Digital Health Innovation Research Articles

Incorporating new ways of doing by learning from everyday experiences and interactions using a multifactorial mHealth app.

Digital health innovations can support the prevention and management of risk factors for cardiovascular diseases, such as stroke. However, little is known about people's everyday experiences of digitally augmented stroke-prevention programmes combining onsite group sessions including peers and healthcare professionals with interaction and support from a multifactorial mHealth app. The aim of this study was to explore how people with stroke risk experienced interaction with a multifactorial mHealth app as support in the make my day stroke-prevention programme. Repeated interviews and observations with 12 adults with moderate to high stroke risk were analysed using a constant comparative method informed by constructive grounded theory. Incorporating new ways of doing into everyday life involves a process through which participants learn from both being and doing in different environments (e.g., digital, physical and social). Digital self-monitoring combined with seemingly trivial everyday experiences played central roles in the process of increasing awareness of health and stroke risks, and providing tools to support increased self-reflection on everyday behaviours. Adoption of positive health behaviours in everyday life was supported or hindered by how easy to use and personally relevant the mHealth app was perceived to be. An experience-based group programme together with a personally relevant multifactorial mHealth app can be supportive in stroke prevention to increase general health literacy and stroke risk literacy, and promote the incorporation of new ways of doing in everyday life. Routines of doing digital self-monitoring and health-promoting activities were however strongly influenced by different environments in which choices are presented. It is therefore important to explore how both self-monitoring and health-promoting activities can be incorporated into everyday routines for different individuals. Research should also explore how personally relevant mHealth can be developed and integrated into prevention practices in primary healthcare.

Moving from development to implementation of digital innovations within the NHS: myHealthE, a remote monitoring system for tracking patient outcomes in child and adolescent mental health services.

This paper aims to report our experience of developing, implementing, and evaluating myHealthE (MHE), a digital innovation for Child and Adolescents Mental Health Services (CAMHS), which automates the remote collection and reporting of Patient-Reported Outcome Measures (PROMs) into National Health Services (NHS) electronic healthcare records. We describe the logistical and governance issues encountered in developing the MHE interface with patient-identifiable information, and the steps taken to overcome these development barriers. We describe the application's architecture and hosting environment to enable its operability within the NHS, as well as the capabilities needed within the technical team to bridge the gap between academic development and NHS operational teams. We present evidence on the feasibility and acceptability of this system within clinical services and the process of iterative development, highlighting additional functions that were incorporated to increase system utility. This article provides a framework with which to plan, develop, and implement automated PROM collection from remote devices back to NHS infrastructure. The challenges and solutions described in this paper will be pertinent to other digital health innovation researchers aspiring to deploy interoperable systems within NHS clinical systems.

Toward a meta-vaccine future: Promoting vaccine confidence in the metaverse.

The metaverse has a promising role to serve as a global platform and tackle one of the most intractable public health challenges; vaccine hesitancy. Active efforts in this field can enhance vaccine acceptance thus leading to better community health protection. By embracing digital health innovations, the metaverse potentially creates an interactive environment for interdisciplinary collaborations that can foster novel approaches in tackling vaccine hesitancy as well as future pandemics. This paper aims to highlight the unique areas where the metaverse can enhance vaccination confidence, educate about vaccine working principles, and offer collaborative healthcare initiatives in this virtual community.

Innovative blockchain-based Agent digital passport solution

In this paper, we mean by digital health passport a digital passport or immunity passport that stores information about an individual's personal data, health status, travel history, health conditions, and medical and drug records. The proposed innovative scheme can ease travel, ensure free movement, and minimize economic damages. However, protecting personal and digital health passport information during a crisis is challenging. Therefore, this paper aims to propose an agent-based secure decentralized innovative digital health passport protocol that is interoperable, fault-tolerant, and compatible with privacy standards. The proposed solution is known as Secure Mobile Digital Passport Agent (SMDPA), uses: (1) Private Set Intersection (PSI) to (a) protect Digital Health Passport Information (DHPA) against surveillance, especially during the crisis, (b) generate Bit Passing Coin (BPC); (2) blockchain to store serialized SMDPAs copies (3) mobile agent to disseminate DHPA autonomously; (4) Location and time attributes for data minimization. We prototype the proposed solution using the JADE agent framework. The performance measurements show that the result is acceptable.

Co-design of digital health interventions with young people: A scoping review.

Innovative health promotion strategies are crucial for enhancing global quality of life and curbing premature deaths. Digital health promotion is particularly impactful for young individuals often using internet-connected devices. Collaborative methodologies in digital intervention research offer insights into supporting youth during key life stages, such as adolescence. This review sought to examine the literature on digital health interventions for youth co-designed via participatory frameworks. Following the Joanna Briggs Institute Manual and an adapted Arksey & O'Malley's 6-stage framework, this review utilised the PRISMA-ScR checklist for structured reporting. Peer-reviewed research where young individuals (15-35 years) contributed to digital health intervention design was analysed. Systematic synthesis adhered to Braun & Clarke's Thematic Analysis Guidelines, mapping data to research queries and thematic framework. Eighteen articles were systematically synthesised, revealing seven main themes: digital tool, inquiry field, report aim, participatory activities, intervention attributes and behavioural change support. Seventeen distinctive digital health interventions were assessed, mostly within risk mitigation and mental health domains. Predominantly, interventions were web-based, with mental wellness websites emerging as the prevalent tool. User experience testing stood out as the primary reported outcome. Several innovative digital health interventions targeting youth have been identified. Platforms including social media, specialised apps, websites and video games are instrumental for health advice and clinical support dissemination, overcoming access and cost barriers. Participatory techniques are integral for the efficacy of digital health resources, encompassing youth aspirations and anticipations. Continued efforts will enrich comprehension of optimal practices in digital health promotion and intervention formulation.

Navigating the Systemic Conditions of a Digital Health Ecosystem in Alberta, Canada: Embedded Case Study.

Digital health promises numerous value-creating outcomes. These include improved health, reduced costs, and the creation of lucrative markets, which, in turn, provide high-quality employment, productivity growth, and a climate that attracts investment. For this value creation and capture, the activities of a diverse set of stakeholders within a digital health ecosystem require coordination. However, the antecedents of the coordination needed for an effective digital health ecosystem are not well understood. The purpose of this study was to investigate the systemic conditions of the digital health ecosystem in Alberta, Canada, as critical antecedents to ecosystem coordination from the perspective of the authors as applicants to an innovative digital health funding program embedded within the larger digital health ecosystem of innovators or entrepreneurs, health system leaders, support partners, and funders. We employed a qualitative embedded case study of the systemic conditions within the digital health ecosystem in Alberta, Canada (main case) using semistructured interviews with 36 stakeholders representing innovators or entrepreneurs, health system leaders, support partners, and funders (subcases). The interviews were conducted over a 2-month period between May 26 and July 22, 2021. Data were coded for key themes and synthesized around 5 propositions developed from academic publications and policy reports. The findings indicated varying levels of support for each proposition, with moderate support for accessing real problems, data, training, and space for evaluations. However, the most fundamental gap appears to be in ecosystem navigation, in particular, the absence of intermediaries (eg, individuals, organizations, and technology) to provide guidance on the available support services and dependencies among the various ecosystem actors and programs. Navigating the systemic conditions of the digital health ecosystem is extremely challenging for entrepreneurs, especially those without prior health care experience, and this remains an issue even for those with such experience. Policy interventions aimed at increasing collaboration among ecosystem support providers, along with tools and incentives to ensure coordination, are essential as the ecosystem and those dependent on it grow.

MT12 A Targeted Literature Review on Digital Health Innovation (DHI) in Asia Pacific (APAC) Region

DHI is a broad, multidisciplinary concept that applies digital transformation to the healthcare field. We aimed to review the implementation of DHI in APAC region through a targeted literature search.

Health Techequity: Opportunities for Digital Health Innovations to Improve Equity and Diversity in Cardiovascular Care.

In this review, we define health equity, disparities, and social determinants of health; the different components of digital health; the barriers to digital health equity; and cardiovascular digital health trials and possible solutions to improve health equity through digital health. Digital health interventions show incredible potential to improve cardiovascular diseases by obtaining longitudinal, continuous, and actionable patient data; increasing access to care; and by decreasing delivery barriers and cost. However, certain populations have experienced decreased access to digital health innovations and decreased representation in cardiovascular digital health trials. Special efforts will need to be made to expand access to the different elements of digital health, ensuring that the digital divide does not exacerbate health disparities. As the expansion of digital health technologies continues, it is vital to increase representation of minoritized groups in all stages of the process: product development (needs findings and screening, concept generation, product creation, and testing), clinical research (pilot studies, feasibility studies, and randomized control trials), and finally health services deployment.

Recommendations for Successful Implementation of the Use of Vocal Biomarkers for Remote Monitoring of COVID-19 and Long COVID in Clinical Practice and Research.

The COVID-19 pandemic accelerated the use of remote patient monitoring in clinical practice or research for safety and emergency reasons, justifying the need for innovative digital health solutions to monitor key parameters or symptoms related to COVID-19 or Long COVID. The use of voice-based technologies, and in particular vocal biomarkers, is a promising approach, voice being a rich, easy-to-collect medium with numerous potential applications for health care, from diagnosis to monitoring. In this viewpoint, we provide an overview of the potential benefits and limitations of using voice to monitor COVID-19, Long COVID, and related symptoms. We then describe an optimal pipeline to bring a vocal biomarker candidate from research to clinical practice and discuss recommendations to achieve such a clinical implementation successfully.

Advancing Healthcare Excellence: A Critical Review of Developing and Delivering Top-Tier Services in Medical Clinics

In an era where healthcare expectations are continuously evolving, medical clinics are at the forefront of redefining patient care standards. This critical review examines the imperative of developing and delivering top-tier services within medical clinics, amidst the challenges of technological integration, financial constraints, and the diverse needs of the patient population. By dissecting the current landscape of medical clinic services, this article highlights the gaps between existing service delivery and patient expectations. It further explores the multifaceted challenges clinics encounter, from staffing and budgeting to regulatory compliance. Strategic approaches for service enhancement are discussed, emphasizing patient-centered care, technological adoption, staff development, and quality control measures. Through analysis of successful case studies, this review extracts practical insights for clinics striving towards healthcare excellence. Looking forward, the article considers the potential impacts of digital health innovations and the importance of supportive policy frameworks in shaping the future of medical clinic services. This comprehensive examination not only sheds light on the path to elevated healthcare services but also underscores the ongoing commitment required to achieve and sustain healthcare excellence in medical clinics

The Role of Academic Health Systems in Leading the "Third Wave" of Digital Health Innovation.

Investors, entrepreneurs, health care pundits, and venture capital firms all agree that the health care sector is awaiting a digital revolution. Steven Case, in 2016, predicted a "third wave" of innovation that would leverage big data, artificial intelligence, and machine learning to transform medicine and finally achieve reduced costs, improved efficiency, and better patient outcomes. Academic medical centers (AMCs) have the infrastructure and resources needed by digital health intrapreneurs and entrepreneurs to innovate, iterate, and optimize technology solutions for the major pain points of modern medicine. With large unique patient data sets, strong research programs, and subject matter experts, AMCs have the ability to assess, optimize, and integrate new digital health tools with feedback at the point of care and research-based clinical validation. As AMCs begin to explore digital health solutions, they must decide between forming internal teams to develop these innovations or collaborating with external companies. Although each has its drawbacks and benefits, AMCs can both benefit from and drive forward the digital health innovations that will result from this journey. This viewpoint will provide an explanation as to why AMCs are ideal incubators for digital health solutions and describe what these organizations will need to be successful in leading this "third wave" of innovation.

MyStay – Development of nurse-facilitated condition-specific multimedia resources to facilitate patient participation in postoperative care

Improved postoperative outcomes and the global drive toward the provision of patient-centred care underpins efforts to enhance the nature and capacity of patient participation in acute postoperative hospital care. In this paper, we describe the design, framework and processes used to develop a modular, procedure-specific, digital health intervention platform aimed at improving the patient experience and patient participation in care following surgery. The intervention, a multimedia application MyStay, uses bedside delivery of audio-visual and text-based information to engage postoperative patients to better participate in their care. MyStay modules are developed using an iterative, multi-method approach intended to balance procedure-specific best evidence, current clinical practice, and patient preferences. Development involves six key elements: (1) Empathise with target users, (2) Ground in evidence and behavioural theory, (3) Specify target behaviours, (4) Integration of health service standards and clinical care pathways/guidelines, (5) Build and refine the multimedia product and, (6) Pilot implementation to assess potential effectiveness and usability. To-date, we have developed four procedure-specific MyStay modules and an additional three are under development. Initial patient usage data for the Total Knee Replacement (TKR) and cardiac surgery applications indicated that users accessed a wide range of text-based and audio-visual information, most frequently recovery goals and exercises following TKR, and postoperative recovery information for the intensive care unit following cardiac surgery. As previous research that tested MyStay indicated its efficacy in optimising clinical postoperative outcomes, this framework may be useful in the development of other digital health innovations. Further research is required to assess patient and clinician engagement and determine whether MyStay is associated with improved patient outcomes across varied clinical contexts.

Digital Citizenship: Beyond Big Data, Technical Skills, Industry 4.0, and COVID-19.

Big data and data deluge are topics that are well known in the field of systems science. Digital transformation of big data and omics fields is also underway at present. These changes are impacting life sciences broadly, and high-throughput omics inquiries specifically. On the other hand, digital transformation also calls for rethinking citizenship and moving toward critically informed digital citizenship. Past approaches to digital citizenship have tended to frame the digital health issues narrowly, around technocracy, digital literacy, and technical competence in deployment and use of digital technologies. However, digital citizenship also calls for questioning the means and ends of digital transformation, the frames in which knowledge is produced in the current era. In this context, Industry 4.0 has been one of the innovation frameworks for automation through big data, and embedded sensors connected by wireless communication. Industry 4.0 and the attendant "smart" technologies relate to various automation approaches deployed as part of the public health responses to the COVID-19 pandemic as well. This article argues that there is a growing need to steer digital transformation toward critically informed digital citizenship, so that the provenance of digital data and knowledge is held to account from scientific design to implementation science, whether they concern academic or Industry 4.0 paradigms of innovation. There are enormous potentials and expectations from digital transformation in an era of COVID-19 and digital health. For this potential to materialize in ways that are efficient, democratic, and socially just, critical digital citizenship offers new ways forward. Systems science scholarship stands to benefit from a broadening of the focus on high-throughput omics technologies to a realm of critical digital citizenship, so the digital health innovations are well situated in their societal and political contexts.

Qualitative study of the views of people living with cardiovascular disease, and healthcare professionals, towards the use of a digital platform to support cardiovascular disease self-management

ObjectivesThis paper focuses on formative research as part of a broader study to develop and evaluate an innovative digital health platform for the self-management of cardiovascular disease (CVD). The primary...

The law of non-usage attrition in a technology-based behavioral intervention for black adults with poor cardiovascular health.

Digital health innovations, such as telehealth and remote monitoring, have shown promise in addressing patient barriers to accessing evidence-based programs and providing a scalable path for tailored behavioral interventions that support self-management skills, knowledge acquisition and promotion of relevant behavioral change. However, significant attrition continues to plague internet-based studies, a result we believe can be attributed to characteristics of the intervention, or individual user characteristics. In this paper, we provide the first analysis of determinants of non usage attrition in a randomized control trial of a technology-based intervention for improving self-management behaviors among Black adults who face increased cardiovascular risk factors. We introduce a different way to measure nonusage attrition that considers usage over a specific period of time and estimate a cox proportional hazards model of the impact of intervention factors and participant demographics on the risk of a nonusage event. Our results indicated that not having a coach (compared to having a coach) decreases the risk of becoming an inactive user by 36% (HR = .63, P = 0.04). We also found that several demographic factors can influence Non-usage attrition: The risk of nonusage attrition amongst those who completed some college or technical school (HR = 2.91, P = 0.04) or graduated college (HR = 2.98, P = 0.047) is significantly higher when compared to participants who did not graduate high school. Finally, we found that the risk of nonsage attrition among participants with poor cardiovascular from "at-risk" neighborhoods with higher morbidity and mortality rates related to CVD is significantly higher when compared to participants from "resilient" neighborhoods (HR = 1.99, P = 0.03). Our results underscore the importance of understanding challenges to the use of mhealth technologies for cardiovascular health in underserved communities. Addressing these unique barriers is essential, because a lack of diffusion of digital health innovations exacerbates health disparities.

Leo&Giulia: a cartoon series to promote health and prevention in primary school-aged children

Abstract Background Coronavirus (COVID-19) pandemic control measures actively involved people who were called to adopt new and unusual lifestyles. In this context, children had to stay home from school for weeks, had to adapt to new teaching methods and give up socializing. In many countries, not much attention was paid to the educational sector, and, ultimately, to children's physical and psychological well-being. Objectives In this context, we developed an innovative health education audio-visual model to teach children about public health, empower them to adopt preventive behaviours and limit the risk of infection transmission in schools and in the community. Results We designed and produced the animated cartoon series “Leo&Giulia” to convey solid scientific content and key public health messages related to the ongoing COVID-19 pandemic to primary school-aged children. Contents and dialogues were validated by a scientific committee composed of experts in the fields of public health, paediatrics, infectious diseases, and neuroscience, as well as communication experts. The first episode of Leo&Giulia focused on COVID-19 and explained to children what SARS-CoV2 was, its transmission and why schools were closed. Endorsed by the European Commission, it was broadcasted by national public and private television channels and went viral on social media. The second episode of Leo&Giulia, funded by the Italian Ministry of Research, was launched in April 2022 and focused on vaccines and immunization explaining to children how vaccines work and why herd immunity is important for collective health. Conclusions Leo&Giulia is an innovative health education project to help children to better understand how to cope with COVID-19 as a public health challenge. More broadly, the series aims to increase youth engagement by promoting public health values and healthy behaviours. Key messages • Health promotion targeting children is important and contributes to societal health and wellbeing. • Cartoon series are an innovative digital health education tool that effectively increase youth engagement on public health values.

Impact of Digital Health on Awareness innovations

Abstract Background In the era of increasingly expanding digital ecosystem, infodemic became highly risky, especially the information sources which are non-evidence based. This problem is magnified due to the vulnerability of most internet users, especially the adults & adolescent's information seekers who lack health literacy. Communication is the foundation of driving successful outcomes inside of the healthcare ecosystem; leveraging the right techniques for all populations is critical to build successful care delivery including in virtual care scenarios Objective The objective of this abstract is to explore the patterns of digital health usage among population and their level of awareness towards choosing online health information (OHI) as well as its impact on the awareness innovations, and crossing the gap between healthcare professionals and patients to increase patient engagement with remote devices and empower them to take control of their own health. Methods Digitalization of healthcare is not just about adopting new digital technology but it's about reforming the healthcare sector for the digital age using the power of data, AI, cloud-based platforms, and new business models to improve behavioral economics, health outcomes, and improve the human care experience for patients and staff alike. In order to discover the next steps in the future of communication technology and how this can be best utilized by healthcare professionals and consumers, an approach of translational research methodology of T1 and T2 was applied, T1 was the translation from research to application and T2 is translation from application to adaptation of the community, leveraging new tools such as the Cloud and AI, to see if they can build automated, reliable, interoperable workflows. Results (1) Digitalizing Legacy Communication to Streamline Patient Care and Healthcare Operations: • Communication is the foundation of driving successful outcomes inside of the healthcare ecosystem; leveraging the right techniques for all populations is critical to build successful care delivery including in virtual care scenarios • Expand - a member of ICOM Group created ‘MyHealth Digest’ Website and Mobile Application. The vision of this digital platform is to put clear patient communication at the heart of healthcare, improving patient experience and quality of care by connecting them with the best professors and doctors in each specialty, and reducing health inequalities. (2) Support operational, therapeutic, and clinical decision-making with AI: • Integrate AI levers into workflows to support operational, clinical, and shared decision-making along the patient pathway • Learn how to overcome obstacles such as clinician resistance and resource constraints to scale AI pilot schemes into efficient systems used organization wide • Understand the latest advancements in AI that have refined algorithm accuracy and further increased the rate that patient data is analyzed (3) Increase patient engagement with remote devices and empower them to take control of their own health • Improve the regularity of your patient's interaction with remote devices to manage costs, reduce readmissions and improve patient progress outside of the clinical setting • Empower self-health through instructions that are simple and touchpoints for information that are very accessible • Leverage patient data to understand adherent and non-adherent patients and tailor targeted interventions where necessary (4) Ensure digital health is a force for greater health equity • Break down barriers and create Digital Health for all by expanding the availability of digital messaging, self-service, and translation services • Overcome problems of connectivity by leveraging devices that trigger off cellphone towers to provide the critical updates your clinician requires • Provide standardized devices for all patients under your care, that not only enable access to all but also simplify the process of patient monitoring for your clinicians Conclusion The integration of digital technologies into our daily lives and the increasing global connectivity have reached unprecedented levels. Innovation, especially in the digital segment, is progressing at an extraordinary pace. However, the potential for utilizing digital health solutions to enhance population health remains unbroached. There is significant scope for leveraging digital technologies and health innovations to raise awareness and expedite the global achievement of health and well-being.1

A protocol on the effects of interactive digital assistance on engagement and perceived quality of care of surgery patients and self-efficacy and workload of staff.

The workforce shortage in the healthcare context is a growing issue that exerts detrimental effects on employees (e.g., higher workload) and patients (e.g., suboptimal patient care). Since traditional approaches alone may not be enough to solve this problem, there is a need for complementary innovative digital health solutions, such as socially assistive robots. Hence, the proposed study aims to investigate the effects of gamified nursing education and physiotherapy delivered by a socially assistive robot on patient- (engagement, perceived quality of care) and employee-related outcomes (perceived self-efficacy, workload). Approximately 90 vascular and thoracic surgery patients will receive either standard care or standard care with additional robot interactions over the course of 3-5 days. Additionally, approximately 34 nursing and physiotherapeutic employees will fill out self-report questionnaires after weeks of not using a social robot and weeks of using a social robot. The main hypotheses will be tested with mixed-design analyses of variance and paired-samples t-tests. While the proposed study has some limitations, the results will provide high-quality and comprehensive evidence on the effectiveness of socially assistive robots in healthcare. The study was approved by the Medical Ethics Commission of the University Medical Center and registered in the ISRCTN registry (ISRCTN96689284). The study findings will be summarized in international peer-reviewed scientific journals and meetings and communicated to relevant stakeholders.

An Artificial Intelligence-Driven Digital Health Solution to Support Clinical Management of Patients With Long COVID-19: Protocol for a Prospective Multicenter Observational Study.

BackgroundCOVID-19 pandemic has revealed the weaknesses of most health systems around the world, collapsing them and depleting their available health care resources. Fortunately, the development and enforcement of specific public health policies, such as vaccination, mask wearing, and social distancing, among others, has reduced the prevalence and complications associated with COVID-19 in its acute phase. However, the aftermath of the global pandemic has called for an efficient approach to manage patients with long COVID-19. This is a great opportunity to leverage on innovative digital health solutions to provide exhausted health care systems with the most cost-effective and efficient tools available to support the clinical management of this population. In this context, the SENSING-AI project is focused on the research toward the implementation of an artificial intelligence–driven digital health solution that supports both the adaptive self-management of people living with long COVID-19 and the health care staff in charge of the management and follow-up of this population.ObjectiveThe objective of this protocol is the prospective collection of psychometric and biometric data from 10 patients for training algorithms and prediction models to complement the SENSING-AI cohort.MethodsPublicly available health and lifestyle data registries will be consulted and complemented with a retrospective cohort of anonymized data collected from clinical information of patients diagnosed with long COVID-19. Furthermore, a prospective patient-generated data set will be captured using wearable devices and validated patient-reported outcomes questionnaires to complement the retrospective cohort. Finally, the ‘Findability, Accessibility, Interoperability, and Reuse’ guiding principles for scientific data management and stewardship will be applied to the resulting data set to encourage the continuous process of discovery, evaluation, and reuse of information for the research community at large.ResultsThe SENSING-AI cohort is expected to be completed during 2022. It is expected that sufficient data will be obtained to generate artificial intelligence models based on behavior change and mental well-being techniques to improve patients’ self-management, while providing useful and timely clinical decision support services to health care professionals based on risk stratification models and early detection of exacerbations.ConclusionsSENSING-AI focuses on obtaining high-quality data of patients with long COVID-19 during their daily life. Supporting these patients is of paramount importance in the current pandemic situation, including supporting their health care professionals in a cost-effective and efficient management of long COVID-19.Trial RegistrationClinicaltrials.gov NCT05204615; https://clinicaltrials.gov/ct2/show/NCT05204615International Registered Report Identifier (IRRID)DERR1-10.2196/37704

Guest editorial: Advancing integrated care with digital health innovation issue editorial

Guest editorial: Advancing integrated care with digital health innovation issue editorial