%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51098 %T Mapping Theories, Models, and Frameworks to Evaluate Digital Health Interventions: Scoping Review %A Rouleau,Geneviève %A Wu,Kelly %A Ramamoorthi,Karishini %A Boxall,Cherish %A Liu,Rebecca H %A Maloney,Shelagh %A Zelmer,Jennifer %A Scott,Ted %A Larsen,Darren %A Wijeysundera,Harindra C %A Ziegler,Daniela %A Bhatia,Sacha %A Kishimoto,Vanessa %A Steele Gray,Carolyn %A Desveaux,Laura %+ Nursing department, Université du Québec en Outaouais, 5, rue Saint-Joseph, Saint-Jérôme, QC, J7Z 0B7, Canada, 1 819 595 3900, genevieve.rouleau02@uqo.ca %K digital health interventions %K evaluation %K implementation %K integrated knowledge translation, theories %K models %K frameworks %K scoping review %D 2024 %7 5.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations. Objective: This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users. Methods: This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid). Results: A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52). Conclusions: As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven. %M 38315515 %R 10.2196/51098 %U https://www.jmir.org/2024/1/e51098 %U https://doi.org/10.2196/51098 %U http://www.ncbi.nlm.nih.gov/pubmed/38315515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49173 %T Experiences and Outcomes of Using e-Prescribing for Opioids: Rapid Scoping Review %A Guilcher,Sara J T %A Cimino,Stephanie R %A Tadrous,Mina %A McCarthy,Lisa M %A Riad,Jessica %A Tricco,Andrea C %A Hagens,Simon %A Lien,Jennifer %A Tharmalingam,Sukirtha %A Gomes,Tara %+ Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON, M5S3M2, Canada, 1 4169467020, sara.guilcher@utoronto.ca %K e-prescribing %K opioid prescription %K opioid use %K rapid scoping review %D 2023 %7 28.12.2023 %9 Review %J J Med Internet Res %G English %X Background: e-Prescribing is designed to assist in facilitating safe and appropriate prescriptions for patients. Currently, it is unknown to what extent e-prescribing for opioids influences experiences and outcomes. To address this gap, a rapid scoping review was conducted. Objective: This rapid scoping review aims to (1) explore how e-prescribing has been used clinically; (2) examine the effects of e-prescribing on clinical outcomes, the patient or clinician experience, service delivery, and policy; and (3) identify current gaps in the present literature to inform future studies and recommendations. Methods: A rapid scoping review was conducted following the guidance of the JBI 2020 scoping review methodology and the World Health Organization guide to rapid reviews. A comprehensive literature search was completed by an expert librarian from inception until November 16, 2022. Three databases were electronically searched: MEDLINE (Ovid), Embase (Ovid), and Scopus (Elsevier). The search criteria were as follows: (1) e-prescribing programs targeted to the use or misuse of opioids, including those that were complemented or accompanied by clinically focused initiatives, and (2) a primary research study of experimental, quasi-experimental, observational, qualitative, or mixed methods design. An additional criterion of an ambulatory component of e-prescribing (eg, e-prescribing occurred upon discharge from acute care) was added at the full-text stage. No language limitations or filters were applied. All articles were double screened by trained reviewers. Gray literature was manually searched by a single reviewer. Data were synthesized using a descriptive approach. Results: Upon completing screening, 34 articles met the inclusion criteria: 32 (94%) peer-reviewed studies and 2 (6%) gray literature documents (1 thesis study and 1 report). All 33 studies had a quantitative component, with most highlighting e-prescribing from acute care settings to community settings (n=12, 36%). Only 1 (3%) of the 34 articles provided evidence on e-prescribing in a primary care setting. Minimal prescriber, pharmacist, and clinical population characteristics were reported. The main outcomes identified were related to opioid prescribing rates, alerts (eg, adverse drug events and drug-drug interactions), the quantity and duration of opioid prescriptions, the adoption of e-prescribing technology, attitudes toward e-prescribing, and potential challenges with the implementation of e-prescribing into clinical practice. e-Prescribing, including key features such as alerts and dose order sets, may reduce prescribing errors. Conclusions: This rapid scoping review highlights initial promising results with e-prescribing and opioid therapy management. It is important that future work explores the experience of prescribers, pharmacists, and patients using e-prescribing for opioid therapy management with an emphasis on prescribers in the community and primary care. Developing a common set of quality indicators for e-prescribing of opioids will help build a stronger evidence base. Understanding implementation considerations will be of importance as the technology is integrated into clinical practice and health systems. %M 38153776 %R 10.2196/49173 %U https://www.jmir.org/2023/1/e49173 %U https://doi.org/10.2196/49173 %U http://www.ncbi.nlm.nih.gov/pubmed/38153776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42507 %T Patient Perspectives and Preferences for Consent in the Digital Health Context: State-of-the-art Literature Review %A Kassam,Iman %A Ilkina,Daria %A Kemp,Jessica %A Roble,Heba %A Carter-Langford,Abigail %A Shen,Nelson %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, nelson.shen@camh.ca %K consent %K electronic consent %K eConsent %K personal health information %K patient engagement %K digital health %K health IT %K privacy %K eHealth %K data sharing %K artificial intelligence %D 2023 %7 10.2.2023 %9 Review %J J Med Internet Res %G English %X Background: The increasing integration of digital health tools into care may result in a greater flow of personal health information (PHI) between patients and providers. Although privacy legislation governs how entities may collect, use, or share PHI, such legislation has not kept pace with digital health innovations, resulting in a lack of guidance on implementing meaningful consent. Understanding patient perspectives when implementing meaningful consent is critical to ensure that it meets their needs. Consent for research in the context of digital health is limited. Objective: This state-of-the-art review aimed to understand the current state of research as it relates to patient perspectives on digital health consent. Its objectives were to explore what is known about the patient perspective and experience with digital health consent and provide recommendations on designing and implementing digital health consent based on the findings. Methods: A structured literature search was developed and deployed in 4 electronic databases—MEDLINE, IEEE Xplore, Scopus, and Web of Science—for articles published after January 2010. The initial literature search was conducted in March 2021 and updated in March 2022. Articles were eligible for inclusion if they discussed electronic consent or consent, focused on the patient perspective or preference, and were related to digital health or digital PHI. Data were extracted using an extraction template and analyzed using qualitative content analysis. Results: In total, 75 articles were included for analysis. Most studies were published within the last 5 years (58/75, 77%) and conducted in a clinical care context (33/75, 44%) and in the United States (48/75, 64%). Most studies aimed to understand participants’ willingness to share PHI (25/75, 33%) and participants’ perceived usability and comprehension of an electronic consent notice (25/75, 33%). More than half (40/75, 53%) of the studies did not describe the type of consent model used. The broad open consent model was the most explored (11/75, 15%). Of the 75 studies, 68 (91%) found that participants were willing to provide consent; however, their consent behaviors and preferences were context-dependent. Common patient consent requirements included clear and digestible information detailing who can access PHI, for what purpose their PHI will be used, and how privacy will be ensured. Conclusions: There is growing interest in understanding the patient perspective on digital health consent in the context of providing clinical care. There is evidence suggesting that many patients are willing to consent for various purposes, especially when there is greater transparency on how the PHI is used and oversight mechanisms are in place. Providing this transparency is critical for fostering trust in digital health tools and the innovative uses of data to optimize health and system outcomes. %M 36763409 %R 10.2196/42507 %U https://www.jmir.org/2023/1/e42507 %U https://doi.org/10.2196/42507 %U http://www.ncbi.nlm.nih.gov/pubmed/36763409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39662 %T Determinants of e-Mental Health Use During COVID-19: Cross-sectional Canadian Study %A Yu,Ellie %A Xu,Bowen %A Sequeira,Lydia %+ Canada Health Infoway, 150 King St W, Ste 1300, Toronto, ON, M5H 1J9, Canada, 1 4163039181, lsequeira@infoway-inforoute.ca %K digital health %K mental health %K e-Mental health %K user profile %K determinants %K health service %K use %K utilization %K COVID-19 %K pandemic %K Canada %K users %K factors %D 2022 %7 16.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Access to mental health treatment across Canada remains a challenge, with many reporting unmet care needs. National and provincial e-Mental health (eMH) programs have been developed over the past decade across Canada, with many more emerging during COVID-19 in an attempt to reduce barriers related to geography, isolation, transportation, physical disability, and availability. Objective: The aim of this study was to identify factors associated with the utilization of eMH services across Canada during the COVID-19 pandemic using Andersen and Newman’s framework of health service utilization. Methods: This study used data gathered from the 2021 Canadian Digital Health Survey, a cross-sectional, web-based survey of 12,052 Canadians aged 16 years and older with internet access. Bivariate associations between the use of eMH services and health service utilization factors (predisposing, enabling, illness level) of survey respondents were assessed using χ2 tests for categorical variables and t tests for the continuous variable. Logistic regression was used to predict the probability of using eMH services given the respondents’ predisposing, enabling, and illness-level factors while adjusting for respondents’ age and gender. Results: The proportion of eMH service users among survey respondents was small (883/12,052, 7.33%). Results from the logistic regression suggest that users of eMH services were likely to be those with regular family physician access (odds ratio [OR] 1.57, P=.02), living in nonrural communities (OR 1.08, P<.001), having undergraduate (OR 1.40, P=.001) or postgraduate (OR 1.48, P=.003) education, and being eHealth literate (OR 1.05, P<.001). Those with lower eMH usage were less likely to speak English at home (OR 0.06, P<.001). Conclusions: Our study provides empirical evidence on the impact of individual health utilization factors on the use of eMH among Canadians during the COVID-19 pandemic. Given the opportunities and promise of eMH services in increasing access to care, future digital interventions should both tailor themselves toward users of these services and consider awareness campaigns to reach nonusers. Future research should also focus on understanding the reasons behind the use and nonuse of eMH services. %M 36191173 %R 10.2196/39662 %U https://www.jmir.org/2022/11/e39662 %U https://doi.org/10.2196/39662 %U http://www.ncbi.nlm.nih.gov/pubmed/36191173 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e30986 %T Foundations for Meaningful Consent in Canada’s Digital Health Ecosystem: Retrospective Study %A Shen,Nelson %A Kassam,Iman %A Zhao,Haoyu %A Chen,Sheng %A Wang,Wei %A Wickham,Sarah %A Strudwick,Gillian %A Carter-Langford,Abigail %+ Centre for Complex Interventions, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, nelson.shen@camh.ca %K consent %K eConsent %K privacy %K trust %K digital health %K health information exchange %K patient perspective %K health informatics %K Canada %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Canadians are increasingly gaining web-based access to digital health services, and they expect to access their data from these services through a central patient access channel. Implementing data sharing between these services will require patient trust that is fostered through meaningful consent and consent management. Understanding user consent requirements and information needs is necessary for developing a trustworthy and transparent consent management system. Objective: The objective of this study is to explore consent management preferences and information needs to support meaningful consent. Methods: A secondary analysis of a national survey was conducted using a retrospective descriptive study design. The 2019 cross-sectional survey used a series of vignettes and consent scenarios to explore Canadians’ privacy perspectives and preferences regarding consent management. Nonparametric tests and logistic regression analyses were conducted to identify the differences and associations between various factors. Results: Of the 1017 total responses, 716 (70.4%) participants self-identified as potential users. Of the potential users, almost all (672/716, 93.8%) felt that the ability to control their data was important, whereas some (385/716, 53.8%) believed that an all or none control at the data source level was adequate. Most potential users preferred new data sources to be accessible by health care providers (546/716, 76.3%) and delegated parties (389/716, 54.3%) by default. Prior digital health use was associated with greater odds of granting default access when compared with no prior use, with the greatest odds of granting default access to digital health service providers (odds ratio 2.17, 95% CI 1.36-3.46). From a list of 9 information elements found in consent forms, potential users selected an average of 5.64 (SD 2.68) and 5.54 (SD 2.85) items to feel informed in consenting to data access by care partners and commercial digital health service providers, respectively. There was no significant difference in the number of items selected between the 2 scenarios (P>.05); however, there were significant differences (P<.05) in information types that were selected between the scenarios. Conclusions: A majority of survey participants reported that they would register and use a patient access channel and believed that the ability to control data access was important, especially as it pertains to access by those outside their care. These findings suggest that a broad all or none approach based on data source may be accepted; however, approximately one-fifth of potential users were unable to decide. Although vignettes were used to introduce the questions, this study showed that more context is required for potential users to make informed consent decisions. Understanding their information needs will be critical, as these needs vary with the use case, highlighting the importance of prioritizing and tailoring information to enable meaningful consent. %M 35357318 %R 10.2196/30986 %U https://medinform.jmir.org/2022/3/e30986 %U https://doi.org/10.2196/30986 %U http://www.ncbi.nlm.nih.gov/pubmed/35357318 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e33586 %T Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses %A Beauséjour,Waldo %A Hagens,Simon %+ Canada Health Infoway, 150 King St W, Toronto, ON, M5H 1J9, Canada, 1 416 595 3449 ext 3421, wbeausejour@infoway-inforoute.ca %K adoption of virtual care %K secure messaging %K nurses %K nursing %K telehealth %K telehomecare %K telemonitoring %K remote patient monitoring %K virtual videoconferencing %K uptake of virtual care %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. Objective: This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. Methods: We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. Results: In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record–keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses’ perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (χ24=308.7; P<.001) and knowledge (χ24=283.4; P<.001) to use these technologies. Conclusions: This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record–keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery. %M 35357326 %R 10.2196/33586 %U https://nursing.jmir.org/2022/1/e33586 %U https://doi.org/10.2196/33586 %U http://www.ncbi.nlm.nih.gov/pubmed/35357326 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 1 %P e35221 %T Socioeconomic Disparities in the Demand for and Use of Virtual Visits Among Senior Adults During the COVID-19 Pandemic: Cross-sectional Study %A Yu,Ellie %A Hagens,Simon %+ Canada Health Infoway, 150 King Street Unit 1300, Toronto, ON, M5H 1J9, Canada, 1 6476406189, ellieyuyaoyu@gmail.com %K virtual care %K virtual visit %K COVID-19 %K survey %K virtual care demand %K virtual care use %K older adults %K elderly care %K aging %K digital health %K pandemic %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic has limited the provision of in-person care and accelerated the need for virtual care. Older adults (65+ years) were 1 of the highest user groups of in-person health care services prior to the pandemic. Social distancing guidelines and high rates of mortality from coronavirus infections among older adults made receiving in-person health care services challenging for older adults. The provision of virtual care technologies can help to ensure continuity of care and provide essential health care services during the pandemic to those at high risk of contracting the COVID-19 coronavirus, including older adults. It is also essential to understand and address potential socioeconomic, demographic, and health disparities in the demand for and use of virtual care technologies among older adults. Objective: The objective of this study is to investigate socioeconomic disparities in the demand for and use of virtual visits during the COVID-19 pandemic among older adults in Canada. Methods: A cross-sectional web survey was conducted with 12,052 Canadians over the age of 16 years, selected from Leger’s Léger Opinion panel from July 14 to August 6, 2021. Associations between socioeconomic factors and the demand for and use of virtual visits were tested using χ2 tests and logistic regression models for telephone visits, video visits, and secure messaging. Weighting was applied using the 2016 census reference variables to render a representative sample of the Canadian population. Results: A total of 2303 older adults were surveyed. Older adults expressed the highest demand for and use of telephone visits, following by video visits and secure messaging. eHealth literacy was positively associated with the use of all 3 virtual care modalities. Higher income was negatively associated with the use of video visits (odds ratio [OR] 0.65, 95% CI 0.428-0.974, P=.03). Having no private insurance coverage was negatively associated with use of secure messaging (OR 0.73, 95% CI 0.539-0.983, P=.04), but living in a rural community (OR 0.172, 95% CI 1.12-2.645, P=.01) and being born outside of Canada (OR 0.150, 95% CI 1.041-2.173, P=.03) were positively associated with the use of secure messaging. Higher education (OR 0.078, 95% CI 0.633-0.97, P=.02) and being non-White (OR=0.054, 95% CI 0.312-0.92, P=.02) were negatively associated with the use of the telephone. Conclusions: This study found that compared to video visits and secure messaging, the demand for and use of telephone visits were more prevalent among older adults during the pandemic. The gaps between the demand for and use of video and secure messaging services remain substantial. Our results highlight socioeconomic disparities among older adults that could potentially explain this trend. Lower income and a lower education level may act as barriers for older adults in acquiring the skills and technologies necessary to use more complex solutions, such as video and secure messaging. In addition, higher eHealth literacy was found to be critical for older adults to successfully navigate all types of virtual visit technologies. %M 35134746 %R 10.2196/35221 %U https://aging.jmir.org/2022/1/e35221 %U https://doi.org/10.2196/35221 %U http://www.ncbi.nlm.nih.gov/pubmed/35134746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e25863 %T Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice %A Hyman,Antonia %A Stacy,Elizabeth %A Mohsin,Humaira %A Atkinson,Kaitlin %A Stewart,Kurtis %A Novak Lauscher,Helen %A Ho,Kendall %+ Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, 3rd Floor (Blusson Spinal Cord Centre), 818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048228757, kurtis.stewart@ubc.ca %K immigrants %K community-based participatory action research %K eHealth %K delivery of health care %K photovoice %K South Asian %K digital health %K mobile phone %D 2022 %7 13.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: South Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors. Objective: The aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada. Methods: This study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics. Results: A total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools. Conclusions: The results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences. %M 35023842 %R 10.2196/25863 %U https://www.jmir.org/2022/1/e25863 %U https://doi.org/10.2196/25863 %U http://www.ncbi.nlm.nih.gov/pubmed/35023842 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28981 %T Patient Perspectives on the Digitization of Personal Health Information in the Emergency Department: Mixed Methods Study During the COVID-19 Pandemic %A Ly,Sophia %A Tsang,Ricky %A Ho,Kendall %+ Faculty of Medicine, University of British Columbia, 3312-818 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada, 1 6048220327, sophia.ly@alumni.ubc.ca %K emergency medicine %K digital health %K health informatics %K electronic health record %K patient portal %K patient-physician relationship %K COVID-19 %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although the digitization of personal health information (PHI) has been shown to improve patient engagement in the primary care setting, patient perspectives on its impact in the emergency department (ED) are unknown. Objective: The primary objective was to characterize the views of ED users in British Columbia, Canada, on the impacts of PHI digitization on ED care. Methods: This was a mixed methods study consisting of an online survey followed by key informant interviews with a subset of survey respondents. ED users in British Columbia were asked about their ED experiences and attitudes toward PHI digitization in the ED. Results: A total of 108 participants submitted survey responses between January and April 2020. Most survey respondents were interested in the use of electronic health records (79/105, 75%) and patient portals (91/107, 85%) in the ED and were amenable to sharing their ED PHI with ED staff (up to 90% in emergencies), family physicians (up to 91%), and family caregivers (up to 75%). In addition, 16 survey respondents provided key informant interviews in August 2020. Interviewees expected PHI digitization in the ED to enhance PHI access by health providers, patient-provider relationships, patient self-advocacy, and postdischarge care management, although some voiced concerns about patient privacy risk and limited access to digital technologies (eg, smart devices, internet connection). Many participants thought the COVID-19 pandemic could provide momentum for the digitization of health care. Conclusions: Patients overwhelmingly support PHI digitization in the form of electronic health records and patient portals in the ED. The COVID-19 pandemic may represent a critical moment for the development and implementation of these tools. %M 34818211 %R 10.2196/28981 %U https://medinform.jmir.org/2022/1/e28981 %U https://doi.org/10.2196/28981 %U http://www.ncbi.nlm.nih.gov/pubmed/34818211 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25797 %T Closing the Virtual Gap in Health Care: A Series of Case Studies Illustrating the Impact of Embedding Evaluation Alongside System Initiatives %A Desveaux,Laura %A Budhwani,Suman %A Stamenova,Vess %A Bhattacharyya,Onil %A Shaw,James %A Bhatia,R Sacha %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 4302, laura.desveaux@thp.ca %K virtual care %K primary care %K embedded research %K implementation %K knowledge exchange %K health policy %D 2021 %7 3.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X Early decisions relating to the implementation of virtual care relied on necessity and clinical judgement, but there is a growing need for the generation of evidence to inform policy and practice designs. The need for stronger partnerships between researchers and decision-makers is well recognized, but how these partnerships can be structured and how research can be embedded alongside existing virtual care initiatives remain unclear. We present a series of case studies that illustrate how embedded research can inform policy decisions related to the implementation of virtual care, where decisions are either to (1) discontinue (red light), (2) redesign (yellow light), or (3) scale up existing initiatives (green light). Data were collected through document review and informal interviews with key study personnel. Case 1 involved an evaluation of a mobile diabetes platform that demonstrated a mismatch between the setting and the technology (decision outcome: discontinue). Case 2 involved an evaluation of a mental health support platform that suggested evidence-based modifications to the delivery model (decision outcome: redesign). Case 3 involved an evaluation of video visits that generated evidence to inform the ideal model of implementation at scale (decision outcome: scale up). In this paper, we highlight the characteristics of the partnership and the process that enabled success and use the cases to illustrate how these characteristics were operationalized. Structured communication included monthly check-ins and iterative report development. We also outline key characteristics of the partnership (ie, trust and shared purpose) and the process (ie, timeliness, tailored reporting, and adaptability) that drove the uptake of evidence in decision-making. Across each case, the evaluation was designed to address policy questions articulated by our partners. Furthermore, structured communication provided opportunities for knowledge mobilization. Structured communication was operationalized through monthly meetings as well as the delivery of interim and final reports. These case studies demonstrate the importance of partnering with health system decision-makers to generate and mobilize scientific evidence. Embedded research partnerships founded on a shared purpose of system service provided an effective strategy to bridge the oft-cited gap between science and policy. Structured communication provided a mechanism for collaborative problem-solving and real-time feedback, and it helped contextualize emerging insights. %M 34477560 %R 10.2196/25797 %U https://www.jmir.org/2021/9/e25797 %U https://doi.org/10.2196/25797 %U http://www.ncbi.nlm.nih.gov/pubmed/34477560 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24509 %T Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre–Post Study %A Ho,Kendall %A Novak Lauscher,Helen %A Cordeiro,Jennifer %A Hawkins,Nathaniel %A Scheuermeyer,Frank %A Mitton,Craig %A Wong,Hubert %A McGavin,Colleen %A Ross,Dianne %A Apantaku,Glory %A Karim,Mohammad Ehsan %A Bhullar,Amrit %A Abu-Laban,Riyad %A Nixon,Suzanne %A Smith,Tyler %+ Digital Emergency Medicine, University of British Columbia, 818 West 10th Avenue, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 822 0327, kendall.ho@ubc.ca %K telemonitoring %K heart failure %K home health monitoring %K technology %K telehealth %K emergency care %K community care %K emergency department %K quality of life %K self-efficacy %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. Objective: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. Methods: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient’s condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. Results: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. Conclusions: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. Trial Registration: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384 %M 34081015 %R 10.2196/24509 %U https://formative.jmir.org/2021/6/e24509 %U https://doi.org/10.2196/24509 %U http://www.ncbi.nlm.nih.gov/pubmed/34081015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20621 %T Patient Care During the COVID-19 Pandemic: Use of Virtual Care %A Wong,Andy %A Bhyat,Rashaad %A Srivastava,Siddhartha %A Boissé Lomax,Lysa %A Appireddy,Ramana %+ Division of Neurology, Queen's University, 76 Stuart Street, Connell 7, Kingston, ON, K7L 2V7, Canada, 1 6135482472, mrra@queensu.ca %K virtual care %K teleneurology %K telemedicine %K medical informatics %K internet %K patient-physician relationship %K email %K digital health %D 2021 %7 21.1.2021 %9 Viewpoint %J J Med Internet Res %G English %X Virtual care, the use of videoconferencing technology to connect with patients, has become critical in providing continuing care for patients during the current COVID-19 pandemic. Virtual care has now been adopted by health care providers across the spectrum, including physicians, residents, nurse practitioners, nurses, and allied health care professionals. Virtual care is novel and nuanced compared to in-person care. Most of the health care providers who are delivering or expected to deliver virtual care have little to no prior experience with it. The nuances of virtual care involve regulatory standards, platforms, technology and troubleshooting, patient selection, etiquette, and workflow, all of which comprise critical points in the provision of health care. It is important to consistently deliver high-quality, equitable, and professional virtual care to inspire patients with the trust they need to continue follow-up of their care in these difficult times. We have been adopting virtual care in our clinical practice for over two years. In partnership with Canada Health Infoway, we have assembled a primer for virtual care that can serve as a guide for any health care provider in Canada and globally, with the goal of providing seamless transitions between in-person and virtual care. %M 33326410 %R 10.2196/20621 %U https://www.jmir.org/2021/1/e20621 %U https://doi.org/10.2196/20621 %U http://www.ncbi.nlm.nih.gov/pubmed/33326410 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e13734 %T Home Virtual Visits for Outpatient Follow-Up Stroke Care: Cross-Sectional Study %A Appireddy,Ramana %A Khan,Sana %A Leaver,Chad %A Martin,Cally %A Jin,Albert %A Durafourt,Bryce A %A Archer,Stephen L %+ Division of Neurology, Department of Medicine, Kingston Health Sciences Centre, Kingston General Hospital, Connell 7, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada, 1 613 549 6666 ext 6320, mrra@queensu.ca %K telemedicine %K eHealth %K eVisit %K mobile health %K health services accessibility %D 2019 %7 7.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Timely, in-person access to health care is a challenge for people living with conditions such as stroke that result in frailty, loss of independence, restrictions in driving and mobility, and physical and cognitive decline. In Southeastern Ontario, access is further complicated by rurality and the long travel distances to visit physician clinics. There is a need to make health care more accessible and convenient. Home virtual visits (electronic visits, eVisits) can conveniently connect physicians to patients. Physicians use a secure personal videoconferencing tool to connect to patients in their homes. Patients use their device of choice (smartphone, tablet, laptop, or desktop) for the visit. Objective: This study aimed to assess the feasibility and logistics of implementing eVisits in a stroke prevention clinic for seniors. Methods: A 6-month eVisit pilot study was initiated in the Kingston Health Sciences Centre stroke prevention clinic in August 2018. eVisits were used only for follow-up patient encounters. An integrated evaluation was used to test the impact of the program on clinic workflow and patient satisfaction. Patient satisfaction was evaluated by telephone interviews, using a brief questionnaire. Access and patient satisfaction metrics were compared with concurrent standard of care (patients’ prior personal experience with in-person visits). Values are presented as median (interquartile range). Results: There were 75 subjects in the pilot. The patients were aged 65 (56-73.5) years, and 39% (29/75) resided in rural areas. There was a shorter wait for an appointment by eVisit versus in-person (mean 59.98 [SD 48.36] days vs mean 78.36 [SD 50.54] days; P<.001). The eVisit was also shorter, taking on an average of only 10 min to deliver follow-up care with a high degree of patient satisfaction versus 90 (60-112) min for in-person care. The total time saved by patients per eVisit was 80 (50-102) min, 44 (21-69) min of which was travel time. Travel distance avoided by the patients was 30.1 km (11.2-82.2). The estimated total out-of-pocket cost savings for patients per eVisit was Can $52.83 (31.26-94.53). The estimated savings (opportunity cost for in-person outpatient care) for our eVisit pilot project was Can $23,832-$28,584. The patient satisfaction with eVisits was very good compared with their prior personal experience with in-person outpatient care. Conclusions: The eVisit program was well received by patients, deemed to be safe by physicians, and avoided unnecessary patient travel and expense. It also has the potential to reduce health care costs. We plan to scale the project within the department and the institution. %M 31593536 %R 10.2196/13734 %U https://www.jmir.org/2019/10/e13734 %U https://doi.org/10.2196/13734 %U http://www.ncbi.nlm.nih.gov/pubmed/31593536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12277 %T Valuing Citizen Access to Digital Health Services: Applied Value-Based Outcomes in the Canadian Context and Tools for Modernizing Health Systems %A Hackett,Christina %A Brennan,Kelsey %A Smith Fowler,Heather %A Leaver,Chad %+ Social Research and Demonstration Corporation, 55 Murray St, Suite 400, Ottawa, ON, K1N5M3, Canada, 1 6132374312, chackett@srdc.org %K personal health records %K patient portals %K electronic health records %K patient engagement %K health care costs %K cost of illness %K economic evaluation %D 2019 %7 06.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In publicly funded health systems, digital health technologies are strategies that aim to improve the quality and safety of health care service delivery and enhance patient experiences and outcomes. In Canada, governments and health organizations have invested in digital health technologies such as personal health records (PHRs) and other electronic service functionalities and innovation across provincial and territorial health systems. Objective: Patients’ access to their own information via secure, Web-based PHRs and integrated virtual care services are promising mechanisms for supporting patient engagement in health care. We draw on current evidence to develop an economic model that estimates the demonstrated and potential value of these digital health initiatives. Methods: We first synthesized results from a variety of Canadian and international studies on the outcomes for patients and service providers associated with PHRs across a continuum of services, ranging from viewing information (eg, laboratory results) on the Web to electronic prescription renewal to email or video conferencing with care teams and providers. We then developed a quantitative model of estimated value, grounded in these demonstrated benefits and citizen use (2016-2017). In addition to estimating the costs saved from patient and system perspectives, we used a novel application of a compensating differential approach to assess the value (independent of costs) to society of improved health and well-being resulting from PHR use. Results: Patients’ access to a range of digital PHR functions generated value for Canadians and health systems by increasing health system productivity, and improving access to and quality of health care provided. As opportunities increased to interact and engage with health care providers via PHR functions, the marginal value generated by utilization of PHR functionalities also increased. Web-based prescription renewal generated the largest share of the total current value from the patient perspective. From the health systems perspective, Canadians’ ability to view their information on the Web was the largest value share. If PHRs were to be implemented with more integrated virtual care services, the value generated from populations with chronic illnesses such as severe and persistent mental illness and diabetes could amount to between Can $800 million and Can $1 billion per year across Canadian health systems. Conclusions: PHRs with higher interactivity could yield substantial potential value from wider implementation in Canada and increased adoption rates in certain target groups—namely, high-frequency health system users and their caregivers. Further research is needed to tie PHR use to health outcomes across PHR functions, care settings, and patient populations. %M 31172965 %R 10.2196/12277 %U https://www.jmir.org/2019/6/e12277/ %U https://doi.org/10.2196/12277 %U http://www.ncbi.nlm.nih.gov/pubmed/31172965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e10838 %T A Web-Based Mental Health Platform for Individuals Seeking Specialized Mental Health Care Services: Multicenter Pragmatic Randomized Controlled Trial %A Hensel,Jennifer M %A Shaw,James %A Ivers,Noah M %A Desveaux,Laura %A Vigod,Simone N %A Cohen,Ashley %A Onabajo,Nike %A Agarwal,Payal %A Mukerji,Geetha %A Yang,Rebecca %A Nguyen,Megan %A Bouck,Zachary %A Wong,Ivy %A Jeffs,Lianne %A Jamieson,Trevor %A Bhatia,R Sacha %+ Women's College Institute for Health Systems Solutions and Virtual Care, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 5126, jennifer.hensel@wchospital.ca %K internet %K mental health %K anxiety %K depression %D 2019 %7 04.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based self-directed mental health applications are rapidly emerging to address health service gaps and unmet needs for information and support. Objective: The aim of this study was to determine if a multicomponent, moderated Web-based mental health application could benefit individuals with mental health symptoms severe enough to warrant specialized mental health care. Methods: A multicenter, pragmatic randomized controlled trial was conducted across several outpatient mental health programs affiliated with 3 hospital programs in Ontario, Canada. Individuals referred to or receiving treatment, aged 16 years or older, with access to the internet and an email address, and having the ability to navigate a Web-based mental health application were eligible. A total of 812 participants were randomized 2:1 to receive immediate (immediate treatment group, ITG) or delayed (delayed treatment group, DTG) access for 3 months to the Big White Wall (BWW), a multicomponent Web-based mental health intervention based in the United Kingdom and New Zealand. The primary outcome was the total score on the Recovery Assessment Scale, revised (RAS-r) which measures mental health recovery. Secondary outcomes were total scores on the Patient Health Questionnaire-9 item (PHQ-9), the Generalized Anxiety Disorder Questionnaire-7 item (GAD-7), the EuroQOL 5-dimension quality of life questionnaire (EQ-5D-5L), and the Community Integration Questionnaire. An exploratory analysis examined the association between actual BWW use (categorized into quartiles) and outcomes among study completers. Results: Intervention participants achieved small, statistically significant increases in adjusted RAS-r score (4.97 points, 95% CI 2.90 to 7.05), and decreases in PHQ-9 score (−1.83 points, 95% CI −2.85 to −0.82) and GAD-7 score (−1.55 points, 95% CI −2.42 to −0.70). Follow-up was achieved for 55% (446/812) at 3 months, 48% (260/542) of ITG participants and 69% (186/270) of DTG participants. Only 58% (312/542) of ITG participants logged on more than once. Some higher BWW user groups had significantly greater improvements in PHQ-9 and GAD-7 relative to the lowest use group. Conclusions: The Web-based application may be beneficial; however, many participants did not engage in an ongoing way. This has implications for patient selection and engagement as well as delivery and funding structures for similar Web-based interventions. Trial Registration: ClinicalTrials.gov NCT02896894; https://clinicaltrials.gov/ct2/show/NCT02896894 (Archived by WebCite at http://www.webcitation.org/78LIpnuRO) %M 31165710 %R 10.2196/10838 %U https://www.jmir.org/2019/6/e10838/ %U https://doi.org/10.2196/10838 %U http://www.ncbi.nlm.nih.gov/pubmed/31165710 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e9720 %T Uptake and Scalability of a Peritoneal Dialysis Virtual Care Solution: Qualitative Study %A Jeffs,Lianne %A Jamieson,Trevor %A Saragosa,Marianne %A Mukerji,Geetha %A Jain,Arsh K %A Man,Rachel %A Desveaux,Laura %A Shaw,James %A Agarwal,Payal %A Hensel,Jennifer M %A Maione,Maria %A Onabajo,Nike %A Nguyen,Megan %A Bhatia,R %+ Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 600 University Avenue, Toronto, ON, M5G 1X5, Canada, 1 4165221052, lianne.jeffs@sinaihealthsystem.ca %K virtual care solutions %K peritoneal dialysis %K qualitative research %K patient-centric care %K chronic kidney disease %D 2019 %7 16.04.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Early research in the area of virtual care solutions with peritoneal dialysis (PD) patients has focused on evaluating the outcomes and impact of these solutions. There has been less attention focused on understanding the factors influencing the uptake, usability, and scalability of virtual care for chronic kidney disease (CKD) patients receiving PD at home. Objective: In this context, a study was undertaken to (1) assess and understand the factors influencing the uptake of a virtual care solution and (2) provide recommendations for the scalability of a virtual care solution aimed at enhancing CKD patients’ outcomes and experiences. Methods: This study used a qualitative design with semistructured interviews and a thematic analysis approach. A total of 25 stakeholders—6 patients and 3 caregivers, 6 health care providers, 2 vendors, and 8 health system decision makers—participated in this study. Results: The following three primary mechanisms emerged to influence the usability of the virtual care solution: (1) receiving hands-on training and ongoing communication from a supportive team, (2) adapting to meet user needs and embedding them into workflow, and (3) being influenced by patient and caregiver characteristics. Further, two overarching recommendations were developed for considerations around scalability: (1) co-design locally, embed into the daily workflow, and deploy over time and (2) share the benefits and build the case. Conclusions: Study findings can be used by key stakeholders in their future efforts to enhance the implementation, uptake, and scalability of virtual care solutions for CKD and managing PD at home. %M 30990460 %R 10.2196/humanfactors.9720 %U https://humanfactors.jmir.org/2019/2/e9720/ %U https://doi.org/10.2196/humanfactors.9720 %U http://www.ncbi.nlm.nih.gov/pubmed/30990460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10321 %T Mobile App for Improved Self-Management of Type 2 Diabetes: Multicenter Pragmatic Randomized Controlled Trial %A Agarwal,Payal %A Mukerji,Geetha %A Desveaux,Laura %A Ivers,Noah M %A Bhattacharyya,Onil %A Hensel,Jennifer M %A Shaw,James %A Bouck,Zachary %A Jamieson,Trevor %A Onabajo,Nike %A Cooper,Madeline %A Marani,Husayn %A Jeffs,Lianne %A Bhatia,R Sacha %+ Women’s College Hospital Institute for Health System Solutions and Virtual Care, Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, payal.agarwal@wchospital.ca %K mobile apps %K diabetes mellitus, type 2 %K self-management %K blood glucose self-monitoring %K randomized controlled trial %K pragmatic clinical trial %D 2019 %7 10.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the increasing prevalence of type 2 diabetes mellitus has put pressure on health systems to appropriately manage these patients, there have been a growing number of mobile apps designed to improve the self-management of diabetes. One such app, BlueStar, has been shown to significantly reduce hemoglobin A1c (HbA1c) levels in small studies and is the first app in the United States to receive Food and Drug Administration approval as a mobile prescription therapy. However, the impact of the app across real-world population among different clinical sites and health systems remains unclear. Objective: The primary objective of this study was to conduct a pragmatic randomized controlled trial of the BlueStar mobile app to determine if app usage leads to improved HbA1c levels among diverse participants in real-life clinical contexts. We hypothesized that this mobile app would improve self-management and HbA1c levels compared with controls. Methods: The study consisted of a multicenter pragmatic randomized controlled trial. Overall, 110 participants randomized to the immediate treatment group (ITG) received the intervention for 6 months, and 113 participants randomized to the wait-list control (WLC) group received usual care for the first 3 months and then received the intervention for 3 months. The primary outcome was glucose control measured by HbA1c levels at 3 months. Secondary outcomes assessed intervention impact on patient self-management, experience of care, and self-reported health utilization using validated scales, including the Problem Areas in Diabetes, the Summary of Diabetes Self-Care Activities, and the EuroQol-5D. Intervention usage data were collected directly from the app. Results: The results of an analysis of covariance controlling for baseline HbA1c levels did not show evidence of intervention impact on HbA1c levels at 3 months (mean difference [ITG−WLC] −0.42, 95% CI −1.05 to 0.21; P=.19). Similarly, there was no intervention effect on secondary outcomes measuring diabetes self-efficacy, quality of life, and health care utilization behaviors. An exploratory analysis of 57 ITG participants investigating the impact of app usage on HbA1c levels showed that each additional day of app use corresponded with a 0.016-point decrease in participants’ 3-month HbA1c levels (95% CI −0.03 to −0.003). App usage varied significantly by site, as participants from 1 site logged in to the app a median of 36 days over 14 weeks (interquartile range [IQR] 10.5-124); those at another site used the app significantly less (median 9; IQR 6-51). Conclusions: The results showed no difference between intervention and control arms for the primary clinical outcome of glycemic control measured by HbA1c levels. Although there was low usage of the app among participants, results indicate contextual factors, particularly site, had a significant impact on overall usage. Future research into the patient and site-specific factors that increase app utilization are needed. Trial Registration: Clinicaltrials.gov NCT02813343; https://clinicaltrials.gov/ct2/show/NCT02813343 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02813343) %M 30632972 %R 10.2196/10321 %U https://mhealth.jmir.org/2019/1/e10321/ %U https://doi.org/10.2196/10321 %U http://www.ncbi.nlm.nih.gov/pubmed/30632972 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 3 %P e43 %T Defining Empowerment and Supporting Engagement Using Patient Views From the Citizen Health Information Portal: Qualitative Study %A Risling,Tracie %A Martinez,Juan %A Young,Jeremy %A Thorp-Froslie,Nancy %+ College of Nursing, University of Saskatchewan, 4218 Health Sciences Building, E-Wing, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada, 1 306 966 6232, tracie.risling@usask.ca %K digital health %K electronic health record %K patient engagement %K patient empowerment %K patient portal %D 2018 %7 10.09.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increasing presence of technology in health care has created new opportunities for patient engagement and with this, an intensified exploration of patient empowerment within the digital health context. While the use of technology, such as patient portals, has been positively received, a clear linkage between digital health solutions, patient empowerment, and health outcomes remains elusive. Objective: The primary objective of this research was to explore the views of participants enrolled in an electronic health record portal access trial regarding the resultant influence of this technology on their feelings of patient empowerment. Methods: The exploration of patient empowerment within a digital health context was done with participants in a tethered patient portal trial using interpretive description. Interpretive description is a qualitative methodology developed to pragmatically address clinical health questions. Patient demographics, self-reported health status, and self-identified technology adaptation contributed to the assessment of empowerment in this qualitative approach. Results: This research produced a view of patient empowerment within the digital health context summarized in two overarching categories: (1) Being Heard and (2) Moving Forward. In each of these, two subcategories further delineate the aspects of empowerment, as viewed by these participants: Knowing More and Seeing What They See under Being Heard, and Owning Future Steps and Promoting Future Care under Moving Forward. This work also highlighted an ongoing interconnectedness between the concepts of patient empowerment, engagement, and activation and the need to further articulate the unique aspects of each of these. Conclusions: The results of this study contribute needed patient voice to the ongoing evolution of the concept of patient empowerment. In order to move toward more concrete and accurate measure of patient empowerment and engagement in digital health, there must be further consideration of what patients themselves identify as essential aspects of these complex concepts. This research has revealed relational and informational elements as two key areas of focus in the ongoing evolution of patient empowerment operationalization and measure. %M 30201603 %R 10.2196/medinform.8828 %U http://medinform.jmir.org/2018/3/e43/ %U https://doi.org/10.2196/medinform.8828 %U http://www.ncbi.nlm.nih.gov/pubmed/30201603 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e177 %T Diffusion of the Digital Health Self-Tracking Movement in Canada: Results of a National Survey %A Paré,Guy %A Leaver,Chad %A Bourget,Claire %+ Research Chair in Digital Health, HEC Montreal, 3000 Cote-Sainte-Catherine Road, Montreal, QC,, Canada, 1 514 340 6812, guy.pare@hec.ca %K self-tracking %K quantified-self %K wearable devices %K activity trackers %K survey methodology %D 2018 %7 02.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: With the ever-increasing availability of mobile apps, consumer wearables, and smart medical devices, more and more individuals are self-tracking and managing their personal health data. Objective: The aim of this study was to investigate the diffusion of the digital self-tracking movement in Canada. It provides a comprehensive, yet detailed account of this phenomenon. It examines the profile of digital self-trackers, traditional self-trackers, and nontrackers, further investigating the primary motivations for self-tracking and reasons for nontracking; barriers to adoption of connected care technologies; users’ appreciation of their self-tracking devices, including what they perceive to be the main benefits; factors that influence people’s intention to continue using connected care technologies in the future; and the reasons for usage discontinuance. Methods: We conducted an online survey with a sample of 4109 Canadian adults, one of the largest ever. To ensure a representative sample, quota method was used (gender, age), following stratification by region. The maximum margin of error is estimated at 1.6%, 19 times out of 20. Results: Our findings reveal that 66.20% (2720/4109) of our respondents regularly self-track one or more aspects of their health. About one in 4 respondents (1014/4109, 24.68%) currently owns a wearable or smart medical device, and 57.20% (580/1014) use their devices on a regular basis for self-tracking purposes. Digital self-trackers are typically young or mature adults, healthy, employed, university educated, with an annual family income of over $80,000 CAD. The most popular reported device is the fitness tracker or smartwatch that can capture a range of parameters. Currently, mobile apps and digital self-tracking devices are mainly used to monitor physical activity (856/1669, 51.13%), nutrition (545/1669, 32.65%), sleep patterns (482/1669, 28.88%) and, to a much lesser extent, cardiovascular and pulmonary biomarkers (215/1669, 12.88%), medication intake (126/1669, 7.55%), and glucose level (79/1669, 4.73%). Most users of connected care technologies (481/580, 83.0%) are highly satisfied and 88.2% (511/580) intend to continue using their apps and devices in the future. A majority said smart digital devices have allowed them to maintain or improve their health condition (398/580, 68.5%) and to be better informed about their health in general (387/580, 66.6%). About 33.80% of our sample (1389/4109) is composed of people who do not monitor their health or well-being on a regular basis. Conclusions: Our study shows an opportunity to advance the health of Canadians through connected care technologies. Our findings can be used to set baseline information for future research on the rise of digital health self-tracking and its impacts. Although the use of mobile apps, consumer wearables, and smart medical devices could potentially benefit the growing population of patients with chronic conditions, the question remains as to whether it will diffuse broadly beyond early adopters and across cost inequities. %M 29720359 %R 10.2196/jmir.9388 %U http://www.jmir.org/2018/5/e177/ %U https://doi.org/10.2196/jmir.9388 %U http://www.ncbi.nlm.nih.gov/pubmed/29720359 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e81 %T A Mobile App to Improve Self-Management of Individuals With Type 2 Diabetes: Qualitative Realist Evaluation %A Desveaux,Laura %A Shaw,James %A Saragosa,Marianne %A Soobiah,Charlene %A Marani,Husayn %A Hensel,Jennifer %A Agarwal,Payal %A Onabajo,Nike %A Bhatia,R Sacha %A Jeffs,Lianne %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 8356, laura.desveaux@wchospital.ca %K telemedicine %K diabetes mellitus %K self-management %K qualitative research %D 2018 %7 16.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing use of Web-based solutions for health prevention and promotion presents opportunities to improve self-management and adherence to guideline-based therapy for individuals with type 2 diabetes (T2DM). Despite promising preliminary evidence, many users stop using Web-based solutions due to the burden of data entry, hidden costs, loss of interest, and a lack of comprehensive features. Evaluations tend to focus on effectiveness or impact and fail to evaluate the nuanced variables that may interact to contribute to outcome success (or failure). Objective: This study aimed to evaluate a Web-based solution for improving self-management in T2DM to identify key combinations of contextual variables and mechanisms of action that explain for whom the solution worked best and in what circumstances. Methods: A qualitative realist evaluation was conducted with one-on-one, semistructured telephonic interviews completed at baseline, and again toward the end of the intervention period (3 months). Topics included participants’ experiences of using the Web-based solution, barriers and facilitators of self-management, and barriers and facilitators to effective use. Transcripts were analyzed using thematic analysis strategies, after which the key themes were used to develop statements of the relationships between the key contextual factors, mechanisms of action, and impact on the primary outcome (glycated hemoglobin, HbA1c). Results: Twenty-six interviews (14 baseline, 12 follow-up) were completed with 16 participants with T2DM, and the following 3 key groups emerged: the easiest fit, the best fit, and those who failed to activate. Self-efficacy and willingness to engage with the solution facilitated improvement in HbA1c, whereas competing priorities and psychosocial issues created barriers to engagement. Individuals with high baseline self-efficacy who were motivated, took ownership for their actions, and prioritized diabetes management were early and eager adopters of the app and recorded improvements in HbA1c over the intervention period. Individuals with moderate baseline self-efficacy and no competing priorities, who identified gaps in understanding of how their actions influence their health, were slow to adopt use but recorded the greatest improvements in HbA1c. The final group had low baseline self-efficacy and identified a range of psychosocial issues and competing priorities. These participants were uncertain of the benefits of using a Web-based solution to support self-management, ultimately resulting in minimal engagement and no improvement in HbA1c. Conclusions: Self-efficacy, competing priorities, previous behavior change, and beliefs about Web-based solutions interact to determine engagement and impact on the clinical outcomes. Considering the balance of these patient characteristics is likely to help health care providers identify individuals who are apt to benefit from a Web-based solution to support self-management of T2DM. Web-based solutions could be modified to incorporate the existing screening measures to identify individuals who are at risk of suboptimal adherence to inform the provision of additional support(s) as needed. %M 29549070 %R 10.2196/jmir.8712 %U http://www.jmir.org/2018/3/e81/ %U https://doi.org/10.2196/jmir.8712 %U http://www.ncbi.nlm.nih.gov/pubmed/29549070 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e177 %T Virtual Visits and Patient-Centered Care: Results of a Patient Survey and Observational Study %A McGrail,Kimberlyn Marie %A Ahuja,Megan Alyssa %A Leaver,Chad Andrew %+ Centre for Health Services and Policy Research, 201-2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 778 998 3821, kim.mcgrail@ubc.ca %K virtual visits %K telehealth %K primary care delivery %K patient-centered care %D 2017 %7 26.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual visits are clinical interactions in health care that do not involve the patient and provider being in the same room at the same time. The use of virtual visits is growing rapidly in health care. Some health systems are integrating virtual visits into primary care as a complement to existing modes of care, in part reflecting a growing focus on patient-centered care. There is, however, limited empirical evidence about how patients view this new form of care and how it affects overall health system use. Objective: Descriptive objectives were to assess users and providers of virtual visits, including the reasons patients give for use. The analytic objective was to assess empirically the influence of virtual visits on overall primary care use and costs, including whether virtual care is with a known or a new primary care physician. Methods: The study took place in British Columbia, Canada, where virtual visits have been publicly funded since October 2012. A survey of patients who used virtual visits and an observational study of users and nonusers of virtual visits were conducted. Comparison groups included two groups: (1) all other BC residents, and (2) a group matched (3:1) to the cohort. The first virtual visit was used as the intervention and the main outcome measures were total primary care visits and costs. Results: During 2013-2014, there were 7286 virtual visit encounters, involving 5441 patients and 144 physicians. Younger patients and physicians were more likely to use and provide virtual visits (P<.001), with no differences by sex. Older and sicker patients were more likely to see a known provider, whereas the lowest socioeconomic groups were the least likely (P<.001). The survey of 399 virtual visit patients indicated that virtual visits were liked by patients, with 372 (93.2%) of respondents saying their virtual visit was of high quality and 364 (91.2%) reporting their virtual visit was “very” or “somewhat” helpful to resolve their health issue. Segmented regression analysis and the corresponding regression parameter estimates suggested virtual visits appear to have the potential to decrease primary care costs by approximately Can $4 per quarter (Can –$3.79, P=.12), but that benefit is most associated with seeing a known provider (Can –$8.68, P<.001). Conclusions: Virtual visits may be one means of making the health system more patient-centered, but careful attention needs to be paid to how these services are integrated into existing health care delivery systems. %M 28550006 %R 10.2196/jmir.7374 %U http://www.jmir.org/2017/5/e177/ %U https://doi.org/10.2196/jmir.7374 %U http://www.ncbi.nlm.nih.gov/pubmed/28550006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e97 %T Connecting Families to Their Health Record and Care Team: The Use, Utility, and Impact of a Client/Family Health Portal at a Children’s Rehabilitation Hospital %A King,Gillian %A Maxwell,Joanne %A Karmali,Amir %A Hagens,Simon %A Pinto,Madhu %A Williams,Laura %A Adamson,Keith %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3323, gking27@uwo.ca %K disability %K engagement %K health information %K caregivers %K children with disabilities %K patient portals %K electronic health records %D 2017 %7 06.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care portals have the potential to provide consumers with timely, transparent access to health care information and engage them in the care process. Objective: The objective was to examine the use, utility, and impact on engagement in care and caregiver-provider communication of a client/family portal providing access to electronic health records (EHRs) and secure, 2-way e-messaging with care providers. Methods: We conducted a prospective, mixed-methods study involving collection of caregivers’ portal usage information over a 14-month period (from portal introduction in January 2015 to the end of the study period in March 2016), a Web-based survey for caregivers administered after a minimum of 2 months’ exposure to the portal and repeated 2 months later, and focus groups or individual interviews held with caregivers and service providers at the same points in time. The survey assessed caregivers’ perceptions of the utility of and satisfaction with the EHR and e-messaging, and the portal’s impact on client engagement and perceptions of caregiver-provider communication. A total of 18 caregivers (parents) completed surveys and 6 also took part in focus groups or interviews. In addition, 5 service providers from different disciplines took part in focus groups or interviews. Results: Although usage patterns varied, the typical pattern was a steady level of use (2.5 times a month over an average of 9 months), which is higher than typically reported use. The portal pages most frequently accessed were the home page, health record main page, appointment main page, and reports main page. The Web-based survey captured caregivers’ perceptions of usefulness of and satisfaction with the EHR and portal messaging, as well as the portal’s impact on their engagement in care and perceptions of caregiver-provider communication. The surveys indicated a moderate degree of utility of and satisfaction with the portal features, and a low but emerging impact on engagement in care and caregiver-provider communication (survey scales measuring these outcomes displayed excellent internal consistency, with Cronbach alpha ranging from .89 to .95). Qualitative themes from focus groups and interviews supported and extended the survey findings. Caregivers and service providers saw appreciable information benefits and provided recommendations to increase portal use and utility. Caregivers focused on the scope of organizational adoption of the portal system and indicated their hopes for the future of the portal, whereas service providers were concerned about how to best manage their investment of time and effort in preparing client-friendly reports and messaging clients via the portal. Conclusions: Overall, the findings show the promise of the portal and the need for ongoing evaluation to show the portal’s ultimate potential in enhancing engagement in care and communication with care providers. %M 28385680 %R 10.2196/jmir.6811 %U http://www.jmir.org/2017/4/e97/ %U https://doi.org/10.2196/jmir.6811 %U http://www.ncbi.nlm.nih.gov/pubmed/28385680 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e294 %T A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation %A Kipping,Sarah %A Stuckey,Melanie I %A Hernandez,Alexandra %A Nguyen,Tan %A Riahi,Sanaz %+ Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON, L1N5S9, Canada, 1 9054304055, kippings@ontarioshores.ca %K efficiency, organizational %K electronic health records %K mental health %K mental disorders %K patient activation %D 2016 %7 16.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Treatment for mental illness has shifted from focusing purely on treatment of symptoms to focusing on personal recovery. Patient activation is an important component of the recovery journey. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown. Objective: To conduct a benefits evaluation of a Web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on (1) patient activation, (2) recovery, (3) productivity, and (4) administrative efficiencies. Methods: All registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal and those who did not were designated as “users” and “nonusers,” respectively. All patients received usual treatment. Users had Web-based access to view parts of their electronic medical record, view upcoming appointments, and communicate with their health care provider. Users could attend portal training or support sessions led by either the engagement coordinator or peer support specialists. A subset of patients who created and utilized their portal account completed 2 Web-based surveys at baseline (just after enrollment; n=91) and at follow-up (6 and 10 months; n=65). The total score of the Mental Health Recovery Measure (MHRM) was a proxy for patient activation and the individual domains measured recovery. The System and Use Survey Tool (SUS) examined the use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and nonusers missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation. Results: A total of 461 patients (44.0% male, n=203) registered for the portal, which was used 4761 times over the 1-year follow-up period. The majority of uses (95.34%, 4539/4761) were for e-views. The overall MHRM score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at combined follow-up (P=.01). Of the 8 recovery domains, 7 were increased at follow-up (all P<.05). The odds of a portal user attending an appointment were 67% (CI 56%-79%) greater than that of nonusers over the follow-up period. Compared with 2014, over 2015 there was an 86% and 57% decrease in requests for information in users and nonusers, respectively. The SUS revealed that users felt an increased sense of autonomy and found the portal to be user-friendly, helpful, and efficient but felt that more information should be accessible. Conclusions: The benefits evaluation suggested that access to personal health records via patient portals may improve patient activation, recovery scores, and organizational efficiencies in a tertiary level mental health care facility. %M 27852556 %R 10.2196/jmir.6483 %U http://www.jmir.org/2016/11/e294/ %U https://doi.org/10.2196/jmir.6483 %U http://www.ncbi.nlm.nih.gov/pubmed/27852556 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 4 %N 2 %P e10 %T Understanding the Impact of Electronic Medical Record Use on Practice-Based Population Health Management: A Mixed-Method Study %A Vaghefi,Isaac %A Hughes,John B %A Law,Susan %A Lortie,Michel %A Leaver,Chad %A Lapointe,Liette %+ School of Management, State University of New York at Binghamton, Academic A, 400 Vestal Pkwy E, Binghamton, NY, 13902, United States, 1 (607) 777 6859, svaghefi@binghamton.edu %K primary health care %K electronic medical records %K population health management %K medical informatics %K practice-based care %D 2016 %7 04.04.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Practice-based population health (PBPH) management is the proactive management of patients by their primary care clinical team. The ability of clinics to engage in PBPH and the means by which they incorporate it in a clinical setting remain unknown. Objective: We conducted the Canadian Population Health Management Challenge to determine the capacity and preparedness of primary care settings to engage in PBPH using their existing medical record systems and to understand the complexities that may exist in PBPH implementation. Methods: We recruited a sample of electronic medical record (EMR) -enabled and paper-based clinics from across Canada to participate in the challenge. The challenge required clinic staff and physicians to complete time-controlled, evidence-based practice reviews of their patients who may benefit from evidence-informed care, treatment, or interventions across five different areas (immunization, postmyocardial infarction care, cancer screening, diabetes management, and medication recall). We formulated a preparedness index to measure the capacity of clinics to engage in PBPH management. Finally, we conducted follow-up qualitative interviews to provide richer understanding of PBPH implementation and related issues (ie, challenges and facilitators). Results: A total of 11 primary care clinics participated, representing 21 clinician practices. EMR-enabled clinics completed a full review of charts in an average of 1.37 hours. On the contrary, paper-based clinics reviewed nearly 10% of their charts in an average of 3.9 hours, hinting that they would have required an estimated 40 hours to complete a review of charts in their practice. Furthermore, the index revealed a major gap in preparedness between the EMR and paper-based clinics (0.86–3.78 vs 0.05–0.12), as well as a broad range among the EMR clinics. Finally, building on the results of the qualitative analysis, we identified factors facilitating the integration of PBPH. Conclusions: Our results suggest that EMR usage is pivotal in setting the foundation to support PBPH. The wide range of performance variation among EMR-enabled clinics suggests that EMR functionality and optimization, its support of clinical practice workflow, and policy issues to ensure adoption of standards are critical issues to facilitate PBPH. %M 27044411 %R 10.2196/medinform.4577 %U http://medinform.jmir.org/2016/2/e10/ %U https://doi.org/10.2196/medinform.4577 %U http://www.ncbi.nlm.nih.gov/pubmed/27044411 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e191 %T The Effects of Web-Based Patient Access to Laboratory Results in British Columbia: A Patient Survey on Comprehension and Anxiety %A Mák,Geneviève %A Smith Fowler,Heather %A Leaver,Chad %A Hagens,Simon %A Zelmer,Jennifer %+ Canada Health Infoway, 150 King St West, suite 1300, Toronto, ON, M5H1J9, Canada, 1 4164274182, shagens@infoway-inforoute.ca %K patient access to information %K online access to laboratory results %K consumer health solutions %K personal health records %K patient anxiety %K patient comprehension %K laboratory results %D 2015 %7 04.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based patient access to personal health information is limited but increasing in Canada and internationally. Objective: This exploratory study aimed to increase understanding of how Web-based access to laboratory test results in British Columbia (Canada), which has been broadly available since 2010, affects patients’ experiences. Methods: In November 2013, we surveyed adults in British Columbia who had had a laboratory test in the previous 12 months. Using a retrospective cohort design, we compared reported wait-time for results, test result comprehension, and anxiety levels of “service users” who had Web-based access to their test results (n=2047) with those of a general population panel that did not have Web-based access (n=1245). Results: The vast majority of service users (83.99%, 95% CI 82.31-85.67) said they received their results within “a few days”, compared to just over a third of the comparison group (37.84%, 95% CI 34.96-40.73). Most in both groups said they understood their test results, but the rate was lower for service users than the comparison group (75.55%, 95% CI 73.58-77.49 vs 84.69%, 95% CI 82.59-86.81). There was no significant difference between groups in levels of reported anxiety after receiving test results. Conclusions: While most patients who received their laboratory test results online reported little anxiety after receiving their results and were satisfied with the service, there may be opportunities to improve comprehension of results. %M 26242801 %R 10.2196/jmir.4350 %U http://www.jmir.org/2015/8/e191/ %U https://doi.org/10.2196/jmir.4350 %U http://www.ncbi.nlm.nih.gov/pubmed/26242801 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e35 %T Mobile Access to ClinicalConnect: A User Feedback Survey on Usability, Productivity, and Quality %A Eapen,Bell Raj %A Chapman,Barbara %+ HNHB eHealth Office, Suite 108, 293 Wellington Street North, Hamilton, ON, L8L8E7, Canada, 1 9058700577, eapenb@hhsc.ca %K mHealth %K health information exchange %K ClinicalConnect %D 2015 %7 14.04.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: ClinicalConnect, a federated clinical viewer for South West Ontario, Canada, launched a mobile interface in June 2012. Objective: The aim of the study was to assess usability of the mobile interface and the perceived impact on productivity of health care providers and quality of healthcare delivery. Methods: A survey was conducted using the System Usability Scale (SUS) and questionnaires designed to measure productivity and quality based on Canada Health Infoway's Benefits Evaluation framework. Results: The mean SUS score was 67 based on 77 responses. The mean scores for productivity and quality were 3.37 (N=74) and 3.62 (N=71), respectively, on a 5-point Likert scale where 3 was neutral. Conclusions: Users perceived the mobile interface of ClinicalConnect as useful but were neutral about the ease of use. %M 25877226 %R 10.2196/mhealth.4011 %U http://mhealth.jmir.org/2015/2/e35/ %U https://doi.org/10.2196/mhealth.4011 %U http://www.ncbi.nlm.nih.gov/pubmed/25877226 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e10 %T Teleophthalmology for First Nations Clients at Risk of Diabetic Retinopathy: A Mixed Methods Evaluation %A Kim,Julie %A Driver,D Dean %+ University of Victoria, PO Box 3050 STN CSC, Victoria, BC, V8W 3P5, Canada, 1 250 721 8575, juliekim@uvic.ca %K Ophthalmology %K Diabetic Retinopathy %K Telemedicine %K Mobile Health %K underserved populations %D 2015 %7 23.02.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Access to health services is a particular challenge for First Nations (aboriginal Canadians) communities living in remote or underserviced areas. Teleophthalmology can provide them with the same level of retinal screening services provided to those in urban centers. This screening can lead to the identification of high-risk individuals who can then be monitored and receive treatment related to their diabetes or other health issues. Objective: The intent was to develop, implement, and evaluate a service delivery model for teleophthalmology screening and follow-up for at-risk and diabetic First Nations clients on Vancouver Island, British Columbia, Canada. Methods: A highly consultative, culturally appropriate, and collaborative approach was used to develop and deploy a teleophthalmology service delivery model to First Nations communities. This project was evaluated with regard to utilization and operational costs. Also, clinicians and team members involved in the teleophthalmology project provided assessments of the teleopthalmology quality, productivity, and access. Health providers in First Nations communities provided their perceptions of areas of improvement for the remote retinal screening services, areas where expansion of services could be offered, and opportunities to increase client education and health promotion. Results: All 51 First Nations communities on Vancouver Island expressed interest in receiving teleopthalmology services. During the 1-year project, teleopthalmology clinics were held in 43 of 51 communities on Vancouver Island. During these clinics, 524 clients were screened and 140 of those clients were referred to a general ophthalmologist, family doctor, retinal specialist, optometrist, or other provider. Ratings of teleopthalmology system quality, information quality, service quality, and system usage were positive. Satisfaction with the teleopthalmology project was high among clinicians involved with the project. Satisfaction was also high among health providers in First Nations communities, with clinic scheduling identified as a potential area of improvement moving forward. The average cost savings per client, taking project costs into consideration, was calculated to be CAN $28.16, which was largely due to the elimination of client travel costs. Conclusions: Teleophthalmology was a welcome addition to health services by the First Nations communities on Vancouver Island, as evidenced by the 100% rate of interest from those communities. There was no evidence of dissatisfaction by clinicians involved in the teleopthalmology project or by First Nations community health providers. The now-operational teleopthalmology program is a testament to the early success of the project. %M 25705814 %R 10.2196/medinform.3872 %U http://medinform.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/medinform.3872 %U http://www.ncbi.nlm.nih.gov/pubmed/25705814 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Client Perceptions of the Mental Health Engagement Network: A Secondary Analysis of an Intervention Using Smartphones and Desktop Devices for Individuals Experiencing Mood or Psychotic Disorders in Canada %A Forchuk,Cheryl %A Donelle,Lorie %A Ethridge,Paige %A Warner,Laura %+ Lawson Health Research Institute, Suite 102, 750 Baseline Road East, London, ON, N6C 2R5, Canada, 1 519 685 8500 ext 77034, cforchuk@uwo.ca %K mental health %K mobile health %K eHealth %K personal health records %K mood disorders %K psychotic disorders %K mental disorders %D 2015 %7 21.01.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: The use of innovative technologies in mental health care has the potential to improve system efficiency, enhance quality of care, and increase patient engagement. The Mental Health Engagement Network (MHEN) project developed, delivered, and evaluated an interactive Web-based personal health record, the Lawson SMART Record (LSR), to assist mental health clients in managing their care and connecting with their care providers. This paper presents a secondary analysis of data collected in the MHEN project regarding clients’ perceptions of technology and the use of these technologies in their care. Objective: We aimed to answer six questions: (1) What is the level of comfort with technology within a sample of individuals experiencing mood or psychotic disorders? (2) How easy to use and helpful are the MHEN technologies from the perspective of individuals experiencing a mental illness? (3) Are there differences in how helpful or useful individuals find the smartphone compared to the LSR? (4) Are there specific functions of MHEN technologies (eg, reminders for medications or appointments) that are more valued than others? (5) What are the other ways that individuals are using MHEN technologies in their daily lives? (6) How likely are individuals to be able to retain and maintain their smartphone? Methods: Mental health clients aged 18-80 (N=400) and diagnosed with a mood or psychotic disorder were provided with a smartphone (iPhone 4S) and participating care providers (n=52) were provided with a tablet (iPad) in order to access and engage with the LSR. A delayed implementation design with mixed methods was used. Survey and interview data were collected over the course of 18 months through semistructured interviews conducted by experienced research assistants every 6 months post-implementation of the intervention. Paired t tests were used to determine differences between 6 and 12-month data for perceptions of the MHEN technologies. A paired t test was used to examine whether differences existed between perceptions of the smartphone and the LSR at 12 months post-implementation. Results: Due to dropout or loss of contact, 394 out of 400 individuals completed the study. At the end of the study, 52 devices were lost or unusable. Prior to the intervention, participants reported being comfortable using technology. Perceptions of the MHEN technologies and their functions were generally positive. Positive perceptions of the smartphone increased over time (P=.002), while positive perceptions of the LSR decreased over time (P<.001). Conclusions: Quantitative and qualitative findings from this analysis demonstrated that these technologies positively impacted the lives of individuals experiencing severe mental illnesses and dispeled some of the myths regarding retention of technology among marginalized populations. This secondary analysis supported the acceptability of using mental health technologies within this population and provided considerations for future development. Trial Registration: ClinicalTrials.gov NCT01473550; http://clinicaltrials.gov/show/NCT01473550 (Archived by WebCite at http://www.webcitation.org/6SLNcoKb8). %M 26543906 %R 10.2196/mental.3926 %U http://mental.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/mental.3926 %U http://www.ncbi.nlm.nih.gov/pubmed/26543906 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e1 %T Impact of Information Technology on Information Gaps in Canadian Ambulatory Care Encounters %A Korosec,Lauren %A Balenko,Krista %A Hagens,Simon %+ Canada Health Infoway, 150 King Street West, #1300, Toronto, ON, M5H 1J9, Canada, 1 888 733 6462, kbalenko@infoway-inforoute.ca %K digital health %K information gaps %K ambulatory %K outpatient %D 2015 %7 08.01.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Specialist physicians require clinical information for patient visits in ambulatory encounters, some of which they may access via digital health solutions. Objective: This study explored the completeness of information for patient care and the consequences of gaps for ambulatory specialist services provided in ambulatory settings in Canada. Methods: A sample of specialist physicians practising in outpatient clinics was recruited from a health care provider research panel. The study (n=1800 patient encounters) looked at the completeness of patient information experienced by physicians who work in environments with rich health information exchange (Connected) and a comparison cohort with less information available electronically (Unconnected). Results: Unconnected physicians were significantly more likely to be missing information they needed for patient encounters (13% of encounters for Unconnected physicians vs 7% for Connected physicians). Unconnected physicians were also more likely to report that missing information had consequences (23% vs 13% of encounters). Lab results were the most common type of patient information missing for both Unconnected and Connected specialists (25% for Unconnected physicians vs 11% Connected physicians). Conclusions: The results from this study indicate that Canadian physicians commonly experience information gaps in ambulatory encounters, and that many of these gaps are of consequence to themselves, their patients, and the healthcare system. Wasting physician and patient time, as well as being forced to proceed with incomplete information, were the most common consequences of information gaps reported. %M 25595130 %R 10.2196/medinform.4066 %U http://medinform.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/medinform.4066 %U http://www.ncbi.nlm.nih.gov/pubmed/25595130 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 1 %P e2 %T Impact of Early Electronic Prescribing on Pharmacists’ Clarification Calls in Four Community Pharmacies Located in St John’s, Newfoundland %A Phillips,Jennifer L %A Shea,Jennifer M %A Leung,Valerie %A MacDonald,Don %+ NL Centre for Health Information, Research and Evaluation, 70 O'Leary Avenue, St John's, NL, A1B 2C7, Canada, 1 709 752 6022, jennifer.phillips@nlchi.nl.ca %K electronic prescribing %K pharmacy %K pharmacists %K Clinical Pharmacy Information Systems %D 2015 %7 06.01.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic prescribing (e-prescribing) can potentially help prevent medication errors. As the use of e-prescribing increases across Canada, understanding the benefits and gaps of early e-prescribing can help inform deployment of future e-prescribing systems. Objective: The purpose of this exploratory study was to determine the prevalence of, reasons for, and average time taken for pharmacist clarification calls to prescribers for electronic medical record (EMR)-generated and handwritten prescriptions. Methods: Four community pharmacies in St John’s, Newfoundland, Canada prospectively collected information on clarification calls to prescribers for new prescriptions over a period of 17 to 19 weeks. Four semistructured interviews were conducted following the data collection period to gain further insight. Results: An estimated 1.33% of handwritten prescriptions required clarification compared with 0.66% of EMR-generated prescriptions. Overall, 1.11% of prescriptions required clarification with the prescriber. While illegibility was eliminated with EMR-generated prescriptions, clarification was still required for missing information (24%) and appropriateness (51%). Key themes, including errors unique to EMR-generated prescriptions, emerged from the qualitative interviews. Conclusions: Advanced e-prescribing functionality will enable secure transmission of prescriptions from prescribers to a patient’s pharmacy of choice through a provincial electronic Drug Information System (DIS)/Pharmacy Network, which will lessen the need for clarification calls, especially in the domains of missing information and appropriateness of the prescription. This exploratory study provides valuable insight into the benefits and gaps of early e-prescribing. Advanced e-prescribing systems will provide an opportunity for further realization of quality and safety benefits related to medication prescribing. %M 25595165 %R 10.2196/medinform.3541 %U http://medinform.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/medinform.3541 %U http://www.ncbi.nlm.nih.gov/pubmed/25595165 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 2 %P e25 %T Return on Investment in Electronic Health Records in Primary Care Practices: A Mixed-Methods Study %A Jang,Yeona %A Lortie,Michel A %A Sanche,Steven %+ McGill University, Desautels Faculty of Management, 1001 Rue Sherbrooke Ouest, Montreal, QC, H3A 1G5, Canada, 1 514 398 8489, yeona.jang@mcgill.ca %K return on investment in electronic health records %K cost recovery from EHR implementation %K ROI indicator %K physician satisfaction with EHR %K primary care practices %D 2014 %7 29.09.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: The use of electronic health records (EHR) in clinical settings is considered pivotal to a patient-centered health care delivery system. However, uncertainty in cost recovery from EHR investments remains a significant concern in primary care practices. Objective: Guided by the question of “When implemented in primary care practices, what will be the return on investment (ROI) from an EHR implementation?”, the objectives of this study are two-fold: (1) to assess ROI from EHR in primary care practices and (2) to identify principal factors affecting the realization of positive ROI from EHR. We used a break-even point, that is, the time required to achieve cost recovery from an EHR investment, as an ROI indicator of an EHR investment. Methods: Given the complexity exhibited by most EHR implementation projects, this study adopted a retrospective mixed-method research approach, particularly a multiphase study design approach. For this study, data were collected from community-based primary care clinics using EHR systems. Results: We collected data from 17 primary care clinics using EHR systems. Our data show that the sampled primary care clinics recovered their EHR investments within an average period of 10 months (95% CI 6.2-17.4 months), seeing more patients with an average increase of 27% in the active-patients-to-clinician-FTE (full time equivalent) ratio and an average increase of 10% in the active-patients-to-clinical-support-staff-FTE ratio after an EHR implementation. Our analysis suggests, with a 95% confidence level, that the increase in the number of active patients (P=.006), the increase in the active-patients-to-clinician-FTE ratio (P<.001), and the increase in the clinic net revenue (P<.001) are positively associated with the EHR implementation, likely contributing substantially to an average break-even point of 10 months. Conclusions: We found that primary care clinics can realize a positive ROI with EHR. Our analysis of the variances in the time required to achieve cost recovery from EHR investments suggests that a positive ROI does not appear automatically upon implementing an EHR and that a clinic’s ability to leverage EHR for process changes seems to play a role. Policies that provide support to help primary care practices successfully make EHR-enabled changes, such as support of clinic workflow optimization with an EHR system, could facilitate the realization of positive ROI from EHR in primary care practices. %M 25600508 %R 10.2196/medinform.3631 %U http://medinform.jmir.org/2014/2/e25/ %U https://doi.org/10.2196/medinform.3631 %U http://www.ncbi.nlm.nih.gov/pubmed/25600508 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 2 %P e24 %T Adoption, Use, and Impact of E-Booking in Private Medical Practices: Mixed-Methods Evaluation of a Two-Year Showcase Project in Canada %A Paré,Guy %A Trudel,Marie-Claude %A Forget,Pascal %+ HEC Montreal, 3000 Chemin de la Cote-Ste-Catherine, Montreal, QC, H3T 2A7, Canada, 1 514 340 6812, guy.pare@hec.ca %K e-booking %K medical practices %K primary care %K missed appointments %K mixed-methods evaluative study %D 2014 %7 24.09.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: Managing appointments in private medical practices and ambulatory care settings is a complex process. Various strategies to reduce missed appointments can be implemented. E-booking systems, which allow patients to schedule and manage medical appointments online, represents such a strategy. To better support clinicians seeking to offer an e-booking service to their patients, health authorities in Canada recently invested in a showcase project involving six private medical clinics. Objective: The objectives pursued in this study were threefold: (1) to measure adoption and use of the e-booking system in each of the clinics over a 2-year period, (2) to assess patients’ perceptions regarding the characteristics and benefits of using the system, and (3) to measure the impact of the e-booking system on the number of missed appointments in each clinic. Methods: A mixed-methods approach was adopted in this study. We first extracted and analyzed raw data from the e-booking system deployed in each of the medical practices to monitor adoption and use of the system over time and to assess the impact of the system on the number of missed appointments. Second, we conducted a Web-based survey of patients’ perceptions in the spring of 2013. Results: The patients and physicians targeted by this showcase project showed a growing interest in the e-booking system as the number of users, time slots made available by physicians, and online appointments grew steadily over time. The great majority of patients said that they appreciated the system mainly because of the benefits they derived from it, namely, scheduling flexibility, time savings, and automated reminders that prevented forgotten appointments. Importantly, our findings suggest that the system’s automated reminders help significantly reduce the number of missed appointments. Conclusions: E-booking systems seem to represent a win-win solution for patients and physicians in private medical practices. We encourage researchers to replicate and extend our work in other primary care settings in order to test the generalizability of our findings. %M 25600414 %R 10.2196/medinform.3669 %U http://medinform.jmir.org/2014/2/e24/ %U https://doi.org/10.2196/medinform.3669 %U http://www.ncbi.nlm.nih.gov/pubmed/25600414 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 2 %N 1 %P e12 %T Electronic Clinical Safety Reporting System: A Benefits Evaluation %A Elliott,Pamela %A Martin,Desmond %A Neville,Doreen %+ Elliott's Enterprises, 320 Torbay Road, Suite 204, St John's, NL, A1A 4E1, Canada, 1 709 754 6706, pelliott@nl.rogers.com %K electronic occurrence reporting %K electronic clinical safety reporting %K adverse event reporting in health care %K evaluating electronic reporting systems in health care %K health information technology evaluations %D 2014 %7 11.06.2014 %9 Original Paper %J JMIR Med Inform %G English %X Background: Eastern Health, a large health care organization in Newfoundland and Labrador (NL), started a staged implementation of an electronic occurrence reporting system (used interchangeably with “clinical safety reporting system”) in 2008, completing Phase One in 2009. The electronic clinical safety reporting system (CSRS) was designed to replace a paper-based system. The CSRS involves reporting on occurrences such as falls, safety/security issues, medication errors, treatment and procedural mishaps, medical equipment malfunctions, and close calls. The electronic system was purchased from a vendor in the United Kingdom that had implemented the system in the United Kingdom and other places, such as British Columbia. The main objective of the new system was to improve the reporting process with the goal of improving clinical safety. The project was funded jointly by Eastern Health and Canada Health Infoway. Objective: The objectives of the evaluation were to: (1) assess the CSRS on achieving its stated objectives (particularly, the benefits realized and lessons learned), and (2) identify contributions, if any, that can be made to the emerging field of electronic clinical safety reporting. Methods: The evaluation involved mixed methods, including extensive stakeholder participation, pre/post comparative study design, and triangulation of data where possible. The data were collected from several sources, such as project documentation, occurrence reporting records, stakeholder workshops, surveys, focus groups, and key informant interviews. Results: The findings provided evidence that frontline staff and managers support the CSRS, identifying both benefits and areas for improvement. Many benefits were realized, such as increases in the number of occurrences reported, in occurrences reported within 48 hours, in occurrences reported by staff other than registered nurses, in close calls reported, and improved timelines for notification. There was also user satisfaction with the tool regarding ease of use, accessibility, and consistency. The implementation process encountered challenges related to customizing the software and the development of the classification system for coding occurrences. This impacted on the ability of the managers to close-out files in a timely fashion. The issues that were identified, and suggestions for improvements to the form itself, were shared with the Project Team as soon as they were noted. Changes were made to the system before the rollout. Conclusions: There were many benefits realized from the new system that can contribute to improved clinical safety. The participants preferred the electronic system over the paper-based system. The lessons learned during the implementation process resulted in recommendations that informed the rollout of the system in Eastern Health, and in other health care organizations in the province of Newfoundland and Labrador. This study also informed the evaluation of other health organizations in the province, which was completed in 2013. %M 25600569 %R 10.2196/medinform.3316 %U http://medinform.jmir.org/2014/1/e12/ %U https://doi.org/10.2196/medinform.3316 %U http://www.ncbi.nlm.nih.gov/pubmed/25600569