A New Clinical Model for Primary Care: A Critical Component of Healthcare Innovation Zones

The overall aim of this research and design project is to develop a primary care setting that responds to the current changes in the healthcare system and accommodates predicted developments in the future. It takes advantage of opportunities created by the Affordable Care Act and initiatives started under the new Center for Medicare and Medicaid Innovation. One of these includes the creation of Healthcare Innovation Zones as a way to bring integrative, comprehensive health services to a wider population through the network of a teaching hospital, physicians, and other clinical entities. The proposed ambulatory care setting is a model for this clinical entity conceived to reconsider critical components of a Healthcare Innovation Zone. Through the process of literature review and case study analysis, existing problems and evolving trends in both the healthcare and architectural contexts were identified. Following this process, guidelines were developed that outline architectural design criteria fundamental to this proposed type of primary care clinical entity; these include gradient zones, transparency, simplified circulation, modular planning, pod groupings, open team hubs, standardized care rooms, and transformable space. A model program and site selection criteria are also developed that incorporate elements critical to defining a Healthcare Innovation Zone and completing one within the specific context of downtown Winston-Salem, North Carolina. The new model will represent an innovative but attainable design that places the patient at the center of a collaborative network of care providers affiliated with Wake Forest Baptist Medical Center. The spirit of collaboration is intended to bring together the public, patients, providers, and medical students as all users of the space take part in educational experiences. Unlike traditional outpatient clinics, this new setting is conceived as a highly accessible, integrated part of people\u27s overall lifestyle, merging public, educational, and medical spheres. The facility will function as a support center to informed, active patients and caring, proactive providers who are concerned with preventive measures and comprehensive management, rather than merely reactive treatment. It will be engaged and complimented by forward-thinking individuals who stand at the forefront of developing new practices and technologies to improve the individual\u27s lifestyle. The center has the potential to become a replicable model that other communities could adopt to further a primary care revolution and ensure higher-quality healthcare to the greater society

HOW LIGHTWEIGHT TECHNOLOGIES SUPPORT DIGITAL INNOVATION IN THE CONTEXT OF PATIENT-CENTERED CARE

A central challenge for healthcare is technology innovation. The literature has reported on the many challenges to IT innovation efforts in hospitals and in digital health services in general. Recently, the increased use of mobile apps, personal devices, web interfaces – so-called lightweight technology – has introduced a novel innovation logic where recombinability seems to emerge as a core capability to enable innovation. However, we still know little about how recombinability supports digital innovation in healthcare. Specifically, we explore the recombinability of lightweight technologies in the context of digital innovation for patient- centeredness. Our research builds on a comparative analysis of two case studies in Scandinavia. The two cases show that recombinability is crucial to enable flexible personalization. We discuss different strategies of recombinability to enable digital innovation for patient-centered health practice

Security and usability of a personalized user authentication paradigm : insights from a longitudinal study with three healthcare organizations

Funding information: This research has been partially supported by the EU Horizon 2020 Grant 826278 "Securing Medical Data in Smart Patient-Centric Healthcare Systems" (Serums) , and the Research and Innovation Foundation (Project DiversePass: COMPLEMENTARY/0916/0182).This paper proposes a user-adaptable and personalized authentication paradigm for healthcare organizations, which anticipates to seamlessly reflect patients’ episodic and autobiographical memories to graphical and textual passwords aiming to improve the security strength of user-selected passwords and provide a positive user experience. We report on a longitudinal study that spanned over three years in which three public European healthcare organizations participated in order to design and evaluate the aforementioned paradigm. Three studies were conducted (n=169) with different stakeholders: i) a verification study aiming to identify existing authentication practices of the three healthcare organizations with diverse stakeholders (n=9); ii) a patient-centric feasibility study during which users interacted with the proposed authentication system (n=68); and iii) a human guessing attack study focusing on vulnerabilities among people sharing common experiences within location-aware images used for graphical passwords (n=92). Results revealed that the suggested paradigm scored high with regards to users’ likeability, perceived security, usability and trust, but more importantly it assists the creation of more secure passwords. On the downside, the suggested paradigm introduces password guessing vulnerabilities by individuals sharing common experiences with the end-users. Findings are expected to scaffold the design of more patient-centric knowledge-based authentication mechanisms within nowadays dynamic computation realms.PostprintPeer reviewe

Virtual Clinical Trials: One Step Forward, Two Steps Back

Virtual clinical trials have entered the medical research landscape. Today’s clinical trials recruit subjects online, obtain informed consent online, send treatments such as medications or devices to the subjects’ homes, and require subjects to record their responses online. Virtual clinical trials could be a way to democratize clinical research and circumvent geographical limitations by allowing access to clinical research for people who live far from traditional medical research centers. But virtual clinical trials also depart dramatically from traditional medical research studies in ways that can harm individuals and the public at large. This article addresses the issues presented by virtual clinical trials with regard to: (1) recruitment methods; (2) informed consent; (3) confidentiality; (4) potential risks to the subjects; and (5) the safety and efficacy of treatments that are approved

BOUNDED RECOMBINABILITY OF DIGITAL TECHNOLOGIES FOR PATIENT-CENTRED CARE

A central challenge for healthcare is technology innovation. The literature has reported on the many challenges to IT innovation efforts in hospitals and in digital health services in general. Recently, the increased use of mobile apps, personal devices, web interfaces – so-called lightweight technology – has introduced a novel innovation logic where recombinability seems to emerge as a core capability to enable innovation. However, we still know little about how recombinability supports digital innovation in healthcare. Specifically, we explore the recombinability of lightweight technologies in the con- text of digital innovation for patient-centeredness. Our research builds on a comparative analysis of two case studies in Scandinavia. The two cases show that recombinability is crucial to enable personalization and the collaborative management of illness between patient and healthcare and it entails reorganizing the healthcare practice. In addition, the findings show that the logic of recombinability was in both cases bounded by the patient and healthcare practice. We discuss bounded recombinability as a logic to maximize the value of digital innovation for a local practice

ICT Framework to Support a Patient-Centric approach in Public Healthcare: A Case Study of Malawi

Although Information and Communication Technologies (ICTs) in the healthcare sector are extensively deployed globally, they are not used effectively in developing countries. Many resource poor countries face numerous challenges in implementing the ICT interventions. For instance, many health applications that have been deployed are not user-centric. As a result, such ICT interventions do not benefit many health consumers. The lack of an ICT framework to support patient-centric healthcare services in Malawi renders the e-health and mhealth interventions less sustainable and less cost effective. The aim of the study was therefore to develop an ICT Framework that could support patient-centric healthcare services in the public health sector in Malawi. The comprehensive literature review and semi-structured interviews highlighted many challenges underlying ICT development in Malawi. An ICT framework for patient-centric healthcare services is therefore proposed to ensure that eHealth and mobile health interventions are more sustainable and cost effective. The framework was validated by five experts selected from different areas of expertise including mhealth application developers, ICT policy makers and public health practitioners. Results show that the framework is relevant, useful and applicable within the setting of Malawi. The framework can also be implemented in various countries with similar settings

Recent advances of HCI in decision-making tasks for optimized clinical workflows and precision medicine.

The ever-increasing amount of biomedical data is enabling new large-scale studies, even though ad hoc computational solutions are required. The most recent Machine Learning (ML) and Artificial Intelligence (AI) techniques have been achieving outstanding performance and an important impact in clinical research, aiming at precision medicine, as well as improving healthcare workflows. However, the inherent heterogeneity and uncertainty in the healthcare information sources pose new compelling challenges for clinicians in their decision-making tasks. Only the proper combination of AI and human intelligence capabilities, by explicitly taking into account effective and safe interaction paradigms, can permit the delivery of care that outperforms what either can do separately. Therefore, Human-Computer Interaction (HCI) plays a crucial role in the design of software oriented to decision-making in medicine. In this work, we systematically review and discuss several research fields strictly linked to HCI and clinical decision-making, by subdividing the articles into six themes, namely: Interfaces, Visualization, Electronic Health Records, Devices, Usability, and Clinical Decision Support Systems. However, these articles typically present overlaps among the themes, revealing that HCI inter-connects multiple topics. With the goal of focusing on HCI and design aspects, the articles under consideration were grouped into four clusters. The advances in AI can effectively support the physicians' cognitive processes, which certainly play a central role in decision-making tasks because the human mental behavior cannot be completely emulated and captured; the human mind might solve a complex problem even without a statistically significant amount of data by relying upon domain knowledge. For this reason, technology must focus on interactive solutions for supporting the physicians effectively in their daily activities, by exploiting their unique knowledge and evidence-based reasoning, as well as improving the various aspects highlighted in this review

Holistic System Design for Distributed National eHealth Services

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