The Critical Role of Hospital Information Systems in Digital Health Innovation Projects

Societal demand and political support still drive researchers and practitioners to work in numerous initiatives to create Digital Innovations (DI) in healthcare. Despite all support, the problem of unsuccessful or not-satisfying translation of project outputs into the healthcare reality remains. One critical aspect is the integration of a DI into evolved Hospital Information Systems (HIS). As DI projects often are conducted in practice research consortia, such projects can provide close insights into real-world settings. Therefore, a rigor analysis is necessary, which we perform using the Action Design Research approach that helps to analyze the role of HIS in DI projects for healthcare. The main contribution of this paper is the detailed description of a context-specific framework for the formalization of learning plus a systematic presentation of enablers and barriers of DI projects in healthcare. The framework matches both a project management perspective by considering different stages of a DI project and an interoperability perspective as an overall key factor for successful implementation.

The full article can be downloaded below.  

Predictive, Preventive and Precision Medicine: The Future of Healthcare

Medical field is rapidly undergoing, a paradigm shift in the way the future healthcare will be delivered. The million -dollar question is, are we ready to embrace these changes? Are our medical colleges, and various medical departments ready to accept, learn new things, assimilate, and develop integrated healthcare? We keep hearing discussions about a new systems approach, to disease diagnosis and management, “Predictive, Preventive, and Personalized or Precision Medicine.” It sounds very impressive, high-powered, and doable. How do we go about incorporating these buzz words, into a real-time practice of medicine? What we are talking about is, development of capacity to predict the early onset of a disease, or a risk factor or clusters of risk factors, for a disease, develop appropriate preventive strategies, and integrate available technologies, to deliver a personalized, precision medicine.

The full article can be downloaded below.  

How do mobile health applications support behaviour changes? A scoping review of mobile health applications relating to physical activity and eating behaviours

The objective of this review was to analyse how researchers conducting studies about mobile health applications (MHApps) effectiveness assess the conditions of this effectiveness.

We conducted a scoping review of efficacy/effectiveness conditions in high internal validity studies assessing the efficacy of MHApps in changing physical activity behaviours and eating habits. We used the PubMed, Web of Science, SPORTDiscus and PsycINFO databases and processed the review according to the O'Malley and PRISMA-ScR recommendations. We selected studies with high internal validity methodologies (randomised controlled trials, quasi-experimental studies, systematic reviews and metaanalyses), dealing with dietary and/or physical activity behaviours; covering primary, secondary or tertiary prevention and dealing with behaviour change (uptake, maintenance). We excluded articles on MHApps relating to high-level sport and telemedicine. The process for selecting studies followed a set protocol with two authors who independently appraised the studies.

Twenty-two articles were finally selected and analysed. We noted that the mechanisms and techniques to support behaviour changes were poorly reported and studied. There was no explanation of how these MHApps work and how they could be transferred or not. Indeed, the main efficacy conditions reported by authors refer to practical aspects of the tools. Moreover, the issue of social inequalities was essentially reduced to access to the technology (the shrinking access divide), and literacy was poorly studied, even though it is an important consideration in digital prevention. All in all, even when they dealt with behaviours, the evaluations were tool-focused rather than intervention-focused and did not allow a comprehensive assessment of MHApps.

To understand the added value of MHApps in supporting behaviour changes, it seems important to draw on the paradigms relating to health technology assessment considering the characteristics of the technologies and on the evaluation of complex interventions considering the characteristics of prevention. This combined approach may help to clarify how these patient-focused MHApps work and is a condition for improved assessment of MHApps in terms of effectiveness, transferability and scalability.

The full article can be downloaded below.  

Precision medicine in adult and pediatric obesity: a clinical perspective

It remains largely unknown as to why some individuals experience substantial weight loss with obesity interventions, while others receiving these same interventions do not. Person-specific characteristics likely play a significant role in this heterogeneity in treatment response. The practice of precision medicine accounts for an individual’s genes, environment, and lifestyle when deciding upon treatment type and intensity in order to optimize benefit and minimize risk. In this review, we first discuss biopsychosocial determinants of obesity, as understanding the complexity of this disease is necessary for appreciating how difficult it is to develop individualized treatment plans. Next, we present literature on person-specific characteristics associated with, and predictive of, weight loss response to various obesity treatments including lifestyle modification, pharmacotherapy, metabolic and bariatric surgery, and medical devices. Finally, we discuss important gaps in our understanding of the causes of obesity in relation to the suboptimal treatment outcomes in certain patients, and offer solutions that may lead to the development of more effective and targeted obesity therapies.

The full article can be downloaded below.  

Impact of Integrated Care on Patient-Related Outcomes Among Older People – A Systematic Review

This systematic review has explored multiple patient-related outcomes of integrated care targeting older people. The findings suggest that integrated care may have a positive impact on hospital admission rates in older age. Integrated care may also positively influence the length of hospital stay and possibly also patient satisfaction and readmission. In contrast, integrated care did not have an impact on mortality. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Whilst this review has tried to identify patient-related outcomes important in integrated care provided to older adults, further theory-based research is needed to assess the effect on these outcomes in integrated care settings.

The full article can be downloaded below.  

A systematic review of reasons for and against asking patients about their socioeconomic contexts

This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.

The full article can be downloaded below.  

Back to all news The Digital Doctor: The Next Big Leap in Healthcare

Technology has become increasingly important to the healthcare industry. Video chat allows patients to see a doctor in the comfort of their home; apps and wearable technology have revolutionized how health can be monitored. 

However, as technology’s role becomes clearer, so does the uncertainty around its regulations, efficacy, and access.  

Tabassum Salam, MD, American College of Physician (ACP) vice president for medical education, believes despite these clear challenges, telemedicine is here to stay.  

The full MD Magazine article can be viewed at this link.  

Physician burnout and medical breakthroughs: a patient’s story

I entered my doctor’s exam room worried about my health. I exited worried about his.

A lack of pressure when he placed the stethoscope over my heart. His ghost-eyed look when I spoke. His nearly inaudible voice. All of this registered as the most severe depletion of spirit — or what is sometimes and inadequately referred to as burnout — I’d seen in one of my doctors. And I’ve seen a lot of doctors over the years.

The full STAT article can be viewed at this link.  

Strong medicine is needed to solve America’s rural health crisis

The health care situation in rural America has gotten worse since my childhood. Rural Americans face serious health disparities because of the shortage of physicians and the resulting lack of access to care. According to the Centers for Disease Control and Prevention, rural residents are generally sicker and poorer than urban residents, and are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. Residents of rural areas who have cancer are diagnosed at later stages of the disease, have less access to clinical trials, worse outcomes, and spend 66% more time traveling to see cancer care providers.

The full STAT article can be viewed at this link.  

Mistrust And Lack Of Genetic Diversity Slow Gains In Precision Medicine

Precision medicine is the field of dreams for human health. Drugs and treatments that would take into account a person's individual DNA configurations, as well as lifestyle and environment, would presumably be better tailored to each person's needs. Still, while the goal of precision medicine is to help everybody, the current research available has a major flaw. It's largely based on the genes of people who are predominantly of white and European descent.

That's an issue with implications both ethically and scientifically, says anthropologist and bioethicist Sandra Soo-Jin Lee. She heads up Columbia University Medical Center's new Division of Ethics and is leading a $2.8 million study, funded by the National Human Genome Research Institute, that will look at precision medicine research at academic medical centers around the U.S. and help researchers figure out ways to expand the diversity of the genetics data gathered.

Lee recently wrote about ethics in personalized medicine research for Science magazine, and we spoke with her about why increasing diversity is important. The interview has been edited for length and clarity.

The full NPR article can be viewed at this link.