%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 28 %N %P e88429 %T Channel Allocation and Equity in Preventive Campaigns for Older Adults: Agent-Based Modeling Study %A Lee,Jihye %A Park,Juyoung %A Kim,Yuna %A Kong,Duk-Jo %K preventive campaigns %K channel allocation %K older adults %K agent-based modeling %K distributional equity %K resource allocation %K budget constraints %K influenza vaccination %K loss framing %K strategic planning %D 2026 %7 1.4.2026 %9 %J J Med Internet Res %G English %X Background: Preventive campaigns for older adults must decide how to allocate limited resources across media channels. However, these channel allocation and budget decisions rarely use explicit criteria for distributional equity or structured strategic planning tools. Consequently, health systems may optimize average uptake while leaving large gaps across socioeconomic groups and media use profiles. Objective: This study aimed to develop and apply a data-driven agent-based model as a strategic planning tool for preventive campaigns targeting older adults, comparing channel allocation, personalization, and loss framing options under explicit budget and equity guardrails. Methods: We built an agent-based model calibrated to national survey data from South Korea on influenza vaccination and routine health screening among older adults (vaccination, N=2405; screening, N=2400). Fifteen prespecified campaign scenarios varied channel allocation across television, digital, and print media; budget intensity; 2 equity-focused personalization strategies; and graded loss framing. Primary outcomes were final adoption and time to adoption. Equity outcomes included the minimum class-level adoption and 90‐10 gap across latent classes. Each scenario was simulated over 12 monthly steps with 100 Monte Carlo replications. We conducted sensitivity analyses varying link functions and key social reinforcement parameters. Results: Personalization improved uptake and equity relative to the integrated baseline. In the vaccination model (N=2405), adoption increased from 91.2% (n=2193) to 93.3% (n=2244) and 94.6% (n=2275). Minimum class-level adoption increased from 86.8% to 90.3% and 90.9%. The 90‐10 gap narrowed from 5.7 to 4.5 and 4.7 percentage points. In the screening model (N=2400), adoption increased from 83.8% (n=2011) to 88.2% (n=2117) and 89.5% (n=2148). Minimum class-level adoption increased from 77.6% to 83.2% and 85.3%. The 90‐10 gap narrowed from 9.2 to 7.4 and 6.2 percentage points. Television-only strategies achieved high adoption but had less favorable equity profiles than personalization. High-budget strategies achieved high adoption but required higher total exposure. Stronger loss framing produced small, monotonic gains in adoption and shortened the time to adoption without worsening equity in the tested range. Scenario rankings were stable in sensitivity analyses. Conclusions: This agent-based modeling study illustrates how ex ante planning can improve preventive campaign design by comparing channel allocation and personalization options under explicit equity and budget criteria. For campaigns targeting older adults, equity-focused reweighting and class-tailored television-digital portfolios improved or preserved mean adoption while strengthening distributional equity under fixed budgets. In contrast, undifferentiated channel diversification without personalization offered a less favorable efficiency-equity trade-off. These findings support integrating explicit equity guardrails into early-stage channel allocation and prioritizing targeted personalization over simple channel diversification. Future work should validate these patterns in other populations and health systems and link simulated diffusion trajectories with observed exposure and engagement in real-world campaigns. It should also extend guardrail-based planning tools to organizational settings and multiyear decision contexts. %R 10.2196/88429 %U https://www.jmir.org/2026/1/e88429 %U https://doi.org/10.2196/88429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e81463 %T Digital Health Technologies: Learnings and Perspectives From a Patient Engagement Stakeholder Expectations Matrix Study %A West,Leanne %A Mitchell,Derick %A Faulkner,Stuart D %A Bauer,Birgit %A Brooke,Nicholas %A Priest,Elizabeth %+ Georgia Institute of Technology, North Avenue, Atlanta, GA, 30332, United States, 1 404 431 9894, lwest@gatech.edu %K digital health %K patient engagement %K stakeholder perspectives %K health technology %K cocreation %K digital health literacy %K patient-centered design %K health data governance %K multistakeholder collaboration %K artificial intelligence in health care %K system-level impact %K digital therapeutics %D 2025 %7 9.12.2025 %9 Viewpoint %J J Med Internet Res %G English %X As digital health technologies become increasingly integrated into health care systems worldwide, there is growing recognition that their full potential can be realized only when development is rooted in patient engagement (PE). Despite its proven value in clinical research and health care delivery, PE remains insufficiently embedded in digital health design and implementation. This perspective paper explores the current state of PE in digital health through findings from the Stakeholder Expectations Matrix program developed by Patient Focused Medicines Development. Drawing from 37 in-depth interviews across 6 key stakeholder groups, complemented by insights gathered during a multisession cocreation track at the Patient Engagement Open Forum, this paper highlights differing perspectives on digital health, the barriers to meaningful engagement, and the fragmented nature of data governance and technology adoption. Findings point not only to significant gaps in shared understanding, infrastructure, and policy but also to clear opportunities for collaboration, including early recommendations for building a more inclusive and patient-centered digital health ecosystem, one that supports sustainable innovation, trust, and systemwide impact. %M 41364917 %R 10.2196/81463 %U https://www.jmir.org/2025/1/e81463 %U https://doi.org/10.2196/81463 %U http://www.ncbi.nlm.nih.gov/pubmed/41364917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e77840 %T Digital Health Technology Adoption Among Chinese Physicians: Latent Profile Analysis and Cross-Sectional Study %A Wang,Zhichao %A Lu,Jiao %A Zhou,Zhongliang %A Liu,Guanping %A Zhai,Xiaohui %A Cao,Dan %A Gong,Shaoqing %K digital health technology %K physician adoption %K latent profile analysis %K heterogeneous adoption profiles %K implementation strategies %D 2025 %7 26.11.2025 %9 %J J Med Internet Res %G English %X Background: Digital health technologies (DHTs) are transforming global health care delivery, yet physician adoption remains highly variable and influenced by a complex interplay of individual, institutional, and technological factors. In China, despite national initiatives such as the “Healthy China 2030” strategy promoting DHT integration, understanding physicians' heterogeneous perceptions is essential for effective implementation. Objective: This study aimed to identify distinct latent profiles of Chinese physicians based on their perceptions of DHT benefits, barriers, and behavioral intention, and to examine the demographic and occupational factors associated with profile membership. Methods: A cross-sectional survey was conducted among 4851 physicians (female, n=2994, 60.69% ; mean age 38.4, SD 8.7 years; 51.58% (n=2502) with more than 10 y working experience) from 46 hospitals in Shaanxi Province, China, between October and December 2023. Assessment included nine indicators across three domains: Perceived Benefits (4 items), Adoption Barriers (4 items), and Behavioral Intention (1 item). Latent profile analysis was used to identify distinct subgroups of physicians based on their response patterns. Multinomial logistic regression examined predictors of profile membership, and results were reported as odds ratios (ORs) with 95% CIs. Results: The latent profile analysis identified 5 distinct profiles: Reform-Adaptable (n=516, 10.64%; 95% CI 9.76%-11.52%), Negative (n=1003, 20.68%; 95% CI 19.50%-21.86%), Neutral (n=2276, 46.92%; 95% CI 45.50%-48.34%), Reform-Conservative (n=545, 11.23%; 95% CI 10.33%-12.13%), and Positive (n=511, 10.53%; 95% CI 9.66%-11.40%). Significant intergroup differences were observed in demographic and occupational characteristics. For instance, compared with the Negative profile, male physicians were less likely to belong to the Neutral (OR 0.76, 95% CI 0.64‐0.90; P=.001) and Reform-Conservative (OR 0.67, 95% CI 0.54‐0.84; P=.001) profiles. Compared to the Neutral profile, physicians with a master’s degree or above were less likely to be in the Reform-Conservative profile (OR 0.75, 95% CI 0.59‐0.96; P=.052). Those working in tertiary hospitals were less likely to belong to the Positive group (OR range 0.56‐0.66, P=.001). High-income physicians were more likely to be in the Reform-Conservative group (OR range 1.83‐2.38, P=.001). In addition, higher occupational stress was associated with a greater likelihood of Positive profile membership (OR range 1.12‐1.26, P=.001), while better work satisfaction predicted higher odds of Positive profile membership (OR range 1.04‐1.16, P=.001). Conclusions: This study introduces a novel, person-centered approach by identifying five distinct perceptual typologies among physicians, moving beyond traditional variable-centered analyses. This typology provides an evidence-based foundation for tailored interventions. For instance, the Reform-Adaptable group may need barrier reduction, while the Reform-Conservative group may require clearer value demonstrations. This nuanced understanding can help healthcare systems enhance the impact and scalability of digital health technologies in real-world clinical practice. %R 10.2196/77840 %U https://www.jmir.org/2025/1/e77840 %U https://doi.org/10.2196/77840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e77157 %T Regional Disparities in the Use and Demand for Digital Health Services for Autism Spectrum Disorder in China: Cross-Sectional Survey of Stakeholder Perspectives %A Zou,Mingyang %A Gong,Xiaomei %A Feng,Liwen %A Li,Shengqi %A Lu,Chenyang %A Liu,Zhuoqiong %A Sun,Caihong %A Wu,Lijie %+ Department of Developmental Behavioral Pediatrics, The Sixth Affiliated Hospital, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang Province, Harbin, 150023, China, 86 451 87502675, wulijiehyd@126.com %K autism spectrum disorder %K digital health %K caregivers %K rehabilitation therapists %K China %D 2025 %7 3.10.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Autism spectrum disorder (ASD) is a lifelong neurodevelopmental condition, the prevalence of which is increasing in China and worldwide. Digital health technologies offer promising solutions for improving screening, diagnosis, and rehabilitation of children with ASD, particularly in resource-limited settings. However, digital health technologies for ASD have not been adopted in China. Understanding utilization patterns, influencing factors, and user needs is essential to inform equitable, effective digital health strategies. Objective: This study aimed to assess the current use, influencing factors, and perceived needs of digital health services among parents of children with ASD and rehabilitation therapists in 2 distinct provinces in China. Methods: A cross-sectional survey was carried out between November 2023 and February 2024 in Heilongjiang and Fujian provinces. Purposive sampling recruited a total of 780 parents and 745 rehabilitation therapists to complete a structured questionnaire. Data were analyzed using descriptive statistics, stepwise multivariable logistic regression, and multiple response analysis. Results: The use of digital health services was low among parents (46/780, 5.9%) and rehabilitation therapists (161/745, 21.6%), although the demand was substantially higher (621/780, 79.6% and 671/745, 90.0%, respectively). Among parents, higher use was positively associated with younger age (20-29 years), employment, lower income (≤CNY 3000/month [US $421.247/month]), and delayed ASD diagnosis (7-12 years old). Among rehabilitation therapists, male, special education background, and autism-specific training experience predicted higher use (all P<.05). Demand was significantly greater in Fujian than in Heilongjiang and was positively associated with higher education levels in parents and rehabilitation therapists (P<.05). Parents and rehabilitation therapists valued a greater understanding of ASD behaviors and development and easier access to resources as primary benefits. Common barriers to the use of digital health services included high cost, need for additional equipment, and usability challenges. The smartphone-WeChat mini-program was the preferred device and platform, respectively. Parents prioritized access to rehabilitation courses, remote guidance, and policy information, while rehabilitation therapists favored personalized plans and professional skills training. Conclusions: Despite a strong demand, digital health services are underused in ASD care across China, with adoption of digital health services influenced by regional disparities and sociodemographic factors. This study, as the first comparative analysis of parents and rehabilitation therapists in 2 Chinese provinces, provides stakeholder-specific insights to guide targeted, locally relevant interventions. Bridging the digital divide through inclusive policies, training, and cross-sector collaboration will be essential for equitable integration into ASD care pathways. %M 41043146 %R 10.2196/77157 %U https://www.jmir.org/2025/1/e77157 %U https://doi.org/10.2196/77157 %U http://www.ncbi.nlm.nih.gov/pubmed/41043146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54472 %T Typology and Ethical Considerations of Digital Health Promotion Tools for Youth in Sub-Saharan Africa: Review of Examples From Ghana, Kenya, and South Africa %A Ferretti,Agata %A Hubbs,Shannon %A Dzikunu,Richard Mawutor %A Moodley,Keymanthri %A Wekesah,Frederick Murunga %A Wright,Jonty %A Vayena,Effy %K youth %K young people %K low- and middle-income countries %K LMICs %K health promotion %K digital health %K Sub-Saharan Africa %K taxonomy %K digital health %K tool %K African %K technology %K digital tool %K health information %K digital health information %D 2025 %7 15.9.2025 %9 %J JMIR Form Res %G English %X Background: Digital technologies for health promotion have proliferated over the past decade, with uptake increasing steadily among young people, including those in low- and middle-income countries (LMICs). Youth increasingly rely on digital tools for health information, and the early influence of this digital technology can have an impact throughout the lifespan. While there is a growing body of literature on the opportunities and challenges of digital health promotion (DHP) for young people, a gap remains in research that closely examines the characteristics of digital health strategies developed specifically for youth in LMICs. Objective: In this paper, we investigate and compare selected examples of DHP tools from 3 countries in Sub-Saharan Africa, namely Ghana, Kenya, and South Africa. Our aim is to create a multidimensional descriptive typology of DHP tools developed specifically to promote the health of adolescents and young adults in these countries. Methods: To select the tools, we conducted systematic internet-based searches using relevant keywords, incorporating the expertise of local professionals to ensure a thorough search. Included solutions originated from one of the 3 countries of focus and could take any number of forms such as apps, websites, chatbots, or social media initiatives. We thereafter deductively created a typology describing selected features of each tool, including the health area of focus, key stakeholders, type of service, and ethical values explicitly referenced within the tool. While such high-level features of interest were selected based on the existing literature in the field, the detailed descriptive categories were identified through an inductive analysis of the tools. Results: A total of 31 DHP tools were identified. Sexual and reproductive health was the most common health area of focus for DHP services, which were primarily funded and supported by local non-governmental organizations, foundations, and international organizations. The assessed tools were predominantly web-based and social media-based, with the overarching goal and core value of expanding health knowledge and offering access to health promotion services to young people. Conclusions: With sustained investment, DHP can improve the health of young people while relieving pressure on health care services. The areas of mental health, as well as substance use prevention and nutrition, stand out with clear potential for health gains through investment in DHP. Addressing ethical concerns such as privacy, transparency, equity, and inclusiveness is essential to the safety, usefulness, and fairness of DHP. To achieve the greatest benefit, local youth perspectives and priorities should be included in DHP development. Local initiatives have the potential to be the most agile, flexible, and relevant for the target audience of young people, with the overall goal of early intervention and greater health quality throughout the lifespan, and more efficient use of health care resources. %R 10.2196/54472 %U https://formative.jmir.org/2025/1/e54472 %U https://doi.org/10.2196/54472 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e72588 %T Opportunities and Challenges for an Organizational Digital Public Health Strategy in a Provincial Public Health Program in Canada: Qualitative Description of Practitioner Perspectives %A Iyamu,Ihoghosa %A Haag,Devon %A Carson,Anna %A Wang,Ivy %A King,Colin %A Roe,Ian %A Kerr,Kristy %A Bartlett,Sofia %A McKee,Geoffrey %A Gilbert,Mark %K digital health %K digital public health %K implementation science %K digital health strategy %D 2025 %7 12.8.2025 %9 %J JMIR Public Health Surveill %G English %X Background: The digital transformation of health services accelerated during the pandemic. While “digital health” strategies were created, they paid minimal attention to public health services like health promotion, disease surveillance, emergency preparedness, and health protection. Objective: This study aimed to inform a digital public health (DPH) strategy at the British Columbia Centre for Disease Control (BCCDC) and explored public health practitioners’ perspectives on challenges and opportunities of integrating digital technologies into public health functions within the organization. Methods: In this qualitative description, we conducted 18 focus groups (FGs) between January and June 2023, drawing practitioners from 9 organizational subunits of the BCCDC including population and public health, environmental health, clinical services, vaccine-preventable diseases, communications, knowledge translation, data analytics, and Indigenous health (2 FGs per subunit). Discussions explored practitioners’ application of digital technologies in their public health work, focusing on challenges encountered during implementation (current state FGs) and perceived opportunities (future state FGs). Sessions were audio-recorded, and detailed field notes were taken. Thematic analysis was conducted, comparing perspectives across groups using constant comparative techniques. Results: We identified 3 themes. First, “bridging existing inequities—an opportunity and a challenge contingent on public trust” described participants’ excitement about opportunities for DPH to disrupt historical inequities if centered on trust and reconciliation, while recognizing current digital transformation efforts risk exacerbating existing inequities with the digital divide. Second, “a sense of disconnect between “digital” and “public health” functions” described perceptions of DPH as being out of scope of core public health duties, requiring new competencies and navigation of complex organizational policies for which support is suboptimal. Third, “balancing the need for responsive DPH with necessary reactivity” highlighted practitioners’ yearnings for a proactive DPH strategy rather than current issue-based reactive approaches. Participants suggest that a centralized systematic program can help achieve this goal. Conclusions: A cohesive, systematic, and proactive organizational strategy for DPH is critical to enable equity-focused digital transformation. Such a strategy can bridge perceived disconnects between digital and public health functions through organizational supports like competency development and streamlined policies that can better support public health practitioners to integrate digital technologies into their work. %R 10.2196/72588 %U https://publichealth.jmir.org/2025/1/e72588 %U https://doi.org/10.2196/72588 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63355 %T The Implementation Outcomes and Population Impact of a Statewide IT Deployment for Family Caregivers: Mixed Methods Study %A Tonkikh,Orly %A Young,Heather M %A Bell,Janice F %A Famula,Jessica %A Whitney,Robin %A Mongoven,Jennifer %A Kelly,Kathleen %+ Betty Irene Moore School of Nursing, University of California Davis, 2570 48th Street, Sacramento, CA, 95817, United States, 1 9167342145, hmyoung@ucdavis.edu %K web-based assessment %K caregiver %K technology implementation %K Consolidated Framework for Implementation Research %K CFIR %K information technology %K IT %K family caregivers %K eHealth %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: In 2022, the US Department of Health and Human Services released the first National Strategy to Support Family Caregivers, identifying actions for both government and the private sector. One of the major goals is to expand data, research, and evidence-based practices to support family caregivers. While IT tools are widely deployed in health care settings, they are rarely available at scale in community agencies. In 2019, the state of California recognized the importance of a statewide database and a platform to serve caregivers remotely by enhancing existing service supports and investing in a web-based platform, CareNav. Implementation commenced in early 2020 across all 11 California Caregiver Resource Centers. Objective: This paper describes the implementation strategies and outcomes of the statewide implementation of CareNav, a web-based platform to support family caregivers. Methods: The Consolidated Framework for Implementation Research (CFIR), including a recent addendum, guided this mixed methods evaluation. Two major approaches were used to evaluate the implementation process: in-depth qualitative interviews with key informants (n=82) and surveys of staff members (n=112) and caregivers (n=2229). We analyzed the interview transcripts using qualitative descriptive methods; subsequently, we identified subthemes and relationships among the ideas, mapping the findings to the CFIR addendum. For the surveys, we used descriptive statistics. Results: We present our findings about implementation strategies, implementation outcomes (ie, adoption, fidelity, and sustainment), and the impact on population health (organizational effectiveness and equity, as well as caregiver satisfaction, health, and well-being). The platform was fully adopted within 18 months, and the system is advancing toward sustainment through statewide collaboration. The deployment has augmented organizational effectiveness and quality, enhanced equity, and improved caregiver health and well-being. Conclusions: This study provides a use case for technological implementation across a multisite system with diverse community-based agencies. Future research can expand the understanding of the barriers and facilitators to achieving relevant outcomes and population impact. %M 39657176 %R 10.2196/63355 %U https://aging.jmir.org/2024/1/e63355 %U https://doi.org/10.2196/63355 %U http://www.ncbi.nlm.nih.gov/pubmed/39657176 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60258 %T Digital Information Ecosystems in Modern Care Coordination and Patient Care Pathways and the Challenges and Opportunities for AI Solutions %A Chen,You %A Lehmann,Christoph U %A Malin,Bradley %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 37203, United States, 1 6153431939, you.chen@vanderbilt.edu %K patient care pathway %K care journey %K care coordination %K digital information ecosystem %K digital technologies %K artificial intelligence %K information interoperability %K information silos %K workload %K information retrieval %K care transitions %K patient-reported outcome measures %K clinical workflow %K usability %K user experience workflow %K health care information systems %K networks of health care professionals %K patient information flow %D 2024 %7 2.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X The integration of digital technologies into health care has significantly enhanced the efficiency and effectiveness of care coordination. Our perspective paper explores the digital information ecosystems in modern care coordination, focusing on the processes of information generation, updating, transmission, and exchange along a patient’s care pathway. We identify several challenges within this ecosystem, including interoperability issues, information silos, hard-to-map patient care journeys, increased workload on health care professionals, coordination and communication gaps, and compliance with privacy regulations. These challenges are often associated with inefficiencies and diminished care quality. We also examine how emerging artificial intelligence (AI) tools have the potential to enhance the management of patient information flow. Specifically, AI can boost interoperability across diverse health systems; optimize and monitor patient care pathways; improve information retrieval and care transitions; humanize health care by integrating patients’ desired outcomes and patient-reported outcome measures; and optimize clinical workflows, resource allocation, and digital tool usability and user experiences. By strategically leveraging AI, health care systems can establish a more robust and responsive digital information ecosystem, improving care coordination and patient outcomes. This perspective underscores the importance of continued research and investment in AI technologies in patient care pathways. We advocate for a thoughtful integration of AI into health care practices to fully realize its potential in revolutionizing care coordination. %M 39622048 %R 10.2196/60258 %U https://www.jmir.org/2024/1/e60258 %U https://doi.org/10.2196/60258 %U http://www.ncbi.nlm.nih.gov/pubmed/39622048 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e50375 %T Maturity Assessment of District Health Information System Version 2 Implementation in Ethiopia: Current Status and Improvement Pathways %A Yilma,Tesfahun Melese %A Taddese,Asefa %A Mamuye,Adane %A Endehabtu,Berhanu Fikadie %A Alemayehu,Yibeltal %A Senay,Asaye %A Daka,Dawit %A Abraham,Loko %A Tadesse,Rabeal %A Melkamu,Gemechis %A Wendrad,Naod %A Kaba,Oli %A Mohammed,Mesoud %A Denboba,Wubshet %A Birhan,Dawit %A Biru,Amanuel %A Tilahun,Binyam %+ Department of Health Informatics, Center for Digital Health and Implementation Science, University of Gondar, Chechela Street, College of Medicine and Health Sciences, University of Gondar, Gondar, 196, Ethiopia, 251 918779820, tesfahun.melese@uog.edu.et %K health information system %K digital health system %K District Health Information System version 2 %K DHIS2 %K maturity assessment %K Stages of Continuous Improvement %K Ethiopia %D 2024 %7 26.7.2024 %9 Implementation Report %J JMIR Med Inform %G English %X Background: Although Ethiopia has made remarkable progress in the uptake of the District Health Information System version 2 (DHIS2) for national aggregate data reporting, there has been no comprehensive assessment of the maturity level of the system. Objective: This study aims to assess the maturity level of DHIS2 implementation in Ethiopia and propose a road map that could guide the progress toward a higher level of maturity. We also aim to assess the current maturity status, implementation gaps, and future directions of DHIS2 implementation in Ethiopia. The assessment focused on digital health system governance, skilled human resources, information and communication technology (ICT) infrastructure, interoperability, and data quality and use. Methods: A collaborative assessment was conducted with the engagement of key stakeholders through consultative workshops using the Stages of Continuous Improvement tool to measure maturity levels in 5 core domains, 13 components, and 39 subcomponents. A 5-point scale (1=emerging, 2=repeatable, 3=defined, 4=managed, and 5=optimized) was used to measure the DHIS2 implementation maturity level. Results: The national DHIS2 implementation’s maturity level is currently at the defined stage (score=2.81) and planned to move to the manageable stage (score=4.09) by 2025. The domain-wise maturity score indicated that except for ICT infrastructure, which is at the repeatable stage (score=2.14), the remaining 4 domains are at the defined stage (score=3). The development of a standardized and basic DHIS2 process at the national level, the development of a 10-year strategic plan to guide the implementation of digital health systems including DHIS2, and the presence of the required competencies at the facility level to accomplish specific DHIS2-related tasks are the major strength of the Ministry of Health of Ethiopia so far. The lack of workforce competency guidelines to support the implementation of DHIS2; the unavailability of core competencies (knowledge, skills, and abilities) required to accomplish DHIS2 tasks at all levels of the health system; and ICT infrastructures such as communication network and internet connectivity at the district, zonal, and regional levels are the major hindrances to effective DHIS2 implementation in the country. Conclusions: On the basis of the Stages of Continuous Improvement maturity model toolkit, the implementation status of DHIS2 in Ethiopia is at the defined stage, with the ICT infrastructure domain being at the lowest stage as compared to the other 4 domains. By 2025, the maturity status is planned to move from the defined stage to the managed stage by improving the identified gaps. Various action points are suggested to address the identified gaps and reach the stated maturity level. The responsible body, necessary resources, and methods of verification required to reach the specified maturity level are also listed. %M 39059005 %R 10.2196/50375 %U https://medinform.jmir.org/2024/1/e50375 %U https://doi.org/10.2196/50375 %U http://www.ncbi.nlm.nih.gov/pubmed/39059005 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54821 %T The Power of Rapid Reviews for Bridging the Knowledge-to-Action Gap in Evidence-Based Virtual Health Care %A MacPherson,Megan %A Rourke,Sarah %+ Fraser Health, 400-13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada, 1 6045616605, meganmargaretmacpherson@gmail.com %K virtual health care %K rapid reviews %K evidence synthesis %K evidence-informed decision-making %K knowledge translation %D 2024 %7 22.5.2024 %9 Viewpoint %J J Med Internet Res %G English %X Despite the surge in popularity of virtual health care services as a means of delivering health care through technology, the integration of research evidence into practice remains a challenge. Rapid reviews, a type of time-efficient evidence synthesis, offer a potential solution to bridge the gap between knowledge and action. This paper aims to highlight the experiences of the Fraser Health Authority’s Virtual Health team in conducting rapid reviews. This paper discusses the experiences of the Virtual Health team in conducting 15 rapid reviews over the course of 1.5 years and the benefit of involving diverse stakeholders including researchers, project and clinical leads, and students for the creation of user-friendly knowledge products to summarize results. The Virtual Health team found rapid reviews to be a valuable tool for evidence-informed decision-making in virtual health care. Involving stakeholders and focusing on implementation considerations are crucial for maximizing the impact of rapid reviews. Health care decision makers are encouraged to consider implementing rapid review processes to improve the translation of research evidence into practice, ultimately enhancing patient outcomes and promoting a culture of evidence-informed care. %M 38776542 %R 10.2196/54821 %U https://www.jmir.org/2024/1/e54821 %U https://doi.org/10.2196/54821 %U http://www.ncbi.nlm.nih.gov/pubmed/38776542 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52150 %T Tanzania’s and Germany’s Digital Health Strategies and Their Consistency With the World Health Organization’s Global Strategy on Digital Health 2020-2025: Comparative Policy Analysis %A Holl,Felix %A Kircher,Jennifer %A Hertelendy,Attila J %A Sukums,Felix %A Swoboda,Walter %+ DigiHealth Institute, Neu-Ulm University of Applied Sciences, Wileystraße 1, Neu-Ulm, 89231, Germany, 49 7319762 ext 1613, felix.holl@hnu.de %K digital health strategies %K comparative policy analysis %K DHS %K eHealth %K digital health %K strategy %K strategies %K policy %K policies %K document analysis %K document analyses %K GSDH %K Germany %K Europe %K Africa %K Tanzania %D 2024 %7 18.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, the fast-paced adoption of digital health (DH) technologies has transformed health care delivery. However, this rapid evolution has also led to challenges such as uncoordinated development and information silos, impeding effective health care integration. Recognizing these challenges, nations have developed digital health strategies (DHSs), aligning with their national health priorities and guidance from global frameworks. The World Health Organization (WHO)’s Global Strategy on Digital Health 2020-2025 (GSDH) guides national DHSs. Objective: This study analyzes the DHSs of Tanzania and Germany as case studies and assesses their alignment with the GSDH and identifies strengths, shortcomings, and areas for improvement. Methods: A comparative policy analysis was conducted, focusing on the DHSs of Tanzania and Germany as case studies, selected for their contrasting health care systems and cooperative history. The analysis involved a three-step process: (1) assessing consistency with the GSDH, (2) comparing similarities and differences, and (3) evaluating the incorporation of emergent technologies. Primary data sources included national eHealth policy documents and related legislation. Results: Both Germany’s and Tanzania’s DHSs align significantly with the WHO’s GSDH, incorporating most of its 35 elements, but each missing 5 distinct elements. Specifically, Tanzania’s DHS lacks in areas such as knowledge management and capacity building for leaders, while Germany’s strategy falls short in engaging health care service providers and beneficiaries in development phases and promoting health equity. Both countries, however, excel in other aspects like collaboration, knowledge transfer, and advancing national DHSs, reflecting their commitment to enhancing DH infrastructures. The high ratings of both countries on the Global Digital Health Monitor underscore their substantial progress in DH, although challenges persist in adopting the rapidly advancing technologies and in the need for more inclusive and comprehensive strategies. Conclusions: This study reveals that both Tanzania and Germany have made significant strides in aligning their DHSs with the WHO’s GSDH. However, the rapid evolution of technologies like artificial intelligence and machine learning presents challenges in keeping strategies up-to-date. This study recommends the development of more comprehensive, inclusive strategies and regular revisions to align with emerging technologies and needs. The research underscores the importance of context-specific adaptations in DHSs and highlights the need for broader, strategic guidelines to direct the future development of the DH ecosystem. The WHO’s GSDH serves as a crucial blueprint for national DHSs. This comparative analysis demonstrates the value and challenges of aligning national strategies with global guidelines. Both Tanzania and Germany offer valuable insights into developing and implementing effective DHSs, highlighting the importance of continuous adaptation and context-specific considerations. Future policy assessments require in-depth knowledge of the country’s health care needs and structure, supplemented by stakeholder input for a comprehensive evaluation. %M 38498021 %R 10.2196/52150 %U https://www.jmir.org/2024/1/e52150 %U https://doi.org/10.2196/52150 %U http://www.ncbi.nlm.nih.gov/pubmed/38498021 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44258 %T Perspectives on the COVID-19 Vaccination Rollout in 17 Countries: Reflexive Thematic and Frequency Analysis Based on the Strengths, Weaknesses, Opportunities, and Threats (SWOT) Framework %A Kopilaš,Vanja %A Nasadiuk,Khrystyna %A Martinelli,Lucia %A Lhotska,Lenka %A Todorovic,Zoran %A Vidmar,Matjaz %A Machado,Helena %A Svalastog,Anna Lydia %A Gajović,Srećko %+ BIMIS-Biomedical Research Center Šalata, University of Zagreb School of Medicine, Šalata 4, Zagreb, 10000, Croatia, 385 1 4566 948, srecko.gajovic@hiim.hr %K SARS-CoV-2 virus %K COVID-19 vaccination %K pandemic %K hesitancy %K safety %K vaccination %K COVID-19 %K tool %K implementation %K vaccine hesitancy %K effectiveness %K sociocultural %K communication %K disinformation %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As the SARS-CoV-2 virus created a global pandemic and rapidly became an imminent threat to the health and lives of people worldwide, the need for a vaccine and its quick distribution among the population was evident. Due to the urgency, and on the back of international collaboration, vaccines were developed rapidly. However, vaccination rollouts showed different success rates in different countries and some also led to increased vaccine hesitancy. Objective: The aim of this study was to identify the role of information sharing and context sensitivity in various vaccination programs throughout the initial COVID-19 vaccination rollout in different countries. Moreover, we aimed to identify factors in national vaccination programs related to COVID-19 vaccine hesitancy, safety, and effectiveness. Toward this end, multidisciplinary and multinational opinions from members of the Navigating Knowledge Landscape (NKL) network were analyzed. Methods: From May to July 2021, 25 completed questionnaires from 27 NKL network members were collected. These contributors were from 17 different countries. The responses reflected the contributors’ subjective viewpoints on the status and details of the COVID-19 vaccination rollout in their countries. Contributors were asked to identify strengths, weaknesses, opportunities, and threats (ie, SWOT) of the respective vaccination programs. The responses were analyzed using reflexive thematic analysis, followed by frequency analysis of identified themes according to the represented countries. Results: The perspectives of NKL network members showed a link between organizational elements of the vaccination rollout and the accompanying societal response, both of which were related to strengths and weaknesses of the process. External sociocultural variables, improved public communication around vaccination-related issues, ethical controversies, and the spread of disinformation were the dominant themes related to opportunities and challenges. In the SWOT 2×2 matrix, Availability and Barriers emerged as internal categories, whereas Transparent communication and promotion and Societal divide emerged as key external categories. Conclusions: Inventory of themes and categories inspired by elements of the SWOT framework provides an informative multidisciplinary perspective for effective implementation of public health strategies in the battle against COVID-19 or any future pandemics of a similar nature. %M 38373020 %R 10.2196/44258 %U https://humanfactors.jmir.org/2024/1/e44258 %U https://doi.org/10.2196/44258 %U http://www.ncbi.nlm.nih.gov/pubmed/38373020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51671 %T Public Health Dashboards in Overdose Prevention: The Rhode Island Approach to Public Health Data Literacy, Partnerships, and Action %A Yedinak,Jesse %A Krieger,Maxwell S %A Joseph,Raynald %A Levin,Stacey %A Edwards,Sarah %A Bailer,Dennis A %A Goyer,Jonathan %A Daley Ndoye,Colleen %A Schultz,Cathy %A Koziol,Jennifer %A Elmaleh,Rachael %A Hallowell,Benjamin D %A Hampson,Todd %A Duong,Ellen %A Shihipar,Abdullah %A Goedel,William C %A Marshall,Brandon DL %+ Department of Epidemiology, Brown University School of Public Health, Box G S 121-3, 121 South Main Street, 3rd Floor, Providence, RI, 02912, United States, 1 401 863 3375, jesse_yedinak@brown.edu %K community engagement %K data dashboards %K data literacy %K health literacy %K overdose %K public health communication %K public health surveillance %D 2024 %7 12.2.2024 %9 Viewpoint %J J Med Internet Res %G English %X As the field of public health rises to the demands of real-time surveillance and rapid data-sharing needs in a postpandemic world, it is time to examine our approaches to the dissemination and accessibility of such data. Distinct challenges exist when working to develop a shared public health language and narratives based on data. It requires that we assess our understanding of public health data literacy, revisit our approach to communication and engagement, and continuously evaluate our impact and relevance. Key stakeholders and cocreators are critical to this process and include people with lived experience, community organizations, governmental partners, and research institutions. In this viewpoint paper, we offer an instructive approach to the tools we used, assessed, and adapted across 3 unique overdose data dashboard projects in Rhode Island, United States. We are calling this model the “Rhode Island Approach to Public Health Data Literacy, Partnerships, and Action.” This approach reflects the iterative lessons learned about the improvement of data dashboards through collaboration and strong partnerships across community members, state agencies, and an academic research team. We will highlight key tools and approaches that are accessible and engaging and allow developers and stakeholders to self-assess their goals for their data dashboards and evaluate engagement with these tools by their desired audiences and users. %M 38345849 %R 10.2196/51671 %U https://www.jmir.org/2024/1/e51671 %U https://doi.org/10.2196/51671 %U http://www.ncbi.nlm.nih.gov/pubmed/38345849 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e50373 %T AI-Enabled Medical Education: Threads of Change, Promising Futures, and Risky Realities Across Four Potential Future Worlds %A Knopp,Michelle I %A Warm,Eric J %A Weber,Danielle %A Kelleher,Matthew %A Kinnear,Benjamin %A Schumacher,Daniel J %A Santen,Sally A %A Mendonça,Eneida %A Turner,Laurah %+ Department of Medical Education, College of Medicine, University of Cincinnati, Cincinnati, OH, United States, 1 5133303999, turnela@ucmail.uc.edu %K artificial intelligence %K medical education %K scenario planning %K future of healthcare %K ethics and AI %K future %K scenario %K ChatGPT %K generative %K GPT-4 %K ethic %K ethics %K ethical %K strategic planning %K Open-AI %K OpenAI %K privacy %K autonomy %K autonomous %D 2023 %7 25.12.2023 %9 Viewpoint %J JMIR Med Educ %G English %X Background: The rapid trajectory of artificial intelligence (AI) development and advancement is quickly outpacing society's ability to determine its future role. As AI continues to transform various aspects of our lives, one critical question arises for medical education: what will be the nature of education, teaching, and learning in a future world where the acquisition, retention, and application of knowledge in the traditional sense are fundamentally altered by AI? Objective: The purpose of this perspective is to plan for the intersection of health care and medical education in the future. Methods: We used GPT-4 and scenario-based strategic planning techniques to craft 4 hypothetical future worlds influenced by AI's integration into health care and medical education. This method, used by organizations such as Shell and the Accreditation Council for Graduate Medical Education, assesses readiness for alternative futures and effectively manages uncertainty, risk, and opportunity. The detailed scenarios provide insights into potential environments the medical profession may face and lay the foundation for hypothesis generation and idea-building regarding responsible AI implementation. Results: The following 4 worlds were created using OpenAI’s GPT model: AI Harmony, AI conflict, The world of Ecological Balance, and Existential Risk. Risks include disinformation and misinformation, loss of privacy, widening inequity, erosion of human autonomy, and ethical dilemmas. Benefits involve improved efficiency, personalized interventions, enhanced collaboration, early detection, and accelerated research. Conclusions: To ensure responsible AI use, the authors suggest focusing on 3 key areas: developing a robust ethical framework, fostering interdisciplinary collaboration, and investing in education and training. A strong ethical framework emphasizes patient safety, privacy, and autonomy while promoting equity and inclusivity. Interdisciplinary collaboration encourages cooperation among various experts in developing and implementing AI technologies, ensuring that they address the complex needs and challenges in health care and medical education. Investing in education and training prepares professionals and trainees with necessary skills and knowledge to effectively use and critically evaluate AI technologies. The integration of AI in health care and medical education presents a critical juncture between transformative advancements and significant risks. By working together to address both immediate and long-term risks and consequences, we can ensure that AI integration leads to a more equitable, sustainable, and prosperous future for both health care and medical education. As we engage with AI technologies, our collective actions will ultimately determine the state of the future of health care and medical education to harness AI's power while ensuring the safety and well-being of humanity. %M 38145471 %R 10.2196/50373 %U https://mededu.jmir.org/2023/1/e50373 %U https://doi.org/10.2196/50373 %U http://www.ncbi.nlm.nih.gov/pubmed/38145471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45224 %T Strengths, Weaknesses, Opportunities, and Threats Analysis of the Use of Digital Health Technologies in Primary Health Care in the Sub-Saharan African Region: Qualitative Study %A O'Brien,Niki %A Li,Edmond %A Chaibva,Cynthia N %A Gomez Bravo,Raquel %A Kovacevic,Lana %A Kwame Ayisi-Boateng,Nana %A Lounsbury,Olivia %A Nwabufo,Ngnedjou Francoise F %A Senkyire,Ephraim Kumi %A Serafini,Alice %A Surafel Abay,Eleleta %A van de Vijver,Steven %A Wanjala,Mercy %A Wangari,Marie-Claire %A Moosa,Shabir %A Neves,Ana Luisa %+ Institute of Global Health Innovation, Imperial College London, Room 1035/7, QEQM Wing, St Mary's Hospital, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk %K digital health %K digital health technology %K telemedicine %K remote care %K primary care %K primary health carel PHC %K COVID-19 %K global health %K sub-Saharan Africa %K eHealth %D 2023 %7 7.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health technologies (DHTs) have become increasingly commonplace as a means of delivering primary care. While DHTs have been postulated to reduce inequalities, increase access, and strengthen health systems, how the implementation of DHTs has been realized in the sub-Saharan Africa (SSA) health care environment remains inadequately explored. Objective: This study aims to capture the multidisciplinary experiences of primary care professionals using DHTs to explore the strengths and weaknesses, as well as opportunities and threats, regarding the implementation and use of DHTs in SSA primary care settings. Methods: A combination of qualitative approaches was adopted (ie, focus groups and semistructured interviews). Participants were recruited through the African Forum for Primary Care and researchers’ contact networks using convenience sampling and included if having experience with digital technologies in primary health care in SSA. Focus and interviews were conducted, respectively, in November 2021 and January-March 2022. Topic guides were used to cover relevant topics in the interviews, using the strengths, weaknesses, opportunities, and threats framework. Transcripts were compiled verbatim and systematically reviewed by 2 independent reviewers using framework analysis to identify emerging themes. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results: A total of 33 participants participated in the study (n=13 and n=23 in the interviews and in focus groups, respectively; n=3 participants participated in both). The strengths of using DHTs ranged from improving access to care, supporting the continuity of care, and increasing care satisfaction and trust to greater collaboration, enabling safer decision-making, and hastening progress toward universal health coverage. Weaknesses included poor digital literacy, health inequalities, lack of human resources, inadequate training, lack of basic infrastructure and equipment, and poor coordination when implementing DHTs. DHTs were perceived as an opportunity to improve patient digital literacy, increase equity, promote more patient-centric design in upcoming DHTs, streamline expenditure, and provide a means to learn international best practices. Threats identified include the lack of buy-in from both patients and providers, insufficient human resources and local capacity, inadequate governmental support, overly restrictive regulations, and a lack of focus on cybersecurity and data protection. Conclusions: The research highlights the complex challenges of implementing DHTs in the SSA context as a fast-moving health delivery modality, as well as the need for multistakeholder involvement. Future research should explore the nuances of these findings across different technologies and settings in the SSA region and implications on health and health care equity, capitalizing on mixed-methods research, including the use of real-world quantitative data to understand patient health needs. The promise of digital health will only be realized when informed by studies that incorporate patient perspective at every stage of the research cycle. %M 37676721 %R 10.2196/45224 %U https://www.jmir.org/2023/1/e45224 %U https://doi.org/10.2196/45224 %U http://www.ncbi.nlm.nih.gov/pubmed/37676721 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e41144 %T Health System Resilience in the Eastern Mediterranean Region: Perspective on the Recent Lessons Learned %A Amiri,Mirwais %A Al Nsour,Mohannad %A Alonso-Garbayo,Alvaro %A Al Serouri,Abdulwahed %A Maiteh,Adna %A Badr,Elsheikh %+ Global Health Development, Eastern Mediterranean Public Health Network, Shmeisani, Abdallah Ben Abbas Street, Bldg No 42, Amman, 11196, Jordan, 962 792985349, mamiri@globalhealthdev.org %K health systems resilience %K resilience %K vulnerability %K public health %K Eastern Mediterranean Region countries %K COVID-19 %D 2022 %7 21.12.2022 %9 Viewpoint %J Interact J Med Res %G English %X Background: Public health has a pivotal role in strengthening resilience at individual, community, and system levels as well as building healthy communities. During crises, resilient health systems can effectively adapt in response to evolving situations and reduce vulnerability across and beyond the systems. To engage national, regional, and international public health entities and experts in a discussion of challenges hindering achievement of health system resilience (HSR) in the Eastern Mediterranean Region, the Eastern Mediterranean Public Health Network (EMPHNET) held its seventh regional conference in Amman, Jordan, between November 15 and 18, 2021, under the theme “Towards Resilient Health Systems in the Eastern Mediterranean: Breaking Barriers.” This viewpoint paper portrays the roundtable discussion of experts on the core themes of that conference. Objective: Our aim was to provide insights on lessons learned from the past and explore new opportunities to attain more resilient health systems to break current barriers. Methods: The roundtable brought together a panel of public health experts representing Field Epidemiology Training Programs (FETPs), Centers for Disease Control and Prevention in Atlanta, World Health Organization, EMPHNET, universities or academia, and research institutions at regional and global levels. To set the ground, the session began with four 10-12–minute presentations introducing the concept of HSR and its link to workforce development with an overall reflection on the matter and lessons learned through collective experiences. The presentations were followed by an open question and answer session to allow for an interactive debate among panel members and the roundtable audience. Results: The panel discussed challenges faced by health systems and lessons learned in times of the new public health threats to move toward more resilient health systems, overcome current barriers, and explore new opportunities to enhance the HSR. They presented field experiences in building resilient health systems and the role of FETPs with an example from Yemen FETP. Furthermore, they debated the lessons learned from COVID-19 response and how it can reshape our thinking and strategies for approaching HSR. Finally, the panel discussed how health systems can effectively adapt and prosper in the face of challenges and barriers to recover from extreme disruptions while maintaining the core functions of the health systems. Conclusions: Considering the current situation in the region, there is a need to strengthen both pandemic preparedness and health systems, through investing in essential public health functions including those required for all-hazards emergency risk management. Institutionalized mechanisms for whole-of-society engagement, strengthening primary health care approaches for health security and universal health coverage, as well as promoting enabling environments for research, innovation, and learning should be ensured. Investing in building epidemiological capacity through continuous support to FETPs to work toward strengthening surveillance systems and participating in regional and global efforts in early response to outbreaks is crucial. %M 36480685 %R 10.2196/41144 %U https://www.i-jmr.org/2022/2/e41144 %U https://doi.org/10.2196/41144 %U http://www.ncbi.nlm.nih.gov/pubmed/36480685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33742 %T Impact of Hospital Characteristics and Governance Structure on the Adoption of Tracking Technologies for Clinical and Supply Chain Use: Longitudinal Study of US Hospitals %A Zhu,Xiao %A Tao,Youyou %A Zhu,Ruilin %A Wu,Dezhi %A Ming,Wai-kit %+ Management Science Department, Lancaster University Management School, Lancaster University, Bailrigg, Lancaster, LA1 4YX, United Kingdom, 44 1524592938, ruilin.zhu@lancaster.ac.uk %K radio frequency identification %K bar coding %K tracking technology adoption %K smart hospital %K hospital affiliation %K governance structure %K location %K clinical use %K supply chain use %D 2022 %7 26.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing adoption rate of tracking technologies in hospitals in the United States, few empirical studies have examined the factors involved in such adoption within different use contexts (eg, clinical and supply chain use contexts). To date, no study has systematically examined how governance structures impact technology adoption in different use contexts in hospitals. Given that the hospital governance structure fundamentally governs health care workflows and operations, understanding its critical role provides a solid foundation from which to explore factors involved in the adoption of tracking technologies in hospitals. Objective: This study aims to compare critical factors associated with the adoption of tracking technologies for clinical and supply chain uses and examine how governance structure types affect the adoption of tracking technologies in hospitals. Methods: This study was conducted based on a comprehensive and longitudinal national census data set comprising 3623 unique hospitals across 50 states in the United States from 2012 to 2015. Using mixed effects population logistic regression models to account for the effects within and between hospitals, we captured and examined the effects of hospital characteristics, locations, and governance structure on adjustments to the innate development of tracking technology over time. Results: From 2012 to 2015, we discovered that the proportion of hospitals in which tracking technologies were fully implemented for clinical use increased from 36.34% (782/2152) to 54.63% (1316/2409), and that for supply chain use increased from 28.58% (615/2152) to 41.3% (995/2409). We also discovered that adoption factors impact the clinical and supply chain use contexts differently. In the clinical use context, compared with hospitals located in urban areas, hospitals in rural areas (odds ratio [OR] 0.68, 95% CI 0.56-0.80) are less likely to fully adopt tracking technologies. In the context of supply chain use, the type of governance structure influences tracking technology adoption. Compared with hospitals not affiliated with a health system, implementation rates increased as hospitals affiliated with a more centralized health system—1.9-fold increase (OR 1.87, 95% CI 1.60-2.13) for decentralized or independent hospitals, 2.4-fold increase (OR 2.40, 95% CI 2.07-2.80) for moderately centralized health systems, and 3.1-fold increase for centralized health systems (OR 3.07, 95% CI 2.67-3.53). Conclusions: As the first of such type of studies, we provided a longitudinal overview of how hospital characteristics and governance structure jointly affect adoption rates of tracking technology in both clinical and supply chain use contexts, which is essential for developing intelligent infrastructure for smart hospital systems. This study informs researchers, health care providers, and policy makers that hospital characteristics, locations, and governance structures have different impacts on the adoption of tracking technologies for clinical and supply chain use and on health resource disparities among hospitals of different sizes, locations, and governance structures. %M 35617002 %R 10.2196/33742 %U https://www.jmir.org/2022/5/e33742 %U https://doi.org/10.2196/33742 %U http://www.ncbi.nlm.nih.gov/pubmed/35617002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32392 %T Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review %A Tran,Duc Minh %A Thwaites,C Louise %A Van Nuil,Jennifer Ilo %A McKnight,Jacob %A Luu,An Phuoc %A Paton,Chris %A , %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ward 1, District 5, Ho Chi Minh City, 700000, Vietnam, 84 356574593, ductm@oucru.org %K digital health %K eHealth %K policy %K Vietnam %K hospital care %K data %K health %K electronic medical records %K standards %K compulsory %K patient ID %K administrative information %K health insurance ID %K mobile phone %D 2022 %7 9.2.2022 %9 Review %J J Med Internet Res %G English %X Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence–based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government’s requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Thư Viện Pháp Luật, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians’ performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system’s capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting. %M 35138264 %R 10.2196/32392 %U https://www.jmir.org/2022/2/e32392 %U https://doi.org/10.2196/32392 %U http://www.ncbi.nlm.nih.gov/pubmed/35138264 %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 %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28643 %T Making the COVID-19 Pandemic a Driver for Digital Health: Brazilian Strategies %A Donida,Bruna %A da Costa,Cristiano André %A Scherer,Juliana Nichterwitz %+ SOFTWARELAB - Software Innovation Laboratory, Universidade do Vale do Rio dos Sinos, Av. Unisinos 950, São Leopoldo, 93022-750, Brazil, 55 5135908161, cac@unisinos.br %K COVID-19 %K digital technology %K Brazil %K public health %K medical informatics %K digital health %K strategy %K outbreak %K system %K data %K health data %K implementation %K monitoring %D 2021 %7 29.6.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 outbreak exposed several problems faced by health systems worldwide, especially concerning the safe and rapid generation and sharing of health data. However, this pandemic scenario has also facilitated the rapid implementation and monitoring of technologies in the health field. In view of the occurrence of the public emergency caused by SARS-CoV-2 in Brazil, the Department of Informatics of the Brazilian Unified Health System created a contingency plan. In this paper, we aim to report the digital health strategies applied in Brazil and the first results obtained during the fight against COVID-19. Conecte SUS, a platform created to store all the health data of an individual throughout their life, is the center point of the Brazilian digital strategy. Access to the platform can be obtained through an app by the patient and the health professionals involved in the case. Health data sharing became possible due to the creation of the National Health Data Network (Rede Nacional de Dados em Saúde, RNDS). A mobile app was developed to guide citizens regarding the need to go to a health facility and to assist in disseminating official news about the virus. The mobile app can also alert the user if they have had contact with an infected person. The official numbers of cases and available hospital beds are updated and published daily on a website containing interactive graphs. These data are obtained due to creating a web-based notification system that uses the RNDS to share information about the cases. Preclinical care through telemedicine has become essential to prevent overload in health facilities. The exchange of experiences between medical teams from large centers and small hospitals was made possible using telehealth. Brazil took a giant step toward digital health adoption, creating and implementing important initiatives; however, these initiatives do not yet cover the entire health system. It is expected that the sharing of health data that are maintained and authorized by the patient will become a reality in the near future. The intention is to obtain better clinical outcomes, cost reduction, and faster and better services in the public health network. %M 34101613 %R 10.2196/28643 %U https://publichealth.jmir.org/2021/6/e28643 %U https://doi.org/10.2196/28643 %U http://www.ncbi.nlm.nih.gov/pubmed/34101613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e23350 %T Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research %A Rossman,Andrea H %A Reid,Hadley W %A Pieters,Michelle M %A Mizelle,Cecelia %A von Isenburg,Megan %A Ramanujam,Nimmi %A Huchko,Megan J %A Vasudevan,Lavanya %+ Department of Family Medicine and Community Health, Duke University School of Medicine, 2200 W. Main Street, Suite 600, Durham, NC, 27705, United States, 1 9196131423, lavanya.vasudevan@duke.edu %K cervical cancer %K digital health %K mobile phones %K low- and middle-income countries %K colposcopy %K uterine cervical neoplasms %K telemedicine or mobile apps %K cell phones %K developing countries %D 2021 %7 27.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Nearly 90% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system–level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. Objective: We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. Methods: A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. Results: In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. Conclusions: Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies. %M 34042592 %R 10.2196/23350 %U https://www.jmir.org/2021/5/e23350 %U https://doi.org/10.2196/23350 %U http://www.ncbi.nlm.nih.gov/pubmed/34042592 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e23306 %T The Effect of Innovation Capabilities of Health Care Organizations on the Quality of Health Information Technology: Model Development With Cross-sectional Data %A Esdar,Moritz %A Hübner,Ursula %A Thye,Johannes %A Babitsch,Birgit %A Liebe,Jan-David %+ Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Caprivistr 30A, Osnabrueck, 49076, Germany, 49 541 969 2012, u.huebner@hs-osnabrueck.de %K organizational innovation %K health information management %K organizational culture %K diffusion of innovation %K hospital information systems %K organizational change management %D 2021 %7 15.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Large health organizations often struggle to build complex health information technology (HIT) solutions and are faced with ever-growing pressure to continuously innovate their information systems. Limited research has been conducted that explores the relationship between organizations’ innovative capabilities and HIT quality in the sense of achieving high-quality support for patient care processes. Objective: The aim of this study is to explain how core constructs of organizational innovation capabilities are linked to HIT quality based on a conceptual sociotechnical model on innovation and quality of HIT, called the IQHIT model, to help determine how better information provision in health organizations can be achieved. Methods: We designed a survey to assess various domains of HIT quality, innovation capabilities of health organizations, and context variables and administered it to hospital chief information officers across Austria, Germany, and Switzerland. Data from 232 hospitals were used to empirically fit the model using partial least squares structural equation modeling to reveal associations and mediating and moderating effects. Results: The resulting empirical IQHIT model reveals several associations between the analyzed constructs, which can be summarized in 2 main insights. First, it illustrates the linkage between the constructs measuring HIT quality by showing that the professionalism of information management explains the degree of HIT workflow support (R²=0.56), which in turn explains the perceived HIT quality (R²=0.53). Second, the model shows that HIT quality was positively influenced by innovation capabilities related to the top management team, the information technology department, and the organization at large. The assessment of the model’s statistical quality criteria indicated valid model specifications, including sufficient convergent and discriminant validity for measuring the latent constructs that underlie the measures of HIT quality and innovation capabilities. Conclusions: The proposed sociotechnical IQHIT model points to the key role of professional information management for HIT workflow support in patient care and perceived HIT quality from the viewpoint of hospital chief information officers. Furthermore, it highlights that organizational innovation capabilities, particularly with respect to the top management team, facilitate HIT quality and suggests that health organizations establish this link by applying professional information management practices. The model may serve to stimulate further scientific work in the field of HIT adoption and diffusion and to provide practical guidance to managers, policy makers, and educators on how to achieve better patient care using HIT. %M 33720029 %R 10.2196/23306 %U https://medinform.jmir.org/2021/3/e23306 %U https://doi.org/10.2196/23306 %U http://www.ncbi.nlm.nih.gov/pubmed/33720029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15976 %T How Geographical Isolation and Aging in Place Can Be Accommodated Through Connected Health Stakeholder Management: Qualitative Study With Focus Groups %A Chen,Sonia Chien-I %A Liu,Chenglian %A Wang,Zhenyuan %A McAdam,Rodney %A Brennan,Michael %A Davey,Shirley %A Cheng,Teng Yuan %+ Faculty of Economics and Management, East China Normal University, Room 307, S Fashang Building, No 500, Dongchuan Rd, Minhang District, Shanghai, 201108, China, 86 15800705298, wangzhenyuan@dbm.ecnu.edu.cn %K connected health care %K remote areas %K business strategy %K Taiwan %K population aging %K knowledge sharing %D 2020 %7 27.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In remote areas, connected health (CH) is needed, but as local resources are often scarce and the purchasing power of residents is usually poor, it is a challenge to apply CH in these settings. In this study, CH is defended as a technological solution for reshaping the direction of health care to be more proactive, preventive, and precisely targeted—and thus, more effective. Objective: The objective of this study was to explore the identity of CH stakeholders in remote areas of Taiwan and their interests and power in order to determine ideal strategies for applying CH. We aimed to explore the respective unknowns and discover insights for those facing similar issues. Methods: Qualitative research was conducted to investigate and interpret the phenomena of the aging population in a remote setting. An exploratory approach was employed involving semistructured interviews with 22 participants from 8 remote allied case studies. The interviews explored perspectives on stakeholder arrangements, including the power and interests of stakeholders and the needs of all the parties in the ecosystem. Results: Results were obtained from in-depth interviews and focus groups that included identifying the stakeholders of remote health and determining how they influence its practice, as well as how associated agreements bring competitive advantages. Stakeholders included people in government sectors, industrial players, academic researchers, end users, and their associates who described their perspectives on their power and interests in remote health service delivery. Specific facilitators of and barriers to effective delivery were identified. A number of themes, such as government interests and power of decision making, were corroborated across rural and remote services. These themes were broadly grouped into the disclosure of conflicts of interest, asymmetry in decision making, and data development for risk assessment. Conclusions: This study contributes to current knowledge by exploring the features of CH in remote areas and investigating its implementation from the perspectives of stakeholder management. It offers insights into managing remote health through a CH platform, which can be used for preliminary quantitative research. Consequently, these findings could help to more effectively facilitate diverse stakeholder engagement for health information sharing and social interaction. %M 32459181 %R 10.2196/15976 %U http://www.jmir.org/2020/5/e15976/ %U https://doi.org/10.2196/15976 %U http://www.ncbi.nlm.nih.gov/pubmed/32459181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17348 %T Clinical and Technical Considerations of an Open Access Telehealth Network in South Carolina: Definition and Deployment %A King,Kathryn %A Ford,Dee %A Haschker,Michael %A Harvey,Jillian %A Kruis,Ryan %A McElligott,James %+ Department of Healthcare Leadership and Management, Medical University of South Carolina, 151B Rutledge Ave, MSC 962, Charleston, SC, 29425, United States, 1 8437923431, harveyji@musc.edu %K telehealth %K health information technology %D 2020 %7 22.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Today, telehealth is experiencing exponential growth in utilization. Paralleling this trend is the growth in the telehealth industry, with sharp increases in the number of platforms, functionalities, and levels of integrations within both the electronic health record and other technical systems supporting health care. When a telehealth network is intended to be used across independent health care systems, an additional layer of complexity emerges. In the context of regionalized telehealth networks that are not within the same health care system, not only are technical interoperability challenges a practical barrier, but administrative, clinical, and competitive elements also quickly emerge, resulting in fragmented, siloed technologies. Objective: The study aimed to describe a statewide approach to deploying an interoperable open access telehealth network across multiple health systems. Methods: One promising solution to the abovementioned concerns is an open access telehealth network. In the field of telehealth, an open access network (OAN) can be defined as a network infrastructure that can be used by health care providers without a closed or proprietary platform, specific obligatory network, or service-specific telehealth technologies. This framework for the development of an OAN is grounded in practical examples of clinical programs that function in each stage of network maturity based on the experience of the South Carolina Telehealth Alliance (SCTA). The SCTA’s experience details successes and challenges in an ongoing effort to achieve an OAN. The model describes an OAN in stages of collaborative maturity and provides insights into the technological, clinical, and administrative implications of making the collaboration possible. Results: The four stages of an OAN are defined according to operational maturity, ranging from feasibility to demonstration of implementation. Each stage is associated with infrastructure and resource requirements and technical and clinical activities. In stage 1, technical standards are agreed upon, and the clinical programs are designed to utilize compliant technologies. In stage 2, collaboration is demonstrated through technical teams working together to address barriers, whereas clinical and administrative teams share best practices. In stage 3, a functional interoperable network is demonstrated with different institutions providing service through common telehealth end points at different patient care sites. In stage 4, clinical workflows are streamlined and standardized across institutions, and economies of scale are achieved through technical and administrative innovations. Conclusions: The approach to OAN development described provides a roadmap for achieving a functional telehealth network across independent health systems. The South Carolina experience reveals both successes and challenges in achieving this goal. The next steps toward the development of OANs include advocacy and ongoing engagement with the developers of telehealth technologies regarding their commitment to interoperability. %M 32441657 %R 10.2196/17348 %U http://www.jmir.org/2020/5/e17348/ %U https://doi.org/10.2196/17348 %U http://www.ncbi.nlm.nih.gov/pubmed/32441657 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19106 %T Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak %A Pérez Sust,Pol %A Solans,Oscar %A Fajardo,Joan Carles %A Medina Peralta,Manuel %A Rodenas,Pepi %A Gabaldà,Jordi %A Garcia Eroles,Luis %A Comella,Adrià %A Velasco Muñoz,César %A Sallent Ribes,Josuè %A Roma Monfa,Rosa %A Piera-Jimenez,Jordi %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Av del Tibidabo 39, Barcelona, 08035, Spain, 34 651041515, jpiera@bsa.cat %K digital health %K eHealth %K telemedicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K policymaking %D 2020 %7 4.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia. %M 32339998 %R 10.2196/19106 %U http://publichealth.jmir.org/2020/2/e19106/ %U https://doi.org/10.2196/19106 %U http://www.ncbi.nlm.nih.gov/pubmed/32339998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14201 %T Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study %A Chen,Sonia Chien-I %A Hu,Ridong %A McAdam,Rodney %+ Institute of Quantitative Economics, Huaqiao University, No. 668, Jimei Avenue, Jimei dist, Xiamen, 361021, China, 86 17750619886, j_rdhu@hqu.edu.cn %K connected health care %K smart health care %K health care quality %K access %K remote monitoring %K precision medicine %K self-management %D 2020 %7 28.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care’s direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. %M 32343254 %R 10.2196/14201 %U http://www.jmir.org/2020/4/e14201/ %U https://doi.org/10.2196/14201 %U http://www.ncbi.nlm.nih.gov/pubmed/32343254