Health information technology and digital innovation for national learning health and care systems

Health information technology can support the development of national learning health and care systems, which can be defined as health and care systems that continuously use data-enabled infrastructure to support policy and planning, public health, and personalisation of care. The COVID-19 pandemic has offered an opportunity to assess how well equipped the UK is to leverage health information technology and apply the principles of a national learning health and care system in response to a major public health shock. With the experience acquired during the pandemic, each country within the UK should now re-evaluate their digital health and care strategies. After leaving the EU, UK countries now need to decide to what extent they wish to engage with European efforts to promote interoperability between electronic health records. Major priorities for strengthening health information technology in the UK include achieving the optimal balance between top-down and bottom-up implementation, improving usability and interoperability, developing capacity for handling, processing, and analysing data, addressing privacy and security concerns, and encouraging digital inclusivity. Current and future opportunities include integrating electronic health records across health and care providers, investing in health data science research, generating real-world data, developing artificial intelligence and robotics, and facilitating public–private partnerships. Many ethical challenges and unintended consequences of implementation of health information technology exist. To address these, there is a need to develop regulatory frameworks for the development, management, and procurement of artificial intelligence and health information technology systems, create public–private partnerships, and ethically and safely apply artificial intelligence in the National Health Service

Aplicaciones psicosociales de la tecnología para la capacitación en salud y bienestar de adultos mayores con demencia y deterioro cognitivo leve y sus cuidadores en zonas rurales

Tesis por compendio de publicaciones.[EN]Introduction: The transition to an ageing population has brought several challenges to societies and healthcare systems around the world. The need for new healthcare approaches and interventions to adjust to the new situation is one of the most relevant issues worldwide. This project particularly targets three of these challenges: the complexity of older adult care, the increase of people living with dementia and their caregivers, and the poor accessibility of rural populations to access healthcare services to face these challenges. Aims: To develop a proof of concept of a technological platform integrating several innovative digital tools for health and wellness coaching of older adults with dementia and cognitive impairment and their carers, and to study the effects of utilisation of the platform on physical health, mental and emotional wellbeing, activities of daily living, social and cognitive functioning and professional care use. To involve older adults with dementia and their carers in the design and development of the platform, assessing their satisfaction, the impact of the system in realistic settings, acceptability and usability, to enable them to manage the system autonomously in daily life. Methodologies: Two systematic reviews were conducted in July 2021 and April 2023 in PubMed, CINAHL, and Web of Science. A qualitative appraisal/risk of bias was performed for the studies included. Three qualitative studies were conducted, implementing online and face-to-face workshops, semi-structured interviews, focus groups, and co-design and co-production processes with Patient and Public Involvement (PPI). Thematic analysis was the chosen approach for the analysis of the results. A mixed-methods usability and user experience study and a pilot study of an online training and support programme for caregivers of people living with dementia are being carried out, implementing semi-structured interviews and questionnaires targeting usability, dementia knowledge and caregiver burden. Results: A series of steps necessary to create the foundations of a technological platform were identified: a) the interRAI LTFC and the interRAI HC were recommended as the CGAs to be used for the assessment and monitoring of potential users in long-term care facilities and home care, respectively; b) the barriers for the usability and implementation of DHTs to assist and to help to reach the full potential of CGAs are described, as well as a series of recommendations to improve its usability and implementation by healthcare professionals and clinical settings; c) a framework to study the pros and cons of developing digital patient and public involvement and suggestions to improve the implementation of e-PPI were developed and identified; d) the facilitators and barriers to implementing the socio-community intervention of the Meeting Centre Support Programme were identified and several recommendations were described to overcome the limitations for a successful implementation; and e) as an attempt to offer a support service alternative for caregivers of PLwD in remote rural areas, the cultural adaptation of the iSupport training and support programme for carers of PLwD was developed, and its usability and user-experience, and impact on dementia knowledge and caregiver burden are under study. Conclusions: This project described a series of steps necessary to create the foundations of a technological platform for health and wellness coaching of older adults with dementia and cognitive impairment and their carers. By embedding the findings in this project and including novel technologies such as AI, robotics, wearable technologies, and monitoring devices, the idea of the technological platform could be feasible. Further projects could implement these initiatives to generate an impact on facing the current challenges of the ageing population. [ES]Introducción: La transición hacia una población que envejece ha planteado varios retos a las sociedades y los sistemas sanitarios de todo el mundo. La necesidad de nuevos enfoques e intervenciones sanitarias para adaptarse a la nueva situación es una de las cuestiones más relevantes en todo el mundo. Este proyecto se centra especialmente en tres de estos retos: la complejidad de la atención a los adultos mayores, el aumento del número de personas que viven con demencia y de sus cuidadores, y la escasa accesibilidad de las poblaciones rurales a los servicios sanitarios para hacer frente a estos retos. Objetivos: Desarrollar una prueba de concepto de una plataforma tecnológica que integre varias herramientas digitales innovadoras para la capacitación en salud y bienestar de adultos mayores con demencia y deterioro cognitivo y sus cuidadores, y estudiar los efectos de la utilización de la plataforma en la salud física, el bienestar mental y emocional, las actividades de la vida diaria, el funcionamiento social y cognitivo y el uso para los cuidados profesionales. Involucrar a los adultos mayores con demencia y a sus cuidadores en el diseño y desarrollo de la plataforma, evaluando su satisfacción, el impacto del sistema en entornos realistas, su aceptabilidad y usabilidad, para permitirles manejar el sistema de forma autónoma en la vida diaria. Métodos: Se realizaron dos revisiones sistemáticas en julio de 2021 y abril de 2023 en PubMed, CINAHL y Web of Science. Se realizó una valoración cualitativa/riesgo de sesgo de los estudios incluidos. Se realizaron tres estudios cualitativos, implementando talleres online y presenciales, entrevistas semiestructuradas, grupos focales y procesos de codiseño y coproducción con Participación de Pacientes y Público (PPI). El análisis temático fue el enfoque elegido para el análisis de los resultados. Se está llevando a cabo un estudio de usabilidad y experiencia de usuario con métodos mixtos y un estudio piloto de un programa en línea para la capacitación y formación de cuidadores de personas que viven con demencia, en los que se aplicarán entrevistas semiestructuradas y cuestionarios sobre usabilidad, conocimiento de la demencia y sobrecarga de los cuidadores. Resultados: Se identificaron una serie de pasos necesarios para crear las bases de una plataforma tecnológica: a) se recomendaron el interRAI LTFC y el interRAI HC como las Evaluaciones Geriátricas Integrales (EGI) que se utilizarán para la evaluación y el seguimiento de los usuarios potenciales en los centros de larga estancia y en la atención domiciliaria, respectivamente; b) se describen las barreras para la usabilidad y la implementación de las Tecnologías de Salud Digital (TSD) para asistir y ayudar a alcanzar todo el potencial de las EGI, así como una serie de recomendaciones para mejorar su usabilidad e implementación por parte de los profesionales sanitarios y los entornos clínicos; c) se desarrolló e identificó un marco para estudiar los pros y los contras del desarrollo de la participación digital de pacientes y público (e-PPI, por sus siglas en inglés) y sugerencias para mejorar la implementación de e-PPI; d) se identificaron los factores que facilitan y dificultan la aplicación de la intervención sociocomunitaria del Programa de Atención de Centros de Encuentro (MCSP, por sus siglas en inglés) y se describieron varias recomendaciones para superar las limitaciones y lograr una aplicación satisfactoria; y e) como intento de ofrecer una alternativa de servicio de apoyo a los cuidadores de personas que viven con demencia en zonas rurales remotas, se desarrolló la adaptación cultural del programa de formación y apoyo iSupport para cuidadores de personas que viven con demencia, y se está estudiando su usabilidad y experiencia de usuario, así como su impacto en los conocimientos sobre la demencia y la sobrecarga en los cuidadores. Conclusión: Este proyecto describe una serie de pasos necesarios para crear los cimientos de una plataforma tecnológica para la capacitación en salud y bienestar de los adultos mayores con demencia y deterioro cognitivo y sus cuidadores. La idea de la plataforma tecnológica podría ser factible si se incorporan los resultados de este proyecto y se incluyen tecnologías novedosas como la inteligencia artificial, la robótica, las tecnologías ponibles y los dispositivos de monitorización. Otros proyectos podrían poner en práctica estas iniciativas para generar un impacto a la hora de afrontar los retos actuales del envejecimiento de la población

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe