%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60553 %T Adaptation of the Stakeholders’ Walkability/Wheelability Audit in Neighborhoods (SWAN) Tool for Individuals With Diverse Disabilities: Protocol for a Mixed Methods Study %A Mahmood,Atiya %A Rikhtehgaran,Farinaz %A Nasiri,Rojan %A Hedayati,Niloofar %A Pandsheno,Sepehr %A Sharrock,Aislynn %A Mora,Diana Juanita %A Haji Hosseini,Sogol %A Routhier,François %A Mortenson,W.Ben %+ Department of Gerontology, Simon Fraser University, 515 West Hastings St., Vancouver, BC, V6B5K3, Canada, 1 7789958564, amahmood@sfu.ca %K age and accessibility %K disability experiences %K community engaged research %K inclusive urban design %K user-led built environment audits %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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. %M 40210206 %R 10.2196/60553 %U https://www.researchprotocols.org/2025/1/e60553 %U https://doi.org/10.2196/60553 %U http://www.ncbi.nlm.nih.gov/pubmed/40210206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56306 %T Finding Consensus on Trust in AI in Health Care: Recommendations From a Panel of International Experts %A Starke,Georg %A Gille,Felix %A Termine,Alberto %A Aquino,Yves Saint James %A Chavarriaga,Ricardo %A Ferrario,Andrea %A Hastings,Janna %A Jongsma,Karin %A Kellmeyer,Philipp %A Kulynych,Bogdan %A Postan,Emily %A Racine,Elise %A Sahin,Derya %A Tomaszewska,Paulina %A Vold,Karina %A Webb,Jamie %A Facchini,Alessandro %A Ienca,Marcello %+ Institute for History and Ethics of Medicine, Technical University of Munich, Ismaninger Str. 22, Munich, 81675, Germany, 49 8941404041, georg.starke@tum.de %K expert consensus %K trust %K artificial intelligence %K clinical decision support %K assistive technologies %K public health surveillance %K framework analysis %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39969962 %R 10.2196/56306 %U https://www.jmir.org/2025/1/e56306 %U https://doi.org/10.2196/56306 %U http://www.ncbi.nlm.nih.gov/pubmed/39969962 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67145 %T Ethical Considerations for Wastewater Surveillance Conducted by the US Department of Defense %A Smith,Hunter Jackson %A Agans,Richard T %A Kowallis,William J %K wastewater %K surveillance %K ethics %K military %K Department of Defense %D 2025 %7 6.2.2025 %9 %J JMIR Public Health Surveill %G English %X The US Department of Defense (DoD) is establishing its wastewater surveillance capacities to support national security objectives and promote the public health and medical readiness of US service members. Wastewater surveillance is an emerging technology that has traditionally been leveraged for detecting infectious diseases. However, its potential future applications could yield a vast and unpredictable amount of information that could be used for a wide variety of both health- and nonhealth-related purposes. The US military also serves an inimitable role for the country and its citizens, and exercises significant levels of control over its service members compared to civilian organizations. Further, its present and potential wastewater surveillance activities may reach far beyond just military installations. These factors raise unique ethical considerations that must be accounted for by leaders and policymakers to ensure the DoD implements a wastewater surveillance network in a manner that is both impactful in supporting public health and appropriate to the scope and population under surveillance. This paper explores important ethical features in conducting wastewater surveillance that are both specific to the DoD experience and applicable to wider public health initiatives. %R 10.2196/67145 %U https://publichealth.jmir.org/2025/1/e67145 %U https://doi.org/10.2196/67145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53558 %T Regulation and Compliance in Telemedicine: Viewpoint %A Ivanova,Julia %A Cummins,Mollie R %A Ong,Triton %A Soni,Hiral %A Barrera,Janelle %A Wilczewski,Hattie %A Welch,Brandon %A Bunnell,Brian %+ Doxy.me Research, Doxy.me, Inc, 18 Broad Street, Unit 300, Charleston, SC, 29401, United States, 1 844 436 9963, julia.ivanova@doxy.me %K telemedicine %K telehealth %K policy %K COVID-19 %K PHE %K rules and regulations %K compliance %K privacy and security %K regulation %K rule %K public health %K US %K United States %K implementation %K regulatory %K professional %K organizational %K ethical %K concern %K privacy %K security %K government literature %K law %K health care %K patient %D 2025 %7 23.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X The US COVID-19 Public Health Emergency ended on May 11, 2023. Lawmakers and regulators extended some flexibilities while they deliberate effective long-term telemedicine policy. Here, we discuss critical challenges in telemedicine compliance and regulation grounded in scholarly literature and current events. We specifically consider obstacles and progress toward solutions in telemedicine law and regulation regarding privacy and security issues, care across state borders, and prescribing over telemedicine in the United States. We conclude that simplified policies are needed to keep telemedicine accessible to providers and patients and that current privacy and security measures need refinement to protect patients appropriately. %M 39847413 %R 10.2196/53558 %U https://www.jmir.org/2025/1/e53558 %U https://doi.org/10.2196/53558 %U http://www.ncbi.nlm.nih.gov/pubmed/39847413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66356 %T 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 %A Gehder,Sara %A Goeldner,Moritz %+ Working Group for Data-Driven Innovation, Hamburg University of Technology, Am Schwarzenberg-Campus 4, Hamburg, 21073, Germany, 49 40 428784777, moritz.goeldner@tuhh.de %K regulatory market access pathways %K digital health application %K DiGA %K patient-relevant structural and procedural improvement %K pSVV pathway analysis %K qualitative and systemic analysis %K policy and stakeholder insights %K innovation system analysis %D 2025 %7 6.1.2025 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39761562 %R 10.2196/66356 %U https://www.jmir.org/2025/1/e66356 %U https://doi.org/10.2196/66356 %U http://www.ncbi.nlm.nih.gov/pubmed/39761562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60832 %T Promoting Digital Health Data Literacy: The Datum Project %A Powell,Daniel %A Asad,Laiba %A Zavaglia,Elissa %A Ferrari,Manuela %K health data %K digital data %K medical records %K legislation %K ethics %K knowledge dissemination %K learning health system %K data bank %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X With the increased use of digital health innovations in Canadian health care, educating health care users, professionals, and researchers on the ethical challenges and privacy implications of these tools is essential. The Datum project, funded by the Fondation Barreau du Quebec, was created to help these actors better understand legal and ethical issues regarding the collection, use, and disclosure of digital health data for the purposes of scientific research, thereby enhancing literacy around data privacy. The project consists of a multimedia website divided into legislation and policy documents and narrative-based video content. Users can access the core legislation and policies governing the collection and use of health care data geared toward researchers and health practitioners. Users can also view the narrative-based video content explaining key concepts related to digital health data. The Datum project makes an original contribution to the field of law and ethics in health science research by using novel approaches, such as learning health systems and data banks, to improve equity in health care delivery and by generating multimedia content aimed at encouraging health care users to become better consumers and supporting the collective use of their data. The Datum project also promotes digital literacy as a digital communication tool, which has the significant potential to improve health outcomes, bridge the digital divide, and reduce health inequities. %R 10.2196/60832 %U https://formative.jmir.org/2025/1/e60832 %U https://doi.org/10.2196/60832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54661 %T Concerns Over Vuse e-Cigarette Digital Marketing and Implications for Public Health Regulation: Content Analysis %A Han,Eileen %A Lempert,Lauren K %A Vescia,Francesca %A Halpern-Felsher,Bonnie %K e-cigarette %K social media marketing %K Vuse %K adolescents and young adults %K Food and Drug Administration %K FDA %K smoker %K smoking %K smoking device %K tobacco %K social media %K Instagram %K Facebook %K promote %K marketing %K mobile phone %D 2024 %7 27.12.2024 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/54661 %U https://formative.jmir.org/2024/1/e54661 %U https://doi.org/10.2196/54661 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e64439 %T Public Awareness and Use of Price Transparency: Report From a National Survey %A Pathak,Yuvraj %A Muhlestein,David %+ West Health Institute, 10350 N Torrey Pines Rd, La Jolla, CA, 92037, United States, 1 8585357000, ypathak@westhealth.org %K price transparency %K consumer choice %K survey %K questionnaire %K finance %K cost %K economics %K price %K pricing %K consumer %K transparent %K Medicare %K Medicaid %K insurance %D 2024 %7 12.12.2024 %9 Research Letter %J Interact J Med Res %G English %X %M 39666968 %R 10.2196/64439 %U https://www.i-jmr.org/2024/1/e64439 %U https://doi.org/10.2196/64439 %U http://www.ncbi.nlm.nih.gov/pubmed/39666968 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56699 %T Health Insurance Payment for Telehealth Services: Scoping Review and Narrative Synthesis %A Li,Qingqing %A Cheng,Feng %A Zeng,Huatang %A Xu,Junfang %+ School of Public Health, Second Affiliated Hospital, Zhejiang University School of Medicine, School of Public Health, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China, Hangzhou, China, , China, 86 18801230482, junfangxuhappy1987@163.com %K telehealth %K internet-based health care %K reimbursement %K health insurance payment %K health care %K scoping review %K narrative synthesis %K mobile phone %D 2024 %7 9.12.2024 %9 Review %J J Med Internet Res %G English %X 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. %M 39652868 %R 10.2196/56699 %U https://www.jmir.org/2024/1/e56699 %U https://doi.org/10.2196/56699 %U http://www.ncbi.nlm.nih.gov/pubmed/39652868 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59717 %T Investigating the Norwegian eHealth Governance Model: Document Study %A Linstad,Line Helen %A Bjørnå,Hilde %A Moen,Anne %A Tunby Kristiansen,Truls %A Hansen,Anne Helen %+ Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Stakkevollan, Tromsø, 9037, Norway, 47 41682342, line.h.linstad@uit.no %K eHealth policy %K fragmented decision authority %K top-down governance %K bottom-up network %K participation %K electronic health record %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39631067 %R 10.2196/59717 %U https://www.jmir.org/2024/1/e59717 %U https://doi.org/10.2196/59717 %U http://www.ncbi.nlm.nih.gov/pubmed/39631067 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56790 %T Reporting Guidelines for the Early-Phase Clinical Evaluation of Applications Using Extended Reality: RATE-XR Qualitative Study Guideline %A Vlake,Johan H %A Drop,Denzel L Q %A Van Bommel,Jasper %A Riva,Giuseppe %A Wiederhold,Brenda K %A Cipresso,Pietro %A Rizzo,Albert S %A Rothbaum,Barbara O %A Botella,Cristina %A Hooft,Lotty %A Bienvenu,Oscar J %A Jung,Christian %A Geerts,Bart %A Wils,Evert-Jan %A Gommers,Diederik %A van Genderen,Michel E %A , %+ Department of Intensive Care, Erasmus Medical Center, Doctor Molewaterplein, Rotterdam, 3015 GD, Netherlands, 31 107040704, m.vangenderen@erasmusmc.nl %K extended reality %K XR %K virtual reality %K augmented reality %K mixed reality %K reporting guideline %K Delphi process %K consensus %K computer-generated simulation %K simulation %K virtual world %K simulation experience %K clinical evaluation %D 2024 %7 29.11.2024 %9 Tutorial %J J Med Internet Res %G English %X 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. %R 10.2196/56790 %U https://www.jmir.org/2024/1/e56790 %U https://doi.org/10.2196/56790 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e65740 %T Vaccine Certificates Must Go Digital: An Urgent Call for Better Public Health Outcomes %A Barbosa da Silva Júnior,Jarbas %A Garcia-Saiso,Sebastian %A Marti,Myrna %A Salas,Daniel %A Contreras,Marcela %A Velandia-Gonzalez,Martha %A Luna,Daniel %A Nelson,Jennifer %A Fitzgerald,James %A Bascolo,Ernesto %A Talavera Romero,Ivy Lorena %A Chomali,May %A Curioso,Walter H %A Plazzotta,Fernando %A Otero,Carlos %A Lopez Osornio,Alejandro %A Lennemann,Tessa %A Salinas,Karen %A D'Agostino,Marcelo %K medical informatics %K health systems %K immunizations %K public health %K viewpoint %K health challenges %K digital vaccine certificates %K outbreak management %K outbreak %K accuracy %K healthcare %K surveillance %K health outcomes %K global health %K mobile phone %D 2024 %7 26.11.2024 %9 %J JMIR Public Health Surveill %G English %X From our roles within international public health organizations, we have collectively witnessed the global challenges presented by outdated health information systems, platforms, and applications. The COVID-19 pandemic has clearly exposed the limitations of our current paper-based vaccine certification methods and highlighted the deficiencies of outdated technological platforms that lack interoperability standards, a situation that underscores the critical need for a digital transformation in how we manage and verify immunization records. Digital vaccination certificates are understood to be secure, electronically stored, and easily accessible records that provide verifiable proof of a person’s immunization status. The Pan American Health Organization (PAHO) envisions leveraging digital technologies to strengthen health systems, enhance data-driven decision-making, and improve health outcomes. The organization’s vision emphasizes the integration of innovative technologies to build resilient and responsive health systems capable of addressing modern public health challenges. In an era of unprecedented technological advancement, our continued reliance on paper-based vaccine certificates is not just anachronistic—it is a significant liability for global public health that impacts the efficiency and effectiveness of our health systems on multiple fronts, limiting our ability to respond to public health crises effectively. With the strategic guidance from its Member States, PAHO has agreed to move toward the digital transformation of the health sector across the entire continent with an initiative that aims to improve health outcomes, ensure equitable access to health services, and enhance the overall efficiency of health systems in the Americas. The roadmap for this digital transformation outlines strategic actions and goals to achieve a connected, efficient, and resilient health sector. %R 10.2196/65740 %U https://publichealth.jmir.org/2024/1/e65740 %U https://doi.org/10.2196/65740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57612 %T Perspectives of Digital Health Innovations in Low- and Middle-Income Health Care Systems From South and Southeast Asia %A Yi,Siyan %A Yam,Esabelle Lo Yan %A Cheruvettolil,Kochukoshy %A Linos,Eleni %A Gupta,Anshika %A Palaniappan,Latha %A Rajeshuni,Nitya %A Vaska,Kiran Gopal %A Schulman,Kevin %A Eggleston,Karen N %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 6914, siyan@nus.edu.sg %K digital health innovations %K public health %K South and Southeast Asia %K health care challenges %K low- and middle-income countries %K LMICs %K global health %K health AI %K artificial intelligence %K public health responses %K global health contexts %K digital health %D 2024 %7 25.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital health innovations have emerged globally as a transformative force for addressing health system challenges, particularly in resource-constrained settings. The COVID-19 pandemic underscored the critical importance of these innovations for enhancing public health. In South and Southeast Asia, a region known for its cultural diversity and complex health care landscape, digital health innovations present a dynamic interplay of challenges and opportunities. We advocate for ongoing research built into system development and an evidence-based strategy focusing on designing and scaling national digital health infrastructures combined with a vibrant ecosystem or “marketplace” of local experiments generating shared experience about what works in which settings. As the global digital health revolution unfolds, the perspectives drawn from South and Southeast Asia—including the importance of local partnerships—may provide valuable insights for shaping future strategies and informing similar initiatives in low- and middle-income countries, contributing to effective digital health strategies across diverse global health contexts. %M 39586089 %R 10.2196/57612 %U https://www.jmir.org/2024/1/e57612 %U https://doi.org/10.2196/57612 %U http://www.ncbi.nlm.nih.gov/pubmed/39586089 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50235 %T 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 %A Jefferson,Emily %A Milligan,Gordon %A Johnston,Jenny %A Mumtaz,Shahzad %A Cole,Christian %A Best,Joseph %A Giles,Thomas Charles %A Cox,Samuel %A Masood,Erum %A Horban,Scott %A Urwin,Esmond %A Beggs,Jillian %A Chuter,Antony %A Reilly,Gerry %A Morris,Andrew %A Seymour,David %A Hopkins,Susan %A Sheikh,Aziz %A Quinlan,Philip %+ Population Health and Genomics, School of Medicine, University of Dundee, The Health Informatics Centre, Ninewells Hospital and Medical School, Dundee, DD2 1FD, United Kingdom, 44 01382383943, e.r.jefferson@dundee.ac.uk %K COVID-19 %K infrastructure %K trusted research environments %K safe havens %K feasibility analysis %K cohort discovery %K federated analytics %K federated discovery %K lessons learned %K population wide %K data %K public health %K analysis %K CO-CONNECT %K challenges %K data transformation %D 2024 %7 20.11.2024 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19-Curated and Open Analysis and Research Platform (CO-CONNECT) project worked with 22 organizations across the United Kingdom to build a federated platform, enabling researchers to instantaneously and dynamically query federated datasets to find relevant data for their study. Finding relevant data takes time and effort, reducing the efficiency of research. Although data controllers could understand the value of such a system, there were significant challenges and delays in setting up the platform in response to COVID-19. This paper aims to present the challenges and lessons learned from the CO-CONNECT project to support other similar initiatives in the future. The project encountered many challenges, including the impacts of lockdowns on collaboration, understanding the new architecture, competing demands on people’s time during a pandemic, data governance approvals, different levels of technical capabilities, data transformation to a common data model, access to granular-level laboratory data, and how to engage public and patient representatives meaningfully on a highly technical project. To overcome these challenges, we developed a range of methods to support data partners such as explainer videos; regular, short, “touch base” videoconference calls; drop-in workshops; live demos; and a standardized technical onboarding documentation pack. A 4-stage data governance process emerged. The patient and public representatives were fully integrated team members. Persistence, patience, and understanding were key. We make 8 recommendations to change the landscape for future similar initiatives. The new architecture and processes developed are being built upon for non–COVID-19–related data, providing an infrastructural legacy. %M 39566065 %R 10.2196/50235 %U https://www.jmir.org/2024/1/e50235 %U https://doi.org/10.2196/50235 %U http://www.ncbi.nlm.nih.gov/pubmed/39566065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51594 %T Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts %A Zhou,Xinyi %A Hao,Xinyu %A Chen,Yuhang %A Deng,Hui %A Fang,Ling %A Zhang,Lingyun %A Yan,Xiaotao %A Zheng,Pinpin %A Wang,Fan %+ Fudan Development Institute, Fudan University, Think Tank Building, Room 415, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K e-cigarette %K marketing strategy %K social media %K teenagers %K content analysis %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39509702 %R 10.2196/51594 %U https://www.jmir.org/2024/1/e51594 %U https://doi.org/10.2196/51594 %U http://www.ncbi.nlm.nih.gov/pubmed/39509702 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59674 %T Patient Health Record Protection Beyond the Health Insurance Portability and Accountability Act: Mixed Methods Study %A Subramanian,Hemang %A Sengupta,Arijit %A Xu,Yilin %+ Florida International University, 11200 SW 8th Street, Miami, FL, 33199-2156, United States, 1 3053488446, hsubrama@fiu.edu %K security %K privacy %K security breach %K breach report %K health care %K health care infrastructure %K regulatory %K law enforcement %K Omnibus Rule %K qualitative analysis %K AI-generated data %K artificial intelligence %K difference-in-differences %K best practice %K data privacy %K safe practice %D 2024 %7 6.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39504550 %R 10.2196/59674 %U https://www.jmir.org/2024/1/e59674 %U https://doi.org/10.2196/59674 %U http://www.ncbi.nlm.nih.gov/pubmed/39504550 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59830 %T Developing Evidence to Support Policy: Protocol for the StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) %A Pugh,Mary Jo %A Haun,Jolie N %A White,P Jon %A Cochran,Gerald %A Mohanty,April F %A McAndrew,Lisa M %A Gordon,Adam J %A Nelson,Richard E %A Vanneman,Megan E %A Naranjo,Diana E %A Benzinger,Rachel C %A Jones,Audrey L %A Kean,Jacob %A Zickmund,Susan L %A Fagerlin,Angela %+ James A. Haley Veterans' Hospital, Research and Development Service, 8900 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 7622, rachel.benzinger@va.gov %K evidence-based policy-making %K policy evaluation %K knowledge translation %K veterans %K implementation science %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39298752 %R 10.2196/59830 %U https://www.researchprotocols.org/2024/1/e59830 %U https://doi.org/10.2196/59830 %U http://www.ncbi.nlm.nih.gov/pubmed/39298752 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59836 %T Rethinking Health Systems Responsiveness in Low- and Middle-Income Countries: Validation Study %A Iqbal,Meesha %A Cazaban,Cecilia Ganduglia %A Morgan,Robert %A Bauer,Cici %A Siddiqi,Sameen %+ School of Public Health, the University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX, 77030, United States, 1 2088215705, meesha_jazz@hotmail.com %K health system %K healthcare system %K health care %K responsiveness %K Pakistan %K Low-and middle-income countries %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 ɑ 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 %M 39293061 %R 10.2196/59836 %U https://www.researchprotocols.org/2024/1/e59836 %U https://doi.org/10.2196/59836 %U http://www.ncbi.nlm.nih.gov/pubmed/39293061 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e58080 %T Exploring Impediments Imposed by the Medical Device Regulation EU 2017/745 on Software as a Medical Device %A Svempe,Liga %+ Faculty of Social Sciences, Riga Stradins University, Dzirciema 16, Riga, LV1007, Latvia, 371 67409120, liga.svempe@rsu.edu.lv %K software %K artificial intelligence %K medical device regulation %K rights %K digital health %D 2024 %7 5.9.2024 %9 Viewpoint %J JMIR Med Inform %G English %X In light of rapid technological advancements, the health care sector is undergoing significant transformation with the continuous emergence of novel digital solutions. Consequently, regulatory frameworks must continuously adapt to ensure their main goal to protect patients. In 2017, the new Medical Device Regulation (EU) 2017/745 (MDR) came into force, bringing more complex requirements for development, launch, and postmarket surveillance. However, the updated regulation considerably impacts the manufacturers, especially small- and medium-sized enterprises, and consequently, the accessibility of medical devices in the European Union market, as many manufacturers decide to either discontinue their products, postpone the launch of new innovative solutions, or leave the European Union market in favor of other regions such as the United States. This could lead to reduced health care quality and slower industry innovation efforts. Effective policy calibration and collaborative efforts are essential to mitigate these effects and promote ongoing advancements in health care technologies in the European Union market. This paper is a narrative review with the objective of exploring hindering factors to software as a medical device development, launch, and marketing brought by the new regulation. It exclusively focuses on the factors that engender obstacles. Related regulations, directives, and proposals were discussed for comparison and further analysis. %M 39235850 %R 10.2196/58080 %U https://medinform.jmir.org/2024/1/e58080 %U https://doi.org/10.2196/58080 %U http://www.ncbi.nlm.nih.gov/pubmed/39235850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47389 %T Policy Guidance for Direct-to-Consumer Genetic Testing Services: Framework Development Study %A Onstwedder,Suzanne Maria %A Jansen,Marleen Elizabeth %A Cornel,Martina Cornelia %A Rigter,Tessel %+ Department of Public Health Genomics and Screening, Centre for Health Protection, Dutch National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 088 689 8989, suzanne.onstwedder@rivm.nl %K genetic testing %K direct-to-consumer testing %K health policy %K genetic privacy %K online market %K informed consent %K public health genomics %K policy decision %K mHealth %K mobile health %K privacy %D 2024 %7 17.7.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39018558 %R 10.2196/47389 %U https://www.jmir.org/2024/1/e47389 %U https://doi.org/10.2196/47389 %U http://www.ncbi.nlm.nih.gov/pubmed/39018558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50483 %T Cost Evaluation of the Ontario Virtual Urgent Care Pilot Program: Population-Based, Matched Cohort Study %A Tarride,Jean-Eric %A Hall,Justin N %A Mondoux,Shawn %A Dainty,Katie N %A McCarron,Joy %A Paterson,J Michael %A Plumptre,Lesley %A Borgundvaag,Emily %A Ovens,Howard %A McLeod,Shelley L %+ Centre for Health Economics and Policy Analysis, McMaster University, Communication Research Laboratory 227, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 522 9140 ext 20205, tarride@mcmaster.ca %K virtual urgent care %K health care expenditures %K Canada %K virtual care %K economic evaluation %K pilot program %K pilot %K Ontario %K urgent care %K care %K emergency department %K users %K patient %K patients %K resources %K resource allocation %K policy decision %K decision-making %K policy %D 2024 %7 15.7.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39008348 %R 10.2196/50483 %U https://www.jmir.org/2024/1/e50483 %U https://doi.org/10.2196/50483 %U http://www.ncbi.nlm.nih.gov/pubmed/39008348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51327 %T Public Perceptions and Discussions of the US Food and Drug Administration's JUUL Ban Policy on Twitter: Observational Study %A Liu,Pinxin %A Lou,Xubin %A Xie,Zidian %A Shang,Ce %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarettes %K JUUL %K Twitter %K deep learning %K FDA %K Food and Drug Administration %K vape %K vaping %K smoking %K social media %K regulation %D 2024 %7 11.7.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38990633 %R 10.2196/51327 %U https://formative.jmir.org/2024/1/e51327 %U https://doi.org/10.2196/51327 %U http://www.ncbi.nlm.nih.gov/pubmed/38990633 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55061 %T Medical Information Protection in Internet Hospital Apps in China: Scale Development and Content Analysis %A Jiang,Jiayi %A Zheng,Zexing %+ Law School, Central South University, Number 932 Lushan South Road, Yuelu District, Changsha, 410083, China, 86 18718479720, xing986@126.com %K hospital apps %K privacy policy %K personal information protection %K policy evaluation %K content analysis %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 38904994 %R 10.2196/55061 %U https://mhealth.jmir.org/2024/1/e55061 %U https://doi.org/10.2196/55061 %U http://www.ncbi.nlm.nih.gov/pubmed/38904994 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55194 %T From the Public Health Perspective: a Scalable Model for Improving Epidemiological Testing Efficacy in Low- and Middle-Income Areas %A Huang,Xuefeng %A Kong,Qian-Yi %A Wan,Xiaowen %A Huang,Yating %A Wang,Rongrong %A Wang,Xiaoxue %A Li,Yingying %A Wu,Yuqing %A Guan,Chongyuan %A Wang,Junyang %A Zhang,Yuanyuan %+ School of Public Health, Dalian Medical University, No 9, West Section of Lvshun South Road, Dalian, 116041, China, 86 18641106272, zhangyuan@dmu.edu.cn %K low- and middle-income country %K LMIC %K pandemic %K epidemiological surveillance %K universal public health %K nonpharmacological interventions %K public health %K callable model %K efficacy %K COVID-19 %K public safety threats %K effectiveness %K China %K detection %K epidemic %D 2024 %7 10.6.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The globe is an organically linked whole, and in the pandemic era, COVID-19 has brought heavy public safety threats and economic costs to humanity as almost all countries began to pay more attention to taking steps to minimize the risk of harm to society from sudden-onset diseases. It is worth noting that in some low- and middle-income areas, where the environment for epidemic detection is complex, the causative and comorbid factors are numerous, and where public health resources are scarce. It is often more difficult than in other areas to obtain timely and effective detection and control in the event of widespread virus transmission, which, in turn, is a constant threat to local and global public health security. Pandemics are preventable through effective disease surveillance systems, with nonpharmacological interventions (NPIs) as the mainstay of the control system, effectively controlling the spread of epidemics and preventing larger outbreaks. However, current state-of-the-art NPIs are not applicable in low- and middle-income areas and tend to be decentralized and costly. Based on a 3-year case study of SARS-CoV-2 preventive detection in low-income areas in south-central China, we explored a strategic model for enhancing disease detection efficacy in low- and middle-income areas. For the first time, we propose an integrated and comprehensive approach that covers structural, social, and personal strategies to optimize the epidemic surveillance system in low- and middle-income areas. This model can improve the local epidemic detection efficiency, ensure the health care needs of more people, reduce the public health costs in low- and middle-income areas in a coordinated manner, and ensure and strengthen local public health security sustainably. %M 38857063 %R 10.2196/55194 %U https://publichealth.jmir.org/2024/1/e55194 %U https://doi.org/10.2196/55194 %U http://www.ncbi.nlm.nih.gov/pubmed/38857063 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52349 %T Impact of Responsible AI on the Occurrence and Resolution of Ethical Issues: Protocol for a Scoping Review %A Boege,Selina %A Milne-Ives,Madison %A Meinert,Edward %+ Translational and Clinical Research Institute, Newcastle University, Campus for Ageing and Vitality, Westgate Road, Newcastle-upon-Tyne, NE4 6BE, United Kingdom, 44 01912336161, edward.meinert@newcastle.ac.uk %K artificial intelligence %K AI %K responsible artificial intelligence %K RAI %K ethical artificial intelligence %K trustworthy artificial intelligence %K explainable artificial intelligence %K XAI %K digital ethics %D 2024 %7 5.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 38838329 %R 10.2196/52349 %U https://www.researchprotocols.org/2024/1/e52349 %U https://doi.org/10.2196/52349 %U http://www.ncbi.nlm.nih.gov/pubmed/38838329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50344 %T Does an App a Day Keep the Doctor Away? AI Symptom Checker Applications, Entrenched Bias, and Professional Responsibility %A Zawati,Ma'n H %A Lang,Michael %+ Centre of Genomics and Policy, McGill University, 5200-740 Dr Penfield Avenue, Montreal, QC, H3A 0G1, Canada, 1 5143988155, man.zawati@mcgill.ca %K artificial intelligence %K applications %K mobile health %K mHealth %K bias %K biases %K professional obligations %K professional obligation %K app %K apps %K application %K symptom checker %K symptom checkers %K diagnose %K diagnosis %K self-diagnose %K self-diagnosis %K ethic %K ethics %K ethical %K regulation %K regulations %K legal %K law %K laws %K safety %K mobile phone %D 2024 %7 5.6.2024 %9 Viewpoint %J J Med Internet Res %G English %X The growing prominence of artificial intelligence (AI) in mobile health (mHealth) has given rise to a distinct subset of apps that provide users with diagnostic information using their inputted health status and symptom information—AI-powered symptom checker apps (AISympCheck). While these apps may potentially increase access to health care, they raise consequential ethical and legal questions. This paper will highlight notable concerns with AI usage in the health care system, further entrenchment of preexisting biases in the health care system and issues with professional accountability. To provide an in-depth analysis of the issues of bias and complications of professional obligations and liability, we focus on 2 mHealth apps as examples—Babylon and Ada. We selected these 2 apps as they were both widely distributed during the COVID-19 pandemic and make prominent claims about their use of AI for the purpose of assessing user symptoms. First, bias entrenchment often originates from the data used to train AI systems, causing the AI to replicate these inequalities through a “garbage in, garbage out” phenomenon. Users of these apps are also unlikely to be demographically representative of the larger population, leading to distorted results. Second, professional accountability poses a substantial challenge given the vast diversity and lack of regulation surrounding the reliability of AISympCheck apps. It is unclear whether these apps should be subject to safety reviews, who is responsible for app-mediated misdiagnosis, and whether these apps ought to be recommended by physicians. With the rapidly increasing number of apps, there remains little guidance available for health professionals. Professional bodies and advocacy organizations have a particularly important role to play in addressing these ethical and legal gaps. Implementing technical safeguards within these apps could mitigate bias, AIs could be trained with primarily neutral data, and apps could be subject to a system of regulation to allow users to make informed decisions. In our view, it is critical that these legal concerns are considered throughout the design and implementation of these potentially disruptive technologies. Entrenched bias and professional responsibility, while operating in different ways, are ultimately exacerbated by the unregulated nature of mHealth. %M 38838309 %R 10.2196/50344 %U https://www.jmir.org/2024/1/e50344 %U https://doi.org/10.2196/50344 %U http://www.ncbi.nlm.nih.gov/pubmed/38838309 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49276 %T Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model %A He,Yanyun %A Yang,Qian %A Alish,Yousef %A Ma,Shaoying %A Qiu,Zefeng %A Chen,Jian %A Wagener,Theodore %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Rd, Columbus, OH, 43214, United States, 1 9739607969, yanyun.he@osumc.edu %K e-cigarette devices %K price %K web-based vape shop %K battery capacity %K output wattage %K e-cigarette %K vape %K vaping %K consumers %K costs %K prices %K pricing %K feature %K features %K device %K devices %K consumer %K cost %K smoking products %K product safety %K consumer safety %K smoking %K smoker %K smokers %K tax %K taxes %K taxation %K economic %K economics %K regression %K regression model %K health economics %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38723251 %R 10.2196/49276 %U https://formative.jmir.org/2024/1/e49276 %U https://doi.org/10.2196/49276 %U http://www.ncbi.nlm.nih.gov/pubmed/38723251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50629 %T Usability of Health Care Price Transparency Data in the United States: Mixed Methods Study %A Maleki,Negar %A Padmanabhan,Balaji %A Dutta,Kaushik %+ School of Information Systems and Management, Muma College of Business, University of South Florida, 4202 E Fowler Avenue, Tampa, FL, 33620, United States, 1 8139742011, negarmaleki@usf.edu %K price transparency %K user experiments %K schema analysis %K health care %K patients %K algorithms %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38442238 %R 10.2196/50629 %U https://www.jmir.org/2024/1/e50629 %U https://doi.org/10.2196/50629 %U http://www.ncbi.nlm.nih.gov/pubmed/38442238 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52587 %T Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance %A Rigby,Ryan C %A Ferdinand,Alva O %A Kum,Hye-Chung %A Schmit,Cason %+ Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77845, United States, 1 9794360277, schmit@tamu.edu %K syndromic surveillance %K federalism %K COVID-19 %K public health %K SARS-CoV-2 %K COVID-19 pandemic %K United States %K decentralized %K data sharing %K digital health %K ethical guidelines %K risk score %K technology %K innovation %K information system %K collaborative framework %K infodemiology %K digital technology %K health information %K health data %K health policy %K surveillance %D 2024 %7 28.3.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction’s consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system. %M 38546731 %R 10.2196/52587 %U https://publichealth.jmir.org/2024/1/e52587 %U https://doi.org/10.2196/52587 %U http://www.ncbi.nlm.nih.gov/pubmed/38546731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53921 %T The Impact of Broadband Infrastructure Construction on Medical Resource Mismatch: Quasi-Natural Experiment From the Broadband China Policy %A Chai,Yulin %A Yuan,Xiaoping %A Guo,Lin %A Chen,Zhongming %+ School of Management, Shandong Second Medical University, 7166 Baotong West St, Weifang, 261053, China, 86 0536 8462573, guolin19860818@163.com %K broadband %K infrastructure %K medical resources %K resource mismatch %K Broadband China Policy %D 2024 %7 21.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38512327 %R 10.2196/53921 %U https://www.jmir.org/2024/1/e53921 %U https://doi.org/10.2196/53921 %U http://www.ncbi.nlm.nih.gov/pubmed/38512327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49822 %T Investigating the Roles and Responsibilities of Institutional Signing Officials After Data Sharing Policy Reform for Federally Funded Research in the United States: National Survey %A Baek,Jinyoung %A Lawson,Jonathan %A Rahimzadeh,Vasiliki %+ Center for Medical Ethics and Health Policy, Baylor College of Medicine, 1 Baylor Plaza, Suite 310DF, Houston, TX, 77030, United States, 1 (713) 798 3500, vasiliki.rahimzadeh@bcm.edu %K biomedical research %K survey %K surveys %K data sharing %K data management %K secondary use %K National Institutes of Health %K signing official %K information sharing %K exchange %K access %K data science %K accessibility %K policy %K policies %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38506894 %R 10.2196/49822 %U https://formative.jmir.org/2024/1/e49822 %U https://doi.org/10.2196/49822 %U http://www.ncbi.nlm.nih.gov/pubmed/38506894 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52150 %T 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 %A Holl,Felix %A Kircher,Jennifer %A Hertelendy,Attila J %A Sukums,Felix %A Swoboda,Walter %+ DigiHealth Institute, Neu-Ulm University of Applied Sciences, Wileystraße 1, Neu-Ulm, 89231, Germany, 49 7319762 ext 1613, felix.holl@hnu.de %K digital health strategies %K comparative policy analysis %K DHS %K eHealth %K digital health %K strategy %K strategies %K policy %K policies %K document analysis %K document analyses %K GSDH %K Germany %K Europe %K Africa %K Tanzania %D 2024 %7 18.3.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 38498021 %R 10.2196/52150 %U https://www.jmir.org/2024/1/e52150 %U https://doi.org/10.2196/52150 %U http://www.ncbi.nlm.nih.gov/pubmed/38498021 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e49177 %T Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators %A Sisk,Bryan %A Antes,Alison L %A Bereitschaft,Christine %A Enloe,Madi %A Bourgeois,Fabienne %A DuBois,James %+ Bioethics Research Center, Department of Medicine, Washington University School of Medicine, MSC 8116-43-10, 660 S Euclid, St Louis, MO, 63110, United States, 1 3142739084, siskb@wustl.edu %K adolescent %K patient portal %K electronic health records %K policy %K ethics %K portal %K portals %K adolescents %K youth %K health record %K health records %K EHR %K EHRs %K perspective %K perspectives %K policies %K administrator %K administration %K informatics %K information system %K information systems %K guidelines %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X 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. %M 38466976 %R 10.2196/49177 %U https://pediatrics.jmir.org/2024/1/e49177 %U https://doi.org/10.2196/49177 %U http://www.ncbi.nlm.nih.gov/pubmed/38466976 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47197 %T Understanding the Integrated Health Management System Policy in China From Multiple Perspectives: Systematic Review and Content Analysis %A Yu,Yang %A Wang,Sufen %A You,Lijue %+ Glorious Sun School of Business and Management, Donghua University, 1882 West Yan-an Road, Shanghai, 200051, China, 86 18116350361, sf_wang@dhu.edu.cn %K integrated health management system %K medical association %K medical consortium %K policy tools %K content analysis %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %D 2024 %7 24.1.2024 %9 Review %J J Med Internet Res %G English %X 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. %M 38265862 %R 10.2196/47197 %U https://www.jmir.org/2024/1/e47197 %U https://doi.org/10.2196/47197 %U http://www.ncbi.nlm.nih.gov/pubmed/38265862 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48702 %T 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 %A Pedrera-Jiménez,Miguel %A García-Barrio,Noelia %A Frid,Santiago %A Moner,David %A Boscá-Tomás,Diego %A Lozano-Rubí,Raimundo %A Kalra,Dipak %A Beale,Thomas %A Muñoz-Carrero,Adolfo %A Serrano-Balazote,Pablo %+ Data Science Unit, Hospital Universitario 12 de Octubre, Av. de Córdoba, s/n, Madrid, 28041, Spain, 34 634209791, mpedrerajimenez@gmail.com %K electronic health records %K FAIR principles %K health information standards %K HL7 FHIR %K ISO 13606 %K OpenEHR %K semantics %D 2023 %7 28.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X In order to maximize the value of electronic health records (EHRs) for both health care and secondary use, it is necessary for the data to be interoperable and reusable without loss of the original meaning and context, in accordance with the findable, accessible, interoperable, and reusable (FAIR) principles. To achieve this, it is essential for health data platforms to incorporate standards that facilitate addressing needs such as formal modeling of clinical knowledge (health domain concepts) as well as the harmonized persistence, query, and exchange of data across different information systems and organizations. However, the selection of these specifications has not been consistent across the different health data initiatives, often applying standards to address needs for which they were not originally designed. This issue is essential in the current scenario of implementing the European Health Data Space, which advocates harmonization, interoperability, and reuse of data without regulating the specific standards to be applied for this purpose. Therefore, this viewpoint aims to establish a coherent, agnostic, and homogeneous framework for the use of the most impactful EHR standards in the new-generation health data spaces: OpenEHR, International Organization for Standardization (ISO) 13606, and Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR). Thus, a panel of EHR standards experts has discussed several critical points to reach a consensus that will serve decision-making teams in health data platform projects who may not be experts in these EHR standards. It was concluded that these specifications possess different capabilities related to modeling, flexibility, and implementation resources. Because of this, in the design of future data platforms, these standards must be applied based on the specific needs they were designed for, being likewise fully compatible with their combined functional and technical implementation. %M 38153779 %R 10.2196/48702 %U https://www.jmir.org/2023/1/e48702 %U https://doi.org/10.2196/48702 %U http://www.ncbi.nlm.nih.gov/pubmed/38153779 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45266 %T National Initiatives on Salt Substitutes: Scoping Review %A Kong,Bingxuan %A Yang,Shanyue %A Long,Jiewei %A Tang,Yuhan %A Liu,Yang %A Ge,Zeng %A Rong,Shuang %A Wu,Yangfeng %A Ding,Gangqiang %A Yang,Yuexin %A Yao,Ping %A Gao,Chao %+ National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, 29 Nanwei Road, Beijing, 100050, China, 86 010 66237206, gaochao20090901@163.com %K salt substitute %K nutrition policy %K initiatives %K strategies %D 2023 %7 17.11.2023 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 37435719 %R 10.2196/45266 %U https://publichealth.jmir.org/2023/1/e45266 %U https://doi.org/10.2196/45266 %U http://www.ncbi.nlm.nih.gov/pubmed/37435719 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50199 %T Exploring Political Mistrust in Pandemic Risk Communication: Mixed-Method Study Using Social Media Data Analysis %A Unlu,Ali %A Truong,Sophie %A Tammi,Tuukka %A Lohiniva,Anna-Leena %+ Finnish Institute for Health and Welfare, Mannerheimintie 166, Helsinki, 00271, Finland, 358 295246000, ali.unlu@thl.fi %K political trust %K social media %K text classification %K topic modeling %K COVID-19 %K Finland %K trust %K authority %K public health outcome %K pandemic %K perception %K mistrust %K interaction %K Twitter %K Facebook %K analysis %K computational method %K natural language processing %K misinformation %K communication %K crisis %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37862088 %R 10.2196/50199 %U https://www.jmir.org/2023/1/e50199 %U https://doi.org/10.2196/50199 %U http://www.ncbi.nlm.nih.gov/pubmed/37862088 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40149 %T Cancer and Atrial Fibrillation Comorbidities Among 25 Million Citizens in Shanghai, China: Medical Insurance Database Study %A Chen,Mu %A Li,Cheng %A Zhang,Jiwei %A Cui,Xin %A Tian,Wenqi %A Liao,Peng %A Wang,Qunshan %A Sun,Jian %A Luo,Li %A Wu,Hong %A Li,Yi-Gang %+ Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Rd, Yangpu District, Shanghai, 200092, China, 86 21 25077275, liyigang@xinhuamed.com.cn %K cardiovascular %K malignancy %K arrhythmia %K cardio-oncology %K prevalence %K epidemiology %K atrial fibrillation %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37847541 %R 10.2196/40149 %U https://publichealth.jmir.org/2023/1/e40149 %U https://doi.org/10.2196/40149 %U http://www.ncbi.nlm.nih.gov/pubmed/37847541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50306 %T Policies and Management Interventions to Enhance Health and Care Workforce Capacity for Addressing the COVID-19 Pandemic: Protocol for a Living Systematic Review %A Cavalcante de Oliveira,Ana Paula %A Lopes Galante,Mariana %A Senna Maia,Leila %A Craveiro,Isabel %A Pereira da Silva,Alessandra %A Fronteira,Ines %A Chança,Raphael %A Ferrinho,Paulo %A Dal Poz,Mario %+ Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524 – 7º andar, Blocos D e E – Maracanã, Rio de Janeiro, 20550-013, Brazil, 55 21 2334 0504 ext 205, apco.hrh@gmail.com %K COVID-19 %K health and care workforce policy %K health and care workforce capacity %K management interventions %K SARS-CoV-2 %K pandemic %D 2023 %7 5.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37796568 %R 10.2196/50306 %U https://www.researchprotocols.org/2023/1/e50306 %U https://doi.org/10.2196/50306 %U http://www.ncbi.nlm.nih.gov/pubmed/37796568 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49150 %T Digital Rights and Mobile Health in Low- and Middle-Income Countries: Protocol for a Scoping Review %A Poulsen,Adam %A Song,Yun J C %A Fosch-Villaronga,Eduard %A LaMonica,Haley M %A Iannelli,Olivia %A Alam,Mafruha %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney, 2050, Australia, 61 481082211, adam.poulsen@sydney.edu.au %K human right %K digital right %K mobile health %K mHealth %K smartphone %K mobile phone %K digital health %K scoping review %K health equity %K patient empowerment %D 2023 %7 3.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37788054 %R 10.2196/49150 %U https://www.researchprotocols.org/2023/1/e49150 %U https://doi.org/10.2196/49150 %U http://www.ncbi.nlm.nih.gov/pubmed/37788054 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49003 %T Digital Health Reimbursement Strategies of 8 European Countries and Israel: Scoping Review and Policy Mapping %A van Kessel,Robin %A Srivastava,Divya %A Kyriopoulos,Ilias %A Monti,Giovanni %A Novillo-Ortiz,David %A Milman,Ran %A Zhang-Czabanowski,Wojciech Wilhelm %A Nasi,Greta %A Stern,Ariel Dora %A Wharton,George %A Mossialos,Elias %+ LSE Health, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom, 44 7772 707841, e.a.mossialos@lse.ac.uk %K digital health %K telehealth %K telemedicine %K reimbursement %K policy %K Europe %K policy mapping %K mapping %K pricing %K digital health app %K application %K health care ecosystem %K framework %K integration %D 2023 %7 29.9.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X 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. %M 37773610 %R 10.2196/49003 %U https://mhealth.jmir.org/2023/1/e49003 %U https://doi.org/10.2196/49003 %U http://www.ncbi.nlm.nih.gov/pubmed/37773610 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e51760 %T Effective Infodemic Management: A Substantive Article of the Pandemic Accord %A Taguchi,Kazuho %A Matsoso,Precious %A Driece,Roland %A da Silva Nunes,Tovar %A Soliman,Ahmed %A Tangcharoensathien,Viroj %+ International Health Policy Program, Ministry of Public Health, Tivanond Road, Nonthaburi, 11000, Thailand, 66 818480297, viroj@ihpp.thaigov.net %K Pandemic Accord %K infodemic %K infodemic management %K COVID-19 %K social media %K Intergovernmental Negotiating Body %K INB %K INB Bureau %K World Health Organization %K WHO %K misinformation %K disinformation %K public health %D 2023 %7 20.9.2023 %9 Editorial %J JMIR Infodemiology %G English %X Social media has proven to be valuable for disseminating public health information during pandemics. However, the circulation of misinformation through social media during public health emergencies, such as the SARS (severe acute respiratory syndrome), Ebola, and COVID-19 pandemics, has seriously hampered effective responses, leading to negative consequences. Intentionally misleading and deceptive fake news aims to harm organizations and individuals. To effectively respond to misinformation, governments should strengthen the management of an “infodemic,” which involves monitoring the impact of infodemics through social listening, detecting signals of infodemic spread, mitigating the harmful effects of infodemics, and strengthening the resilience of individuals and communities. The global spread of misinformation requires multisectoral collaboration, such as researchers identifying leading sources of misinformation and superspreaders, media agencies identifying and debunking misinformation, technology platforms reducing the distribution of false or misleading posts and guiding users to health information from credible sources, and governments disseminating clear public health information in partnership with trusted messengers. Additionally, fact-checking has room for improvement through the use of automated checks. Collaboration between governments and fact-checking agencies should also be strengthened via effective and timely debunking mechanisms. Though the Intergovernmental Negotiating Body (INB) has yet to define the term “infodemic,” Article 18 of the INB Bureau’s text, developed for the Pandemic Accord, encompasses a range of actions aimed at enhancing infodemic management. The INB Bureau continues to facilitate evidence-informed discussion for an implementable article on infodemic management. %M 37728969 %R 10.2196/51760 %U https://infodemiology.jmir.org/2023/1/e51760 %U https://doi.org/10.2196/51760 %U http://www.ncbi.nlm.nih.gov/pubmed/37728969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48824 %T Strengthening Cybersecurity for Patient Data Protection in Europe %A van Kessel,Robin %A Haig,Madeleine %A Mossialos,Elias %+ LSE Health, Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom, 44 7772 707841, e.a.mossialos@lse.ac.uk %K cybersecurity %K Europe %K European Health Data Space %K digital health %K mHealth %K medical informatics %K data privacy %K patient safety %K privacy %K health service %D 2023 %7 24.8.2023 %9 Viewpoint %J J Med Internet Res %G English %X The health care sector experiences 76% of cybersecurity breaches due to basic web application attacks, miscellaneous errors, and system intrusions, resulting in compromised health data or disrupted health services. The European Commission proposed the European Health Data Space (EHDS) in 2022 to enhance care delivery and improve patients’ lives by offering all European Union (EU) citizens control over their personal health data in a private and secure environment. The EU has taken an important step in homogenizing the health data environment of the European health ecosystem, although more attention needs to be paid to keeping the health data of EU citizens safe and secure within the EHDS. The pooling of health data across countries can have tremendous benefits, but it may also become a target for cybercriminals or state-sponsored hackers. State-of-the-art security measures are essential, and the current EHDS proposal lacks sufficient measures to warrant a cybersecure and resilient environment. %M 37616048 %R 10.2196/48824 %U https://www.jmir.org/2023/1/e48824 %U https://doi.org/10.2196/48824 %U http://www.ncbi.nlm.nih.gov/pubmed/37616048 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44150 %T Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study %A Akahane,Manabu %A Kanagawa,Yoshiyuki %A Takahata,Yoshihisa %A Nakanishi,Yasuhiro %A Akahane,Takemi %A Imamura,Tomoaki %+ Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako, 351-0197, Japan, 81 484586347, akahane.m.aa@niph.go.jp %K food defense %K health hazards %K intentional contamination %K foreign substances %K food delivery service %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 37616047 %R 10.2196/44150 %U https://formative.jmir.org/2023/1/e44150 %U https://doi.org/10.2196/44150 %U http://www.ncbi.nlm.nih.gov/pubmed/37616047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46854 %T 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 %A Yi,Min %A Cao,Yuebin %A Wang,Lin %A Gu,Yaowen %A Zheng,Xueqian %A Wang,Jiangjun %A Chen,Wei %A Wei,Liangyu %A Zhou,Yujin %A Shi,Chenyi %A Cao,Yanlin %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, No 3 Yabao Road Chaoyang District, Beijing, 100020, China, 86 13370136475, cao.yanlin@imicams.ac.cn %K medical workers %K medical disputes %K hospital legal construction %K machine learning %K multicenter analysis %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37590041 %R 10.2196/46854 %U https://www.jmir.org/2023/1/e46854 %U https://doi.org/10.2196/46854 %U http://www.ncbi.nlm.nih.gov/pubmed/37590041 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45602 %T Nurses’ Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey %A Zhang,Jinghui %A Peng,Sha %A Hou,Jianmei %A Ma,Guiyuan %A Liu,Yanhui %A Fan,Yuhua %A Luo,Lingxia %A Shi,Zhengkun %+ Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, China, 86 15874032339, zhangjh-1206@163.com %K Internet+home care services %K willingness %K demand %K clinical nurses %K municipal hospitals %D 2023 %7 4.8.2023 %9 Original Paper %J J Med Internet Res %G English %X 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 >¥10,000 increased the likelihood of nurses’ willingness to provide IHC services, by 1.187 times, compared with an income <¥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 ¥5000 to ¥10,000 (B=0.894, P<.001) and >¥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 <¥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. %M 37540546 %R 10.2196/45602 %U https://www.jmir.org/2023/1/e45602 %U https://doi.org/10.2196/45602 %U http://www.ncbi.nlm.nih.gov/pubmed/37540546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42483 %T The Digital Divide in Brazil and Barriers to Telehealth and Equal Digital Health Care: Analysis of Internet Access Using Publicly Available Data %A Nakayama,Luis Filipe %A Binotti,William Warr %A Link Woite,Naira %A Fernandes,Chrystinne Oliveira %A Alfonso,Pia Gabrielle %A Celi,Leo Anthony %A Regatieri,Caio Vinicius %+ Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, United States, 1 617 253 781, luisnaka@mit.edu %K digital divide %K digital health %K health equity %K internet access %K medical care %D 2023 %7 21.7.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37477958 %R 10.2196/42483 %U https://www.jmir.org/2023/1/e42483 %U https://doi.org/10.2196/42483 %U http://www.ncbi.nlm.nih.gov/pubmed/37477958 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41369 %T The Effects of COVID-19 Pandemic Policy on Social Needs Across the State of Kansas and Western Missouri: Paired Survey Response Testing %A Mudaranthakam,Dinesh Pal %A Pepper,Sam %A Fortney,Tanner %A Alsup,Alexander %A Woodward,Jennifer %A Sykes,Kevin %A Calhoun,Elizabeth %+ Department of Biostatistics & Data Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 9139456922, dmudaranthakam@kumc.edu %K social determinants of health %K COVID-19 %K food assistance program %K public health %K quality of life %K well-being %K health disparity %K health inequity %K health policy %K Kansas %K social work %K socioeconomic %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36977199 %R 10.2196/41369 %U https://publichealth.jmir.org/2023/1/e41369 %U https://doi.org/10.2196/41369 %U http://www.ncbi.nlm.nih.gov/pubmed/36977199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41588 %T Federated Machine Learning, Privacy-Enhancing Technologies, and Data Protection Laws in Medical Research: Scoping Review %A Brauneck,Alissa %A Schmalhorst,Louisa %A Kazemi Majdabadi,Mohammad Mahdi %A Bakhtiari,Mohammad %A Völker,Uwe %A Baumbach,Jan %A Baumbach,Linda %A Buchholtz,Gabriele %+ Hamburg University Faculty of Law, University of Hamburg, Rothenbaumchaussee 33, Hamburg, 20148, Germany, 49 40 42838 2328, alissa.brauneck@uni-hamburg.de %K federated learning %K data protection regulation %K data protection by design %K privacy protection %K General Data Protection Regulation compliance %K GDPR compliance %K privacy-preserving technologies %K differential privacy %K secure multiparty computation %D 2023 %7 30.3.2023 %9 Review %J J Med Internet Res %G English %X 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. %M 36995759 %R 10.2196/41588 %U https://www.jmir.org/2023/1/e41588 %U https://doi.org/10.2196/41588 %U http://www.ncbi.nlm.nih.gov/pubmed/36995759 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46700 %T 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” %A Tewari,Ambuj %+ Department of Statistics, University of Michigan, 1085 S University Ave, Ann Arbor, MI, 48109-1107, United States, 1 734 615 0928, tewaria@umich.edu %K mHealth %K differential privacy %K private synthetic data %K federated learning %K data protection regulation %K data protection by design %K privacy protection %K General Data Protection Regulation %K GDPR compliance %K privacy-preserving technologies %K secure multiparty computation %K multiparty computation %K machine learning %K privacy %D 2023 %7 30.3.2023 %9 Commentary %J J Med Internet Res %G English %X Brauneck and colleagues have combined technical and legal perspectives in their timely and valuable paper “Federated Machine Learning, Privacy-Enhancing Technologies, and Data Protection Laws in Medical Research: Scoping Review.” Researchers who design mobile health (mHealth) systems must adopt the same privacy-by-design approach that privacy regulations (eg, General Data Protection Regulation) do. In order to do this successfully, we will have to overcome implementation challenges in privacy-enhancing technologies such as differential privacy. We will also have to pay close attention to emerging technologies such as private synthetic data generation. %M 36995757 %R 10.2196/46700 %U https://www.jmir.org/2023/1/e46700 %U https://doi.org/10.2196/46700 %U http://www.ncbi.nlm.nih.gov/pubmed/36995757 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44070 %T The Association Between Social Determinants of Health and Population Health Outcomes: Ecological Analysis %A Vo,Ace %A Tao,Youyou %A Li,Yan %A Albarrak,Abdulaziz %+ Information Systems and Business Analytics Department, Loyola Marymount University, 1 Loyola Marymount University Dr, Los Angeles, CA, 90045, United States, 1 3103384522, ace.vo@lmu.edu %K social determinants of health %K public policy %K health outcomes %K policy recommendation %K cities %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36989028 %R 10.2196/44070 %U https://publichealth.jmir.org/2023/1/e44070 %U https://doi.org/10.2196/44070 %U http://www.ncbi.nlm.nih.gov/pubmed/36989028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41408 %T Assessment of Stakeholder Perceptions and Attitudes Toward Health Data Governance Principles in Botswana: Web-Based Survey %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Chibemba,Star %A Wanyee,Steven %A Oluoch,Tom %+ Department of Health Information Management, Botho University, Botho Education Park, Diratsame Mosielele, Gaborone, PO Box 501564, Botswana, 267 3919999, kabelo.mauco@bothouniversity.ac.bw %K health data %K governance %K Botswana %K digital health %K decision-making %K health care stakeholders %K perceptions %K health policy %K data governance %K data policy %K implementation %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36912870 %R 10.2196/41408 %U https://formative.jmir.org/2023/1/e41408 %U https://doi.org/10.2196/41408 %U http://www.ncbi.nlm.nih.gov/pubmed/36912870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42021 %T Attitudes and Experiences of Clinicians After Mandated Implementation of Open Notes by the 21st Century Cures Act: Survey Study %A Leonard,Sophia M %A Zackula,Rosalee %A Wilcher,Jonathan %+ Kansas City Campus, The University of Kansas School of Medicine, 3901 Rainbow Blvd., Kansas City, KS, 66160, United States, 1 3167599185, sleonard7@kumc.edu %K 21st Century Cures Act %K Final Rule %K shared notes %K open notes %K OpenNotes %K health policy %K clinician opinion %K mobile phone %D 2023 %7 28.2.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36853747 %R 10.2196/42021 %U https://www.jmir.org/2023/1/e42021 %U https://doi.org/10.2196/42021 %U http://www.ncbi.nlm.nih.gov/pubmed/36853747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43754 %T Ethics of Medical Archival Internet Research Data %A Rashi,Tsuriel %A Yom-Tov,Elad %+ School of Communication, Ariel University, Ramat HaGolan St 65, Ariel, 4974005, Israel, 972 39325046, tsuriel.rashi@gmail.com %K ethic %K archival internet research data %K three laws of robotics %D 2023 %7 31.1.2023 %9 Viewpoint %J J Med Internet Res %G English %X Medical research based on internet archive data, which in some ways is quite different from other data-based studies, is becoming more and more common. Despite its uniqueness and the challenges that characterize it, clear ethical rules designed to guide practitioners in this field have not yet been written. This article points to the lacuna that exists in legal and ethical texts today and offers an ethically balancing alternative. Among other features, the balance is based on the famous three laws of robotics by Asimov and a series of values, including transparency, accountability, fairness, and privacy. %M 36719736 %R 10.2196/43754 %U https://www.jmir.org/2023/1/e43754 %U https://doi.org/10.2196/43754 %U http://www.ncbi.nlm.nih.gov/pubmed/36719736 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39631 %T Policy Preferences Regarding Health Data Sharing Among Patients With Cancer: Public Deliberations %A Raj,Minakshi %A Ryan,Kerry %A Amara,Philip Sahr %A Nong,Paige %A Calhoun,Karen %A Trinidad,M Grace %A Thiel,Daniel %A Spector-Bagdady,Kayte %A De Vries,Raymond %A Kardia,Sharon %A Platt,Jodyn %+ Department of Kinesiology and Community Health, University of Illinois Urbana Champaign, 2007 Huff Hall, 1206 South Fourth Street, Champaign, IL, 61820, United States, 1 2173006336, mraj@illinois.edu %K public deliberation %K data sharing %K precision health %K health information exchange %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 36719719 %R 10.2196/39631 %U https://cancer.jmir.org/2023/1/e39631 %U https://doi.org/10.2196/39631 %U http://www.ncbi.nlm.nih.gov/pubmed/36719719 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42441 %T Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis %A Vassey,Julia %A Donaldson,Scott I %A Dormanesh,Allison %A Allem,Jon-Patrick %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 3rd Floor, SSB 312D, 1845 N Soto St, Los Angeles, CA, 90032, United States, 1 323 442 7921, allem@usc.edu %K cigarillo %K little cigar %K social media %K TikTok %K video %K cigar %K cigarette %K smoker %K smoking %K tobacco %K social media %K content analysis %K youth %K young adult %K adolescent %K user generated content %D 2022 %7 16.11.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36383406 %R 10.2196/42441 %U https://www.jmir.org/2022/11/e42441 %U https://doi.org/10.2196/42441 %U http://www.ncbi.nlm.nih.gov/pubmed/36383406 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e42345 %T Medicare Opt-Out Trends Among Dermatologists May Reflect Systemic Health Policy: Cross-sectional Analysis %A Agarwal,Aneesh %A Han,Joseph %A Luu,Yen %A Gulati,Nicholas %+ Department of Dermatology, Icahn School of Medicine at Mount Sinai, 5 East 98th Street, Fifth Floor, New York, NY, 10029, United States, 1 212 241 3288, nicholas.gulati@mssm.edu %K Medicare %K dermatology %K opt out %K private contracting %K %K CMS %K health policy %K insurance %K health coverage %K Medicaid %D 2022 %7 8.11.2022 %9 Short Paper %J JMIR Dermatol %G English %X 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. %M 37632903 %R 10.2196/42345 %U https://derma.jmir.org/2022/4/e42345 %U https://doi.org/10.2196/42345 %U http://www.ncbi.nlm.nih.gov/pubmed/37632903 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e41750 %T The Patient Role in a Federal National-Scale Health Information Exchange %A Mandel,Joshua C %A Pollak,J P %A Mandl,Kenneth D %+ Computational Health Information Program, Boston Children's Hospital, 401 Park Drive, LM5506, Mailstop BCH3187, Boston, MA, 02215, United States, 1 617 355 4145, kenneth_mandl@harvard.edu %K health information exchange %K patient control %K Health Insurance Portability and Accountability Act %K HIPAA %K patient record %K information exchange %K information sharing %K health record %K privacy %K security %K public health %K health policy %K health information %K federal trusted exchange %K insurance company %K patient data %D 2022 %7 4.11.2022 %9 Viewpoint %J J Med Internet Res %G English %X The federal Trusted Exchange Framework and Common Agreement (TEFCA) aims to reduce fragmentation of patient records by expanding query-based health information exchange with nationwide connectivity for diverse purposes. TEFCA provides a common agreement and security framework allowing clinicians, and possibly insurance company staff, public health officials, and other authorized users, to query for health information about hundreds of millions of patients. TEFCA presents an opportunity to weave information exchange into the fabric of our national health information economy. We define 3 principles to promote patient autonomy and control within TEFCA: (1) patients can query for data about themselves, (2) patients can know when their data are queried and shared, and (3) patients can configure what is shared about them. We believe TEFCA should address these principles by the time it launches. While health information exchange already occurs on a large scale today, the launch of TEFCA introduces a major, new, and cohesive component of 21st-century US health care information infrastructure. We strongly advocate for a substantive role for the patient in TEFCA, one that will be a model for other systems and policies. %M 36331535 %R 10.2196/41750 %U https://www.jmir.org/2022/11/e41750 %U https://doi.org/10.2196/41750 %U http://www.ncbi.nlm.nih.gov/pubmed/36331535 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37236 %T Bridging the European Data Sharing Divide in Genomic Science %A Molnár-Gábor,Fruzsina %A Beauvais,Michael J S %A Bernier,Alexander %A Jimenez,Maria Pilar Nicolas %A Recuero,Mikel %A Knoppers,Bartha Maria %+ Faculty of Law, University of Heidelberg, BioQuant Centre, Im Neuenheimer Feld 267 (BQ267), Heidelberg, 69120, Germany, 49 62215451 ext 336, fruzsina.molnar-gabor@uni-heidelberg.de %K international data transfer %K scientific research %K genomics %K safe data spaces %K data protection %D 2022 %7 19.10.2022 %9 Viewpoint %J J Med Internet Res %G English %X In this viewpoint, we argue for the importance of creating data spaces for genomic research that are detached from contexts in which fundamental rights concerns related to surveillance measures override a purpose-specific balancing of fundamental rights. Genomic research relies on molecular and phenotypic data, on comparing findings within large data sets, on searchable metadata, and on translating research results into a clinical setting. These methods require sensitive genetic and health data to be shared across borders. International data sharing between the European Union (EU) or the European Economic Area and third countries has accordingly become a cornerstone of genomics. The EU General Data Protection Regulation contains rules that accord privileged status to data processing for research purposes to ensure that strict data protection requirements do not impede biomedical research. However, the General Data Protection Regulation rules applicable to international transfers of data accord no such preferential treatment to international data transfers made in the research context. The rules that govern the international transfer of data create considerable barriers to international data sharing because of the cost-intensive procedural and substantive compliance burdens that they impose. For certain jurisdictions and select use cases, there exist practically no lawful mechanisms to enable the international transfer of data because of concerns about the protection of fundamental rights. The proposed solutions further fail to address the need to share large data sets of local and regional cohorts across national borders to enable joint analyses. The European Health Data Space is an emerging federated, EU-wide data infrastructure that is intended to function as an infrastructure bringing together EU health data to improve patient care and enable the secondary use of health-related data for research purposes. Such infrastructure is implementing new institutions to support its functioning and is being implemented in reliance on a new enabling law, the regulation on the European Health Data Space. This innovation provides the opportunity to facilitate EU contribution to international genomic research efforts. The draft regulation for this data space provides for a concept of data infrastructure intended to enable cross-border data exchange and access, including access to genetic and health data for scientific analysis purposes. The draft regulation also provides for obligations of national actors aimed at making data widely available. This effort is laudable. However, in the absence of further, more fundamental changes to the manner in which the EU regulates the secondary use of health data, it is reasonable to believe that EU participation in international genomic research efforts will remain impeded. %M 36260387 %R 10.2196/37236 %U https://www.jmir.org/2022/10/e37236 %U https://doi.org/10.2196/37236 %U http://www.ncbi.nlm.nih.gov/pubmed/36260387 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e37887 %T The Impact of Nonrandom Missingness in Surveillance Data for Population-Level Summaries: Simulation Study %A Weiss,Paul Samuel %A Waller,Lance Allyn %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Room 308, Atlanta, GA, 30322-4201, United States, 1 404 712 9641, paul.weiss@emory.edu %K surveillance %K estimation %K missing data %K population-level estimates %K health policy %K public health policy %K estimates %K data %K policy decision %K bias %K response rate %D 2022 %7 9.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36083618 %R 10.2196/37887 %U https://publichealth.jmir.org/2022/9/e37887 %U https://doi.org/10.2196/37887 %U http://www.ncbi.nlm.nih.gov/pubmed/36083618 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e32969 %T Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys %A Garrett,Paul M %A White,Joshua P %A Dennis,Simon %A Lewandowsky,Stephan %A Yang,Cheng-Ta %A Okan,Yasmina %A Perfors,Andrew %A Little,Daniel R %A Kozyreva,Anastasia %A Lorenz-Spreen,Philipp %A Kusumi,Takashi %A Kashima,Yoshihisa %+ Melbourne School of Psychological Sciences, The University of Melbourne, 12th Floor Redmond Barry Building, Parkville Campus, Melbourne, 3010, Australia, 61 8344 6377 ext 03, paul.garrett@unimelb.edu.au %K COVID-19 %K immunity passport %K vaccination passport %K cross-cultural %K health policy %K digital certificates %K SARS-CoV-2 %K vaccine %K policy %K international %D 2022 %7 15.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35377317 %R 10.2196/32969 %U https://publichealth.jmir.org/2022/7/e32969 %U https://doi.org/10.2196/32969 %U http://www.ncbi.nlm.nih.gov/pubmed/35377317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37574 %T Outpatient Care Among Users and Nonusers of Direct-to-Patient Telehealth: Observational Study %A Cuellar,Alison %A Pomeroy,J Mary Louise %A Burla,Sriteja %A Jena,Anupam B %+ Department of Health Administration and Policy, George Mason University, MS 1J3, 4400 University Dr, Fairfax, VA, 22030, United States, 1 703 993 5048, aevanscu@gmu.edu %K telemedicine %K insurance %K policy %K telehealth %K user %K primary care %K outpatient %K claims %K in-person %K virtual %K insurer %K coverage %D 2022 %7 6.6.2022 %9 Short Paper %J J Med Internet Res %G English %X 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. %M 35666556 %R 10.2196/37574 %U https://www.jmir.org/2022/6/e37574 %U https://doi.org/10.2196/37574 %U http://www.ncbi.nlm.nih.gov/pubmed/35666556 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e30050 %T Assessing the Legal Aspects of Information Security Requirements for Health Care in 3 Countries: Scoping Review and Framework Development %A Yeng,Prosper Kandabongee %A Fauzi,Muhammad Ali %A Sun,Luyi %A Yang,Bian %+ Department of Information Security and Communication Technology, Norwegian University of Science and Technology, Teknologivegen 22, Gjovik, 2815, Norway, 47 96992743, prosper.yeng@ntnu.no %K legal requirement %K information security %K healthcare %K security practice %D 2022 %7 25.5.2022 %9 Review %J JMIR Hum Factors %G English %X 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. %M 35612891 %R 10.2196/30050 %U https://humanfactors.jmir.org/2022/2/e30050 %U https://doi.org/10.2196/30050 %U http://www.ncbi.nlm.nih.gov/pubmed/35612891 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e36448 %T The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review %A Archer,Jessica %A Robinson,Luke %A Brown,Ted %+ Department of Occupational Therapy, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Level 4, Building G, 47-49 McMahon's Road, Frankston, 3199, Australia, 61 399044462, jessica.archer@monash.edu %K allied health %K healthcare funding %K interprofessional collaboration %K integrated healthcare %K primary health %K primary care %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 35559853 %R 10.2196/36448 %U https://www.researchprotocols.org/2022/5/e36448 %U https://doi.org/10.2196/36448 %U http://www.ncbi.nlm.nih.gov/pubmed/35559853 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e33240 %T Barriers to Clinical Trial Participation: Comparative Study Between Rural and Urban Participants %A Mudaranthakam,Dinesh Pal %A Gajewski,Byron %A Krebill,Hope %A Coulter,James %A Springer,Michelle %A Calhoun,Elizabeth %A Hughes,Dorothy %A Mayo,Matthew %A Doolittle,Gary %+ University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66085, United States, 1 9139456922, dmudaranthakam@kumc.edu %K rural residents %K clinical trials %K screening %K cancer %K patients %K lung cancer %K health policy epidemiology %K cancer patients %K electronic screening logs %K electronic screening %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 35451964 %R 10.2196/33240 %U https://cancer.jmir.org/2022/2/e33240 %U https://doi.org/10.2196/33240 %U http://www.ncbi.nlm.nih.gov/pubmed/35451964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32678 %T Modeling Access Across the Digital Divide for Intersectional Groups Seeking Web-Based Health Information: National Survey %A Medero,Kristina %A Merrill Jr,Kelly %A Ross,Morgan Quinn %+ School of Communication, Ohio State University, 154 N Oval Mall, Columbus, OH, 43210-1132, United States, 1 5313017556, medero.2@osu.edu %K Black %K African American %K first-level digital divide %K health disparities %K home computer %K internet access %K intersectionality %K Latino %K Latine %K Hispanic %K mobile %K online health information seeking %K public computer %K structural equation modeling %K work computer %K mobile phone %D 2022 %7 15.3.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35289761 %R 10.2196/32678 %U https://www.jmir.org/2022/3/e32678 %U https://doi.org/10.2196/32678 %U http://www.ncbi.nlm.nih.gov/pubmed/35289761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e24582 %T Scale-up of Digital Innovations in Health Care: Expert Commentary on Enablers and Barriers %A Schlieter,Hannes %A Marsch,Lisa A %A Whitehouse,Diane %A Otto,Lena %A Londral,Ana Rita %A Teepe,Gisbert Wilhelm %A Benedict,Martin %A Ollier,Joseph %A Ulmer,Tom %A Gasser,Nathalie %A Ultsch,Sabine %A Wollschlaeger,Bastian %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 632 94 8, tobias.kowatsch@unisg.ch %K digital health %K health care delivery %K health interventions %K digital health services %K enablers %K barriers %D 2022 %7 11.3.2022 %9 Viewpoint %J J Med Internet Res %G English %X Health care delivery is undergoing a rapid change from traditional processes toward the use of digital health interventions and personalized medicine. This movement has been accelerated by the COVID-19 crisis as a response to the need to guarantee access to health care services while reducing the risk of contagion. Digital health scale-up is now also vital to achieve population-wide impact: it will only accomplish sustainable effects if and when deployed into regular health care delivery services. The question of how sustainable digital health scale-up can be successfully achieved has, however, not yet been sufficiently resolved. This paper identifies and discusses enablers and barriers for scaling up digital health innovations. The results discussed in this paper were gathered by scientists and representatives of public bodies as well as patient organizations at an international workshop on scaling up digital health innovations. Results are explored in the context of prior research and implications for future work in achieving large-scale implementations that will benefit the population as a whole. %M 35275065 %R 10.2196/24582 %U https://www.jmir.org/2022/3/e24582 %U https://doi.org/10.2196/24582 %U http://www.ncbi.nlm.nih.gov/pubmed/35275065 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31684 %T A National Network of Safe Havens: Scottish Perspective %A Gao,Chuang %A McGilchrist,Mark %A Mumtaz,Shahzad %A Hall,Christopher %A Anderson,Lesley Ann %A Zurowski,John %A Gordon,Sharon %A Lumsden,Joanne %A Munro,Vicky %A Wozniak,Artur %A Sibley,Michael %A Banks,Christopher %A Duncan,Chris %A Linksted,Pamela %A Hume,Alastair %A Stables,Catherine L %A Mayor,Charlie %A Caldwell,Jacqueline %A Wilde,Katie %A Cole,Christian %A Jefferson,Emily %+ Health Informatics Centre, Ninewells Hospital & Medical School, University of Dundee, Mail Box 15, , Dundee, DD1 9SY, United Kingdom, 44 (0)1382 383943, e.r.jefferson@dundee.ac.uk %K electronic health records %K Safe Haven %K data governance %D 2022 %7 9.3.2022 %9 Viewpoint %J J Med Internet Res %G English %X For over a decade, Scotland has implemented and operationalized a system of Safe Havens, which provides secure analytics platforms for researchers to access linked, deidentified electronic health records (EHRs) while managing the risk of unauthorized reidentification. In this paper, a perspective is provided on the state-of-the-art Scottish Safe Haven network, including its evolution, to define the key activities required to scale the Scottish Safe Haven network’s capability to facilitate research and health care improvement initiatives. A set of processes related to EHR data and their delivery in Scotland have been discussed. An interview with each Safe Haven was conducted to understand their services in detail, as well as their commonalities. The results show how Safe Havens in Scotland have protected privacy while facilitating the reuse of the EHR data. This study provides a common definition of a Safe Haven and promotes a consistent understanding among the Scottish Safe Haven network and the clinical and academic research community. We conclude by identifying areas where efficiencies across the network can be made to meet the needs of population-level studies at scale. %M 35262495 %R 10.2196/31684 %U https://www.jmir.org/2022/3/e31684 %U https://doi.org/10.2196/31684 %U http://www.ncbi.nlm.nih.gov/pubmed/35262495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e37419 %T 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” %A Stausberg,Jürgen %A Uslu,Aykut %+ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, 45122, Germany, 49 201 723 77201, stausberg@ekmed.de %K cost analysis %K costs and cost analyses %K economic advantage %K electronic medical records %K electronic records %K health care %K hospitals %K computerized medical records systems %K quality of health care %K secondary data %D 2022 %7 4.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35254272 %R 10.2196/37419 %U https://www.jmir.org/2022/3/e37419 %U https://doi.org/10.2196/37419 %U http://www.ncbi.nlm.nih.gov/pubmed/35254272 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e37208 %T 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” %A Shakibaei Bonakdeh,Erfan %+ Department of Management, Monash Business School, Monash University, 900 Dandenong Rd, Caulfield East, Melbourne, VIC, 3145, Australia, 61 1399032000, erfan.shakibaeibonakdeh@monash.edu %K cost analysis %K costs and cost analyses %K economic advantage %K electronic medical records %K electronic records %K health care %K hospitals %K computerized medical records system %K quality of health care %K secondary data %D 2022 %7 4.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35254276 %R 10.2196/37208 %U https://www.jmir.org/2022/3/e37208 %U https://doi.org/10.2196/37208 %U http://www.ncbi.nlm.nih.gov/pubmed/35254276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30524 %T Passive Data Use for Ethical Digital Public Health Surveillance in a Postpandemic World %A Kilgallon,John L %A Tewarie,Ishaan Ashwini %A Broekman,Marike L D %A Rana,Aakanksha %A Smith,Timothy R %+ Computational Neurosciences Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, United States, 1 9145395441, jkilgallon@bwh.harvard.edu %K passive data %K public health surveillance %K digital public health surveillance %K pandemic response %K data privacy %K digital phenotyping %K smartphone %K mobile phone %K mHealth %K digital health %K informed consent %K data equity %K data ownership %D 2022 %7 15.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X There is a fundamental need to establish the most ethical and effective way of tracking disease in the postpandemic era. The ubiquity of mobile phones is generating large amounts of passive data (collected without active user participation) that can be used as a tool for tracking disease. Although discussions of pragmatism or economic issues tend to guide public health decisions, ethical issues are the foremost public concern. Thus, officials must look to history and current moral frameworks to avoid past mistakes and ethical pitfalls. Past pandemics demonstrate that the aftermath is the most effective time to make health policy decisions. However, an ethical discussion of passive data use for digital public health surveillance has yet to be attempted, and little has been done to determine the best method to do so. Therefore, we aim to highlight four potential areas of ethical opportunity and challenge: (1) informed consent, (2) privacy, (3) equity, and (4) ownership. %M 35166676 %R 10.2196/30524 %U https://www.jmir.org/2022/2/e30524 %U https://doi.org/10.2196/30524 %U http://www.ncbi.nlm.nih.gov/pubmed/35166676 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29541 %T Health Information Systems for Older Persons in Select Government Tertiary Hospitals and Health Centers in the Philippines: Cross-sectional Study %A Garcia,Angely P %A De La Vega,Shelley F %A Mercado,Susan P %+ Institute on Aging, National Institutes of Health, University of the Philippines Manila, Rm 211 NIH Bldg, 623 Pedro Gil St. Ermita, Manila, 1000, Philippines, 63 9064029690, apgarcia@up.edu.ph %K health information systems %K the Philippines %K aged %K hospitals %K community health centers %K database %K geriatric assessment %K elderly %K digital health %K medical records %K health policy %D 2022 %7 14.2.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35156927 %R 10.2196/29541 %U https://www.jmir.org/2022/2/e29541 %U https://doi.org/10.2196/29541 %U http://www.ncbi.nlm.nih.gov/pubmed/35156927 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30838 %T Attentional Harms and Digital Inequalities %A Hartford,Anna %A Stein,Dan J %+ Brain-Behaviour Unit, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, 7935, South Africa, 27 214042174, annahartford@gmail.com %K digital inequalities %K attentional harms %K excessive internet use %K persuasive technologies %K internet ethics %K attention economies %D 2022 %7 11.2.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Recent years have seen growing public concern about the effects of persuasive digital technologies on public mental health and well-being. As the draws on our attention reach such staggering scales and as our ability to focus our attention on our own considered ends erodes ever further, the need to understand and articulate what is at stake has become pressing. In this ethical viewpoint, we explore the concept of attentional harms and emphasize their potential seriousness. We further argue that the acknowledgment of these harms has relevance for evolving debates on digital inequalities. An underdiscussed aspect of web-based inequality concerns the persuasions, and even the manipulations, that help to generate sustained attentional loss. These inequalities are poised to grow, and as they do, so will concerns about justice with regard to the psychological and self-regulatory burdens of web-based participation for different internet users. In line with calls for multidimensional approaches to digital inequalities, it is important to recognize these potential harms as well as to empower internet users against them even while expanding high-quality access. %M 35147504 %R 10.2196/30838 %U https://mental.jmir.org/2022/2/e30838 %U https://doi.org/10.2196/30838 %U http://www.ncbi.nlm.nih.gov/pubmed/35147504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32392 %T Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review %A Tran,Duc Minh %A Thwaites,C Louise %A Van Nuil,Jennifer Ilo %A McKnight,Jacob %A Luu,An Phuoc %A Paton,Chris %A , %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, 700000, Vietnam, 84 356574593, ductm@oucru.org %K digital health %K eHealth %K policy %K Vietnam %K hospital care %K data %K health %K electronic medical records %K standards %K compulsory %K patient ID %K administrative information %K health insurance ID %K mobile phone %D 2022 %7 9.2.2022 %9 Review %J J Med Internet Res %G English %X 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 Thư Viện Pháp Luật, 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. %M 35138264 %R 10.2196/32392 %U https://www.jmir.org/2022/2/e32392 %U https://doi.org/10.2196/32392 %U http://www.ncbi.nlm.nih.gov/pubmed/35138264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31146 %T An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint %A Shen,Francis X %A Silverman,Benjamin C %A Monette,Patrick %A Kimble,Sara %A Rauch,Scott L %A Baker,Justin T %+ Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, United States, 1 617 462 3845, fshen1@mgh.harvard.edu %K digital phenotyping %K computataional psychiatry %K ethics %K law %K privacy %K informed consent %D 2022 %7 9.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X 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. %M 35138261 %R 10.2196/31146 %U https://www.jmir.org/2022/2/e31146 %U https://doi.org/10.2196/31146 %U http://www.ncbi.nlm.nih.gov/pubmed/35138261 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e30755 %T Implementation and Experiences of Telehealth: Balancing Policies With Practice in Countries of South Asia, Kuwait, and the European Union %A John,Oommen %A Sarbadhikari,Suptendra Nath %A Prabhu,Thanga %A Goel,Ashvini %A Thomas,Alexander %A Shroff,Sunil %A Allaudin,Fazilah %A Weerabaddana,Chaminda %A Alhuwail,Dari %A Koirala,Udaya %A Johnrose,Jayalal %A Codyre,Patricia %A Bleaden,Andy %A Singh,Shubnum %A Bajaj,Shuchin %+ The George Institute for Global Health India, F-BLOCK, 311-312, Third Floor, Jasola Vihar, New Delhi, 110025, India, 91 9717669574, supten@gmail.com %K telehealth policy and practice %K implementation lessons %K challenges in scaling up %K capacity building of human resources %K data privacy %K telehealth %K health policy %K telemedicine %K implementation %K challenges %K human resources %K digital health %K data security %D 2022 %7 8.2.2022 %9 Viewpoint %J Interact J Med Res %G English %X This viewpoint summarizes the discussion that occurred during the “Translating Policy to Practice in Telehealth–Lessons from Global Implementation Experiences” panel that was held virtually at Telemedicon2020, December 18-20, 2020. This panel brought together policy and implementation experts from some countries of South Asia, Kuwait, and the European Union to share their experiences in the development and implementation of telehealth standards and of the scale up of telehealth interventions within health systems. Several common themes arose from the discussion, including the significant role of people; encouragement by respective government policymakers; addressing concerns, particularly related to privacy, confidentiality, and security; and capacity building of human resources. These are discussed in turn, along with the future directions identified by the panelists, which emphasized the need for active encouragement toward the adoption and diffusion of digital health in general and of telehealth in particular. All stakeholders, ranging from governmental policymakers to common citizens, need to come together to build trusting partnerships to realize the advantages offered by telehealth. %M 35133279 %R 10.2196/30755 %U https://www.i-jmr.org/2022/1/e30755 %U https://doi.org/10.2196/30755 %U http://www.ncbi.nlm.nih.gov/pubmed/35133279 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33081 %T Ethical Issues of Digital Twins for Personalized Health Care Service: Preliminary Mapping Study %A Huang,Pei-hua %A Kim,Ki-hun %A Schermer,Maartje %+ Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC University Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, 31 650031752, p.huang.1@erasmusmc.nl %K digital twins %K digital health %K personalized health care service %K data-driven health care %K value-sensitive design %K ethics of health care technology %D 2022 %7 31.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35099399 %R 10.2196/33081 %U https://www.jmir.org/2022/1/e33081 %U https://doi.org/10.2196/33081 %U http://www.ncbi.nlm.nih.gov/pubmed/35099399 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31623 %T Governing Data and Artificial Intelligence for Health Care: Developing an International Understanding %A Morley,Jessica %A Murphy,Lisa %A Mishra,Abhishek %A Joshi,Indra %A Karpathakis,Kassandra %+ Oxford Internet Institute, University of Oxford, 1 St. Giles', Oxford, OX1 3JS, United Kingdom, 44 (0)1865 287210, jessica.morley@phc.ox.ac.uk %K digital health %K artificial intelligence %K health policy %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 35099403 %R 10.2196/31623 %U https://formative.jmir.org/2022/1/e31623 %U https://doi.org/10.2196/31623 %U http://www.ncbi.nlm.nih.gov/pubmed/35099403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28870 %T Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study %A Neher,Margit %A Nygårdh,Annette %A Broström,Anders %A Lundgren,Johan %A Johansson,Peter %+ Department of Rehabilitation, School of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, 551 11, Sweden, 46 70 7892336, margit.neher@ju.se %K clients %K computer-assisted therapy %K consultation telehealth %K decision-makers %K implementation %K patients %K politicians %K qualitative methods %K remote %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35089139 %R 10.2196/28870 %U https://www.jmir.org/2022/1/e28870 %U https://doi.org/10.2196/28870 %U http://www.ncbi.nlm.nih.gov/pubmed/35089139 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29880 %T Quantifying the Impact of COVID-19 on Telemedicine Utilization: Retrospective Observational Study %A Vogt,Emily Louise %A Welch,Brandon M %A Bunnell,Brian E %A Barrera,Janelle F %A Paige,Samantha R %A Owens,Marisa %A Coffey,Patricia %A Diazgranados,Nancy %A Goldman,David %+ Lab of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Rm 3S-32: MSC 9412, Rockville, MD, 20892, United States, 1 301 443 0059, davidgoldman@mail.nih.gov %K telemedicine %K COVID-19 %K utilization %K impact %K retrospective %K observational %K trend %K telehealth %K health policy %K policy %D 2022 %7 28.1.2022 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 34751158 %R 10.2196/29880 %U https://www.i-jmr.org/2022/1/e29880 %U https://doi.org/10.2196/29880 %U http://www.ncbi.nlm.nih.gov/pubmed/34751158 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30749 %T Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey and Enhanced Outbreak Study %A Plugge,Emma %A Burke,Danielle %A Czachorowski,Maciej %A Gutridge,Kerry %A Maxwell,Fiona %A McGrath,Nuala %A O'Mara,Oscar %A O'Moore,Eamonn %A Parkes,Julie %+ University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, United Kingdom, 44 07789033336, emma.plugge@phe.gov.uk %K COVID-19 %K epidemiology %K prison %K outbreak %K testing %K health inequalities %K SARS-CoV-2 %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34751157 %R 10.2196/30749 %U https://www.researchprotocols.org/2022/1/e30749 %U https://doi.org/10.2196/30749 %U http://www.ncbi.nlm.nih.gov/pubmed/34751157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25440 %T Understanding the Nature of Metadata: Systematic Review %A Ulrich,Hannes %A Kock-Schoppenhauer,Ann-Kristin %A Deppenwiese,Noemi %A Gött,Robert %A Kern,Jori %A Lablans,Martin %A Majeed,Raphael W %A Stöhr,Mark R %A Stausberg,Jürgen %A Varghese,Julian %A Dugas,Martin %A Ingenerf,Josef %+ IT Center for Clinical Research, University of Lübeck, Ratzeburger Allee 160, Lübeck, 23564, Germany, 49 45131015607, h.ulrich@uni-luebeck.de %K metadata %K metadata definition %K systematic review %K data integration %K data identification %K data classification %D 2022 %7 11.1.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35014967 %R 10.2196/25440 %U https://www.jmir.org/2022/1/e25440 %U https://doi.org/10.2196/25440 %U http://www.ncbi.nlm.nih.gov/pubmed/35014967 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32220 %T Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study %A Bønes,Erlend %A Granja,Conceição %A Solvoll,Terje %+ Norwegian Centre for e-Health Research, University Hospital of North Norway, PO Box 35, Tromsø, 9038, Norway, 47 97655680, erlend.bones@ehealthresearch.no %K mental health %K FACT %K electronic health records %K eHealth %K FACT implementation %K EHR %K implementation %K assessment %K model %K community %K treatment %K policy %K regulation %K infrastructure %K literature %K challenge %K intervention %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35006087 %R 10.2196/32220 %U https://www.jmir.org/2022/1/e32220 %U https://doi.org/10.2196/32220 %U http://www.ncbi.nlm.nih.gov/pubmed/35006087 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e31066 %T The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study %A Eum,Nam Ji %A Kim,Seung Hyun %+ School of Business, Yonsei University, 50 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 2506, seungkim@yonsei.ac.kr %K health policy %K telehealth %K physical distancing %K disease transmission %K COVID-19 %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34817392 %R 10.2196/31066 %U https://publichealth.jmir.org/2022/1/e31066 %U https://doi.org/10.2196/31066 %U http://www.ncbi.nlm.nih.gov/pubmed/34817392 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28762 %T Comparing International Experiences With Electronic Health Records Among Emergency Medicine Physicians in the United States and Norway: Semistructured Interview Study %A Garcia,Gracie %A Crenner,Christopher %+ Department of History and Philosophy of Medicine, University of Kansas School of Medicine, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 6209514171, grace.c.garcia1@gmail.com %K electronic health records %K electronic medical records %K health information technology %K health information exchange %K health policy %K international %K emergency medicine %K medical informatics %K meaningful use %K burnout %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 34994702 %R 10.2196/28762 %U https://humanfactors.jmir.org/2022/1/e28762 %U https://doi.org/10.2196/28762 %U http://www.ncbi.nlm.nih.gov/pubmed/34994702 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e29288 %T Purpose Formulation, Coalition Building, and Evidence Use in Public–Academic Partnerships: Web-Based Survey Study %A Kang-Yi,Christina D %A Page,Amy %+ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, United States, 1 215 746 6715, christina.kang-yi@pennmedicine.upenn.edu %K use of research evidence %K public care policy %K public–academic partnership %K partnership purpose formulation %K partnership coalition building %K youth mental health and well-being %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X 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 %M 34989678 %R 10.2196/29288 %U https://humanfactors.jmir.org/2022/1/e29288 %U https://doi.org/10.2196/29288 %U http://www.ncbi.nlm.nih.gov/pubmed/34989678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31752 %T Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review %A Kruse,Clemens %A Heinemann,Katharine %+ School of Health Administration, Texas State University, Encino Hall, Room 250, 601 University Dr, San Marcos, TX, 78666, United States, 1 5122454462, scottkruse@txstate.edu %K telemedicine %K pandemic %K technology acceptance %K COVID-19 %K digital health %K telehealth %K health policy %K health care %D 2022 %7 4.1.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 34854815 %R 10.2196/31752 %U https://www.jmir.org/2022/1/e31752 %U https://doi.org/10.2196/31752 %U http://www.ncbi.nlm.nih.gov/pubmed/34854815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e20466 %T 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 %A Silva,Patrícia %A Delerue Matos,Alice %A Martinez-Pecino,Roberto %+ Communication and Society Research Centre, University of Minho, Campus Gualtar, Social Sciences Institute, Braga, 4710-057, Portugal, 351 253604212, patriciasilva@ics.uminho.pt %K social isolation %K internet %K 50+ individuals %K e-inclusion %K SHARE %D 2022 %7 3.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34982040 %R 10.2196/20466 %U https://www.jmir.org/2022/1/e20466 %U https://doi.org/10.2196/20466 %U http://www.ncbi.nlm.nih.gov/pubmed/34982040 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e31633 %T Breaking the Data Value-Privacy Paradox in Mobile Mental Health Systems Through User-Centered Privacy Protection: A Web-Based Survey Study %A Zhang,Dongsong %A Lim,Jaewan %A Zhou,Lina %A Dahl,Alicia A %+ The University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223-0001, United States, 1 7046871893, dzhang15@uncc.edu %K mobile apps %K mental health %K privacy concerns %K privacy protection %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X 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. %M 34951604 %R 10.2196/31633 %U https://mental.jmir.org/2021/12/e31633 %U https://doi.org/10.2196/31633 %U http://www.ncbi.nlm.nih.gov/pubmed/34951604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26323 %T Value of the Electronic Medical Record for Hospital Care: Update From the Literature %A Uslu,Aykut %A Stausberg,Jürgen %+ Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, Essen, 45122, Germany, 49 201 72377201, stausberg@ekmed.de %K cost analysis %K costs and cost analyses %K economic advantage %K electronic medical records %K electronic records %K health care %K hospitals %K medical records systems computerized %K quality of health care %K secondary data %D 2021 %7 23.12.2021 %9 Review %J J Med Internet Res %G English %X 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. %M 34941544 %R 10.2196/26323 %U https://www.jmir.org/2021/12/e26323 %U https://doi.org/10.2196/26323 %U http://www.ncbi.nlm.nih.gov/pubmed/34941544 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31702 %T Prescribing Smartphone Apps for Physical Activity Promotion in Primary Care: Modeling Study of Health Gain and Cost Savings %A Grout,Leah %A Telfer,Kendra %A Wilson,Nick %A Cleghorn,Christine %A Mizdrak,Anja %+ Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago Wellington, 23A Mein Street, Newtown, Wellington, 6242, New Zealand, 64 49186192, anja.mizdrak@otago.ac.nz %K physical activity %K smartphone apps %K mobile health %K mHealth %K modeling %K primary care %K mobile phone %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 Māori than in non-Māori. 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. %M 34931993 %R 10.2196/31702 %U https://www.jmir.org/2021/12/e31702 %U https://doi.org/10.2196/31702 %U http://www.ncbi.nlm.nih.gov/pubmed/34931993 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e31510 %T Global Research on Coronaviruses: Metadata-Based Analysis for Public Health Policies %A Warin,Thierry %+ HEC Montréal, 3000, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 2A7, Canada, 1 5146082106, thierry.warin@hec.ca %K COVID-19 %K SARS-CoV-2 %K natural language processing %K coronavirus %K unstructured data %K data science %K health 4.0 %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 34596570 %R 10.2196/31510 %U https://medinform.jmir.org/2021/11/e31510 %U https://doi.org/10.2196/31510 %U http://www.ncbi.nlm.nih.gov/pubmed/34596570 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 4 %P e20652 %T Tracking the Presence of Software as a Medical Device in US Food and Drug Administration Databases: Retrospective Data Analysis %A Ceross,Aaron %A Bergmann,Jeroen %+ Natural Interaction Lab, Department of Engineering Science, University of Oxford, Parks Road, Oxford, OX1 3PJ, United Kingdom, 44 01865 273000, aaron.ceross@eng.ox.ac.uk %K regulation %K software %K medical device %D 2021 %7 3.11.2021 %9 Proposal %J JMIR Biomed Eng %G English %X 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. %M 38907384 %R 10.2196/20652 %U https://biomedeng.jmir.org/2021/4/e20652 %U https://doi.org/10.2196/20652 %U http://www.ncbi.nlm.nih.gov/pubmed/38907384 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28069 %T Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis %A Haupt,Michael Robert %A Xu,Qing %A Yang,Joshua %A Cai,Mingxiang %A Mackey,Tim K %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 951 491 4161, tmackey@ucsd.edu %K vaping %K alternative tobacco industry %K e-cigarettes %K Facebook %K social network analysis %K social networks %K ehealth %K health policy %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34714245 %R 10.2196/28069 %U https://www.jmir.org/2021/10/e28069 %U https://doi.org/10.2196/28069 %U http://www.ncbi.nlm.nih.gov/pubmed/34714245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30545 %T Algorithm Change Protocols in the Regulation of Adaptive Machine Learning–Based Medical Devices %A Gilbert,Stephen %A Fenech,Matthew %A Hirsch,Martin %A Upadhyay,Shubhanan %A Biasiucci,Andrea %A Starlinger,Johannes %+ Else Kröner-Fresenius Center for Digital Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Postfach 151, Fetscherstraße 74, Dresden, 01307, Germany, 49 17680396015, ra.ekfz@tu-dresden.de %K artificial intelligence %K machine learning %K regulation %K algorithm change protocol %K healthcare %K regulatory framework %K health care %D 2021 %7 26.10.2021 %9 Viewpoint %J J Med Internet Res %G English %X One of the greatest strengths of artificial intelligence (AI) and machine learning (ML) approaches in health care is that their performance can be continually improved based on updates from automated learning from data. However, health care ML models are currently essentially regulated under provisions that were developed for an earlier age of slowly updated medical devices—requiring major documentation reshape and revalidation with every major update of the model generated by the ML algorithm. This creates minor problems for models that will be retrained and updated only occasionally, but major problems for models that will learn from data in real time or near real time. Regulators have announced action plans for fundamental changes in regulatory approaches. In this Viewpoint, we examine the current regulatory frameworks and developments in this domain. The status quo and recent developments are reviewed, and we argue that these innovative approaches to health care need matching innovative approaches to regulation and that these approaches will bring benefits for patients. International perspectives from the World Health Organization, and the Food and Drug Administration’s proposed approach, based around oversight of tool developers’ quality management systems and defined algorithm change protocols, offer a much-needed paradigm shift, and strive for a balanced approach to enabling rapid improvements in health care through AI innovation while simultaneously ensuring patient safety. The draft European Union (EU) regulatory framework indicates similar approaches, but no detail has yet been provided on how algorithm change protocols will be implemented in the EU. We argue that detail must be provided, and we describe how this could be done in a manner that would allow the full benefits of AI/ML-based innovation for EU patients and health care systems to be realized. %M 34697010 %R 10.2196/30545 %U https://www.jmir.org/2021/10/e30545 %U https://doi.org/10.2196/30545 %U http://www.ncbi.nlm.nih.gov/pubmed/34697010 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29984 %T 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 %A Marshall,Emily Gard %A Breton,Mylaine %A Cossette,Benoit %A Isenor,Jennifer %A Mathews,Maria %A Ayn,Caitlyn %A Smithman,Mélanie Ann %A Stock,David %A Frymire,Eliot %A Edwards,Lynn %A Green,Michael %+ Primary Care Research Unit, Dalhousie Family Medicine, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada, 1 902 473 4155, emily.marshall@dal.ca %K primary care %K health services research %K health policy %K mixed methods research %K COVID-19 %K protocol %K policy %K longitudinal %K coordination %K access %K impact %K virtual care %K virtual health %K Canada %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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, Québec (Centre intégré universitaire de santé 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 %M 34559672 %R 10.2196/29984 %U https://www.researchprotocols.org/2021/10/e29984 %U https://doi.org/10.2196/29984 %U http://www.ncbi.nlm.nih.gov/pubmed/34559672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26317 %T Privacy Practices of Health Information Technologies: Privacy Policy Risk Assessment Study and Proposed Guidelines %A LaMonica,Haley M %A Roberts,Anna E %A Lee,Grace Yeeun %A Davenport,Tracey A %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 88 Mallett Street, Camperdown, 2050, Australia, 61 0426955658, haley.lamonica@sydney.edu.au %K privacy %K mental health %K technology %K digital tools %K smartphone %K apps %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34528895 %R 10.2196/26317 %U https://www.jmir.org/2021/9/e26317 %U https://doi.org/10.2196/26317 %U http://www.ncbi.nlm.nih.gov/pubmed/34528895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26887 %T Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study %A Patel,Kunal N %A Mazurenko,Olena %A Ford,Eric %+ Northern Illinois University, 1425 West Lincoln Highway, DeKalb, IL, 60115, United States, 1 815 753 1891, kpatel27@niu.edu %K chargemaster %K standard charge %K price transparency %K health care %K diagnosis-related group %K DRG %K quality measures %K the Centers for Medicare and Medicaid Services regulation %K CMS %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Form Res %G English %X 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 (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=−.919; P<.001), efficient use of medical imaging (β=−.458; P=.001), and patient recommendation scores (β=−.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. %M 34420914 %R 10.2196/26887 %U https://formative.jmir.org/2021/8/e26887 %U https://doi.org/10.2196/26887 %U http://www.ncbi.nlm.nih.gov/pubmed/34420914 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e24523 %T Online News Coverage of the Sugar-Sweetened Beverages Tax in Malaysia: Content Analysis %A Mohd Hanim,Muhammad Faiz %A Md Sabri,Budi Aslinie %A Yusof,Norashikin %+ Centre of Population Oral Health and Clinical Prevention Studies, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), UiTM Sg. Buloh Campus, Sungai Buloh, 47000, Malaysia, 60 3 6126 6621, nyshikin@gmail.com %K sugar-sweetened beverages %K obesity %K taxes %K media content analysis %K public health policy %K media content %K public health %K netnography %K malaysia %K budget %D 2021 %7 18.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34406125 %R 10.2196/24523 %U https://publichealth.jmir.org/2021/8/e24523 %U https://doi.org/10.2196/24523 %U http://www.ncbi.nlm.nih.gov/pubmed/34406125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29759 %T Every Child on the Map: A Theory of Change Framework for Improving Childhood Immunization Coverage and Equity Using Geospatial Data and Technologies %A Chaney,Sarah Cunard %A Mechael,Patricia %A Thu,Nay Myo %A Diallo,Mamadou S %A Gachen,Carine %+ HealthEnabled, 6 Wherry Road, Muizenberg, Cape Town, South Africa, 27 21 701 0766, patty@healthenabled.org %K geospatial data %K immunization %K health information systems %K service delivery %K equity mapping %K theory %K framework %K children %K immunization %K vaccine %K equity %K geospatial %K data %K outcome %K coverage %K low- and middle-income %K LMIC %D 2021 %7 3.8.2021 %9 Viewpoint %J J Med Internet Res %G English %X The effective use of geospatial data and technologies to collect, manage, analyze, model, and visualize geographic data has great potential to improve data-driven decision-making for immunization programs. This article presents a theory of change for the use of geospatial technologies for immunization programming—a framework to illustrate the ways in which geospatial data and technologies can contribute to improved immunization outcomes and have a positive impact on childhood immunization coverage rates in low- and middle-income countries. The theory of change is the result of a review of the state of the evidence and literature; consultation with implementers, donors, and immunization and geospatial technology experts; and a review of country-level implementation experiences. The framework illustrates how the effective use of geospatial data and technologies can help immunization programs realize improvements in the number of children immunized by producing reliable estimates of target populations, identifying chronically missed settlements and locations with the highest number of zero-dose and under-immunized children, and guiding immunization managers with solutions to optimize resource distribution and location of health services. Through these direct effects on service delivery, geospatial data and technologies can contribute to the strengthening of the overall health system with equity in immunization coverage. Recent implementation of integrated geospatial data and technologies for the immunization program in Myanmar demonstrate the process that countries may experience on the path to achieving lasting systematic improvements. The theory of change presented here may serve as a guide for country program managers, implementers, donors, and other stakeholders to better understand how geospatial tools can support immunization programs and facilitate integrated service planning and equitable delivery through the unifying role of geography and geospatial data. %M 34342584 %R 10.2196/29759 %U https://www.jmir.org/2021/8/e29759 %U https://doi.org/10.2196/29759 %U http://www.ncbi.nlm.nih.gov/pubmed/34342584 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e23779 %T Understanding “Internet Plus Healthcare” in China: Policy Text Analysis %A Yang,Feng %A Shu,Huilin %A Zhang,Xiaoqian %+ McGill University, 3661 Peel St., Montreal, QC, H3A 1X1, Canada, 1 5149674660, xiaoqian.zhang@mail.mcgill.ca %K internet plus health care %K China %K policy analysis %K COVID-19 %K epidemic %D 2021 %7 26.7.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34309581 %R 10.2196/23779 %U https://www.jmir.org/2021/7/e23779 %U https://doi.org/10.2196/23779 %U http://www.ncbi.nlm.nih.gov/pubmed/34309581 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e22330 %T Policy Interventions, Development Trends, and Service Innovations of Internet Hospitals in China: Documentary Analysis and Qualitative Interview Study %A Lai,Yunfeng %A Chen,Shengqi %A Li,Meng %A Ung,Carolina Oi Lam %A Hu,Hao %+ State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Room 2057, Research Building N22, Avenida da Universidade, Taipa, Macau, Macau, 999078, China, 853 88228538, haohu@um.edu.mo %K internet hospital %K health policy %K medical service %K public hospital %K digital health %K China %D 2021 %7 20.7.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34283025 %R 10.2196/22330 %U https://www.jmir.org/2021/7/e22330 %U https://doi.org/10.2196/22330 %U http://www.ncbi.nlm.nih.gov/pubmed/34283025 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25021 %T Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity %A Willems,Sofie H %A Rao,Jyotsna %A Bhambere,Sailee %A Patel,Dipu %A Biggins,Yvonne %A Guite,Jessica W %+ Center for Advancement in Managing Pain, School of Nursing, The University of Connecticut, 231 Glenbrook Road, Storrs, CT, 06269-4026, United States, 1 215 964 5582, jessica.guite@uconn.com %K coronavirus %K digital health %K multiplatform %K chat %K symptom tracking %K well-being %K COVID-19 %K online platform %K symptom %K monitoring %K follow-up %D 2021 %7 11.6.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future. %M 34033575 %R 10.2196/25021 %U https://mhealth.jmir.org/2021/6/e25021 %U https://doi.org/10.2196/25021 %U http://www.ncbi.nlm.nih.gov/pubmed/34033575 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e24668 %T Ethics and Law in Research on Algorithmic and Data-Driven Technology in Mental Health Care: Scoping Review %A Gooding,Piers %A Kariotis,Timothy %+ Melbourne Law School, University of Melbourne, 185 Pelham Street, Melbourne, 3053, Australia, 61 383440910, p.gooding@unimelb.edu.au %K digital psychiatry %K digital mental health %K machine learning %K algorithmic technology %K data-driven technology %K artificial intelligence %K ethics %K regulation %K law %K mobile phone %D 2021 %7 10.6.2021 %9 Review %J JMIR Ment Health %G English %X 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. %M 34110297 %R 10.2196/24668 %U https://mental.jmir.org/2021/6/e24668 %U https://doi.org/10.2196/24668 %U http://www.ncbi.nlm.nih.gov/pubmed/34110297 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 1 %P e23011 %T Data Sharing Goals for Nonprofit Funders of Clinical Trials %A Coetzee,Timothy %A Ball,Mad Price %A Boutin,Marc %A Bronson,Abby %A Dexter,David T %A English,Rebecca A %A Furlong,Patricia %A Goodman,Andrew D %A Grossman,Cynthia %A Hernandez,Adrian F %A Hinners,Jennifer E %A Hudson,Lynn %A Kennedy,Annie %A Marchisotto,Mary Jane %A Matrisian,Lynn %A Myers,Elizabeth %A Nowell,W Benjamin %A Nosek,Brian A %A Sherer,Todd %A Shore,Carolyn %A Sim,Ida %A Smolensky,Luba %A Williams,Christopher %A Wood,Julie %A Terry,Sharon F %+ Genetic Alliance, 4301 Connecticut Ave NW #404, Washington, DC, United States, 1 (202) 966 5557, sterry@geneticalliance.org %K clinical trial %K biomedical research %K data sharing %K patients %D 2021 %7 29.3.2021 %9 Viewpoint %J J Participat Med %G English %X Sharing clinical trial data can provide value to research participants and communities by accelerating the development of new knowledge and therapies as investigators merge data sets to conduct new analyses, reproduce published findings to raise standards for original research, and learn from the work of others to generate new research questions. Nonprofit funders, including disease advocacy and patient-focused organizations, play a pivotal role in the promotion and implementation of data sharing policies. Funders are uniquely positioned to promote and support a culture of data sharing by serving as trusted liaisons between potential research participants and investigators who wish to access these participants’ networks for clinical trial recruitment. In short, nonprofit funders can drive policies and influence research culture. The purpose of this paper is to detail a set of aspirational goals and forward thinking, collaborative data sharing solutions for nonprofit funders to fold into existing funding policies. The goals of this paper convey the complexity of the opportunities and challenges facing nonprofit funders and the appropriate prioritization of data sharing within their organizations and may serve as a starting point for a data sharing toolkit for nonprofit funders of clinical trials to provide the clarity of mission and mechanisms to enforce the data sharing practices their communities already expect are happening. %M 33779573 %R 10.2196/23011 %U https://jopm.jmir.org/2021/1/e23011 %U https://doi.org/10.2196/23011 %U http://www.ncbi.nlm.nih.gov/pubmed/33779573 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e21286 %T Assessing the Effectiveness of Policies Relating to Breastfeeding Promotion, Protection, and Support in Southeast Asia: Protocol for a Mixed Methods Study %A Nguyen,Tuan T %A Weissman,Amy %A Cashin,Jennifer %A Ha,Tran T %A Zambrano,Paul %A Mathisen,Roger %+ Alive & Thrive, FHI 360, 702, Opera Business Center, 60 Ly Thai To Street, Hanoi, 100000, Vietnam, 84 393522795, tnguyen@fhi360.org %K breastfeeding %K breast milk substitute %K Code of Marketing of Breast-milk Substitutes (The Code) %K maternity protection %K maternal, infant, and young child nutrition %K mixed methods study %K Southeast Asia %D 2020 %7 21.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 32955449 %R 10.2196/21286 %U http://www.researchprotocols.org/2020/9/e21286/ %U https://doi.org/10.2196/21286 %U http://www.ncbi.nlm.nih.gov/pubmed/32955449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19311 %T Public Health in the Information Age: Recognizing the Infosphere as a Social Determinant of Health %A Morley,Jessica %A Cowls,Josh %A Taddeo,Mariarosaria %A Floridi,Luciano %+ Oxford Internet Institute, University of Oxford, 1 St Giles',, Oxford, OX1 3JS, United Kingdom, 44 01865 287210, jessica.morley@phc.ox.ac.uk %K COVID-19 %K public health %K misinformation %K disinformation %K infodemic %K infodemiology %K infosphere %K social determinants of health %K information ethics %D 2020 %7 3.8.2020 %9 Proposal %J J Med Internet Res %G English %X Since 2016, social media companies and news providers have come under pressure to tackle the spread of political mis- and disinformation (MDI) online. However, despite evidence that online health MDI (on the web, on social media, and within mobile apps) also has negative real-world effects, there has been a lack of comparable action by either online service providers or state-sponsored public health bodies. We argue that this is problematic and seek to answer three questions: why has so little been done to control the flow of, and exposure to, health MDI online; how might more robust action be justified; and what specific, newly justified actions are needed to curb the flow of, and exposure to, online health MDI? In answering these questions, we show that four ethical concerns—related to paternalism, autonomy, freedom of speech, and pluralism—are partly responsible for the lack of intervention. We then suggest that these concerns can be overcome by relying on four arguments: (1) education is necessary but insufficient to curb the circulation of health MDI, (2) there is precedent for state control of internet content in other domains, (3) network dynamics adversely affect the spread of accurate health information, and (4) justice is best served by protecting those susceptible to inaccurate health information. These arguments provide a strong case for classifying the quality of the infosphere as a social determinant of health, thus making its protection a public health responsibility. In addition, they offer a strong justification for working to overcome the ethical concerns associated with state-led intervention in the infosphere to protect public health. %M 32648850 %R 10.2196/19311 %U https://www.jmir.org/2020/8/e19311 %U https://doi.org/10.2196/19311 %U http://www.ncbi.nlm.nih.gov/pubmed/32648850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19357 %T A Global Digital Citizen Science Policy to Tackle Pandemics Like COVID-19 %A Katapally,Tarun R %+ University of Regina, 2155 College Ave, Johnson Shoyama Graduate School of Public Policy, Regina, SK, S4P4V5, Canada, 1 3065854544, tarun.katapally@uregina.ca %K COVID-19 %K pandemic %K citizen science %K smartphones %K population health %K mHealth %K eHealth %K big data %K virus %K infectious diseases %K public health %K digital epidemiology %D 2020 %7 26.5.2020 %9 Proposal %J J Med Internet Res %G English %X The coronavirus disease (COVID-19) pandemic is an extremely complex existential threat that requires cohesive societal effort to address health system inefficiencies. When our society has faced existential crises in the past, we have banded together by using the technology at hand to overcome them. The COVID-19 pandemic is one such threat that requires not only a cohesive effort, but also enormous trust to follow public health guidelines, maintain social distance, and share necessities. However, are democratic societies with civil liberties capable of doing this? Mobile technology has immense potential for addressing pandemics like COVID-19, as it gives us access to big data in terms of volume, velocity, veracity, and variety. These data are particularly relevant to understand and mitigate the spread of pandemics such as COVID-19. In order for such intensive and potentially intrusive data collection measures to succeed, we need a cohesive societal effort with full buy-in from citizens and their representatives. This article outlines an evidence-based global digital citizen science policy that provides the theoretical and methodological foundation for ethically sourcing big data from citizens to tackle pandemics such as COVID-19. %M 32408267 %R 10.2196/19357 %U http://www.jmir.org/2020/5/e19357/ %U https://doi.org/10.2196/19357 %U http://www.ncbi.nlm.nih.gov/pubmed/32408267 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16346 %T Toward a Risk-Utility Data Governance Framework for Research Using Genomic and Phenotypic Data in Safe Havens: Multifaceted Review %A Jones,Kerina %A Daniels,Helen %A Heys,Sharon %A Lacey,Arron %A Ford,David V %+ Population Data Science, Swansea University Medical School, Swansea University, Population Data Science, Swansea University Medical School,, Singleton Park, Swansea, SA28PP, United Kingdom, 44 01792602764, k.h.jones@swansea.ac.uk %K genomic data %K data safe havens %K data governance %D 2020 %7 15.5.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32412420 %R 10.2196/16346 %U https://www.jmir.org/2020/5/e16346 %U https://doi.org/10.2196/16346 %U http://www.ncbi.nlm.nih.gov/pubmed/32412420 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19043 %T The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will %A Guest,Jodie L %A del Rio,Carlos %A Sanchez,Travis %+ Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 8403, Travis.Sanchez@emory.edu %K COVID-19 %K coronavirus %K SARS-CoV-2 %D 2020 %7 6.4.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X The world is experiencing the expansive spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in a global pandemic that is placing strain on health care, economic, and social systems. Commitment to implementing proven public health strategies will require bold public health leadership and courageous acts by politicians. Developing new innovative communication, mitigation, and health care approaches, particularly in the era of social media, is also clearly warranted. We believe that the best public health evidence must inform activities in three priority areas to stop this pandemic: (1) coordinated and consistent stay-at-home orders across multiple jurisdictions, including potential nationwide mandates; (2) rapid scale-up of SARS-CoV-2 testing; and (3) improved health care capacity to respond. This editorial outlines those areas, the rationale behind them, and the call for innovation and engagement of bold public health leadership to empower courageous political action to reduce the number of deaths during this pandemic. %M 32240972 %R 10.2196/19043 %U https://publichealth.jmir.org/2020/2/e19043 %U https://doi.org/10.2196/19043 %U http://www.ncbi.nlm.nih.gov/pubmed/32240972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15816 %T The Value of Data: Applying a Public Value Model to the English National Health Service %A Wilson,James %A Herron,Daniel %A Nachev,Parashkev %A McNally,Nick %A Williams,Bryan %A Rees,Geraint %+ Department of Philosophy, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 207 679 0213, james.wilson@ucl.ac.uk %K health policy %K innovation %K public value %K intellectual property %K NHS Constitution %D 2020 %7 27.3.2020 %9 Proposal %J J Med Internet Res %G English %X Research and innovation in biomedicine and health care increasingly depend on electronic data. The emergence of data-driven technologies and associated digital transformations has focused attention on the value of such data. Despite the broad consensus of the value of health data, there is less consensus on the basis for that value; thus, the nature and extent of health data value remain unclear. Much of the existing literature presupposes that the value of data is to be understood primarily in financial terms, and assumes that a single financial value can be assigned. We here argue that the value of a dataset is instead relational; that is, the value depends on who wants to use it and for what purposes. Moreover, data are valued for both nonfinancial and financial reasons. Thus, it may be more accurate to discuss the values (plural) of a dataset rather than the singular value. This plurality of values opens up an important set of questions about how health data should be valued for the purposes of public policy. We argue that public value models provide a useful approach in this regard. According to public value theory, public value is created, or captured, to the extent that public sector institutions further their democratically established goals, and their impact on improving the lives of citizens. This article outlines how adopting such an approach might be operationalized within existing health care systems such as the English National Health Service, with particular focus on actionable conclusions. %M 32217501 %R 10.2196/15816 %U http://www.jmir.org/2020/3/e15816/ %U https://doi.org/10.2196/15816 %U http://www.ncbi.nlm.nih.gov/pubmed/32217501 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e14436 %T Just Because (Most) Hospitals Are Publishing Charges Does Not Mean Prices Are More Transparent %A Mullens,Cody Lendon %A Hernandez,J Andres %A Anderson,Evan D %A Allen,Lindsay %+ Center for Public Health Initiatives, University of Pennsylvania, 3620 Hamilton Walk, Philadelphia, PA, , United States, 1 3047238039, cmullen3@mix.wvu.edu %K health care costs %K delivery of health care %K health policy %D 2020 %7 6.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %R 10.2196/14436 %U http://medinform.jmir.org/2020/2/e14436/ %U https://doi.org/10.2196/14436 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15301 %T Mind the App: Considerations for the Future of Mobile Health in Canada %A Zawati,Ma'n H %A Lang,Michael %+ Centre of Genomics and Policy, McGill University, 740, Avenue Dr Penfield, Suite 5203, Montreal, QC, H3A 0G1, Canada, 1 5146686599, man.zawati@mcgill.ca %K smartphone %K mobile phone %K regulation %K patients %K physicians %D 2019 %7 4.11.2019 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Over the past decade, smartphone technology has become increasingly sophisticated and ubiquitous. Modern smartphones, now owned by more than three quarters of Canadians and 94% of millennials, perform an array of functions that are potentially useful in the health care context, such as tracking fitness data, enabling health record sharing, and providing user-friendly platforms for disease management. Approximately half of smartphone users have downloaded at least one health app, and clinicians are increasingly using them in their practice. However, despite widespread use, there is little evidence that supports their safety and efficacy. Few apps have been independently evaluated and many lack basic patient protections such as privacy policies. In this context, the demand for the regulation of mobile health apps has increased. Against this backdrop, regulators, including Health Canada, have begun to propose regulating the use of smartphones in health care. In this viewpoint, we respond to Health Canada’s recent proposal to regulate smartphone use in Canada according to a risk-based model. We argue that although Health Canada’s recent proposed approach is promising, it may require complementary regulation and oversight. %M 31682580 %R 10.2196/15301 %U https://mhealth.jmir.org/2019/11/e15301 %U https://doi.org/10.2196/15301 %U http://www.ncbi.nlm.nih.gov/pubmed/31682580 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10414 %T A Path to Better-Quality mHealth Apps %A Larson,Richard S %+ School of Medicine, University of New Mexico Health Sciences Center, MSC08 4560, 1 University of New Mexico, Albuquerque, NM, 87131-0001, United States, 1 505 272 5102, RLarson@salud.unm.edu %K mobile apps %K smartphone %K software validation %K medical device legislation %K United States Food and Drug Administration %D 2018 %7 30.07.2018 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The rapid growth of mobile health (mHealth) apps has resulted in confusion among health care providers and the public about which products rely on evidence-based medicine. Only a small subset of mHealth apps are regulated by the US Food and Drug Administration. The system similar to that used to accredit and certify laboratory testing under the Clinical Laboratory Improvement Amendment offers a potential model for ensuring basic standards of quality and safety for mHealth apps. With these products expanding into the realm of diagnosis and treatment, physicians and consumers are in a strong position to demand oversight that delivers safe and high-quality mHealth apps. %M 30061091 %R 10.2196/10414 %U http://mhealth.jmir.org/2018/7/e10414/ %U https://doi.org/10.2196/10414 %U http://www.ncbi.nlm.nih.gov/pubmed/30061091 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10725 %T Reimagining Health Data Exchange: An Application Programming Interface–Enabled Roadmap for India %A Balsari,Satchit %A Fortenko,Alexander %A Blaya,Joaquín A %A Gropper,Adrian %A Jayaram,Malavika %A Matthan,Rahul %A Sahasranam,Ram %A Shankar,Mark %A Sarbadhikari,Suptendra N %A Bierer,Barbara E %A Mandl,Kenneth D %A Mehendale,Sanjay %A Khanna,Tarun %+ Harvard FXB Center for Health and Human Rights, 651 Huntington Avenue, 703C, Boston, MA,, United States, 1 6174320011, sbalsari@bidmc.harvard.edu %K health information exchange %K India %K health APIs %D 2018 %7 13.07.2018 %9 Policy Proposal %J J Med Internet Res %G English %X In February 2018, the Government of India announced a massive public health insurance scheme extending coverage to 500 million citizens, in effect making it the world’s largest insurance program. To meet this target, the government will rely on technology to effectively scale services, monitor quality, and ensure accountability. While India has seen great strides in informational technology development and outsourcing, cellular phone penetration, cloud computing, and financial technology, the digital health ecosystem is in its nascent stages and has been waiting for a catalyst to seed the system. This National Health Protection Scheme is expected to provide just this impetus for widespread adoption. However, health data in India are mostly not digitized. In the few instances that they are, the data are not standardized, not interoperable, and not readily accessible to clinicians, researchers, or policymakers. While such barriers to easy health information exchange are hardly unique to India, the greenfield nature of India’s digital health infrastructure presents an excellent opportunity to avoid the pitfalls of complex, restrictive, digital health systems that have evolved elsewhere. We propose here a federated, patient-centric, application programming interface (API)–enabled health information ecosystem that leverages India’s near-universal mobile phone penetration, universal availability of unique ID systems, and evolving privacy and data protection laws. It builds on global best practices and promotes the adoption of human-centered design principles, data minimization, and open standard APIs. The recommendations are the result of 18 months of deliberations with multiple stakeholders in India and the United States, including from academia, industry, and government. %M 30006325 %R 10.2196/10725 %U http://www.jmir.org/2018/7/e10725/ %U https://doi.org/10.2196/10725 %U http://www.ncbi.nlm.nih.gov/pubmed/30006325 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e94 %T Social Media as a Catalyst for Policy Action and Social Change for Health and Well-Being: Viewpoint %A Yeung,Douglas %+ RAND Corporation, 1776 Main Street, Santa Monica, CA,, United States, 1 3103930411, dyeung@rand.org %K social media %K health policy %K health promotion %K health knowledge, attitudes, practice %K social change %D 2018 %7 19.03.2018 %9 Viewpoint %J J Med Internet Res %G English %X This viewpoint paper argues that policy interventions can benefit from the continued use of social media analytics, which can serve as an important complement to traditional social science data collection and analysis. Efforts to improve well-being should provide an opportunity to explore these areas more deeply, and encourage the efforts of those conducting national and local data collection on health to incorporate more of these emerging data sources.Social media remains a relatively untapped source of information to catalyze policy action and social change. However, the diversity of social media platforms and available analysis techniques provides multiple ways to offer insight for policy making and decision making. For instance, social media content can provide timely information about the impact of policy interventions. Social media location information can inform where to deploy resources or disseminate public messaging. Network analysis of social media connections can reveal underserved populations who may be disconnected from public services. Machine learning can help recognize important patterns for disease surveillance or to model population sentiment. To fully realize these potential policy uses, limitations to social media data will need to be overcome, including data reliability and validity, and potential privacy risks.Traditional data collection may not fully capture the upstream factors and systemic relationships that influence health and well-being. Policy actions and social change efforts, such as the Robert Wood Johnson Foundation’s effort to advance a culture of health, which are intended to drive change in a network of upstream health drivers, will need to incorporate a broad range of behavioral information, such as health attitudes or physical activity levels. Applying innovative techniques to emerging data has the potential to extract insight from unstructured data or fuse disparate sources of data, such as linking health attitudes that are expressed to health behaviors or broader health and well-being outcomes. %M 29555624 %R 10.2196/jmir.8508 %U http://www.jmir.org/2018/3/e94/ %U https://doi.org/10.2196/jmir.8508 %U http://www.ncbi.nlm.nih.gov/pubmed/29555624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e66 %T Medicaid Becomes the First Third-Party Payer to Cover Passive Remote Monitoring for Home Care: Policy Analysis %A Berridge,Clara %+ School of Social Work, University of Washington, 4101 15th Ave NE, Seattle, WA, 98105, United States, 1 206 685 2180, clarawb@uw.edu %K policy making %K Medicaid %K long-term care %K aging %K information technology %K passive remote monitoring %K sensing %K ethics %K technology implementation %D 2018 %7 21.02.2018 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 29467120 %R 10.2196/jmir.9650 %U http://www.jmir.org/2018/2/e66/ %U https://doi.org/10.2196/jmir.9650 %U http://www.ncbi.nlm.nih.gov/pubmed/29467120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e121 %T Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases %A Labrique,Alain %A Blynn,Emily %A Ahmed,Saifuddin %A Gibson,Dustin %A Pariyo,George %A Hyder,Adnan A %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, W5501, Johns Hopkins Bloomberg SPH, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4102361568, alabriqu@jhsph.edu %K surveys and questionnaires %K sampling studies %K mobile health %K mobile phone %K research methodology %D 2017 %7 05.05.2017 %9 Policy Proposal %J J Med Internet Res %G English %X In low- and middle-income countries (LMICs), historically, household surveys have been carried out by face-to-face interviews to collect survey data related to risk factors for noncommunicable diseases. The proliferation of mobile phone ownership and the access it provides in these countries offers a new opportunity to remotely conduct surveys with increased efficiency and reduced cost. However, the near-ubiquitous ownership of phones, high population mobility, and low cost require a re-examination of statistical recommendations for mobile phone surveys (MPS), especially when surveys are automated. As with landline surveys, random digit dialing remains the most appropriate approach to develop an ideal survey-sampling frame. Once the survey is complete, poststratification weights are generally applied to reduce estimate bias and to adjust for selectivity due to mobile ownership. Since weights increase design effects and reduce sampling efficiency, we introduce the concept of automated active strata monitoring to improve representativeness of the sample distribution to that of the source population. Although some statistical challenges remain, MPS represent a promising emerging means for population-level data collection in LMICs. %M 28476726 %R 10.2196/jmir.7329 %U http://www.jmir.org/2017/5/e121/ %U https://doi.org/10.2196/jmir.7329 %U http://www.ncbi.nlm.nih.gov/pubmed/28476726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e115 %T Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries %A Pariyo,George W %A Wosu,Adaeze C %A Gibson,Dustin G %A Labrique,Alain B %A Ali,Joseph %A Hyder,Adnan A %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street E 8648, Baltimore, MD, 21205, United States, 1 410 502 5790, gpariyo1@jhu.edu %K NCDs %K policy %K mHealth %K policy analysis %K surveys %D 2017 %7 05.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X The growing burden of noncommunicable diseases (NCDs), for example, cardiovascular diseases and chronic respiratory diseases, in low- and middle-income countries (LMICs) presents special challenges for policy makers, due to resource constraints and lack of timely data for decision-making. Concurrently, the increasing ubiquity of mobile phones in LMICs presents possibilities for rapid collection of population-based data to inform the policy process. The objective of this paper is to highlight potential benefits of mobile phone surveys (MPS) for developing, implementing, and evaluating NCD prevention and control policies. To achieve this aim, we first provide a brief overview of major global commitments to NCD prevention and control, and subsequently explore how countries can translate these commitments into policy action at the national level. Using the policy cycle as our frame of reference, we highlight potential benefits of MPS which include (1) potential cost-effectiveness of using MPS to inform NCD policy actions compared with using traditional household surveys; (2) timeliness of assessments to feed into policy and planning cycles; (3) tracking progress of interventions, hence assessment of reach, coverage, and distribution; (4) better targeting of interventions, for example, to high-risk groups; (5) timely course correction for suboptimal or non-effective interventions; (6) assessing fairness in financial contribution and financial risk protection for those affected by NCDs in the spirit of universal health coverage (UHC); and (7) monitoring progress in reducing catastrophic medical expenditure due to chronic health conditions in general, and NCDs in particular. We conclude that MPS have potential to become a powerful data collection tool to inform policies that address public health challenges such as NCDs. Additional forthcoming assessments of MPS in LMICs will inform opportunities to maximize this technology. %M 28476720 %R 10.2196/jmir.7302 %U http://www.jmir.org/2017/5/e115/ %U https://doi.org/10.2196/jmir.7302 %U http://www.ncbi.nlm.nih.gov/pubmed/28476720 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 4 %N 4 %P e34 %T It’s Time for Innovation in the Health Insurance Portability and Accountability Act (HIPAA) %A Colorafi,Karen %A Bailey,Bryan %+ College of Nursing, Washington State University, 103 E Spokane Falls Blvd, Spokane, WA, 99202, United States, 1 509 324 7318, karen.colorafi@wsu.edu %K innovation %K HIPAA %K electronic health record demonstration %D 2016 %7 02.11.2016 %9 Viewpoint %J JMIR Med Inform %G English %X Whether it is the result of a tragic news story, a thoughtful commentary, or a segment on the entertainment networks, patient privacy rights are never far from the top of our minds. The Privacy and Security Rules contained in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) represent a concerted effort to protect the privacy and security of the volumes of patient data generated by the health care system. However, the last twenty years has seen innovations and advancements in health information technology that were unimaginable at that time. It is time for innovation to the Privacy and Security Rules. We offer a common and relatable scenario as proof that certain Privacy and Security Rules can tie the hands of educators and innovators and need to be transformed. %M 27806923 %R 10.2196/medinform.6372 %U http://medinform.jmir.org/2016/4/e34/ %U https://doi.org/10.2196/medinform.6372 %U http://www.ncbi.nlm.nih.gov/pubmed/27806923 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e50 %T A Mobile App Development Guideline for Hospital Settings: Maximizing the Use of and Minimizing the Security Risks of "Bring Your Own Devices" Policies %A Al Ayubi,Soleh U %A Pelletier,Alexandra %A Sunthara,Gajen %A Gujral,Nitin %A Mittal,Vandna %A Bourgeois,Fabienne C %+ Innovation & Digital Health Accelerator, Boston Children's Hospital, Landmark Center, 7th Floor, 7399.2, 300 Longwood Ave, Boston, MA, 02115, United States, 1 8572183242, soleh.alayubi@childrens.harvard.edu %K BYOD %K guideline %K safeguard %K custom application %K hospital settings %K security %K privacy %K mobile application %K electronic medical records %D 2016 %7 11.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X 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. %M 27169345 %R 10.2196/mhealth.4424 %U http://mhealth.jmir.org/2016/2/e50/ %U https://doi.org/10.2196/mhealth.4424 %U http://www.ncbi.nlm.nih.gov/pubmed/27169345 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e9 %T Possibilities and Expectations for mHealth in the Pacific Islands: Insights From Key Informants %A Umali,Elaine %A McCool,Judith %A Whittaker,Robyn %+ Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, , New Zealand, 64 3737599 ext 82372, elaine.umali@gmail.com %K mHealth %K Pacific Islands %K prevention %K health systems %K health policy %D 2016 %7 20.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X 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. %M 26792386 %R 10.2196/mhealth.4626 %U http://mhealth.jmir.org/2016/1/e9/ %U https://doi.org/10.2196/mhealth.4626 %U http://www.ncbi.nlm.nih.gov/pubmed/26792386 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 3 %P e30 %T Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities %A Slight,Sarah Patricia %A Berner,Eta S %A Galanter,William %A Huff,Stanley %A Lambert,Bruce L %A Lannon,Carole %A Lehmann,Christoph U %A McCourt,Brian J %A McNamara,Michael %A Menachemi,Nir %A Payne,Thomas H %A Spooner,S Andrew %A Schiff,Gordon D %A Wang,Tracy Y %A Akincigil,Ayse %A Crystal,Stephen %A Fortmann,Stephen P %A Vandermeer,Meredith L %A Bates,David W %+ The Centre for Patient Safety Research and Practice, Division of General Internal Medicine, Brigham and Womens Hospital, 1620 Tremont Street, Boston, MA, MA 02120-1613, United States, 1 617 732 5650, dbates@partners.org %K medical informatics %K health policy %K electronic health records %K meaningful use %D 2015 %7 18.9.2015 %9 Original Paper %J JMIR Med Inform %G English %X 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. %R 10.2196/medinform.4457 %U http://medinform.jmir.org/2015/3/e30/ %U https://doi.org/10.2196/medinform.4457 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e73 %T The New Health-Related Top-Level Domains Are Coming: Will Cureforcancer.health Go to the Highest Bidder? %A Eysenbach,Gunther %+ Techna Institute, Centre for Global eHealth Innovation, University Health Network and University of Toronto, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 4163404800 ext 6427, editor@jmir.org %K top-level domains %K global community health %K health information sources %K quality health information %D 2014 %7 05.03.2014 %9 Editorial %J J Med Internet Res %G English %X In 2012, the Internet Corporation for Assigned Names and Numbers (ICANN) opened a new round of applications for generic top-level domain (gTLD) names, receiving 1930 applications, of which at least 18 were related to health (eg, “.doctor”, “.health”, “.med”). The entry of new, commercial players applying to create health-related names reopens the debate on the role of international organizations, governments, non-governmental organizations, and other stakeholders regarding the safeguards and policies needed to protect consumers. %M 24598704 %R 10.2196/jmir.3358 %U http://www.jmir.org/2014/3/e73/ %U https://doi.org/10.2196/jmir.3358 %U http://www.ncbi.nlm.nih.gov/pubmed/24598704 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e62 %T Health Domains for Sale: The Need for Global Health Internet Governance %A Mackey,Tim Ken %A Liang,Bryan A %A Kohler,Jillian C %A Attaran,Amir %+ Department of Anethesiology, University of California, San Diego, 200 W Arbor Drive, San Diego, CA, 92103-8770, United States, 1 951 491 4161, tmackey@ucsd.edu %K eHealth %K global health governance %K information technology %K Internet %K domain names %D 2014 %7 05.03.2014 %9 Viewpoint %J J Med Internet Res %G English %X A debate on Internet governance for health, or “eHealth governance”, is emerging with the impending award of a new dot-health (.health) generic top-level domain name (gTLD) along with a host of other health-related domains. This development is critical as it will shape the future of the health Internet, allowing largely unrestricted use of .health second-level domain names by future registrants, raising concerns about the potential for privacy, use and marketing of health-related information, credibility of online health content, and potential for Internet fraud and abuse. Yet, prospective .health gTLD applicants do not provide adequate safeguards for use of .health or related domains and have few or no ties to the global health community. If approved, one of these for-profit corporate applicants would effectively control the future of the .health address on the Internet with arguably no active oversight from important international public health stakeholders. This would represent a lost opportunity for the public health, medical, and broader health community in establishing a trusted, transparent and reliable source for health on the Internet. Countries, medical associations, civil society, and consumer advocates have objected to these applications on grounds that they do not meet the public interest. We argue that there is an immediate need for action to postpone awarding of the .health gTLD and other health-related gTLDs to address these concerns and ensure the appropriate development of sound eHealth governance rules, principles, and use. This would support the crucial need of ensuring access to quality and evidence-based sources of health information online, as well as establishing a safe and reliable space on the Internet for health. We believe, if properly governed, .health and other domains could represent such a promise in the future. %M 24598602 %R 10.2196/jmir.3276 %U http://www.jmir.org/2014/3/e62/ %U https://doi.org/10.2196/jmir.3276 %U http://www.ncbi.nlm.nih.gov/pubmed/24598602 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e155 %T Principles and Framework for eHealth Strategy Development %A Scott,Richard E %A Mars,Maurice %+ Nelson R Mandela School of Medicine, Department of TeleHealth, University of KwaZulu-Natal, Private Bag 7, Congella 4013, Durban, , South Africa, 27 31 260 4543, rscott@ukzn.ac.za %K eHealth strategy %K eHealth strategy development framework %K eHealth %K telehealth %K telemedicine %K e-learning %D 2013 %7 30.07.2013 %9 Viewpoint %J J Med Internet Res %G English %X Significant investment in eHealth solutions is being made in nearly every country of the world. How do we know that these investments and the foregone opportunity costs are the correct ones? Absent, poor, or vague eHealth strategy is a significant barrier to effective investment in, and implementation of, sustainable eHealth solutions and establishment of an eHealth favorable policy environment. Strategy is the driving force, the first essential ingredient, that can place countries in charge of their own eHealth destiny and inform them of the policy necessary to achieve it. In the last 2 years, there has been renewed interest in eHealth strategy from the World Health Organization (WHO), International Telecommunications Union (ITU), Pan American Health Organization (PAHO), the African Union, and the Commonwealth; yet overall, the literature lacks clear guidance to inform countries why and how to develop their own complementary but locally specific eHealth strategy. To address this gap, this paper further develops an eHealth Strategy Development Framework, basing it upon a conceptual framework and relevant theories of strategy and complex system analysis available from the literature. We present here the rationale, theories, and final eHealth strategy development framework by which a systematic and methodical approach can be applied by institutions, subnational regions, and countries to create holistic, needs- and evidence-based, and defensible eHealth strategy and to ensure wise investment in eHealth. %M 23900066 %R 10.2196/jmir.2250 %U http://www.jmir.org/2013/7/e155/ %U https://doi.org/10.2196/jmir.2250 %U http://www.ncbi.nlm.nih.gov/pubmed/23900066 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e143 %T Digital Social Media, Youth, and Nonmedical Use of Prescription Drugs: The Need for Reform %A Mackey,Tim K %A Liang,Bryan A %A Strathdee,Steffanie A %+ School of Medicine, Department of Anesthesiology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0629, United States, 1 951 491 4161, tmackey@ucsd.edu %K non-medical use of prescription medications (NUPM) %K eHealth %K Internet %K social media %K youth and adolescents %K drug abuse %K substance abuse %D 2013 %7 26.07.2013 %9 Viewpoint %J J Med Internet Res %G English %X The tragic death of 18-year-old Ryan Haight highlighted the ethical, public health, and youth patient safety concerns posed by illicit online nonmedical use of prescription drugs (NUPM) sourcing, leading to a federal law in an effort to address this concern. Yet despite the tragedy and resulting law, the NUPM epidemic in the United States has continued to escalate and represents a dangerous and growing trend among youth and adolescents. A critical point of access associated with youth NUPM is the Internet. Internet use among this vulnerable patient group is ubiquitous and includes new, emerging, and rapidly developing technologies—particularly social media networking (eg, Facebook and Twitter). These unregulated technologies may pose a potential risk for enabling youth NUPM behavior. In order to address limitations of current regulations and promote online safety, we advocate for legislative reform to specifically address NUPM promotion via social media and other new online platforms. Using more comprehensive and modernized federal legislation that anticipates future online developments is critical in substantively addressing youth NUPM behavior occurring through the Internet. %M 23892156 %R 10.2196/jmir.2464 %U http://www.jmir.org/2013/7/e143/ %U https://doi.org/10.2196/jmir.2464 %U http://www.ncbi.nlm.nih.gov/pubmed/23892156 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e34 %T Scope of Policy Issues in eHealth: Results From a Structured Literature Review %A Khoja,Shariq %A Durrani,Hammad %A Nayani,Parvez %A Fahim,Ammad %+ AKDN eHealth Resource Centre, The Aga Khan University, 3rd Parklands Avenue, Nairobi, PO Box 30270-00100, Kenya, 254 20 3662236, shariq.khoja@aku.edu %K eHealth %K eHealth policies %K telehealth %K telemedicine %K health informatics %K electronic health records %K health telematics %K guidelines %K standards %D 2012 %7 17.02.2012 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 22343270 %R 10.2196/jmir.1633 %U http://www.jmir.org/2012/1/e34/ %U https://doi.org/10.2196/jmir.1633 %U http://www.ncbi.nlm.nih.gov/pubmed/22343270 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e126 %T CONSORT-EHEALTH: Improving and Standardizing Evaluation Reports of Web-based and Mobile Health Interventions %A Eysenbach,Gunther %A , %+ University Health Network, Centre for Global eHealth Innovation & Techna Institute, 190 Elizabeth St, Toronto, ON, M4L3Y7, Canada, 1 416 7866970, geysenba@uhnres.utoronto.ca %K evaluation %K Internet %K mobile health %K reporting standards %K publishing standards %K guidelines %K quality control %K randomized controlled trials as topic %K medical informatics %D 2011 %7 31.12.2011 %9 Editorial %J J Med Internet Res %G English %X 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. %M 22209829 %R 10.2196/jmir.1923 %U http://www.jmir.org/2011/4/e126/ %U https://doi.org/10.2196/jmir.1923 %U http://www.ncbi.nlm.nih.gov/pubmed/22209829