@Article{info:doi/10.2196/60553,
author="Mahmood, Atiya
and Rikhtehgaran, Farinaz
and Nasiri, Rojan
and Hedayati, Niloofar
and Pandsheno, Sepehr
and Sharrock, Aislynn
and Mora, Juanita Diana
and Haji Hosseini, Sogol
and Routhier, Fran{\c{c}}ois
and Mortenson, W.Ben",
title="Adaptation of the Stakeholders' Walkability/Wheelability Audit in Neighborhoods (SWAN) Tool for Individuals With Diverse Disabilities: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="10",
volume="14",
pages="e60553",
keywords="age and accessibility",
keywords="disability experiences",
keywords="community engaged research",
keywords="inclusive urban design",
keywords="user-led built environment audits",
abstract="Background: The prevalence of sensory, cognitive, and mobility disabilities in Canada underscores the need to address environmental barriers. This study adapts and validates the Stakeholders' Walkability/Wheelability Audit in Neighborhoods (SWAN) tool to assess the challenges the built environment poses for individuals with disabilities, aiming to inform policy changes for accessibility and inclusivity. Objective: This study aims to (1) adapt the SWAN tool for those with hearing, vision, or cognitive disabilities; (2) validate SWAN tool for researching environmental barriers for people with disabilities, including older adults; and (3) offer insights for policy changes in the built environment, contributing to literature and guiding future research. Methods: The study uses a community-based research approach, carried out over 4 phases within an 18-month period in British Columbia. Phase 1 includes adapting and pilot-testing of the SWAN tool. In Phase 2, street intersections are identified for data collection using Geographic Information System tools and consultations with municipal officials. Phase 3 involves recruiting participants across four disability categories. The final phase includes analyzing the data and disseminating findings. Results: Data collection concluded in September 2024, involving 80 eligible participants across four streams in preidentified hotspots. The results are expected to be published in March 2025. To date, data collection is ongoing, and we are currently in the process of data analysis. Conclusions: This study will contribute to the growing body of research on built environment accessibility by adapting the SWAN tool for individuals with diverse disabilities. By identifying key barriers in urban spaces, the study aims to inform policy changes that will lead to more inclusive, accessible, and safe urban environments for all individuals. ",
doi="10.2196/60553",
url="https://www.researchprotocols.org/2025/1/e60553"
}


@Article{info:doi/10.2196/56306,
author="Starke, Georg
and Gille, Felix
and Termine, Alberto
and Aquino, James Yves Saint
and Chavarriaga, Ricardo
and Ferrario, Andrea
and Hastings, Janna
and Jongsma, Karin
and Kellmeyer, Philipp
and Kulynych, Bogdan
and Postan, Emily
and Racine, Elise
and Sahin, Derya
and Tomaszewska, Paulina
and Vold, Karina
and Webb, Jamie
and Facchini, Alessandro
and Ienca, Marcello",
title="Finding Consensus on Trust in AI in Health Care: Recommendations From a Panel of International Experts",
journal="J Med Internet Res",
year="2025",
month="Feb",
day="19",
volume="27",
pages="e56306",
keywords="expert consensus",
keywords="trust",
keywords="artificial intelligence",
keywords="clinical decision support",
keywords="assistive technologies",
keywords="public health surveillance",
keywords="framework analysis",
abstract="Background: The integration of artificial intelligence (AI) into health care has become a crucial element in the digital transformation of health systems worldwide. Despite the potential benefits across diverse medical domains, a significant barrier to the successful adoption of AI systems in health care applications remains the prevailing low user trust in these technologies. Crucially, this challenge is exacerbated by the lack of consensus among experts from different disciplines on the definition of trust in AI within the health care sector. Objective: We aimed to provide the first consensus-based analysis of trust in AI in health care based on an interdisciplinary panel of experts from different domains. Our findings can be used to address the problem of defining trust in AI in health care applications, fostering the discussion of concrete real-world health care scenarios in which humans interact with AI systems explicitly. Methods: We used a combination of framework analysis and a 3-step consensus process involving 18 international experts from the fields of computer science, medicine, philosophy of technology, ethics, and social sciences. Our process consisted of a synchronous phase during an expert workshop where we discussed the notion of trust in AI in health care applications, defined an initial framework of important elements of trust to guide our analysis, and agreed on 5 case studies. This was followed by a 2-step iterative, asynchronous process in which the authors further developed, discussed, and refined notions of trust with respect to these specific cases. Results: Our consensus process identified key contextual factors of trust, namely, an AI system's environment, the actors involved, and framing factors, and analyzed causes and effects of trust in AI in health care. Our findings revealed that certain factors were applicable across all discussed cases yet also pointed to the need for a fine-grained, multidisciplinary analysis bridging human-centered and technology-centered approaches. While regulatory boundaries and technological design features are critical to successful AI implementation in health care, ultimately, communication and positive lived experiences with AI systems will be at the forefront of user trust. Our expert consensus allowed us to formulate concrete recommendations for future research on trust in AI in health care applications. Conclusions: This paper advocates for a more refined and nuanced conceptual understanding of trust in the context of AI in health care. By synthesizing insights into commonalities and differences among specific case studies, this paper establishes a foundational basis for future debates and discussions on trusting AI in health care. ",
doi="10.2196/56306",
url="https://www.jmir.org/2025/1/e56306",
url="http://www.ncbi.nlm.nih.gov/pubmed/39969962"
}


@Article{info:doi/10.2196/67145,
author="Smith, Jackson Hunter
and Agans, T. Richard
and Kowallis, J. William",
title="Ethical Considerations for Wastewater Surveillance Conducted by the US Department of Defense",
journal="JMIR Public Health Surveill",
year="2025",
month="Feb",
day="6",
volume="11",
pages="e67145",
keywords="wastewater",
keywords="surveillance",
keywords="ethics",
keywords="military",
keywords="Department of Defense",
doi="10.2196/67145",
url="https://publichealth.jmir.org/2025/1/e67145"
}


@Article{info:doi/10.2196/53558,
author="Ivanova, Julia
and Cummins, R. Mollie
and Ong, Triton
and Soni, Hiral
and Barrera, Janelle
and Wilczewski, Hattie
and Welch, Brandon
and Bunnell, Brian",
title="Regulation and Compliance in Telemedicine: Viewpoint",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="23",
volume="27",
pages="e53558",
keywords="telemedicine",
keywords="telehealth",
keywords="policy",
keywords="COVID-19",
keywords="PHE",
keywords="rules and regulations",
keywords="compliance",
keywords="privacy and security",
keywords="regulation",
keywords="rule",
keywords="public health",
keywords="US",
keywords="United States",
keywords="implementation",
keywords="regulatory",
keywords="professional",
keywords="organizational",
keywords="ethical",
keywords="concern",
keywords="privacy",
keywords="security",
keywords="government literature",
keywords="law",
keywords="health care",
keywords="patient",
doi="10.2196/53558",
url="https://www.jmir.org/2025/1/e53558",
url="http://www.ncbi.nlm.nih.gov/pubmed/39847413"
}


@Article{info:doi/10.2196/66356,
author="Gehder, Sara
and Goeldner, Moritz",
title="Unpacking Performance Factors of Innovation Systems and Studying Germany's Attempt to Foster the Role of the Patient Through a Market Access Pathway for Digital Health Applications (DiGAs): Exploratory Mixed Methods Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e66356",
keywords="regulatory market access pathways",
keywords="digital health application",
keywords="DiGA",
keywords="patient-relevant structural and procedural improvement",
keywords="pSVV pathway analysis",
keywords="qualitative and systemic analysis",
keywords="policy and stakeholder insights",
keywords="innovation system analysis",
abstract="Background: Health care innovation faces significant challenges, including system inertia and diverse stakeholders, making regulated market access pathways essential for facilitating the adoption of new technologies. The German Digital Healthcare Act, introduced in 2019, offers a model by enabling digital health applications (DiGAs) to be reimbursed by statutory health insurance, improving market access and patient empowerment. However, the factors influencing the success of these pathways in driving innovation remain unclear. Objective: This study aims to identify the key performance factors of the innovation system shaped by the patient-relevant structural and procedural improvement (pSVV) pathway within the DiGA model. By examining how this pathway supports the entry of innovative digital health technologies, we seek to uncover the systemic dynamics that influence its effectiveness in fostering patient-centered digital health solutions. Methods: This study, conducted from May 2023 to November 2024, used a mixed methods approach. A descriptive analysis assessed how DiGA manufacturers use positive health care effects, giving a market overview of the pSVV technology. A qualitative analysis using grounded theory and Gioia methodology provided insights into stakeholder perspectives, focusing on manufacturers and regulatory bodies. A functional-structural analysis examined how components of the innovation system, such as actors, institutions, interactions, and infrastructure, interact and impact the effectiveness of the pathway. Results: The descriptive analysis showed that only 11 (20\%) of the 56 DiGAs available in Germany used the pSVV pathway, with only 1 (2\%) provisionally listed DiGA using pSVV as a primary end point; 6 of 9 (67\%) pSVV key areas were used. The qualitative analysis revealed that manufacturers prioritize demonstrating medical benefits over pSVV due to evidence requirements and uncertainties around pSVV acceptance. Operational barriers hindered the adoption of pSVV, despite a positive reception among stakeholders. The systemic analysis identified key issues, including a lack of entrepreneurial focus on pSVV, limited regulatory experience, inadequate measurement methods, and entrenched practices prioritizing medical benefits, that hinder market formation and legitimacy. Conclusions: This study identifies key factors for effectively implementing innovation systems through regulated market access pathways, including content and format security, clearer framework specification, active innovation process management, and market formation stimulation. Addressing these factors can reduce uncertainties and promote wider adoption of digital health technologies. The findings highlight the need for future research on patient empowerment and the development of methodologies beyond traditional therapeutic outcomes. ",
doi="10.2196/66356",
url="https://www.jmir.org/2025/1/e66356"
}


@Article{info:doi/10.2196/60832,
author="Powell, Daniel
and Asad, Laiba
and Zavaglia, Elissa
and Ferrari, Manuela",
title="Promoting Digital Health Data Literacy: The Datum Project",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="3",
volume="9",
pages="e60832",
keywords="health data",
keywords="digital data",
keywords="medical records",
keywords="legislation",
keywords="ethics",
keywords="knowledge dissemination",
keywords="learning health system",
keywords="data bank",
doi="10.2196/60832",
url="https://formative.jmir.org/2025/1/e60832"
}


@Article{info:doi/10.2196/54661,
author="Han, Eileen
and Lempert, K. Lauren
and Vescia, Francesca
and Halpern-Felsher, Bonnie",
title="Concerns Over Vuse e-Cigarette Digital Marketing and Implications for Public Health Regulation: Content Analysis",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="27",
volume="8",
pages="e54661",
keywords="e-cigarette",
keywords="social media marketing",
keywords="Vuse",
keywords="adolescents and young adults",
keywords="Food and Drug Administration",
keywords="FDA",
keywords="smoker",
keywords="smoking",
keywords="smoking device",
keywords="tobacco",
keywords="social media",
keywords="Instagram",
keywords="Facebook",
keywords="promote",
keywords="marketing",
keywords="mobile phone",
abstract="Background: Electronic cigarettes (e-cigarettes) are the most used form of tobacco products among adolescents and young adults, and Vuse is one of the most popular brands of e-cigarettes among US adolescents. In October 2021, Vuse Solo became the first e-cigarette brand to receive marketing granted orders (MGOs) from the US Food and Drug Administration (FDA), authorizing its marketing and their tobacco-flavored pods. Vuse Ciro and Vuse Vibe, and their tobacco-only (``original'') e-liquids, were authorized for marketing in May 2022 and Vuse Alto tobacco-flavored devices were authorized in July 2024. These marketing authorizations are contingent upon the company adhering to the MGOs' stated marketing restrictions, including reducing exposure and appeal to youth via digital, radio, television, print, and point-of-sale advertising. Objective: In this study, we analyzed the official social media channels of Vuse (Instagram and Facebook) to examine how Vuse marketed its products on social media and whether these marketing posts contain potentially youth-appealing themes. Methods: We conducted content analysis of the official RJ Reynolds Vapor Company Instagram and Facebook accounts. We collected all posts from October 10, 2019, when RJ Reynolds Vapor Company submitted its premarket tobacco product application to the FDA, to February 21, 2022, to cover the first winter holiday season after the MGO. Two coders developed the codebook with 17 themes based on the Content Appealing to Youth index to capture the posts' characteristics and potentially youth-appealing content. We calculated the percentage of posts in which each code was present. Results: A total of 439 unique posts were identified. During this study's period, there were no posts on Instagram or Facebook marketing Vuse Solo (the authorized product at that time). Instead, Vuse Alto (unauthorized to date of study) was heavily marketed, with 59.5\% (n=261) of the posts specifically mentioning the product name. Further, ``Vuse'' more generally was marketed on social media without differentiating between the authorized and unauthorized products (n=182, 41.5\%). The marketing messages contained several potentially youth-appealing themes including creativity or innovation (n=189, 43.1\%), individuality or freedom (n=106, 24.2\%), and themes related to art (n=150, 34.2\%), music (n=77, 17.5\%), sports (n=125, 28.5\%), nature (with n=49, 11.2\% of the posts containing flora imageries), alcohol imagery (n=10, 2.3\%), and technology (n=6, 1.4\%). Conclusions: Although Vuse Alto e-cigarettes had not yet obtained FDA marketing authorization during the 28 months of data collection, they were the primary Vuse e-cigarette devices marketed on social media. Vuse social media posts use themes that are appealing to and likely promote youth use, including creativity and innovation, individuality or freedom, arts and music, nature, technology, and alcohol imagery. The FDA should (1) prohibit companies from comarketing unauthorized products alongside authorized products, and (2) exercise enforcement against even authorized products that are marketed using youth-appealing features. ",
doi="10.2196/54661",
url="https://formative.jmir.org/2024/1/e54661"
}


@Article{info:doi/10.2196/64439,
author="Pathak, Yuvraj
and Muhlestein, David",
title="Public Awareness and Use of Price Transparency: Report From a National Survey",
journal="Interact J Med Res",
year="2024",
month="Dec",
day="12",
volume="13",
pages="e64439",
keywords="price transparency",
keywords="consumer choice",
keywords="survey",
keywords="questionnaire",
keywords="finance",
keywords="cost",
keywords="economics",
keywords="price",
keywords="pricing",
keywords="consumer",
keywords="transparent",
keywords="Medicare",
keywords="Medicaid",
keywords="insurance",
doi="10.2196/64439",
url="https://www.i-jmr.org/2024/1/e64439"
}


@Article{info:doi/10.2196/56699,
author="Li, Qingqing
and Cheng, Feng
and Zeng, Huatang
and Xu, Junfang",
title="Health Insurance Payment for Telehealth Services: Scoping Review and Narrative Synthesis",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="9",
volume="26",
pages="e56699",
keywords="telehealth",
keywords="internet-based health care",
keywords="reimbursement",
keywords="health insurance payment",
keywords="health care",
keywords="scoping review",
keywords="narrative synthesis",
keywords="mobile phone",
abstract="Background: As telehealth services have demonstrated significant advantages in providing qualified and accessible care, health insurance payments for telehealth services have been issued by various countries. However, the optimization of health insurance payments for telehealth services remains uncertain. Objective: We conducted a scoping review of the current situation regarding health insurance payments for telehealth services, with the aim of providing evidence to enhance policies related to health insurance payments for such services. Methods: This scoping review was conducted by comprehensively retrieving data from 6 electronic bibliographic databases from inception to October 2023. The databases included China National Knowledge Infrastructure, Wan Fang, Weipu, Web of Science, PubMed, and Embase, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Two authors independently assessed search results, extracted data, and evaluated the quality of the included studies using the Critical Appraisal Skills Programme checklist. After the initial screening of titles and abstracts, full texts were obtained and examined. The data regarding the first author, date of publication, country, type of telehealth services introduced in health insurance, health insurance reimbursement providers, reimbursement standards for telehealth (eg, the condition for the reimbursement and reimbursement rate), and key findings of studies were extracted and analyzed. Moreover, we also conducted a narrative synthesis to summarize and report the findings. Results: A total of 7232 papers were retrieved. Following quality assessment, 23 papers were finally included, with the covered countries including China, the United States, Australia, France, Japan, the United Kingdom, and Germany. The forms of the services vary across different regions, mainly including consultation services, medical monitoring services, mental health services, health education services, and other services. Payment standards are generally categorized into fee-for-service and global budget payment, with clear health insurance payment quotas or proportions and certain restrictions (eg, specifying the location of medical visits and setting the limitation on distance from home to hospitals). The paying entities for health insurance payment include national health insurance and commercial health insurance. In addition, there are 2 kinds of reimbursement rates---a comparable rate for both telehealth and in-person health care services, and a lower rate for telehealth services compared to in-person health care services. Conclusions: To enhance the accessibility of telehealth services through health insurance payment, it is crucial to further refine the design of health insurance payment for telehealth and strengthen the supervision of services quality, bridging the gap between telehealth and in-person health care services. Additionally, this review did not include studies from all countries, and we recommend that future reviews should include a broader range of countries to provide a more comprehensive view of global telehealth insurance systems. ",
doi="10.2196/56699",
url="https://www.jmir.org/2024/1/e56699"
}


@Article{info:doi/10.2196/59717,
author="Linstad, Helen Line
and Bj{\o}rn{\aa}, Hilde
and Moen, Anne
and Tunby Kristiansen, Truls
and Hansen, Helen Anne",
title="Investigating the Norwegian eHealth Governance Model: Document Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="4",
volume="26",
pages="e59717",
keywords="eHealth policy",
keywords="fragmented decision authority",
keywords="top-down governance",
keywords="bottom-up network",
keywords="participation",
keywords="electronic health record",
abstract="Background: Governments and policy makers struggle to achieve a balance between hierarchical steering and horizontal governance in systems characterized by fragmented decision authority and multiple interests. To realize its One Citizen--One Journal eHealth policy vision, the Norwegian government established a special eHealth board of stakeholders to create an inclusive governance model that aligned stakeholders' interests with the?government's ambitions through coordination and consensus. Little empirical knowledge exists on how countries realize inclusive governance models. Objective: This study aims to investigate how the Norwegian inclusive eHealth governance model was developed as a tool to align the government's policy ambitions with stakeholders' concerns from January 2012 to December 2022. Methods: This document study used a thematic analysis based on a constructivist research approach. We included 16 policy documents and 175 consultation response documents issued between January 2012 and December 2022 related to the Norwegian One Citizen--One Journal policy implementation process. The themes were constructed deductively from a review of governance models and public governance theory and were applied as our analytical lens to each document. The findings were interpreted, analyzed, and synthesized. Results: The national policy implementation process progressed through 3 phases, with changes in stakeholder inclusion and perceived influence on the decision-making process characterizing transitions from phase to phase. Tension developed between 2 contrasting views regarding top-down government authority and stakeholders' autonomy. The view of the regional health trusts, municipalities, health care professional organizations, and industry actors contrasted with that of the patient organizations. Governmental insensitivity to participation, lack of transparency, and decreasing trust by stakeholder groups challenged the legitimacy of the inclusive governance model. Conclusions: We illustrated that Norway's One Citizen--One Journal policy trajectory was characterized by a process that unfolded across 3 distinct phases. The process was characterized by 2 contrasting stakeholder perspectives. Finally, it was shaped by diminishing trust in the inclusive governance model. The National eHealth Governance Board faced challenges in establishing legitimacy as a top-down inclusive governance model, primarily attributed to its addressing of participation, transparency, and trust dilemmas. Such dilemmas represent significant obstacles to inclusive governance models and require ongoing governmental vigilance and responsiveness from governmental entities. ",
doi="10.2196/59717",
url="https://www.jmir.org/2024/1/e59717"
}


@Article{info:doi/10.2196/56790,
author="Vlake, H. Johan
and Drop, Q. Denzel L.
and Van Bommel, Jasper
and Riva, Giuseppe
and Wiederhold, K. Brenda
and Cipresso, Pietro
and Rizzo, S. Albert
and Rothbaum, O. Barbara
and Botella, Cristina
and Hooft, Lotty
and Bienvenu, J. Oscar
and Jung, Christian
and Geerts, Bart
and Wils, Evert-Jan
and Gommers, Diederik
and van Genderen, E. Michel
and ",
title="Reporting Guidelines for the Early-Phase Clinical Evaluation of Applications Using Extended Reality: RATE-XR Qualitative Study Guideline",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="29",
volume="26",
pages="e56790",
keywords="extended reality",
keywords="XR",
keywords="virtual reality",
keywords="augmented reality",
keywords="mixed reality",
keywords="reporting guideline",
keywords="Delphi process",
keywords="consensus",
keywords="computer-generated simulation",
keywords="simulation",
keywords="virtual world",
keywords="simulation experience",
keywords="clinical evaluation",
abstract="Background: Extended reality (XR), encompassing technologies such as virtual reality, augmented reality, and mixed reality, has rapidly gained prominence in health care. However, existing XR research often lacks rigor, proper controls, and standardization. Objective: To address this and to enhance the transparency and quality of reporting in early-phase clinical evaluations of XR applications, we present the ``Reporting for the early-phase clinical evaluation of applications using extended reality'' (RATE-XR) guideline. Methods: We conducted a 2-round modified Delphi process involving experts from diverse stakeholder categories, and the RATE-XR is therefore the result of a consensus-based, multistakeholder effort. Results: The guideline comprises 17 XR-specific (composed of 18 subitems) and 14 generic reporting items, each with a complementary Explanation \& Elaboration section. Conclusions: The items encompass critical aspects of XR research, from clinical utility and safety to human factors and ethics. By offering a comprehensive checklist for reporting, the RATE-XR guideline facilitates robust assessment and replication of early-stage clinical XR studies. It underscores the need for transparency, patient-centeredness, and balanced evaluation of the applications of XR in health care. By providing an actionable checklist of minimal reporting items, this guideline will facilitate the responsible development and integration of XR technologies into health care and related fields. ",
doi="10.2196/56790",
url="https://www.jmir.org/2024/1/e56790"
}


@Article{info:doi/10.2196/65740,
author="Barbosa da Silva J{\'u}nior, Jarbas
and Garcia-Saiso, Sebastian
and Marti, Myrna
and Salas, Daniel
and Contreras, Marcela
and Velandia-Gonzalez, Martha
and Luna, Daniel
and Nelson, Jennifer
and Fitzgerald, James
and Bascolo, Ernesto
and Talavera Romero, Lorena Ivy
and Chomali, May
and Curioso, H. Walter
and Plazzotta, Fernando
and Otero, Carlos
and Lopez Osornio, Alejandro
and Lennemann, Tessa
and Salinas, Karen
and D'Agostino, Marcelo",
title="Vaccine Certificates Must Go Digital: An Urgent Call for Better Public Health Outcomes",
journal="JMIR Public Health Surveill",
year="2024",
month="Nov",
day="26",
volume="10",
pages="e65740",
keywords="medical informatics",
keywords="health systems",
keywords="immunizations",
keywords="public health",
keywords="viewpoint",
keywords="health challenges",
keywords="digital vaccine certificates",
keywords="outbreak management",
keywords="outbreak",
keywords="accuracy",
keywords="healthcare",
keywords="surveillance",
keywords="health outcomes",
keywords="global health",
keywords="mobile phone",
doi="10.2196/65740",
url="https://publichealth.jmir.org/2024/1/e65740"
}


@Article{info:doi/10.2196/57612,
author="Yi, Siyan
and Yam, Yan Esabelle Lo
and Cheruvettolil, Kochukoshy
and Linos, Eleni
and Gupta, Anshika
and Palaniappan, Latha
and Rajeshuni, Nitya
and Vaska, Gopal Kiran
and Schulman, Kevin
and Eggleston, N. Karen",
title="Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="25",
volume="26",
pages="e57612",
keywords="digital health innovations",
keywords="public health",
keywords="South and Southeast Asia",
keywords="health care challenges",
keywords="low- and middle-income countries",
keywords="LMICs",
keywords="global health",
keywords="health AI",
keywords="artificial intelligence",
keywords="public health responses",
keywords="global health contexts",
keywords="digital health",
doi="10.2196/57612",
url="https://www.jmir.org/2024/1/e57612"
}


@Article{info:doi/10.2196/50235,
author="Jefferson, Emily
and Milligan, Gordon
and Johnston, Jenny
and Mumtaz, Shahzad
and Cole, Christian
and Best, Joseph
and Giles, Charles Thomas
and Cox, Samuel
and Masood, Erum
and Horban, Scott
and Urwin, Esmond
and Beggs, Jillian
and Chuter, Antony
and Reilly, Gerry
and Morris, Andrew
and Seymour, David
and Hopkins, Susan
and Sheikh, Aziz
and Quinlan, Philip",
title="The Challenges and Lessons Learned Building a New UK Infrastructure for Finding and Accessing Population-Wide COVID-19 Data for Research and Public Health Analysis: The CO-CONNECT Project",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e50235",
keywords="COVID-19",
keywords="infrastructure",
keywords="trusted research environments",
keywords="safe havens",
keywords="feasibility analysis",
keywords="cohort discovery",
keywords="federated analytics",
keywords="federated discovery",
keywords="lessons learned",
keywords="population wide",
keywords="data",
keywords="public health",
keywords="analysis",
keywords="CO-CONNECT",
keywords="challenges",
keywords="data transformation",
doi="10.2196/50235",
url="https://www.jmir.org/2024/1/e50235"
}


@Article{info:doi/10.2196/51594,
author="Zhou, Xinyi
and Hao, Xinyu
and Chen, Yuhang
and Deng, Hui
and Fang, Ling
and Zhang, Lingyun
and Yan, Xiaotao
and Zheng, Pinpin
and Wang, Fan",
title="Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="7",
volume="26",
pages="e51594",
keywords="e-cigarette",
keywords="marketing strategy",
keywords="social media",
keywords="teenagers",
keywords="content analysis",
abstract="Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52\%) mentioned product characteristics. In 313 (36.3\%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3\%) posts, and purchase channels were not mentioned in 790 (98.3\%) posts. Social interaction--related posts received attention (n=548, 63.5\%), particularly those featuring hashtag content (n=538, 62.3\%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6\%) or information on health warnings (n=839, 97.2\%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. ",
doi="10.2196/51594",
url="https://www.jmir.org/2024/1/e51594"
}


@Article{info:doi/10.2196/59674,
author="Subramanian, Hemang
and Sengupta, Arijit
and Xu, Yilin",
title="Patient Health Record Protection Beyond the Health Insurance Portability and Accountability Act: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="6",
volume="26",
pages="e59674",
keywords="security",
keywords="privacy",
keywords="security breach",
keywords="breach report",
keywords="health care",
keywords="health care infrastructure",
keywords="regulatory",
keywords="law enforcement",
keywords="Omnibus Rule",
keywords="qualitative analysis",
keywords="AI-generated data",
keywords="artificial intelligence",
keywords="difference-in-differences",
keywords="best practice",
keywords="data privacy",
keywords="safe practice",
abstract="Background: The security and privacy of health care information are crucial for maintaining the societal value of health care as a public good. However, governance over electronic health care data has proven inefficient, despite robust enforcement efforts. Both federal (HIPAA [Health Insurance Portability and Accountability Act]) and state regulations, along with the ombudsman rule, have not effectively reduced the frequency or impact of data breaches in the US health care system. While legal frameworks have bolstered data security, recent years have seen a concerning increase in breach incidents. This paper investigates common breach types and proposes best practices derived from the data as potential solutions. Objective: The primary aim of this study is to analyze health care and hospital breach data, comparing it against HIPAA compliance levels across states (spatial analysis) and the impact of the Omnibus Rule over time (temporal analysis). The goal is to establish guidelines for best practices in handling sensitive information within hospitals and clinical environments. Methods: The study used data from the Department of Health and Human Services on reported breaches, assessing the severity and impact of each breach type. We then analyzed secondary data to examine whether HIPAA's storage and retention rule amendments have influenced security and privacy incidents across all 50 states. Finally, we conducted a qualitative analysis of textual data from vulnerability and breach reports to identify actionable best practices for health care settings. Results: Our findings indicate that hacking or IT incidents have the most significant impact on the number of individuals affected, highlighting this as a primary breach category. The overall difference-in-differences trend reveals no significant reduction in breach rates (P=.50), despite state-level regulations exceeding HIPAA requirements and the introduction of the ombudsman rule. This persistence in breach trends implies that even strengthened protections and additional guidelines have not effectively curbed the rising number of affected individuals. Through qualitative analysis, we identified 15 unique values and associated best practices from industry standards. Conclusions: Combining quantitative and qualitative insights, we propose the ``SecureSphere framework'' to enhance data security in health care institutions. This framework presents key security values structured in concentric circles: core values at the center and peripheral values around them. The core values include employee management, policy, procedures, and IT management. Peripheral values encompass the remaining security attributes that support these core elements. This structured approach provides a comprehensive security strategy for protecting patient health information and is designed to help health care organizations develop sustainable practices for data security. ",
doi="10.2196/59674",
url="https://www.jmir.org/2024/1/e59674"
}


@Article{info:doi/10.2196/59830,
author="Pugh, Jo Mary
and Haun, N. Jolie
and White, Jon P.
and Cochran, Gerald
and Mohanty, F. April
and McAndrew, M. Lisa
and Gordon, J. Adam
and Nelson, E. Richard
and Vanneman, E. Megan
and Naranjo, E. Diana
and Benzinger, C. Rachel
and Jones, L. Audrey
and Kean, Jacob
and Zickmund, L. Susan
and Fagerlin, Angela",
title="Developing Evidence to Support Policy: Protocol for the StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT)",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="19",
volume="13",
pages="e59830",
keywords="evidence-based policy-making",
keywords="policy evaluation",
keywords="knowledge translation",
keywords="veterans",
keywords="implementation science",
abstract="Background: All federal agencies are required to support appropriation requests with evidence and evaluation (US Public Law 115-435; the Evidence Act). The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is 1 of 6 centers that help the Department of Veterans Affairs (VA) meet this requirement. Objective: Working with the existing VA evaluation structure, SALIENT evaluations will contribute to (1) optimize policies and programs for veteran populations; (2) improve outcomes regarding health, equity, cost, and provider well-being; (3) advance the science of dissemination and knowledge translation; and (4) expand the implementation and dissemination science workforce. Methods: We leverage the Lean Sprint methodology (iterative, incremental, rule-governed approach to clearly defined, and time-boxed work) and 3 cores to develop our evaluation plans collaboratively with operational partners and key stakeholders including veterans, policy experts, and clinicians. The Operations Core will work with evaluation teams to develop timelines, facilitate work, monitor progress, and guide quality improvement within SALIENT. The Methods Core will work with evaluation teams to identify the most appropriate qualitative, quantitative, and mixed methods approaches to address each evaluation, ensure that the analyses are conducted appropriately, and troubleshoot when problems with data acquisition and analysis arise. The Knowledge Translation (KT) Core will target key partners and decision makers using a needs-based market segmentation approach to ensure that needs are incorporated in the dissemination of knowledge. The KT Core will create communications briefs, playbooks, and other materials targeted at these market segments to facilitate implementation of evidence-based practices and maximize the impact of evaluation results. Results: The SALIENT team has developed a center infrastructure to support high-priority evaluations, often to be responsive to shifting operational needs and priorities. Our team has engaged in our core missions and operations to rapidly evaluate a high-priority areas, develop a comprehensive Lean Sprint systems redesign approach to training, and accelerate rapid knowledge translation. Conclusions: With an array of interdisciplinary expertise, operational partnerships, and integrated resources, SALIENT has an established and evolving infrastructure to rapidly develop and implement high-impact evaluations. Projects are developed with sustained efficiency approaches that can pivot to new priorities as needed and effectively translate knowledge for key stakeholders and policy makers, while creating a learning health system infrastructure to foster the next generation of evaluation and implementation scientists. International Registered Report Identifier (IRRID): PRR1-10.2196/59830 ",
doi="10.2196/59830",
url="https://www.researchprotocols.org/2024/1/e59830"
}


@Article{info:doi/10.2196/59836,
author="Iqbal, Meesha
and Cazaban, Ganduglia Cecilia
and Morgan, Robert
and Bauer, Cici
and Siddiqi, Sameen",
title="Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study",
journal="JMIR Res Protoc",
year="2024",
month="Sep",
day="18",
volume="13",
pages="e59836",
keywords="health system",
keywords="healthcare system",
keywords="health care",
keywords="responsiveness",
keywords="Pakistan",
keywords="Low-and middle-income countries",
abstract="Background: Health systems responsiveness (HSR) is the ability of systems to respond to legitimate non-health expectations of the population. The concept of HSR by the World Health Organization (WHO) includes respect for dignity, individual autonomy, confidentiality, prompt attention to care, availability of basic amenities, choice of provider, access to social support networks, and clarity of communication. The WHO tool is applied globally to assess HSR in low, middle, and high-income countries. Objective: We have revised the conceptual framework of HSR following a rigorous systematic review and made it specific for low- and middle-income countries (L\&MICs). This study is designed to (1) run the Delphi technique to validate the upgraded conceptual framework of HSR, (2) modify and upgrade the WHO measurement tool for assessing HSR in the context of L\&MICs, and (3) determine the validity of the upgraded HSR measurement tool by pilot testing it in Pakistan. Methods: The Delphi technique will be run by inviting global public health experts to provide suggestions on the domains and subdomains of HSR specific to L\&MICs. Cronbach ? will be calculated to determine internal consistency among the participants. The upgraded HSR conceptual framework will serve as a beacon to modify the measurement tool by the research team, which will be reviewed by subject experts for refinement. The modified tool will be pilot-tested by administering it to 1128 participants from primary, secondary, and tertiary care hospitals in Rawalpindi district, Pakistan. Additionally, an ``observation checklist'' of HSR domains and subdomains will be completed to objectively measure the state of HSR across health care facilities. HSR assessment will be further strengthened by incorporating the perspective of hospital managers, service providers, and policy makers (ie, the supply side) as well as community leaders and representatives (ie, the demand side) through qualitative interviews. Results: The study was started in January 2024 and will continue until February 2025. A multidimensional approach will yield significant quantifiable information on HSR from the demand and supply sides of L\&MICs. Conclusions: This study will provide a conceptual understanding of HSR and a corresponding measurement tool specific to L\&MICs. It will contribute to global public health literature and provide a snapshot of HSR in Rawalpindi district, Pakistan, with concrete action points for policy makers. International Registered Report Identifier (IRRID): DERR1-10.2196/59836 ",
doi="10.2196/59836",
url="https://www.researchprotocols.org/2024/1/e59836"
}


@Article{info:doi/10.2196/58080,
author="Svempe, Liga",
title="Exploring Impediments Imposed by the Medical Device Regulation EU 2017/745 on Software as a Medical Device",
journal="JMIR Med Inform",
year="2024",
month="Sep",
day="5",
volume="12",
pages="e58080",
keywords="software",
keywords="artificial intelligence",
keywords="medical device regulation",
keywords="rights",
keywords="digital health",
doi="10.2196/58080",
url="https://medinform.jmir.org/2024/1/e58080",
url="http://www.ncbi.nlm.nih.gov/pubmed/39235850"
}


@Article{info:doi/10.2196/47389,
author="Onstwedder, Maria Suzanne
and Jansen, Elizabeth Marleen
and Cornel, Cornelia Martina
and Rigter, Tessel",
title="Policy Guidance for Direct-to-Consumer Genetic Testing Services: Framework Development Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="17",
volume="26",
pages="e47389",
keywords="genetic testing",
keywords="direct-to-consumer testing",
keywords="health policy",
keywords="genetic privacy",
keywords="online market",
keywords="informed consent",
keywords="public health genomics",
keywords="policy decision",
keywords="mHealth",
keywords="mobile health",
keywords="privacy",
abstract="Background: The online offer of commercial genetic tests, also called direct-to-consumer genetic tests (DTC-GTs), enables citizens to gain insight into their health and disease risk based on their genetic profiles. DTC-GT offers often consist of a combination of services or aspects, including advertisements, information, DNA analysis, and medical or lifestyle advice. The risks and benefits of DTC-GT services have been debated and studied extensively, but instruments that assess DTC-GT services and aid policy are lacking. This leads to uncertainty among policy makers, law enforcers, and regulators on how to ensure and balance both public safety and autonomy and about the responsibilities these 3 parties have toward the public. Objective: This study aimed to develop a framework that outlines aspects of DTC-GTs that lead to policy issues and to help provide policy guidance regarding DTC-GT services. Methods: We performed 3 steps: (1) an integrative literature review to identify risks and benefits of DTC-GT services for consumers and society in Embase and Medline (January 2014-June 2022), (2) structuring benefits and risks in different steps of the consumer journey, and (3) development of a checklist for policy guidance. Results: Potential risks and benefits of DTC-GT services were mapped from 134 papers and structured into 6 phases. In summary, these phases were called the consumer journey: (1) exposure, (2) pretest information, (3) DNA analysis, (4) data management, (5) posttest information, and (6) individual and societal impact. The checklist for evaluation of DTC-GT services consisted of 8 themes, covering 38 items that may raise policy issues in DTC-GT services. The themes included the following aspects: general service content, validity and quality assurance, potential data and privacy risks, scientific evidence and robustness, and quality of the provided information. Conclusions: Both the consumer journey and the checklist break the DTC-GT offer down into key aspects that may impact and compromise individual and public health, safety, and autonomy. This framework helps policy makers, regulators, and law enforcers develop methods to interpret, assess, and act in the DTC-GT service market. ",
doi="10.2196/47389",
url="https://www.jmir.org/2024/1/e47389"
}


@Article{info:doi/10.2196/50483,
author="Tarride, Jean-Eric
and Hall, N. Justin
and Mondoux, Shawn
and Dainty, N. Katie
and McCarron, Joy
and Paterson, Michael J.
and Plumptre, Lesley
and Borgundvaag, Emily
and Ovens, Howard
and McLeod, L. Shelley",
title="Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="15",
volume="26",
pages="e50483",
keywords="virtual urgent care",
keywords="health care expenditures",
keywords="Canada",
keywords="virtual care",
keywords="economic evaluation",
keywords="pilot program",
keywords="pilot",
keywords="Ontario",
keywords="urgent care",
keywords="care",
keywords="emergency department",
keywords="users",
keywords="patient",
keywords="patients",
keywords="resources",
keywords="resource allocation",
keywords="policy decision",
keywords="decision-making",
keywords="policy",
abstract="Background: In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for in-person emergency department (ED) visits for patients with low acuity health concerns. Objective: This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Methods: Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD \$1=US \$0.76 is applicable). Results: We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99\% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98\% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral (\$2805 vs \$2299; difference of \$506, 95\% CI \$139-\$885) and significantly lower for the VUC cohort of patients who did not require ED referral (\$907 vs \$1270; difference of \$362, 95\% CI 284-\$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were \$18.9 million (ie, \$6.0 million + \$12.9 million) versus \$22.9 million (\$4.9 million + \$18.0 million) for the 2 in-person ED cohorts. Conclusions: This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions. ",
doi="10.2196/50483",
url="https://www.jmir.org/2024/1/e50483",
url="http://www.ncbi.nlm.nih.gov/pubmed/39008348"
}


@Article{info:doi/10.2196/51327,
author="Liu, Pinxin
and Lou, Xubin
and Xie, Zidian
and Shang, Ce
and Li, Dongmei",
title="Public Perceptions and Discussions of the US Food and Drug Administration's JUUL Ban Policy on Twitter: Observational Study",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="11",
volume="8",
pages="e51327",
keywords="e-cigarettes",
keywords="JUUL",
keywords="Twitter",
keywords="deep learning",
keywords="FDA",
keywords="Food and Drug Administration",
keywords="vape",
keywords="vaping",
keywords="smoking",
keywords="social media",
keywords="regulation",
abstract="Background: On June 23, 2022, the US Food and Drug Administration announced a JUUL ban policy, to ban all vaping and electronic cigarette products sold by Juul Labs. Objective: This study aims to understand public perceptions and discussions of this policy using Twitter (subsequently rebranded as X) data. Methods: Using the Twitter streaming application programming interface, 17,007 tweets potentially related to the JUUL ban policy were collected between June 22, 2022, and July 25, 2022. Based on 2600 hand-coded tweets, a deep learning model (RoBERTa) was trained to classify all tweets into propolicy, antipolicy, neutral, and irrelevant categories. A deep learning model (M3 model) was used to estimate basic demographics (such as age and gender) of Twitter users. Furthermore, major topics were identified using latent Dirichlet allocation modeling. A logistic regression model was used to examine the association of different Twitter users with their attitudes toward the policy. Results: Among 10,480 tweets related to the JUUL ban policy, there were similar proportions of propolicy and antipolicy tweets (n=2777, 26.5\% vs n=2666, 25.44\%). Major propolicy topics included ``JUUL causes youth addition,'' ``market surge of JUUL,'' and ``health effects of JUUL.'' In contrast, major antipolicy topics included ``cigarette should be banned instead of JUUL,'' ``against the irrational policy,'' and ``emotional catharsis.'' Twitter users older than 29 years were more likely to be propolicy (have a positive attitude toward the JUUL ban policy) than those younger than 29 years. Conclusions: Our study showed that the public showed different responses to the JUUL ban policy, which varies depending on the demographic characteristics of Twitter users. Our findings could provide valuable information to the Food and Drug Administration for future electronic cigarette and other tobacco product regulations. ",
doi="10.2196/51327",
url="https://formative.jmir.org/2024/1/e51327",
url="http://www.ncbi.nlm.nih.gov/pubmed/38990633"
}


@Article{info:doi/10.2196/55061,
author="Jiang, Jiayi
and Zheng, Zexing",
title="Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="21",
volume="12",
pages="e55061",
keywords="hospital apps",
keywords="privacy policy",
keywords="personal information protection",
keywords="policy evaluation",
keywords="content analysis",
abstract="Background: Hospital apps are increasingly being adopted in many countries, especially since the start of the COVID-19 pandemic. Web-based hospitals can provide valuable medical services and enhanced accessibility. However, increasing concerns about personal information (PI) and strict legal compliance requirements necessitate privacy assessments for these platforms. Guided by the theory of contextual integrity, this study investigates the regulatory compliance of privacy policies for internet hospital apps in the mainland of China. Objective: In this paper, we aim to evaluate the regulatory compliance of privacy policies of internet hospital apps in the mainland of China and offer recommendations for improvement. Methods: We obtained 59 internet hospital apps on November 7, 2023, and reviewed 52 privacy policies available between November 8 and 23, 2023. We developed a 3-level indicator scale based on the information processing activities, as stipulated in relevant regulations. The scale comprised 7 level-1 indicators, 26 level-2 indicators, and 70 level-3 indicators. Results: The mean compliance score of the 52 assessed apps was 73/100 (SD 22.4\%), revealing a varied spectrum of compliance. Sensitive PI protection compliance (mean 73.9\%, SD 24.2\%) lagged behind general PI protection (mean 90.4\%, SD 14.7\%), with only 12 apps requiring separate consent for processing sensitive PI (mean 73.9\%, SD 24.2\%). Although most apps (n=41, 79\%) committed to supervising subcontractors, only a quarter (n=13, 25\%) required users' explicit consent for subcontracting activities. Concerning PI storage security (mean 71.2\%, SD 29.3\%) and incident management (mean 71.8\%, SD 36.6\%), half of the assessed apps (n=27, 52\%) committed to bear corresponding legal responsibility, whereas fewer than half (n=24, 46\%) specified the security level obtained. Most privacy policies stated the PI retention period (n=40, 77\%) and instances of PI deletion or anonymization (n=41, 79\%), but fewer (n=20, 38.5\%) committed to prompt third-party PI deletion. Most apps delineated various individual rights, but only a fraction addressed the rights to obtain copies (n=22, 42\%) or to refuse advertisement based on automated decision-making (n=13, 25\%). Significant deficiencies remained in regular compliance audits (mean 11.5\%, SD 37.8\%), impact assessments (mean 13.5\%, SD 15.2\%), and PI officer disclosure (mean 48.1\%, SD 49.3\%). Conclusions: Our analysis revealed both strengths and significant shortcomings in the compliance of internet hospital apps' privacy policies with relevant regulations. As China continues to implement internet hospital apps, it should ensure the informed consent of users for PI processing activities, enhance compliance levels of relevant privacy policies, and fortify PI protection enforcement across the information processing stages. ",
doi="10.2196/55061",
url="https://mhealth.jmir.org/2024/1/e55061",
url="http://www.ncbi.nlm.nih.gov/pubmed/38904994"
}


@Article{info:doi/10.2196/55194,
author="Huang, Xuefeng
and Kong, Qian-Yi
and Wan, Xiaowen
and Huang, Yating
and Wang, Rongrong
and Wang, Xiaoxue
and Li, Yingying
and Wu, Yuqing
and Guan, Chongyuan
and Wang, Junyang
and Zhang, Yuanyuan",
title="From the Public Health Perspective: a Scalable Model for Improving Epidemiological Testing Efficacy in Low- and Middle-Income Areas",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="10",
volume="10",
pages="e55194",
keywords="low- and middle-income country",
keywords="LMIC",
keywords="pandemic",
keywords="epidemiological surveillance",
keywords="universal public health",
keywords="nonpharmacological interventions",
keywords="public health",
keywords="callable model",
keywords="efficacy",
keywords="COVID-19",
keywords="public safety threats",
keywords="effectiveness",
keywords="China",
keywords="detection",
keywords="epidemic",
doi="10.2196/55194",
url="https://publichealth.jmir.org/2024/1/e55194",
url="http://www.ncbi.nlm.nih.gov/pubmed/38857063"
}


@Article{info:doi/10.2196/52349,
author="Boege, Selina
and Milne-Ives, Madison
and Meinert, Edward",
title="Impact of Responsible AI on the Occurrence and Resolution of Ethical Issues: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="5",
volume="13",
pages="e52349",
keywords="artificial intelligence",
keywords="AI",
keywords="responsible artificial intelligence",
keywords="RAI",
keywords="ethical artificial intelligence",
keywords="trustworthy artificial intelligence",
keywords="explainable artificial intelligence",
keywords="XAI",
keywords="digital ethics",
abstract="Background: Responsible artificial intelligence (RAI) emphasizes the use of ethical frameworks implementing accountability, responsibility, and transparency to address concerns in the deployment and use of artificial intelligence (AI) technologies, including privacy, autonomy, self-determination, bias, and transparency. Standards are under development to guide the support and implementation of AI given these considerations. Objective: The purpose of this review is to provide an overview of current research evidence and knowledge gaps regarding the implementation of RAI principles and the occurrence and resolution of ethical issues within AI systems. Methods: A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines was proposed. PubMed, ERIC, Scopus, IEEE Xplore, EBSCO, Web of Science, ACM Digital Library, and ProQuest (Arts and Humanities) will be systematically searched for articles published since 2013 that examine RAI principles and ethical concerns within AI. Eligibility assessment will be conducted independently and coded data will be analyzed along themes and stratified across discipline-specific literature. Results: The results will be included in the full scoping review, which is expected to start in June 2024 and completed for the submission of publication by the end of 2024. Conclusions: This scoping review will summarize the state of evidence and provide an overview of its impact, as well as strengths, weaknesses, and gaps in research implementing RAI principles. The review may also reveal discipline-specific concerns, priorities, and proposed solutions to the concerns. It will thereby identify priority areas that should be the focus of future regulatory options available, connecting theoretical aspects of ethical requirements for principles with practical solutions. International Registered Report Identifier (IRRID): PRR1-10.2196/52349 ",
doi="10.2196/52349",
url="https://www.researchprotocols.org/2024/1/e52349",
url="http://www.ncbi.nlm.nih.gov/pubmed/38838329"
}


@Article{info:doi/10.2196/50344,
author="Zawati, H. Ma'n
and Lang, Michael",
title="Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="5",
volume="26",
pages="e50344",
keywords="artificial intelligence",
keywords="applications",
keywords="mobile health",
keywords="mHealth",
keywords="bias",
keywords="biases",
keywords="professional obligations",
keywords="professional obligation",
keywords="app",
keywords="apps",
keywords="application",
keywords="symptom checker",
keywords="symptom checkers",
keywords="diagnose",
keywords="diagnosis",
keywords="self-diagnose",
keywords="self-diagnosis",
keywords="ethic",
keywords="ethics",
keywords="ethical",
keywords="regulation",
keywords="regulations",
keywords="legal",
keywords="law",
keywords="laws",
keywords="safety",
keywords="mobile phone",
doi="10.2196/50344",
url="https://www.jmir.org/2024/1/e50344",
url="http://www.ncbi.nlm.nih.gov/pubmed/38838309"
}


@Article{info:doi/10.2196/49276,
author="He, Yanyun
and Yang, Qian
and Alish, Yousef
and Ma, Shaoying
and Qiu, Zefeng
and Chen, Jian
and Wagener, Theodore
and Shang, Ce",
title="Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model",
journal="JMIR Form Res",
year="2024",
month="May",
day="9",
volume="8",
pages="e49276",
keywords="e-cigarette devices",
keywords="price",
keywords="web-based vape shop",
keywords="battery capacity",
keywords="output wattage",
keywords="e-cigarette",
keywords="vape",
keywords="vaping",
keywords="consumers",
keywords="costs",
keywords="prices",
keywords="pricing",
keywords="feature",
keywords="features",
keywords="device",
keywords="devices",
keywords="consumer",
keywords="cost",
keywords="smoking products",
keywords="product safety",
keywords="consumer safety",
keywords="smoking",
keywords="smoker",
keywords="smokers",
keywords="tax",
keywords="taxes",
keywords="taxation",
keywords="economic",
keywords="economics",
keywords="regression",
keywords="regression model",
keywords="health economics",
abstract="Background: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. Objective: This study will examine how product features are associated with the prices of devices sold in web-based vape shops. Methods: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container--only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. Results: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device--only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. Conclusions: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products. ",
doi="10.2196/49276",
url="https://formative.jmir.org/2024/1/e49276",
url="http://www.ncbi.nlm.nih.gov/pubmed/38723251"
}


@Article{info:doi/10.2196/50629,
author="Maleki, Negar
and Padmanabhan, Balaji
and Dutta, Kaushik",
title="Usability of Health Care Price Transparency Data in the United States: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="29",
volume="26",
pages="e50629",
keywords="price transparency",
keywords="user experiments",
keywords="schema analysis",
keywords="health care",
keywords="patients",
keywords="algorithms",
abstract="Background: Increasing health care expenditure in the United States has put policy makers under enormous pressure to find ways to curtail costs. Starting January 1, 2021, hospitals operating in the United States were mandated to publish transparent, accessible pricing information online about the items and services in a consumer-friendly format within comprehensive machine-readable files on their websites. Objective: The aims of this study are to analyze the available files on hospitals' websites, answering the question---is price transparency (PT) information as provided usable for patients or for machines?---and to provide a solution. Methods: We analyzed 39 main hospitals in Florida that have published machine-readable files on their website, including commercial carriers. We created an Excel (Microsoft) file that included those 39 hospitals along with the 4 most popular services---Current Procedural Terminology (CPT) 45380, 29827, and 70553 and Diagnosis-Related Group (DRG) 807---for the 4 most popular commercial carriers (Health Maintenance Organization [HMO] or Preferred Provider Organization [PPO] plans)---Aetna, Florida Blue, Cigna, and UnitedHealthcare. We conducted an A/B test using 67 MTurkers (randomly selected from US residents), investigating the level of awareness about PT legislation and the usability of available files. We also suggested format standardization, such as master field names using schema integration, to make machine-readable files consistent and usable for machines. Results: The poor usability and inconsistent formats of the current PT information yielded no evidence of its usefulness for patients or its quality for machines. This indicates that the information does not meet the requirements for being consumer-friendly or machine readable as mandated by legislation. Based on the responses to the first part of the experiment (PT awareness), it was evident that participants need to be made aware of the PT legislation. However, they believe it is important to know the service price before receiving it. Based on the responses to the second part of the experiment (human usability of PT information), the average number of correct responses was not equal between the 2 groups, that is, the treatment group (mean 1.23, SD 1.30) found more correct answers than the control group (mean 2.76, SD 0.58; t65=6.46; P<.001; d=1.52). Conclusions: Consistent machine-readable files across all health systems facilitate the development of tools for estimating customer out-of-pocket costs, aligning with the PT rule's main objective---providing patients with valuable information and reducing health care expenditures. ",
doi="10.2196/50629",
url="https://www.jmir.org/2024/1/e50629",
url="http://www.ncbi.nlm.nih.gov/pubmed/38442238"
}


@Article{info:doi/10.2196/52587,
author="Rigby, C. Ryan
and Ferdinand, O. Alva
and Kum, Hye-Chung
and Schmit, Cason",
title="Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance",
journal="JMIR Public Health Surveill",
year="2024",
month="Mar",
day="28",
volume="10",
pages="e52587",
keywords="syndromic surveillance",
keywords="federalism",
keywords="COVID-19",
keywords="public health",
keywords="SARS-CoV-2",
keywords="COVID-19 pandemic",
keywords="United States",
keywords="decentralized",
keywords="data sharing",
keywords="digital health",
keywords="ethical guidelines",
keywords="risk score",
keywords="technology",
keywords="innovation",
keywords="information system",
keywords="collaborative framework",
keywords="infodemiology",
keywords="digital technology",
keywords="health information",
keywords="health data",
keywords="health policy",
keywords="surveillance",
doi="10.2196/52587",
url="https://publichealth.jmir.org/2024/1/e52587",
url="http://www.ncbi.nlm.nih.gov/pubmed/38546731"
}


@Article{info:doi/10.2196/53921,
author="Chai, Yulin
and Yuan, Xiaoping
and Guo, Lin
and Chen, Zhongming",
title="The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="21",
volume="26",
pages="e53921",
keywords="broadband",
keywords="infrastructure",
keywords="medical resources",
keywords="resource mismatch",
keywords="Broadband China Policy",
abstract="Background: Whether the construction of broadband infrastructure can alleviate the problem of mismatched medical resources is crucial to the national information strategy, residents' well-being, and social equity. However, the academic community lacks a comprehensive theoretical analysis and rigorous empirical research on this issue. Objective: This study aims to construct a preliminary theoretical framework to scientifically assess the effects of broadband infrastructure development on the mitigation of health care resource mismatch from both theoretical and empirical perspectives, to explore the potential mechanisms of influence, and ultimately to develop several practical policy recommendations. Methods: We first used a theoretical analysis to propose testable theoretical hypotheses and establish a preliminary theoretical framework. Then, based on balanced panel data from 300 cities from 2010 to 2021, a 2-way fixed effects difference-in-differences model was used for empirical testing. Mechanism tests, robustness analyses, and heterogeneity analyses were further conducted. Results: The research findings demonstrate that the Broadband China Policy significantly reduces the degree of mismatch in medical resources by primarily using innovation effects and integration effects, resulting in a reduction of 13.2\%. In addition, the heterogeneity analysis reveals that the central and eastern regions, cities with large populations, and areas with a high proportion of young people benefit more significantly. Conclusions: This study fully confirms, both theoretically and empirically, that broadband infrastructure construction can effectively reduce the mismatch of medical resources not only by expanding the existing literature on the impact of broadband on public services but also by providing valuable opportunities for policy makers to optimize the allocation of medical resources. ",
doi="10.2196/53921",
url="https://www.jmir.org/2024/1/e53921",
url="http://www.ncbi.nlm.nih.gov/pubmed/38512327"
}


@Article{info:doi/10.2196/49822,
author="Baek, Jinyoung
and Lawson, Jonathan
and Rahimzadeh, Vasiliki",
title="Investigating the Roles and Responsibilities of Institutional Signing Officials After Data Sharing Policy Reform for Federally Funded Research in the United States: National Survey",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="20",
volume="8",
pages="e49822",
keywords="biomedical research",
keywords="survey",
keywords="surveys",
keywords="data sharing",
keywords="data management",
keywords="secondary use",
keywords="National Institutes of Health",
keywords="signing official",
keywords="information sharing",
keywords="exchange",
keywords="access",
keywords="data science",
keywords="accessibility",
keywords="policy",
keywords="policies",
abstract="Background: New federal policies along with rapid growth in data generation, storage, and analysis tools are together driving scientific data sharing in the United States. At the same, triangulating human research data from diverse sources can also create situations where data are used for future research in ways that individuals and communities may consider objectionable. Institutional gatekeepers, namely, signing officials (SOs), are therefore at the helm of compliant management and sharing of human data for research. Of those with data governance responsibilities, SOs most often serve as signatories for investigators who deposit, access, and share research data between institutions. Although SOs play important leadership roles in compliant data sharing, we know surprisingly little about their scope of work, roles, and oversight responsibilities. Objective: The purpose of this study was to describe existing institutional policies and practices of US SOs who manage human genomic data access, as well as how these may change in the wake of new Data Management and Sharing requirements for National Institutes of Health--funded research in the United States. Methods: We administered an anonymous survey to institutional SOs recruited from biomedical research institutions across the United States. Survey items probed where data generated from extramurally funded research are deposited, how researchers outside the institution access these data, and what happens to these data after extramural funding ends. Results: In total, 56 institutional SOs participated in the survey. We found that SOs frequently approve duplicate data deposits and impose stricter access controls when data use limitations are unclear or unspecified. In addition, 21\% (n=12) of SOs knew where data from federally funded projects are deposited after project funding sunsets. As a consequence, most investigators deposit their scientific data into ``a National Institutes of Health--funded repository'' to meet the Data Management and Sharing requirements but also within the ``institution's own repository'' or a third-party repository. Conclusions: Our findings inform 5 policy recommendations and best practices for US SOs to improve coordination and develop comprehensive and consistent data governance policies that balance the need for scientific progress with effective human data protections. ",
doi="10.2196/49822",
url="https://formative.jmir.org/2024/1/e49822",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506894"
}


@Article{info:doi/10.2196/52150,
author="Holl, Felix
and Kircher, Jennifer
and Hertelendy, J. Attila
and Sukums, Felix
and Swoboda, Walter",
title="Tanzania's and Germany's Digital Health Strategies and Their Consistency With the World Health Organization's Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="18",
volume="26",
pages="e52150",
keywords="digital health strategies",
keywords="comparative policy analysis",
keywords="DHS",
keywords="eHealth",
keywords="digital health",
keywords="strategy",
keywords="strategies",
keywords="policy",
keywords="policies",
keywords="document analysis",
keywords="document analyses",
keywords="GSDH",
keywords="Germany",
keywords="Europe",
keywords="Africa",
keywords="Tanzania",
abstract="Background: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)'s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. Objective: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. Methods: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. Results: Both Germany's and Tanzania's DHSs align significantly with the WHO's GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania's DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany's strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. Conclusions: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO's GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO's GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country's health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation. ",
doi="10.2196/52150",
url="https://www.jmir.org/2024/1/e52150",
url="http://www.ncbi.nlm.nih.gov/pubmed/38498021"
}


@Article{info:doi/10.2196/49177,
author="Sisk, Bryan
and Antes, L. Alison
and Bereitschaft, Christine
and Enloe, Madi
and Bourgeois, Fabienne
and DuBois, James",
title="Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators",
journal="JMIR Pediatr Parent",
year="2024",
month="Mar",
day="11",
volume="7",
pages="e49177",
keywords="adolescent",
keywords="patient portal",
keywords="electronic health records",
keywords="policy",
keywords="ethics",
keywords="portal",
keywords="portals",
keywords="adolescents",
keywords="youth",
keywords="health record",
keywords="health records",
keywords="EHR",
keywords="EHRs",
keywords="perspective",
keywords="perspectives",
keywords="policies",
keywords="administrator",
keywords="administration",
keywords="informatics",
keywords="information system",
keywords="information systems",
keywords="guidelines",
abstract="Background: Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. Objective: We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. Methods: We interviewed informatics administrators from US hospitals with ?50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. Results: We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent's health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. Conclusions: Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent's health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers. ",
doi="10.2196/49177",
url="https://pediatrics.jmir.org/2024/1/e49177",
url="http://www.ncbi.nlm.nih.gov/pubmed/38466976"
}


@Article{info:doi/10.2196/47197,
author="Yu, Yang
and Wang, Sufen
and You, Lijue",
title="Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis",
journal="J Med Internet Res",
year="2024",
month="Jan",
day="24",
volume="26",
pages="e47197",
keywords="integrated health management system",
keywords="medical association",
keywords="medical consortium",
keywords="policy tools",
keywords="content analysis",
keywords="PRISMA",
keywords="Preferred Reporting Items for Systematic Reviews and Meta-Analyses",
abstract="Background: The integrated health management system (IHMS), which unites all health care--related institutions under a health-centered organizational framework, is of great significance to China in promoting the hierarchical treatment system and improving the new health care reform. China's IHMS policy consists of multiple policies at different levels and at different times; however, there is a lack of comprehensive interpretation and analysis of these policies, which is not conducive to the further development of the IHMS in China. Objective: This study aims to comprehensively analyze and understand the characteristics, development, and evolution of China's IHMS policy to inform the design and improvement of the system. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to collect 152 policy documents. With the perspective of policy tools and policy orientation as the core, a comprehensive 6D framework including policy level, policy nature, release time, policy tools, stakeholders, and policy orientation was established by combining the content of policy texts. These dimensions were then analyzed using content analysis. Results: First, we found that, regarding the coordination of policy tools and stakeholders, China's IHMS policy was more inclined to use environment-based policy tools (1089/1929, 56.45\%), which suggests a need for further balance in the internal structure of policy tools. Attention to different actors varied, and the participation of physicians and residents needs further improvement (65/2019, 3.22\% and 11/2019, 0.54\%, respectively). Second, in terms of level differences, Shanghai's IHMS policy used fewer demand-based policy tools (43/483, 8.9\%), whereas the national IHMS policy and those of other provinces and cities used fewer supply-based tools (61/357, 17.1\% and 248/357, 69.5\%, respectively). The national IHMS strategy placed more emphasis on the construction of smart health care (including digital health; 10/275, 3.6\%), whereas Shanghai was a leader in the development of healthy community and healthy China (9/158, 5.7\% and 4/158, 2.5\%, respectively). Third, in terms of time evolution, the various policy tools showed an increasing and then decreasing trend from 2014 to 2021, with relatively more use of environment-based policy tools and less use of demand-based policy tools in the last 3 years. The growth of China's IHMS policy can be divided into 3 stages: the disease-centered period (2014-2017), the e-health technology development period (2017-2019), and the health-centered period (2018-2021). Conclusions: Policy makers should make several adjustments, such as coordinating policy tools and the uneven relationships among stakeholders; grasping key policy priorities in the context of local characteristics; and focusing on horizontal, multidimensional integration of health resources starting from the community. This study expands the objects of policy research and improves the framework for policy analysis. The findings provide some possible lessons for future policy formulation and optimization. ",
doi="10.2196/47197",
url="https://www.jmir.org/2024/1/e47197",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265862"
}


@Article{info:doi/10.2196/48702,
author="Pedrera-Jim{\'e}nez, Miguel
and Garc{\'i}a-Barrio, Noelia
and Frid, Santiago
and Moner, David
and Bosc{\'a}-Tom{\'a}s, Diego
and Lozano-Rub{\'i}, Raimundo
and Kalra, Dipak
and Beale, Thomas
and Mu{\~n}oz-Carrero, Adolfo
and Serrano-Balazote, Pablo",
title="Can OpenEHR, ISO 13606, and HL7 FHIR Work Together? An Agnostic Approach for the Selection and Application of Electronic Health Record Standards to the Next-Generation Health Data Spaces",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="28",
volume="25",
pages="e48702",
keywords="electronic health records",
keywords="FAIR principles",
keywords="health information standards",
keywords="HL7 FHIR",
keywords="ISO 13606",
keywords="OpenEHR",
keywords="semantics",
doi="10.2196/48702",
url="https://www.jmir.org/2023/1/e48702",
url="http://www.ncbi.nlm.nih.gov/pubmed/38153779"
}


@Article{info:doi/10.2196/45266,
author="Kong, Bingxuan
and Yang, Shanyue
and Long, Jiewei
and Tang, Yuhan
and Liu, Yang
and Ge, Zeng
and Rong, Shuang
and Wu, Yangfeng
and Ding, Gangqiang
and Yang, Yuexin
and Yao, Ping
and Gao, Chao",
title="National Initiatives on Salt Substitutes: Scoping Review",
journal="JMIR Public Health Surveill",
year="2023",
month="Nov",
day="17",
volume="9",
pages="e45266",
keywords="salt substitute",
keywords="nutrition policy",
keywords="initiatives",
keywords="strategies",
abstract="Background: Salt substitutes are edible salts that contain less sodium chloride owing to its partial substitution with other minerals, which serve as an important and effective intervention and public health strategy targeting hypertension and its secondary diseases, despite a small degree of controversy. Objective: This study aimed to identify the current salt substitute initiatives in various nations and intergovernmental organizations (IGOs) worldwide and summarize their types and characteristics. Methods: A scoping review was performed based on Arksey and O'Malley's framework and the latest guidance from the Joanna Briggs Institute. Searches were conducted on Google; government websites on food, health, and other related topics; PubMed; Web of Science; and Google Scholar from January 2022 to May 2022. Initiatives related to salt substitutes that were included in the study focused on the involvement of governments or IGOs through the publication of standards, actions, collaborations, funding, and so on. Data were extracted into Microsoft Excel (version 2019; Microsoft Corp) based on predefined items and analyzed using narrative synthesis and frequency count methods. Results: A total of 35 initiatives from 11 countries (of which 9 are high-income countries) and 3 IGOs were identified. We classified all salt substitute initiatives into 5 types, namely benefit-risk assessments and cautions; plans and actions; regulations and standards; labels; and food reformulation, cooperation with the food industry, and media. More than half (18/35, 51\%) of the salt substitute initiatives were launched within the past 5 years. Except for regulations and standards, salt substitute initiatives are, in general, part of the salt reduction framework. No nation or IGO has yet reported on the monitoring and implications of the use of salt substitutes. Conclusions: Despite the limited number of salt substitute initiatives worldwide at present, a review on the different types and characteristics of such initiatives could be helpful in providing a reference for policy makers and stakeholders. Given the great potential of salt substitutes in improving hypertension and stroke, we call on more nations to pay attention to these substitutes and propose salt substitute initiatives in line with their national conditions. ",
doi="10.2196/45266",
url="https://publichealth.jmir.org/2023/1/e45266",
url="http://www.ncbi.nlm.nih.gov/pubmed/37435719"
}


@Article{info:doi/10.2196/50199,
author="Unlu, Ali
and Truong, Sophie
and Tammi, Tuukka
and Lohiniva, Anna-Leena",
title="Exploring Political Mistrust in Pandemic Risk Communication: Mixed-Method Study Using Social Media Data Analysis",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="20",
volume="25",
pages="e50199",
keywords="political trust",
keywords="social media",
keywords="text classification",
keywords="topic modeling",
keywords="COVID-19",
keywords="Finland",
keywords="trust",
keywords="authority",
keywords="public health outcome",
keywords="pandemic",
keywords="perception",
keywords="mistrust",
keywords="interaction",
keywords="Twitter",
keywords="Facebook",
keywords="analysis",
keywords="computational method",
keywords="natural language processing",
keywords="misinformation",
keywords="communication",
keywords="crisis",
abstract="Background: This research extends prior studies by the Finnish Institute for Health and Welfare on pandemic-related risk perception, concentrating on the role of trust in health authorities and its impact on public health outcomes. Objective: The paper aims to investigate variations in trust levels over time and across social media platforms, as well as to further explore 12 subcategories of political mistrust. It seeks to understand the dynamics of political trust, including mistrust accumulation, fluctuations over time, and changes in topic relevance. Additionally, the study aims to compare qualitative research findings with those obtained through computational methods. Methods: Data were gathered from a large-scale data set consisting of 13,629 Twitter and Facebook posts from 2020 to 2023 related to COVID-19. For analysis, a fine-tuned FinBERT model with an 80\% accuracy rate was used for predicting political mistrust. The BERTopic model was also used for superior topic modeling performance. Results: Our preliminary analysis identifies 43 mistrust-related topics categorized into 9 major themes. The most salient topics include COVID-19 mortality, coping strategies, polymerase chain reaction testing, and vaccine efficacy. Discourse related to mistrust in authority is associated with perceptions of disease severity, willingness to adopt health measures, and information-seeking behavior. Our findings highlight that the distinct user engagement mechanisms and platform features of Facebook and Twitter contributed to varying patterns of mistrust and susceptibility to misinformation during the pandemic. Conclusions: The study highlights the effectiveness of computational methods like natural language processing in managing large-scale engagement and misinformation. It underscores the critical role of trust in health authorities for effective risk communication and public compliance. The findings also emphasize the necessity for transparent communication from authorities, concluding that a holistic approach to public health communication is integral for managing health crises effectively. ",
doi="10.2196/50199",
url="https://www.jmir.org/2023/1/e50199",
url="http://www.ncbi.nlm.nih.gov/pubmed/37862088"
}


@Article{info:doi/10.2196/40149,
author="Chen, Mu
and Li, Cheng
and Zhang, Jiwei
and Cui, Xin
and Tian, Wenqi
and Liao, Peng
and Wang, Qunshan
and Sun, Jian
and Luo, Li
and Wu, Hong
and Li, Yi-Gang",
title="Cancer and Atrial Fibrillation Comorbidities Among 25 Million Citizens in Shanghai, China: Medical Insurance Database Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Oct",
day="17",
volume="9",
pages="e40149",
keywords="cardiovascular",
keywords="malignancy",
keywords="arrhythmia",
keywords="cardio-oncology",
keywords="prevalence",
keywords="epidemiology",
keywords="atrial fibrillation",
abstract="Background: With population aging, the prevalence of both cancer and atrial fibrillation (AF) have increased. However, there is scarce epidemiological data concerning the comorbid state of cancer and AF in low- and middle-income countries, including China. Objective: We aimed to evaluate the site-, sex-, and age-specific profiles of cancer and AF comorbidities in Chinese populations. Methods: Data from the Shanghai Municipal Health Commission database between 2015 and 2020 were screened, covering all medical records of Shanghai residents with medical insurance. Site-specific cancer profiles were evaluated for the population with AF relative to the age- and sex-adjusted population of residents without AF. The sex distribution and peak age of cancer diagnosis were also assessed. Results: A total of 25,964,447 adult patients were screened. Among them, 22,185 patients presented cancers comorbid with AF (median 77, IQR 67-82 years of age; men: n=13,631, 61.44\%), while 839,864 presented cancers without AF (median 67, IQR 57-72 years of age; men: n=419,020, 49.89\%), thus yielding a higher cancer prevalence among residents with AF (8.27\%) than among those without AF (6.05\%; P<.001). In the population with AF, the most prevalent cancer type was lung cancer, followed by colorectal, male genital organ, stomach, breast, liver, bladder, thyroid, leukemia, and esophageal cancers. AF was associated with an average of nearly 1.4-fold (prevalence ratio [PR] 1.37, 95\% CI 1.35-1.38) increased prevalence of cancer after adjusting for age and sex. For site-specific analyses, an increased prevalence of cancer in the population with AF was observed in 20 of 21 cancer sites. This increased prevalence was most prominent for nonsolid tumors, including multiple myeloma (PR 2.56, 95\% CI 2.28-2.87), leukemia (PR 1.73, 95\% CI 1.57-1.90), and non-Hodgkin lymphoma (PR 1.59, 95\% CI 1.43-1.77); intrathoracic malignancies, including mediastinum (PR 2.34, 95\% CI 1.89-2.90), lung (PR 1.64, 95\% CI 1.59-1.69), and esophageal cancers (PR 1.41, 95\% CI 1.28-1.56); bone and soft tissue neoplasms (PR 1.56, 95\% CI 1.37-1.77); and kidney cancer (PR 1.53, 95\% CI 1.36-1.72). Cancer prevalence in the population with AF relative to that in the population without AF was higher in men than in women in 14 of 18 cancer sites, and female predominance was only observed for thyroid cancer. The peak age of index cancer diagnosis was lower in the population with AF (age group: 70-74 years) than in that without AF (age group: 75-79 years), especially for specific cancer types, including thyroid, central nervous system, mediastinum, esophageal, bladder, and biliary cancers. Conclusions: Patients with AF are associated with increased prevalence, heightened male predominance, and younger peak age of cancer. Further studies are needed to determine whether early screening of specific cancers is cost-effective and beneficial for patients with AF. ",
doi="10.2196/40149",
url="https://publichealth.jmir.org/2023/1/e40149",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847541"
}


@Article{info:doi/10.2196/50306,
author="Cavalcante de Oliveira, Paula Ana
and Lopes Galante, Mariana
and Senna Maia, Leila
and Craveiro, Isabel
and Pereira da Silva, Alessandra
and Fronteira, Ines
and Chan{\c{c}}a, Raphael
and Ferrinho, Paulo
and Dal Poz, Mario",
title="Policies and Management Interventions to Enhance Health and Care Workforce Capacity for Addressing the COVID-19 Pandemic: Protocol for a Living Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="5",
volume="12",
pages="e50306",
keywords="COVID-19",
keywords="health and care workforce policy",
keywords="health and care workforce capacity",
keywords="management interventions",
keywords="SARS-CoV-2",
keywords="pandemic",
abstract="Background: Countries and health systems have had to make challenging resource allocation and capacity-building decisions to promote proper patient care and ensure health and care workers' safety and well-being, so that they can effectively address the present COVID-19 pandemic as well as upcoming public health problems and natural catastrophes. As innovations are already in place and updated evidence is published daily, more information is required to inform the development and implementation of policies and interventions to improve health and care workforce capacity to address the COVID-19 pandemic response. Objective: The objective of this protocol review is to identify countries' range of experiences with policies and management interventions that can improve health and care workers' capacity to address the COVID-19 pandemic response and synthesize evidence on the effectiveness of the interventions. Methods: We will conduct a living systematic review of quantitative, qualitative, and mixed methods studies and gray literature (technical and political documents) published in English, French, Hindi, Portuguese, Italian, and Spanish between January 1, 2000, and March 1, 2022. The databases to be searched are MEDLINE (PubMed), Embase, SCOPUS, and Latin American and Caribbean Health Sciences Literature. In addition, the World Health Organization's COVID-19 Research Database and the websites of international organizations (International Labour Organization, Economic Co-operation and Development, and The Health System Response Monitor) will be searched for unpublished studies and gray literature. Data will be extracted from the selected documents using an electronic form adapted from the Joanna Briggs Institute quantitative and qualitative tools for data extraction. A convergent integrated approach to synthesis and integration will be used. The risk of bias will be assessed with Joanna Briggs Institute critical appraisal tools, and the certainty of the evidence in the presented outcomes will be assessed with the Grading of Recommendations, Assessment, Development and Evaluation. Results: The database and gray literature search retrieved 3378 documents. Data are being analyzed by 2 independent reviewers. The study is expected to be published by the end of 2023 in a peer-reviewed journal. Conclusions: This review will allow us to identify and describe the policies and strategies implemented by countries and their effectiveness, as well as identify gaps in the evidence. Trial Registration: PROSPERO CRD42022327041; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=327041 International Registered Report Identifier (IRRID): RR1-10.2196/50306 ",
doi="10.2196/50306",
url="https://www.researchprotocols.org/2023/1/e50306",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796568"
}


@Article{info:doi/10.2196/49150,
author="Poulsen, Adam
and Song, C. Yun J.
and Fosch-Villaronga, Eduard
and LaMonica, M. Haley
and Iannelli, Olivia
and Alam, Mafruha
and Hickie, B. Ian",
title="Digital Rights and Mobile Health in Low- and Middle-Income Countries: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="3",
volume="12",
pages="e49150",
keywords="human right",
keywords="digital right",
keywords="mobile health",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
keywords="digital health",
keywords="scoping review",
keywords="health equity",
keywords="patient empowerment",
abstract="Background: Digital technology is a means to uphold or violate human rights in various domains, including business, military, and health. Given the pervasiveness of mobile technology in low- and middle-income countries (LMICs), mobile health (mHealth) interventions present an opportunity to reach remote populations and enable them to exercise civil and political rights and economic, social, and cultural rights, such as the right to health and education. Simultaneously, the ubiquity of mobile phones involves processing sensitive data which can threaten rights, including the right to privacy and nondiscrimination. Digital health is often promoted as advancing human rights and health equity; however, digital rights are underexplored in the literature on mHealth in LMICs. As such, creating an understanding of the digital rights topics covered in the 2022 literature is important to avoid exacerbating existing inequities relating to digital health design, use, implementation, and access. Objective: This scoping review aims to identify digital rights topics in the 2022 peer-reviewed literature on mHealth in LMICs. Methods: The Arksey and O'Malley framework for scoping reviews guides this review. Searches were performed across 7 electronic databases (Web of Science, Scopus, Ovid, ACM Digital Library, IEEE Xplore, ProQuest, and PubMed). The screening processes were guided by the research question ``What digital rights topics have been explored in the 2022 literature on mHealth in LMICs?'' Only papers addressing mHealth in LMICs and digital rights topics were included. Data extraction will include publication title, year, and type; first author's affiliation country; LMICs implicated; infrastructure challenges; study aims, design, limitations, and future work; health area; mHealth technology, functions, purpose or application, and target end users; human or digital right terms used; explicit rights topics cited; and implied rights topics. The results will be reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Results: This scoping review was registered in Open Science Framework (December 22, 2022). Title and abstract screening and full-text paper screening were completed in 2023. This resulted in 56 papers being included in the study. The target date for completing data extraction and publishing a case study of the initial findings is the end of 2023. The full scoping review findings are expected to be disseminated through various pathways benefiting academia, practice, and policy making by the end of 2024. These include journal papers, conference presentations, publicly available toolkits for research and practice, public webinars, and policy briefs with evidence-based policy recommendations emerging from this review. Conclusions: The planned scoping review will identify digital rights topics in the 2022 literature at the intersection of mHealth and LMICs. Furthermore, it will highlight the importance of patient empowerment, data protection, and inclusion in mHealth research and related policies in LMICs. Trial Registration: Open Science Framework osf.io/7mz24; https://osf.io/7mz24 International Registered Report Identifier (IRRID): DERR1-10.2196/49150 ",
doi="10.2196/49150",
url="https://www.researchprotocols.org/2023/1/e49150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788054"
}


@Article{info:doi/10.2196/49003,
author="van Kessel, Robin
and Srivastava, Divya
and Kyriopoulos, Ilias
and Monti, Giovanni
and Novillo-Ortiz, David
and Milman, Ran
and Zhang-Czabanowski, Wilhelm Wojciech
and Nasi, Greta
and Stern, Dora Ariel
and Wharton, George
and Mossialos, Elias",
title="Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Sep",
day="29",
volume="11",
pages="e49003",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="reimbursement",
keywords="policy",
keywords="Europe",
keywords="policy mapping",
keywords="mapping",
keywords="pricing",
keywords="digital health app",
keywords="application",
keywords="health care ecosystem",
keywords="framework",
keywords="integration",
abstract="Background: The adoption of digital health care within health systems is determined by various factors, including pricing and reimbursement. The reimbursement landscape for digital health in Europe remains underresearched. Although various emergency reimbursement decisions were made during the COVID-19 pandemic to enable health care delivery through videoconferencing and asynchronous care (eg, digital apps), research so far has primarily focused on the policy innovations that facilitated this outside of Europe. Objective: This study examines the digital health reimbursement strategies in 8 European countries (Belgium, France, Germany, Italy, the Netherlands, Poland, Sweden, and the United Kingdom) and Israel. Methods: We mapped available digital health reimbursement strategies using a scoping review and policy mapping framework. We reviewed the literature on the MEDLINE, Embase, Global Health, and Web of Science databases. Supplementary records were identified through Google Scholar and country experts. Results: Our search strategy yielded a total of 1559 records, of which 40 (2.57\%) were ultimately included in this study. As of August 2023, digital health solutions are reimbursable to some extent in all studied countries except Poland, although the mechanism of reimbursement differs significantly across countries. At the time of writing, the pricing of digital health solutions was mostly determined through discussions between national or regional committees and the manufacturers of digital health solutions in the absence of value-based assessment mechanisms. Financing digital health solutions outside traditional reimbursement schemes was possible in all studied countries except Poland and typically occurs via health innovation or digital health--specific funding schemes. European countries have value-based pricing frameworks that range from nonexistent to embryonic. Conclusions: Studied countries show divergent approaches to the reimbursement of digital health solutions. These differences may complicate the ability of patients to seek cross-country health care in another country, even if a digital health app is available in both countries. Furthermore, the fragmented environment will present challenges for developers of such solutions, as they look to expand their impact across countries and health systems. An increased emphasis on developing a clear conceptualization of digital health, as well as value-based pricing and reimbursement mechanisms, is needed for the sustainable integration of digital health. This study can therein serve as a basis for further, more detailed research as the field of digital health reimbursement evolves. ",
doi="10.2196/49003",
url="https://mhealth.jmir.org/2023/1/e49003",
url="http://www.ncbi.nlm.nih.gov/pubmed/37773610"
}


@Article{info:doi/10.2196/51760,
author="Taguchi, Kazuho
and Matsoso, Precious
and Driece, Roland
and da Silva Nunes, Tovar
and Soliman, Ahmed
and Tangcharoensathien, Viroj",
title="Effective Infodemic Management: A Substantive Article of the Pandemic Accord",
journal="JMIR Infodemiology",
year="2023",
month="Sep",
day="20",
volume="3",
pages="e51760",
keywords="Pandemic Accord",
keywords="infodemic",
keywords="infodemic management",
keywords="COVID-19",
keywords="social media",
keywords="Intergovernmental Negotiating Body",
keywords="INB",
keywords="INB Bureau",
keywords="World Health Organization",
keywords="WHO",
keywords="misinformation",
keywords="disinformation",
keywords="public health",
doi="10.2196/51760",
url="https://infodemiology.jmir.org/2023/1/e51760",
url="http://www.ncbi.nlm.nih.gov/pubmed/37728969"
}


@Article{info:doi/10.2196/48824,
author="van Kessel, Robin
and Haig, Madeleine
and Mossialos, Elias",
title="Strengthening Cybersecurity for Patient Data Protection in Europe",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="24",
volume="25",
pages="e48824",
keywords="cybersecurity",
keywords="Europe",
keywords="European Health Data Space",
keywords="digital health",
keywords="mHealth",
keywords="medical informatics",
keywords="data privacy",
keywords="patient safety",
keywords="privacy",
keywords="health service",
doi="10.2196/48824",
url="https://www.jmir.org/2023/1/e48824",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616048"
}


@Article{info:doi/10.2196/44150,
author="Akahane, Manabu
and Kanagawa, Yoshiyuki
and Takahata, Yoshihisa
and Nakanishi, Yasuhiro
and Akahane, Takemi
and Imamura, Tomoaki",
title="Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="24",
volume="7",
pages="e44150",
keywords="food defense",
keywords="health hazards",
keywords="intentional contamination",
keywords="foreign substances",
keywords="food delivery service",
abstract="Background: Various stages of the food chain, from production to processing to distribution, can impact food safety. The concept of ``food defense'' has emerged as a countermeasure against intentional contamination of food with foreign substances. Although knowledge of food hygiene is common among consumers, there are currently no reports of consumer surveys on food defense. Objective: This study aims to investigate consumer awareness of food defense and food safety. We analyzed the results focusing on how consumers behave when they find abnormalities in food to further our knowledge on promoting food defense measures. Methods: Participants completed a web-based questionnaire that included items related to awareness of food safety and food defense, as well as actions to be taken in cases of food abnormalities, such as contamination by foreign substances, the presence of a bad smell in purchased food, and the inclusion of extra items not selected by the individual. The participants were asked to indicate their preference among the 5 suggested actions in each case using a 6-point Likert scale. Data analysis involved aggregating responses into binary values. Stepwise linear regression analysis was conducted to examine the relationship between selected actions and questionnaire items, such as sex, age, and personality. Results: A total of 1442 respondents completed the survey, and the majority of participants placed importance on food safety when making food purchases. The recognition of each term was as follows: 95.2\% (n=1373) for ``food security and safety,'' 95.6\% (n=1379) for ``food hygiene,'' and 17.1\% (n=247) for ``food defense.'' The percentages of those who answered that they would ``eat without worrying'' in the case of ``contamination by foreign substances,'' ``bad smell,'' or ``including unpurchased product'' in the frozen food they purchased were 9.1\% (n=131), 4.8\% (n=69), and 30.7\% (n=443), respectively. The results showed that contacting the manufacturer was the most common action when faced with contaminated food or food with a bad smell. Interestingly, a significant percentage of respondents indicated they would upload the issue on social networking sites. Logistic regression analysis revealed that male participants and the younger generation were more likely to choose the option of eating contaminated food without worrying. Additionally, the tendency to upload the issue on social networking sites was higher among respondents who were sociable and brand-conscious. Conclusions: The findings of this study indicate that if food intentionally contaminated with a foreign substance is sold and delivered to consumers, it is possible consumers may eat it and experience health problems. Therefore, it is crucial for not only food manufacturers but also food delivery service providers to consider food defense measures such as protecting food from intentional contamination. Additionally, promoting consumer education and awareness regarding food defense can contribute to enhancing food safety throughout the food chain. ",
doi="10.2196/44150",
url="https://formative.jmir.org/2023/1/e44150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616047"
}


@Article{info:doi/10.2196/46854,
author="Yi, Min
and Cao, Yuebin
and Wang, Lin
and Gu, Yaowen
and Zheng, Xueqian
and Wang, Jiangjun
and Chen, Wei
and Wei, Liangyu
and Zhou, Yujin
and Shi, Chenyi
and Cao, Yanlin",
title="Prediction of Medical Disputes Between Health Care Workers and Patients in Terms of Hospital Legal Construction Using Machine Learning Techniques: Externally Validated Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="17",
volume="25",
pages="e46854",
keywords="medical workers",
keywords="medical disputes",
keywords="hospital legal construction",
keywords="machine learning",
keywords="multicenter analysis",
abstract="Background: Medical disputes are a global public health issue that is receiving increasing attention. However, studies investigating the relationship between hospital legal construction and medical disputes are scarce. The development of a multicenter model incorporating machine learning (ML) techniques for the individualized prediction of medical disputes would be beneficial for medical workers. Objective: This study aimed to identify predictors related to medical disputes from the perspective of hospital legal construction and the use of ML techniques to build models for predicting the risk of medical disputes. Methods: This study enrolled 38,053 medical workers from 130 tertiary hospitals in Hunan province, China. The participants were randomly divided into a training cohort (34,286/38,053, 90.1\%) and an internal validation cohort (3767/38,053, 9.9\%). Medical workers from 87 tertiary hospitals in Beijing were included in an external validation cohort (26,285/26,285, 100\%). This study used logistic regression and 5 ML techniques: decision tree, random forest, support vector machine, gradient boosting decision tree (GBDT), and deep neural network. In total, 12 metrics, including discrimination and calibration, were used for performance evaluation. A scoring system was developed to select the optimal model. Shapley additive explanations was used to generate the importance coefficients for characteristics. To promote the clinical practice of our proposed optimal model, reclassification of patients was performed, and a web-based app for medical dispute prediction was created, which can be easily accessed by the public. Results: Medical disputes occurred among 46.06\% (17,527/38,053) of the medical workers in Hunan province, China. Among the 26 clinical characteristics, multivariate analysis demonstrated that 18 characteristics were significantly associated with medical disputes, and these characteristics were used for ML model development. Among the ML techniques, GBDT was identified as the optimal model, demonstrating the lowest Brier score (0.205), highest area under the receiver operating characteristic curve (0.738, 95\% CI 0.722-0.754), and the largest discrimination slope (0.172) and Youden index (1.355). In addition, it achieved the highest metrics score (63 points), followed by deep neural network (46 points) and random forest (45 points), in the internal validation set. In the external validation set, GBDT still performed comparably, achieving the second highest metrics score (52 points). The high-risk group had more than twice the odds of experiencing medical disputes compared with the low-risk group. Conclusions: We established a prediction model to stratify medical workers into different risk groups for encountering medical disputes. Among the 5 ML models, GBDT demonstrated the optimal comprehensive performance and was used to construct the web-based app. Our proposed model can serve as a useful tool for identifying medical workers at high risk of medical disputes. We believe that preventive strategies should be implemented for the high-risk group. ",
doi="10.2196/46854",
url="https://www.jmir.org/2023/1/e46854",
url="http://www.ncbi.nlm.nih.gov/pubmed/37590041"
}


@Article{info:doi/10.2196/45602,
author="Zhang, Jinghui
and Peng, Sha
and Hou, Jianmei
and Ma, Guiyuan
and Liu, Yanhui
and Fan, Yuhua
and Luo, Lingxia
and Shi, Zhengkun",
title="Nurses' Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="4",
volume="25",
pages="e45602",
keywords="Internet+home care services",
keywords="willingness",
keywords="demand",
keywords="clinical nurses",
keywords="municipal hospitals",
abstract="Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60\% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses' willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >{\textyen}10,000 increased the likelihood of nurses' willingness to provide IHC services, by 1.187 times, compared with an income <{\textyen}5000. Nurses' total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses' demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of {\textyen}5000 to {\textyen}10,000 (B=0.894, P<.001) and >{\textyen}10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <{\textyen}5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. ",
doi="10.2196/45602",
url="https://www.jmir.org/2023/1/e45602",
url="http://www.ncbi.nlm.nih.gov/pubmed/37540546"
}


@Article{info:doi/10.2196/42483,
author="Nakayama, Filipe Luis
and Binotti, Warr William
and Link Woite, Naira
and Fernandes, Oliveira Chrystinne
and Alfonso, Gabrielle Pia
and Celi, Anthony Leo
and Regatieri, Vinicius Caio",
title="The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="21",
volume="25",
pages="e42483",
keywords="digital divide",
keywords="digital health",
keywords="health equity",
keywords="internet access",
keywords="medical care",
abstract="Background: The COVID-19 pandemic has increased the use of digital solutions in medical care, especially for patients in remote areas and those requiring regular medical care. However, internet access is essential for the implementation of digital health care. The digital divide is the unequal distribution of access to digital technology, and the first level digital divide encompasses structural barriers. Brazil, a country with economic inequality and uneven population distribution, faces challenges in achieving internet access for all. Objective: This study aims to provide a comprehensive overview of the first-level digital divide in Brazil, estimate the relationship between variables, and identify the challenges and opportunities for digital health care implementation. Methods: Data were retrieved from the Brazilian Institute of Geography and Statistics National Continuous House survey database, including demographic, health, and internet-related variables. Statistical analysis included 2-tailed t tests, chi-square, and multivariate logistic regression to assess associations between variables. Results: Our analysis included 279,382 interviews throughout Brazil. The sample included more houses from the northeast (n=99,553) and fewer houses from the central west (n=30,804). A total of 223,386 (80.13\%) of the interviewed population used the internet, with urban areas having higher internet access (187,671/212,109, 88.48\%) than rural areas (35,715/67,077, 53.24\%). Among the internet users, those interviewed who lived in urban houses, were women, were younger, and had higher income had a statistically higher prevalence (P<.001). Cell phones were the most common device used to access the internet (141,874/143,836, 98.63\%). Reasons for not using the internet included lack of interest, knowledge, availability, and cost, with regional variations. The prevalence of internet access also varied among races, with 84,747 of 98,968 (85.63\%) White respondents having access, compared to 22,234 of 28,272 (78.64\%) Black respondents, 113,518 of 148,191 (76.6\%) multiracial respondents, and 2887 of 3755 (76.88\%) other respondents. In the southeast, central west, and south regions, the numbers of people with internet access were 49,790 of 56,298 (88.44\%), 27,209 of 30,782 (88.39\%), and 27,035 of 31,226 (86.58\%), respectively, and in the north and northeast, 45,038 of 61,404 (73.35\%) and 74,314 of 99,476 (74.7\%). The income of internet users was twice the income of internet nonusers. Among those with diabetes-related limitations in daily activities, 945 of 2377 (39.75\%) did not have internet access, and among those with daily activity restrictions, 1381 of 3644 (37.89\%) did not have access. In a multivariate logistic regression analysis, women (odds ratio [OR] 1.147, 95\% CI 0.118-0.156; P<.001), urban households (OR 6.743, 95\% CI 1.888-1.929; P<.001), and those earning more than the minimum wage (OR 2.087, 95\% CI 0.716-0.756; P<.01) had a positive association with internet access. Conclusions: Brazil's diverse regions have different demographic distributions, house characteristics, and internet access levels, requiring targeted measures to address the first-level digital divide in rural areas and reduce inequalities in digital health solutions. Older people, poor, and rural populations face the greatest challenges in the first level digital divide in Brazil, highlighting the need to tackle the digital divide in order to promote equitable access to digital health care. ",
doi="10.2196/42483",
url="https://www.jmir.org/2023/1/e42483",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477958"
}


@Article{info:doi/10.2196/41369,
author="Mudaranthakam, Pal Dinesh
and Pepper, Sam
and Fortney, Tanner
and Alsup, Alexander
and Woodward, Jennifer
and Sykes, Kevin
and Calhoun, Elizabeth",
title="The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing",
journal="JMIR Public Health Surveill",
year="2023",
month="Apr",
day="25",
volume="9",
pages="e41369",
keywords="social determinants of health",
keywords="COVID-19",
keywords="food assistance program",
keywords="public health",
keywords="quality of life",
keywords="well-being",
keywords="health disparity",
keywords="health inequity",
keywords="health policy",
keywords="Kansas",
keywords="social work",
keywords="socioeconomic",
abstract="Background: Studying patients' social needs is critical to the understanding of health conditions and disparities, and to inform strategies for improving health outcomes. Studies have shown that people of color, low-income families, and those with lower educational attainment experience greater hardships related to social needs. The COVID-19 pandemic represents an event that severely impacted people's social needs. This pandemic was declared by the World Health Organization on March 11, 2020, and contributed to food and housing insecurity, while highlighting weaknesses in the health care system surrounding access to care. To combat these issues, legislators implemented unique policies and procedures to help alleviate worsening social needs throughout the pandemic, which had not previously been exerted to this degree. We believe that improvements related to COVID-19 legislature and policy have positively impacted people's social needs in Kansas and Missouri, United States. In particular, Wyandotte County is of interest as it suffers greatly from issues related to social needs that many of these COVID-19--related policies aimed to improve. Objective: The research objective of this study was to evaluate the change in social needs before and after the COVID-19 pandemic declaration based on responses to a survey from The University of Kansas Health System (TUKHS). We further aimed to compare the social needs of respondents from Wyandotte County from those of respondents in other counties in the Kansas City metropolitan area. Methods: Social needs survey data from 2016 to 2022 were collected from a 12-question patient-administered survey distributed by TUKHS during a patient visit. This provided a longitudinal data set with 248,582 observations, which was narrowed down into a paired-response data set for 50,441 individuals who had provided at least one response before and after March 11, 2020. These data were then bucketed by county into Cass (Missouri), Clay (Missouri), Jackson (Missouri), Johnson (Kansas), Leavenworth (Kansas), Platte (Missouri), Wyandotte (Kansas), and Other counties, creating groupings with at least 1000 responses in each category. A pre-post composite score was calculated for each individual by adding their coded responses (yes=1, no=0) across the 12 questions. The Stuart-Maxwell marginal homogeneity test was used to compare the pre and post composite scores across all counties. Additionally, McNemar tests were performed to compare responses before and after March 11, 2020, for each of the 12 questions across all counties. Finally, McNemar tests were performed for questions 1, 7, 8, 9, and 10 for each of the bucketed counties. Significance was assessed at P<.05 for all tests. Results: The Stuart-Maxwell test for marginal homogeneity was significant (P<.001), indicating that respondents were overall less likely to identify an unmet social need after the COVID-19 pandemic. McNemar tests for individual questions indicated that after the COVID-19 pandemic, respondents across all counties were less likely to identify unmet social needs related to food availability (odds ratio [OR]=0.4073, P<.001), home utilities (OR=0.4538, P<.001), housing (OR=0.7143, P<.001), safety among cohabitants (OR=0.6148, P<.001), safety in their residential location (OR=0.6172, P<.001), child care (OR=0.7410, P<0.01), health care access (OR=0.3895, P<.001), medication adherence (OR=0.5449, P<.001), health care adherence (OR=0.6378, P<.001), and health care literacy (0.8729, P=.02), and were also less likely to request help with these unmet needs (OR=0.7368, P<.001) compared with prepandemic responses. Responses from individual counties were consistent with the overall results for the most part. Notably, no individual county demonstrated a significant reduction in social needs relating to a lack of companionship. Conclusions: Post-COVID-19 responses showed improvement across almost all social needs--related questions, indicating that the federal policy response possibly had a positive impact on social needs across the populations of Kansas and western Missouri. Some counties were impacted more than others and positive outcomes were not limited to urban counties. The availability of resources, safety net services, access to health care, and educational opportunities could play a role in this change. Future research should focus on improving survey response rates from rural counties to increase their sample size, and to evaluate other explanatory variables such as food pantry access, educational status, employment opportunities, and access to community resources. Government policies should be an area of focused research as they may affect the social needs and health of the individuals considered in this analysis. ",
doi="10.2196/41369",
url="https://publichealth.jmir.org/2023/1/e41369",
url="http://www.ncbi.nlm.nih.gov/pubmed/36977199"
}


@Article{info:doi/10.2196/41588,
author="Brauneck, Alissa
and Schmalhorst, Louisa
and Kazemi Majdabadi, Mahdi Mohammad
and Bakhtiari, Mohammad
and V{\"o}lker, Uwe
and Baumbach, Jan
and Baumbach, Linda
and Buchholtz, Gabriele",
title="Federated Machine Learning, Privacy-Enhancing Technologies, and Data Protection Laws in Medical Research: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="30",
volume="25",
pages="e41588",
keywords="federated learning",
keywords="data protection regulation",
keywords="data protection by design",
keywords="privacy protection",
keywords="General Data Protection Regulation compliance",
keywords="GDPR compliance",
keywords="privacy-preserving technologies",
keywords="differential privacy",
keywords="secure multiparty computation",
abstract="Background: The collection, storage, and analysis of large data sets are relevant in many sectors. Especially in the medical field, the processing of patient data promises great progress in personalized health care. However, it is strictly regulated, such as by the General Data Protection Regulation (GDPR). These regulations mandate strict data security and data protection and, thus, create major challenges for collecting and using large data sets. Technologies such as federated learning (FL), especially paired with differential privacy (DP) and secure multiparty computation (SMPC), aim to solve these challenges. Objective: This scoping review aimed to summarize the current discussion on the legal questions and concerns related to FL systems in medical research. We were particularly interested in whether and to what extent FL applications and training processes are compliant with the GDPR data protection law and whether the use of the aforementioned privacy-enhancing technologies (DP and SMPC) affects this legal compliance. We placed special emphasis on the consequences for medical research and development. Methods: We performed a scoping review according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). We reviewed articles on Beck-Online, SSRN, ScienceDirect, arXiv, and Google Scholar published in German or English between 2016 and 2022. We examined 4 questions: whether local and global models are ``personal data'' as per the GDPR; what the ``roles'' as defined by the GDPR of various parties in FL are; who controls the data at various stages of the training process; and how, if at all, the use of privacy-enhancing technologies affects these findings. Results: We identified and summarized the findings of 56 relevant publications on FL. Local and likely also global models constitute personal data according to the GDPR. FL strengthens data protection but is still vulnerable to a number of attacks and the possibility of data leakage. These concerns can be successfully addressed through the privacy-enhancing technologies SMPC and DP. Conclusions: Combining FL with SMPC and DP is necessary to fulfill the legal data protection requirements (GDPR) in medical research dealing with personal data. Even though some technical and legal challenges remain, for example, the possibility of successful attacks on the system, combining FL with SMPC and DP creates enough security to satisfy the legal requirements of the GDPR. This combination thereby provides an attractive technical solution for health institutions willing to collaborate without exposing their data to risk. From a legal perspective, the combination provides enough built-in security measures to satisfy data protection requirements, and from a technical perspective, the combination provides secure systems with comparable performance with centralized machine learning applications. ",
doi="10.2196/41588",
url="https://www.jmir.org/2023/1/e41588",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995759"
}


@Article{info:doi/10.2196/46700,
author="Tewari, Ambuj",
title="mHealth Systems Need a Privacy-by-Design Approach: Commentary on ``Federated Machine Learning, Privacy-Enhancing Technologies, and Data Protection Laws in Medical Research: Scoping Review''",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="30",
volume="25",
pages="e46700",
keywords="mHealth",
keywords="differential privacy",
keywords="private synthetic data",
keywords="federated learning",
keywords="data protection regulation",
keywords="data protection by design",
keywords="privacy protection",
keywords="General Data Protection Regulation",
keywords="GDPR compliance",
keywords="privacy-preserving technologies",
keywords="secure multiparty computation",
keywords="multiparty computation",
keywords="machine learning",
keywords="privacy",
doi="10.2196/46700",
url="https://www.jmir.org/2023/1/e46700",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995757"
}


@Article{info:doi/10.2196/44070,
author="Vo, Ace
and Tao, Youyou
and Li, Yan
and Albarrak, Abdulaziz",
title="The Association Between Social Determinants of Health and Population Health Outcomes: Ecological Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="29",
volume="9",
pages="e44070",
keywords="social determinants of health",
keywords="public policy",
keywords="health outcomes",
keywords="policy recommendation",
keywords="cities",
abstract="Background: With the increased availability of data, a growing number of studies have been conducted to address the impact of social determinants of health (SDOH) factors on population health outcomes. However, such an impact is either examined at the county level or the state level in the United States. The results of analysis at lower administrative levels would be useful for local policy makers to make informed health policy decisions. Objective: This study aimed to investigate the ecological association between SDOH factors and population health outcomes at the census tract level and the city level. The findings of this study can be applied to support local policy makers in efforts to improve population health, enhance the quality of care, and reduce health inequity. Methods: This ecological analysis was conducted based on 29,126 census tracts in 499 cities across all 50 states in the United States. These cities were grouped into 5 categories based on their population density and political affiliation. Feature selection was applied to reduce the number of SDOH variables from 148 to 9. A linear mixed-effects model was then applied to account for the fixed effect and random effects of SDOH variables at both the census tract level and the city level. Results: The finding reveals that all 9 selected SDOH variables had a statistically significant impact on population health outcomes for ?2 city groups classified by population density and political affiliation; however, the magnitude of the impact varied among the different groups. The results also show that 4 SDOH risk factors, namely, asthma, kidney disease, smoking, and food stamps, significantly affect population health outcomes in all groups (P<.01 or P<.001). The group differences in health outcomes for the 4 factors were further assessed using a predictive margin analysis. Conclusions: The analysis reveals that population density and political affiliation are effective delineations for separating how the SDOH affects health outcomes. In addition, different SDOH risk factors have varied effects on health outcomes among different city groups but similar effects within city groups. Our study has 2 policy implications. First, cities in different groups should prioritize different resources for SDOH risk mitigation to maximize health outcomes. Second, cities in the same group can share knowledge and enable more effective SDOH-enabled policy transfers for population health. ",
doi="10.2196/44070",
url="https://publichealth.jmir.org/2023/1/e44070",
url="http://www.ncbi.nlm.nih.gov/pubmed/36989028"
}


@Article{info:doi/10.2196/41408,
author="Ndlovu, Kagiso
and Mauco, Leonard Kabelo
and Chibemba, Star
and Wanyee, Steven
and Oluoch, Tom",
title="Assessment of Stakeholder Perceptions and Attitudes Toward Health Data Governance Principles in Botswana: Web-Based Survey",
journal="JMIR Form Res",
year="2023",
month="Mar",
day="13",
volume="7",
pages="e41408",
keywords="health data",
keywords="governance",
keywords="Botswana",
keywords="digital health",
keywords="decision-making",
keywords="health care stakeholders",
keywords="perceptions",
keywords="health policy",
keywords="data governance",
keywords="data policy",
keywords="implementation",
abstract="Background: The use of information and communication technologies for health---eHealth---is described as having potential to improve the quality of health care service delivery. Consequently, there is an increased global trend toward?adoption of eHealth interventions by health care systems worldwide. Despite the proliferation of eHealth solutions, many health care institutions especially in transitioning countries are struggling to attain effective data governance approaches.?The Ministry of Health in?Botswana is an exemplar institution continually seeking better approaches to strengthen health data governance (HDG) approaches following the adoption of eHealth solutions. Recognizing the need for a global HDG framework, the Transform Health coalition conceptualized HDG principles that are structured around 3 interconnected objectives: protecting people, promoting the value of health, and prioritizing equity. Objective: The aim of the study is to solicit and evaluate perceptions and attitudes of health sector workers in Botswana toward the HDG principles by Transform Health and derive any future guidance. Methods: Purposive sampling was used to select participants. A total of 23 participants from various health care organizations in Botswana completed a web-based survey and 10 participated in a follow-up remote round-table discussion. The aim of the round-table discussion was to gain further insight into participants' responses from the web-based survey. Participants were from the following health care cadres: nurses, doctors, information technology professionals, and health informaticians. Both validity and reliability testing were performed for the survey tool before sharing it with study participants. An analysis of participants' close-ended responses from the survey?was performed using descriptive statistics. Thematic analysis of open-ended responses from the questionnaire?and the?round-table discussion was achieved using the Delve software and the widely accepted principles of thematic analysis. Results: Although some participants highlighted having measures in place similar to the HDG principles, there were some who either did not know or disagreed that their organizations already had in place mechanisms similar to the proposed HDG principles. Participants further expressed relevance and importance of the HDG principles in the context of Botswana.?However, some modifications to the principles were also suggested. Conclusions: This study highlights the necessity of data governance in health care particularly toward meeting the requirements for Universal Health Coverage. The existence of other health data governance frameworks calls for a critical analysis to assess the most appropriate and applicable framework in the context of Botswana and similar transitioning countries. An organization-centered approach may be most appropriate, as well as strengthening of existing organizations' HDG practices with the Transform Health principles. ",
doi="10.2196/41408",
url="https://formative.jmir.org/2023/1/e41408",
url="http://www.ncbi.nlm.nih.gov/pubmed/36912870"
}


@Article{info:doi/10.2196/42021,
author="Leonard, M. Sophia
and Zackula, Rosalee
and Wilcher, Jonathan",
title="Attitudes and Experiences of Clinicians After Mandated Implementation of Open Notes by the 21st Century Cures Act: Survey Study",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="28",
volume="25",
pages="e42021",
keywords="21st Century Cures Act",
keywords="Final Rule",
keywords="shared notes",
keywords="open notes",
keywords="OpenNotes",
keywords="health policy",
keywords="clinician opinion",
keywords="mobile phone",
abstract="Background: On December 13, 2016, the US Congress enacted the 21st Century Cures Act (hereafter the Cures Act), which contained the Final Rule mandate that took effect on April 5, 2021. Since then, health systems have been required to provide patients digital access to their eHealth information ``without delay'' and without charge. Objective: This study aimed to assess clinicians' initial experiences with, and attitudes toward, sharing visit notes with patients after being mandated to do so by the Cures Act and to determine clinician preferences regarding instant record release. Methods: This cross-sectional survey study was conducted between June 10, 2021, and August 15, 2021, at the University of Kansas Health System, a large academic medical center in Kansas City, Kansas, United States. Participants included clinicians currently employed by the health system, including resident and attending physicians, physician assistants, nurse practitioners, and critical care and emergency medicine registered nurses. Results: A total of 1574 attending physicians, physician assistants, and nurse practitioners, as well as 506 critical care and emergency medicine nurses, were sent invitations; 538 (34.18\%) and 72 (14.2\%), respectively, responded. Of 609 resident physicians, 4 (response rate not applicable because it was unknown how many residents viewed the website while the link was available) responded. The majority of respondents were attending physicians (402/614, 65.5\%) and within the department of internal medicine (160/614, 26.1\%). Most agreed that sharing visit notes was a good idea (355/613, 57.9\%) and that it is important to speak with the patients before they accessed their records (431/613, 70.3\%). Those who agreed that sharing visit notes is a good idea tended to view the practice as a useful tool for engaging patients (``Agree'': 139/355, 39.2\%; ``Somewhat agree'': 161/355, 45.4\%; P<.001) and experience no change in the clinical value of their notes for other clinicians (326/355, 91.8\%; P<.001). Those who disagreed (or were neutral) tended not to encourage patients to read their notes (235/258, 91.1\%; P<.001) and were more likely to experience a change in their charting practice (168/257, 65.4\%; P<.001) and increased time charting (99/258, 38.4\%; P<.001). Conclusions: The findings of this study may be generalizable to institutions similar to the University of Kansas Health System, and the clinician testimonies gathered in this study may provide valuable insight into the initial opinions and experiences of clinicians at these institutions. In addition, these clinician experiences collected early in the transition period may be used to guide future health policy implementation and to understand how best to prepare clinicians for these changes in practice. ",
doi="10.2196/42021",
url="https://www.jmir.org/2023/1/e42021",
url="http://www.ncbi.nlm.nih.gov/pubmed/36853747"
}


@Article{info:doi/10.2196/43754,
author="Rashi, Tsuriel
and Yom-Tov, Elad",
title="Ethics of Medical Archival Internet Research Data",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="31",
volume="25",
pages="e43754",
keywords="ethic",
keywords="archival internet research data",
keywords="three laws of robotics",
doi="10.2196/43754",
url="https://www.jmir.org/2023/1/e43754",
url="http://www.ncbi.nlm.nih.gov/pubmed/36719736"
}


@Article{info:doi/10.2196/39631,
author="Raj, Minakshi
and Ryan, Kerry
and Amara, Sahr Philip
and Nong, Paige
and Calhoun, Karen
and Trinidad, Grace M.
and Thiel, Daniel
and Spector-Bagdady, Kayte
and De Vries, Raymond
and Kardia, Sharon
and Platt, Jodyn",
title="Policy Preferences Regarding Health Data Sharing Among Patients With Cancer: Public Deliberations",
journal="JMIR Cancer",
year="2023",
month="Jan",
day="31",
volume="9",
pages="e39631",
keywords="public deliberation",
keywords="data sharing",
keywords="precision health",
keywords="health information exchange",
abstract="Background: Precision health offers the promise of advancing clinical care in data-driven, evidence-based, and personalized ways. However, complex data sharing infrastructures, for-profit (commercial) and nonprofit partnerships, and systems for data governance have been created with little attention to the values, expectations, and preferences of patients about how they want to be engaged in the sharing and use of their health information. We solicited patient opinions about institutional policy options using public deliberation methods to address this gap. Objective: We aimed to understand the policy preferences of current and former patients with cancer regarding the sharing of health information collected in the contexts of health information exchange and commercial partnerships and to identify the values invoked and perceived risks and benefits of health data sharing considered by the participants when formulating their policy preferences. Methods: We conducted 2 public deliberations, including predeliberation and postdeliberation surveys, with patients who had a current or former cancer diagnosis (n=61). Following informational presentations, the participants engaged in facilitated small-group deliberations to discuss and rank policy preferences related to health information sharing, such as the use of a patient portal, email or SMS text messaging, signage in health care settings, opting out of commercial data sharing, payment, and preservation of the status quo. The participants ranked their policy preferences individually, as small groups by mutual agreement, and then again individually in the postdeliberation survey. Results: After deliberation, the patient portal was ranked as the most preferred policy choice. The participants ranked no change in status quo as the least preferred policy option by a wide margin. Throughout the study, the participants expressed concerns about transparency and awareness, convenience, and accessibility of information about health data sharing. Concerns about the status quo centered around a lack of transparency, awareness, and control. Specifically, the patients were not aware of how, when, or why their data were being used and wanted more transparency in these regards as well as greater control and autonomy around the use of their health data. The deliberations suggested that patient portals would be a good place to provide additional information about data sharing practices but that over time, notifications should be tailored to patient preferences. Conclusions: Our study suggests the need for increased disclosure of health information sharing practices. Describing health data sharing practices through patient portals or other mechanisms personalized to patient preferences would minimize the concerns expressed by patients about the extent of data sharing that occurs without their knowledge. Future research and policies should identify ways to increase patient control over health data sharing without reducing the societal benefits of data sharing. ",
doi="10.2196/39631",
url="https://cancer.jmir.org/2023/1/e39631",
url="http://www.ncbi.nlm.nih.gov/pubmed/36719719"
}


@Article{info:doi/10.2196/42441,
author="Vassey, Julia
and Donaldson, I. Scott
and Dormanesh, Allison
and Allem, Jon-Patrick",
title="Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="16",
volume="24",
number="11",
pages="e42441",
keywords="cigarillo",
keywords="little cigar",
keywords="social media",
keywords="TikTok",
keywords="video",
keywords="cigar",
keywords="cigarette",
keywords="smoker",
keywords="smoking",
keywords="tobacco",
keywords="content analysis",
keywords="youth",
keywords="young adult",
keywords="adolescent",
keywords="user generated content",
abstract="Background: Little cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. Objective: This study analyzed LCC-related content on TikTok, an audio and video--based platform popular among youth. Methods: Publicly available posts (N=811) that contained the LCC-related hashtags \#swishersweets or \#backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. Results: Among the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5\%), followed by music (n=559, 68.9\%), youth (n=332, 40.9\%), humor (n=263, 32.4\%), LCC use (n=242, 29.8\%), flavors (n=232, 28.6\%), branding (n=182, 22.4\%), paraphernalia (n=137, 16.9\%), blunt rolling (n=94, 11.6\%), and price (n=84, 10.4\%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5\%), (2) youth (264/811, 32.6\%), (3) humor (219/811, 27\%), (4) flavors (214/811, 26.4\%), and (5) LCC use (207/811, 25.5\%). Conclusions: LCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok's community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform. ",
doi="10.2196/42441",
url="https://www.jmir.org/2022/11/e42441",
url="http://www.ncbi.nlm.nih.gov/pubmed/36383406"
}


@Article{info:doi/10.2196/42345,
author="Agarwal, Aneesh
and Han, Joseph
and Luu, Yen
and Gulati, Nicholas",
title="Medicare Opt-Out Trends Among Dermatologists May Reflect Systemic Health Policy: Cross-sectional Analysis",
journal="JMIR Dermatol",
year="2022",
month="Nov",
day="8",
volume="5",
number="4",
pages="e42345",
keywords="Medicare",
keywords="dermatology",
keywords="opt out",
keywords="private contracting",
keywords="",
keywords="CMS",
keywords="health policy",
keywords="insurance",
keywords="health coverage",
keywords="Medicaid",
abstract="Background: Provider opt-out of accepting Medicare insurance is a nationally tracked metric by the Centers for Medicare \& Medicaid Services (CMS) for all physicians, including dermatologists. Although this usually only consists of a small number of providers, the magnitude of opting out has varied historically, often tracing changes in systemic health care policy. Objective: In this paper, we explored dermatologist opt-out data since 2001, as reported by the CMS, to characterize trends and provide evidence that shifts in provider opt-out may represent a potential indicator of the state of health policy and possible needs for reform as it pertains to Medicare. Methods: The publicly available Opt Out Affidavits data set, available from the CMS, was evaluated for providers in all dermatologic specialties from January 1, 2001, to May 27, 2022. Results: There were a total of 196 dermatology opt-outs in the overall period, with the largest spike being 33 providers in 2016, followed by generally consistent decreases through 2021. In the most recent 12 months of data, the number of new monthly opt-outs from January 2022 to May 2022 was significantly higher than that of the trailing 7 months of 2021 (P=.03). Conclusions: Despite decreasing numbers of dermatologist opt-outs in the late-2010s, 2022 was marked by a significant increase in opt-outs. The reduced acceptance of Medicare by dermatologists may present risks to care access, so it is important to frequently assess physician opt-out data and changes over time. ",
doi="10.2196/42345",
url="https://derma.jmir.org/2022/4/e42345",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632903"
}


@Article{info:doi/10.2196/41750,
author="Mandel, C. Joshua
and Pollak, P. J.
and Mandl, D. Kenneth",
title="The Patient Role in a Federal National-Scale Health Information Exchange",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="4",
volume="24",
number="11",
pages="e41750",
keywords="health information exchange",
keywords="patient control",
keywords="Health Insurance Portability and Accountability Act",
keywords="HIPAA",
keywords="patient record",
keywords="information exchange",
keywords="information sharing",
keywords="health record",
keywords="privacy",
keywords="security",
keywords="public health",
keywords="health policy",
keywords="health information",
keywords="federal trusted exchange",
keywords="insurance company",
keywords="patient data",
doi="10.2196/41750",
url="https://www.jmir.org/2022/11/e41750",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331535"
}


@Article{info:doi/10.2196/37236,
author="Moln{\'a}r-G{\'a}bor, Fruzsina
and Beauvais, S. Michael J.
and Bernier, Alexander
and Jimenez, Nicolas Maria Pilar
and Recuero, Mikel
and Knoppers, Maria Bartha",
title="Bridging the European Data Sharing Divide in Genomic Science",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="19",
volume="24",
number="10",
pages="e37236",
keywords="international data transfer",
keywords="scientific research",
keywords="genomics",
keywords="safe data spaces",
keywords="data protection",
doi="10.2196/37236",
url="https://www.jmir.org/2022/10/e37236",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260387"
}


@Article{info:doi/10.2196/37887,
author="Weiss, Samuel Paul
and Waller, Allyn Lance",
title="The Impact of Nonrandom Missingness in Surveillance Data for Population-Level Summaries: Simulation Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Sep",
day="9",
volume="8",
number="9",
pages="e37887",
keywords="surveillance",
keywords="estimation",
keywords="missing data",
keywords="population-level estimates",
keywords="health policy",
keywords="public health policy",
keywords="estimates",
keywords="data",
keywords="policy decision",
keywords="bias",
keywords="response rate",
abstract="Background: Surveillance data are essential public health resources for guiding policy and allocation of human and capital resources. These data often consist of large collections of information based on nonrandom sample designs. Population estimates based on such data may be impacted by the underlying sample distribution compared to the true population of interest. In this study, we simulate a population of interest and allow response rates to vary in nonrandom ways to illustrate and measure the effect this has on population-based estimates of an important public health policy outcome. Objective: The aim of this study was to illustrate the effect of nonrandom missingness on population-based survey sample estimation. Methods: We simulated a population of respondents answering a survey question about their satisfaction with their community's policy regarding vaccination mandates for government personnel. We allowed response rates to differ between the generally satisfied and dissatisfied and considered the effect of common efforts to control for potential bias such as sampling weights, sample size inflation, and hypothesis tests for determining missingness at random. We compared these conditions via mean squared errors and sampling variability to characterize the bias in estimation arising under these different approaches. Results: Sample estimates present clear and quantifiable bias, even in the most favorable response profile. On a 5-point Likert scale, nonrandom missingness resulted in errors averaging to almost a full point away from the truth. Efforts to mitigate bias through sample size inflation and sampling weights have negligible effects on the overall results. Additionally, hypothesis testing for departures from random missingness rarely detect the nonrandom missingness across the widest range of response profiles considered. Conclusions: Our results suggest that assuming surveillance data are missing at random during analysis could provide estimates that are widely different from what we might see in the whole population. Policy decisions based on such potentially biased estimates could be devastating in terms of community disengagement and health disparities. Alternative approaches to analysis that move away from broad generalization of a mismeasured population at risk are necessary to identify the marginalized groups, where overall response may be very different from those observed in measured respondents. ",
doi="10.2196/37887",
url="https://publichealth.jmir.org/2022/9/e37887",
url="http://www.ncbi.nlm.nih.gov/pubmed/36083618"
}


@Article{info:doi/10.2196/32969,
author="Garrett, M. Paul
and White, P. Joshua
and Dennis, Simon
and Lewandowsky, Stephan
and Yang, Cheng-Ta
and Okan, Yasmina
and Perfors, Andrew
and Little, R. Daniel
and Kozyreva, Anastasia
and Lorenz-Spreen, Philipp
and Kusumi, Takashi
and Kashima, Yoshihisa",
title="Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys",
journal="JMIR Public Health Surveill",
year="2022",
month="Jul",
day="15",
volume="8",
number="7",
pages="e32969",
keywords="COVID-19",
keywords="immunity passport",
keywords="vaccination passport",
keywords="cross-cultural",
keywords="health policy",
keywords="digital certificates",
keywords="SARS-CoV-2",
keywords="vaccine",
keywords="policy",
keywords="international",
abstract="Background: In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. Objective: We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. Methods: We collected 13,678 participants through online representative sampling across six countries---Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom---during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. Results: Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43\%) and the United Kingdom (759/1484, 51.15\%); followed by Taiwan (2841/5989, 47.44\%), Australia (963/2086, 46.16\%), and Spain (693/1491, 46.48\%); and was the lowest in Japan (241/1081, 22.94\%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95\% CI 1.13-1.22), personal concern (OR 1.07, 95\% CI 1.00-1.16), perceived virus severity (OR 1.07, 95\% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95\% CI 2.36-2.66), liking immunity passports (OR 2.77, 95\% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95\% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95\% CI 0.82-0.98), immunity passport concern (OR 0.61, 95\% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95\% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. Conclusions: Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world. ",
doi="10.2196/32969",
url="https://publichealth.jmir.org/2022/7/e32969",
url="http://www.ncbi.nlm.nih.gov/pubmed/35377317"
}


@Article{info:doi/10.2196/37574,
author="Cuellar, Alison
and Pomeroy, Louise J. Mary
and Burla, Sriteja
and Jena, B. Anupam",
title="Outpatient Care Among Users and Nonusers of Direct-to-Patient Telehealth: Observational Study",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="6",
volume="24",
number="6",
pages="e37574",
keywords="telemedicine",
keywords="insurance",
keywords="policy",
keywords="telehealth",
keywords="user",
keywords="primary care",
keywords="outpatient",
keywords="claims",
keywords="in-person",
keywords="virtual",
keywords="insurer",
keywords="coverage",
abstract="Background: Expansion of telehealth insurance coverage is hampered by concerns that such coverage may encourage excessive use and spending. Objective: The aim of this paper is to examine whether users of telehealth services rely more on other forms of outpatient care than nonusers, and to estimate the differences in payment rates. Methods: We examined claims data from a large national insurer in 2017. We limited our analysis to patients with visits for 3 common diagnoses (N=660,546). We calculated the total number of visits per patient, overall, and by setting, and adjusted for patient- and county-level factors. Results: After multivariable adjustment, telehealth-visit users, compared to nonusers, had 0.44 fewer visits to primary care, 0.11 fewer visits to emergency departments, and 0.17 fewer visits to retail and urgent care. All estimates are statistically significant at P<.001. Average payment rates for telehealth visits were lower than all other settings. Conclusions: These findings suggest that telehealth visits may substitute rather than add to in-person care for some types of care. Our study suggests that telehealth visits may offer an efficient and less costly alternative. ",
doi="10.2196/37574",
url="https://www.jmir.org/2022/6/e37574",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666556"
}


@Article{info:doi/10.2196/30050,
author="Yeng, Kandabongee Prosper
and Fauzi, Ali Muhammad
and Sun, Luyi
and Yang, Bian",
title="Assessing the Legal Aspects of Information Security Requirements for Health Care in 3 Countries: Scoping Review and Framework Development",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="25",
volume="9",
number="2",
pages="e30050",
keywords="legal requirement",
keywords="information security",
keywords="healthcare",
keywords="security practice",
abstract="Background: The loss of human lives from cyberattacks in health care is no longer a probabilistic quantification but a reality that has begun. In addition, the threat scope is also expanding to involve a threat of national security, among others, resulting in surging data breaches within the health care sector. For that matter, there have been provisions of various legislation, regulations, and information security governance tools such as policies, standards, and directives toward enhancing health care information security--conscious care behavior among users. Meanwhile, in a research scenario, there are no comprehensive required security practices to serve as a yardstick in assessing security practices in health care. Moreover, an analysis of the holistic view of the requirements that need more concentration of management, end users, or both has not been comprehensively developed. Thus, there is a possibility that security practice research will leave out vital requirements. Objective: The objective of this study was to systematically identify, assess, and analyze the state-of-the-art information security requirements in health care. These requirements can be used to develop a framework to serve as a yardstick for measuring the future real security practices of health care staff. Methods: A scoping review was, as a result, adopted to identify, assess, and analyze the information security requirement sources within health care in Norway, Indonesia, and Ghana. Results: Of 188 security and privacy requirement sources that were initially identified, 130 (69.1\%) were fully read by the authors. Subsequently, of these 188 requirement documents, 82 (43.6\%) fully met the inclusion criteria and were accessed and analyzed. In total, 253 security and privacy requirements were identified in this work. The findings were then used to develop a framework to serve as a benchmark for modeling and analyzing health care security practices. Conclusions: On the basis of these findings, a framework for modeling, analyzing, and developing effective security countermeasures, including incentivization measures, was developed. Following this framework, research results of health care security practices would be more reliable and effective than relying on incomprehensive security requirements. ",
doi="10.2196/30050",
url="https://humanfactors.jmir.org/2022/2/e30050",
url="http://www.ncbi.nlm.nih.gov/pubmed/35612891"
}


@Article{info:doi/10.2196/36448,
author="Archer, Jessica
and Robinson, Luke
and Brown, Ted",
title="The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2022",
month="May",
day="13",
volume="11",
number="5",
pages="e36448",
keywords="allied health",
keywords="healthcare funding",
keywords="interprofessional collaboration",
keywords="integrated healthcare",
keywords="primary health",
keywords="primary care",
abstract="Background: Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding--related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic. Objective: The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels. Methods: A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures. Results: Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022. Conclusions: The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability. International Registered Report Identifier (IRRID): DERR1-10.2196/36448 ",
doi="10.2196/36448",
url="https://www.researchprotocols.org/2022/5/e36448",
url="http://www.ncbi.nlm.nih.gov/pubmed/35559853"
}


@Article{info:doi/10.2196/33240,
author="Mudaranthakam, Pal Dinesh
and Gajewski, Byron
and Krebill, Hope
and Coulter, James
and Springer, Michelle
and Calhoun, Elizabeth
and Hughes, Dorothy
and Mayo, Matthew
and Doolittle, Gary",
title="Barriers to Clinical Trial Participation: Comparative Study Between Rural and Urban Participants",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="21",
volume="8",
number="2",
pages="e33240",
keywords="rural residents",
keywords="clinical trials",
keywords="screening",
keywords="cancer",
keywords="patients",
keywords="lung cancer",
keywords="health policy epidemiology",
keywords="cancer patients",
keywords="electronic screening logs",
keywords="electronic screening",
abstract="Background: The National Clinical Trials Network program conducts phase 2 or phase 3 treatment trials across all National Cancer Institute's designated cancer centers. Participant accrual across these clinical trials is a critical factor in deciding their success. Cancer centers that cater to rural populations, such as The University of Kansas Cancer Center, have an additional responsibility to ensure rural residents have access and are well represented across these studies. Objective: There are scant data available regarding the factors that act as barriers to the accrual of rural residents in these clinical trials. This study aims to use electronic screening logs that were used to gather patient data at several participating sites in The Kansas University of Cancer Center's Catchment area. Methods: Screening log data were used to assess what clinical trial participation barriers are faced by these patients. Additionally, the differences in clinical trial participation barriers were compared between rural and urban participating sites. Results: Analysis revealed that the hospital location rural urban category, defined as whether the hospital was in an urban or rural setting, had a medium effect on enrolment of patients in breast cancer and lung cancer trials (Cohen d=0.7). Additionally, the hospital location category had a medium effect on the proportion of recurrent lung cancer cases at the time of screening (d=0.6). Conclusions: In consideration of the financially hostile nature of cancer treatment as well as geographical and transportation barriers, clinical trials extended to rural communities are uniquely positioned to alleviate the burden of nonmedical costs in trial participation. However, these options can be far less feasible for patients in rural settings. Since the number of patients with cancer who are eligible for a clinical trial is already limited by the stringent eligibility criteria required of such a complex disease, improving accessibility for rural patients should be a greater focus in health policy. ",
doi="10.2196/33240",
url="https://cancer.jmir.org/2022/2/e33240",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451964"
}


@Article{info:doi/10.2196/32678,
author="Medero, Kristina
and Merrill Jr, Kelly
and Ross, Quinn Morgan",
title="Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="15",
volume="24",
number="3",
pages="e32678",
keywords="Black",
keywords="African American",
keywords="first-level digital divide",
keywords="health disparities",
keywords="home computer",
keywords="internet access",
keywords="intersectionality",
keywords="Latino",
keywords="Latine",
keywords="Hispanic",
keywords="mobile",
keywords="online health information seeking",
keywords="public computer",
keywords="structural equation modeling",
keywords="work computer",
keywords="mobile phone",
abstract="Background: The digital divide refers to technological disparities based on demographic characteristics (eg, race and ethnicity). Lack of physical access to the internet inhibits online health information seeking (OHIS) and exacerbates health disparities. Research on the digital divide examines where and how people access the internet, whereas research on OHIS investigates how intersectional identities influence OHIS. We combine these perspectives to explicate how unique context--device access pairings operate differently across intersectional identities---particularly racial and ethnic groups---in the domain of OHIS. Objective: This study aims to examine how different types of internet access relate to OHIS for different racial and ethnic groups. We investigate relationships among predisposing characteristics (ie, age, sex, education, and income), internet access (home computer, public computer, work computer, and mobile), health needs, and OHIS. Methods: Analysis was conducted using data from the 2019 Health Information National Trends Survey. Our theoretical model of OHIS explicates the roles of internet access and health needs for racial and ethnic minority groups' OHIS. Participant responses were analyzed using structural equation modeling. Three separate group structural equation modeling models were specified based on Black, Latine, and White self-categorizations. Results: Overall, predisposing characteristics (ie, age, sex, education, and income) were associated with internet access, health needs, and OHIS; internet access was associated with OHIS; and health needs were associated with OHIS. Home computer and mobile access were most consistently associated with OHIS. Several notable linkages between predisposing characteristics and internet access differed for Black and Latine individuals. Older racial and ethnic minorities tended to access the internet on home and public computers less frequently; home computer access was a stronger predictor of OHIS for White individuals, and mobile access was a stronger predictor of OHIS for non-White individuals. Conclusions: Our findings necessitate a deeper unpacking of how physical internet access, the foundational and multifaceted level of the digital divide, affects specific racial and ethnic groups and their OHIS. We not only find support for prior work on the digital divide but also surface new insights, including distinct impacts of context--device access pairings for OHIS and several relationships that differ between racial and ethnic groups. As such, we propose interventions with an intersectional approach to access to ameliorate the impact of the digital divide. ",
doi="10.2196/32678",
url="https://www.jmir.org/2022/3/e32678",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289761"
}


@Article{info:doi/10.2196/24582,
author="Schlieter, Hannes
and Marsch, A. Lisa
and Whitehouse, Diane
and Otto, Lena
and Londral, Rita Ana
and Teepe, Wilhelm Gisbert
and Benedict, Martin
and Ollier, Joseph
and Ulmer, Tom
and Gasser, Nathalie
and Ultsch, Sabine
and Wollschlaeger, Bastian
and Kowatsch, Tobias",
title="Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="11",
volume="24",
number="3",
pages="e24582",
keywords="digital health",
keywords="health care delivery",
keywords="health interventions",
keywords="digital health services",
keywords="enablers",
keywords="barriers",
doi="10.2196/24582",
url="https://www.jmir.org/2022/3/e24582",
url="http://www.ncbi.nlm.nih.gov/pubmed/35275065"
}


@Article{info:doi/10.2196/31684,
author="Gao, Chuang
and McGilchrist, Mark
and Mumtaz, Shahzad
and Hall, Christopher
and Anderson, Ann Lesley
and Zurowski, John
and Gordon, Sharon
and Lumsden, Joanne
and Munro, Vicky
and Wozniak, Artur
and Sibley, Michael
and Banks, Christopher
and Duncan, Chris
and Linksted, Pamela
and Hume, Alastair
and Stables, L. Catherine
and Mayor, Charlie
and Caldwell, Jacqueline
and Wilde, Katie
and Cole, Christian
and Jefferson, Emily",
title="A National Network of Safe Havens: Scottish Perspective",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="9",
volume="24",
number="3",
pages="e31684",
keywords="electronic health records",
keywords="Safe Haven",
keywords="data governance",
doi="10.2196/31684",
url="https://www.jmir.org/2022/3/e31684",
url="http://www.ncbi.nlm.nih.gov/pubmed/35262495"
}


@Article{info:doi/10.2196/37419,
author="Stausberg, J{\"u}rgen
and Uslu, Aykut",
title="Authors' Reply to: Interpretation Bias Toward the Positive Impacts of Digital Interventions in Health Care. Comment on ``Value of the Electronic Medical Record for Hospital Care: Update From the Literature''",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="4",
volume="24",
number="3",
pages="e37419",
keywords="cost analysis",
keywords="costs and cost analyses",
keywords="economic advantage",
keywords="electronic medical records",
keywords="electronic records",
keywords="health care",
keywords="hospitals",
keywords="computerized medical records systems",
keywords="quality of health care",
keywords="secondary data",
doi="10.2196/37419",
url="https://www.jmir.org/2022/3/e37419",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254272"
}


@Article{info:doi/10.2196/37208,
author="Shakibaei Bonakdeh, Erfan",
title="Interpretation Bias Toward the Positive Impacts of Digital Interventions in Health Care. Comment on ``Value of the Electronic Medical Record for Hospital Care: Update From the Literature''",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="4",
volume="24",
number="3",
pages="e37208",
keywords="cost analysis",
keywords="costs and cost analyses",
keywords="economic advantage",
keywords="electronic medical records",
keywords="electronic records",
keywords="health care",
keywords="hospitals",
keywords="computerized medical records system",
keywords="quality of health care",
keywords="secondary data",
doi="10.2196/37208",
url="https://www.jmir.org/2022/3/e37208",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254276"
}


@Article{info:doi/10.2196/30524,
author="Kilgallon, L. John
and Tewarie, Ashwini Ishaan
and Broekman, D. Marike L.
and Rana, Aakanksha
and Smith, R. Timothy",
title="Passive Data Use for Ethical Digital Public Health Surveillance in a Postpandemic World",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="15",
volume="24",
number="2",
pages="e30524",
keywords="passive data",
keywords="public health surveillance",
keywords="digital public health surveillance",
keywords="pandemic response",
keywords="data privacy",
keywords="digital phenotyping",
keywords="smartphone",
keywords="mobile phone",
keywords="mHealth",
keywords="digital health",
keywords="informed consent",
keywords="data equity",
keywords="data ownership",
doi="10.2196/30524",
url="https://www.jmir.org/2022/2/e30524",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166676"
}


@Article{info:doi/10.2196/29541,
author="Garcia, P. Angely
and De La Vega, F. Shelley
and Mercado, P. Susan",
title="Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="14",
volume="24",
number="2",
pages="e29541",
keywords="health information systems",
keywords="the Philippines",
keywords="aged",
keywords="hospitals",
keywords="community health centers",
keywords="database",
keywords="geriatric assessment",
keywords="elderly",
keywords="digital health",
keywords="medical records",
keywords="health policy",
abstract="Background: The rapid aging of the world's population requires systems that support health facilities' provision of integrated care at multiple levels of the health care system. The use of health information systems (HISs) at the point of care has shown positive effects on clinical processes and patient health in several settings of care. Objective: We sought to describe HISs for older persons (OPs) in select government tertiary hospitals and health centers in the Philippines. Specifically, we aimed to review the existing policies and guidelines related to HISs for OPs in the country, determine the proportion of select government hospitals and health centers with existing health information specific for OPs, and describe the challenges related to HISs in select health facilities. Methods: We utilized the data derived from the findings of the Focused Interventions for Frail Older Adults Research and Development Project (FITforFrail), a cross-sectional and ethics committee--approved study. A facility-based listing of services and human resources specific to geriatric patients was conducted in purposively sampled 27 tertiary government hospitals identified as geriatric centers and 16 health centers across all regions in the Philippines. We also reviewed the existing policies and guidelines related to HISs for OPs in the country. Results: Based on the existing guidelines, multiple agencies were involved in the provision of services for OPs, with several records containing health information of OPs. However, there is no existing HIS specific for OPs in the country. Only 14 (52\%) of the 27 hospitals and 4 (25\%) of the 16 health centers conduct comprehensive geriatric assessment (CGA). All tertiary hospitals and health centers are able to maintain medical records of their patients, and almost all (26/27, 96\%) hospitals and all (16/16, 100\%) health centers have data on top causes of morbidity and mortality. Meanwhile, the presence of specific disease registries varied per hospitals and health centers. Challenges to HISs include the inability to update databases due to inadequately trained personnel, use of an offline facility--based HIS, an unstable internet connection, and technical issues and nonuniform reporting of categories for age group classification. Conclusions: Current HISs for OPs are characterized by fragmentation, multiple sources, and inaccessibility. Barriers to achieving appropriate HISs for OPs include the inability to update HISs in hospitals and health centers and a lack of standardization by age group and disease classification. Thus, we recommend a 1-person, 1-record electronic medical record system for OPs and the disaggregation and analysis across demographic and socioeconomic parameters to inform policies and programs that address the complex needs of OPs. CGA as a required routine procedure for all OPs and its integration with the existing HISs in the country are also recommended. ",
doi="10.2196/29541",
url="https://www.jmir.org/2022/2/e29541",
url="http://www.ncbi.nlm.nih.gov/pubmed/35156927"
}


@Article{info:doi/10.2196/30838,
author="Hartford, Anna
and Stein, J. Dan",
title="Attentional Harms and Digital Inequalities",
journal="JMIR Ment Health",
year="2022",
month="Feb",
day="11",
volume="9",
number="2",
pages="e30838",
keywords="digital inequalities",
keywords="attentional harms",
keywords="excessive internet use",
keywords="persuasive technologies",
keywords="internet ethics",
keywords="attention economies",
doi="10.2196/30838",
url="https://mental.jmir.org/2022/2/e30838",
url="http://www.ncbi.nlm.nih.gov/pubmed/35147504"
}


@Article{info:doi/10.2196/32392,
author="Tran, Minh Duc
and Thwaites, Louise C.
and Van Nuil, Ilo Jennifer
and McKnight, Jacob
and Luu, Phuoc An
and Paton, Chris
and ",
title="Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="9",
volume="24",
number="2",
pages="e32392",
keywords="digital health",
keywords="eHealth",
keywords="policy",
keywords="Vietnam",
keywords="hospital care",
keywords="data",
keywords="health",
keywords="electronic medical records",
keywords="standards",
keywords="compulsory",
keywords="patient ID",
keywords="administrative information",
keywords="health insurance ID",
keywords="mobile phone",
abstract="Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence--based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government's requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Th? Vi?n Ph{\'a}p Lu?t, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians' performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system's capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting. ",
doi="10.2196/32392",
url="https://www.jmir.org/2022/2/e32392",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138264"
}


@Article{info:doi/10.2196/31146,
author="Shen, X. Francis
and Silverman, C. Benjamin
and Monette, Patrick
and Kimble, Sara
and Rauch, L. Scott
and Baker, T. Justin",
title="An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="9",
volume="24",
number="2",
pages="e31146",
keywords="digital phenotyping",
keywords="computataional psychiatry",
keywords="ethics",
keywords="law",
keywords="privacy",
keywords="informed consent",
abstract="Background: Psychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data---on location, movement, email and text communications, and social media---with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI). Objective: The goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols. Methods: We explored the ELSI of digital health research in psychiatry, with a particular focus on what we label ``deep phenotyping'' psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue. Results: Consistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (``the Ethics Checklist''). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report. Conclusions: Deep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey. ",
doi="10.2196/31146",
url="https://www.jmir.org/2022/2/e31146",
url="http://www.ncbi.nlm.nih.gov/pubmed/35138261"
}


@Article{info:doi/10.2196/30755,
author="John, Oommen
and Sarbadhikari, Nath Suptendra
and Prabhu, Thanga
and Goel, Ashvini
and Thomas, Alexander
and Shroff, Sunil
and Allaudin, Fazilah
and Weerabaddana, Chaminda
and Alhuwail, Dari
and Koirala, Udaya
and Johnrose, Jayalal
and Codyre, Patricia
and Bleaden, Andy
and Singh, Shubnum
and Bajaj, Shuchin",
title="Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union",
journal="Interact J Med Res",
year="2022",
month="Feb",
day="8",
volume="11",
number="1",
pages="e30755",
keywords="telehealth policy and practice",
keywords="implementation lessons",
keywords="challenges in scaling up",
keywords="capacity building of human resources",
keywords="data privacy",
keywords="telehealth",
keywords="health policy",
keywords="telemedicine",
keywords="implementation",
keywords="challenges",
keywords="human resources",
keywords="digital health",
keywords="data security",
doi="10.2196/30755",
url="https://www.i-jmr.org/2022/1/e30755",
url="http://www.ncbi.nlm.nih.gov/pubmed/35133279"
}


@Article{info:doi/10.2196/33081,
author="Huang, Pei-hua
and Kim, Ki-hun
and Schermer, Maartje",
title="Ethical Issues of Digital Twins for Personalized Health Care Service: Preliminary Mapping Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="31",
volume="24",
number="1",
pages="e33081",
keywords="digital twins",
keywords="digital health",
keywords="personalized health care service",
keywords="data-driven health care",
keywords="value-sensitive design",
keywords="ethics of health care technology",
abstract="Background: The concept of digital twins has great potential for transforming the existing health care system by making it more personalized. As a convergence of health care, artificial intelligence, and information and communication technologies, personalized health care services that are developed under the concept of digital twins raise a myriad of ethical issues. Although some of the ethical issues are known to researchers working on digital health and personalized medicine, currently, there is no comprehensive review that maps the major ethical risks of digital twins for personalized health care services. Objective: This study aims to fill the research gap by identifying the major ethical risks of digital twins for personalized health care services. We first propose a working definition for digital twins for personalized health care services to facilitate future discussions on the ethical issues related to these emerging digital health services. We then develop a process-oriented ethical map to identify the major ethical risks in each of the different data processing phases. Methods: We resorted to the literature on eHealth, personalized medicine, precision medicine, and information engineering to identify potential issues and developed a process-oriented ethical map to structure the inquiry in a more systematic way. The ethical map allows us to see how each of the major ethical concerns emerges during the process of transforming raw data into valuable information. Developers of a digital twin for personalized health care service may use this map to identify ethical risks during the development stage in a more systematic way and can proactively address them. Results: This paper provides a working definition of digital twins for personalized health care services by identifying 3 features that distinguish the new application from other eHealth services. On the basis of the working definition, this paper further layouts 10 major operational problems and the corresponding ethical risks. Conclusions: It is challenging to address all the major ethical risks that a digital twin for a personalized health care service might encounter proactively without a conceptual map at hand. The process-oriented ethical map we propose here can assist the developers of digital twins for personalized health care services in analyzing ethical risks in a more systematic manner. ",
doi="10.2196/33081",
url="https://www.jmir.org/2022/1/e33081",
url="http://www.ncbi.nlm.nih.gov/pubmed/35099399"
}


@Article{info:doi/10.2196/31623,
author="Morley, Jessica
and Murphy, Lisa
and Mishra, Abhishek
and Joshi, Indra
and Karpathakis, Kassandra",
title="Governing Data and Artificial Intelligence for Health Care: Developing an International Understanding",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="31",
volume="6",
number="1",
pages="e31623",
keywords="digital health",
keywords="artificial intelligence",
keywords="health policy",
abstract="Background: Although advanced analytical techniques falling under the umbrella heading of artificial intelligence (AI) may improve health care, the use of AI in health raises safety and ethical concerns. There are currently no internationally recognized governance mechanisms (policies, ethical standards, evaluation, and regulation) for developing and using AI technologies in health care. A lack of international consensus creates technical and social barriers to the use of health AI while potentially hampering market competition. Objective: The aim of this study is to review current health data and AI governance mechanisms being developed or used by Global Digital Health Partnership (GDHP) member countries that commissioned this research, identify commonalities and gaps in approaches, identify examples of best practices, and understand the rationale for policies. Methods: Data were collected through a scoping review of academic literature and a thematic analysis of policy documents published by selected GDHP member countries. The findings from this data collection and the literature were used to inform semistructured interviews with key senior policy makers from GDHP member countries exploring their countries' experience of AI-driven technologies in health care and associated governance and inform a focus group with professionals working in international health and technology to discuss the themes and proposed policy recommendations. Policy recommendations were developed based on the aggregated research findings. Results: As this is an empirical research paper, we primarily focused on reporting the results of the interviews and the focus group. Semistructured interviews (n=10) and a focus group (n=6) revealed 4 core areas for international collaborations: leadership and oversight, a whole systems approach covering the entire AI pipeline from data collection to model deployment and use, standards and regulatory processes, and engagement with stakeholders and the public. There was a broad range of maturity in health AI activity among the participants, with varying data infrastructure, application of standards across the AI life cycle, and strategic approaches to both development and deployment. A demand for further consistency at the international level and policies was identified to support a robust innovation pipeline. In total, 13 policy recommendations were developed to support GDHP member countries in overcoming core AI governance barriers and establishing common ground for international collaboration. Conclusions: AI-driven technology research and development for health care outpaces the creation of supporting AI governance globally. International collaboration and coordination on AI governance for health care is needed to ensure coherent solutions and allow countries to support and benefit from each other's work. International bodies and initiatives have a leading role to play in the international conversation, including the production of tools and sharing of practical approaches to the use of AI-driven technologies for health care. ",
doi="10.2196/31623",
url="https://formative.jmir.org/2022/1/e31623",
url="http://www.ncbi.nlm.nih.gov/pubmed/35099403"
}


@Article{info:doi/10.2196/28870,
author="Neher, Margit
and Nyg{\aa}rdh, Annette
and Brostr{\"o}m, Anders
and Lundgren, Johan
and Johansson, Peter",
title="Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="28",
volume="24",
number="1",
pages="e28870",
keywords="clients",
keywords="computer-assisted therapy",
keywords="consultation telehealth",
keywords="decision-makers",
keywords="implementation",
keywords="patients",
keywords="politicians",
keywords="qualitative methods",
keywords="remote",
keywords="mobile phone",
abstract="Background: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth. ",
doi="10.2196/28870",
url="https://www.jmir.org/2022/1/e28870",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089139"
}


@Article{info:doi/10.2196/29880,
author="Vogt, Louise Emily
and Welch, M. Brandon
and Bunnell, E. Brian
and Barrera, F. Janelle
and Paige, R. Samantha
and Owens, Marisa
and Coffey, Patricia
and Diazgranados, Nancy
and Goldman, David",
title="Quantifying the Impact of COVID-19 on Telemedicine Utilization: Retrospective Observational Study",
journal="Interact J Med Res",
year="2022",
month="Jan",
day="28",
volume="11",
number="1",
pages="e29880",
keywords="telemedicine",
keywords="COVID-19",
keywords="utilization",
keywords="impact",
keywords="retrospective",
keywords="observational",
keywords="trend",
keywords="telehealth",
keywords="health policy",
keywords="policy",
abstract="Background: While telemedicine has been expanding over the past decade, the COVID-19--related restrictions regarding in-person care have led to unprecedented levels of telemedicine utilization. To the authors' knowledge, no studies to date have quantitatively analyzed both national and regional trends in telemedicine utilization during the pandemic, both of which have key implications for informing health policy. Objective: This study aimed to investigate how trends in telemedicine utilization changed across the course of the COVID-19 pandemic. Methods: Using data from doxy.me, the largest free telemedicine platform, and the NIH (National Institutes of Health) Clinical Center, the largest clinical research hospital in the United States, we assessed changes in total telemedicine minutes, new provider registrations, monthly sessions, and average session length from March to November 2020. We also conducted a state-level analysis of how telemedicine expansion differed by region. Results: National telemedicine utilization peaked in April 2020 at 291 million minutes and stabilized at 200 to 220 million monthly minutes from May to November 2020. Surges were strongest in New England and weakest in the South and West. Greater telemedicine expansion during the COVID-19 pandemic was geographically associated with fewer COVID-19 cases per capita. The nature of telemedicine visits also changed, as the average monthly visits per provider doubled and the average visit length decreased by 60\%. Conclusions: The COVID-19 pandemic led to an abrupt and subsequently sustained uptick in telemedicine utilization. Regional and institute-level differences in telemedicine utilization should be further investigated to inform policy and procedures for sustaining meaningful telemedicine use in clinical practice. ",
doi="10.2196/29880",
url="https://www.i-jmr.org/2022/1/e29880",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751158"
}


@Article{info:doi/10.2196/30749,
author="Plugge, Emma
and Burke, Danielle
and Czachorowski, Maciej
and Gutridge, Kerry
and Maxwell, Fiona
and McGrath, Nuala
and O'Mara, Oscar
and O'Moore, Eamonn
and Parkes, Julie",
title="Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey and Enhanced Outbreak Study",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="12",
volume="11",
number="1",
pages="e30749",
keywords="COVID-19",
keywords="epidemiology",
keywords="prison",
keywords="outbreak",
keywords="testing",
keywords="health inequalities",
keywords="SARS-CoV-2",
abstract="Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases. Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors. Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons. Results: The UK Government's Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants. Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons. International Registered Report Identifier (IRRID): DERR1-10.2196/30749 ",
doi="10.2196/30749",
url="https://www.researchprotocols.org/2022/1/e30749",
url="http://www.ncbi.nlm.nih.gov/pubmed/34751157"
}


@Article{info:doi/10.2196/25440,
author="Ulrich, Hannes
and Kock-Schoppenhauer, Ann-Kristin
and Deppenwiese, Noemi
and G{\"o}tt, Robert
and Kern, Jori
and Lablans, Martin
and Majeed, W. Raphael
and St{\"o}hr, R. Mark
and Stausberg, J{\"u}rgen
and Varghese, Julian
and Dugas, Martin
and Ingenerf, Josef",
title="Understanding the Nature of Metadata: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="11",
volume="24",
number="1",
pages="e25440",
keywords="metadata",
keywords="metadata definition",
keywords="systematic review",
keywords="data integration",
keywords="data identification",
keywords="data classification",
abstract="Background: Metadata are created to describe the corresponding data in a detailed and unambiguous way and is used for various applications in different research areas, for example, data identification and classification. However, a clear definition of metadata is crucial for further use. Unfortunately, extensive experience with the processing and management of metadata has shown that the term ``metadata'' and its use is not always unambiguous. Objective: This study aimed to understand the definition of metadata and the challenges resulting from metadata reuse. Methods: A systematic literature search was performed in this study following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting on systematic reviews. Five research questions were identified to streamline the review process, addressing metadata characteristics, metadata standards, use cases, and problems encountered. This review was preceded by a harmonization process to achieve a general understanding of the terms used. Results: The harmonization process resulted in a clear set of definitions for metadata processing focusing on data integration. The following literature review was conducted by 10 reviewers with different backgrounds and using the harmonized definitions. This study included 81 peer-reviewed papers from the last decade after applying various filtering steps to identify the most relevant papers. The 5 research questions could be answered, resulting in a broad overview of the standards, use cases, problems, and corresponding solutions for the application of metadata in different research areas. Conclusions: Metadata can be a powerful tool for identifying, describing, and processing information, but its meaningful creation is costly and challenging. This review process uncovered many standards, use cases, problems, and solutions for dealing with metadata. The presented harmonized definitions and the new schema have the potential to improve the classification and generation of metadata by creating a shared understanding of metadata and its context. ",
doi="10.2196/25440",
url="https://www.jmir.org/2022/1/e25440",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014967"
}


@Article{info:doi/10.2196/32220,
author="B{\o}nes, Erlend
and Granja, Concei{\c{c}}{\~a}o
and Solvoll, Terje",
title="Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="10",
volume="24",
number="1",
pages="e32220",
keywords="mental health",
keywords="FACT",
keywords="electronic health records",
keywords="eHealth",
keywords="FACT implementation",
keywords="EHR",
keywords="implementation",
keywords="assessment",
keywords="model",
keywords="community",
keywords="treatment",
keywords="policy",
keywords="regulation",
keywords="infrastructure",
keywords="literature",
keywords="challenge",
keywords="intervention",
abstract="Background: Flexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway. Objective: The objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams. Methods: We have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway. Results: FACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams. Conclusions: Weaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers. ",
doi="10.2196/32220",
url="https://www.jmir.org/2022/1/e32220",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006087"
}


@Article{info:doi/10.2196/31066,
author="Eum, Ji Nam
and Kim, Hyun Seung",
title="The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study",
journal="JMIR Public Health Surveill",
year="2022",
month="Jan",
day="7",
volume="8",
number="1",
pages="e31066",
keywords="health policy",
keywords="telehealth",
keywords="physical distancing",
keywords="disease transmission",
keywords="COVID-19",
abstract="Background: Despite worldwide efforts, control of COVID-19 transmission and its after effects is lagging. As seen from the cases of SARS-CoV-2 and influenza, worldwide crises associated with infections and their side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to identify the factors that can mitigate disease spread. We observed that the transmission speed and severity of consequences of COVID-19 varied substantially across countries, signaling the need for a country-level investigation. Objective: We aimed to investigate how distancing-enabling information and communications technology (ICT) infrastructure and medical ICT infrastructure, and related policies have affected the cumulative number of confirmed cases, fatality rate, and initial speed of transmission across different countries. Methods: We analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics, including demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density. Results: Our full sample analysis showed that implied telehealth policy, which refers to the lack of a specific telehealth-related policy but presence of a general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (P=.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7\%. Interestingly, stated telehealth policy, which refers to the existence of a specified telehealth policy, was found to not be associated with lower fatality rates (P=.30). Furthermore, countries with a government-run health website had 36\% fewer confirmed cases than those without it, when controlled for cultural characteristics (P=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (P=.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in the full sample analysis (P=.04), but not in the subsample analysis (P=.76), highlighting that distancing-enabling ICT is more useful in densely populated countries. Conclusions: Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians' autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics. ",
doi="10.2196/31066",
url="https://publichealth.jmir.org/2022/1/e31066",
url="http://www.ncbi.nlm.nih.gov/pubmed/34817392"
}


@Article{info:doi/10.2196/28762,
author="Garcia, Gracie
and Crenner, Christopher",
title="Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="7",
volume="9",
number="1",
pages="e28762",
keywords="electronic health records",
keywords="electronic medical records",
keywords="health information technology",
keywords="health information exchange",
keywords="health policy",
keywords="international",
keywords="emergency medicine",
keywords="medical informatics",
keywords="meaningful use",
keywords="burnout",
abstract="Background: The variability in physicians' attitudes regarding electronic health records (EHRs) is widely recognized. Both human and technological factors contribute to user satisfaction. This exploratory study considers these variables by comparing emergency medicine physician experiences with EHRs in the United States and Norway. Objective: This study is unique as it aims to compare individual experiences with EHRs. It creates an opportunity to expand perspective, challenge the unknown, and explore how this technology affects clinicians globally. Research often highlights the challenge that health information technology has created for users: Are the negative consequences of this technology shared among countries? Does it affect medical practice? What determines user satisfaction? Can this be measured internationally? Do specific factors account for similarities or differences? This study begins by investigating these questions by comparing cohort experiences. Fundamental differences between nations will also be addressed. Methods: We used semistructured, participant-driven, in-depth interviews (N=12) for data collection in conjunction with ethnographic observations. The conversations were recorded and transcribed. Texts were then analyzed using NVivo software (QSR International) to develop codes for direct comparison among countries. Comprehensive understanding of the data required triangulation, specifically using thematic and interpretive phenomenological analysis. Narrative analysis ensured appropriate context of the NVivo (QSR International) query results. Results: Each interview resulted in mixed discussions regarding the benefits and disadvantages of EHRs. All the physicians recognized health care's dependence on this technology. In Norway, physicians perceived more benefits compared with those based in the United States. Americans reported fewer benefits and disproportionally high disadvantages. Both cohorts believed that EHRs have increased user workload. However, this was mentioned 2.6 times more frequently by Americans (United States [n=40] vs Norway [n=15]). Financial influences regarding health information technology use were of great concern for American physicians but rarely mentioned among Norwegian physicians (United States [n=37] vs Norway [n=6]). Technology dysfunctions were the most common complaint from Norwegian physicians. Participants from each country noted increased frustration among older colleagues. Conclusions: Despite differences spanning geographical, organizational, and cultural boundaries, much is to be learned by comparing individual experiences. Both cohorts experienced EHR-related frustrations, although etiology differed. The overall number of complaints was significantly higher among American physicians. This study augments the idea that policy, regulation, and administration have compelling influence on user experience. Global EHR optimization requires additional investigation, and these results help to establish a foundation for future research. ",
doi="10.2196/28762",
url="https://humanfactors.jmir.org/2022/1/e28762",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994702"
}


@Article{info:doi/10.2196/29288,
author="Kang-Yi, D. Christina
and Page, Amy",
title="Purpose Formulation, Coalition Building, and Evidence Use in Public--Academic Partnerships: Web-Based Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="5",
volume="9",
number="1",
pages="e29288",
keywords="use of research evidence",
keywords="public care policy",
keywords="public--academic partnership",
keywords="partnership purpose formulation",
keywords="partnership coalition building",
keywords="youth mental health and well-being",
abstract="Background: Partnerships between academic institutions and public care agencies (public--academic partnerships [PAPs]) can promote effective policy making and care delivery. Public care agencies are often engaged in PAPs for evidence-informed policy making in health care. Previous research has reported essential partnership contextual factors and mechanisms that promote evidence-based policy making and practice in health care. However, the studies have not yet informed whether public care agency leaders' and academic researchers' perceptions of partnership purpose formulation and coalition building evolve through the PAP life cycle and whether public care agency leaders' use of research evidence differs through life cycle stages. Objective: This exploratory study aims to focus on PAPs designed to improve youth mental health and well-being outcomes. This study also aims to identify public care agency leaders' and academic researchers' perceptions of PAP purpose formulation (structure, goals, primary function, and agenda-setting process) and coalition building (mutual benefits, trust, convener's role, member role clarity, and conflict management) by PAP life cycle stage and examine whether public care agency leaders' use of research evidence differs according to the perception of PAP purpose formulation and coalition building through the PAP life cycle. Methods: A web-based survey of PAP experience was conducted by recruiting academic researchers (n=40) and public care agency leaders (n=26) who were engaged in PAPs for the past 10 years. Public care agency leaders additionally participated in the survey of the Structured Interview for Evidence Use scale (n=48). Results: Most public care agency leaders and academic researchers in PAPs formed, matured, and sustained perceived their PAP as having purpose formulation context well aligned with their organizational purpose formulation context, pursuing mutual benefits, having leadership representation and role clarity, having a higher level of trust, and knowing how to handle conflicts. Most PAPs across all life cycle stages crystallized another issue to focus, but not all PAPs with issue crystallization had purpose reformulation. Public care agency leaders who trusted academic researchers in their PAP had greater use of research evidence. Public care agency leaders in PAPs that had gone through new issue crystallization also showed greater use of research evidence compared with those that had not. Conclusions: To promote public care agency leaders' use of research evidence, focusing on developing trusting partnerships and continuously crystallizing PAP issues are important. International Registered Report Identifier (IRRID): RR2-10.2196/14382 ",
doi="10.2196/29288",
url="https://humanfactors.jmir.org/2022/1/e29288",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989678"
}


@Article{info:doi/10.2196/31752,
author="Kruse, Clemens
and Heinemann, Katharine",
title="Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="4",
volume="24",
number="1",
pages="e31752",
keywords="telemedicine",
keywords="pandemic",
keywords="technology acceptance",
keywords="COVID-19",
keywords="digital health",
keywords="telehealth",
keywords="health policy",
keywords="health care",
abstract="Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective: The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods: The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22\% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27\% reported an improvement in administrative or efficiency results (as compared with a control group), 14\% reported no statistically significant difference from the control group, and 40\% and 10\% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted. ",
doi="10.2196/31752",
url="https://www.jmir.org/2022/1/e31752",
url="http://www.ncbi.nlm.nih.gov/pubmed/34854815"
}


@Article{info:doi/10.2196/20466,
author="Silva, Patr{\'i}cia
and Delerue Matos, Alice
and Martinez-Pecino, Roberto",
title="The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="3",
volume="24",
number="1",
pages="e20466",
keywords="social isolation",
keywords="internet",
keywords="50+ individuals",
keywords="e-inclusion",
keywords="SHARE",
abstract="Background: Social isolation has a negative impact on the quality of life of older people; therefore, studies have focused on identifying its sociodemographic, economic, and health determinants. In view of the growing importance of the internet as a means of communication, it is essential to assess whether internet use interferes with social isolation. Objective: This study specifically aims to clarify the relationship between internet use and social isolation of individuals aged ?50 years, for which other surveys present contradictory results. Methods: We performed logistic regression analysis with social isolation as the dependent variable, internet use as the interest variable, and several other sociodemographic, economic, and health characteristics of the individuals as control variables. The sample size was 67,173 individuals aged 50 years and older from 17 European countries (Portugal, Greece, Italy, Spain, Denmark, Sweden, Austria, Belgium, France, Germany, Switzerland, Luxemburg, Poland, Czech Republic, Slovenia, Estonia, and Croatia) plus Israel, who were interviewed in the Survey of Health, Ageing and Retirement in Europe (SHARE), wave 6. Results: The results show that countries differ in the level of social isolation and rate of internet use by individuals aged 50 years and older. They also evidence that in most of the countries analyzed, social isolation of internet users was lower compared to that of nonusers after controlling for a set of sociodemographic, economic, and health characteristics of the individuals that have been previously described in the literature as determinants of social isolation. Indeed, on average, although 31.4\% of individuals in the nonuser group experienced high social isolation, only 12.9\% of individuals who used the internet experienced this condition. Conclusions: Internet users show lower social isolation. This result underlines the importance of promoting e-inclusion in Europe as a way to counter social isolation of individuals aged 50 years and older. ",
doi="10.2196/20466",
url="https://www.jmir.org/2022/1/e20466",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982040"
}


@Article{info:doi/10.2196/31633,
author="Zhang, Dongsong
and Lim, Jaewan
and Zhou, Lina
and Dahl, A. Alicia",
title="Breaking the Data Value-Privacy Paradox in Mobile Mental Health Systems Through User-Centered Privacy Protection: A Web-Based Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="24",
volume="8",
number="12",
pages="e31633",
keywords="mobile apps",
keywords="mental health",
keywords="privacy concerns",
keywords="privacy protection",
keywords="mobile phone",
abstract="Background: Mobile mental health systems (MMHS) have been increasingly developed and deployed in support of monitoring, management, and intervention with regard to patients with mental disorders. However, many of these systems rely on patient data collected by smartphones or other wearable devices to infer patients' mental status, which raises privacy concerns. Such a value-privacy paradox poses significant challenges to patients' adoption and use of MMHS; yet, there has been limited understanding of it. Objective: To address the significant literature gap, this research aims to investigate both the antecedents of patients' privacy concerns and the effects of privacy concerns on their continuous usage intention with regard to MMHS. Methods: Using a web-based survey, this research collected data from 170 participants with MMHS experience recruited from online mental health communities and a university community. The data analyses used both repeated analysis of variance and partial least squares regression. Results: The results showed that data type (P=.003), data stage (P<.001), privacy victimization experience (P=.01), and privacy awareness (P=.08) have positive effects on privacy concerns. Specifically, users report higher privacy concerns for social interaction data (P=.007) and self-reported data (P=.001) than for biometrics data; privacy concerns are higher for data transmission (P=.01) and data sharing (P<.001) than for data collection. Our results also reveal that privacy concerns have an effect on attitude toward privacy protection (P=.001), which in turn affects continuous usage intention with regard to MMHS. Conclusions: This study contributes to the literature by deepening our understanding of the data value-privacy paradox in MMHS research. The findings offer practical guidelines for breaking the paradox through the design of user-centered and privacy-preserving MMHS. ",
doi="10.2196/31633",
url="https://mental.jmir.org/2021/12/e31633",
url="http://www.ncbi.nlm.nih.gov/pubmed/34951604"
}


@Article{info:doi/10.2196/26323,
author="Uslu, Aykut
and Stausberg, J{\"u}rgen",
title="Value of the Electronic Medical Record for Hospital Care: Update From the Literature",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e26323",
keywords="cost analysis",
keywords="costs and cost analyses",
keywords="economic advantage",
keywords="electronic medical records",
keywords="electronic records",
keywords="health care",
keywords="hospitals",
keywords="medical records systems computerized",
keywords="quality of health care",
keywords="secondary data",
abstract="Background: Electronic records could improve quality and efficiency of health care. National and international bodies propagate this belief worldwide. However, the evidence base concerning the effects and advantages of electronic records is questionable. The outcome of health care systems is influenced by many components, making assertions about specific types of interventions difficult. Moreover, electronic records itself constitute a complex intervention offering several functions with possibly positive as well as negative effects on the outcome of health care systems. Objective: The aim of this review is to summarize empirical studies about the value of electronic medical records (EMRs) for hospital care published between 2010 and spring 2019. Methods: The authors adopted their method from a series of literature reviews. The literature search was performed on MEDLINE with ``Medical Record System, Computerized'' as the essential keyword. The selection process comprised 2 phases looking for a consent of both authors. Starting with 1345 references, 23 were finally included in the review. The evaluation combined a scoring of the studies' quality, a description of data sources in case of secondary data analyses, and a qualitative assessment of the publications' conclusions concerning the medical record's impact on quality and efficiency of health care. Results: The majority of the studies stemmed from the United States (19/23, 83\%). Mostly, the studies used publicly available data (``secondary data studies''; 17/23, 74\%). A total of 18 studies analyzed the effect of an EMR on the quality of health care (78\%), 16 the effect on the efficiency of health care (70\%). The primary data studies achieved a mean score of 4.3 (SD 1.37; theoretical maximum 10); the secondary data studies a mean score of 7.1 (SD 1.26; theoretical maximum 9). From the primary data studies, 2 demonstrated a reduction of costs. There was not one study that failed to demonstrate a positive effect on the quality of health care. Overall, 9/16 respective studies showed a reduction of costs (56\%); 14/18 studies showed an increase of health care quality (78\%); the remaining 4 studies missed explicit information about the proposed positive effect. Conclusions: This review revealed a clear evidence about the value of EMRs. In addition to an awesome majority of economic advantages, the review also showed improvements in quality of care by all respective studies. The use of secondary data studies has prevailed over primary data studies in the meantime. Future work could focus on specific aspects of electronic records to guide their implementation and operation. ",
doi="10.2196/26323",
url="https://www.jmir.org/2021/12/e26323",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941544"
}


@Article{info:doi/10.2196/31702,
author="Grout, Leah
and Telfer, Kendra
and Wilson, Nick
and Cleghorn, Christine
and Mizdrak, Anja",
title="Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e31702",
keywords="physical activity",
keywords="smartphone apps",
keywords="mobile health",
keywords="mHealth",
keywords="modeling",
keywords="primary care",
keywords="mobile phone",
abstract="Background: Inadequate physical activity is a substantial cause of health loss worldwide, and this loss is attributable to diseases such as coronary heart disease, diabetes, stroke, and certain forms of cancer. Objective: This study aims to assess the potential impact of the prescription of smartphone apps in primary care settings on physical activity levels, health gains (in quality-adjusted life years [QALYs]), and health system costs in New Zealand (NZ). Methods: A proportional multistate lifetable model was used to estimate the change in physical activity levels and predict the resultant health gains in QALYs and health system costs over the remaining life span of the NZ population alive in 2011 at a 3\% discount rate. Results: The modeled intervention resulted in an estimated 430 QALYs gained (95\% uncertainty interval 320-550), with net cost savings of 2011 NZ \$2.2 million (2011 US \$1.5 million) over the remaining life span of the 2011 NZ population. On a per capita basis, QALY gains were generally larger in women than in men and larger in M?ori than in non-M?ori. The health impact and cost-effectiveness of the intervention were highly sensitive to assumptions on intervention uptake and decay. For example, the scenario analysis with the largest benefits, which assumed a 5-year maintenance of additional physical activity levels, delivered 1750 QALYs and 2011 NZ \$22.5 million (2011 US \$15.1 million) in cost savings. Conclusions: The prescription of smartphone apps for promoting physical activity in primary care settings is likely to generate modest health gains and cost savings at the population level in this high-income country. Such gains may increase with ongoing improvements in app design and increased health worker promotion of the apps to patients. ",
doi="10.2196/31702",
url="https://www.jmir.org/2021/12/e31702",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931993"
}


@Article{info:doi/10.2196/31510,
author="Warin, Thierry",
title="Global Research on Coronaviruses: Metadata-Based Analysis for Public Health Policies",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="30",
volume="9",
number="11",
pages="e31510",
keywords="COVID-19",
keywords="SARS-CoV-2",
keywords="natural language processing",
keywords="coronavirus",
keywords="unstructured data",
keywords="data science",
keywords="health 4.0",
abstract="Background: Within the context of the COVID-19 pandemic, this paper suggests a data science strategy for analyzing global research on coronaviruses. The application of reproducible research principles founded on text-as-data information, open science, the dissemination of scientific data, and easy access to scientific production may aid public health in the fight against the virus. Objective: The primary goal of this paper was to use global research on coronaviruses to identify critical elements that can help inform public health policy decisions. We present a data science framework to assist policy makers in implementing cutting-edge data science techniques for the purpose of developing evidence-based public health policies. Methods: We used the EpiBibR (epidemiology-based bibliography for R) package to gain access to coronavirus research documents worldwide (N=121,231) and their associated metadata. To analyze these data, we first employed a theoretical framework to group the findings into three categories: conceptual, intellectual, and social. Second, we mapped the results of our analysis in these three dimensions using machine learning techniques (ie, natural language processing) and social network analysis. Results: Our findings, firstly, were methodological in nature. They demonstrated the potential for the proposed data science framework to be applied to public health policies. Additionally, our findings indicated that the United States and China were the primary contributors to global coronavirus research during the study period. They also demonstrated that India and Europe were significant contributors, albeit in a secondary position. University collaborations in this domain were strong between the United States, Canada, and the United Kingdom, confirming the country-level findings. Conclusions: Our findings argue for a data-driven approach to public health policy, particularly when efficient and relevant research is required. Text mining techniques can assist policy makers in calculating evidence-based indices and informing their decision-making process regarding specific actions necessary for effective health responses. ",
doi="10.2196/31510",
url="https://medinform.jmir.org/2021/11/e31510",
url="http://www.ncbi.nlm.nih.gov/pubmed/34596570"
}


@Article{info:doi/10.2196/20652,
author="Ceross, Aaron
and Bergmann, Jeroen",
title="Tracking the Presence of Software as a Medical Device in US Food and Drug Administration Databases: Retrospective Data Analysis",
journal="JMIR Biomed Eng",
year="2021",
month="Nov",
day="3",
volume="6",
number="4",
pages="e20652",
keywords="regulation",
keywords="software",
keywords="medical device",
abstract="Background: Software as a medical device (SaMD) has gained the attention of medical device regulatory bodies as the prospects of standalone software for use in diagnositic and therapeutic settings have increased. However, to date, figures related to SaMD have not been made available by regulators, which limits the understanding of how prevalent these devices are and what actions should be taken to regulate them. Objective: The aim of this study is to empirically evaluate the market approvals and clearances related to SaMD and identify adverse incidents related to these devices. Methods: Using databases managed by the US medical device regulator, the US Food and Drug Administration (FDA), we identified the counts of SaMD registered with the FDA since 2016 through the use of product codes, mapped the path SaMD takes toward classification, and recorded adverse events. Results: SaMD does not seem to be registered at a rate dissimilar to that of other medical devices; thus, adverse events for SaMD only comprise a small portion of the total reported number. Conclusions: Although SaMD has been identified in the literature as an area of development, our analysis suggests that this growth has been modest. These devices are overwhelmingly classified as moderate to high risk, and they take a very particular path to that classification. The digital revolution in health care is less pronounced when evidence related to SaMD is considered. In general, the addition of SaMD to the medical device market seems to mimic that of other medical devices. ",
doi="10.2196/20652",
url="https://biomedeng.jmir.org/2021/4/e20652"
}


@Article{info:doi/10.2196/28069,
author="Haupt, Robert Michael
and Xu, Qing
and Yang, Joshua
and Cai, Mingxiang
and Mackey, K. Tim",
title="Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="29",
volume="23",
number="10",
pages="e28069",
keywords="vaping",
keywords="alternative tobacco industry",
keywords="e-cigarettes",
keywords="Facebook",
keywords="social network analysis",
keywords="social networks",
keywords="ehealth",
keywords="health policy",
abstract="Background: In response to recent policy efforts to regulate tobacco and vaping products, the vaping industry has been aggressive in mobilizing opposition by using a network of manufacturers, trade associations, and tobacco user communities, and by appealing to the general public. One strategy the alternative tobacco industry uses to mobilize political action is coordinating on social media platforms, such as the social networking site Facebook. However, few studies have specifically assessed how platforms such as Facebook are used to influence public sentiment and attitudes towards tobacco control policy. Objective: This study used social network analysis to examine how the alternative tobacco industry uses Facebook to mobilize online users to influence tobacco control policy outcomes with a focus on the state of California. Methods: Data were collected from local and national alternative tobacco Facebook groups that had affiliations with activities in the state of California. Network ties were constructed based on users' reactions to posts (eg, ``like'' and ``love'') and comments to characterize political mobilization networks. Results: Findings show that alternative tobacco industry employees were more likely to engage within these networks and that these employees were also more likely to be influential members (ie, be more active) in the network. Comparisons between subnetworks show that communication within the local alternative tobacco advocacy group network was less dense and more centralized in contrast to a national advocacy group that had overall higher levels of engagement among members. A timeline analysis found that a higher number of influential posts that disseminated widely across networks occurred during e-cigarette--related legislative events, suggesting strategic online engagement and increased mobilization of online activity for the purposes of influencing policy outcomes. Conclusions: Results from this study provide important insights into how tobacco industry--related advocacy groups leverage the Facebook platform to mobilize their online constituents in an effort to influence public perceptions and coordinate to defeat tobacco control efforts at the local, state, and federal level. Study results reveal one part of a vast network of socially enabled alternative tobacco industry actors and constituents that use Facebook as a mobilization point to support goals of the alternative tobacco industry. ",
doi="10.2196/28069",
url="https://www.jmir.org/2021/10/e28069",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714245"
}


@Article{info:doi/10.2196/30545,
author="Gilbert, Stephen
and Fenech, Matthew
and Hirsch, Martin
and Upadhyay, Shubhanan
and Biasiucci, Andrea
and Starlinger, Johannes",
title="Algorithm Change Protocols in the Regulation of Adaptive Machine Learning--Based Medical Devices",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="26",
volume="23",
number="10",
pages="e30545",
keywords="artificial intelligence",
keywords="machine learning",
keywords="regulation",
keywords="algorithm change protocol",
keywords="healthcare",
keywords="regulatory framework",
keywords="health care",
doi="10.2196/30545",
url="https://www.jmir.org/2021/10/e30545",
url="http://www.ncbi.nlm.nih.gov/pubmed/34697010"
}


@Article{info:doi/10.2196/29984,
author="Marshall, Gard Emily
and Breton, Mylaine
and Cossette, Benoit
and Isenor, Jennifer
and Mathews, Maria
and Ayn, Caitlyn
and Smithman, Ann M{\'e}lanie
and Stock, David
and Frymire, Eliot
and Edwards, Lynn
and Green, Michael",
title="Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="13",
volume="10",
number="10",
pages="e29984",
keywords="primary care",
keywords="health services research",
keywords="health policy",
keywords="mixed methods research",
keywords="COVID-19",
keywords="protocol",
keywords="policy",
keywords="longitudinal",
keywords="coordination",
keywords="access",
keywords="impact",
keywords="virtual care",
keywords="virtual health",
keywords="Canada",
abstract="Background: The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. Objective: The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. Methods: The PUPPY study builds on an existing research program exploring patients' access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. Results: This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences \& Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Qu{\'e}bec (Centre int{\'e}gr{\'e} universitaire de sant{\'e} et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. Conclusions: To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient's attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. International Registered Report Identifier (IRRID): DERR1-10.2196/29984 ",
doi="10.2196/29984",
url="https://www.researchprotocols.org/2021/10/e29984",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559672"
}


@Article{info:doi/10.2196/26317,
author="LaMonica, M. Haley
and Roberts, E. Anna
and Lee, Yeeun Grace
and Davenport, A. Tracey
and Hickie, B. Ian",
title="Privacy Practices of Health Information Technologies: Privacy Policy Risk Assessment Study and Proposed Guidelines",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e26317",
keywords="privacy",
keywords="mental health",
keywords="technology",
keywords="digital tools",
keywords="smartphone",
keywords="apps",
abstract="Background: Along with the proliferation of health information technologies (HITs), there is a growing need to understand the potential privacy risks associated with using such tools. Although privacy policies are designed to inform consumers, such policies have consistently been found to be confusing and lack transparency. Objective: This study aims to present consumer preferences for accessing privacy information; develop and apply a privacy policy risk assessment tool to assess whether existing HITs meet the recommended privacy policy standards; and propose guidelines to assist health professionals and service providers with understanding the privacy risks associated with HITs, so that they can confidently promote their safe use as a part of care. Methods: In phase 1, participatory design workshops were conducted with young people who were attending a participating headspace center, their supportive others, and health professionals and service providers from the centers. The findings were knowledge translated to determine participant preferences for the presentation and availability of privacy information and the functionality required to support its delivery. Phase 2 included the development of the 23-item privacy policy risk assessment tool, which incorporated material from international privacy literature and standards. This tool was then used to assess the privacy policies of 34 apps and e-tools. In phase 3, privacy guidelines, which were derived from learnings from a collaborative consultation process with key stakeholders, were developed to assist health professionals and service providers with understanding the privacy risks associated with incorporating HITs as a part of clinical care. Results: When considering the use of HITs, the participatory design workshop participants indicated that they wanted privacy information to be easily accessible, transparent, and user-friendly to enable them to clearly understand what personal and health information will be collected and how these data will be shared and stored. The privacy policy review revealed consistently poor readability and transparency, which limited the utility of these documents as a source of information. Therefore, to enable informed consent, the privacy guidelines provided ensure that health professionals and consumers are fully aware of the potential for privacy risks in using HITs to support health and well-being. Conclusions: A lack of transparency in privacy policies has the potential to undermine consumers' ability to trust that the necessary measures are in place to secure and protect the privacy of their personal and health information, thus precluding their willingness to engage with HITs. The application of the privacy guidelines will improve the confidence of health professionals and service providers in the privacy of consumer data, thus enabling them to recommend HITs to provide or support care. ",
doi="10.2196/26317",
url="https://www.jmir.org/2021/9/e26317",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528895"
}


@Article{info:doi/10.2196/26887,
author="Patel, N. Kunal
and Mazurenko, Olena
and Ford, Eric",
title="Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="19",
volume="5",
number="8",
pages="e26887",
keywords="chargemaster",
keywords="standard charge",
keywords="price transparency",
keywords="health care",
keywords="diagnosis-related group",
keywords="DRG",
keywords="quality measures",
keywords="the Centers for Medicare and Medicaid Services regulation",
keywords="CMS",
abstract="Background: The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective: This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods: In this cross-sectional study, we collected and analyzed a random 5.02\% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results: We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality ($\beta$=.929; P<.001) and readmissions ($\beta$=.514; P<.001). Other quality indicators, such as the effectiveness of care ($\beta$=?.919; P<.001), efficient use of medical imaging ($\beta$=?.458; P=.001), and patient recommendation scores ($\beta$=?.414; P<.001), were negatively associated with standard charges. Conclusions: We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100\% of US hospital prices posted publicly on the internet and their relationship with quality measures. ",
doi="10.2196/26887",
url="https://formative.jmir.org/2021/8/e26887",
url="http://www.ncbi.nlm.nih.gov/pubmed/34420914"
}


@Article{info:doi/10.2196/24523,
author="Mohd Hanim, Faiz Muhammad
and Md Sabri, Aslinie Budi
and Yusof, Norashikin",
title="Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis",
journal="JMIR Public Health Surveill",
year="2021",
month="Aug",
day="18",
volume="7",
number="8",
pages="e24523",
keywords="sugar-sweetened beverages",
keywords="obesity",
keywords="taxes",
keywords="media content analysis",
keywords="public health policy",
keywords="media content",
keywords="public health",
keywords="netnography",
keywords="malaysia",
keywords="budget",
abstract="Background: In Malaysia, the Sugar-Sweetened Beverages (SSBs) tax was announced during the parliament's 2019 Budget Speech. The tax was slated to be enforced by April 2019 but was later postponed to July 2019. The announcement has since generated significant media coverage and public feedback. Objective: This study presents a qualitative and quantitative cross-sectional study using netnography to examine how Malaysian online news articles responded to the SSBs tax after the announcement and postimplementation. Methods: Online news articles published on popular online news platforms from November 2018 to August 2019 were downloaded using NCapture and imported into NVivo for analysis using the inductive approach and thematic content analysis following the initial SSBs implementation announcement. Results: A total of 62 news articles were analyzed. Most of the articles positively portrayed the SSBs tax (46.8\%) and highlighted its health impacts (76\%). There were 7 key framing arguments identified in the articles. The positive arguments revolved around incentivizing manufacturers to introduce healthier products voluntarily, positive health consequences, the tax's impact on government revenue, and the use of the generated revenue toward beneficial social programs. The opposing arguments included increased operating costs to the manufacturer, the increased retail price of drinks, and how the SSBs tax is not a robust solution to obesity. The top priority sector considered in introducing the tax was the health perspective, followed by economic purposes and creating policies such as regulating the food and drinks industry. Conclusions: The majority of online news articles positively reported the implementation of the SSBs tax in Malaysia. This suggests media played a role in garnering support for the health policy. As such, relevant bodies can use negative findings to anticipate and reframe counteracting arguments opposing the SSBs tax. ",
doi="10.2196/24523",
url="https://publichealth.jmir.org/2021/8/e24523",
url="http://www.ncbi.nlm.nih.gov/pubmed/34406125"
}


@Article{info:doi/10.2196/29759,
author="Chaney, Cunard Sarah
and Mechael, Patricia
and Thu, Myo Nay
and Diallo, S. Mamadou
and Gachen, Carine",
title="Every Child on the Map: A Theory of Change Framework for Improving Childhood Immunization Coverage and Equity Using Geospatial Data and Technologies",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="3",
volume="23",
number="8",
pages="e29759",
keywords="geospatial data",
keywords="immunization",
keywords="health information systems",
keywords="service delivery",
keywords="equity mapping",
keywords="theory",
keywords="framework",
keywords="children",
keywords="vaccine",
keywords="equity",
keywords="geospatial",
keywords="data",
keywords="outcome",
keywords="coverage",
keywords="low- and middle-income",
keywords="LMIC",
doi="10.2196/29759",
url="https://www.jmir.org/2021/8/e29759",
url="http://www.ncbi.nlm.nih.gov/pubmed/34342584"
}


@Article{info:doi/10.2196/23779,
author="Yang, Feng
and Shu, Huilin
and Zhang, Xiaoqian",
title="Understanding ``Internet Plus Healthcare'' in China: Policy Text Analysis",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="26",
volume="23",
number="7",
pages="e23779",
keywords="internet plus health care",
keywords="China",
keywords="policy analysis",
keywords="COVID-19",
keywords="epidemic",
abstract="Background: The combination of the internet and healthcare has excellent benefits and far-reaching positive effects in improving service efficiency and promoting social equity. The role of the ``internet plus healthcare'' (IPHC) has been recognized, especially during the COVID-19 pandemic. This new healthcare model is also familiar to people and shows a bright prospect. Objective: This article seeks to accurately understand and fully grasp the characteristics of IPHC policies that can enlighten the formulation of future policies. Methods: The content analysis method was used to analyze China's IPHC policies collected from the Beida Fabao database and several official websites. Results: We found that the development of IPHC policy has gone through 4 stages and is currently entering a phase of rapid development. IPHC policymakers are primarily health administrative departments. In addition, policy instruments are classified into either supply, environment, or demand, and policy themes can be summarized into 4 categories: facilities, technology, service, and management. Conclusions: China's IPHC policy has good prospects from the perspective of development trends. The health administrative departments mainly lead the development of China's IPHC policy. It is suggested that these departments involve other stakeholders (ie, medical workers, medical industries, and technology sectors) in formulating policies. Policies prefer to use supply-based and environment-based policy instruments. The policy themes emphasize improving infrastructure construction and high-quality diagnostic and treatment services, strengthening the supporting role of information technology, and ensuring all stakeholders understand their responsibilities. ",
doi="10.2196/23779",
url="https://www.jmir.org/2021/7/e23779",
url="http://www.ncbi.nlm.nih.gov/pubmed/34309581"
}


@Article{info:doi/10.2196/22330,
author="Lai, Yunfeng
and Chen, Shengqi
and Li, Meng
and Ung, Lam Carolina Oi
and Hu, Hao",
title="Policy Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="20",
volume="23",
number="7",
pages="e22330",
keywords="internet hospital",
keywords="health policy",
keywords="medical service",
keywords="public hospital",
keywords="digital health",
keywords="China",
abstract="Background: Internet hospitals have been encouraged by the Chinese government to develop an innovative medical service model that mainly uses new internet-based technologies to increase access to health care and improve the quality and efficiency of health care delivery. However, the academic exploration of the institutional and sectoral development of internet hospitals in China is scarce in the existing literature. Objective: This study aimed to investigate the policy interventions, development trends, and service innovations of internet hospitals in China. It is expected that the findings from this study will contribute to the further innovation of internet hospitals in China and provide references for the international development of internet hospitals for personalized digital health and patient-centric services. Methods: This study analyzed official policies related to internet hospitals that were implemented by the government in China since 2005. The data of formally approved internet hospitals were collected from official websites to analyze development trends. In-depth semistructured interviews were conducted with 58 key stakeholders who represented comprehensive viewpoints about the service innovations of internet hospitals between March and November 2019. Results: In total, 25 policies that promoted the development of internet hospitals in China were identified. These policies encompassed informatization infrastructure construction, medical resource integration, development model design, service model design, and payment model design. Of the 268 internet hospitals that had received an official license from the government, 153 public internet hospitals had been built mainly by medical institutions. Public tertiary hospitals were the main actors in founding internet hospitals that were created to provide services that targeted patients with common diseases or chronic diseases or patients living in remote and rural areas. Promoting convenient access to high-quality medical resources and saving patients' and their families' time were the key values of internet hospitals. Conclusions: The policy interventions strongly promoted the development of internet hospitals in China. Public tertiary hospitals led the development of internet hospitals. However, internet hospitals in China have mainly played roles that are complementary to those of physical medical institutions. The service model of internet hospitals needs more distinguished innovations to provide personalized digital health and patient-centric services. ",
doi="10.2196/22330",
url="https://www.jmir.org/2021/7/e22330",
url="http://www.ncbi.nlm.nih.gov/pubmed/34283025"
}


@Article{info:doi/10.2196/25021,
author="Willems, H. Sofie
and Rao, Jyotsna
and Bhambere, Sailee
and Patel, Dipu
and Biggins, Yvonne
and Guite, W. Jessica",
title="Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jun",
day="11",
volume="9",
number="6",
pages="e25021",
keywords="coronavirus",
keywords="digital health",
keywords="multiplatform",
keywords="chat",
keywords="symptom tracking",
keywords="well-being",
keywords="COVID-19",
keywords="online platform",
keywords="symptom",
keywords="monitoring",
keywords="follow-up",
doi="10.2196/25021",
url="https://mhealth.jmir.org/2021/6/e25021",
url="http://www.ncbi.nlm.nih.gov/pubmed/34033575"
}


@Article{info:doi/10.2196/24668,
author="Gooding, Piers
and Kariotis, Timothy",
title="Ethics and Law in Research on Algorithmic and Data-Driven Technology in Mental Health Care: Scoping Review",
journal="JMIR Ment Health",
year="2021",
month="Jun",
day="10",
volume="8",
number="6",
pages="e24668",
keywords="digital psychiatry",
keywords="digital mental health",
keywords="machine learning",
keywords="algorithmic technology",
keywords="data-driven technology",
keywords="artificial intelligence",
keywords="ethics",
keywords="regulation",
keywords="law",
keywords="mobile phone",
abstract="Background: Uncertainty surrounds the ethical and legal implications of algorithmic and data-driven technologies in the mental health context, including technologies characterized as artificial intelligence, machine learning, deep learning, and other forms of automation. Objective: This study aims to survey empirical scholarly literature on the application of algorithmic and data-driven technologies in mental health initiatives to identify the legal and ethical issues that have been raised. Methods: We searched for peer-reviewed empirical studies on the application of algorithmic technologies in mental health care in the Scopus, Embase, and Association for Computing Machinery databases. A total of 1078 relevant peer-reviewed applied studies were identified, which were narrowed to 132 empirical research papers for review based on selection criteria. Conventional content analysis was undertaken to address our aims, and this was supplemented by a keyword-in-context analysis. Results: We grouped the findings into the following five categories of technology: social media (53/132, 40.1\%), smartphones (37/132, 28\%), sensing technology (20/132, 15.1\%), chatbots (5/132, 3.8\%), and miscellaneous (17/132, 12.9\%). Most initiatives were directed toward detection and diagnosis. Most papers discussed privacy, mainly in terms of respecting the privacy of research participants. There was relatively little discussion of privacy in this context. A small number of studies discussed ethics directly (10/132, 7.6\%) and indirectly (10/132, 7.6\%). Legal issues were not substantively discussed in any studies, although some legal issues were discussed in passing (7/132, 5.3\%), such as the rights of user subjects and privacy law compliance. Conclusions: Ethical and legal issues tend to not be explicitly addressed in empirical studies on algorithmic and data-driven technologies in mental health initiatives. Scholars may have considered ethical or legal matters at the ethics committee or institutional review board stage. If so, this consideration seldom appears in published materials in applied research in any detail. The form itself of peer-reviewed papers that detail applied research in this field may well preclude a substantial focus on ethics and law. Regardless, we identified several concerns, including the near-complete lack of involvement of mental health service users, the scant consideration of algorithmic accountability, and the potential for overmedicalization and techno-solutionism. Most papers were published in the computer science field at the pilot or exploratory stages. Thus, these technologies could be appropriated into practice in rarely acknowledged ways, with serious legal and ethical implications. ",
doi="10.2196/24668",
url="https://mental.jmir.org/2021/6/e24668",
url="http://www.ncbi.nlm.nih.gov/pubmed/34110297"
}


@Article{info:doi/10.2196/23011,
author="Coetzee, Timothy
and Ball, Price Mad
and Boutin, Marc
and Bronson, Abby
and Dexter, T. David
and English, A. Rebecca
and Furlong, Patricia
and Goodman, D. Andrew
and Grossman, Cynthia
and Hernandez, F. Adrian
and Hinners, E. Jennifer
and Hudson, Lynn
and Kennedy, Annie
and Marchisotto, Jane Mary
and Matrisian, Lynn
and Myers, Elizabeth
and Nowell, Benjamin W.
and Nosek, A. Brian
and Sherer, Todd
and Shore, Carolyn
and Sim, Ida
and Smolensky, Luba
and Williams, Christopher
and Wood, Julie
and Terry, F. Sharon",
title="Data Sharing Goals for Nonprofit Funders of Clinical Trials",
journal="J Participat Med",
year="2021",
month="Mar",
day="29",
volume="13",
number="1",
pages="e23011",
keywords="clinical trial",
keywords="biomedical research",
keywords="data sharing",
keywords="patients",
doi="10.2196/23011",
url="https://jopm.jmir.org/2021/1/e23011",
url="http://www.ncbi.nlm.nih.gov/pubmed/33779573"
}


@Article{info:doi/10.2196/21286,
author="Nguyen, T. Tuan
and Weissman, Amy
and Cashin, Jennifer
and Ha, T. Tran
and Zambrano, Paul
and Mathisen, Roger",
title="Assessing the Effectiveness of Policies Relating to Breastfeeding Promotion, Protection, and Support in Southeast Asia: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="21",
volume="9",
number="9",
pages="e21286",
keywords="breastfeeding",
keywords="breast milk substitute",
keywords="Code of Marketing of Breast-milk Substitutes (The Code)",
keywords="maternity protection",
keywords="maternal, infant, and young child nutrition",
keywords="mixed methods study",
keywords="Southeast Asia",
abstract="Background: Despite its well-known benefits, breastfeeding practices remain suboptimal worldwide, including in Southeast Asia. Many countries in the region have thus enacted policies, such as maternity protection and the World Health Assembly International Code of Marketing of Breast-milk Substitutes (the Code), that protect, promote, and support breastfeeding. Yet the impact of such national legislation on breastfeeding practices is not well understood. Objective: This study aims to review the content, implementation, and potential impact of policies relating to maternity protection and the Code in Myanmar, the Philippines, Thailand, and Vietnam. Methods: This mixed methods study includes a desk review, trend and secondary data analyses, and quantitative and qualitative data collection. Desk reviews will examine and compare the contents, implementation strategies, coverage, monitoring, and enforcement of national policies focusing on maternity protection and the Code in each country with global standards. Trend and secondary data analyses will examine the potential impact of these policies on relevant variables such as breast milk substitute (BMS) sales and women's workforce participation. Quantitative data collection and analysis will be conducted to examine relevant stakeholders' and beneficiaries' perceptions about these policies. In each country, we will conduct up to 24 in-depth interviews (IDI) with stakeholders at national and provincial levels and 12 employers or 12 health workers. Per country, we will survey approximately 930 women who are pregnant or have a child aged 0-11 months, of whom approximately 36 will be invited for an IDI; 12 partners of the interviewed mothers or fathers of children from 0-11 months will also be interviewed. Results: This study, funded in June 2018, was approved by the Institutional Review Boards of the relevant organizations (FHI 360: April 16, 2019 and May 18, 2020; and Hanoi University of Public Health: December 6, 2019). The dates of data collection are as follows: Vietnam: November and December 2019, May and June 2020; the Philippines: projected August 2020; Myanmar and Thailand: pending based on permissions and funding. Results are expected to be published in January 2021. As of July 2020, we had enrolled 1150 participants. We will present a comparison of key contents of the policies across countries and against international standards and recommendations and a comparison of implementation strategies, coverage, monitoring, and enforcement across countries. We will also present findings from secondary data and trend data analyses to propose the potential impact of a new or amended policy. For the surveys with women, we will present associations between exposure to maternity protection or BMS promotion on infant and young child feeding practices and their determinants. Findings from IDIs will highlight relevant stakeholders' and beneficiaries' perceptions. Conclusions: This study will increase the understanding of the effectiveness of policy interventions to improve breastfeeding, which will be used to advocate for stronger policy adoption and enforcement in study countries and beyond. International Registered Report Identifier (IRRID): DERR1-10.2196/21286 ",
doi="10.2196/21286",
url="http://www.researchprotocols.org/2020/9/e21286/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955449"
}


@Article{info:doi/10.2196/19311,
author="Morley, Jessica
and Cowls, Josh
and Taddeo, Mariarosaria
and Floridi, Luciano",
title="Public Health in the Information Age: Recognizing the Infosphere as a Social Determinant of Health",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="3",
volume="22",
number="8",
pages="e19311",
keywords="COVID-19",
keywords="public health",
keywords="misinformation",
keywords="disinformation",
keywords="infodemic",
keywords="infodemiology",
keywords="infosphere",
keywords="social determinants of health",
keywords="information ethics",
doi="10.2196/19311",
url="https://www.jmir.org/2020/8/e19311",
url="http://www.ncbi.nlm.nih.gov/pubmed/32648850"
}


@Article{info:doi/10.2196/19357,
author="Katapally, R. Tarun",
title="A Global Digital Citizen Science Policy to Tackle Pandemics Like COVID-19",
journal="J Med Internet Res",
year="2020",
month="May",
day="26",
volume="22",
number="5",
pages="e19357",
keywords="COVID-19",
keywords="pandemic",
keywords="citizen science",
keywords="smartphones",
keywords="population health",
keywords="mHealth",
keywords="eHealth",
keywords="big data",
keywords="virus",
keywords="infectious diseases",
keywords="public health",
keywords="digital epidemiology",
doi="10.2196/19357",
url="http://www.jmir.org/2020/5/e19357/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32408267"
}


@Article{info:doi/10.2196/16346,
author="Jones, Kerina
and Daniels, Helen
and Heys, Sharon
and Lacey, Arron
and Ford, V. David",
title="Toward a Risk-Utility Data Governance Framework for Research Using Genomic and Phenotypic Data in Safe Havens:  Multifaceted Review",
journal="J Med Internet Res",
year="2020",
month="May",
day="15",
volume="22",
number="5",
pages="e16346",
keywords="genomic data",
keywords="data safe havens",
keywords="data governance",
abstract="Background: Research using genomic data opens up new insights into health and disease. Being able to use the data in association with health and administrative record data held in safe havens can multiply the benefits. However, there is much discussion about the use of genomic data with perceptions of particular challenges in doing so safely and effectively. Objective: This study aimed to work toward a risk-utility data governance framework for research using genomic and phenotypic data in an anonymized form for research in safe havens. Methods: We carried out a multifaceted review drawing upon data governance arrangements in published research, case studies of organizations working with genomic and phenotypic data, public views and expectations, and example studies using genomic and phenotypic data in combination. The findings were contextualized against a backdrop of legislative and regulatory requirements and used to create recommendations. Results: We proposed recommendations toward a risk-utility model with a flexible suite of controls to safeguard privacy and retain data utility for research. These were presented as overarching principles aligned to the core elements in the data sharing framework produced by the Global Alliance for Genomics and Health and as practical control measures distilled from published literature and case studies of operational safe havens to be applied as required at a project-specific level. Conclusions: The recommendations presented can be used to contribute toward a proportionate data governance framework to promote the safe, socially acceptable use of genomic and phenotypic data in safe havens. They do not purport to eradicate risk but propose case-by-case assessment with transparency and accountability. If the risks are adequately understood and mitigated, there should be no reason that linked genomic and phenotypic data should not be used in an anonymized form for research in safe havens. ",
doi="10.2196/16346",
url="https://www.jmir.org/2020/5/e16346",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412420"
}


@Article{info:doi/10.2196/19043,
author="Guest, L. Jodie
and del Rio, Carlos
and Sanchez, Travis",
title="The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will",
journal="JMIR Public Health Surveill",
year="2020",
month="Apr",
day="6",
volume="6",
number="2",
pages="e19043",
keywords="COVID-19",
keywords="coronavirus",
keywords="SARS-CoV-2",
doi="10.2196/19043",
url="https://publichealth.jmir.org/2020/2/e19043",
url="http://www.ncbi.nlm.nih.gov/pubmed/32240972"
}


@Article{info:doi/10.2196/15816,
author="Wilson, James
and Herron, Daniel
and Nachev, Parashkev
and McNally, Nick
and Williams, Bryan
and Rees, Geraint",
title="The Value of Data: Applying a Public Value Model to the English National Health Service",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="27",
volume="22",
number="3",
pages="e15816",
keywords="health policy",
keywords="innovation",
keywords="public value",
keywords="intellectual property",
keywords="NHS Constitution",
doi="10.2196/15816",
url="http://www.jmir.org/2020/3/e15816/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32217501"
}


@Article{info:doi/10.2196/14436,
author="Mullens, Lendon Cody
and Hernandez, Andres J.
and Anderson, D. Evan
and Allen, Lindsay",
title="Just Because (Most) Hospitals Are Publishing Charges Does Not Mean Prices Are More Transparent",
journal="JMIR Med Inform",
year="2020",
month="Feb",
day="6",
volume="8",
number="2",
pages="e14436",
keywords="health care costs",
keywords="delivery of health care",
keywords="health policy",
abstract="Background: The Centers for Medicare and Medicaid Services (CMS) recently mandated that all hospitals publish their charge description masters (CDMs) online, in a machine-readable format, by January 1, 2019. In addition, CMS recommended that CDM data be made available in a manner that was consumer friendly and accessible to patients. Objective: This study aimed to (1) examine all hospitals across the state of Pennsylvania to understand policy compliance and (2) use established metrics to measure accessibility and consumer friendliness of posted CDM data. Methods: A cross-sectional analysis was conducted to quantify hospital website compliance with the recent CMS policies requiring hospitals to publish their CDM. Data were collected from all Pennsylvania hospital websites. Consumer friendliness was assessed based on searchability, number of website clicks to data, and supplemental educational materials accompanying CDMs such as videos or text. Results: Most hospitals (189/234, 80.1\%) were compliant, but significant variation in data presentation was observed. The mean number of website clicks to the CDM was 3.7 (SD 1.3; range: 1-8). A total of 23.1\% of compliant hospitals provided no supplemental educational material with their CDM. Conclusions: Although disclosure of charges has improved, the data may not be sufficient to meaningfully influence patient decision making. ",
doi="10.2196/14436",
url="http://medinform.jmir.org/2020/2/e14436/"
}


@Article{info:doi/10.2196/15301,
author="Zawati, H. Ma'n
and Lang, Michael",
title="Mind the App: Considerations for the Future of Mobile Health in Canada",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="4",
volume="7",
number="11",
pages="e15301",
keywords="smartphone",
keywords="mobile phone",
keywords="regulation",
keywords="patients",
keywords="physicians",
doi="10.2196/15301",
url="https://mhealth.jmir.org/2019/11/e15301",
url="http://www.ncbi.nlm.nih.gov/pubmed/31682580"
}


@Article{info:doi/10.2196/10414,
author="Larson, S. Richard",
title="A Path to Better-Quality mHealth Apps",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jul",
day="30",
volume="6",
number="7",
pages="e10414",
keywords="mobile apps",
keywords="smartphone",
keywords="software validation",
keywords="medical device legislation",
keywords="United States Food and Drug Administration",
doi="10.2196/10414",
url="http://mhealth.jmir.org/2018/7/e10414/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30061091"
}


@Article{info:doi/10.2196/10725,
author="Balsari, Satchit
and Fortenko, Alexander
and Blaya, A. Joaqu{\'i}n
and Gropper, Adrian
and Jayaram, Malavika
and Matthan, Rahul
and Sahasranam, Ram
and Shankar, Mark
and Sarbadhikari, N. Suptendra
and Bierer, E. Barbara
and Mandl, D. Kenneth
and Mehendale, Sanjay
and Khanna, Tarun",
title="Reimagining Health Data Exchange: An Application Programming Interface--Enabled Roadmap for India",
journal="J Med Internet Res",
year="2018",
month="Jul",
day="13",
volume="20",
number="7",
pages="e10725",
keywords="health information exchange",
keywords="India",
keywords="health APIs",
doi="10.2196/10725",
url="http://www.jmir.org/2018/7/e10725/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30006325"
}


@Article{info:doi/10.2196/jmir.8508,
author="Yeung, Douglas",
title="Social Media as a Catalyst for Policy Action and Social Change for Health and Well-Being: Viewpoint",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="19",
volume="20",
number="3",
pages="e94",
keywords="social media",
keywords="health policy",
keywords="health promotion",
keywords="health knowledge, attitudes, practice",
keywords="social change",
doi="10.2196/jmir.8508",
url="http://www.jmir.org/2018/3/e94/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29555624"
}


@Article{info:doi/10.2196/jmir.9650,
author="Berridge, Clara",
title="Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis",
journal="J Med Internet Res",
year="2018",
month="Feb",
day="21",
volume="20",
number="2",
pages="e66",
keywords="policy making",
keywords="Medicaid",
keywords="long-term care",
keywords="aging",
keywords="information technology",
keywords="passive remote monitoring",
keywords="sensing",
keywords="ethics",
keywords="technology implementation",
abstract="Background: Recent years have seen an influx of location-tracking, activity-monitoring sensors, and Web-cameras to remotely monitor the safety of older adults in their homes and to reduce reliance on in-person assistance. The state of research on these monitoring technologies leaves open crucial financial, social, and ethical cost-benefit questions, which have prevented widespread use. Medicaid is now the first large third-party payer in the United States to pay for these technologies, and their use is likely to increase as states transition to managed long-term services and supports (MLTSS). Objectives: This is the first study to examine how state Medicaid programs are treating passive remote monitoring technologies. This study identifies (1) which states allow location tracking, sensor systems, and cameras; (2) what policies are in place to track their use; (3) what implementation processes and program monitoring mechanisms are in place; and (4) what related insights Medicaid program stakeholders would like to learn from researchers. Methods: Interviews were conducted with 43 state, federal, and managed care organization (MCO) Medicaid program stakeholders about how these technologies are used in state waivers serving community-dwelling older adults in 15 states, and what policies are in place to regulate them. The interviews were analyzed by the research team using the framework analysis method for applied policy research. Results: Two-thirds of the states cover location tracking and activity-monitoring sensors and one-third cover cameras, but only 3 states have specific service categories that allow them to track when they are paying for any of these technologies, impeding regulation and understanding of their use at the state and federal level. Consideration of ethical and social risks is limited, and states struggle to understand which circumstances warrant use. They are further challenged by extreme resource restrictions and transitions to MLTSS by MCOs inexperienced in serving this growing ``high-need, high-cost'' population. Conclusions: Decisions about Medicaid reimbursement of technologies that have the potential to dramatically alter the way older adults receive supportive services are being made without research on their use, social and ethical implications, or outcomes. At a minimum, new service categories are needed to enable oversight. Participants prioritized 3 research aims to inform practice: (1) determine cost-effectiveness; (2) identify what type of information beneficiaries want to be generated and whom they want it to be shared with; and (3) understand how to support ethical decision making for beneficiaries with cognitive impairment. These findings provide direction for future research and reveal that greater interaction between policy makers and researchers in this field is needed. ",
doi="10.2196/jmir.9650",
url="http://www.jmir.org/2018/2/e66/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29467120"
}


@Article{info:doi/10.2196/jmir.7329,
author="Labrique, Alain
and Blynn, Emily
and Ahmed, Saifuddin
and Gibson, Dustin
and Pariyo, George
and Hyder, A. Adnan",
title="Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e121",
keywords="surveys and questionnaires",
keywords="sampling studies",
keywords="mobile health",
keywords="mobile phone",
keywords="research methodology",
doi="10.2196/jmir.7329",
url="http://www.jmir.org/2017/5/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476726"
}


@Article{info:doi/10.2196/jmir.7302,
author="Pariyo, W. George
and Wosu, C. Adaeze
and Gibson, G. Dustin
and Labrique, B. Alain
and Ali, Joseph
and Hyder, A. Adnan",
title="Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries",
journal="J Med Internet Res",
year="2017",
month="May",
day="05",
volume="19",
number="5",
pages="e115",
keywords="NCDs",
keywords="policy",
keywords="mHealth",
keywords="policy analysis",
keywords="surveys",
doi="10.2196/jmir.7302",
url="http://www.jmir.org/2017/5/e115/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28476720"
}


@Article{info:doi/10.2196/medinform.6372,
author="Colorafi, Karen
and Bailey, Bryan",
title="It's Time for Innovation in the Health Insurance Portability and Accountability Act (HIPAA)",
journal="JMIR Med Inform",
year="2016",
month="Nov",
day="02",
volume="4",
number="4",
pages="e34",
keywords="innovation",
keywords="HIPAA",
keywords="electronic health record demonstration",
doi="10.2196/medinform.6372",
url="http://medinform.jmir.org/2016/4/e34/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27806923"
}


@Article{info:doi/10.2196/mhealth.4424,
author="Al Ayubi, U. Soleh
and Pelletier, Alexandra
and Sunthara, Gajen
and Gujral, Nitin
and Mittal, Vandna
and Bourgeois, C. Fabienne",
title="A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of ``Bring Your Own Devices'' Policies",
journal="JMIR mHealth uHealth",
year="2016",
month="May",
day="11",
volume="4",
number="2",
pages="e50",
keywords="BYOD",
keywords="guideline",
keywords="safeguard",
keywords="custom application",
keywords="hospital settings",
keywords="security",
keywords="privacy",
keywords="mobile application",
keywords="electronic medical records",
abstract="Background: Hospitals today are introducing new mobile apps to improve patient care and workflow processes. Mobile device adoption by hospitals fits with present day technology behavior; however, requires a deeper look into hospital device policies and the impact on patients, staff, and technology development. Should hospitals spend thousands to millions of dollars to equip all personnel with a mobile device that is only used in a hospital environment? Allowing health care professionals to use personal mobile devices at work, known as bring-your-own-device (BYOD), has the potential to support both the hospital and its employees to deliver effective and efficient care. Objective: The objectives of this research were to create a mobile app development guideline for a BYOD hospital environment, apply the guideline to the development of an in-house mobile app called TaskList, pilot the TaskList app within Boston Children's Hospital (BCH), and refine the guideline based on the app pilot. TaskList is an Apple operating system (iOS)-based app designed for medical residents to monitor, create, capture, and share daily collaborative tasks associated with patients. Methods: To create the BYOD guidelines, we developed TaskList that required the use of mobile devices among medical resident. The TaskList app was designed in four phases: (1) mobile app guideline development, (2) requirements gathering and developing of TaskList fitting the guideline, (3) deployment of TaskList using BYOD with end-users, and (4) refinement of the guideline based on the TaskList pilot. Phase 1 included understanding the existing hospital BYOD policies and conducting Web searches to find best practices in software development for a BYOD environment. Phase 1 also included gathering subject matter input from the Information Services Department (ISD) at BCH. Phase 2 involved the collaboration between the Innovation Acceleration Program at BCH, the ISD Department and the TaskList Clinical team in understanding what features should be built into the app. Phase 3 involved deployment of TaskList on a clinical floor at BCH. Lastly, Phase 4 gathered the lessons learned from the pilot to refine the guideline. Results: Fourteen practical recommendations were identified to create the BCH Mobile Application Development Guideline to safeguard custom applications in hospital BYOD settings. The recommendations were grouped into four categories: (1) authentication and authorization, (2) data management, (3) safeguarding app environment, and (4) remote enforcement. Following the guideline, the TaskList app was developed and then was piloted with an inpatient ward team. Conclusions: The Mobile Application Development guideline was created and used in the development of TaskList. The guideline is intended for use by developers when addressing integration with hospital information systems, deploying apps in BYOD health care settings, and meeting compliance standards, such as Health Insurance Portability and Accountability Act (HIPAA) regulations. ",
doi="10.2196/mhealth.4424",
url="http://mhealth.jmir.org/2016/2/e50/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27169345"
}


@Article{info:doi/10.2196/mhealth.4626,
author="Umali, Elaine
and McCool, Judith
and Whittaker, Robyn",
title="Possibilities and Expectations for mHealth in the Pacific Islands: Insights From Key Informants",
journal="JMIR mHealth uHealth",
year="2016",
month="Jan",
day="20",
volume="4",
number="1",
pages="e9",
keywords="mHealth",
keywords="Pacific Islands",
keywords="prevention",
keywords="health systems",
keywords="health policy",
abstract="Background: The increase in mobile phone use across the globe is creating mounting interest for its application in addressing health system constraints. Although still limited, there is growing evidence of success in using mobile phones for health (mHealth) in low- and middle- income countries. The promise of mHealth to address key health system issues presents a huge potential for the Pacific Island countries where mobile use has radically increased. Current projections indicate an improved information and communications technology (ICT) environment to support greater access to mobile and digital devices in the Pacific region. Objective: The objective of the study was to explore key stakeholder perspectives on the potential for mHealth in the Pacific region. Methods: A series of in-depth interviews were conducted either face-to-face, via Skype or by email, with a series of key informants from the Pacific Rim region. Interviews were audio-recorded and later transcribed for detailed thematic analysis. Results: We found widespread support for the potential to use mobile phones as a mechanism to facilitate improved health service delivery in the region. Essential elements for the successful development and implementation of mHealth were identified by these stakeholders. These included: developing an understanding of the local context and the problems that may be usefully addressed by the addition of mHealth to existing strategies and services; consideration of local infrastructure, capability, policy, mobile literacy and engagement; learning from others, particularly other low- and middle-income countries (LMICs); the importance of building supportive environments and of evaluation to provide evidence of impact and total cost. Conclusions: The rapid growth of mobile phone use in the region presents a unique juxtaposition of opportunity and promise. Though the region lags behind other LMICs in the adoption of mHealth technologies, this offers the convenience of learning from past mHealth interventions and applying these learnings to achieve scale, sustainability and success. This study deepens the understanding of the potential of mHealth for the region, and offers a baseline from which discussions can be made to examine the limitations, barriers and complexities inherent in mHealth applications. ",
doi="10.2196/mhealth.4626",
url="http://mhealth.jmir.org/2016/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26792386"
}


@Article{info:doi/10.2196/medinform.4457,
author="Slight, Patricia Sarah
and Berner, S. Eta
and Galanter, William
and Huff, Stanley
and Lambert, L. Bruce
and Lannon, Carole
and Lehmann, U. Christoph
and McCourt, J. Brian
and McNamara, Michael
and Menachemi, Nir
and Payne, H. Thomas
and Spooner, Andrew S.
and Schiff, D. Gordon
and Wang, Y. Tracy
and Akincigil, Ayse
and Crystal, Stephen
and Fortmann, P. Stephen
and Vandermeer, L. Meredith
and Bates, W. David",
title="Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities",
journal="JMIR Med Inform",
year="2015",
month="Sep",
day="18",
volume="3",
number="3",
pages="e30",
keywords="medical informatics",
keywords="health policy",
keywords="electronic health records",
keywords="meaningful use",
abstract="Background: With the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for ``meaningful use'' (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems. Objective: The Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. Methods: We gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group. Results: Stakeholders' knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs. Conclusions: Although MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children. ",
doi="10.2196/medinform.4457",
url="http://medinform.jmir.org/2015/3/e30/"
}


@Article{info:doi/10.2196/jmir.3358,
author="Eysenbach, Gunther",
title="The New Health-Related Top-Level Domains Are Coming: Will Cureforcancer.health Go to the Highest Bidder?",
journal="J Med Internet Res",
year="2014",
month="Mar",
day="05",
volume="16",
number="3",
pages="e73",
keywords="top-level domains",
keywords="global community health",
keywords="health information sources",
keywords="quality health information",
doi="10.2196/jmir.3358",
url="http://www.jmir.org/2014/3/e73/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24598704"
}


@Article{info:doi/10.2196/jmir.3276,
author="Mackey, Ken Tim
and Liang, A. Bryan
and Kohler, C. Jillian
and Attaran, Amir",
title="Health Domains for Sale: The Need for Global Health Internet Governance",
journal="J Med Internet Res",
year="2014",
month="Mar",
day="05",
volume="16",
number="3",
pages="e62",
keywords="eHealth",
keywords="global health governance",
keywords="information technology",
keywords="Internet",
keywords="domain names",
doi="10.2196/jmir.3276",
url="http://www.jmir.org/2014/3/e62/",
url="http://www.ncbi.nlm.nih.gov/pubmed/24598602"
}


@Article{info:doi/10.2196/jmir.2250,
author="Scott, E. Richard
and Mars, Maurice",
title="Principles and Framework for eHealth Strategy Development",
journal="J Med Internet Res",
year="2013",
month="Jul",
day="30",
volume="15",
number="7",
pages="e155",
keywords="eHealth strategy",
keywords="eHealth strategy development framework",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="e-learning",
doi="10.2196/jmir.2250",
url="http://www.jmir.org/2013/7/e155/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23900066"
}


@Article{info:doi/10.2196/jmir.2464,
author="Mackey, K. Tim
and Liang, A. Bryan
and Strathdee, A. Steffanie",
title="Digital Social Media, Youth, and Nonmedical Use of Prescription Drugs: The Need for Reform",
journal="J Med Internet Res",
year="2013",
month="Jul",
day="26",
volume="15",
number="7",
pages="e143",
keywords="non-medical use of prescription medications (NUPM)",
keywords="eHealth",
keywords="Internet",
keywords="social media",
keywords="youth and adolescents",
keywords="drug abuse",
keywords="substance abuse",
doi="10.2196/jmir.2464",
url="http://www.jmir.org/2013/7/e143/",
url="http://www.ncbi.nlm.nih.gov/pubmed/23892156"
}


@Article{info:doi/10.2196/jmir.1633,
author="Khoja, Shariq
and Durrani, Hammad
and Nayani, Parvez
and Fahim, Ammad",
title="Scope of Policy Issues in eHealth: Results From a Structured Literature Review",
journal="J Med Internet Res",
year="2012",
month="Feb",
day="17",
volume="14",
number="1",
pages="e34",
keywords="eHealth",
keywords="eHealth policies",
keywords="telehealth",
keywords="telemedicine",
keywords="health informatics",
keywords="electronic health records",
keywords="health telematics",
keywords="guidelines",
keywords="standards",
abstract="Background: eHealth is widely used as a tool for improving health care delivery and information. However, distinct policies and strategies are required for its proper implementation and integration at national and international levels. Objective: To determine the scope of policy issues faced by individuals, institutions, or governments in implementing eHealth programs. Methods: We conducted a structured review of both peer-reviewed and gray literature from 1998--2008. A Medline search for peer-reviewed articles found 40 papers focusing on different aspects of eHealth policy. In addition, a Google search found 20 national- and international-level policy papers and documents. We reviewed these articles to extract policy issues and solutions described at different levels of care. Results: The literature search found 99 policy issues related to eHealth. We grouped these issues under the following themes: (1) networked care, (2) interjurisdictional practice, (3) diffusion of eHealth/digital divide, (4) eHealth integration with existing systems, (5) response to new initiatives, (6) goal-setting for eHealth policy, (7) evaluation and research, (8) investment, and (9) ethics in eHealth. Conclusions: We provide a list of policy issues that should be understood and addressed by policy makers at global, jurisdictional, and institutional levels, to facilitate smooth and reliable planning of eHealth programs. ",
doi="10.2196/jmir.1633",
url="http://www.jmir.org/2012/1/e34/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22343270"
}


@Article{info:doi/10.2196/jmir.1923,
author="Eysenbach, Gunther
and ",
title="CONSORT-EHEALTH: Improving and Standardizing Evaluation Reports of Web-based and Mobile Health Interventions",
journal="J Med Internet Res",
year="2011",
month="Dec",
day="31",
volume="13",
number="4",
pages="e126",
keywords="evaluation",
keywords="Internet",
keywords="mobile health",
keywords="reporting standards",
keywords="publishing standards",
keywords="guidelines",
keywords="quality control",
keywords="randomized controlled trials as topic",
keywords="medical informatics",
abstract="Background: Web-based and mobile health interventions (also called ``Internet interventions'' or ``eHealth/mHealth interventions'') are tools or treatments, typically behaviorally based, that are operationalized and transformed for delivery via the Internet or mobile platforms. These include electronic tools for patients, informal caregivers, healthy consumers, and health care providers. The Consolidated Standards of Reporting Trials (CONSORT) statement was developed to improve the suboptimal reporting of randomized controlled trials (RCTs). While the CONSORT statement can be applied to provide broad guidance on how eHealth and mHealth trials should be reported, RCTs of web-based interventions pose very specific issues and challenges, in particular related to reporting sufficient details of the intervention to allow replication and theory-building. Objective: To develop a checklist, dubbed CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth), as an extension of the CONSORT statement that provides guidance for authors of eHealth and mHealth interventions. Methods: A literature review was conducted, followed by a survey among eHealth experts and a workshop. Results: A checklist instrument was constructed as an extension of the CONSORT statement. The instrument has been adopted by the Journal of Medical Internet Research (JMIR) and authors of eHealth RCTs are required to submit an electronic checklist explaining how they addressed each subitem. Conclusions: CONSORT-EHEALTH has the potential to improve reporting and provides a basis for evaluating the validity and applicability of eHealth trials. Subitems describing how the intervention should be reported can also be used for non-RCT evaluation reports. As part of the development process, an evaluation component is essential; therefore, feedback from authors will be solicited, and a before-after study will evaluate whether reporting has been improved. ",
doi="10.2196/jmir.1923",
url="http://www.jmir.org/2011/4/e126/",
url="http://www.ncbi.nlm.nih.gov/pubmed/22209829"
}