Mobile Telemedicine for Diabetes Care

Diabetes Mellitus is nowadays one of the most frequent non-contagious diseases in the world and remains a major health problem for the national health care programs. It is well proved that Telemedicine helps diabetic patients controlling their glucose levels, facilitating their day to-day therapy management and the communication with health care personnel. The rapid growth and development of information technologies in the areas of mobile computing and mobile Internet is shaping a new technological scenario of telemedicine and shared care systems. In this chapter we will show one approach to Mobile Telemedicine for Diabetes Care

Sharing is caring: integrating health information systems to support patient-centred shared homecare

In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives. The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare. An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts. In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need

The Second International Conference on Health Information Technology Advancement

TABLE OF CONTENTS I. Message from the Conference Co-Chairs B. Han and S. Falan …………………………....….……………. 5 II. Message from the Transactions Editor H. Lee …...………..………….......………….……….………….... 7 III. Referred Papers A. Emerging Health Information Technology and Applications The Role of Mobile Technology in Enhancing the Use of Personal Health Records Mohamed Abouzahra and Joseph Tan………………….……………. 9 Mobile Health Information Technology and Patient Care: Methods, Themes, and Research Gaps Bahae Samhan, Majid Dadgar, and K. D. Joshi…………..…. 18 A Balanced Perspective to Perioperative Process Management Jim Ryan, Barbara Doster, Sandra Daily, and Carmen Lewis…..….…………… 30 The Impact of Big Data on the Healthcare Information Systems Kuo Lane Chen and Huei Lee………….…………… 43 B. Health Care Communication, Literacy, and Patient Care Quality Digital Illness Narratives: A New Form of Health Communication Jofen Han and Jo Wiley…..….……..…. 47 Relationships, Caring, and Near Misses: Michael’s Story Sharie Falan and Bernard Han……………….…..…. 53 What is Your Informatics Skills Level? -- The Reliability of an Informatics Competency Measurement Tool Xiaomeng Sun and Sharie Falan.….….….….….….…. 61 C. Health Information Standardization and Interoperability Standardization Needs for Effective Interoperability Marilyn Skrocki…………………….…….………….… 76 Data Interoperability and Information Security in Healthcare Reid Berryman, Nathan Yost, Nicholas Dunn, and Christopher Edwards.…. 84 Michigan Health Information Network (MiHIN) Shared Services vs. the HIE Shared Services in Other States Devon O’Toole, Sean O’Toole, and Logan Steely…..……….…… 94 D. Health information Security and Regulation A Threat Table Based Approach to Telemedicine Security John C. Pendergrass, Karen Heart, C. Ranganathan, and V.N. Venkatakrishnan …. 104 Managing Government Regulatory Requirements for Security and Privacy Using Existing Standard Models Gregory Schymik and Dan Shoemaker…….…….….….… 112 Challenges of Mobile Healthcare Application Security Alan Rea………………………….……………. 118 E. Healthcare Management and Administration Analytical Methods for Planning and Scheduling Daily Work in Inpatient Care Settings: Opportunities for Research and Practice Laila Cure….….……………..….….….….… 121 Predictive Modeling in Post-reform Marketplace Wu-Chyuan Gau, Andrew France, Maria E. Moutinho, Carl D. Smith, and Morgan C. Wang…………...…. 131 A Study on Generic Prescription Substitution Policy as a Cost Containment Approach for Michigan’s Medicaid System Khandaker Nayeemul Islam…….…...……...………………….… 140 F. Health Information Technology Quality Assessment and Medical Service Delivery Theoretical, Methodological and Practical Challenges in Designing Formative Evaluations of Personal eHealth Tools Michael S. Dohan and Joseph Tan……………….……. 150 The Principles of Good Health Care in the U.S. in the 2010s Andrew Targowski…………………….……. 161 Health Information Technology in American Medicine: A Historical Perspective Kenneth A. Fisher………………….……. 171 G. Health Information Technology and Medical Practice Monitoring and Assisting Maternity-Infant Care in Rural Areas (MAMICare) Juan C. Lavariega, Gustavo Córdova, Lorena G Gómez, Alfonso Avila….… 175 An Empirical Study of Home Healthcare Robots Adoption Using the UTUAT Model Ahmad Alaiad, Lina Zhou, and Gunes Koru.…………………….….………. 185 HDQM2: Healthcare Data Quality Maturity Model Javier Mauricio Pinto-Valverde, Miguel Ángel Pérez-Guardado, Lorena Gomez-Martinez, Martha Corrales-Estrada, and Juan Carlos Lavariega-Jarquín.… 199 IV. A List of Reviewers …………………………..…….………………………208 V. WMU – IT Forum 2014 Call for Papers …..…….…………………20

Medication Adherence with Smart Phones: Pharmacists Focused Apps

Medication adherence relates to the concept of compliance to a medicine regimen and is defined as ‘the extent to which a patient acts in accordance with the prescribed interval and dose of a dosing regimen’ (Cramer et al., 2008). Often desired health outcomes are not achieved due to patients, not taking their prescribed medication or taking them incompletely or inconsistently (Miller et al., 1997). This results in higher negative health outcomes and increasing cost of care and is therefore a growing global concern. Tackling the problem of non-adherence requires a collaborative, patient-centric approach and can be guided by modern technologies that offer efficient ways to managing healthcare (Williams et al., 2014). Over the last two decades, the internet has revamped the way information is accessed and mobile devices have taken this a step further by allowing users to access any and every information they want at their fingertips. The availability of over one and a half million applications or apps for download endorses the growing interest in the technology (Bexley et al., 2010). Mobile apps can provide an opportunity for both the healthcare professional and the patient to access user-friendly ways of accessing important medical information quickly, for improving patient health and advancing support and care (Choi et al. 2015; Miller et al., 1997). According to the eMarketer1, 2014, about 58.2% of the global population was using mobile phones in 2012; this percentage increased to 61.1% in 2013 and is further expected to increase to 69.4% of the world’s population by 2017. As of April 2014, 62% of smartphone users have searched for health information using their devices. Evidently, mobile is rapidly becoming the preferred consumer channel for communication including health services. Mobile-HealthNews.com2 highlights that the Apple App Store already has about 6,000 mobile health related apps, indicating consumers’ interest in a more active role in their own health management

Defining the Enablers and Barriers to the Implementation of Large-scale, Health Care-Related Mobile Technology: Qualitative Case Study in a Tertiary Hospital Setting

BACKGROUND: The successful implementation of clinical smartphone apps in hospital settings requires close collaboration with industry partners. A large-scale, hospital-wide implementation of a clinical mobile app for health care professionals developed in partnership with Google Health and academic partners was deployed on a bring-your-own-device basis using mobile device management at our UK academic hospital. As this was the first large-scale implementation of this type of innovation in the UK health system, important insights and lessons learned from the deployment may be useful to other organizations considering implementing similar technology in partnership with commercial companies. OBJECTIVE: The aims of this study are to define the key enablers and barriers and to propose a road map for the implementation of a hospital-wide clinical mobile app developed in collaboration with an industry partner as a data processor and an academic partner for independent evaluation. METHODS: Semistructured interviews were conducted with high-level stakeholders from industry, academia, and health care providers who had instrumental roles in the implementation of the app at our hospital. The interviews explored the participants' views on the enablers and barriers to the implementation process. The interviews were analyzed using a broadly deductive approach to thematic analysis. RESULTS: In total, 14 participants were interviewed. Key enablers identified were the establishment of a steering committee with high-level clinical involvement, well-defined roles and responsibilities between partners, effective communication strategies with end users, safe information governance precautions, and increased patient engagement and transparency. Barriers identified were the lack of dedicated resources for mobile change at our hospital, risk aversion, unclear strategy and regulation, and the implications of bring-your-own-device and mobile device management policies. The key lessons learned from the deployment process were highlighted, and a road map for the implementation of large-scale clinical mobile apps in hospital settings was proposed. CONCLUSIONS: Despite partnering with one of the world's biggest technology companies, the cultural and technological change required for mobile working and implementation in health care was found to be a significant challenge. With an increasing requirement for health care organizations to partner with industry for advanced mobile technologies, the lessons learned from our implementation can influence how other health care organizations undertake a similar mobile change and improve the chances of successful widespread mobile transformation

Telemedicine and e-health in Algeria facing challenges in medical practice

The Algerian health system operates in a demographic, economic, environmental, and societal specific context to meet the challenges of epidemiological transition. Development of information and communication technologies in this atmosphere allow telemedicine and e-health emergence in the vast country of Algeria. Thus, the country may face these challenges by including them in a national telemedicine plan and making a major focus of global action for the prevention and control of prevalent diseases. The interest to adopt this tool in daily practice stems from an improvement in the quality of communication between practitioners and in the doctor–patient relationship with a possibility of quick access to care and more efficient care pathways. Thus, national goals in fight plans against diseases will be achieved. Telemedicine and e-health projects that methodologically well-defined, respecting regulations and using all means and all available resources, including WHO mobile health, are to be designed and implemented in all areas, especially in the national plan against not-communicated diseases, maternal and child health, old aging health, and mental health. This approach will integrate telemedicine in the health care system whose inevitable implementation can be done on solid foundations and will be actively supported by SATeS

Using mobile technology to promote access, effective patient–provider communication, and adherence in underserved populations

Federally Qualified Health Centers (FQHCs) are community based centers created to provide comprehensive primary and preventive care to individuals unable to access care in the commercial medical system (e.g. related to poverty, and/or race-ethnicity). The Affordable Care Act (ACA) proposes offering Medicaid coverage to many such individuals, thus, FQHCs should receive many new Medicaid enrollees. The ACA has triggered a number of new ideas to improve affordability, health status and patient experience, commonly known as the “triple aim.” These initiatives include quality incentive programs, payment reform, and the promotion of medical homes and accountable care organizations (ACOs). These are in addition to earlier efforts to facilitate market reform, such as incentives to develop information and communication tools, such as interoperable electronic health records (EHRs) (Doebbeling, Chou \u26 Tierney, 2006). The goals of the “triple aim” cannot be met unless there is greater access to primary and preventive care. Since limited access to poor and minority populations exists today, the FQHC system could easily become overwhelmed with demand. Innovative models are essential to ensure access to needed care. If health care coverage expands beginning in 2014 as expected, FQHCs will be in a position to transition their uninsured patient population to Medicaid and state insurance exchanges. Provider networks, such as FQHCs, will be held accountable for reaching the triple aim, as measured by cost, quality, and patient experience. Recent federal and state cutbacks in the funding of Medicaid and FQHCs has led to problems with access to care and little improvement in quality of care, efficiency or satisfaction in many states. Recent “secret shopper” calls of FQHCs demonstrated access to care problems for a variety of common significant health problems at most clinics in Indiana. To investigate this problem, we have recently conducted a series of key informant interviews of clinicians, staff and leaders at three FQHCs in Indiana, regarding operational challenges and access to care. Due to current fiscal shortfalls, current patients often have difficulty in being seen and “no show\u22 cases are common. We found the leadership and clinicians at each of our participating FQHCs interested in opportunities to improve access to care and reduce no-shows, as well as strategies to improve provider-patient communication. Our findings suggest an opportunity to design and implement novel models of patient-centered care and redesign current policies and workflow to ensure that primary care is available, timely, coordinated, and cost effective. In order to address these issues, we are partnering with FQHCs and a not for profit health maintenance organization (MDwise, Inc) in Indiana to test new information and access strategies. In the proposed project, we will explore the feasibility of using mobile technology to increase access to information that will improve patient access to care and satisfaction. Short message service (SMS), or text messaging, is one way in which mobile technology has been used in healthcare. In a review of 61 studies, 50 presented findings showing a positive effect on the desired outcome from the intervention (Yeager \u26 Menachemi, 2011). Most of these studies looked at the influence of text messaging on health behaviors, however, 10 examined the impact of text messaging on administrative processes in healthcare. Nine of the ten studies found text message reminders systems reduced the no-show rates in clinics; several found text messaging was more cost effective than phone call reminders (Yeager \u26 Menachemi, 2011). The authors noted that only two of these 10 studies were conducted in primary care and none were conducted in the United States. In addition, few studies have explored the benefits of using this type of technology in vulnerable populations which are cared for by FQHCs. Thus, the present project will help to address this knowledge gap. In our project, we intend to extend beyond text messaging, into the use of social media such as Facebook and Twitter, to provide patient easy access to clinic information and ease scheduling. Other opportunities to leverage mobile technologies in community health centers that will be considered include: 1) immunization reminders; 2) management of chronic disease; 3) reduction in emergency room visits for urgent care; 4) facilitation of Medicaid reenrollment; 5) education to advance health literacy; and 6) enhance communication to improve member retention. Table 1 outlines our proposed phased approach to developing and deploying the mobile technology solution. First, we will conduct a survey to assess the feasibility of using these mobile technologies in the target population. In a recent study examined the interest in using mobile technology for appointment reminders at a safety-net clinic serving an indigent urban population (Denizard-Thompson et al, 2011). Over three hundred surveys were collected in ten days from patients who were “predominantly African-American (68 vs. 27% white, 3% Latino), and female (65% female vs. 35% male),” with a payer distribution of 24% Medicaid, 27% self-pay, 30% Medicare, and 9% privately insured (Denizard-Thompson et al, p. 458). Over half of the patients surveyed were interested in managing clinic appointments by text message (57%) and emphasized the value of surveying the clinic population to better understand its unique needs. In the proposed research, we plan to adapt the methodology and survey instrument used by Denizard-Thompson et al. Next, we propose conducting focus groups with staff, clinicians and patients in order to assess the needs from the technology and gather design ideas, selected across 5-6 FQHCs. After a prototype is developed, we will conduct a pilot test involving at least one patient from each center. Feedback from interviews conducted during this stage will be used to modify the technology as needed. Rollout to all participating centers will follow a formal training period at each clinic. Table 1 – Mobile Technology Development Plan Month Complete Study Duration/ Center Study Description 6 1 week of data collection with patients as they come to clinic for care Survey Assess patient’s current use of mobile technology and willingness to use for healthcare appointment management and alerts. 1-2 hours Needs Assessment/Formative Evaluation Focus Group/ Design Workshop with Center Staff and Care Providers 1-2 hours Needs Assessment/Formative Evaluation Focus Group/ Design Workshop with Center Patients and Caregivers 12 n/a Professional prototype development 18 Pilot Test Test technology with at least one patient, selected based on criteria deemed important by center staff and care providers. Weeks 4, 8, \u26 12: Contextual interview with patient/caregiver and center staff/ care providers 24 n/a Professional technology development Changes based on pilot testing 36 1-2 hours System Training Roll out to all participating centers In conclusion, we have found that there is a need to improve scheduling, access to care and patient-provider communication in community health centers, such as FQHCs. The proposed application of inexpensive mobile technology available on most cell phones holds promise for both improving access and ensuring higher utilization, as well as in improving patient-provider communication and adherence to current medical care guidelines. References: Doebbeling, B.N., Chou, A.F., Tierney, W.M. Priorities and Strategies for Implementation of an Integrated Informatics and Communications Technology System for Evidence-based Practices. J. Gen. Intern. Med. 21:S98-S105, 2006. Yeager, V.A., Menachemi, N. Text Messaging in Health Care: A Systematic Review of Impact Studies. Biennial Review of Health Care Management. (2011) 235-261. Denizard-Thompson, Nancy M; Feiereisel, Kirsten B; Stevens, Sheila F; Miller, David P; Wofford, James. The Digital Divide at an Urban Community Health Center: Implications for Quality Improvement and Health Care Access. Journal of community health (2011) 36: 456-460

User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach

Background: Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. Objective: The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? Methods: The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. Results: The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. Conclusions: The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF.User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development ApproachpublishedVersio

Integration of mHealth technologies to support service interaction moments in tertiary healthcare of Western Cape, South Africa

There is an increasing publication of scholar articles that describe the ubiquitous nature of mobile technologies as an enabler of mobility. However, there is limited empirical evidence that indicates the defined service interaction moments wherein mobile Health (mHealth) technologies could be useful and are actually used during the execution of work activities with minimal disruption in a clinical setting. The nature of healthcare professionals work activities often requires mobility and continuous management of information but the predominant use of paper-based systems and desktop computer workstations cause time and location constraints. This ultimately defeats the purpose of health information technologies to provide automation of work activities and enhance performance efficiency at points-of-care during service delivery. Hence, it is arguable that mHealth technologies could somewhat redress time and location constraints at points-of-care in clinical practice. The study adopts an interpretivist approach to understand work activities of healthcare professionals in relation to the integration of mHealth technologies, by means of service design as a strategy. Preliminary findings show that, there are specific forms of mHealth applications developed by clinicians but it can be disruptive during work activities while consulting with patients. Ultimately, the study indicates how the interplay between human and machine agencies influence work activities. Furthermore, mHealth technologies would integrate into workflow of professionals at points-of-care where coordinated care involves several professionals for communication purposes. The overall intended outcome of this study would contribute as groundwork on which future studies could design mHealth technologies specific to the work practices of healthcare professionals in sub-Saharan Africa public hospitals

Timely digital patient-clinician communication in specialist clinical services for young people : a mixed-methods study (the LYNC study)

BACKGROUND: Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. OBJECTIVE: Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. METHODS: We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. RESULTS: Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can improve trust. The clinical teams studied had not themselves formally evaluated the impact of their intervention. Staff time is the main cost driver, but offsetting savings are likely elsewhere in the health service. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information, and communication failures, which are mostly mitigated by young people and clinicians using common-sense approaches. CONCLUSIONS: As NHS policy prompts more widespread use of digital communication to improve the health care experience, our findings suggest that benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team, and where there is identifiable need for patients to have flexible access, such as when transitioning between services, treatments, or lived context. Clinical teams need a proactive approach to ethics, governance, and patient safety