Trustworthy Evidence to Support Quality Digital Healthcare Policy for Underserved Communities: What Needs to Happen to Translate Evidence into Policy?

In this paper, we explore what is needed to generate quality research to guide evidence-informed digital health policy and call the Canadian community of patients, clinicians, policy (decision) makers and researchers to action in setting digital health research priorities for supporting underserved communities. Using specific examples, we describe how evidence is produced and implemented to guide digital health policy. We study how research environments must change to reflect and include the communities for whom the policy is intended. Our goal is to guide how future evidence reaches policy makers to help them shape healthcare services and how these services are delivered to underserved communities in Canada. Understanding the pathways through which evidence can make a difference to equitable and sustainable digital health policy is vital for guiding the types of research that attract priority resources.

Enabling Connected Care with a Person-Centred Data Foundation.

Having the right information at the right time and at the fingertips of the right individuals is not just a necessity for a well-functioning healthcare system but it is also the difference between life and death for Canadians. It is particularly critical to enable improved access to and quality of care for equity-deserving individuals because these data eliminate blind spots for clinicians, policy makers and system planners. The COVID-19 pandemic put a spotlight on the health data challenges that exist across Canada and the tangible impact those have on the healthcare system's ability to meet the needs of underserved populations. It sparked unified urgency at the federal and provincial/territorial levels to build a learning health system powered by connected health data for clinical care, patient access, care organization operations, health system use and population/public health. Person-centric data content standards will lie at the foundation of Canada's learning health system, enabling the creation and exchange of data.

Human-like tele-health robotics for older adults - A preliminary feasibility trial and vision.

Introduction: The global increase of the aging population presents major challenges to healthcare service delivery. Further, the COVID-19 pandemic exposed older adults' vulnerability to rapid deterioration of health when deprived of access to care due to the need for social distancing. Robotic technology advancements show promise to improve provision of quality care, support independence for patients and augment the capabilities of clinicians to perform tasks remotely. Aim: This study explored the feasibility and end-user acceptance of using a novel human-like tele-robotic system with touch feedback to conduct a remote medical examination and deliver safe care. Method: Testing of a remotely controlled robot was conducted with in-person clinician support to gather ECG readings of 11 healthy participants through a digital medical device. Post-study feedback about the system and the remote examinations conducted was obtained from study participants and study clinicians. Results: The findings demonstrated the system's capability to support remote examination of participants, and validated the system's perceived acceptability by clinicians and end-users who all reported feeling safe interacting with the robot and 72% preferred remote robotic exam over in-person examination. Conclusion: This paper discusses potential implications of robot-assisted telehealth for patients including older adults who are precluded from having in-person medical visits due to geographic distance or mobility, and proposes next steps for advancing robot-assisted telehealth delivery.

The presence of psychological distress in healthcare workers across different care settings in Windsor, Ontario, during the COVID-19 pandemic: A cross-sectional study.

Introduction: Few studies have examined psychological distress in healthcare workers (HCWs) across the care continuum. This study describes distress levels reported by HCWs across care settings and factors associated with distress. Methods: A cross-sectional survey of HCWs from Windsor, Ontario, was conducted between May 30th, 2020, and June 30th, 2020. The survey included the Kessler Psychological Distress Scale (K10), sociodemographic, frontline status, perceptions of training, protection, support, respect among teams, and professional and personal stressors. Univariate analyses were used to compare across settings and multivariate logistic regression assessed factors associated with distress. Results: Four hundred and three HCWs from the hospital (49.4%), community health and social service (18.4%), first responder (14.7%), primary care (7.9%), home (6.0%), and long-term care (LTC; 4.0%) participated in the survey. Common concerns included fear of transmitting COVID-19 to family, safety on the job, and balancing personal care with work demands. LTC and home-care HCWs reported greater concern about workload and staffing levels, whereas community health workers were more anxious about their financial security. Overall, 228 (74.2%) HCWs who completed the K10 reported high distress, with greater rates among hospital and LTC HCWs. Distress was more likely in HCWs who identified as female, younger than 55, perceived lower respect among team, and experienced greater worry about physical and mental health and managing high workloads. Conclusion: Results showed a high degree of distress experienced by HCWs across care settings and the impact of the COVID-19 pandemic on personal and work-related stress. Promoting self-care and supportive and collaborative healthcare teams are promising avenues for mitigating symptoms of distress.

VitalSeer: The development of a contactless sensing technology based on a user-centric data-driven clinical approach.

The COVID-19 pandemic presented challenges to the healthcare system while catalyzing the adoption of virtual care. The need for remote assessment and real-time monitoring of physiological vital signs has driven towards a need for virtual care solutions. This paper presents the outcome of a multidisciplinary collaboration to ensure clinical usability of a remote contactless sensing technology, VitalSeer, and to help close gaps between emerging technologies and clinical practice. The paper describes the user-centric data-driven clinical approach to address the needs as identified by clinical experts through the iterative and agile development cycle. It highlights findings from preliminary studies to validate proof-of-concept VitalSeer's adoptability, accessibility and usability. The studies on volunteers demonstrated the accuracy of VitalSeer's heart rate model at a low MAE of 0.74 (bpm) and a RMSE of 1.2 bpm, below the threshold of clinical grade contact-based sensors. The paper concludes with a discussion on the technology implications in emergency medicine and community care.

Testing the Feasibility of Sensor-Based Home Health Monitoring (TEC4Home) to Support the Convalescence of Patients With Heart Failure: Pre-Post Study.

BACKGROUND: Patients with heart failure (HF) can be affected by disabling symptoms and low quality of life. Furthermore, they may frequently need to visit the emergency department or be hospitalized due to their condition deteriorating. Home telemonitoring can play a role in tracking symptoms, reducing hospital visits, and improving quality of life. OBJECTIVE: Our objective was to conduct a feasibility study of a home health monitoring (HHM) solution for patients with HF in British Columbia, Canada, to prepare for conducting a randomized controlled trial. METHODS: Patients with HF were recruited from 3 urban hospitals and provided with HHM technology for 60 days of monitoring postdischarge. Participants were asked to monitor their weight, blood pressure, and heart rate and to answer symptomology questions via Bluetooth sensors and a tablet computer each day. A monitoring nurse received this data and monitored the patient's condition. In our evaluation, the primary outcome was the combination of unscheduled emergency department revisits of discharged participants or death within 90 days. Secondary outcomes included 90-day hospital readmissions, patient quality of life (as measured by Veterans Rand 12-Item Health Survey and Kansas City Cardiomyopathy Scale), self-efficacy (as measured by European Heart Failure Self-Care Behaviour Scale 9), end-user experience, and health system cost-effectiveness including cost reduction and hospital bed capacity. In this feasibility study, we also tested the recruitment strategy, clinical protocols, evaluation framework, and data collection methods. RESULTS: Seventy participants were enrolled into this trial. Participant engagement to monitoring was measured at 94% (N=70; ie, data submitted 56/60 days on average). Our evaluation framework allowed us to collect sound data, which also showed encouraging trends: a 79% reduction of emergency department revisits post monitoring, an 87% reduction in hospital readmissions, and a 60% reduction in the median hospital length of stay (n=36). Cost of hospitalization for participants decreased by 71%, and emergency department visit costs decreased by 58% (n=30). Overall health system costs for our participants showed a 56% reduction post monitoring (n=30). HF-specific quality of life (Kansas City Cardiomyopathy Scale) scores showed a significant increase of 101% (n=35) post monitoring (P<.001). General quality of life (Veterans Rand 12-Item Health Survey) improved by 19% (n=35) on the mental component score (P<.001) and 19% (n=35) on the physical component score (P=.02). Self-efficacy improved by 6% (n=35). Interviews with participants revealed that they were satisfied overall with the monitoring program and its usability, and participants reported being more engaged, educated, and involved in their self-management. CONCLUSIONS: Results from this small-sample feasibility study suggested that our HHM intervention can be beneficial in supporting patients post discharge. Additionally, key insights from the trial allowed us to refine our methods and procedures, such as shifting our recruitment methods to in-patient wards and increasing our scope of data collection. Although these findings are promising, a more rigorous trial design is required to test the true efficacy of the intervention. The results from this feasibility trial will inform our next step as we proceed with a randomized controlled trial across British Columbia. TRIAL REGISTRATION: ClinicalTrials.gov NCT03439384; https://clinicaltrials.gov/ct2/show/NCT03439384.

Expanding the Reach of Continuing Educational Offerings Through a Web-Based Virtual Network: The Experience of InspireNet.

Virtual platforms using webinars, e-posters, e-newsletters, wikis and blogs connect people who have common interests in new ways. When those individuals are healthcare providers, a professional network that operates on a virtual platform can support their needs for learning, professional development and information currency. The practice of e-learning for continuing professional development is emerging , particularly in nursing where shift work shift inhibits their ability to attend conferences and classes. This article reports the experience of the InspireNet network that provided e-learning models to: 1) provide opportunities for healthcare providers to organize themselves into learning communities through development of electronic communities of practice; 2) support learning on demand; and 3) dramatically increase the reach of educational offerings.

Growing a professional network to over 3000 members in less than 4 years: evaluation of InspireNet, British Columbia's virtual nursing health services research network.

BACKGROUND: Use of Web 2.0 and social media technologies has become a new area of research among health professionals. Much of this work has focused on the use of technologies for health self-management and the ways technologies support communication between care providers and consumers. This paper addresses a new use of technology in providing a platform for health professionals to support professional development, increase knowledge utilization, and promote formal/informal professional communication. Specifically, we report on factors necessary to attract and sustain health professionals' use of a network designed to increase nurses' interest in and use of health services research and to support knowledge utilization activities in British Columbia, Canada. OBJECTIVE: "InspireNet", a virtual professional network for health professionals, is a living laboratory permitting documentation of when and how professionals take up Web 2.0 and social media. Ongoing evaluation documents our experiences in establishing, operating, and evaluating this network. METHODS: Overall evaluation methods included (1) tracking website use, (2) conducting two member surveys, and (3) soliciting member feedback through focus groups and interviews with those who participated in electronic communities of practice (eCoPs) and other stakeholders. These data have been used to learn about the types of support that seem relevant to network growth. RESULTS: Network growth exceeded all expectations. Members engaged with varying aspects of the network's virtual technologies, such as teams of professionals sharing a common interest, research teams conducting their work, and instructional webinars open to network members. Members used wikis, blogs, and discussion groups to support professional work, as well as a members' database with contact information and areas of interest. The database is accessed approximately 10 times per day. InspireNet public blog posts are accessed roughly 500 times each. At the time of writing, 21 research teams conduct their work virtually using the InspireNet platform; 10 topic-based Action Teams meet to address issues of mutual concern. Nursing and other health professionals, even those who rated themselves as computer literate, required significant mentoring and support in their efforts to adopt their practice to a virtual environment. There was a steep learning curve for professionals to learn to work in a virtual environment and to benefit from the available technologies. CONCLUSIONS: Virtual professional networks can be positioned to make a significant contribution to ongoing professional practice and to creating environments supportive of information sharing, mentoring, and learning across geographical boundaries. Nonetheless, creation of a Web 2.0 and social media platform is not sufficient, in and of itself, to attract or sustain a vibrant community of professionals interested in improving their practice. Essential support includes instruction in the use of Web-based activities and time management, a biweekly e-Newsletter, regular communication from leaders, and an annual face-to-face conference.