The essence of healthcare records: embedded electronic health record system microblogging functionality for patient care narrative

Introduction: Electronic health record (EHR) systems capture information relating to patients across many specialties but can be complex, making rapid evaluation and communication of current important issues difficult. Methods: As part of a children's hospital EHR implementation, we developed and implemented an embedded microblogging platform to allow users to provide a short summary of main issues or actions relating to the encounter, 'Essence' capturing the essence of the interaction. We reviewed usage by specialty and user type over a 1-year period. Results: Ninety-one thousand, nine-hundred and fifty Essence entries were committed across 49 specialty areas during a 12-month period, April 2019 - April 2020. The specialties with greatest usage were cardiology, neurosurgery, intensive care, respiratory medicine and neurology, with 70% of entries by nursing staff. The median number of words used per entry was 17 words (range 1-120; mean 20.7), and microblogs were mainly used to describe actions, events or planned care. Manual content analysis of 200 representative entries demonstrated categories of importance (including clinical status, treatment plan, investigations, procedures and diagnoses) suggesting appropriate clinical utility. Conclusion: Incorporation of an embedded EHR microblogging platform to capture key interactions with healthcare professionals represents a novel approach to coordinating care communication and is widely used across specialties, especially by nursing staff

Transforming HIV Prevention & Care for Marginalised Populations: using information & communication technologies (ICTs) in community-based & led approaches

[Extract] Information and communication technology (ICT) is transforming community-based and community-led HIV prevention and care services for gay men, other men who have sex with men (MSM) and transgender people. This book celebrates and shares crucial work of frontline HIV workers, activists, researchers and educators whom are using innovative ICT. The book builds on, and extends the work included in two earlier issues of Digital Culture & Education (DCE), entitled 'Prevention is a solution: Building the HIVe'(Singh and Walsh, 2012) and 'Innovative programmatic approaches to HIV prevention and care services for gay men, other men who have sex with men (MSM) and transgender persons using information and communication technology (ICT)'(Adams, Klindera, Walsh and Wolf, 2014). It also includes three additional articles published by the journal

Transforming HIV Prevention & Care for Marginalised Populations: using information & communication technologies (ICTs) in community-based & led approaches

[Extract] Information and communication technology (ICT) is transforming community-based and community-led HIV prevention and care services for gay men, other men who have sex with men (MSM) and transgender people. This book celebrates and shares crucial work of frontline HIV workers, activists, researchers and educators whom are using innovative ICT. The book builds on, and extends the work included in two earlier issues of Digital Culture & Education (DCE), entitled 'Prevention is a solution: Building the HIVe'(Singh and Walsh, 2012) and 'Innovative programmatic approaches to HIV prevention and care services for gay men, other men who have sex with men (MSM) and transgender persons using information and communication technology (ICT)'(Adams, Klindera, Walsh and Wolf, 2014). It also includes three additional articles published by the journal

Social Media and Public Health: Opportunities and Challenges

Social media has the potential to provide rapid insights into unfolding public health emergencies such as infectious disease outbreaks. They can also be drawn upon for rapid, survey-based insights into various health topics. Social media has also been utilised by medical professionals for the purposes of sharing scholarly works, international collaboration, and engaging in policy debates. One benefit of using social media platforms to gain insight into health is that they have the ability to capture unfiltered public opinion in large volumes, avoiding the potential biases introduced by surveys or interviews. Social media platforms can also be utilised to pilot surveys, for instance, though the use of Twitter polls. Social media data have also been drawn upon in medical emergencies and crisis situations as a public health surveillance tool. A number of software and online tools also exist, developed specifically to aide public health research utilising social media data. In recent years, ethical issues regarding the retrieval and analysis of data have also arisen

Designing a Patient-Centered Clinical Workflow to Assess Cyberbully Experiences of Youths in the U.S. Healthcare System

Cyberbullying or online harassment is often defined as when someone repeatedly and intentionally harasses, mistreats, or makes fun of others aiming to scare, anger or shame them using electronic devices [296]. Youths experiencing cyberbullying report higher levels of anxiety and depression, mental distress, suicide thoughts, and substance abuse than their non-bullied peers [360, 605, 261, 354]. Even though bullying is associated with significant health problems, to date, very little youth anti-bullying efforts are initiated and directed in clinical settings. There is presently no standardized procedure or workflow across health systems for systematically assessing cyberbullying or other equally dangerous online activities among vulnerable groups like children or adolescents [599]. Therefore, I developed a series of research projects to link digital indicators of cyberbullying or online harassment to clinical practices by advocating design considerations for a patient-centered clinical assessment and workflow that addresses patients’ needs and expectations to ensure quality care. Through this dissertation, I aim to answer these high-level research questions:RQ1. How does the presence of severe online harassment on online platforms contribute to negative experiences and risky behaviors within vulnerable populations? RQ2. How efficient is the current mechanism of screening these risky online negative experiences and behaviors, specifically related to cyberbully, within at-risk populations like adolescent in clinical settings? RQ3. How might evidence of activities and negative harassing experiences on online platforms best be integrated into electronic health records during clinical treatment? I first explore how harassment is presented within different social media platforms from diverse contexts and cultural norms (study 1,2, and 3); next, by analyzing actual patient data, I address current limitations in the screening process in clinical settings that fail to efficiently address core aspect of cyberbullying and their consequences within adolescent patients (study 4 and 5); finally, connecting all my findings, I recommend specific design guidelines for a refined screening tool and structured processes for implementation and integration of the screened data into patients’ electronic health records (EHRs) for better patient assessment and treatment outcomes around cyberbully within adolescent patients (study 6)

Social media narratives in non-communicable disease: their dynamics and value for patients, communities and health researchers

Background: Usage of social media is now widespread and growing, as is the number of people living with Non-Communicable Diseases (NCDs) such as diabetes and cancer. This thesis examines how social media are being used to share or discuss NCDs and the benefits, challenges and implications of these trends as a manifestation of digital public health. Aim and research questions: The aim of this research is to address the gap in empirical, evidence-based research into the secondary use of data from social media to understand patient health issues and inform public health research into NCDs. To this end, seven research questions, each linked to a sub-project, were defined and tested during the course of the six-year programme: 1.What is the status of the existing multi-disciplinary research literature based on analysis of data posted on social media for public health research, and where are the gaps in this research? 2.Can existing systematic review methods be re-purposed and applied to analyse data posted on social media? 3.How are research sponsors and researchers addressing the ethical challenges of analysing data posted on social media? 4.To what extent are diabetes-related posts on Twitter relevant to the clinical condition and what topics and intentions are represented in these posts? 5.In what ways do people affected by Type 1 diabetes use different social media (e.g. for social interaction, support-seeking, information-sharing) and what are the implications for researchers wishing to use these data sources in their studies? 6.Are these differences in platform usage and associated data types also seen in people affected by lung cancer? 7.Can characteristic illness trajectories be seen in a cancer patient’s digital narrative and what insights can be gained to inform palliative care services? Methods: A range of different qualitative and quantitative methods and frameworks were used to address each of the research questions listed. Arksey and O’Malley’s five-stage scoping review framework and the PRISMA guidelines are applied to the systematic scoping review of existing literature. The PRISMA guidelines and checklist are re-purposed and applied to the manual extraction and analysis of social media posts. Bjerglund-Andersen and Söderqvist’s typology of social media uses in research and Conway’s taxonomy of ethical considerations are used to classify the ethics guidelines available to researchers. The findings of these were used to inform the research design of the four empirical studies. The methods applied in the conduct of the empirical studies include a content and narrative analysis of cross-sectional and longitudinal data sourced from Twitter, Facebook, the Type 1 diabetes discussion forum on Diabetes.co.uk and the lung cancer discussion forum on Macmillan.org.uk, as well as the application of Bales’ Interaction Process Analysis and Emanuel and Emanuel’s framework for a good death. Results : Of the 49 systematic, quasi-systematic and scoping reviews identified, 24 relate to the secondary use of data from social media, with eight of these focused on infectious disease surveillance and only two on NCDs. Existing reviews tend to be fragmented, narrow in scope and siloed in different academic communities, with limited consideration of the different types of data, analytical methods and ethical issues involved, therefore creating a need for further reviews to synthesise the emerging evidence-base. The rapid increase in the volume of published research is evident, from the results of RQ1, with 87% of the eligible studies published between 2013-2017. Of the 105 eligible empirical studies that focused on NCDs, cancer (54%) and diabetes (20%) dominate the literature. Data is sourced from Twitter (26%), Facebook (14%) and blogs (10%), conducted, published and funded by the medical community. Since 2012, automated methods have increasingly been applied to extract and analyse large volumes of data. Those that use manual methods for extraction did not apply a consistent approach to doing so; the PRISMA guidelines and checklist were therefore re-purposed and applied to analyse data extracted from social media in response to RQ2. The deficit of ethical guidance available to inform research that involves social media data was also identified as a result of RQ3 and the guidelines provided by the ESRC, BPS, AoIR and NIHR were prioritised for the purposes of this research project. Results from the four empirical studies (RQ4-7) reveal that different forms of social interaction and support are represented in the variety of social media platforms available and that this is influenced by the type and nature of the condition with which people are affected, as well as the affordances offered by such platforms. In the pilot study associated with RQ4, Twitter was identified as a ‘noisy’ source of data about diabetes, with only 66% of the sample being relevant to the clinical condition. Twelve per cent of the eligible sample was associated with Type 2 diabetes, compared to 6% for Type 1, and most were information-giving in nature (49%) and correlated with the diagnosis, treatment and management of the condition (44%). A comparison of Twitter to the Type 1 Diabetes community on Facebook and the discussion forum on Diabetes.co.uk for RQ5 indicated that all three social media platforms were used to disseminate information about the condition. However, the Type 1 Diabetes Group on Facebook and the Type 1 discussion forum on Diabetes.co.uk were also used for social interaction and peer support, hence defying the generalisations made in public health studies, where social media platforms were often considered equal or synonymous. The results from the third empirical study into lung cancer (RQ6) support this, indicating that, by virtue of their digital architecture, user base and self-moderating communities, the Lung Cancer Support Group on Facebook and the lung cancer discussion forum on Macmillan.org.uk are more successful in their utility for social interaction and emotional and informational support. Meanwhile, the sample derived from Twitter hashtags showed greater companionship support. The final empirical study in this PhD research project is associated with RQ7 and used longitudinal data posted by a terminally ill patient on Twitter. This revealed that patient activity on social media mirrors the different phases of the end-of-life illness trajectory described in the literature and that it is comparable to or compliments insights garnered using more traditional qualitative research techniques. It also shows the value of such innovative methods for understanding how terminal disease is experienced by and affects individuals, how they cope, how support is sought and obtained and how patients feel about the ability of palliative care services to meet their needs at different stages. Conclusions: The analysis of health data posted on social media continues to be an expanding and evolving field of multi-disciplinary research. The results of the studies included in this thesis reveal the emergence of new methods and ethical considerations to inform research design as well as ethics policy. The re-purposed PRISMA guidelines and checklist were presented at the 2014 Medicine 2.0 Summit and World Congress whilst the review of ethical guidelines was published in the Research Ethics journal. The four empirical studies that extracted and analysed data from social media provide novel insight into the social narratives of those impacted by diabetes and cancer and can be used to inform future research and practice. The results of these studies have, to date, been presented at four international conferences and published in npj Digital Medicine and BMC Palliative Care. Although this thesis and associated publications contribute to an emerging body of knowledge, further research is warranted into the manual versus automated techniques that can be applied and the differences in social interaction and support needed by people affected by different NCDs

Perceptions of Nurse\u27s Personal Smartphone Use at Work

Distracted nurses who use their personal smartphone at work has resulted in the diversion of attention from patient care. The specific problem is the personal smartphone use by nurses in the hospital settings has resulted in distracted patient care, leading to wrongful release of patient’s information, medical errors, injury or preventable patient death. The purpose of this qualitative study was to describe the perceptions of nurses regarding distracted patient care in their clinical workplace due to personal smartphone use by nurses. The study was grounded in the distraction-conflict theory conceptual framework. The key research question examined the perceptions of nurses regarding distracted patient care in their clinical workplace due to personal smartphone use by nurses. A single case study with embedded units was conducted and involved a total of 54 participants. The trustworthiness of the study’s data was supported by employing methodological triangulation from the study’s three data sources: semi-structured interviews, a focus group, and an open-ended questionnaire. Four themes and 9 subthemes were revealed after thematic analysis. The findings clearly demonstrated that nurses perceive their smartphones as an integral tool to assist in patient care and, if misused, a distraction that may create a negative impact on patient care. This study is likely to promote positive social change by providing guidance for nursing management on defining policies and practices based on nurses’ smartphone use that incorporate the perceptions and insight of the nurses to provide professional application that heighten the awareness of distracted health care

ALT-C 2012 Abstracts

This is a PDF of the abstracts for all the sessions at the 2012 ALT conference. It is designed to be used alongside the online version of the conference programme. It was made public on 7 September 2012

Mobile phone text messaging data collection on care-seeking for childhood diarrhoea and pneumonia in rural China: a mixed methods study

Background. Health information systems are inadequate in many countries. For childhood diarrhoea and pneumonia specifically, the leading infectious causes of child mortality worldwide, current data collection methods are not providing sufficient information for surveillance. The collection of health data could be greatly assisted with the use of mobile devices (mHealth). Mobile phone text messaging is widely used, but its potential for health data collection has not yet been realised. Aim. To explore the application of mHealth-based collection of information relevant to childhood diarrhoea and pneumonia in rural China. Methods. A mixed methods approach was used: (i) a survey and semi-structured interviews to assess the usage of mobile phones by caregivers of young children; (ii) cognitive interviews, usability testing and a cluster randomised cross-over study to determine the validity of a text messaging survey on care-seeking for childhood diarrhoea and pneumonia; and (iii) researchers’ observations and structured interviews with participants of the cross-over study to evaluate factors influencing participation in mHealth-based studies. Results. Many of the 1854 survey participants (1620; 87.4%) used mobile phones. Of 1014 participants in the cross-over study, 662 (65.3%) responded to the first text message. Of 651 participants willing to participate, 356 (54.7%) completed the text messaging survey. Overall, text message data were moderately to substantially equivalent to face-to-face data. The text messaging survey was acceptable to parents, but grandparents were often unable to use text messages. Among many factors influencing participation were trust, perceived usefulness and ease of use. Conclusions. Text messaging can be applied to collect data on care-seeking for childhood diarrhoea and pneumonia in rural China, but several questions remain, including how to improve accuracy and response rates. Further work needs to advance innovative mHealth-based data collection methods that can improve health surveillance, enhance implementation of appropriate interventions and ultimately save children’s lives.Open Acces