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Journal Description

The Journal of Medical Internet Research (JMIR), now in its 21st 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 2018: 4.945, ranked #1 out of 26 journals in the medical informatics category) 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 a 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 an open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as with 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: freepik; Copyright: pressfoto; URL: https://www.freepik.com/free-photo/handsome-physician-having-appointment_5535616.htm#page=7&query=doctor+with+patient&position=4; License: Licensed by JMIR.

    Tools to Assess the Trustworthiness of Evidence-Based Point-of-Care Information for Health Care Professionals: Systematic Review

    Abstract:

    Background: User-friendly information at the point of care should be well structured, rapidly accessible, and comprehensive. Also, this information should be trustworthy, as it will be used by health care practitioners to practice evidence-based medicine. Therefore, a standard, validated tool to evaluate the trustworthiness of such point-of-care information resources is needed. Objective: This systematic review sought to search for tools to assess the trustworthiness of point-of-care resources and to describe and analyze the content of these tools. Methods: A systematic search was performed on three sources: (1) we searched online for initiatives that worked off of the trustworthiness of medical information; (2) we searched Medline (PubMed) until June 2019 for relevant literature; and (3) we scanned reference lists and lists of citing papers via Web of Science for each retrieved paper. We included all studies, reports, websites, or methodologies that reported on tools that assessed the trustworthiness of medical information for professionals. From the selected studies, we extracted information on the general characteristics of the tools. As no standard, risk-of-bias assessment instruments are available for these types of studies, we described how each tool was developed, including any assessments on reliability and validity. We analyzed the criteria used in the different tools and divided them into five categories: (1) author-related information; (2) evidence-based methodology; (3) website quality; (4) website design and usability; and (5) website interactivity. The percentage of tools in compliance with these categories and the different criteria were calculated. Results: Included in this review was a total of 17 tools, all published between 1997 and 2018. The tools were developed for different purposes, from a general quality assessment of medical information to very detailed analyses, all specifically for point-of-care resources. However, the development process of the tools was poorly described. Overall, seven tools had a scoring system implemented, two were assessed for reliability only, and two other tools were assessed for both validity and reliability. The content analysis showed that all the tools assessed criteria related to an evidence-based methodology: 82% of the tools assessed author-related information, 71% assessed criteria related to website quality, 71% assessed criteria related to website design and usability, and 47% of the tools assessed criteria related to website interactivity. There was significant variability in criteria used, as some were very detailed while others were more broadly defined. Conclusions: The 17 included tools encompass a variety of items important for the assessment of the trustworthiness of point-of-care information. Overall, two tools were assessed for both reliability and validity, but they lacked some essential criteria for the assessment of the trustworthiness of medical information for use at the point-of-care. Currently, a standard, validated tool does not exist. The results of this review may contribute to the development of such an instrument, which may enhance the quality of point-of-care information in the long term.

  • Source: Unsplash; Copyright: Everson Mayer; URL: https://unsplash.com/photos/T5_rSquoI-M; License: Licensed by JMIR.

    Tools for App- and Web-Based Self-Testing of Cognitive Impairment: Systematic Search and Evaluation

    Abstract:

    Background: Tools for app- and Web-based self-testing for identification of cognitive impairment are widely available but are of uncertain quality. Objective: The objective of this study was to undertake a scoping review of app- and Web-based self-tests for cognitive impairment and determine the validity of these tests. Methods: We conducted systematic searches in electronic databases, including Google search, Google Play Store, and iPhone Operating System App Store, using the search terms “Online OR Internet-based AND Memory OR Brain OR Dementia OR mild cognitive impairment OR MCI AND Test OR Screen OR Check.” Results: We identified 3057 tools, of which 25 were included in the review. Most tools meeting the inclusion criteria assessed multiple cognitive domains. The most frequently assessed domains were memory, attention, and executive function. We then conducted an electronic survey with the developers of the tools to identify data relating to development and validation of each tool. If no response to the survey was received, Google (to identify gray literature), Google Scholar, and Medical Literature Analysis and Retrieval System Online were searched using key terms “(name of developer, if available)” AND “(the name of the tool)” to identify any additional data. Only 7 tools had any information concerning psychometric quality, and only 1 tool reported data on performance norms, reliability, validity, sensitivity, and specificity for the detection of cognitive impairment. Conclusions: The number of cognitive self-assessment electronic health tools for cognitive impairment is increasing, but most are of uncertain quality. There is a need for well-validated tools and guidance for users concerning which tools provide reliable information about possible cognitive impairment that could warrant further investigation.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: https://www.jmir.org/2020/1/e15188; License: Creative Commons Attribution (CC-BY).

    The True Colours Remote Symptom Monitoring System: A Decade of Evolution

    Abstract:

    The True Colours remote mood monitoring system was developed over a decade ago by researchers, psychiatrists, and software engineers at the University of Oxford to allow patients to report on a range of symptoms via text messages, Web interfaces, or mobile phone apps. The system has evolved to encompass a wide range of measures, including psychiatric symptoms, quality of life, and medication. Patients are prompted to provide data according to an agreed personal schedule: weekly, daily, or at specific times during the day. The system has been applied across a number of different populations, for the reporting of mood, anxiety, substance use, eating and personality disorders, psychosis, self-harm, and inflammatory bowel disease, and it has shown good compliance. Over the past decade, there have been over 36,000 registered True Colours patients and participants in the United Kingdom, with more than 20 deployments of the system supporting clinical service and research delivery. The system has been adopted for routine clinical care in mental health services, supporting more than 3000 adult patients in secondary care, and 27,263 adolescent patients are currently registered within Oxfordshire and Buckinghamshire. The system has also proven to be an invaluable scientific resource as a platform for research into mood instability and as an electronic outcome measure in randomized controlled trials. This paper aimed to report on the existing applications of the system, setting out lessons learned, and to discuss the implications for tailored symptom monitoring, as well as the barriers to implementation at a larger scale.

  • Using question and answer (Q&A) platforms for personalized health advice. Source: Freepik; Copyright: katemangostar; URL: https://www.freepik.com/free-photo/sick-young-woman-coughing-sitting-home-working-laptop_4167109.htm#page=1&query=sick%20person,%20computer&position=22; License: Licensed by JMIR.

    You Get What You Pay for on Health Care Question and Answer Platforms: Nonparticipant Observational Study

    Abstract:

    Background: Seeking health information on the internet is very popular despite the debatable ability of lay users to evaluate the quality of health information and uneven quality of information available on the Web. Consulting the internet for health information is pervasive, particularly when other sources are inaccessible because of time, distance, and money constraints or when sensitive or embarrassing questions are to be explored. Question and answer (Q&A) platforms are Web-based services that provide personalized health advice upon the information seekers’ request. However, it is not clear how the quality of health advices is ensured on these platforms. Objective: The objective of this study was to identify how platform design impacts the quality of Web-based health advices and equal access to health information on the internet. Methods: A total of 900 Q&As were collected from 9 Q&A platforms with different design features. Data on the design features for each platform were generated. Paid physicians evaluated the data to quantify the quality of health advices. Guided by the literature, the design features that affected information quality were identified and recorded for each Q&A platform. The least absolute shrinkage and selection operator and unbiased regression tree methods were used for the analysis. Results: Q&A platform design and health advice quality were related. Expertise of information providers (beta=.48; P=.001), financial incentive (beta=.4; P=.001), external reputation (beta=.28; P=.002), and question quality (beta=.12; P=.001) best predicted health advice quality. Virtual incentive, Web 2.0 mechanisms, and reputation systems were not associated with health advice quality. Conclusions: Access to high-quality health advices on the internet is unequal and skewed toward high-income and high-literacy groups. However, there are possibilities to generate high-quality health advices for free.

  • The transformation process from text to visualization. Source: The Authors / Unsplash (Thought Catalog); Copyright: The Authors; URL: https://www.jmir.org/2020/1/e16249; License: Creative Commons Attribution (CC-BY).

    Visualizing an Ethics Framework: A Method to Create Interactive Knowledge Visualizations From Health Policy Documents

    Abstract:

    Background: Data have become an essential factor in driving health research and are key to the development of personalized and precision medicine. Primary and secondary use of personal data holds significant potential for research; however, it also introduces a new set of challenges around consent processes, privacy, and data sharing. Research institutions have issued ethical guidelines to address challenges and ensure responsible data processing and data sharing. However, ethical guidelines directed at researchers and medical professionals are often complex; require readers who are familiar with specific terminology; and can be hard to understand for people without sufficient background knowledge in legislation, research, and data processing practices. Objective: This study aimed to visually represent an ethics framework to make its content more accessible to its stakeholders. More generally, we wanted to explore the potential of visualizing policy documents to combat and prevent research misconduct by improving the capacity of actors in health research to handle data responsibly. Methods: We used a mixed methods approach based on knowledge visualization with 3 sequential steps: qualitative content analysis (open and axial coding, among others); visualizing the knowledge structure, which resulted from the previous step; and adding interactive functionality to access information using rapid prototyping. Results: Through our iterative methodology, we developed a tool that allows users to explore an ethics framework for data sharing through an interactive visualization. Our results represent an approach that can make policy documents easier to understand and, therefore, more applicable in practice. Conclusions: Meaningful communication and understanding each other remain a challenge in various areas of health care and medicine. We contribute to advancing communication practices through the introduction of knowledge visualization to bioethics to offer a novel way to tackle this relevant issue.

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://www.jmir.org/2020/1/e15071/; License: Creative Commons Attribution (CC-BY).

    An Online Pain Education Program for Working Adults: Pilot Randomized Controlled Trial

    Abstract:

    Background: Pain is a common public health concern, and the pain situation among the general population is serious in mainland China. Working adults commonly experience pain because of long sitting times, a lack of free time, and exercise. A lack of pain-related knowledge is also a significant factor. Educational and therapeutic programs delivered online were used more often in Western countries, and accessible programs in China are limited, especially for pain management. Therefore, we carried out an online pain education program for working adults to self-manage pain. The program was delivered through WeChat, a popular and secure social media with a large population base in China. Objective: This study aimed to (1) provide pain-related knowledge and self-relief strategies, (2) help participants reduce pain and improve pain-related emotional well-being, and (3) explore participants’ learning performance and the acceptability of the online pain education program. Methods: This was a randomized controlled trial. Chinese adults aged between 16 and 60 years with full-time employment, with pain in the past 6 months, and without any mental illness were recruited using snowball sampling through the internet and were randomly allocated to an experimental group and a control group in 1:1 ratio after the baseline assessment. The 4-week educational program that included basic knowledge of pain, pharmacological and nonpharmacological treatments, and related resources was provided only to the experimental group. Outcomes of pain, depression, anxiety, stress, and pain self-efficacy were measured at baseline (T0), posttreatment (T1), and 1-month follow-up (T2). Participants’ acceptability and satisfaction were explored after completing the educational program. Results: In total, 95 eligible participants joined in the program: 47 in the experimental group and 48 in the control group. Neck and shoulder, head, and back were most commonly reported pain sites with high pain scores. Pain intensity and interference of the experimental group were significantly reduced after the educational program. Depression, anxiety, and stress clinically improved and pain self-efficacy improved after the educational program. The difference in depression, anxiety, stress, and pain self-efficacy within a group or between groups was not statistically significant; however, clinical improvements were demonstrated. A significant correlation between dosage of the intervention and pain intensity and depression was demonstrated. After completing the educational program, more than half of the participants showed acceptance of and satisfaction with the program, and they were willing to recommend the program to others. Conclusions: Our findings highlight the significant potential of this online education program in the treatment of pain. Clinical Trial: ClinicalTrials.gov NCT03952910; https://clinicaltrials.gov/ct2/show/NCT03952910

  • Source: Pexels.com; Copyright: Christina Morillo; URL: https://www.pexels.com/photo/woman-using-macbook-1181288/; License: Licensed by JMIR.

    A Data-Driven Social Network Intervention for Improving Organ Donation Awareness Among Minorities: Analysis and Optimization of a Cross-Sectional Study

    Abstract:

    Background: Increasing the number of organ donors may enhance organ transplantation, and past health interventions have shown the potential to generate both large-scale and sustainable changes, particularly among minorities. Objective: This study aimed to propose a conceptual data-driven framework that tracks digital markers of public organ donation awareness using Twitter and delivers an optimized social network intervention (SNI) to targeted audiences using Facebook. Methods: We monitored digital markers of organ donation awareness across the United States over a 1-year period using Twitter and examined their association with organ donation registration. We delivered this SNI on Facebook with and without optimized awareness content (ie, educational content with a weblink to an online donor registration website) to low-income Hispanics in Los Angeles over a 1-month period and measured the daily number of impressions (ie, exposure to information) and clicks (ie, engagement) among the target audience. Results: Digital markers of organ donation awareness on Twitter are associated with donation registration (beta=.0032; P<.001) such that 10 additional organ-related tweets are associated with a 3.20% (33,933/1,060,403) increase in the number of organ donor registrations at the city level. In addition, our SNI on Facebook effectively reached 1 million users, and the use of optimization significantly increased the rate of clicks per impression (beta=.0213; P<.004). Conclusions: Our framework can provide a real-time characterization of organ donation awareness while effectively delivering tailored interventions to minority communities. It can complement past approaches to create large-scale, sustainable interventions that are capable of raising awareness and effectively mitigate disparities in organ donation.

  • Source: Freepik; Copyright: pressfoto; URL: https://www.freepik.com/free-photo/discussing-records-with-senior-patient_5633825.htm#page=1&query=patient+tablet&position=3; License: Licensed by JMIR.

    Patient Recommendations to Improve the Implementation of and Engagement With Portals in Acute Care: Hospital-Based Qualitative Study

    Abstract:

    Background: The inclusion of patient portals into electronic health records in the inpatient setting lags behind progress in the outpatient setting. Objective: The aim of this study was to understand patient perceptions of using a portal during an episode of acute care and explore patient-perceived barriers and facilitators to portal use during hospitalization. Methods: We utilized a mixed methods approach to explore patient experiences in using the portal during hospitalization. All patients received a tablet with a brief tutorial, pre- and postuse surveys, and completed in-person semistructured interviews. Qualitative data were coded using thematic analysis to iteratively develop 18 codes that were integrated into 3 themes framed as patient recommendations to hospitals to improve engagement with the portal during acute care. Themes from these qualitative data guided our approach to the analysis of quantitative data. Results: We enrolled 97 participants: 53 (53/97, 55%) women, 44 (44/97, 45%) nonwhite with an average age of 48 years (19-81 years), and the average length of hospitalization was 6.4 days. A total of 47 participants (47/97, 48%) had an active portal account, 59 participants (59/97, 61%) owned a smartphone, and 79 participants (79/97, 81%) accessed the internet daily. In total, 3 overarching themes emerged from the qualitative analysis of interviews with these patients during their hospital stay: (1) hospitals should provide both access to a device and bring-your-own-device platform to access the portal; (2) hospitals should provide an orientation both on how to use the device and how to use the portal; and (3) hospitals should ensure portal content is up to date and easy to understand. Conclusions: Patients independently and consistently identified basic needs for device and portal access, education, and usability. Hospitals should prioritize these areas to enable successful implementation of inpatient portals to promote greater patient engagement during acute care. Clinical Trial: ClinicalTrials.gov NCT00102401; https://clinicaltrials.gov/ct2/show/NCT01970852

  • Source: Freepik; Copyright: nensuria; URL: https://www.freepik.com/free-photo/happy-read-pretty-girl-fun_1093682.htm; License: Licensed by JMIR.

    The Impact of Advertisement Messaging on Enrollment of Young Men Who Have Sex With Men for Web-Based Research: Observational Study

    Abstract:

    Background: Recruiting young men who have sex with men (YMSM) in community settings is difficult. The use of Web-based social networks and dating apps for recruitment can be successful approaches, although little work has been done on the impact of study advertisement content on recruitment. Objective: The aim of this study was to evaluate the effects of advertisement message content on the recruitment of YMSM (aged 18-26 years) for a Web-based focus group study, examining perspectives and preferences for a mobile app that was designed to support sexual health among YMSM. Methods: Between March and April 2017, a recruitment campaign to promote human papillomavirus vaccination was launched on a popular social networking and dating app for YMSM, with 3 different text-based advertisement themes (technology, cancer prevention, and sexual innuendo). The campaign recruited YMSM across 3 states (Massachusetts, New York, and Pennsylvania). We examined the click-through rates, conversion rates, and enrollment rates of each of the advertisements and examined differences in views and clicks by age, state, and time of day. Results: The sexual innuendo advertisement had the highest click rates when compared with both the technology (click rate ratio [CRR] 2.06, 95% CI 1.74-2.45) and cancer prevention (CRR 1.62, 95% CI 1.38-1.90) advertisements. The sexual innuendo advertisement also had higher study enrollment rates compared with the technology (CRR 1.90, 95% CI 1.23-2.83) and cancer prevention (CRR 2.06, 95% CI 1.37-3.13) advertisements. No differences were observed in clicks or enrollment by age, state, or time of day. Conclusions: Our marketing campaign, targeting YMSM, was effective in recruiting participants for a qualitative study, using Web-based focus groups. The sexual innuendo advertisement was the most effective and cost-efficient advertisement of the 3 approaches trialed. Different populations need different targeted strategies for study recruitment. Researchers should work with key representatives to develop and test culturally relevant messaging and approaches that utilize current and popular technologies.

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://www.jmir.org/2020/1/e15793/; License: Creative Commons Attribution (CC-BY).

    A Culturally Targeted eLearning Module on Organ Donation (Promotoras de Donación): Design and Development

    Abstract:

    Background: As an overrepresented population on the transplant waitlist, stagnated rates of organ donation registration among Latinxs must be redressed. Promotoras (community health workers), who are effective at advocating and spearheading health promotion efforts in the Latinx community, show promise in their ability to educate about organ donation and donor registration. Objective: This study aimed (1) to develop an interactive, evidence-based program to educate promotoras about organ donation, the need for organ donors in the Latinx American community, and ways to register as deceased organ donors and (2) to train promotoras to lead discussions about organ donation and to promote the act of donor registration. Methods: In partnership with 4 promotoras organizations, the culturally targeted Promotoras de Donación eLearning module was developed based on input from 12 focus groups conducted with Latina women (n=61) and promotoras (n=37). Formative work, existing literature, the Vested Interest Theory, and the Organ Donation Model guided curriculum development. In partnership with the Gift of Life Institute and regional promotoras, the curriculum was designed, filmed, and developed in a visually appealing module interface. The module was beta-tested with promotoras before launch. Results: Promotoras de Donación, available in Spanish with English subtitling, lasts just over an hour. The module comprised 6 sections including various activities and videos, with the curriculum divided into a skills-based communication component and a didactic educational component. Pre- and posttests assessed the module’s direct effects on promotoras’ organ donation knowledge and attitudes as well as confidence promoting the act of donor registration. Conclusions: This novel, theoretically and empirically based intervention leveraged the existing network of promotoras to promote the act of donor registration. Future research should assess whether the module helps increase rates of donor registration within Latinx communities and reduce disparities in access to transplantation. Clinical Trial: ClinicalTrials.gov NCT04007419; https://www.clinicaltrials.gov/ct2/show/NCT04007419

  • Source: The Authors / Placeit; Copyright: JMIR Publications; URL: http://www.jmir.org/2020/1/e15603/; License: Creative Commons Attribution (CC-BY).

    Barriers to Working With National Health Service England’s Open Data

    Abstract:

    Open data is information made freely available to third parties in structured formats without restrictive licensing conditions, permitting commercial and noncommercial organizations to innovate. In the context of National Health Service (NHS) data, this is intended to improve patient outcomes and efficiency. EBM DataLab is a research group with a focus on online tools which turn our research findings into actionable monthly outputs. We regularly import and process more than 15 different NHS open datasets to deliver OpenPrescribing.net, one of the most high-impact use cases for NHS England’s open data, with over 15,000 unique users each month. In this paper, we have described the many breaches of best practices around NHS open data that we have encountered. Examples include datasets that repeatedly change location without warning or forwarding; datasets that are needlessly behind a “CAPTCHA” and so cannot be automatically downloaded; longitudinal datasets that change their structure without warning or documentation; near-duplicate datasets with unexplained differences; datasets that are impossible to locate, and thus may or may not exist; poor or absent documentation; and withholding of data for dubious reasons. We propose new open ways of working that will support better analytics for all users of the NHS. These include better curation, better documentation, and systems for better dialogue with technical teams.

  • Source: Unsplash; Copyright: Samantha Gades; URL: https://unsplash.com/photos/V_d6tUaniK8; License: Licensed by the authors.

    Effectiveness and Cost-Effectiveness of a Self-Guided Internet Intervention for Social Anxiety Symptoms in a General Population Sample: Randomized Controlled...

    Abstract:

    Background: Many people are accessing digital self-help for mental health problems, often with little evidence of effectiveness. Social anxiety is one of the most common sources of mental distress in the population, and many people with symptoms do not seek help for what represents a significant public health problem. Objective: This study aimed to evaluate the effectiveness of a self-guided cognitive behavioral internet intervention for people with social anxiety symptoms in the general population. Methods: We conducted a two-group randomized controlled trial in England between May 11, 2016, and June 27, 2018. Adults with social anxiety symptoms who were not receiving treatment for social anxiety were recruited using online advertisements. All participants had unrestricted access to usual care and were randomized in a 1:1 ratio to either a Web-based unguided self-help intervention based on cognitive behavioral principles or a waiting list control group. All outcomes were collected through self-report online questionnaires. The primary outcome was the change in 17-item Social Phobia Inventory (SPIN-17) score from baseline to 6 weeks using a linear mixed-effect model that used data from all time points (6 weeks, 3 months, 6 months, and 12 months). Results: A total of 2122 participants were randomized, and 6 were excluded from analyses because they were ineligible. Of the 2116 eligible randomized participants (mean age 37 years; 80.24%, 1698/2116 women), 70.13% (1484/2116) had follow-up data available for analysis, and 56.95% (1205/2116) had data on the primary outcome, although attrition was higher in the intervention arm. At 6 weeks, the mean (95% CI) adjusted difference in change in SPIN-17 score in the intervention group compared with control was −1.94 (−3.13 to −0.75; P=.001), a standardized mean difference effect size of 0.2. The improvement was maintained at 12 months. Given the high dropout rate, sensitivity analyses explored missing data assumptions, with results that were consistent with those of the primary analysis. The economic evaluation demonstrated cost-effectiveness with a small health status benefit and a reduction in health service utilization. Conclusions: For people with social anxiety symptoms who are not receiving other forms of help, this study suggests that the use of an online self-help tool based on cognitive behavioral principles can provide a small improvement in social anxiety symptoms compared with no intervention, although dropout rates were high. Clinical Trial: ClinicalTrials.gov NCT02451878; https://clinicaltrials.gov/ct2/show/NCT02451878

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  • Artificial Intelligence and Health Technology Assessment: Anticipating a New Level of Complexity

    Date Submitted: Jan 11, 2020

    Open Peer Review Period: Jan 11, 2020 - Mar 7, 2020

    Artificial Intelligence is seen as a strategic lever to improve access, quality and efficiency of care and services, and to build learning and value-based health systems. Many studies examined the tec...

    Artificial Intelligence is seen as a strategic lever to improve access, quality and efficiency of care and services, and to build learning and value-based health systems. Many studies examined the technical performance of AI within an experimental context. These studies provide limited insights into the issues that its use in a real-world context of care and services (RWCCS) raises. To help decision-makers address these issues in a systemic and holistic way, this article relies on the "Health Technology Assessment (HTA) core model" to contrast the expectations of the health sector towards the use of AI with the risks that should be mitigated for its responsible deployment. The analysis adopts the perspective of payors because of their central role in regulating, financing and reimbursing novel technologies. This article suggests that AI-based systems should be seen as a health system transformation lever, rather than a discrete set of technological devices. Their use could bring significant changes and impacts at several levels: technological, clinical, human and cognitive (patient and clinician), professional and organizational, economic, legal and ethical. The assessment of the "AI value proposition" should thus go beyond "technical performance" and "price" logics by performing a holistic analysis of value in a RWCCS. In order to guide AI developments, generate knowledge and draw lessons that can be translated into action, the right political, regulatory, organizational, clinical and technological conditions for innovation should be created as a first step.

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    Date Submitted: Jan 6, 2020

    Open Peer Review Period: Jan 9, 2020 - Mar 5, 2020

    Background: In the era of health informatics, exponential growth of information generated by health information systems and healthcare organizations demands expert and intelligent recommendation syste...

    Background: In the era of health informatics, exponential growth of information generated by health information systems and healthcare organizations demands expert and intelligent recommendation systems. It has become one of the most valuable tools as it reduces problems such as information overload while selecting and suggesting doctors, hospitals, medicine, diagnosis etc according to patients’ interests. Objective: Recommendation uses Hybrid Filtering as one of the most popular approaches, but the major limitations of this approach are selectivity and data integrity issues.Mostly existing recommendation systems & risk prediction algorithms focus on a single domain, on the other end cross-domain hybrid filtering is able to alleviate the degree of selectivity and data integrity problems to a better extent. Methods: We propose a novel algorithm for recommendation & predictive model using KNN algorithm with machine learning algorithms and artificial intelligence (AI). We find the factors that directly impact on diseases and propose an approach for predicting the correct diagnosis of different diseases. We have constructed a series of models with good reliability for predicting different surgery complications and identified several novel clinical associations. We proposed a novel algorithm pr-KNN to use KNN for prediction and recommendation of diseases Results: Beside that we compared the performance of our algorithm with other machine algorithms and found better performance of our algorithm, with predictive accuracy improving by +3.61%. Conclusions: The potential to directly integrate these predictive tools into EHRs may enable personalized medicine and decision-making at the point of care for patient counseling and as a teaching tool. Clinical Trial: dataset for the trials of patient attached

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    Date Submitted: Jan 2, 2020

    Open Peer Review Period: Jan 2, 2020 - Feb 27, 2020

    Background: Background Mental health problems namely depression and anxiety are the most common problems in the community. Often patients do not seek professional care due to the stigma attached to i...

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    Open Peer Review Period: Dec 31, 2019 - Feb 25, 2020

    Background: Although worldwide implementation of patient accessible health records (PAEHR) as an instrument in patient-centered care (PC) is expanding, its advantages and disadvantages do not seem to...

    Background: Although worldwide implementation of patient accessible health records (PAEHR) as an instrument in patient-centered care (PC) is expanding, its advantages and disadvantages do not seem to be structurally evaluated to date. Objective: The objective is to review whether and how the use of a PAEHR contributes to PC both in general and among specific patient groups. Methods: Adapted PRISMA reporting guidelines for scoping reviews were followed. Literature was identified in five databases, using the terms ‘patient-accessible medical records’, ‘patient experiences’ and ‘professional experiences’ as key concepts. A total of 49 articles were included and analyzed with a charting code list containing 10 elements of PC. Results: Studies were diverse in design, country of origin, functionalities of the investigated PAEHR and target population. Respondents in all studies were adults. The effect of PAEHRs on PC was evaluated as moderately positive: patient accessible health records were appreciated for their opportunity to empower patients, to inform them about their health, and to involve them in their own care. There were mixed results for the extent to which PAEHR affected the relation between patients and clinicians. Professionals and patients in mental healthcare held opposing views concerning the impact of transparency, professionals appearing more worried about potential negative impact. Their worries seemed to be influenced by a reluctant attitude toward PC. Disadvantaged groups appeared to have less access to and make less use of patient-accessible records than the average population, but experienced more benefits than the average population when they actually used a PAEHR. Conclusions: The review indicated that PAEHRs bear potential to contribute to patient-centered care. However, concerns from professionals about the impact of transparency on the therapeutic relationship as well as the importance of a patient-centered attitude need to be addressed. Potentially high benefits for disadvantaged groups will be achieved only through easy-accessible and user-friendly PAEHRs. Ultimately, future research needs to address the question how PAEHRs affect PC among youths.

  • Finding the best app for patients with genitourinary tumors: analysis of quality using the Mobile Application Rating Scale (MARS)

    Date Submitted: Dec 27, 2019

    Open Peer Review Period: Dec 27, 2019 - Feb 21, 2020

    Background: The large number of available cancer mobile applications (apps) and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, healt...

    Background: The large number of available cancer mobile applications (apps) and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, healthcare professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, one of the most prevalent types of cancer. Objective: The objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using MARS in order to identify the highest-quality apps. Methods: We performed an observational, cross-sectional, descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we conducted a search of all the apps for patients with genitourinary cancers (bladder, prostate, cervix, uterus, endometrium, kidney, testicular, and vulvar) and/or their caregivers. Applications were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers with the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Aesthetics, Information, and Subjective Quality) with a score of 1 to 5. Results: Forty-six apps were analyzed. Thirty-one (67%) were available in Android, 6 (13%) in iOS, and 9 (20%) in both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% (14/46) of cases and for cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by healthcare organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD = 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Aesthetics, which showed acceptable scores in a third of the apps. The 5 apps with the highest MARS score were: “Bladder cancer manager”, “Kidney cancer manager”, “My prostate cancer manager”, “Target Ovarian Cancer Symptoms Diary” and “My Cancer Coach”. We observed statistically significant differences in the MARS score among the operative systems and the developers (P < .001 and P = .01, respectively), but not by cost (P = .62). Conclusions: MARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is poor; nevertheless, we observed that both participation of health professionals and updating were correlated with quality.

  • Using Web-Based Social Media to Recruit Heavy-Drinking Young Adults for Sleep Intervention: Prospective Observation

    Date Submitted: Dec 22, 2019

    Open Peer Review Period: Dec 22, 2019 - Feb 22, 2020

    Background: Novel alcohol prevention strategies are needed for heavy-drinking young adults. Sleep problems are common among young adults who drink heavily and a risk factor for developing an alcohol u...

    Background: Novel alcohol prevention strategies are needed for heavy-drinking young adults. Sleep problems are common among young adults who drink heavily and a risk factor for developing an alcohol use disorder. Young adults are interested in the connection between sleep and alcohol and are open to getting help for their sleep. Therefore, sleep interventions may offer an innovative solution. This study evaluated social media advertising for reaching young adults and recruiting them for a new alcohol prevention program focused on sleep. Objective: (1) Evaluate the effectiveness and cost of Facebook, Instagram, and Snapchat advertising to reach young adults with heavy drinking for a sleep intervention; (2) characterize sleep, alcohol use, and related concerns and interests among responders; and (3) identify the most appealing advertising content. Methods: In Study 1, advertisements targeting young adults with sleep concerns, heavy alcohol use, and/or interest in participating in a sleep program ran over a 3-month period until enrollment goal achieved. Advertisements directed volunteers to complete a brief Web-based survey to determine initial sleep program eligibility and to characterize the concerns and/or interests that attracted them to click the advertisement. In Study 2, 3 ads ran simultaneously for 2 days to compare the effectiveness of specific advertising themes for reaching and enrolling young adults. Results: In Study 1, ads generated 13,638 clicks, 909 surveys, and 27 enrolled volunteers in 3 months across all the social media. Fees averaged $0.27 per click, $3.99 per completed survey, $11.43 per volunteer meeting initial screening eligibility, and $106.59 per study enrollee. On average, those who completed the Web-based survey were 21.1 (SD 2.3) yrs of age, and 69.4% (631/909) were female. Most reported sleep concerns (79.8%) and interest in the connection between sleep and alcohol use (60.2%) but few had drinking concerns (5.9%). About a third (34.9%, 317/909) were identified as at risk for developing an alcohol use disorder based on a validated alcohol screener. Among this subsample, 8.5% (27/317) met final criteria and enrolled in the trial. Some volunteers also referred additional volunteers by word-of-mouth. In Study 2, ads targeting sleep yielded a higher response rate than ads targeting alcohol use (0.91% vs 0.56% click rate, P < .001). Conclusions: Social media advertisements designed to target young adults with sleep concerns reached those who also drank alcohol heavily, despite few being concerned about their drinking. Moreover, advertisements focused on sleep were more effective than those focused on drinking. Compared to prior studies, our cost-effectiveness was moderate for engagement (impressions to clicks), excellent for conversion (clicks to survey completion), and reasonable for study enrollment. These data demonstrate the utility of social media advertising generally and specifically focused on sleep to reach young adults who drink heavily and recruit for them intervention. Clinical Trial: NCT036589

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