Designing and implementing usable and useful Accountable-eHealth systems

This tutorial primarily focuses on the technical challenges surrounding the design and implementation of Accountable-eHealth (AeH) systems. The potential benefits of shared eHealth records systems are promising for the future of improved healthcare; however, their uptake is hindered by concerns over the privacy and security of patient information. In the current eHealth environment, there are competing requirements between healthcare consumers' (i.e. patients) requirements and healthcare professionals' requirements. While consumers want control over their information, healthcare professionals want access to as much information as required in order to make well informed decisions. This conflict is evident in the review of Australia's PCEHR system. Accountable-eHealth systems aim to balance these concerns by implementing Information Accountability (IA) mechanisms. AeH systems create an eHealth environment where health information is available to the right person at the right time without rigid barriers whilst empowering the consumers with information control and transparency, thus, enabling the creation of shared eHealth records that can be useful to both patients and HCPs. In this half-day tutorial, we will discuss and describe the technical challenges surrounding the implementation of AeH systems and the solutions we have devised. A prototype AeH system will be used to demonstrate the functionality of AeH systems, and illustrate some of the proposed solutions. The topics that will be covered include: designing for usability in AeH systems, the privacy and security of audit mechanisms, providing for diversity of users, the scalability of AeH systems, and finally the challenges of enabling research and Big Data Analytics on shared eHealth Records while ensuring accountability and privacy are maintained

The Design of a System for Online Psychosocial Care: Balancing Privacy and Accountability in Sensitive Online Healthcare Environments

The design of sensitive online healthcare systems must balance the requirements of privacy and accountability for the good of individuals, organizations, and society. Via a design science research approach, we build and evaluate a sophisticated software system for the online provision of psychosocial healthcare to distributed and vulnerable populations. Multidisciplinary research capabilities are embedded within the system to investigate the effectiveness of online treatment protocols. Throughout the development cycles of the system, we build an emergent design theory of scrutiny that applies a multi-layer protocol to support governance of privacy and accountability in sensitive online applications. The design goal is to balance stakeholder privacy protections with the need to provide for accountable interventions in critical and well-defined care situations. The research implications for the development and governance of online applications in numerous privacy-sensitive application areas are explore

Modelling and Analysis of E-Health Ecosystems: A Case Study of the United States

The United States (US), a world leader in medical technology, ironically also happens to be home to one of the least efficient healthcare systems in the world. The country’s mammoth, unsustainable spending on healthcare has triggered several key healthcare reforms to put the country’s healthcare system on the path for a major overhaul. One such reform was the HITECH Act of 2009 which made provision for incentives for adoption of Electronic Health Records by physicians and hospitals. The ultimate goal of this reform was to forge connectivity across the country’s fragmented healthcare system in the hope that it would lead to efficiency and consequently, a drop in the country’s healthcare expenditure. Although the reform no doubt spurred EHR adoption, its intended goal of connectivity has not been fully realized. A set of critical success factors has been proposed to overcome these issues and make the ecosystem both patient-centric and sustainable

Why Do Evaluations of eHealth Programs Fail? An Alternative Set of Guiding Principles

Trisha Greenhalgh and Jill Russell discuss the relative merits of “scientific” and “social practice” approaches to evaluation and argue that eHealth evaluation is in need of a paradigm shift

Electronic health information exchange in underserved settings: examining initiatives in small physician practices & community health centers.

BackgroundHealth information exchange (HIE) is an important tool for improving efficiency and quality and is required for providers to meet Meaningful Use certification from the United States Centers for Medicare and Medicaid Services. However widespread adoption and use of HIE has been difficult to achieve, especially in settings such as smaller-sized physician practices and federally qualified health centers (FQHCs). We assess electronic data exchange activities and identify barriers and benefits to HIE participation in two underserved settings.MethodsWe conducted key-informant interviews with stakeholders at physician practices and health centers. Interviews were recorded, transcribed, and then coded in two waves: first using an open-coding approach and second using selective coding to identify themes that emerged across interviews, including barriers and facilitators to HIE adoption and use.ResultsWe interviewed 24 providers, administrators and office staff from 16 locations in two states. They identified barriers to HIE use at three levels-regional (e.g., lack of area-level exchanges; partner organizations), inter-organizational (e.g., strong relationships with exchange partners; achieving a critical mass of users), and intra-organizational (e.g., type of electronic medical record used; integration into organization's workflow). A major perceived benefit of HIE use was the improved care-coordination clinicians could provide to patients as a direct result of the HIE information. Utilization and perceived benefit of the exchange systems differed based on several practice- and clinic-level factors.ConclusionsThe adoption and use of HIE in underserved settings appears to be impeded by regional, inter-organizational, and intra-organizational factors and facilitated by perceived benefits largely at the intra-organizational level. Stakeholders should consider factors both internal and external to their organization, focusing efforts in changing modifiable factors and tailoring HIE efforts based on all three categories of factors. Collective action between organizations may be needed to address inter-organizational and regional barriers. In the interest of facilitating HIE adoption and use, the impact of interventions at various levels on improving the use of electronic health data exchange should be tested

Accountability in Health Systems and the Potential of mHealth

The rapid spread of information and communication technologies (ICTs) (and of mobile phones in particular) across low- and middle-income countries (LMICs) has generated considerable excitement in development circles regarding their potential to revolutionise service delivery in health systems. Broadly speaking, such innovations, widely referred to as mHealth, make possible new ways of collecting, collating and managing health and health service-related data, and novel means of communication between and among citizens, civil society, health service personnel and government actors. This can empower citizens to better understand, care and advocate for their own health; health workers to deliver improved services; and government actors to enforce or build health policies that uphold the health rights of all citizens, including poor and marginalised groups who are often systematically excluded from health systems. As mHealth is in its infancy, and most projects to date have been small in scale, this potential is still being tested. Furthermore, most research has focused on the extent to which mHealth has improved service delivery and/or health outcomes in the short term. There has been little explicit attention given to whether and how mHealth might improve accountability for public health services – that is, to what extent mHealth can enhance citizens’ abilities to demand improved services from providers and government in line with their rights, and/or augment the capacity and willingness of providers and government to respond to citizens’ needs and demands – both in the short and the long term. This Working Paper aims to begin to fill this gap by exploring literature on accountability in health systems and on mHealth and to build theoretical and empirical bridges between them. In so doing, we lay out a clearer understanding of the role that mHealth can play in accountability for public health services in LMICs, as well as its limitations. At the centre of this role is technology-facilitated information which, for instance, can help governments enforce and improve existing health policy, and which can assist citizens and civil society to communicate with each other to learn more about their rights, and to engage in data collection, monitoring and advocacy. Ultimately however, information, facilitated as it may be by mHealth, does not automatically lead to improved accountability. Different forms of health care come with different accountability challenges to which mHealth is only variably up to task. Furthermore, health systems, embedded as they are in diverse political, social and economic contexts, are extremely complex, and accountability requires far more than information. Thus, mHealth can serve as a tool for accountability, but is likely only able to make a difference in institutional systems that support accountability in other ways (both formal and informal) and in which political actors and health service providers are willing and able to change their behaviour.Future Health Systems Research Programme ConsortiumMaking All Voices CountUnited States Agency for International DevelopmentSwedish International Development Cooperation AgencyOmidyar NetworkUK Department for International DevelopmentEconomic and Social Research Counci

Models of patient enrolment

This Policy Issue Review is an overview of enrolment models relevant to Australian primary health care. A predetermined report structure was designed, reflecting the dimensions of the study questions, and searching was targeted, seeking information sources to answer specific, predetermined questions. Google, Google Scholar and Pub Med were used to locate information sources and supplemented by existing PHC RIS resources and bibliographic references

Understanding and Promoting Effective Engagement With Digital Behavior Change Interventions.

This is the author accepted manuscript. The final version is available from Elsevier via https://doi.org/10.1016/j.amepre.2016.06.015This paper is one in a series developed through a process of expert consensus to provide an overview of questions of current importance in research into engagement with digital behavior change interventions, identifying guidance based on research to date and priority topics for future research. The first part of this paper critically reflects on current approaches to conceptualizing and measuring engagement. Next, issues relevant to promoting effective engagement are discussed, including how best to tailor to individual needs and combine digital and human support. A key conclusion with regard to conceptualizing engagement is that it is important to understand the relationship between engagement with the digital intervention and the desired behavior change. This paper argues that it may be more valuable to establish and promote "effective engagement," rather than simply more engagement, with "effective engagement" defined empirically as sufficient engagement with the intervention to achieve intended outcomes. Appraisal of the value and limitations of methods of assessing different aspects of engagement highlights the need to identify valid and efficient combinations of measures to develop and test multidimensional models of engagement. The final section of the paper reflects on how interventions can be designed to fit the user and their specific needs and context. Despite many unresolved questions posed by novel and rapidly changing technologies, there is widespread consensus that successful intervention design demands a user-centered and iterative approach to development, using mixed methods and in-depth qualitative research to progressively refine the intervention to meet user requirements.This paper is one of the outputs of two workshops, one supported by the Medical Research Council (MRC)/National Institute for Health Research (NIHR) Methodology Research Programme (PI Susan Michie) and the Robert Wood Johnson Foundation (PI Kevin Patrick), and the other by the National Science Foundation (PI Donna Spruitj-Metz, proposal # 1539846)

Toward Integration of mHealth in Primary Care in the Netherlands: A Qualitative Analysis of Stakeholder Perspectives

Background: There is a growing need to structurally change the way chronic illness care is organized as health systems struggle to meet the demand for chronic care. mHealth technologies can alter traditional approaches to health care provision by stimulating self-management of chronically ill patients. The aim of this study was to understand the complex environment related to the introduction of mHealth solutions into primary care for chronic disease management while considering health system functioning and stakeholder views. Methods: A transdisciplinary approach was used informed by the Interactive Learning and Action (ILA) methodology. Exploratory interviews (n = 5) were held with representatives of stakeholder groups to identify and position key stakeholders. Subsequently, professionals and chronically ill patients were consulted separately to elaborate on the barriers and facilitators in integration, using semi-structured interviews (n = 17) and a focus group (n = 6). Follow-up interviews (n = 5) were conducted to discuss initial findings of the stakeholder analysis. Results: Most stakeholders, in particular primary care practitioners and patients, seem to have a supporting or mixed attitude toward integration of mHealth. On the other hand, several powerful stakeholders, including primary care information system developers and medical specialists are likely to show resistance or a lack of initiative toward mHealth integration. Main barriers to mHealth integration were a lack of interoperability with existing information systems; difficulties in financing mHealth implementation; and limited readiness in general practices to change. Potential enablers of integration included co-design of mHealth solutions and incentives for pioneers. Conclusion: Stakeholders acknowledge the benefits of integrating mHealth in primary care. However, important barriers perceived by end-users prevent them to fully adopt and use mHealth. This study shows that the complexity of introducing mHealth into primary care calls for strategies encouraging collaboration between multiple stakeholders to enhance successful implementation