Ethical and Quality of Care-Related Challenges of Digital Health Twins in Older Care Settings: Protocol for a Scoping Review.

BACKGROUND: Digital health twins (DHTs) have been evolving with their diverse applications in medicine, specifically in older care settings, with the increasing demands of older adults. DHTs have already contributed to improving the quality of dementia and trauma care, cardiac treatment, and health care services for older individuals. Despite its many benefits, the optimum implementation of DHTs has faced several challenges associated with ethical issues, quality of care, management and leadership, and design considerations in older care settings. Since the need for such care is continuously rising and there is evident potential for DHTs to meet those needs, this review aims to map key concepts to address the gaps in the research knowledge to improve DHT implementation. OBJECTIVE: The review aims to compile and synthesize the best available evidence regarding the problems encountered by older adults and care providers associated with the application of DHTs. The synthesis will collate the evidence of the issues associated with quality of care, the ethical implications of DHTs, and the strategies undertaken to overcome those challenges in older care settings. METHODS: The review will follow the Joanna Briggs Institute (JBI) methodology. The published studies will be searched through CINAHL, MEDLINE, JBI, and Web of Science, and the unpublished studies through Mednar, Trove, OCLC WorldCat, and Dissertations and Theses. Studies published in English from 2002 will be considered. This review will include studies of older individuals (aged 65 years or older) undergoing care delivery associated with DHTs and their respective care providers. The concept will include the application of the technology, and the context will involve studies based on the older care setting. A broad scope of evidence, including quantitative, qualitative, text and opinion studies, will be considered. A total of 2 independent reviewers will screen the titles and abstracts and then review the full text. Data will be extracted from the included studies using a data extraction tool developed for this study. RESULTS: The results will be presented in a PRISMA-ScR (Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews) flow diagram. A draft charting table will be developed as a data extraction tool. The results will be presented as a "map" of the data in a logical, diagrammatic, or tabular form in a descriptive format. CONCLUSIONS: The evidence synthesis is expected to uncover the shreds of evidence required to address the ethical and care quality-related challenges associated with applying DHTs. A synthesis of various strategies used to overcome identified challenges will provide more prospects for adopting them elsewhere and create a resource allocation model for older individuals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51153.

An integrated methodology for process improvement and delivery system visualization at a multidisciplinary cancer center.

Multidisciplinary cancer centers require an integrated, collaborative, and stream-lined workflow in order to provide high quality of patient care. Due to the complex nature of cancer care and continuing changes to treatment techniques and technologies, it is a constant struggle for centers to obtain a systemic and holistic view of treatment workflow for improving the delivery systems. Project management techniques, Responsibility matrix and a swim-lane activity diagram representing sequence of activities can be combined for data collection, presentation, and evaluation of the patient care. This paper presents this integrated methodology using multidisciplinary meetings and walking the route approach for data collection, integrated responsibility matrix and swim-lane activity diagram with activity time for data representation and 5-why and gap analysis approach for data analysis. This enables collection of right detail of information in a shorter time frame by identifying process flaws and deficiencies while being independent of the nature of the patient's disease or treatment techniques. A case study of a multidisciplinary regional cancer centre is used to illustrate effectiveness of the proposed methodology and demonstrates that the methodology is simple to understand, allowing for minimal training of staff and rapid implementation.

Development of modelling method selection tool for health services management: from problem structuring methods to modelling and simulation methods.

BACKGROUND: There is an increasing recognition that modelling and simulation can assist in the process of designing health care policies, strategies and operations. However, the current use is limited and answers to questions such as what methods to use and when remain somewhat underdeveloped. AIM: The aim of this study is to provide a mechanism for decision makers in health services planning and management to compare a broad range of modelling and simulation methods so that they can better select and use them or better commission relevant modelling and simulation work. METHODS: This paper proposes a modelling and simulation method comparison and selection tool developed from a comprehensive literature review, the research team's extensive expertise and inputs from potential users. Twenty-eight different methods were identified, characterised by their relevance to different application areas, project life cycle stages, types of output and levels of insight, and four input resources required (time, money, knowledge and data). RESULTS: The characterisation is presented in matrix forms to allow quick comparison and selection. This paper also highlights significant knowledge gaps in the existing literature when assessing the applicability of particular approaches to health services management, where modelling and simulation skills are scarce let alone money and time. CONCLUSIONS: A modelling and simulation method comparison and selection tool is developed to assist with the selection of methods appropriate to supporting specific decision making processes. In particular it addresses the issue of which method is most appropriate to which specific health services management problem, what the user might expect to be obtained from the method, and what is required to use the method. In summary, we believe the tool adds value to the scarce existing literature on methods comparison and selection.

Evaluating telemedicine: a focus on patient pathways.

Evaluations of telemedicine have sought to assess various measures of effectiveness (e.g., diagnostic accuracy), efficiency (e.g., cost), and engagement (e.g., patient satisfaction) to determine its success. Few studies, however, have looked at evaluating the organizational impact of telemedicine, which involves technology and process changes that affect the way that it is used and accepted by patients and clinicians alike. This study reviews and discusses the conceptual issues in telemedicine research and proposes a fresh approach for evaluating telemedicine. First, we advance a patient pathway perspective, as most of the existing studies view telemedicine as a support to a singular rather than multiple aspects of a health care process. Second, to conceptualize patient pathways and understand how telemedicine impacts upon them, we propose simulation as a tool to enhance understanding of the traditional and telemedicine patient pathway.

A proposed approach for modelling health-care systems for understanding.

Discrete event simulation (DES) application is not as widely perceived as being useful for problem solving in the health-care arena as in other application areas. Suggests that this might be due to the way DES is applied in health-care modelling, as it follows a traditionally based-on-engineering approach This may not be a problem in itself; however, health-care systems are often complex in that they involve multiple decision-makers and thus understanding and communication between the various stakeholders are potentially problematic. Thinks that problem understanding and efficient communication tools largely contribute to the solution; consequently, proposes a modelling approach to enhance stakeholder understanding and communication. The approach is based on participation of stakeholders; it is also iterative rather than step-based. To demonstrate this approach, gives an example, aiming to show how this approach has been used successfully to facilitate the understanding process, concluding that involving stakeholders throughout not only helps them to understand their problem better, but also enables them to more fully appreciate the findings resulting from the model. This approach thus serves usefully to enrich the communication between the stakeholders.