding and were pledged CAD $3,477,384 (US $2,428,987) from 27,773 donors. The most common underlying medical condition for campaign recipients was cancer, followed by traumatic injuries from collisions and brain injury and stroke. By far, the most common factor of motivation for crowdfunding was seeking financial support for wages lost because of illness (232/684, 33.9%). Some campaigns (65/684, 9.5%) sought help with purchasing medical equipment and supplies; 8.2% (56/684) sought to fund complementary, alternative, or unproven treatments including experimental interventions; 7.2% (49/684) sought financial support to cover travel-related costs, including in-province and out-of-province (49/684, 7.2%) travel; and 6.3% (43/684) campaigns sought help to pay for medication. Conclusions: This analysis demonstrates the potential of crowdfunding data to present timely and context-specific user-created insights into the perceived health-related financial needs of some Canadians. Although the literature on perceived limitations of the Canadian health system focuses on wait times for care and limited access to specialist services, among other issues, these campaigners were much more motivated by gaps in the wider social system such as costs related to unpaid time off work and travel to access care. Our findings demonstrate spatial differences in the underlying medical problems, motivations for crowdfunding, and success using crowdfunding that warrants additional attention. These differences may support established concerns that medical crowdfunding is most commonly used by individuals from relatively privileged socioeconomic backgrounds. We encourage the development of new resources to harness the power of crowdfunding data as a supplementary source of information for Canadian health system stakeholders.

  • J Med Internet Res 2020;22(5):e16982

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  e-Mental Health and Cyberpsychology

  May 22, 2020

  A Cross-Cultural Comparison of an Extended Planned Risk Information Seeking Model on Mental Health Among College Students: Cross-Sectional Study

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  Authors List:

  • Zhaomeng Niu  
  • Jessica Fitts Willoughby  
  • Jing Mei  
  • Shaochun Li  
  • Pengwei Hu  

  Abstract:

  Background: Approximately 42.5 million adults have been affected by mental illness in the United States in 2013, and 173 million people have been affected by a diagnosable psychiatric disorder in China. An increasing number of people tend to seek health information on the Web, and it is important to understand the factors associated with individuals’ mental health information seeking. Identifying factors associated with mental health information seeking may influence the disease progression of potential patients. The planned risk information seeking model (PRISM) was developed in 2010 by integrating multiple information seeking models including the theory of planned behavior. Few studies have replicated PRISM outside the United States and no previous study has examined mental health as a personal risk in different cultures. Objective: This study aimed to test the planned risk information seeking model (PRISM) in China and the United States with a chronic disease, mental illness, and two additional factors, ie, media use and cultural identity, among college students. Methods: Data were collected in both countries using the same online survey through a survey management program (Qualtrics). In China, college instructors distributed the survey link among university students, and it was also posted on a leading social media site called Sina Weibo. In the United States, the data were collected in a college-wide survey pool in a large Northwestern university. Results: The final sample size was 235 for the Chinese sample and 241 for the US sample. Media use was significantly associated with mental health information–seeking intentions in the Chinese sample (P<.001), and cultural identity was significantly associated with intentions in both samples (China: P=.02; United States: P<.001). The extended PRISM had a better model fit than the original PRISM. Conclusions: Cultural identity and media use should be considered when evaluating the process of mental health information seeking or when designing interventions to address mental health information seeking.

  • J Med Internet Res 2020;22(5):e15817

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  Web-based and Mobile Health...

  May 22, 2020

  A Personalized eHealth Intervention for Lifestyle Changes in Patients With Cardiovascular Disease: Randomized Controlled Trial

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  Authors List:

  • Eva Rosalinde Broers  
  • Willem Johan Kop  
  • Johan Denollet  
  • Jos Widdershoven  
  • Mart Wetzels  
  • Idowu Ayoola  
  • Jordi Piera-Jimenez  
  • Mirela Habibovic  

  Abstract:

  Background: Behavior change methods involving new ambulatory technologies may improve lifestyle and cardiovascular disease outcomes. Objective: This study aimed to provide proof-of-concept analyses of an intervention aiming to increase (1) behavioral flexibility, (2) lifestyle change, and (3) quality of life. The feasibility and patient acceptance of the intervention were also evaluated. Methods: Patients with cardiovascular disease (N=149; mean age 63.57, SD 8.30 years; 50/149, 33.5% women) were recruited in the Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) trial and randomized to the Do CHANGE intervention or care as usual (CAU). The intervention involved a 3-month behavioral program in combination with ecological momentary assessment and intervention technologies. Results: The intervention was perceived to be feasible and useful. A significant increase in lifestyle scores over time was found for both groups (F_2,146.6=9.99; P<.001), which was similar for CAU and the intervention group (F_1,149.9=0.09; P=.77). Quality of life improved more in the intervention group (mean 1.11, SD 0.11) than CAU (mean −1.47, SD 0.11) immediately following the intervention (3 months), but this benefit was not sustained at the 6-month follow-up (interaction: P=.02). No significant treatment effects were observed for behavioral flexibility (F_1,149.0=0.48; P=.07). Conclusions: The Do CHANGE 1 intervention was perceived as useful and easy to use. However, no long-term treatment effects were found on the outcome measures. More research is warranted to examine which components of behavioral interventions are effective in producing long-term behavior change. Trial Registration: ClinicalTrials.gov NCT02946281; https://www.clinicaltrials.gov/ct2/show/NCT02946281

  • J Med Internet Res 2020;22(5):e14570

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  JMIR Theme Issue 2020: Covid-19...

  May 22, 2020

  Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study

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  Authors List:

  • Jessica Marian Goodman-Casanova  
  • Elena Dura-Perez  
  • Jose Guzman-Parra  
  • Antonio Cuesta-Vargas  
  • Fermin Mayoral-Cleries  

  Abstract:

  Background: The public health emergency of coronavirus disease (COVID-19) is rapidly evolving worldwide; some countries, including Spain, have implemented restrictive measures. Populations that are vulnerable to this outbreak and its physical and mental health effects include community-dwelling older adults with mild cognitive impairment or mild dementia. Telehealth is a potential tool to deliver health care and decrease exposure risk. Objective: The aims of this study were to explore the impact of confinement on the health and well-being of community-dwelling older adults with mild cognitive impairment or mild dementia, to provide television-based and telephone-based health and social support, and to study the effects of a television-based assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive Integrated Service to supporT European adults living with mild DEMentia or mild cognitive impairment). Methods: A telephone-based survey was administered in Spain to 93 participants in the TV-AssistDem clinical trial from March 25 to April 6, 2020. Results: Of the respondents, 60/93 (65%) were women. The mean age was 73.34 (SD 6.07), and 69/93 (74%) lived accompanied. Lockdown measures forced 17/93 respondents (18%) to change their living arrangements. Health status was found to be optimal in 89/93 respondents (96%), with no COVID-19 symptoms. Grocery and pharmacy outings were performed by family members of 68/93 participants (73%); 57 (61%) reported overall well-being, and 65 (70%) maintained their sleep quality. However, participants living alone reported greater negative feelings and more sleeping problems. Regarding leisure activities, 53/93 respondents (57%) took walks, 32 (35%) played memory games, 55 (60%) watched television, and 91 (98%) telephoned relatives. 58/93 (64%) respondents reported accessing moderate or too much COVID-19 information, 89 (97%) received it from television, and 56 (62%) stated that their understanding of the information was extreme. 39/93 (39%) respondents had contacted health and social services, while 29 (31%) requested information regarding these services during the telephone call. There were no significant differences in health and well-being between the intervention and control groups. Respondents with TV-AssistDem performed more memory exercises (24/93, 52% vs 8/93, 17.4%; P<.001) than control respondents. Conclusions: Our findings suggest that during COVID-19 confinement, the physical and mental health and well-being was optimal for the majority of our vulnerable population. However, those living alone reported greater negative psychological effects and sleeping problems. Measures adopted to address the negative experiences of confinement included keeping informed about the situation, accessing health and social services, having a support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, a daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with cognitive stimulation exercises, and ensuring social connectedness using technology. Television sets were preferred technological devices to access COVID-19 information, watch television as a recreational activity, and perform memory exercises as an intellectual activity. Television-based telehealth support using TV-AssistDem demonstrated potential for cognitive stimulation. Trial Registration: ClinicalTrials.gov NCT03653234; https://clinicaltrials.gov/ct2/show/NCT03653234

  • J Med Internet Res 2020;22(5):e19434

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  Telehealth and Telemonitoring

  May 22, 2020

  Clinical and Technical Considerations of an Open Access Telehealth Network in South Carolina: Definition and Deployment

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  Authors List:

  • Kathryn King  
  • Dee Ford  
  • Michael Haschker  
  • Jillian Harvey  
  • Ryan Kruis  
  • James McElligott  

  Abstract:

  Background: Today, telehealth is experiencing exponential growth in utilization. Paralleling this trend is the growth in the telehealth industry, with sharp increases in the number of platforms, functionalities, and levels of integrations within both the electronic health record and other technical systems supporting health care. When a telehealth network is intended to be used across independent health care systems, an additional layer of complexity emerges. In the context of regionalized telehealth networks that are not within the same health care system, not only are technical interoperability challenges a practical barrier, but administrative, clinical, and competitive elements also quickly emerge, resulting in fragmented, siloed technologies. Objective: The study aimed to describe a statewide approach to deploying an interoperable open access telehealth network across multiple health systems. Methods: One promising solution to the abovementioned concerns is an open access telehealth network. In the field of telehealth, an open access network (OAN) can be defined as a network infrastructure that can be used by health care providers without a closed or proprietary platform, specific obligatory network, or service-specific telehealth technologies. This framework for the development of an OAN is grounded in practical examples of clinical programs that function in each stage of network maturity based on the experience of the South Carolina Telehealth Alliance (SCTA). The SCTA’s experience details successes and challenges in an ongoing effort to achieve an OAN. The model describes an OAN in stages of collaborative maturity and provides insights into the technological, clinical, and administrative implications of making the collaboration possible. Results: The four stages of an OAN are defined according to operational maturity, ranging from feasibility to demonstration of implementation. Each stage is associated with infrastructure and resource requirements and technical and clinical activities. In stage 1, technical standards are agreed upon, and the clinical programs are designed to utilize compliant technologies. In stage 2, collaboration is demonstrated through technical teams working together to address barriers, whereas clinical and administrative teams share best practices. In stage 3, a functional interoperable network is demonstrated with different institutions providing service through common telehealth end points at different patient care sites. In stage 4, clinical workflows are streamlined and standardized across institutions, and economies of scale are achieved through technical and administrative innovations. Conclusions: The approach to OAN development described provides a roadmap for achieving a functional telehealth network across independent health systems. The South Carolina experience reveals both successes and challenges in achieving this goal. The next steps toward the development of OANs include advocacy and ongoing engagement with the developers of telehealth technologies regarding their commitment to interoperability.

  • J Med Internet Res 2020;22(5):e17348

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  eHealth Literacy

  May 21, 2020

  An Informatics Framework to Assess Consumer Health Language Complexity Differences: Proof-of-Concept Study

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  Authors List:

  • Biyang Yu  
  • Zhe He  
  • Aiwen Xing  
  • Mia Liza A Lustria  

  Abstract:

  Background: The language gap between health consumers and health professionals has been long recognized as the main hindrance to effective health information comprehension. Although providing health information access in consumer health language (CHL) is widely accepted as the solution to the problem, health consumers are found to have varying health language preferences and proficiencies. To simplify health documents for heterogeneous consumer groups, it is important to quantify how CHLs are different in terms of complexity among various consumer groups. Objective: This study aimed to propose an informatics framework (consumer health language complexity [CHELC]) to assess the complexity differences of CHL using syntax-level, text-level, term-level, and semantic-level complexity metrics. Specifically, we identified 8 language complexity metrics validated in previous literature and combined them into a 4-faceted framework. Through a rank-based algorithm, we developed unifying scores (CHELC scores [CHELCS]) to quantify syntax-level, text-level, term-level, semantic-level, and overall CHL complexity. We applied CHELCS to compare posts of each individual on online health forums designed for (1) the general public, (2) deaf and hearing-impaired people, and (3) people with autism spectrum disorder (ASD). Methods: We examined posts with more than 4 sentences of each user from 3 health forums to understand CHL complexity differences among these groups: 12,560 posts from 3756 users in Yahoo! Answers, 25,545 posts from 1623 users in AllDeaf, and 26,484 posts from 2751 users in Wrong Planet. We calculated CHELCS for each user and compared the scores of 3 user groups (ie, deaf and hearing-impaired people, people with ASD, and the public) through 2-sample Kolmogorov-Smirnov tests and analysis of covariance tests. Results: The results suggest that users in the public forum used more complex CHL, particularly more diverse semantics and more complex health terms compared with users in the ASD and deaf and hearing-impaired user forums. However, between the latter 2 groups, people with ASD used more complex words, and deaf and hearing-impaired users used more complex syntax. Conclusions: Our results show that the users in 3 online forums had significantly different CHL complexities in different facets. The proposed framework and detailed measurements help to quantify these CHL complexity differences comprehensively. The results emphasize the importance of tailoring health-related content for different consumer groups with varying CHL complexities.

  • J Med Internet Res 2020;22(5):e16795

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