Digital Health Innovation Research Articles

Stuck in translation: Stakeholder perspectives on impediments to responsible digital health.

Spurred by recent advances in machine learning and electronic hardware, digital health promises to profoundly transform medicine. At the same time, however, it raises conspicuous ethical and regulatory issues. This has led to a growing number of calls for responsible digital health. Based on stakeholder engagement methods, this paper sets out to identify core impediments hindering responsible digital health in Switzerland. We developed a participatory research methodology to access stakeholders' fragmented knowledge of digital health, engaging 46 digital health stakeholders over a period of five months (December 2020-April 2021). We identified ineffective stakeholder collaboration, lack of ethical awareness among digital health innovators, and lack of relevant regulation as core impediments to responsible digital health. The stakeholders' accounts indicate that ethical concerns may considerably slow the pace of digital health innovation - implying that responsible innovation is a core catalyst for the progress of digital health overall.

Design, development and randomised controlled trial protocol of a smartphone-delivered version of ‘SOLAR’ for emergency service workers to manage stress and trauma

IntroductionEmergency service workers are routinely exposed to stress and trauma, and there is a need to address mental health symptoms early to prevent chronic impairment and/or psychiatric disorder. Digital health...

E-Health Research in Southeast Asia: A Bibliometric Review

eHealth or digital health innovations expanded tremendously during the COVID-19 pandemic. Innovation and digitalization offer creative solutions to build up a healthy society. The eHealth technologies are quickly taken up by Southeast Asia countries and continue to flourish to alleviate the burden of healthcare challenges. This study is the first review exploring and analyzing the whole literature of eHealth, specifically in the Southeast Asia region. The objective of this study is to document the size, growth trajectory, and geographical distribution of eHealth in Southeast Asia research, identify high-impact authors and documents, explore the intellectual knowledge structure, and analyze the topical trends of the field. The bibliometric analysis was used to analyze a data set of 1405 Scopus-indexed documents between 1976 and 2021. Descriptive analysis, citation, co-citation, and keyword co-occurrence analyses were conducted to gain insights into eHealth in the Southeast Asia knowledge base. The growth rate of literature has rocketed up since 2018, reflecting the significant increase in demand for eHealth in Southeast Asia. Among the eleven Southeast Asian countries, Indonesia, Malaysia, Singapore, and Thailand were the top four countries where the most eHealth-related research was conducted. The intellectual structure of eHealth in Southeast Asia literature comprises four schools of thought (i.e., four groups of similar theoretical perspectives and research interests): (1) analysis and adoption of hospital information system/eHealth records, (2) user intention and acceptance of information technology, (3) technology for healthcare and disease management, and (4) mobile health technology (m-Health). Mobile applications, social networks, the COVID-19 pandemic, patient referral, follow-up, self-care, quality of life, psychology, diabetes mellitus, and hypertension are the recent emerging research themes in the field of study. The eHealth development should consider long-term sustainable management along with the rapid evolution of the field. Additionally, eHealth systems should be holistic and pay attention to technology adoption, data security, and ethical issues involved in medical practices. This bibliometric review delivers reference points for scholars interested in Southeast Asia eHealth, reveals the emerging intellectual structure of this interdisciplinary field, and provides guidance to future research on this domain.

Patient-reported usability and satisfaction with electronic medication event reminder and monitor device for tuberculosis: a multicentre, randomised controlled trial

The success of a tuberculosis digital adherence technology relies on patients' satisfaction with and the usability of the technology. This study aimed to evaluate treatment satisfaction and usability of a digital medication event reminder and monitor (MERM) device for patients with tuberculosis to address the prespecified secondary endpoint of the SELFTB trial. In this multicenter, randomised controlled trial, adults (≥18 years) with new or previously treated, bacteriologically-confirmed, drug-sensitive pulmonary tuberculosis who were eligible to start anti-tuberculosis therapy were recruited from 10 healthcare facilities in Ethiopia. With a computer-generated random number sequence, participants were randomly assigned 1:1 to receive a 15-day tuberculosis medication supply dispensed with an evriMED500® MERM device to self-administer and return every 15 days or the standard in-person DOT. Both arms were followed throughout the standard two-month intensive treatment phase. Treatment was based on the WHO-recommended two-month fixed-dose-combination of first-line anti-tuberculosis drug delivered as a single daily dose (2RHZE). Treatment Satisfaction Questionnaire for Medication version 4 (TSQM 1.4©) was used to measure and compare treatment satisfaction between arms. Adapted System Usability Scale (SUS) was used to assess the usability of the device, with emphasis on ease of use, challenges, benefits, motivation, popularity, and recommendation. The findings were correlated with adherence and clinical endpoints including sputum smear conversion and IsoScreen urine isoniazid test results. This trial is registered with ClinicalTrials.gov, NCT04216420. Between June 2, 2020, and June 15, 2021, 337 patients were screened for eligibility, of whom 109 participants enrolled and completed the satisfaction [control (n=57) and intervention (n=52) arms] and usability [intervention arm (n=52)] questionnaires. TSQM 1.4© geometric mean scores were: Effectiveness 73.25 [geometric standard deviation (GSD) 1.28], Side Effects 100, Convenience 63.31 (GSD 1.45), and Global Satisfaction 77.29 (GSD 1.25). TSQM score was significantly higher in the intervention vs the control: Effectiveness [85.78 vs 63.43, 95% CI 1.35 (1.26-1.45), p<0.001], Convenience [85.41 vs 48.18, 95% CI 1.77 (1.63-1.93), p<0.001], and Global Satisfaction [90.19 vs 67.11, 95% CI 1.34 (1.26-1.43), p<0.001]. There were significant associations between Global Satisfaction and medication adherence (p=0.017). Average SUS score was 97.45%, which was close to the best imaginable SUS value of 100%. Likelihood to Recommend (LTR) value was ≥9, on a scale of 0-10, for 90.4% of MERM users, yielding higher net promoters. There was no significant association between usability and medication adherence (p=0.691). Our findings suggested that treatment satisfaction scores were superior in the intervention vs control arms and across the domains of Effectiveness, Convenience, and Global Satisfaction. There was excellent usability of the MERM device and a significantly higher number of users likely to promote the device. High tuberculosis burden countries may transform patient-centered care through ongoing evaluation and scale-up of digital health innovations. U.S. National Institute of Health (NIH) Fogarty International Center and National Institute of Allergy and Infectious Diseases (D43 TW009127) and the Emory Center for AIDS Research (P30 AI050409).

TBIBank: An International Shared Database to Enhance Research, Teaching and Automated Language Analysis for Traumatic Brain Injury Populations

Traumatic brain injury (TBI) has been established as a priority research area for public health, affecting an estimated 69 million individuals worldwide each year. Large-scale collaborative datasets may help to better understand this heterogenous and chronic health condition. In this paper, we present TBIBank; an innovative digital health resource that aims to establish a shared database for the study of communication disorders after TBI. We provide an overview of the current database, the standard discourse protocol used for the main TBIBank corpus, and the automated language analyses that can enable diagnostic profiling, comparative evaluation of treatment effects and profiling of recovery patterns. We also highlight the e-learning component of the digital health resource as a research translation tool. We conclude with a discussion of the potential research, clinical, and educational applications of TBIBank and future directions for expanding this digital resource.

Designing digital health applications for climate change mitigation and adaptation.

Designing digital health applications for climate change mitigation and adaptation.

Technological Advancements in Interventional Oncology.

Interventional radiology, and particularly interventional oncology, represents one of the medical subspecialties in which technological advancements and innovations play an utterly fundamental role. Artificial intelligence, consisting of big data analysis and feature extrapolation through computational algorithms for disease diagnosis and treatment response evaluation, is nowadays playing an increasingly important role in various healthcare fields and applications, from diagnosis to treatment response prediction. One of the fields which greatly benefits from artificial intelligence is interventional oncology. In addition, digital health, consisting of practical technological applications, can assist healthcare practitioners in their daily activities. This review aims to cover the most useful, established, and interesting artificial intelligence and digital health innovations and updates, to help physicians become more and more involved in their use in clinical practice, particularly in the field of interventional oncology.

Creating a “no cost” automated database tool for managing ILL requests

Winner of the 2022 HLA/MedicalDirector Digital Health Innovation Award, ANZCA’s ILLs MANAGER database was developed as a way of processing an increasing number of document delivery requests whilst at the same time automating many of the associated manual processes.

Challenges developing an electronic patient-reported outcome measurement for palliative home care: A qualitative interview and focus group study

Background: Patient-reported outcome measures have the potential to improve outcomes, quality, and effectiveness of care. Digital use of patient-reported outcome measures could be an option to foster implementation in palliative care. The Palli-MONITOR study focused on developing and testing an electronic patient-reported outcome measure in specialised palliative home care. As part of this study, we examined setting-specific challenges for the development of the measure. Aim: We aimed to identify and explore challenges for the development of electronic patient-reported outcome measures as standardised assessment in specialised palliative home care. Design: Qualitative approach with semi-structured interviews and focus groups. Data were thematically analysed using the framework method. Setting/Participants: Patients and professionals from five German palliative home care teams. Results: Patients described potential problems in using electronic questionnaires due to their deteriorating health. Answering the electronic questionnaire encouraged patients to reflect on their current palliative situation, which was partly perceived as burdensome. Identified concerns and questions regarding the future roll-out of electronic patient-reported outcome measurement addressed the process of receiving and using the provided information in clinical care routine. Challenging factors on organisational and structural level were the potential undermining of the established 24-h emergency call system and the potential use for patients. Conclusions: Our results provide a multifaceted picture of challenges developing electronic systems for patient-reported outcome measurement in palliative home care on the individual and organisational level. The study underpins the benefit of stakeholder involvement creating digital health innovations and emphasises the importance to therefore mind setting specific culture.

Advancing Digital Health Innovation in Oncology: Priorities for High-Value Digital Transformation in Cancer Care

Although health care delivery is becoming increasingly digitized, driven by the pursuit of improved access, equity, efficiency, and effectiveness, progress does not appear to be equally distributed across therapeutic areas. Oncology is renowned for leading innovation in research and in care; digital pathology, digital radiology, real-world data, next-generation sequencing, patient-reported outcomes, and precision approaches driven by complex data and biomarkers are hallmarks of the field. However, remote patient monitoring, decentralized approaches to care and research, "hospital at home," and machine learning techniques have yet to be broadly deployed to improve cancer care. In response, the Digital Medicine Society and Moffitt Cancer Center convened a multistakeholder roundtable discussion to bring together leading experts in cancer care and digital innovation. This viewpoint highlights the findings from these discussions, in which experts agreed that digital innovation is lagging in oncology relative to other therapeutic areas. It reports that this lag is most likely attributed to poor articulation of the challenges in cancer care and research best suited to digital solutions, lack of incentives and support, and missing standardized infrastructure to implement digital innovations. It concludes with suggestions for actions needed to bring the promise of digitization to cancer care to improve lives.

Responsible impact and the reinforcement of responsible innovation in the public sector ecosystem: cases of digital health innovation

ABSTRACT Responsible innovation is an important consideration for digital health innovation. This study explores the responsible innovation processes of digital health innovators, and the reinforcement of responsible innovation practices. Using semi-structured qualitative interviews followed by a thematic analysis and narrative enquiry, we understand the lived experiences of innovators in the UK and Norway. We suggest three contributions. (1) That Responsible Innovation occurs as a process in practice, and we suggest a framework to outline that process. (2) We suggest that ‘responsible impact’ is the fifth domain and the output of RI. (3) We suggest that responsible impact may be a natural reinforcer of the RI process. We suggest that innovators who recognise the impact of their RI practice are more likely to continue those responsible processes. Finally, based on our study we provide an RI action plan framework to encourage the funding of responsible innovators.

Perancangan Clinical Decision Support System (CDSS) untuk Drug Drug Interaction (DDI) pada e-Prescription

Not all drugs side-effect that occur can be avoided, but those caused by drug-drug interactions (DDI) are among the most likely to be prevented and managed due to their predictability. The increasing number of drugs co-prescribed, affects the potential for drug interactions exponentially. Clinical Decision Support System (CDSS) is a promising strategy to prevent patient safety risks caused by drug interactions. This study aims to design a CDSS for DDI on e-Prescription. This research is qualitative study with action research design. The research was carried out at Digital Health Innovation Studio (DHIS) UGM, and at Budi Rahayu Hospital Magelang with the implementation time November 2021 - April 2022. Data collection for user needs analysis was carried out by interviewing management, doctors and pharmacists at the hospital, and also pharmacologists. Design and development of CDSS-DDI was executed in collaboration with DHIS UGM programmers. The evaluation was done by interviews and a System Usability Scale (SUS) questionnaire filled in by 17 system-related users. CDSS-DDI successfully developed according to user needs, it can be accessed by doctors and pharmacy units. The drug interaction warning display pop-up appears on one screen in the e-Prescription menu with a description of drug interactions in Bahasa. Drug interaction data refers to the National Drug Information Center (PIONas) which is managed by the POM. CDSS-DDI then implemented in hospital after going through socialization. Based on evaluation with SUS data processing tools, the CDSS-DDI received a score of 83 in the acceptable category and excellent rating. Based on results of evaluation interviews, CDSS for DDI is considered to have been successfully developed with the principle of user centered design and optimally efficient to help improve the quality of patient care.

Demonstration and Evaluation of the Digital Health Innovation Interoperability Framework

The relevance and role of interoperability currently change due to the unique characteristics of Digital Health Innovations (DHI) and the ongoing demand for defragmentation in Health Information Systems (HIS) landscapes. Efforts towards novel data-centered value propositions, inter-organizational care scenarios, and inter-sectoral collaborations force innovators to parallelly manage to realize the innovative idea and pave the path to seamless integration into complex target environments. Thus, the construct of interoperability shifts from a technical requirement's position to a socio-technical concept that provides guidance for DHI management. This research contributes to the discourse about the reconceptualization of interoperability for DHI. It builds upon a recently proposed Digital Health Innovation Interoperability Framework (DHIIF) and presents, first, a demonstration of its use within an ongoing DHI project on Digital Phenotyping and, second, a small-scale evaluation via an online expert survey. This paper provides the DHIIF's justification and confirms its utility as a conceptual fundament for DHI practice and HIS research.

Identifying developments over a decade in the digital health and telemedicine landscape in the UK using quantitative text mining.

The use of technologies that provide objective, digital data to clinicians, carers, and service users to improve care and outcomes comes under the unifying term Digital Health. This field, which includes the use of high-tech health devices, telemedicine and health analytics has, in recent years, seen significant growth in the United Kingdom and worldwide. It is clearly acknowledged by multiple stakeholders that digital health innovations are necessary for the future of improved and more economic healthcare service delivery. Here we consider digital health-related research and applications by using an informatics tool to objectively survey the field. We have used a quantitative text-mining technique, applied to published works in the field of digital health, to capture and analyse key approaches taken and the diseases areas where these have been applied. Key areas of research and application are shown to be cardiovascular, stroke, and hypertension; although the range seen is wide. We consider advances in digital health and telemedicine in light of the COVID-19 pandemic.

"It depends on the people!" - A qualitative analysis of contextual factors, prior to the implementation of digital health innovations for chronic condition management, in a German integrated care network.

Integrated care and digital health technology interventions are promising approaches to coordinate services for people living with chronic conditions, across different care settings and providers. The EU-funded ADLIFE project intends to provide digitally integrated personalized care to improve and maintain patients' health with advanced chronic conditions. This study conducted a qualitative assessment of contextual factors prior to the implementation of the ADLIFE digital health platforms at the German pilot site. The results of the assessment are then used to derive recommendations for action for the subsequent implementation, and for evaluation of the other pilot sites. Qualitative interviews with healthcare professionals and IT experts were conducted at the German pilot site. The interviews followed a semi-structured interview guideline, based on the HOT-fit framework, focusing on organizational, technological, and human factors. All interviews were audio recorded, transcribed, and subsequently analysed following qualitative content analysis. The results of the 18 interviews show the interviewees' high openness and motivation to use new innovative digital solutions, as well as an apparent willingness of cooperation between different healthcare professionals. Challenges include limited technical infrastructure and large variability of software to record health data, lacking standards and interfaces. Considering contextual factors on different levels is critical for the success of implementing innovations in healthcare and the transfer into other settings. In our study, the HOT-fit framework proved suitable for assessing contextual factors, when implementing IT innovations in healthcare. In a next step, the methodological approach will be transferred to the six other European pilot sites, participating in the project, for a cross-national assessment of contextual factors.

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.