Analysis: Why Alexa’s Bedside Manner Is Bad For Health Care

Virtual communications have streamlined life and transformed many of our relationships for the better. There is little need anymore to sit across the desk from a tax accountant or travel agent or to stand in a queue for a bank teller. And there is certainly room for disruptive digital innovation in our confusing and overpriced health care system.

But it remains an open question whether virtual medicine will prove a valuable, convenient adjunct to health care. Or, instead, will it be a way for the U.S. profit-driven health care system to make big bucks by outsourcing core duties — while providing a paler version of actual medical treatment?

The full Kaiser Health News article can be found at this link.  

Stites and Pianykh, 2016

OBJECTIVE. Despite the long history of digital radiology, one of its most critical aspects—
information security—still remains extremely underdeveloped and poorly standardized.
To study the current state of radiology security, we explored the worldwide security of
medical image archives.
MATERIALS AND METHODS. Using the DICOM data-transmitting standard, we
implemented a highly parallel application to scan the entire World Wide Web of networked
computers and devices, locating open and unprotected radiology servers. We used only legal
and radiology-compliant tools. Our security-probing application initiated a standard DICOM
handshake to remote computer or device addresses, and then assessed their security posture
on the basis of handshake replies.
RESULTS. The scan discovered a total of 2774 unprotected radiology or DICOM servers
worldwide. Of those, 719 were fully open to patient data communications. Geolocation
was used to analyze and rank our findings according to country utilization. As a result, we
built maps and world ranking of clinical security, suggesting that even the most radiology-advanced
countries have hospitals with serious security gaps.
CONCLUSION. Despite more than two decades of active development and implementation,
our radiology data still remains insecure. The results provided should be applied to raise
awareness and begin an earnest dialogue toward elimination of the problem. The application
we designed and the novel scanning approach we developed can be used to identify security
breaches and to eliminate them before they are compromised.

Flexible collaboration infrastructures and healthcare information exchange in hospitals: an empirical resource-based perspective

Exchanging health information and data will enhance the efficiency, quality, cost-effectiveness, and even safety of healthcare practices. However, views and strategies differ on how hospitals can facilitate or enable this exchange process. This study explores a relationship between two constructs, i.e., a flexible collaboration infrastructure—an integrated set of IT assets and networking functionalities that support applications and enable business collaboration—and health information exchange. Second, we argue that the strength of this relationship is influenced by the degree to which hospitals deploy security measures. Findings—based on an SEM-PLS analysis on a sample of 983 European hospitals—show a positive relationship between the two constructs. We additionally find that hospitals’ security measures to protect the confidentiality, integrity, and availability of the data condition this particular relationship. Our findings contribute to the literature and provide valuable insights for hospitals.

The full article can be downloaded below. 

Personal Health Record Interoperability

Personal Health Records (PHRs) is a software application that allows patients to review their medical information remotely through a secure domain. There are four forms of PHRs which are; 1) self-contained Electronic Health Record (EHR), 2) self-contained EHR, 3) PHRs integrated care EHR controlled by health provider and partially by the patient/consumer, 4) PHRs integrated care EHR controlled by the patient/consumer. The methodology for this study was a literature review and semi-structure interview with a specialist in health information technology. Electronic databases used included PubMed, Academic Search Premier, EBSCOhost, LexisNexis and Google Scholar. A total of 38 sources were referenced. Currently, most PHRs are not integrated with other systems. Interoperability exists and has continued to grow steadily, but few individuals perceive the potential benefits of a PHR system including cost and quality of care. Regardless, the review has shown increased PHR use as well as MU adoption. Based on previous literature PHRs, although there has been imported accesses for patient portal as well as major saving for health care providers, the success rate of adoption is still low. The information gathered through semi-structure interview identified PHRs lack of interoperability in the nation and interoperability will not be achieved until the implementation of MU stage 3 by 2019. PHR interoperability has been presented to have significant ability to transform the way individuals have been able to access their PHRs and allowed for increased patient autonomy in the US.

The full article can be downloaded below.  

Deriving a practical framework for the evaluation of health apps

The rise of digital health, fuelled by access to smartphones and connectivity to apps, has resulted in a plethora of mobile technology-based innovations. The US Food and Drug Administration (FDA) estimates that in 2018, 1·7 billion people downloaded mobile health apps. With over 325000 to choose from across all health domains and many updating as frequently as every week, finding and keeping up with useful mental health apps is a challenge.

For patients and clinicians, picking the most suitable apps is difficult because of evolving evidence, emerging privacy risks, usability concerns, and the fact that apps constantly update and change. To help guide selection, people typically rely on the use of star rating systems and user reviews in app stores, despite strong evidence that such evaluation methods are misleading. 

The FDA has realised the diminished value of traditional evaluation approaches and the challenge of regulating apps. To solve this problem, the FDA has begun piloting a novel certification programme, PreCert, that shifts the scrutiny from the apps themselves to the developers. Despite this effort, the programme is nascent, with just nine companies partaking. The UK National Health Service has released a second version of its App Library as another solution.

In this void, numerous app evaluation frameworks have emerged. Although some frameworks have been published in peer-reviewed journals, many live in the grey literature. A systematic review examined existing evaluation frameworks for mobile medical apps, identifying 45 unique frameworks. Not surprisingly, the study found gaps in each framework. Given the obvious need for a more comprehensive evaluation framework, a novel approach is necessary.

We have reframed the app evaluation process away from picking the best-rated app and towards making an informed decision on the basis of clinically-relevant criteria. Just as no single best antidepressant or therapy exists, no single best app exists to treat all patients or mental illnesses. Clinical presentation, patient preferences, technology literacy, accessibility, and treatment goals are all important factors that determine the best course of care for any patient. Such factors must be considered when deciding what the most suitable app might be for a patient in any given situation.

The full article can be downloaded below.  

Beyond Mobile Health Apps

In a recent Next Avenue story, we examined the ubiquity of mobile health apps. Now, our focus shifts to a more expansive view about digital health technologies and on how these technologies are not only playing out today, but what their impact will be in the future.

The full Forbes article can be viewed at this link.  

Primary Care Physicians’ Knowledge, Attitudes, and Experience with Personal Genetic Testing

Primary care providers (PCPs) will play an important role in precision medicine. However, their lack of training and knowledge about genetics and genomics may limit their ability to advise patients or interpret or utilize test results. We evaluated PCPs’ awareness of the role of genetics/genomics in health, knowledge about key concepts in genomic medicine, perception/attitudes towards direct-to-consumer (DTC) genetic testing, and their level of confidence/comfort in discussing testing with patients prior to and after undergoing DTC testing through the 23andMe Health+ Ancestry Service. A total of 130 PCPs completed the study. Sixty-three percent were board-certified in family practice, 32% graduated between 1991 and 2000, and 88% had heard of 23andMe prior to the study. Seventy-two percent decided to participate in the study to gain a better understanding about testing. At baseline, 23% of respondents indicated comfort discussing genetics as a risk factor for common diseases, increasing to 59% after undergoing personal genetic testing (PGT) (p < 0.01). In summary, we find that undergoing PGT augments physicians’ confidence, comfort, and interest in DTC testing.

The full article can be downloaded below.  

The Big Word Holding Health Care Back: Interoperability

While interoperability has become routine in so many industries, it is one of the biggest challenges the health care industry faces right now. The lack of interoperable infrastructure prevents patients from being engaged, prevents providers from efficiently delivering care, and prevents health systems from operating more effectively as an organization. It’s the underlying problem that makes it difficult for the industry to adopt novel technologies.

How did we end up here? It's easy to blame technology vendors who gain market position by data blocking. It's also easy to throw the government under the bus and say they didn't do enough or, conversely, that the regulatory environment itself caused our current problems. The reality, in my view, is that there was, and still are, a lot of moving parts that contribute to the ongoing challenges. I'd like to dive into these factors to understand how a holistic approach should guide the way industry players, from patients to providers and payors to health systems, can solve the problem together in the years to come.

The full Forbes article can be viewed at this link.  

Telemedicine and Infectious Diseases Practice: A Leap Forward or a Step Back?

Infectious Diseases (ID) specialists pride themselves on performing a thorough history and physical exam, and developing a comprehensive diagnosis and management plan. A timely question is whether this tradition is at risk from the coming wave of telemedicine in clinical practice? It would not be if ID specialists embrace the changes ahead and leverage new technologies to enhance the efficiency and reach of their clinical practices. In this report, we highlight the opportunities and challenges offered by telemedicine for ID practice.

The full article can be downloaded below.  

Theories Predicting End-User Acceptance of Telemedicine Use: Systematic Review

Only a few telemedicine applications have made their way into regular care. One reason is the lack of acceptance of telemedicine by potential end users.

The aim of this systematic review was to identify theoretical predictors that influence the acceptance of telemedicine.

An electronic search was conducted in PubMed and PsycINFO in June 2018 and supplemented by a hand search. Articles were identified using predefined inclusion and exclusion criteria. In total, two reviewers independently assessed the title, abstract, and full-text screening and then individually performed a quality assessment of all included studies.

Out of 5917 potentially relevant titles (duplicates excluded), 24 studies were included. The Axis Tool for quality assessment of cross-sectional studies revealed a high risk of bias for all studies except for one study. The most commonly used models were the Technology Acceptance Model (n=11) and the Unified Theory of Acceptance and Use of Technology (n=9). The main significant predictors of acceptance were perceived usefulness (n=11), social influences (n=6), and attitude (n=6). The results show a superiority of technology acceptance versus original behavioral models.

The main finding of this review is the applicability of technology acceptance models and theories on telemedicine adoption. Characteristics of the technology, such as its usefulness, as well as attributes of the individual, such as his or her need for social support, inform end-user acceptance. Therefore, in the future, requirements of the target group and the group’s social environment should already be taken into account when planning telemedicine applications. The results support the importance of theory-guided user-centered design approaches to telemedicine development.

The full article can be downloaded below.