Digital Health Framework Research Articles

Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study.

Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands-requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, "aggregate reporting system" was the system most frequently reported as being in place (n=116, 98.3%), while "reminder system" was the least (n=77, 89%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6%) of countries reported establishing at least one new system, ranging from 72% (n=42) in high-income countries (HICs) to 62% (n=16) in low-income countries. Concurrently, 55.3% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62% (n=36) of HICs reporting this compared to about 53% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance.

A pilot acceptability evaluation of MomMind: A digital health intervention for Peripartum Depression prevention and management focused on health disparities.

Health disparities cause significant strain on the wellbeing of individuals and society. In this study, we focus on the health disparities present in the condition of Peripartum Depression (PPD), a significant public health issue. While PPD can be managed through therapy and medication, many women do not receive adequate PPD treatment due to issues of social stigma and limited access to healthcare resources. Digital health technologies can offer practical tools for PPD management. However, current solutions do not integrate behavior theory and are rarely responsive to the transient information needs stemming from women's unique sociodemographic, clinical and psychosocial profiles. We describe a pilot acceptability evaluation of MomMind, a health-disparities focused digital health intervention for the prevention and management of PPD. A crucial MomMind advantage is its basis on behavior change theory and patient engagement as enabled by the Digilego digital health framework. Following an internal usability evaluation, MomMind was evaluated by patients through cross-sectional acceptability surveys, pre-and-post PPD health literacy surveys, and interviews. Survey respondents included n = 30 peripartum women, of whom n = 16 (53.3%) were Hispanic and n = 17 (56.7%) of low-income. Survey results show that 96.6% of participants (n = 29) approved and welcomed MomMind, and 90% (n = 27) found MomMind to be an appealing intervention. Additionally, significant improvements (p< = 0.05) were observed in participants' PPD health literacy, specifically their ability to recognize PPD symptoms and knowledge of how to seek PPD information. Interview main themes include MomMind's straightforward design and influence of others (family members, providers) on use of technology. Results suggest that enhancement of a digital health framework with health literacy theory can support production of digital health solutions acceptable to vulnerable populations. This study incorporates existing theories from different disciplines into a unified approach for mitigating health disparities, and produced a novel solution for promotion of health in a vulnerable population.

Ethical Considerations and Checklist for Affective Research With Wearables

As the popularity of wearables increases, so does their utility for studying emotions. Using new technologies points to several ethical challenges to be considered to improve research designs. There are several ethical recommendations for utilizing wearables to study human emotions, but they focus on emotion recognition systems applications rather than research design and implementation. To address this gap, we have developed a perspective on wearables, especially in daily life, adapting the ReCODE Health - Digital Health Framework and companion checklist. Therefore, our framework consists of four domains: (1) participation experience, (2) privacy, (3) data management, and (4) access and usability. We identified 33 primary risks of using wearables to study emotions, including research-related negative emotions, collecting, processing, storing, sharing personal and biological information, commercial technology validity and reliability, and exclusivity issues. We also proposed possible strategies for minimizing risks. We consulted the new ethical guidelines with members of ethics committees and relevant researchers. The judges ( <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">N</i> = 26) positively rated our solutions and provided useful feedback that helped us refine our guidance. Finally, we summarized our proposals with a checklist for researchers' convenience. Our guidelines contribute to future research by providing improved protection of participants' and scientists' interests.

A Holistic Digital Health Framework to Support Health Prevention Strategies in the First 1000 Days (Preprint)

A Holistic Digital Health Framework to Support Health Prevention Strategies in the First 1000 Days (Preprint)

How Participatory Health Informatics Catalyzes One Digital Health.

To identify links between Participatory Health Informatics (PHI) and the One Digital Health framework (ODH) and to show how PHI could be used as a catalyst or contributor to ODH. We have analyzed the addressed topics within the ODH framework in previous IMIA Yearbook contributions from our working group during the last 10 years. We have matched main themes with the ODH's framework three perspectives (individual health and wellbeing, population and society, and ecosystem). PHI catalysts ODH individual health and wellbeing perspective by providing a more comprehensive view on human health, attitudes, and relations between human health and animal health. Integration of specific behavior change techniques or gamification strategies in digital solutions are effective to change behaviors which address the P5 paradigm. PHI supports the population and society perspective through the engagement of the various stakeholders in healthcare. At the same time, PHI might increase a risk for health inequities due to technologies inaccessible to all equally and challenges associated with this. PHI is a catalyst for the ecosystem perspective by contributing data into the digital health data ecosystem allowing for analysis of interrelations between the various data which in turn might provide links among all components of the healthcare ecosystem. Our results suggest that PHI can and will involve topics relating to ODH. As the ODH concept crystalizes and becomes increasingly influential, its themes will permeate and become embedded in PHI even more. We look forward to these developments and co-evolution of the two frameworks.

Unlocking the eHealth professionals’ career pathways: A case of Gulf Cooperation Council countries

Unlocking the eHealth professionals’ career pathways: A case of Gulf Cooperation Council countries

FAIR Equivalency in Indonesia's Digital Health Framework

AbstractThe objective of this study was to assess the regulatory framework for health data in Indonesia in order to understand the policy context and explore the possibility of expanding the adoption and implementation of the FAIR Guidelines, which state that data should be Findable, Accessible, Interoperable and Reusable (FAIR), in Indonesia. Although the FAIR Guidelines were not explicitly mentioned in any of the policy documents relevant to the Indonesian digital health sector, six out of the eight documents analysed contained FAIR Equivalent principles. In particular, Indonesia's Population Identification Number (NIK) has the potential, as a unique identifier, to support the integration and interoperability (findability) of data, which is crucial to all other aspects of the FAIR Guidelines. There is also a plan to build standards and protocols into the implementation of information systems in each ministry and government agency to improve data accessibility (accessibility), the integration of the various information systems is planned/ongoing (interoperability), and the need for a standardised arrangement for health information systems related to health data following the community standard is recognised (reusability). The documents at the core of Indonesia's digital health/eHealth policy have the highest FAIR Equivalency Score (FE-Score), showing some degree of alignment between the Indonesian digital health implementation vision and the FAIR Guidelines. This indicates that Indonesia's digital health sector is open to using the FAIR Guidelines.

One Digital Health Is FAIR.

The One Digital Health framework aims at transforming future health ecosystems and guiding the implementation of a digital technologies-based systemic approach to caring for humans' and animals' health in a managed surrounding environment. To integrate and to use the data generated by the ODH data sources, "FAIRness" stands as a prerequisite for proper data management and stewardship.

Digital Health Services among Patients with Diabetes during the COVID-19 Pandemic: A Scoping Review.

Background and Aims:COVID-19 pandemic causes massive disruption of the global health system. The diabetic patients are the vulnerable parts population who are predicted to have a significant issue during the pandemic regarding the conventional type of consultation by face-to-face which may result in the higher risk of COVID-19 exposure. This study aims to observe the use of digital health services for diabetes management during COVID-19 pandemic.Methods:A scoping review was conducted in PubMed, ScienceDirect, and Google Scholar during August until September 2020. The keywords that are used on the searching process are diabetes AND digital service OR telemedicine OR technology AND COVID-19. The criteria included the selection of scientific publication as an original research and reviews.Results:All published articles were gathered from 3 search engines; PubMed, Science Direct, and Google Scholar. The discussion explicates the practical considerations that are in accordance with the current condition of each country. In order to do so, the evidence is classified based on the level of global digital health framework in the developed and developing countries. It was found that the minimal level of digital health that connects diabetes patients with healthcare providers was at level 2, which is by using the video mode. The most advanced is at level 3B, which is applied by using the CGM devices, which provide active monitoring, diagnosis, and treatment based on timely clinical judgment.Conclusion:It is feasible to utilize the digital health service during the COVID-19. This review is projected to be beneficial for the patient and health care providers to select the most feasible approach of digital health that merits the contextual resource.

A Digitally Competent Health Workforce: Scoping Review of Educational Frameworks

BackgroundDigital health technologies can be key to improving health outcomes, provided health care workers are adequately trained to use these technologies. There have been efforts to identify digital competencies for different health care worker groups; however, an overview of these efforts has yet to be consolidated and analyzed.ObjectiveThe review aims to identify and study existing digital health competency frameworks for health care workers and provide recommendations for future digital health training initiatives and framework development.MethodsA literature search was performed to collate digital health competency frameworks published from 2000. A total of 6 databases including gray literature sources such as OpenGrey, ResearchGate, Google Scholar, Google, and websites of relevant associations were searched in November 2019. Screening and data extraction were performed in parallel by the reviewers. The included evidence is narratively described in terms of characteristics, evolution, and structural composition of frameworks. A thematic analysis was also performed to identify common themes across the included frameworks.ResultsIn total, 30 frameworks were included in this review, a majority of which aimed at nurses, originated from high-income countries, were published since 2016, and were developed via literature reviews, followed by expert consultations. The thematic analysis uncovered 28 digital health competency domains across the included frameworks. The most prevalent domains pertained to basic information technology literacy, health information management, digital communication, ethical, legal, or regulatory requirements, and data privacy and security. The Health Information Technology Competencies framework was found to be the most comprehensive framework, as it presented 21 out of the 28 identified domains, had the highest number of competencies, and targeted a wide variety of health care workers.ConclusionsDigital health training initiatives should focus on competencies relevant to a particular health care worker group, role, level of seniority, and setting. The findings from this review can inform and guide digital health training initiatives. The most prevalent competency domains identified represent essential interprofessional competencies to be incorporated into health care workers’ training. Digital health frameworks should be regularly updated with novel digital health technologies, be applicable to low- and middle-income countries, and include overlooked health care worker groups such as allied health professionals.

Digital health in a social health insurance system: new emergent market powers in Germany

Abstract Background This presentation analyses the dynamics of digital health from a governance perspective. It aims to explore the driving forces for the implementation of digital health in Germany. Germany is chosen as a case study of a social health insurance system, which is based on joint self-governance of sickness funds and providers, and strong corporatist power of the medical profession. Methods A qualitative explorative approach is applied, drawing on document analysis and other secondary sources. The research is based on a governance approach adapted from Glassman and Buse's model of public health policy reform. Results The WHO Global Strategy for Digital Health 2020-2024 serves as a key international policy framework. However, the analysis reveals firstly that implementation is shaped by national healthcare systems and may create different results; secondly, the global strategy provides only a weak guidance on the national level. In Germany, strong corporatism and weak state intervention is supporting market forces and private actors. Poorly developed digital health governance has opened a window of opportunity for market powers as driving forces for digital health, thus creating new risks of social inequalities. There is an urgent need for public health to step up advocacy for health literacy to improve the accessibility to digital health for all citizens. Conclusions National healthcare systems strongly shape the implementation of international digital health frameworks, which makes digital health an issue of governance. Stronger public health orientation and a people-centred approach are needed to counteract new emergent social inequalities created by market power. Key messages Market power and private actors are important drivers of digital health in the German healthcare system. Social health insurance systems may be vulnerable to market powers and new digital health inequalities.

Biomedical research in a Digital Health Framework.

This article describes a Digital Health Framework (DHF), benefitting from the lessons learnt during the three-year life span of the FP7 Synergy-COPD project. The DHF aims to embrace the emerging requirements - data and tools - of applying systems medicine into healthcare with a three-tier strategy articulating formal healthcare, informal care and biomedical research. Accordingly, it has been constructed based on three key building blocks, namely, novel integrated care services with the support of information and communication technologies, a personal health folder (PHF) and a biomedical research environment (DHF-research). Details on the functional requirements and necessary components of the DHF-research are extensively presented. Finally, the specifics of the building blocks strategy for deployment of the DHF, as well as the steps toward adoption are analyzed. The proposed architectural solutions and implementation steps constitute a pivotal strategy to foster and enable 4P medicine (Predictive, Preventive, Personalized and Participatory) in practice and should provide a head start to any community and institution currently considering to implement a biomedical research platform.

Predictive medicine: outcomes, challenges and opportunities in the Synergy-COPD project.

BackgroundChronic Obstructive Pulmonary Disease (COPD) is a major challenge for healthcare. Heterogeneities in clinical manifestations and in disease progression are relevant traits in COPD with impact on patient management and prognosis. It is hypothesized that COPD heterogeneity results from the interplay of mechanisms governing three conceptually different phenomena: 1) pulmonary disease, 2) systemic effects of COPD and 3) co-morbidity clustering.ObjectivesTo assess the potential of systems medicine to better understand non-pulmonary determinants of COPD heterogeneity. To transfer acquired knowledge to healthcare enhancing subject-specific health risk assessment and stratification to improve management of chronic patients.MethodUnderlying mechanisms of skeletal muscle dysfunction and of co-morbidity clustering in COPD patients were explored with strategies combining deterministic modelling and network medicine analyses using the Biobridge dataset. An independent data driven analysis of co-morbidity clustering examining associated genes and pathways was done (ICD9-CM data from Medicare, 13 million people). A targeted network analysis using the two studies: skeletal muscle dysfunction and co-morbidity clustering explored shared pathways between them.Results(1) Evidence of abnormal regulation of pivotal skeletal muscle biological pathways and increased risk for co-morbidity clustering was observed in COPD; (2) shared abnormal pathway regulation between skeletal muscle dysfunction and co-morbidity clustering; and, (3) technological achievements of the projects were: (i) COPD Knowledge Base; (ii) novel modelling approaches; (iii) Simulation Environment; and, (iv) three layers of Clinical Decision Support Systems.ConclusionsThe project demonstrated the high potential of a systems medicine approach to address COPD heterogeneity. Limiting factors for the project development were identified. They were relevant to shape strategies fostering 4P Medicine for chronic patients. The concept of Digital Health Framework and the proposed roadmap for its deployment constituted relevant project outcomes.