E-health Implementation Research Articles

The nurse-led GILL eHealth intervention for improving physical health and lifestyle behaviours in clients with severe mental illness: design of a cluster-randomised controlled trial

BackgroundClients with severe mental illness (SMI) have overall poor physical health. SMI reduces life expectancy by 5–17 years, primarily due to physical comorbidity linked to cardiometabolic risks that are mainly driven by unhealthy lifestyle behaviours. To improve physical health in clients with SMI, key elements are systematic somatic screening and lifestyle promotion. The nurse-led GILL eHealth was developed for somatic screening and the implementation of lifestyle activities in clients with SMI. Aims of this study are to evaluate the effectiveness of the GILL eHealth intervention in clients with SMI compared to usual care, and to evaluate the implementation process, and the experiences of clients and healthcare providers with GILL eHealth.MethodsThe GILL study encompasses a cluster-randomised controlled trial in approximately 20 mental health care facilities in the Netherlands. The randomisation takes place at the team level, assigning clients to the eHealth intervention or the usual care group. The GILL eHealth intervention consists of two complementary modules for somatic screening and lifestyle promotion, resulting in personalised somatic treatment and lifestyle plans. Trained mental health nurses and nurse practitioners will implement the intervention within the multidisciplinary treatment context, and will guide and support the participants in promoting their physical health, including cardiometabolic risk management. Usual care includes treatment as currently delivered, with national guidelines as frame of reference. We aim to include 258 clients with SMI and a BMI of 27 or higher. Primary outcome is the metabolic syndrome severity score. Secondary outcomes are physical health measurements and participants’ reports on physical activity, perceived lifestyle behaviours, quality of life, recovery, psychosocial functioning, and health-related self-efficacy. Measurements will be completed at baseline and at 6 and 12 months. A qualitative process evaluation will be conducted alongside, to evaluate the process of implementation and the experiences of clients and healthcare professionals with GILL eHealth.DiscussionThe GILL eHealth intervention is expected to be more effective than usual care in improving physical health and lifestyle behaviours among clients with SMI. It will also provide important information on implementation of GILL eHealth in mental health care. If proven effective, GILL eHealth offers a clinically useful tool to improve physical health and lifestyle behaviours.Trial registrationClinical trial registration NCT05533749, registration date: 8 September 2022.

Predictors of the Use of a Mental Health-Focused eHealth System in Patients With Breast and Prostate Cancer: Bayesian Structural Equation Modeling Analysis of a Prospective Study.

eHealth systems have been increasingly used to manage depressive symptoms in patients with somatic illnesses. However, understanding the factors that drive their use, particularly among patients with breast and prostate cancer, remains a critical area of research. This study aimed to determine the factors influencing use of the NEVERMIND eHealth system among patients with breast and prostate cancer over 12 weeks, with a focus on the Technology Acceptance Model. Data from the NEVERMIND trial, which included 129 patients with breast and prostate cancer, were retrieved. At baseline, participants completed questionnaires detailing demographic data and measuring depressive and stress symptoms using the Beck Depression Inventory-II and the Depression, Anxiety, and Stress Scale-21, respectively. Over a 12-week period, patients engaged with the NEVERMIND system, with follow-up questionnaires administered at 4 weeks and after 12 weeks assessing the system's perceived ease of use and usefulness. Use log data were collected at the 2- and 12-week marks. The relationships among sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness (PU), and system use at various stages were examined using Bayesian structural equation modeling in a path analysis, a technique that differs from traditional frequentist methods. The path analysis was conducted among 100 patients with breast and prostate cancer, with 66% (n=66) being female and 81% (n=81) having a college education. Patients reported good mental health scores, with low levels of depression and stress at baseline. System use was approximately 6 days in the initial 2 weeks and 45 days over the 12-week study period. The results revealed that PU was the strongest predictor of system use at 12 weeks (βuse at 12 weeks is predicted by PU at 12 weeks=.384), whereas system use at 2 weeks moderately predicted system use at 12 weeks (βuse at 12 weeks is predicted by use at 2 weeks=.239). Notably, there were uncertain associations between baseline variables (education, sex, and mental health symptoms) and system use at 2 weeks, indicating a need for better predictors for early system use. This study underscores the importance of PU and early engagement in patient engagement with eHealth systems such as NEVERMIND. This suggests that, in general eHealth implementations, caregivers should educate patients about the benefits and functionalities of such systems, thus enhancing their understanding of potential health impacts. Concentrating resources on promoting early engagement is also essential given its influence on sustained use. Further research is necessary to clarify the remaining uncertainties, enabling us to refine our strategies and maximize the benefits of eHealth systems in health care settings.

EHealth profile of patients with diabetes.

Digital health technology can be useful to improve the health of patients with diabetes and to support patient-centered care and self-management. In this cross-sectional study, we described the eHealth profile of patients with diabetes, based on their use of digital health technology, and its association with sociodemographic characteristics. We used data from the "Qualité Diabète Valais" cohort study, conducted in one region of Switzerland (Canton Valais) since 2019. Participants with type 1 or type 2 diabetes completed questionnaires on sociodemographic characteristics and on the use of digital health technology. We defined eHealth profiles based on three features, i.e., ownership or use of (1) internet-connected devices (smartphone, tablet, or computer), (2) mHealth applications, and (3) connected health tools (activity sensor, smart weight scale, or connected blood glucose meter). We assessed the association between sociodemographic characteristics and participants' eHealth profiles using stratified analyses and logistic regression models. Some 398 participants (38% women) with a mean age of 65 years (min: 25, max: 92) were included. The vast majority (94%) were Swiss citizens or bi-national and 68% were economically inactive; 14% had a primary level education, 51% a secondary level, and 32% a tertiary level. Some 75% of participants had type 2 diabetes. Some 90% of the participants owned internet-connected devices, 43% used mHealth applications, and 44% owned a connected health tool. Older age and a lower educational level were associated with lower odds of all features of the eHealth profile. To a lesser extent, having type 2 diabetes or not being a Swiss citizen were also associated with a lower use of digital health technology. There was no association with sex. While most participants owned internet-connected devices, only about half of them used mHealth applications or owned connected health tools. Older participants and those with a lower educational level were less likely to use digital health technology. eHealth implementation strategies need to consider these sociodemographic patterns among patients with diabetes.

#6762 “PRIMUM NON NOCERE”: DIGITAL TOOLS AND MENTAL LOAD IN CLINICIANS AND PATIENTS: THE “E3 TASK FORCE” PROJECT

Abstract Background and Aims The Covid 19 pandemia has been an extremely potent enhancer of digital health solutions spreading. Telemedicine was already available in France before SARS-COV2, but not used as a standard of care. It seems like when sticking to the expressed needs and objectives, the implementation of digital solutions became a reality with a high level of acceptability. Since e-health is spreading and the commercial offer of digital solutions dramatically increasing, it seems critical to predict the impact of those new tools on mental load of users in order to make sure digital solutions really bring better quality of care together with quality of life (patients) or profesional life (health care professionals). Method Assistance publique -Hôpitaux de Paris launched in 2022 an ambitious project focusing on digital innovation at Hotel Dieu, making the largest hospital in Europe also an active promotor of digital health. This project includes an Innovation Hub, a large incubator for Start-ups, and (among others) the Digital Medical Hub (DMH). DMH is combining an academic platform dedicated to promoting scientific research on E-health and an open innovation structure promoting transformation strategies for e-health projets. Academic DMH initiated (March 2022) an innovative project aiming at defining what are the critical parameters involved into the lived experience of e-health users (clinicians and patients) with regard to mental load. This project included 3 steps: 1) a “consensus of experts” strategy conducted through meetings allowing the group to provide a list of the main dimensions impacting the (positive or negative) changes observed on daily life and mental load. The group includes neurosciences experts, clinicians (nephrologist, cardiologist, psychiatrist), e-health and digital solution experts, neuroergonomics and ergonomics experts, work psychologists, health economy specialist, market access experts). The following task of the group is to identify among those dimensions, those that are measurable or propose a way to evaluate them. 2) In paralell, a large opinion barometer is spread among health care professionals (HCP), digital entrepreneurs, and stakeholders in the field of health in ordre to collect over 500 answers allowing to describe expectations, fears and representations about e-Health implementation in France. 3) The last step of our research project is experimental with semi structured interviewing of health care profesionals in two different hospitals to explore the experience of actors exposed to digital solutions usage daily. The expert group conducting this research has turned into a Task Force to build the research plan for the next steps, after publishing the first conclusions of this work in the form of a “white book”. Results A white paper is under review describing the dimensions identified by the consensus of experts group as impacting mental load of HCP and, when available, the tools for quantitaive assessment of impact. The resultst of the pinion barometers witll be available in June and the qualitative study if ongoing. Conclusion Sharing this experience is shedding light on the importance for the Nephrology community to think about how to take part to the digital revolution in the field of Nephrology. There is incredible need for training and teaching to develop a commun culture about digital health. Patients and profesionals should explore and express needs for digital tools in order to act as promoters of the digital transformation of health system.

Toward Inclusive Approaches in the Design, Development, and Implementation of eHealth in the Intellectual Disability Sector: Scoping Review.

The use of eHealth is more challenging for people with intellectual disabilities (IDs) than for the general population because the technologies often do not fit the complex needs and living circumstances of people with IDs. A translational gap exists between the developed technology and users' needs and capabilities. User involvement approaches have been developed to overcome this mismatch during the design, development, and implementation processes of the technology. The effectiveness and use of eHealth have received much scholarly attention, but little is known about user involvement approaches. In this scoping review, we aimed to identify the inclusive approaches currently used for the design, development, and implementation of eHealth for people with IDs. We reviewed how and in what phases people with IDs and other stakeholders were included in these processes. We used 9 domains identified from the Centre for eHealth Research and Disease management road map and the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability framework to gain insight into these processes. We identified both scientific and gray literature through systematic searches in PubMed, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, Google Scholar, and (websites of) relevant intermediate (health care) organizations. We included studies published since 1995 that showed the design, development, or implementation processes of eHealth for people with IDs. Data were analyzed along 9 domains: participatory development, iterative process, value specification, value proposition, technological development and design, organization, external context, implementation, and evaluation. The search strategy resulted in 10,639 studies, of which 17 (0.16%) met the inclusion criteria. Various approaches were used to guide user involvement (eg, human or user-centered design and participatory development), most of which applied an iterative process mainly during technological development. The involvement of stakeholders other than end users was described in less detail. The literature focused on the application of eHealth at an individual level and did not consider the organizational context. Inclusive approaches in the design and development phases were well described; however, the implementation phase remained underexposed. The participatory development, iterative process, and technological development and design domains showed inclusive approaches applied at the start of and during the development, whereas only a few approaches involved end users and iterative processes at the end of the process and during implementation. The literature focused primarily on the individual use of the technology, and the external, organizational, and financial contextual preconditions received less attention. However, members of this target group rely on their (social) environment for care and support. More attention is needed for these underrepresented domains, and key stakeholders should be included further on in the process to reduce the translational gap that exists between the developed technologies and user needs, capabilities, and context.

A mixed-method study to inform the development and implementation of eHealth in a bariatric surgery service in an Australian public hospital.

This study aimed to explore patient barriers to accessing services, current technology ownership/use and digital device preferences for accessing health information/health service delivery. Additionally, it aimed to explore the Theoretical Domains Framework and the acceptability of future eHealth solutions in bariatric surgery. This mixed-method study (survey and semi-structured interviews) was conducted in a bariatric surgery service in an Australian public hospital. Quantitative data were analysed descriptively, and the qualitative data were deductively and inductively analysed. This study included 117 participants (n = 102 surveyed and n = 15 interviewed). Most participants were aged ≥51 years (n = 70, 60%), and two-thirds were female (n = 76, 65%). One in three participants reported barriers to accessing services (n = 38, 37%), including parking, travel time, and taking time off work. Most participants preferred to receive or access additional health information via email (n = 84, 82%) and were willing to engage with health professionals via email (n = 92, 90%), text messages (n = 87, 85%), and telephone (n = 85, 83%). Deductive analysis of interviews generated three themes: 'Knowledge', 'Social influence' and 'Behavioural regulation, goals and environmental resources'. The inductive analysis generated one theme: 'Seeing a place for eHealth in service delivery'. This study's findings can potentially influence the development of future eHealth solutions. Text message, email, and online approaches may be suitable for delivering further information and resources to patients, particularly regarding diet and physical activity. Online health communities are being used by patients for social support and may be worth further investigation. In addition, developing a bariatric surgery mobile application may be beneficial.

ANALYSIS OF INFORMATION SYSTEM NEED DESIGN FOR RECORDING AND REPORTING INTEGRATED HEALTHCARE CENTER TODDLERS IN KASIN VILLAGE, WORKING AREA OF BARENG COMMUNITY HEALTH CENTER, MALANG CITY

Background: Integrated Healthcare Center is a form of Community Based Health Efforts (UKBM) that has an active role through health cadres in realizing the Community Health Efforts (UKM) to strengthen basic health services (Primary Health Care). Now, it starts to implement a health management information system (Health Management Information System) that is a form of e-health implementation as an effort to accelerate the digital transformation of health in Indonesia according to Regulation of The Minister of Health of The Republic of Indonesia Number 46 of 2017. The recording and reporting system of the integrated Healthcare Center in Kasin Village is still manual and performs the data input using microsoft excel and spreadsheet.
 
 Objectives: This research purpose is providing information system based on website for recording and repoting needed by Integrated Healthcare Center Toddlers in Kasin Village, working area of Bareng Community Health Center, Malang City.
 
 Methods: This research is descriptive qualitative to analyze user needs, system requirements, design system and interface design required for the information system for recording and reporting activities of the Integrated Healthcare Center.
 
 Results: User needs in the recording and reporting of the Integrated Healthcare Center Information System can be identified as the needs of health cadres users and the need of Community Health Center Officers. The design of the information system design for recording and reporting of the Integrated Healthcare Center for toddlers had been compiled using Unified Modeling Language (UML) diagrams using simple and easy to operate features and menus to meet the data needs of the Integrated Healthcare Center and Community Health Center.
 
 Conclusion: The design of the information system that facilities the performance of health cadres and reduce the chance of data errors.

Critical risk and success factors for sustainability of an electronic health data capture, processing and dissemination platform for Uganda.

Several studies have investigated challenges that have marred success or even caused the failure of eHealth implementations in Uganda; however, none has focused on the risks and success factors of their sustainability. This study explored critical risk and success factors for the sustainability of an electronic health data capture, processing and dissemination platform for Uganda. A mixed-method research design was followed involving collecting empirical data from all four regions of Uganda. A purposive sampling strategy was used to select the study districts per region, health facilities per district, and respondents/participants per facility or district. Findings revealed several risks and success factors for sustainability, including; bad leadership, corruption, lack of sustainable maintenance programs, lack of suitable sustainability plans, lack of ICT infrastructure investment, poor management systems, funds, stakeholder buy-ins, data sharing and access rights. The success factors included reinvestments as a partial sustainability plan for ICT infrastructure. These factors can be leveraged to ensure the continued operation of eHealth implementations in Uganda. Every electronic health project aiming at success should always make due consideration/sustainability plan at the onset of project conceptualisation; as lack of such a plan has often resulted in failed projects after the initial funds have been withdrawn.

Implementation and User Evaluation of an eHealth Technology Platform Supporting Patients With Cardiovascular Disease in Managing Their Health After a Cardiac Event: Mixed Methods Study.

eHealth technology can help patients with cardiovascular disease adopt and maintain a healthy lifestyle by supporting self-management and offering guidance, coaching, and tailored information. However, to support patients over time, eHealth needs to blend in with their needs, treatment, and daily lives. Just as needs can differ between patients, needs can change within patients over time. To better adapt technology features to patients' needs, it is necessary to account for these changes in needs and contexts of use. This study aimed to identify and monitor patients' needs for support from a web-based health management platform and how these needs change over time. It aimed to answer the following research questions: "How do novice and more advanced users experience an online health management platform?" "What user expectations support or hinder the adoption of an online health management platform, from a user perspective?" and "How does actual usage relate to user experiences and adoption?" A mixed methods design was adopted. The first method involved 2 rounds of usability testing, followed by interviews, with 10 patients at 0 months (round 1) and 12 patients at 6 months (round 2). In the second method, log data were collected to describe the actual platform use. After starting cardiac rehabilitation, the platform was used frequently. The patients mentioned that they need to have an incentive, set goals, self-monitor their health data, and feel empowered by the platform. However, soon after the rehabilitation program stopped, use of the platform declined or patients even quit because of the lack of continued tailored or personalized advice. The reward system motivated them to log data, but most participants indicated that being healthy should be the main focus, not receiving gifts. A web-based platform is flexible, accessible, and does not have any obligations; however, it should be implemented as an addition to regular care. Although use of the platform declined in the longer term, patients quitting the technology did not directly indicate that the technology was not functioning well or that patients no longer focused on achieving their values. The key to success should not be user adherence to a platform but adherence to healthy lifestyle habits. Therefore, the implementation of eHealth should include the transition to a stage where patients might no longer need support from a technology platform to be independently and sustainably adherent to their healthy lifestyle habits. This emphasizes the importance of conducting multi-iterative evaluations to continuously monitor whether and how patients' needs and contexts of use change over time. Future research should focus on how this transition can be identified and monitored and how these insights can inform the design and implementation of the technology.

EHealth Use on Acute Inpatient Mental Health Units: Implementation Processes, Common Practices, and Barriers to Use.

Information technology to promote health (eHealth) is an important and growing area of mental healthcare, yet little is known about the use of patient-facing eHealth in psychiatric inpatient settings. This quality improvement project examined the current practices, barriers, implementation processes, and contextual factors affecting eHealth use across multiple Veteran Health Administration (VHA) acute mental health inpatient units.Staff from units serving both voluntary and involuntary patients (n = 49 from 37 unique sites) completed surveys regarding current, desired, and barriers to use of Veteran-facing eHealth technologies. Two subsets of respondents were then interviewed (high success sites in eHealth use, n = 6; low success sites, n = 4) to better understand the context of their eHealth use. Survey responses indicated that 20% or less of Veterans were using any type of eHealth technology while inpatient. Tablets and video chat were the most desired overall and most successfully used eHealth technologies. However, many sites noted difficulty implementing these technologies (e.g., limited Wi-Fi access). Qualitative analysis of interviews revealed differences in risk/benefit analysis and implementation support between high and low success eHealth sites. Despite desired use, patient-facing eHealth technology is not regularly implemented on inpatient units due to multiple barriers (e.g., limited staffing, infrastructure needs). Successful implementation of patient-facing eHealth may require an internal champion, guidance from external supports with experience in successful eHealth use, workload balance for staff, and an overall perspective shift in the benefits to eHealth technology versus the risks.

Factors That Influence the Use of eHealth in Home Care: Scoping Review and Cross-sectional Survey

In home care, eHealth implementation requires health care professionals and home care clients to change their behavior because they have to incorporate the use of eHealth into their daily routines. Knowledge of factors that influence the use of eHealth in home care is needed to optimize implementation strategies. However, a comprehensive overview of such factors is lacking. The aims of this study were to (1) provide insight into the types of eHealth that are used and preferred in home care and (2) identify factors that influence the use of eHealth in home care according to health care professionals and home care clients. A scoping review and online, cross-sectional survey were conducted sequentially. The survey was conducted among Dutch health care professionals with a nursing background who were working for a home care organization at the time. The capability, opportunity, motivation, behavior (COM-B) model, which posits that for any behavior (B) to occur, a person must have the capability (C), opportunity (O), and motivation (M) to perform the behavior, was used to identify influencing factors. The use of a theoretical model may contribute to a better understanding of how to achieve and sustain behavior change in clinical practice. We included 30 studies in the scoping review. The most frequently studied type of eHealth was a telecommunication/telemonitoring system. The survey was completed by 102 participants. The most frequently used types of eHealth were electronic health records, social alarms, and online client portals. A health app was the most frequently preferred type of eHealth. We identified 22 factors that influence the use of eHealth in home care according to health care professionals and home care clients. Influencing factors were organized into the components of the COM-B model, namely capability (n=6), opportunity (n=10), and motivation (n=6). We found that there is no single influencing factor that is key to the complexity of eHealth implementation. Different types of eHealth are used, and many types of eHealth are preferred by health care professionals. The identified factors that influence the use of eHealth in home care relate to all components of the COM-B model. These factors need to be addressed and embedded in implementation strategies of eHealth to optimize the use of eHealth in home care.

Feasibility and utility of Point-of-Care electronic clinical data capture in Uganda's healthcare system: a qualitative study.

This study aimed to assess Uganda's readiness for implementing a national Point-of-Care (PoC) electronic clinical data capture platform that can function in near real-time. A qualitative, cross-sectional design was adopted to obtain a snapshot of Uganda's eHealth system landscape with an aim to assess the readiness for implementing PoC platform. A purposive sampling strategy was used to select the study districts per region, health facilities per district, and participants per facility or district. Nine facilitators were identified, including health worker motivation to serve the community, affirmative action on eHealth financing, improved integrating information and communication technology (ICT) infrastructure, Internet and electricity power connectivity, improved human resource skills and knowledge, the culture of sensitizing and training of stakeholders on eHealth interventions, the perceived value of the platform, health workers' motivation to improve health data quality, interest to improve data use, and continuous improvement in the eHealth regulatory environment. Other suggestions entailed several requirements that must be met, including infrastructure, eHealth governance, human resources, as well as functional and data requirements. Uganda, like other low-income countries, has adopted ICT to help solve some of its health system challenges. Although several challenges face eHealth implementations in Uganda, this study revealed facilitators that can be leveraged and requirements that, if met, would facilitate the successful implementation of a near real-time data capture platform capable of improving the country's health outcomes. Other countries with eHealth implementations similar to those faced in Uganda can also leverage identified facilitators and address the stakeholders' requirements.

E-health Implementation by Private Dental Service Providers in Bulawayo, Zimbabwe

E-health Implementation by Private Dental Service Providers in Bulawayo, Zimbabwe

Digital adaptability competency for healthcare professionals: a modified explorative e-Delphi study

AimTo establish items of the digital adaptability competency for healthcare professionals. BackgroundWhile the application and deployment of eHealth has continued at a rapid pace, healthcare professionals are expected to keep up and join the digital evolution. The implementation of eHealth requires a change in the healthcare professionals’ competencies of which the ability to adapt to technological change is fundamental. There’s more needed than just ICT skills, overall competencies to be digitally adaptable between patientcare and the use of eHealth are needed. Today, a distinct and relevant list of items for healthcare professionals related to the competency of digital adaptability is missing. DesignAn exploratory modified e-Delphi study. MethodsThis study was conducted in Flanders, Belgium. An expert group (n = 12) consisting of 2 policymakers of the Belgian federal government, 3 eHealth managers of large organizations in the Belgian healthcare sector, 1 nurse, 1 midwife, 2 health service users and 3 researchers specialized in eHealth research.Through a literature review an initial list of items was developed, consisting of 67 statements. A two-round Delphi survey was performed where experts could rate the relevance of each item. The third round comprised an online meeting, where the expert group discussed the remaining items until agreement was reached to retain, modify, or eliminate the item. ResultsIn round 1, eleven items were included to the final document. In round 2, ten items were included. In round 3, the panel unanimously agreed to add six items, one item was modified into two separate items. In total, 29 items were included in the final document. ConclusionsThe rather abstract concept of digital adaptability is now transformed into a more pragmatic concept of 29 items, reflecting the practical competencies of healthcare professionals necessary to be digital adaptable.

Challenges in e-Health: The effect of digitalisation of frequency voiding charts on compliance in paediatric patients. Randomised controlled trial comparing digital and versus paper frequency voiding charts

Objective Frequency voiding charts are commonly used to gain better insight into the voiding and drinking behaviours of patients with voiding symptoms. Non-compliance when filling out a chart is known to be high. The use of a digital application might increase adherence, but little research has been conducted on this topic. The aim of this study is to compare the quality (number of correctly filled out charts) and quantity (number of complete charts) of digital versus paper frequency voiding charts among children and their parents. Methods A multi-centre parallel randomised controlled trial was conducted. Participants were assigned either a 48-h digital frequency voiding chart or a 48-h paper frequency voiding chart. Completion rates were scored based on a predefined scoring method and transcribed into a percentage. Secondary objectives included user friendliness, feasibility, degree of the child's participation, and attractiveness. Trail registry data: NTR NL9383. Results Ninety-seven patients were randomised to either a digital ( N = 53) or paper ( N = 44) frequency voiding chart. No significant difference in complete and accurately filled out frequency voiding charts was seen between the groups, with 35% ( N = 18) for digital and 50% ( N = 22) for paper, p = 0.12. Subjects considered the digital application more appealing, more educative, and more inviting compared to the paper chart ( p < 0.05). Conclusions In this underpowered study, no significant difference appeared between the groups in the number of complete and accurately filled out frequency voiding charts. Implementation of e-health did not seem to improve compliance. In daily practice, personal preference might offer the best solution.

A systematic literature review on e-health implementation and policies

A systematic literature review on e-health implementation and policies

The Potential of E-Health in Patients after Allogeneic Stem Cell Transplantation

Introduction Modern information and communication technologies (ICT) have become increasingly important in daily life as well as in patient-physician interaction, health monitoring and health related information (E-Health). Progress in allogeneic stem cell transplantation (allo-SCT) has led to improved survival and increasing numbers of patients. However, with a multitude of potential complications, follow-up of allo-SCT patients remains complex requiring close monitoring, support and treatment with a plethora of medical fields involved. Early studies have shown that E-Health can benefit caretaking of these patients. So far, only little information is known about the patients’ current use of E-Health and their perspective on its potential. Yet, this knowledge is of particular importance for re-structurization of follow-up after allo-SCT including the standardized use of E-Health and its comprehensive acceptance. This multicenter study aims to close this knowledge gap by investigating the patients’ view towards E-Health and use of telemedicine after allo-SCT. The results will help to facilitate the implementation of E-Health in standard follow-up after allo-SCT and other cellular therapies with a focus on patients’ perspective. Methods and Results Between May 2021 and June 2022, 237 patients after allo-SCT were asked to answer a structured questionnaire at the university hospitals Aachen, Bonn, Cologne and Duesseldorf (Center for Integrated Oncology, CIO ABCD) in Germany. Overall, 219 patients returned the questionnaire leading to a response rate of 92%. Of these, 34% were female and 66% were male with a median age of 59 years (range 18-81). In our patient cohort, the current distribution of internet-enabled computers/smartphones is over 90% and the electronic devices are mainly used for daily life activities. Nevertheless, the use of ICT in medical monitoring and patient-physician interaction is still limited. Only a minority of patients have digitized medication plans, use digital monitoring of health data/fitness-apps or own wearables for health monitoring such as smartwatches. In contrast, the majority of patients favors additional online patient-physician interaction such as scheduling and transmission of medical reports and 65% of the patients support real-time transmission of health data through wearables to the physician for a limited time period. Of note, 40-50% of patients have concerns regarding data safety, even more when using messenger services (67%). The majority of patients considers online chats or video calls with their physician to be beneficial and expects an improvement of the treatment quality through increased use of E-Health. Additionally, most patients favor local treatment with online correspondence between their local practitioner and a specialized center, especially if the patients are present during the online communication or with intermittent personal patient contact to the center. Subgroup analyses revealed that in most areas there is no gender difference in use and perspective on E-Health. However, male patients consider online chats more beneficial and expect an improved patient-physician interaction through increased use of ICT compared to females. Age and educational attainment are very significant factors in patients’ view on E-Health. Younger (<60 years) as well as higher educated patients favor increased use of online communication, applications and devices in almost all regards and expect benefits of patient-physician interaction and treatment quality, which is in significant contrast to the views of older or less educated patients. Hometown size or distance to a specialized center does not show a relevant impact on the view on E-Health. This is also true for time after allo-SCT or frequency of outpatient visits at the time of questioning. Conclusions Dissemination of internet-enabled devices is wide and the potential of E-Health is high in patients after allo-SCT. The majority of patients favors further standardized implementation of E-Health technologies and telemedically supported caretaking post allo-SCT and potentially other cellular therapies to improve patient-physician interaction and cross-sectoral care. Future research should focus on patients’ needs in the context of data safety and exchange of medical information in interdisciplinary care processes to successfully integrate new E-Health technologies.

Beyond monitoring functionality to results evaluation of eHealth interventions: Development and validation of an eHealth evaluation framework.

Evidencing eHealth interventions, benefits generates data as a basis for assessing whether observed changes in behavior, processes or healthcare outcomes can be attributed to the eHealth interventions. Generating such evidence requires the use of frameworks or some other type of organizing schemes to help in guiding the process and making sense of eHealth systems and the findings. The frameworks available in literature do not clearly guide on how to monitor eHealth implementation and evaluate eHealth implementation results. This study aimed to develop and validate an eHealth evaluation framework to guide the process of monitoring eHealth implementations and evaluation of eHealth results in terms of outcomes and impact on healthcare in developing countries. The Design Science Research Methodology was followed to conduct this study. Recommendations from an eHealth evaluation exploratory study in Uganda and other eHealth evaluation literature formed key inputs into the design and development of the framework. The framework consists of a generic reference model with eHealth monitoring and evaluation dimensions, performance indicators, and guidelines on how to conduct eHealth monitoring and evaluation. The eHealth evaluation framework received high acceptance (>80%) as regards its fitness for purpose during its validation.

EHealth tools to assess neurological function: a systematic review protocol for a mapping exercise

IntroductionPopulation-based epidemiological studies investigating risk/protective factors are outlining prevention strategies for neurological conditions that often do not have effective treatment. However, ascertaining neurological outcomes can be a time consuming and...

Leadership in the context of digital health services: A concept analysis.

To define and clarify the concept of leadership in the context of digital health services using Walker's and Avant's concept analysis model. Conceptualizing leadership in the context of digital health services is needed to deliver higher quality services and advance research. Searches were conducted of MEDLINE (Ovid), Scopus, CINAHL (EBSCO) and ProQuest (ABI/INFORM). Empirical articles were included if they reported attributes, antecedents or consequences of leadership in the study context. A total of 4037 references were identified; 23 were included. Leadership attributes concerned leaders' behaviour, roles and qualities. Antecedents concerned informatics skills and competence, information and tools, understanding care systems and their complexity and education. Consequences related to organization, professionals and patient and care. Based on our results, the term 'e-leadership' should be more widely utilized in nursing practice and research. Nurse leaders need to be strong leaders; they need to be visionary and use strategic thinking to develop existing and new digital solutions. By becoming e-leaders, nurse leaders may increase the successful development and implementation of eHealth and benefit clinicians and patients.