MediLinker: a blockchain-based decentralized health information management platform for patient-centric healthcare.

Patients' control over how their health information is stored has been an ongoing issue in health informatics. Currently, most patients' health information is stored in centralized but siloed health information systems of healthcare institutions, rarely connected to or interoperable with other institutions outside of their specific health system. This centralized approach to the storage of health information is susceptible to breaches, though it can be mitigated using technology that allows for decentralized access. One promising technology that offers the possibility of decentralization, data protection, and interoperability is blockchain. In 2019, our interdisciplinary team from the University of Texas at Austin's Dell Medical School, School of Information, Department of Electrical and Computer Engineering, and Information Technology Services developed MediLinker-a blockchain-based decentralized health information management platform for patient-centric healthcare. This paper provides an overview of MediLinker and outlines its ongoing and future development and implementation. Overall, this paper contributes insights into the opportunities and challenges in developing and implementing blockchain-based technologies in healthcare.

Consumers' longitudinal health information needs and seeking: a scoping review.

Needing and seeking health information often is a longitudinal everyday life information behavior that involves the use of technology. However, no reviews of consumers' longitudinal health information needs (HIN) and health information-seeking (HIS) behavior have been conducted. We performed a scoping review to address this gap. Specifically, we surveyed the characteristics, timeline construction and research findings of studies investigating consumers' longitudinal HIN and HIS. Initial searches were conducted in November 2019 and updated in July 2022. A total of 128 papers were identified, reviewed and analyzed using content and thematic analyses. Results showed that most papers were quantitative, conducted in the USA, related to cancer, conducted during the diagnosis and treatment phases, and followed preset time intervals. Findings concerning the development patterns of consumers' HIN degrees and HIS effort were mixed (i.e. increasing, decreasing or being consistent over time). They seemed to be shaped by factors such as health conditions, data collection methods and the length of data collection. Consumers' use of sources changes depending on health status and source accessibility; their medical terminologies seem to expand over time. HIS has a strong emotional dimension which may lead to adaptive or maladaptive information behaviors (e.g. information avoidance). Overall, the results revealed a lack of understanding of HIN and HIS from a longitudinal perspective, particularly along health condition progression and coping trajectories. There is also a lack of understanding of the role of technologies in the longitudinal HIS process.

The role of emergency physicians in the fight against health misinformation: Implications for resident training.

Emergency physicians on the frontlines of the COVID-19 pandemic are first-hand witnesses to the direct impact of health misinformation and disinformation on individual patients, communities, and public health at large. Therefore, emergency physicians naturally have a crucial role to play to steward factual information and combat health misinformation. Unfortunately, most physicians lack the communications and social media training needed to address health misinformation with patients and online, highlighting an obvious gap in emergency medicine training. We convened an expert panel of academic emergency physicians who have taught and conducted research about health misinformation at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in New Orleans, LA, on May 13, 2022. The panelists represented geographically diverse institutions including Baystate Medical Center/Tufts University, Boston Medical Center, Northwestern University, Rush Medical College, and Stanford University. In this article, we describe the scope and impact of health misinformation, introduce methods for addressing misinformation in the clinical environment and online, acknowledge the challenges of tackling misinformation from our physician colleagues, demonstrate strategies for debunking and prebunking, and highlight implications for education and training in emergency medicine. Finally, we discuss several actionable interventions that define the role of the emergency physician in the management of health misinformation.

Clinical, Organizational and Regulatory, and Ethical and Social (CORES) Issues and Recommendations on Blockchain Deployment for Healthcare: Evidence from Experts.

Objective: While existing research by our team has demonstrated the feasibility of building a decentralized identity management application ("MediLinker") for health information, there are implementation issues related to testing such blockchain-based health applications in real-world clinical settings. In this study, we identified clinical, organizational and regulatory, and ethical and social (CORES) issues, including recommendations, associated with deploying MediLinker, and blockchain in general, for clinical testing. Methods: CORES issues and recommendations were identified through a focus group with 11 academic, industry, and government experts on March 26, 2021. They were grouped according to their expertise: clinical care (n = 4), organizational and regulatory concerns (n = 4), and ethical and social issues (n = 3). The focus group was conducted via Zoom in which experts were briefed about the study aims, formed into breakout groups to identify key issues based on their group's expertise, and reconvened to share identified issues with other groups and to discuss potential recommendations to address such issues. The focus group was video recorded and transcribed. The resulting transcriptions and meeting notes were imported to MAXQDA 2018 for thematic analysis. Results: Clinical experts identified issues that concern the clinical system, clinical administrators, clinicians, and patients. Organizational and regulatory experts emphasized issues on accountability, compliance, and legal safeguards. Ethics and social-context experts raised issues on trust, transparency, digital divide, and health-related digital autonomy. Accordingly, experts proposed six recommendations that could address most of the identified issues: (1) design interfaces based on patient preferences, (2) ensure testing with diverse populations, (3) ensure compliance with existing policies, (4) present potential positive outcomes to top management, (5) maintain clinical workflow, and (6) increase the public's awareness of blockchain. Conclusions: This study identified a myriad of CORES issues associated with deploying MediLinker in clinical settings. Moreover, the study also uncovered several recommendations that could address such issues. The findings raise awareness on CORES issues that should be considered when designing, developing, and deploying blockchain for healthcare. Further, the findings provide additional insights into the development of MediLinker from a prototype to a minimum viable product for clinical testing. Future studies can use CORES as a socio-technical model to identify issues and recommendations associated with deploying health information technologies in clinical settings.

Technical Design and Development of A Self-Sovereign Identity Management Platform for Patient-Centric Health Care Using Blockchain Technology.

Objective: Clinical data in the United States are highly fragmented, stored in numerous different databases, and are defined by service providers or clinical specialties rather than by individuals or their families. As a result, linking or aggregating a complete record for a patient is a major technological, legal, and operational challenge. One of the factors that has made clinical data integration so difficult to achieve is the lack of a universal ID for everyone. This leads to other related problems of having to prove identity at each interaction with the health system and repeatedly providing basic information on demographics, insurance, payment, and medical conditions. Traditional solutions that require complex governance, expensive technology, and risks to privacy and security of the data have failed adequately to solve this interoperability problem. We describe the technical design decisions of a patient-centric decentralized health identity management system using the blockchain technology, called MediLinker, to address some of these challenges. Design: Our multidisciplinary research group developed and implemented an identity wallet, which uses the blockchain technology to manage verifiable credentials issued by healthcare clinics, banks, and insurance companies. To manage patient's self-sovereign identity, we leveraged the Hyperledger Indy blockchain framework to store patient's decentralized identifiers (DIDs) and the schemas or format for each credential type. In contrast, the credentials containing patient data are stored 'off-ledger' in each person's wallet and accessible via a computer or smartphone. We used Hyperledger Aries as a middleware layer (API: Application Programming Interface) to connect Hyperledger Indy with the front-end, which was developed using a JavaScript framework, ReactJS (Web Application) and React Native (iOS Application). Results: MediLinker allows users to store their personal data on digital wallets, which they control. It uses a decentralized trusted identity using Hyperledger Indy and Hyperledger Aries. Patients use MediLinker to register and share their information securely and in a trusted system with healthcare and other service providers. Each MediLinker wallet can have six credential types: health ID with patient demographics, insurance, medication list including COVID-19 vaccination status, credit card, medical power of attorney (MPOA) for guardians of pediatric or geriatric patients, and research consent. The system allows for in-person and remote granting and revoking of such permissions for care, research, or other purposes without repeatedly requiring physical identity documents or enrollment information. Conclusion: We successfully developed and tested a blockchain-based technical architecture, described in this article, as an identity management system that may be operationalized and scaled for future implementation to improve patient experience and control over their personal information.

Designing and testing a blockchain application for patient identity management in healthcare.

OBJECTIVE: Healthcare systems suffer from a lack of interoperability that creates "data silos," causing patient linkage and data sharing problems. Blockchain technology's unique architecture provides individuals greater control over their information and may help address some of the problems related to health data. A multidisciplinary team designed and tested a blockchain application, MediLinker, as a patient-centric identity management system. METHODS: The study used simulated data of "avatars" representing different types of patients. Thirty study participants were enrolled to visit simulated clinics, and perform various activities using MediLinker. Evaluation was based on Bouras' criteria for patient-centric identity management and on the number of errors in entry and sharing of data by participants. RESULTS: Twenty-nine of the 30 participants completed all study activities. MediLinker fulfilled all of Bouras' criteria except for one which was not testable. A majority of data errors were due to user error, such as wrong formatting and misspellings. Generally, the number of errors decreased with time. Due to COVID-19, sprint 2 was completed using "virtual" clinic visits. The number of user errors were less in virtual visits than in personal visits. DISCUSSION: The evaluation of MediLinker provides some evidence of the potential of a patient-centric identity management system using blockchain technology. The results showed a working system where patients have greater control over their information and can also easily provide consent for use of their data. CONCLUSION: Blockchain applications for identity management hold great promise for use in healthcare but further research is needed before real-world adoption.

US Physicians' and Nurses' Motivations, Barriers, and Recommendations for Correcting Health Misinformation on Social Media: Qualitative Interview Study.

BACKGROUND: Health misinformation is a public health concern. Various stakeholders have called on health care professionals, such as nurses and physicians, to be more proactive in correcting health misinformation on social media. OBJECTIVE: This study aims to identify US physicians' and nurses' motivations for correcting health misinformation on social media, the barriers they face in doing so, and their recommendations for overcoming such barriers. METHODS: In-depth interviews were conducted with 30 participants, which comprised 15 (50%) registered nurses and 15 (50%) physicians. Qualitative data were analyzed by using thematic analysis. RESULTS: Participants were personally (eg, personal choice) and professionally (eg, to fulfill the responsibility of a health care professional) motivated to correct health misinformation on social media. However, they also faced intrapersonal (eg, a lack of positive outcomes and time), interpersonal (eg, harassment and bullying), and institutional (eg, a lack of institutional support and social media training) barriers to correcting health misinformation on social media. To overcome these barriers, participants recommended that health care professionals should receive misinformation and social media training, including building their social media presence. CONCLUSIONS: US physicians and nurses are willing to correct health misinformation on social media despite several barriers. Nonetheless, this study provides recommendations that can be used to overcome such barriers. Overall, the findings can be used by health authorities and organizations to guide policies and activities aimed at encouraging more health care professionals to be present on social media to counteract health misinformation.

Healthcare professionals' acts of correcting health misinformation on social media.

BACKGROUND: Health misinformation on social media is a public health concern, and healthcare professionals can help correct it. However, research on how they correct health misinformation on social media is rare. OBJECTIVE: To develop a conceptual model that demonstrates how healthcare professionals correct health misinformation on social media. METHODS: In-depth semi-structured interviews were conducted between January and March 2020 with 30 U.S. healthcare professionals (15 registered nurses and 15 medical doctors). Participants were recruited through purposive and snowball sampling and interviewed via mobile phone calls (using their mobile phone number) or apps (via Zoom or Skype). Interview data were analyzed using a grounded theory approach. RESULTS: This study presents a two-phased conceptual model that shows healthcare professionals' acts of correcting health misinformation on social media (e.g., Twitter and Facebook). The first phase involves acts of authentication by which healthcare professionals verify health-related social media posts to be true or not. They undergo the process of internal acts of authentication (i.e., checking the author, checking for cues, checking the topic) and, if needed, external acts of authentication (i.e., examining the author and examining the content). When social media posts are deemed to contain health misinformation, they proceed to the second phase - acts of correction. In this phase, they undergo correction preparation (i.e., reflect, reveal, relate, and respect) and correction dissemination (i.e., private priming, public priming, public rebuttal, and private rebuttal). CONCLUSIONS: The study proposed a conceptual model that shows how healthcare professionals correct health misinformation on social media. The findings can guide healthcare professionals when identifying and correcting health misinformation on and off social media, and can guide health authorities when developing campaigns against health misinformation.

Policy recommendations on nurses' use of smartphones in the Philippines.

BACKGROUND: One key technology that has a significant implication on how nurses communicate and share information is the mobile phone, particularly the smartphone. However, its use for clinical work should be regulated by policies to minimize risks and maximize benefits. OBJECTIVE: To present policy recommendations on nurses' use of smartphones that are applicable in the context of clinical work in the Philippines. MATERIALS AND METHOD: The policy recommendations were developed by synthesizing findings of a mixed-method research on nurses' use of smartphones in the Philippines conducted from January to July 2017. RESULTS: The four policy recommendations are: (1) improving existing technologies to reduce smartphone usage, (2) providing adequate unit phones and service credits, (3) implementing realistic policies, and (4) educating nurses on the implications of using smartphones at work. DISCUSSION AND CONCLUSION: Although these recommendations might not be ideal considering that smartphone use also presents drawbacks, a pragmatic decision to allow nurses to use it for communication and information seeking purposes can help enhance the quality of care given to patients and nurses' work productivity in settings with scarce manpower and technology. Nonetheless, hospitals should find these recommendations as a temporary solution, and they should strive to come up with a long-term solution of providing nurses with appropriate technologies to facilitate clinical work.

Seniors and mobiles: A qualitative inquiry of mHealth adoption among Singapore seniors.

OBJECTIVE: This study examines how seniors in Singapore use mobile devices for healthcare purposes. METHODS: Semi-structured interviews with 35 mobile phone users aged between 58-82 years old. RESULTS: Seniors regard mobile phones as important personal devices for socialization, security, and emergency purposes. Most of the seniors consider mobile telephony (voice calls and text messaging) as an accessible platform to access healthcare. Perceived usefulness, ease of use, compatibility, technology anxiety, financial cost, and self-efficacy were identified as factors affecting the use of mHealth among seniors. Although a few adopt mHealth applications and mobile Internet for health-information seeking, some younger seniors show enthusiastic attitudes toward its adoption. Additionally, some seniors also have technology anxiety and resistance toward using mHealth applications. CONCLUSION: Seniors use mobile phones for healthcare purposes in their daily life, and its use involves several facilitators and barriers. Interpersonal training is likely to reduce their anxiety and increase mHealth literacy and adoption. Theoretical and practical implications are discussed.

Influence of Organizational Issues on Nurse Administrators' Support to Staff Nurses' Use of Smartphones for Work Purposes in the Philippines: Focus Group Study.

BACKGROUND: Studies show that nurses use their own smartphones for work purposes, and there are several organizational issues related to this. However, it is unclear what these organizational issues are in the Philippines and the influence they have on nurse administrators' (ie, superiors) support to staff nurses' (ie, subordinates) use of smartphones for work purposes. OBJECTIVE: Drawing from the Organizational Support Theory (OST), this study aimed to identify organizational issues that influence nurse administrators' support to staff nurses' use of smartphones for work purposes. METHODS: Between June and July 2017, 9 focus groups with 43 nurse administrators (ie, head nurses, nurse supervisors, and nurse managers) were conducted in 9 tertiary-level general hospitals in Metro Manila, the Philippines. Drawing from OST, issues were classified as those that encouraged or inhibited nurse administrators to support nurses' use of smartphones for work purposes. RESULTS: Nurse administrators were encouraged to support nurses' use of smartphones for work purposes when (1) personal smartphones are superior to workplace technologies, (2) personal smartphones resolve unit phone problems, and (3) policy is unrealistic to implement. Conversely, issues that inhibited nurse administrators to support nurses' use of smartphones for work purposes include (1) smartphone use for nonwork purposes and (2) misinterpretation by patients. CONCLUSIONS: Nurse administrators in the Philippines faced several organizational issues that encouraged or inhibited support to staff nurses' use of smartphones for work purposes. Following OST, the extent of their support can influence staff nurses' perceived organizational support on the use of smartphones for work purposes, Overall, the findings highlight the role and implication of organizational support in the context of smartphone consumerization in hospital settings, especially in developing countries.

Specific stressors relate to nurses' job satisfaction, perceived quality of care, and turnover intention.

AIMS: To determine which stressor has the highest occurrence and what stressors are related to nurse outcomes, such as job satisfaction, perceived quality of care, and turnover intention. BACKGROUND: Numerous stressors have been identified in nursing practice, but it is unclear if specific stressors are related to nurse outcomes. DESIGN: The study used a cross-sectional and descriptive-correlational research design. METHODS: In July and August 2017, survey data were collected from 427 staff nurses employed in a large tertiary-level private hospital in Metro Manila, Philippines. The Nursing Stress Scale was used to measure stress frequency. Structural equation modelling was used to determine the relationship of stressors and nurse outcomes. RESULTS: Exploratory and confirmatory factor analyses indicate nine Nursing Stress Scale factors. Workload is the most frequent stressor. Moreover, workload was negatively related to job satisfaction and perceived quality of care. Workload and conflict with nurses were positively related to turnover intention. CONCLUSIONS: The Nursing Stress Scale has a different factor structure based on a survey of nurses in the Philippines. Only workload and conflict with nurses were related to specific nurse outcomes. Nurse managers should identify and mitigate stressors experienced by nurses since these can lead to turnover and poor quality of care.

Examining Personal and Media Factors Associated with Attitude towards Genetically Modified Foods among University Students in Kunming, China.

: Guided by the theory of reasoned action and media system dependency theory, this study examined attitude towards genetically modified foods (GMF) among university students in Kunming, China, as well as personal and media factors related to such attitude. Data were collected from an online survey with 467 university students across eight universities in Kunming. Results showed that attitude towards GMF were more negative than positive. Moreover, food neophobia and media attention were negatively associated with attitude towards GMF. In contrast, perceived benefit was positively associated with attitude towards GMF. Although the interaction between media dependency and media attention was significant, simple slope analysis confirmed that the interaction slopes were nonsignificant, suggesting that media attention did not moderate the association between media dependency and attitude towards GMF in this study. Theoretical and practical implications are discussed.

Quality of nursing schools in the Philippines: Trends and evidence from the 2010-2016 Nurse Licensure Examination results.

BACKGROUND: The quality of undergraduate nursing programs offered by higher education institutions (HEIs) in the Philippines is usually evaluated using Nurse Licensure Examination (NLE) results. PURPOSE: To describe NLE trends in 2010 to 2016, compare low- and high-performing HEIs, and examine the association of HEIs' characteristics with NLE passing rate. METHODS: NLE and HEI data were collected from two Philippine government agencies. Descriptive statistics were used to present NLE trends, while multiple linear regression was used to determine the association of HEI characteristics with NLE passing rate. DISCUSSION: There was a downward trend for NLE takers and passers from 2010 to 2016. Regression results showed that location, size, type, year of establishment, and student-faculty ratio were associated with NLE passing rate. CONCLUSION: HEIs should consider decreasing their student-faculty ratio to improve NLE performance. Relevant government agencies should take measures to improve most HEIs' NLE performance in the Philippines.

Filipino Nurses' Use of Smartphones in Clinical Settings.

While previous research has examined specific ways that nurses have used smartphones for work purposes in clinical settings, large-sample quantitative studies are limited, particularly in Asia. To address this research gap, this study provided a ranking on how nurses have used their smartphones for work purposes in clinical settings and identified differences based on demographic and organizational factors. In January to June 2017, a pen-and-paper survey was administered to 517 staff nurses employed in 19 tertiary-level general hospitals in Metro Manila, Philippines. Results show that nurses frequently used their smartphones to exchange voice calls and text messages with other nurses and doctors. Results also showed that specific items reflecting the use of smartphones for communication purposes differed according to gender, age, hospital ownership, nursing area, number of patients handled in last shift, and presence of a hospital-provided mobile phone. Next, some items for information-seeking purposes differed according to highest educational attainment and years of clinical experience. Moreover, some items for documentation purposes differed according to age, hospital ownership, and number of patients handled in last shift. Overall, the results of this study can be used to guide policies on the use of smartphones in clinical settings.

Using Google Trends to Examine the Spatio-Temporal Incidence and Behavioral Patterns of Dengue Disease: A Case Study in Metropolitan Manila, Philippines.

Dengue is a major public health concern and an economic burden in the Philippines. Despite the country's improved dengue surveillance, it still suffers from various setbacks and needs to be complemented with alternative approaches. Previous studies have demonstrated the potential of Internet-based surveillance such as Google Dengue Trends (GDT) in supplementing current epidemiological methods for predicting future dengue outbreaks and patterns. With this, our study has two objectives: (1) assess the temporal relationship of weekly GDT and dengue incidence in Metropolitan Manila from 2009⁻2014; and (2) examine the health-seeking behavior based on dengue-related search queries of the population. The study collated the population statistics and reported dengue cases in Metropolitan Manila from respective government agencies to calculate the dengue incidence (DI) on a weekly basis for the entire region and annually per city. Data processing of GDT and dengue incidence was performed by conducting an 'adjustment' and scaling procedures, respectively, and further analyzed for correlation and cross-correlation analyses using Pearson's correlation. The relative search volume of the term 'dengue' and top dengue-related search queries in Metropolitan Manila were obtained and organized from the Google Trends platform. Afterwards, a thematic analysis was employed, and word clouds were generated to examine the health behavior of the population. Results showed that weekly temporal GDT pattern are closely similar to the weekly DI pattern in Metropolitan Manila. Further analysis showed that GDT has a moderate and positive association with DI when adjusted or scaled, respectively. Cross-correlation analysis revealed a delayed effect where GDT leads DI by 1⁻2 weeks. Thematic analysis of dengue-related search queries indicated 5 categories namely; (a) dengue, (b) sign and symptoms of dengue, (c) treatment and prevention, (d) mosquito, and (e) other diseases. The majority of the search queries were classified in 'signs and symptoms' which indicate the health-seeking behavior of the population towards the disease. Therefore, GDT can be utilized to complement traditional disease surveillance methods combined with other factors that could potentially identify dengue hotspots and help in public health decisions.

Psychometric evaluation of the Smartphone for Clinical Work Scale to measure nurses' use of smartphones for work purposes.

Objective: This study reports the development and psychometric evaluation of the Smartphone for Clinical Work Scale (SCWS) to measure nurses' use of smartphones for work purposes. Methods: Items were developed based on literature review and a preliminary study. After expert consultations and pilot testing, a 20-item scale was administered in January-June 2017 to 517 staff nurses from 19 tertiary-level general hospitals in Metro Manila, Philippines. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate construct validity. Structural equation modeling (SEM) was used to test the predictive validity of SCWS on perceived work productivity. Results: EFA results show that 15 out of 20 items loaded on five factors: communication with clinicians via call and text, communication with doctors via instant messaging, information seeking, communication with nurses via instant messaging, and communication with patients via call and text. CFA results suggest that the five factors that form SCWS have adequate fit to the data, thus supporting construct validity. SEM results suggest predictive validity since SCWS was positively associated with perceived work productivity. Conclusions: The 15-item SCWS showed satisfactory psychometric properties for use in future studies. These studies can focus on identifying factors associated with nurses' use of smartphones for work purposes.

Nurses' use of mobile instant messaging applications: A uses and gratifications perspective.

AIM: To explore how and why mobile instant messaging applications are used by Filipino nurses as part of their work. METHODS: Guided by the uses and gratifications theory, in-depth interviews with 20 staff nurses working in 9 hospitals (ie, 4 private and 5 public hospitals) in the Philippines were conducted in July 2015. Interview data were analysed through a phenomenological perspective to thematic analysis. RESULTS: Results show that mobile instant messaging applications such as Facebook Messenger and Viber were mostly used by staff nurses and these were accessed using their own smartphones. Thematic analysis indicates that they were used to meet staff nurses' need for information exchange, socialization, and catharsis. Moreover, user interactions vary depending on members within a chat group. For instance, communication via mobile instant messaging applications are much formal when superiors are included in a chat group. CONCLUSION: In general, the results show that mobile instant messaging applications are routinely used by Filipino staff nurses not only for clinical purposes (ie, information exchange) but also for non-clinical purposes (ie, socialization and catharsis). This paper ends with several practical and theoretical implications including future research directions.

Understanding the Relationships between mHealth Apps' Characteristics, Trialability, and mHealth Literacy.

The widespread adoption of mobile phones has increased the potential of mHealth to improve health communication and health outcomes because these devices could serve as a ubiquitous and affordable means to disseminate health information to large populations. Given that mHealth apps offer free or limited trials as part of promotional strategies, potential users' trialability is a critical step of the preadoption process. Drawing from Rogers' diffusion of innovation theory, this study examines the relationships of adopters' perceived characteristics of mHealth apps (i.e., relative advantage, complexity, compatibility, and observability) with their trialability. It further investigates how the perceived control of mobile devices and trialability of mHealth apps influence two dimensions of mHealth literacy, namely seeking and appraisal of health information. This web survey recruited 295 young mHealth app users from a Singaporean university. Results of partial least squares regression show that the observability of mHealth apps is the only factor positively related to mHealth trialability. Perceived control of mobile devices and trialability of mHealth apps are positively associated with seeking and appraisal of health information. Practical and theoretical implications to mHealth are discussed.