Challenges of developing a digital scribe to reduce clinical documentation burden.

Clinicians spend a large amount of time on clinical documentation of patient encounters, often impacting quality of care and clinician satisfaction, and causing physician burnout. Advances in artificial intelligence (AI) and machine learning (ML) open the possibility of automating clinical documentation with digital scribes, using speech recognition to eliminate manual documentation by clinicians or medical scribes. However, developing a digital scribe is fraught with problems due to the complex nature of clinical environments and clinical conversations. This paper identifies and discusses major challenges associated with developing automated speech-based documentation in clinical settings: recording high-quality audio, converting audio to transcripts using speech recognition, inducing topic structure from conversation data, extracting medical concepts, generating clinically meaningful summaries of conversations, and obtaining clinical data for AI and ML algorithms

mHealth in Practice

This book is available as open access through the Bloomsbury Open Access programme and is available on www.bloomsburycollections.com. There has recently been an explosion of interest around the application of mobile communication technologies to support health initiatives in developing countries (mHealth). As a result, there is a need to promote and share rigorous research for better informed policy, programming, and investment. There are, however, few platforms for the exchange of information and proven practice between practitioners and researchers. The subtopic of prevention, well-being, and health promotion within mHealth is particularly ripe for deeper exploration. While many reports tout the potential of mobiles to influence behaviour change for health, there is limited knowledge about what works (and what does not work), and about how to evaluate current and future programs. This is a focused edited volume with contributions from leading researchers and practitioners to identify best practices in using mobile technologies to promote healthy behaviours (and reduce unhealthy ones) in resource-constrained settings with a special focus on developing countries. This topic is inherently interdisciplinary. Though the opportunities to leverage mobile phones for health are new, the challenges confronting researchers and practitioners are well-established and theoretically complex, with roots in decades of work on mediated behaviour change campaigns and theories

mHealth in Practice

This book is available as open access through the Bloomsbury Open Access programme and is available on www.bloomsburycollections.com. There has recently been an explosion of interest around the application of mobile communication technologies to support health initiatives in developing countries (mHealth). As a result, there is a need to promote and share rigorous research for better informed policy, programming, and investment. There are, however, few platforms for the exchange of information and proven practice between practitioners and researchers. The subtopic of prevention, well-being, and health promotion within mHealth is particularly ripe for deeper exploration. While many reports tout the potential of mobiles to influence behaviour change for health, there is limited knowledge about what works (and what does not work), and about how to evaluate current and future programs. This is a focused edited volume with contributions from leading researchers and practitioners to identify best practices in using mobile technologies to promote healthy behaviours (and reduce unhealthy ones) in resource-constrained settings with a special focus on developing countries. This topic is inherently interdisciplinary. Though the opportunities to leverage mobile phones for health are new, the challenges confronting researchers and practitioners are well-established and theoretically complex, with roots in decades of work on mediated behaviour change campaigns and theories

Development, evaluation and patient experiences of eHealth in the care of abdominal aortic aneurysm

Abdominal aortic aneurysm (AAA) is a weakening and widening of the abdominal aorta to a diameter of 30 mm or more. It is a fairly common condition among older men, and rarely occurs in women. The condition is generally asymptomatic with a slow expansion rate over time. However, AAA rupture is associated with a high mortality and immediate surgical intervention is required. Patients with larger AAA are offered surgical repair to prevent future rupture. Diagnosis, surveillance and surgical treatment impact patients’ wellbeing negatively, and previous studies have highlighted the need for adequate and timely information to prepare patients for the surgical care trajectory. However, patients’ learning needs and perceptions of methods for patient education had not been clarified. Furthermore, little was known about the utilization of modern technology for learning among patients with AAA. The overall aim of this thesis was to investigate the perceived need of learning and psychosocial support in patients with AAA, and evaluate methods to accommodate these needs in a clinical setting. The thesis comprises four scientific papers. Studies I and IV are qualitative interview studies, study II uses mixed methodology and study III is a randomized, controlled trial. Study I aimed to describe AAA patients’ perceived learning needs and explore their experience of different methods for patient education. Our results show that patients’ learning needs are not met by the health care staff, and that they therefore refer to other sources for information. Participants warranted continuous contact with a trusted person for follow-up and support. In study II, an eHealth tool was developed and validated for patients with AAA using a participatory design process. Patients, eHealth developers and health care staff were engaged in the design process, and readability analyses were performed. The final version of the eHealth tool was deemed accurate and relevant, and the language was perceived as understandable. However, the readability analyses produced readability scores exceeding the average literacy levels of older adults. Study III was a randomized, controlled trial with 120 patients scheduled for AAA repair. In the study, the eHealth tool and tailored psychosocial support was evaluated as an adjunct to standard care. The intervention was evaluated by repeated measurements with validated instruments (HADS and SF-12) to assess symptoms of anxiety and depression, and healthrelated quality of life. In the intervention group, 30 participants (50%) used the eHealth tool. App users were younger and had higher educational level than non-users. No significant difference was noted in anxiety mean score analyses between the whole intervention group and the control group. Those who utilized the complete intervention had markedly lower anxiety mean scores at the postoperative follow-up compared to the control group. Patients with low educational level had sustained high anxiety levels postoperatively. In study IV, a qualitative evaluation of the intervention by individual, in-depth interviews with 12 participants from the intervention group in study III was performed. When offered the eHealth tool, participants familiarity with modern technology was influential in their decision to engage in the tool. Those who were unfamiliar with this technology refrained from using the eHealth tool. Furthermore, their mental state at baseline, one week prior to surgery, hindered them to partake in the intervention. The implication and relevance of psychosocial support was not evident to the participants during the perioperative phase but could be understood in retrospect. Adjustment of information to the patient’s mental state and learning needs was believed to quench anxiety. In summary, this thesis provides insight into patients’ perspective on learning and psychosocial support in the AAA care trajectory. It also elucidates the feasibility and effects of an eHealth intervention to decrease anxiety. The studies also shed light on vulnerable groups which risk negative consequences of the digitalization of healthcare, such as those with low educational level and older patients. For successful implementation of eHealth services, future research and quality improvement initiatives should include targeted initiatives to strengthen these groups

MOTIBOT: IL COACH VIRTUALE PER INTERVENTI DI COPING SANO PER ADULTI CON DIABETE MELLITO

Il diabete mellito (DM) è una malattia metabolica autogestita, in cui se l'individuo non è motivato o non è in grado di gestire regolarmente il proprio DM, i risultati medici e psicosociali saranno scarsi. Il DM è più di una condizione di salute fisica: ha impatti comportamentali, fisiologici, psicologici e sociali, e richiede alti livelli di motivazione per seguire le raccomandazioni cliniche e adottare comportamenti sani. A questo scopo, le linee guida dell'American Association of Diabetes Educators (AADE) hanno introdotto il costrutto di coping sano per identificare le strategie di coping per ridurre i sintomi di depressione, ansia, stress e disagio emotivo legato al diabete, migliorando anche il benessere degli adulti con DM. In questo contesto, i Virtual Coaches (VCs) sono diventati un importante risorsa nel supporto e nella gestione delle barriere comuni nel contesto dell'aderenza ai comportamenti sani tra gli adulti con DM. Tuttavia, pochi sono i VC specificamente sviluppati a fornire supporto psicosociale agli adulti con DM. L'obiettivo principale della presente tesi è stato, infatti, lo sviluppo di un VC per fornire supporto psicosociale agli adulti con DM di tipo 1 (T1DM) o DM di tipo 2 (T2DM). Più specificamente, questo VC mirava a motivare gli adulti con DM a ridurre sintomi di depressione, ansia, stress, il disagio emotivo legato al diabete, e a migliorare il loro benessere, incoraggiandoli ad acquisire e coltivare strategie di coping psicosociale sano. Queste abilità di coping facevano riferimento alle linee guida dell'AADE e quindi alla pratica della meditazione; in questo studio è stata, infatti, applicata la Mindfulness-Based Cognitive Therapy. La presente tesi è articolata secondo tre studi. Lo studio 1 mirava a fornire prove meta-analitiche sull'efficacia degli interventi eHealth nel sostenere il benessere psicosociale e medico degli adulti con T1DM o T2DM. Lo studio 2 mirava a testare il prototipo del VC simulato, cioè Wizard of Oz (WOZ), attraverso la piattaforma di messaggistica WhatsApp per 6 settimane, con due sessioni a settimana. In particolare, questo studio ha indagato l'accettabilità preliminare e la User Experience (UX) del protocollo di intervento, che sarà incorporato nel futuro VC. Infatti, il metodo di progettazione è stato duplice. Da un lato, è stato applicato il metodo WOZ, in cui gli studenti di psicologia credevano di interagire con un VC; invece, stavano comunicando con un essere umano. Dall'altro lato, è stato utilizzato il modello Obesity-Related Behavioural Intervention Trials (ORBIT), in particolare le sue prime fasi, poiché favorisce un approccio iterativo. Lo studio 3, seguendo le fasi successive del modello ORBIT, mirava a valutare l'efficacia preliminare del VC, chiamato Motibot - abbreviazione di Motivational bot - sviluppato attraverso una combinazione di Natural Language Processing (NLU) e regole pre-strutturate. Un totale di 13 adulti italiani con DM (Mage = 30.08, SD = 10.61) hanno interagito con Motibot attraverso l'applicazione di messaggistica Telegram per 12 sessioni, in cui il paziente poteva pianificare l'appuntamento secondo le sue esigenze: ha interagito con Motibot una o due sessioni a settimana. Motibot è stato percepito come motivante, incoraggiante e capace di innescare un'auto-riflessione sulle proprie emozioni: gli utenti e i pazienti hanno riferito di aver avuto un'esperienza molto positiva con Motibot. Motibot può essere uno strumento utile per fornire supporto psicosociale agli adulti con DM; potrebbe essere prescritto dal diabetologo come misura preventiva per il benessere del paziente e/o quando il paziente presenta sintomi psicosociali lievi e moderati. L'approccio di design centrato sull'utente e il concetto di bidirezionalità tra fattori psicosociali e medici sono punti chiave nello sviluppo di un trattamento digitale personalizzato.Diabetes Mellitus (DM) is a self-managed, metabolic disease, in which if the individual is unwilling, unmotivated, or unable to regularly self-manage their DM, the medical and psychosocial outcomes will be poor. Indeed, DM is more than a physical health condition: it has behavioural, physiological, psychological, and social impacts, and demands high levels of motivation in order to follow the clinical recommendations and adopt healthy behaviours. To this end, the American Association of Diabetes Educators (AADE) guidelines introduced the healthy coping construct to identify healthy coping strategies for reducing symptoms of depression, anxiety, stress, and diabetes-related emotional distress while also improving the well-being of adults with DM. Virtual Coaches (VCs) have recently become more prevalent in the support and management of common barriers in the context of adherence to healthy behaviours among adults with DM, in particular those regarding medical and physical behaviours. However, few VCs were found to be specifically aimed at providing psychosocial support to adults with DM. The main aim of the present thesis was, indeed, the development and implementation of a VC for the provision of psychosocial support to adults with Type 1 (T1DM) or Type 2 DM (T2DM). More specifically, this VC aimed at motivating adults with DM to reduce depression, anxiety, perceived stress symptoms, diabetes-related emotional distress, and improve their well-being, by encouraging them to acquire and cultivate psychosocial healthy coping strategies. These coping skills referred to the AADE guidelines and thus to practicing meditation; in this study, the Mindfulness-Based Cognitive Therapy has been applied. The present thesis is articulated according to three studies. Study 1 aimed at providing meta-analytical evidence on the efficacy of eHealth interventions in supporting the psychosocial and medical well-being of adults with T1DM or T2DM. Study 2 aimed at testing the prototype of the simulated VC, namely Wizard of Oz (WOZ), via the WhatsApp messaging platform for 6-week, with two sessions per week. In particular, this study investigated the preliminary acceptability and the User Experience (UX) of the intervention protocol, which will be incorporated into the future VC. Indeed, the design method was two-fold. On the one hand, the WOZ method was applied, in which psychology students believed that they were interacting with a VC, instead they were communicating with a human being. On the other hand, the Obesity-Related Behavioural Intervention Trials (ORBIT) model was used, particularly its early phases, since it favours an iterative approach. Study 3, following the next phases of the ORBIT model, aimed at assessing the preliminary efficacy of the VC, called Motibot—the abbreviation for Motivational bot—developed through a combination of Natural Language Processing (NLU) and hand-crafted rules. A total of 13 Italian adults with DM (Mage = 30.08, SD = 10.61) interacted with Motibot through the Telegram messaging application for 12 sessions, in which the patient planned the appointment according to his/her needs: he/she interacted with Motibot one or two sessions per week. Therefore, Motibot was perceived as motivating, encouraging and able to trigger self-reflection on one’s own emotions: users and patients reported having a very positive experience with Motibot. Motibot, thus, can be a useful tool to provide psychosocial support to adults with DM; as such, it might be prescribed by the diabetologist as a preventive measure for the patient’s well-being and/or when the patient presents mild and moderate psychosocial symptoms. The user-centred design approach and the concept of bidirectionality between psychosocial and medical factors are key points in the development of a personalised treatment within the digital intervention

Design Strategy for Integrated Personal Health Records: Improving the User Experience of Digital Healthcare and Wellbeing

This dissertation addresses the timely problem of designing Integrated Personal Health Records (PHR). The goal is to provide citizens with digital user experiences, sustainable and flexible enough, for gaining control over their personal health information in a seamless way. Most importantly, so that people are able to reflect and act upon their selfknowledge, towards the accomplishment of their good health and wellbeing. Towards this end, the Integrated PHR as an emerging model in the field of Health IT, was the framework that set this research forward on exploring how communication and collaboration between patients and providers can be improved, which naturally impacts the field of HCI. Acknowledging that today patients are the ones who own all that is recorded about their health data, this new model was object of a design strategy that shaped the results presented in this dissertation. These have showed how patients can have more control of their health over time, through a patient-centered, organic system, which has the ability of combining multiple sources of data both from patient and provider side. As this new type of PHR fosters the creation of integrated networks, this milestone was achieved in this research by interacting with cross-channel user experiences that took part of nationwide healthcare ecosystems. The work presented herein, has demonstrated through the analysis and development of two use cases in cooperation with organizations connected to the Portuguese Ministry of Health, how an Integrated PHR can be a powerful personal tool, to be used by the citizen with undeniable value to the demands of an aging society. The use cases structured the thesis into two parts. The first part in collaboration with the Portuguese National Patient Portal, combines an Integrated PHR and incorporates the Portuguese Data Sharing Platform (PDS), which can be used by any Portuguese citizen. This use case study led to a proposal of the portal by also creating a foundational model for designing Integrated PHRs. The second part in collaboration with the Portuguese National Senior Telehealth Program (Saúde 24 Sénior), led to another proposal for an Integrated PHR, applying the outcomes from Part 1 and the requirements that derived from the findings explored in this second use case study. The proposed solution, has the potential to be used by the Portuguese senior community in the scope of home assistive care. Both proposals applied a user experience design methodology and included the development of two prototypes. The engagement of the stakeholders during the two case studies was accomplished with participatory design methods and followed a multidisciplinary approach to create solutions that would meet the human, politics and behavior interdependencies that were inherent to the process of working with large healthcare organizations. The provided contributions from this thesis intent to be part of a transition process that is changing the behavior of the healthcare sector, which is increasingly moving towards the improvement of the patient-provider relationship, patient engagement, collaborative care and positive computing, where digital technologies play a key role