Adoption of health technologies for effective health information system: Need of the hour for Pakistan.

Health information technology systems have the capacity to improve health outcomes for the patients thus ensuring quality and efficient services. Health information systems (HIS) are important tools in guidance towards patient safety and better outcomes. However, still, morbidity and mortality attributed to medical errors remain an important issue that needs to be addressed. The objective of the present study was to assess the health information system in terms of technological, environmental, organizational and human factors affecting the adoption as well as the perceptions of stakeholders along with barriers and constraints related to successful implementation. A descriptive cross-sectional study design was used. Prospective data was collected from primary sources by self-administering the pre-validated questionnaires as well as by physical verification of the availability of equipment. After data collection, data was analyzed to assess the health information management systems. The results of the present study showed that the health information system in Pakistan is not up to the mark. The equipment was mostly unavailable at the primary healthcare facilities. The staff was also unsatisfied with the available services. Administrative, financial and human constraints were identified as the major barriers towards successful implementation and management of HIS. The present study concluded that the health information system of Pakistan needs to be revamped. Health information management system partially existed at district and sub-district offices, while was completely absent at tertiary, secondary and primary healthcare levels. The poor adoption of health information technology systems at healthcare facilities might largely be attributed to insufficient human resources with limited resources and budget allocation for health in Pakistan. Effective and timely strategies involving all important stakeholders and healthcare professionals must be designed and implemented at the National level to restructure an affordable, resilient and quality healthcare system.

De la presencialidad a la virtualidad en tiempos de pandemia: la experiencia del Hospital Italiano de Buenos Aires / From face-to-face to virtuality in pandemic times: the experience of the Hospital Italiano de Buenos Aires

El 11 de marzo de 2020, la Organización Mundial de la Salud (OMS) declaró el COVID-19 como pandemia, afectando drásticamente la atención de la salud. A nivel global se adoptaron medidas como el distanciamiento social y la cuarentena. Ello representó un enorme desafío para los Sistemas de Información en Salud (SIS), que rápidamente debieron adaptarse, frente a una razón ineludible para abrazar por completo la transformación digital. Surge la necesidad de explorar las tecnologías digitales utilizadas durante la pandemia y considerarlas para su uso continuado en el tiempo o cíclicamente en caso de brotes recurrentes. Las herramientas informáticas se han utilizado para la prestación de servicios de telemedicina, monitorización remota de pacientes, comunicación digital entre líderes políticos y autoridades científicas, monitorización de datos para analizar la propagación y evolución del COVID-19, etc. Los países y organizaciones han impulsado el uso de soluciones tecnológicas con distintas limitaciones. El Hospital Italiano de Buenos Aires posee una trayectoria de más de 20 años en implementaciones e innovaciones tecnológicas; sin embargo, la pandemia impulsó una serie de adaptaciones en su SIS. El objetivo de este trabajo fue describir dicho proceso de adaptación digital desde marzo a diciembre de 2020, e identificar los principales resultados utilizando un modelo sociotécnico. Se empleó el modelo de Sittig que incluye 8 dimensiones: Infraestructura, Contenido clínico, Interfaz Humano-computadora, Personas, Comunicación y procesos, Regulaciones, Características organizacionales y Políticas internas y Medición y monitorización. (AU)

On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic, dramatically affecting health care. Measures such as social distancing and quarantine were adopted globally. This new context represented a huge challenge for Health Information Systems (HIS) that had to adapt quickly, facing an inescapable reason to fully embrace the digital transformation. There is a need to explore the digital technologies used during the pandemic and consider them for continued use over time or cyclically in the event of recurring outbreaks. Digital tools have been used for the provision of telemedicine services, remote patient monitoring, digital communication between political leaders and scientific authorities, data monitoring to analyze the spread and evolution of COVID-19, etc. Countries and organizations have promoted the use of technological solutions with different limitations. The Hospital Italiano de Buenos Aires has a history of more than 20 years in technological implementations and innovations, however, the pandemic prompted a series of adaptations in its SIS. The objective of this work was to describe said digital adaptation process from March to December 2020, and to identify the main results using a sociotechnical model. Sittig´model was used, which includes 8 dimensions: Infrastructure, Clinical Content, Human-Computer Interface, People, Communication and Processes, Regulations, Organizational Characteristics and Internal Policies, and Measurement and Monitoring. (AU)

Intelligent machines and mental health in the era of COVID-19.

The idea of a network of small devices that would be able to connect each other, appeared in the early 80s. In a prophetic article, Mark Weiser,1 described such a connection, that it is now known under the term of Internet of Things (IoT). In a broadest sense, the term IoT encompasses everything connected to the internet, but it is increasingly being used to define objects that "talk" to each other, creating a network from simple sensors to smartphones and wearables connected. During the recent years this network of communicating devices has been combined with other technological achievements, and particularly with the Virtual Reality (VR)2 and the Artificial Intelligence (AI).3 The emerge of COVID-19 pandemic in 2019, resulted to the poor response and healthcare failures of many countries globally.4 One of the main reasons for such a failure, was the inability of accurate data collection from different sources. Apparently, it was the first time, humanity realized the need for massive amounts of heterogeneous data to be collected, interpreted, and shared. Amid the ongoing COVID-19 pandemic, several innovators and public authorities are looking to leverage IoT tools to reduce the burden on the healthcare systems.5 Mental health is one of the areas that seems to benefit the most of such technologies. A significant decrease of the total amount of ER visits and a dramatic increase of internet access from the patients and care givers along to the development of applications for mental health issues, followed the outbreak of SARS-CoV-2.6 Such technologies proved to be efficient to help mentally ill patients and pioneer the path in the future. Probably the most obvious use of these emerged technologies is the improvement of the telehealth options. Patients who suffer from mental illness face significant problems towards the continuity of care during the crisis.7 Nonetheless, they usually have other health problems, that deprive them from an equitable health care provision. Improved telehealth platforms can give them a single point access to address all their problems. The use of electronic health records can reduce the fragmentary health services and improve the outcome.8 However, this is only the beginning. The COVID-19 crisis and the subsequent social isolation, to reduce both the contamination and the spread of the disease, highlighted the necessity for providing accurate and secure diagnoses and treatments from a safe distance. Virtual reality combined with IoT and AI technologies seem to be a reliable alternative to the classic physical and mental examination and treatment in many areas of mental and neurological diseases.2 These novel techniques can spot the early signs and detect mental illnesses with high accuracy. However, caution and more work are required to bridge the space between these recently thrived technologies and mental health care.7 It is worth mentioning, that internet-oriented health care procedures can also help to reduce the gaps caused by the stigma of mental illness. For example, the development of AI chatbots (an application used to chat directly with a human) can alleviate the fears of judgment of the help seeking persons and provide the professionals with a supplemental support toward improved services to their patients.9 A final remark for conclusion. Humanity is more and more depended to the "intelligent" machines. However, we must not forget that we humans are responsible to set the rules of such co-existence.

Health Information System's Responses to COVID-19 Pandemic in China: A National Cross-sectional Study.

OBJECTIVE: After the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Chinese hospitals and health information technology (HIT) vendors collaborated to provide comprehensive information technology support for pandemic prevention and control. This study aims to describe the responses from the health information systems (HIS) to the COVID-19 pandemic and provide empirical evidence in the application of emerging health technologies in China. METHODS: This observational descriptive study utilized a nationally representative, cross-sectional survey of hospitals in China (N = 1,014) from 30 provincial administrative regions across the country. Participants include hospital managers, hospital information workers, and health care providers. RESULTS: Among all the responses, the most popular interventions and applications include expert question-and-answer sessions and science popularization (61.74%) in online medical consultation, online appointment registration (58.97%) in online medical service, and remote consultation (75.15%) in telehealth service. A total of 63.71% of the participating hospitals expanded their fever clinics during the pandemic, 15.38% hospitals used new or upgraded mobile ward rounds systems, and 44.68% hospitals applied online self-service systems. Challenges and barriers include protecting network information security (57.00%) since some hospitals experienced cybersecurity incidents. 71.79% participants hope to shorten wait time and optimize the treatment process. Health care workers experienced increased amount of work during the pandemic, while hospital information departments did not experience significant changes in their workload. CONCLUSION: In the process of fighting against the COVID-19, hospitals have widely used traditional and emerging novel HITs. These technologies have strengthened the capacity of prevention and control of the pandemic and provided comprehensive information technology support while also improving accessibility and efficiency of health care delivery.

An Emergent Network for the Diffusion of Innovations Among Local Health Departments at the Onset of the COVID-19 Pandemic.

INTRODUCTION: Communication networks among professionals can be pathways for accelerating the diffusion of innovations if some local health departments (LHDs) drive the spread of knowledge. Such a network could prove valuable during public health emergencies such as the novel coronavirus disease 2019 (COVID-19) pandemic. Our objective was to determine whether LHDs in the United States were tied together in an informal network to share information and advice about innovative community health practices, programs, and policies. METHODS: In January and February 2020, we conducted an online survey of 2,303 senior LHD leaders to ask several questions about their sources of advice. We asked respondents to rank up to 3 other LHDs whose practices informed their work on new public health programs, evidence-based practices, and policies intended to improve community health. We used a social network analysis program to assess answers. RESULTS: A total of 329 LHDs responded. An emergent network appeared to operate nationally among 740 LHDs. Eleven LHDs were repeatedly nominated by peers as sources of advice or examples (ie, opinion leaders), and 24 acted as relational bridges to hold these emergent networks together (ie, boundary spanners). Although 2 LHDs played both roles, most LHDs we surveyed performed neither of these roles. CONCLUSION: Opinion leading and boundary spanning health departments can be accessed to increase the likelihood of affecting the rate of interest in and adoption of innovations. Decision makers involved in disseminating new public health practices, programs, or policies may find our results useful both for emergencies and for practice-as-usual.

Construção e validação do sistema informatizado de notificação voluntária de incidentes (SINVI): uma tecnologia para vigilância de incidentes relacionados à prestação do cuidado / Construction and validation of the computerized system of voluntary notification of incidents (SINVI): a technology for surveillance of incidents related to provision of care

Introdução: a gestão de risco nos serviços de saúde tem o papel de aplicar, de forma sistemática e contínua, as políticas, os procedimentos, as condutas e os recursos na identificação, análise, avaliação, comunicação e controle de riscos e eventos adversos que afetam a segurança, a saúde humana, a integridade profissional, o meio ambiente e a imagem institucional. A identificação dos eventos adversos que acontecem nos serviços de saúde é de extrema importância para o planejamento de ações de mitigação das falhas durante a assistência à saúde. Os sistemas de notificações voluntárias são o alicerce para um programa de segurança do paciente, ajudando a identificar melhorias no desenvolvimento de uma cultura de segurança, e funcionam como uma estratégia para garantir a qualidade. Objetivos: construir um protótipo de Sistema Informatizado de Notificação Voluntária de Incidentes Informatizado (SINVI); identificar os principais incidentes relacionados à prestação dos cuidados em banco de dados e discuti-los frente à literatura; validar um protótipo de um sistema informatizado de notificação voluntária de incidentes. Método: estudo metodológico desenvolvido em três etapas: identificação dos principais incidentes relacionados à prestação de cuidados; construção do protótipo de um Sistema Informatizado de Notificação Voluntária de Incidentes (SINVI); validação de conteúdo e usabilidade do protótipo do Sistema Informatizado de Notificação Voluntária de Incidentes (SINVI). Para a validação de conteúdo, foram utilizados o Coeficiente de Validação de Conteúdo (CVC), a Taxa de Concordância (TC) e o coeficiente de Kappa. Para a validação de usabilidade, foi utilizado o escore de System Usability Scale (SUS). Este estudo foi aprovado pelo Comitê de Ética em Pesquisa (CEP) com o número do Parecer: 3.674.180. Resultados: foram produzidos três produtos: dois estruturados em forma de artigo e o terceiro, em produto acadêmico. O primeiro identificou os principais eventos adversos notificados no país no período de 2014 a 2018; o segundo produto consiste na construção e validação do protótipo do SINVI e o terceiro é a apresentação do produto acadêmico, a produção técnica do protótipo do software do SINVI, localizado no estrado T1 na categorização da CAPES. Conclusão: os três produtos deste relatório de dissertação contribuem para a segurança do paciente nos serviços de saúde na medida em que fornecem subsídios para a gestão de risco e o núcleo de segurança do paciente na captação de dados agregados das notificações a partir do uso de um Sistema Informatizado de Notificação Voluntária de Incidentes (SINVI)

Introduction: risk management in health services has the role of applying, in a systematic and continuous manner, the policies, procedures, conducts and resources in the identification, analysis, evaluation, communication and control of risks and adverse events that affect safety, human health, professional integrity, the environment and the institutional image. The identification of adverse events that occur in health services is extremely important for the planning of actions to mitigate failures during health care. Voluntary reporting systems are the foundation of a patient safety program, helping to identify improvements in the development of a safety culture, and serve as a strategy to ensure quality. Objectives: build a prototype of a Computerized Voluntary Incident Notification System (SINVI); identify the main care-related incidents in a database and discuss them against the literature; validate a prototype of a computerized voluntary incident reporting system. Method: methodological study developed in three stages: identification of the main care-related incidents; construction of the prototype of a Computerized Voluntary Incident Notification System (SINVI); content and usability validation of the prototype of the Computerized Voluntary Incident Notification System (SINVI). For content validation, the Content Validation Coefficient (CVC), the Concordance Rate (CR), and the Kappa coefficient were used. For usability validation, the System Usability Scale (UHS) score was used. This study was approved by the Research Ethics Committee (REC) with Opinion number: 3.674.180. Results: Three products were produced: two structured as articles and the third as an academic product. The first identified the main adverse events reported in the country from 2014 to 2018; the second product consists of the construction and validation of the SINVI prototype and the third is the presentation of the academic product, the technical production of the SINVI software prototype, located on the T1 platform in the CAPES categorization. Conclusion: the three products of this dissertation report contribute to patient safety in health services in that they provide subsidies for risk management and the patient safety nucleus in capturing aggregate data from the notifications using a Computerized Voluntary Incident Notification System (SINVI)

De la evolución de los sistemas de nformación para la salud (IS4H) a la tranformación digital del sector de la salud: informe de la conferencia sobre IS4H / From the evolution of information systems for health to the digital transformation of the health sector: IS4H conference report

Esta Conferencia sobre Sistemas de Información para la Salud (IS4H), "De la evolución de los sistemas de información para salud a la transformación digital del sector de la salud" fue organizada por el Departamento de Evidencia e Inteligencia para la Acción de Salud de la Organización Panamericana de la Salud (OPS). Su objetivo fue crear un diálogo para reflexionar con los países de la Región de las Américas sobre sus experiencias con respecto a sus sistemas de información y la salud digital durante los cuatro últimos años, en particular durante la pandemia de COVID-19

This Information Systems for Health (IS4H) Conference, From the Evolution of Information Systems for Health to the Digital Transformation of the Health Sector, was organized by the Department of Evidence and Intelligence for Action in Health of the Pan American Health Organization (PAHO). This event aimed to create a dialogue of reflection with the countries of the Region of the Americas on their experiences regarding their information systems and digital health during the last four years, and in particular during the COVID-19 pandemic

Tecnologías digitales para un nuevo futuro / Digital technologies for a new future

Las tecnologías digitales han crecido exponencialmente y su uso se ha globalizado. La conectividad ubicua y continua llega a gran parte de la humanidad gracias a la masificación del uso de teléfonos inteligentes y al consiguiente acceso a la información, a las redes sociales y al entretenimiento audiovisual. La aceleración del progreso técnico en el universo digital ha vuelto cotidiano el empleo de dispositivos y aplicaciones que usan la computación en la nube, la analítica de grandes datos, las cadenas de bloques o la inteligencia artificial. La revolución tecnológica, aunada al cambio en las estrategias de las empresas líderes en el uso de las tecnologías digitales, ha llevado al auge de las plataformas globales, dando lugar a una excesiva concentración de poder económico y político en no más de una veintena de corporaciones de dos o tres potencias mundiales, un conjunto demasiado pequeño de empresas cuyo valor de mercado supera o se acerca a un billón de dólares

Reporting and utilization of Patient-Reported Outcomes Measurement Information System® (PROMIS®) measures in orthopedic research and practice: a systematic review.

BACKGROUND: The Patient-Reported Outcomes Measurement Information SystemⓇ (PROMISⓇ) is a dynamic system of psychometrically sound patient-reported outcome (PRO) measures. There has been a recent increase in the use of PROMIS measures, yet little has been written about the reporting of these measures in the field of orthopedics. The purpose of this study was to conduct a systematic review to determine the uptake of PROMIS measures across orthopedics and to identify the type of PROMIS measures and domains that are most commonly used in orthopedic research and practice. METHODS: We searched PubMed, Embase, and Scopus using keywords and database-specific subject headings to capture orthopedic studies reporting PROMIS measures through November 2018. Our inclusion criteria were use of PROMIS measures as an outcome or used to describe a population of patients in an orthopedic setting in patients ≥ 18 years of age. We excluded non-quantitative studies, reviews, and case reports. RESULTS: Our final search yielded 88 studies published from 2013 through 2018, with 57% (50 studies) published in 2018 alone. By body region, 28% (25 studies) reported PROMIS measures in the upper extremity (shoulder, elbow, hand), 36% (32 studies) reported PROMIS measures in the lower extremity (hip, knee, ankle, foot), 19% (17 studies) reported PROMIS measures in the spine, 10% (9 studies) reported PROMIS measures in trauma patients, and 6% (5 studies) reported PROMIS measures in general orthopedic patients. The majority of studies reported between one and three PROMIS domains (82%, 73 studies). The PROMIS Computerized Adaptive Test (CAT) approach was most commonly used (81%, 72 studies). The most frequently reported PROMIS domains were physical function (81%, 71 studies) and pain interference (61%, 54 studies). CONCLUSION: Our review found an increase in the reporting of PROMIS measures over the recent years. Utilization of PROMIS measures in orthopedic populations is clinically appropriate and can facilitate communication of outcomes across different provider types and with reduced respondent burden. REGISTRATION: The protocol for this systematic review was designed in accordance with the PRISMA guidelines and is registered with the PROSPERO database (CRD42018088260).

Cultural Considerations for Conducting the Health Information National Trends Survey with Micronesian Communities: Lessons from a Qualitative Study.

A critical barrier to addressing health disparities among minorities is the lack of data, particularly on Pacific Islanders. Typically, national health surveillance systems do not have the resources to ensure proper representation of these small population groups. This study reports factors that guided the cultural adaptation and administration of the National Cancer Institute's Health Information Trends National Survey (HINTS) for a United States-dwelling Pacific Islander population in Hawai'i. To adapt the survey, four focus groups were conducted with 32 purposively-selected Micronesian migrants. Themes on health, healthcare barriers, cancer and methods to implement the survey were extracted from the analyses of the focus group narratives. Key cultural factors were identified that impact health practices, including religious and cancer fatalism, racism, health locus of control and other barriers. Using information from the focus group participants, the HINTS questionnaire was modified and the survey was implemented. The survey data provided will inform the future delivery of health promotion strategies for this unique medically underserved population.

Importância de fortalecer os sistemas de informação / COVID-19 y la importancia de fortalecer los Sistemas de Información / COVID-19 and the importance of strengthening Information Systems

Why are information systems key for pandemic response? During a pandemic, more than in any other public health situation, information systems play a critical role in managing data and other information at the speed the situation requires. They provide essential evidence for taking action, making the most informed decisions possible, and adjusting policies to allow for better intelligence on actions to improve health. Emerging technologies and automation have the potential to improve public health like never before in the history of humankind. Information systems provide immediate, expeditious, and coordinated data access and sharing, and they facilitate the prioritization of care, access, and response, especially for people in conditions of vulnerability. With properly disaggregated health data, it is possible to plan actions that reduce potential health inequities at all levels of care, and facilitate the implementation of strategies to address such inequities.

¿Por qué los sistemas de información son claves para responder a la pandemia? Durante una pandemia, más que en ninguna otra situación de salud pública, los sistemas de información juegan un papel crítico para gerenciar los datos y la información necesaria a la velocidad que la situación lo requiere. Asimismo, son clave para disponer de evidencia para la acción, tomar decisiones lo más informadas posibles y adecuar políticas que permitan una mejor inteligencia en acciones de salud. Por otro lado, las tecnologías emergentes y las posibilidades que ofrece la automatización pueden suponer beneficios para la salud pública como nunca antes en la historia de la humanidad. Los sistemas de información permiten el acceso e intercambio inmediato, ágil y coordinado a los datos y la priorización en la atención, el acceso y la respuesta, sobre todo a aquellos en situación de vulnerabilidad. Los datos de salud adecuadamente desagregados permiten planificar acciones que reduzcan las posibles inequidades en salud en los distintos niveles de atención y facilitan la implementación de estrategias para abordarlos.

Por que os sistemas de informação são cruciais para responder à pandemia? Durante uma pandemia, mais que em nenhuma outra situação de saúde pública, os sistemas de informação cumprem um papel crucial no gerenciamento dos dados e das informações necessárias com a rapidez exigida pela situação. Além disso, são essenciais para dispor de evidências para agir, tomar decisões o mais bem embasadas possíveis e adequar políticas que permitam uma melhor inteligência nas ações de saúde. Por outro lado, as tecnologias emergentes e as possibilidades que a automatização oferece podem trazer benefícios para a saúde pública como nunca antes na história da humanidade. Os sistemas de informação permitem o acesso e intercâmbio imediato, ágil e coordenado dos dados e a priorização da atenção, do acesso e da resposta, sobretudo às pessoas em situação de vulnerabilidade. Os dados de saúde devidamente desagregados permitem planejar ações que reduzam as possíveis desigualdades em saúde nos diferentes níveis da atenção e facilitam a implementação de estratégias para abordá-los.

Using artificial intelligence to analyse and teach communication in healthcare.

Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training.

Horizon scanning in Brazil: outputs and repercussions.

OBJECTIVE: To describe the four types of horizon scanning (HS) outputs developed by the National Committee for Health Technology Incorporation (CONITEC) and show their main repercussions on the decision-making processes of the Brazilian Ministry of Health (MH). METHODS: Descriptive study based on participant observation and document analysis of HS outputs (internal reports, alert reports, briefs and sections for CONITEC recommendation reports) developed between January 2014 and July 2018. RESULTS: Fifteen internal reports, six alert reports, two briefs and 57 HS sections were produced. Each output has a specific structure according to its purpose. The methodological approach adopted for developing HS outputs in Brazil is described by EuroScan International Network. The outputs had institutional and international repercussions. The activities resulted in the inclusion of HS as a tool for reducing health lawsuits in the legal framework of the MH. One of the internal reports on a high-cost drug not approved in Brazil for a rare disease was requested by the Health Technology Assessments Network for the Americas (RedETSA), showing the international relevance of the outputs. The HS sections in recommendation reports influenced discussions about incorporating technologies into the Unified Health System. CONCLUSIONS: The developed outputs have purposes ranging from helping build arguments for defense of the MH in cases of health judicialization to inform decision-making processes. In addition, HS sections in recommendation reports have grown in importance recently. CONITEC's HS system has been structured, and its role as a tool to inform health managers has shown to be been relevant.

Mobile Health Access and Use Among Individuals With or At Risk for Cardiovascular Disease: 2018 Health Information National Trends Survey (HINTS).

Background Mobile health (mHealth) technologies can deliver interventions to prevent and manage cardiovascular disease (CVD), but mHealth uptake among those with or at risk for CVD remains incompletely explored. Therefore, in this group, we assessed the prevalence of mHealth access and usage, and the association between CVD risk and mHealth uptake. Methods and Results Data were from 3248 adults in the 2018 Health Information National Trends Survey. We defined CVD risk as reporting a heart condition, diabetes mellitus, hypertension, and/or current smoking (n=1903). Multivariable logistic regression, adjusting for demographics, was used to assess the relationship between CVD risk and mHealth uptake. Most individuals with CVD risk owned a smartphone (73%, 95% CI: 69%-76%) and 48% (95% CI: 44%-52%) had a health app. Among men, those with CVD risk were more likely to use a wearable device (odds ratio 2.43, 95% CI: 1.44-4.10) than those without CVD risk, while there was no difference among women. In both sexes, CVD risk was associated with sharing information from a smartphone/wearable with a clinician (odds ratio 1.63, 95% CI 1.12-2.35 in women; odds ratio 3.99, 95% CI 2.30-6.95 in men). However, there was no difference in the odds of using mHealth to track health progress, make health decisions, aid healthcare discussions, or text a clinician. Conclusions In a nationally representative sample, there was high prevalence of smartphone ownership but incomplete mHealth uptake. Having CVD or its risk factors was associated with sharing information from smartphone/wearables, suggesting potential to leverage clinically validated mHealth interventions for CVD prevention.

Patient-Generated Health Data in Surgical Site Infection: Changing Clinical Workflow and Care Delivery.

Background: The patient's history of present illness provides an important part of the data with which clinicians diagnose and treat. Once surgical patients are discharged, the ability to incorporate direct observation requires coordinating patient and provider for a clinical visit. Mobile technologies offer the ability to gather and organize the patient's history, supplement that history with photographs and other clinical observations, and convey those data accurately and rapidly to the entire clinical team. Methods: We review our experience with patient-generated health data in surgical site infection, draw parallels with similar work in other domains, and identify principles we have found useful. Results: Health information system implementations require substantial changes in provider workflow. Shared expectations between the patient and the surgical team, an incremental approach to change in clinical processes, and an emphasis on clinical utility all support successful implementation. Conclusions: The data collection and rapid information exchange afforded by monitoring post-operative, post-discharge patients using mobile technologies can support the expectations of both patients and providers and may provide a novel data source for public health surveillance of surgical site infection. Both uses of these data require careful attention to introducing changes in clinical workflow.

Conference season.

Health library and information workers no longer find themselves restricted to presenting at purely local or national health-related library events, a diversity evidenced by the two conferences supported by CILIP's Health Libraries Group this month, June 2019. The Health Libraries Group is an official sponsor of #EBLIP10, the 10th international Evidence Based Library and Information Practice conference, which encourages us to think about the evidence we collect and use to inform practice. The Health Libraries Group also strengthens its links with EAHIL: The European Association of Health Information and Libraries by aligning the content of this year's Virtual Issue of the Health Information and Libraries Journal with EAHIL 2019s themes of evidence-based practice, impact & assessment, and technology uptake, available at: https://bit.ly/2PAZw2X.

Global Strategy on Digital Health 2020-2024

The proposed definition qualifies Digital Health as going beyond the rather simplistic meaning of the use of digital technologies in health. When understood as a broader field of knowledge and practice, Digital Health becomes more comprehensive and able to foster the diversity required to understand its multiple categories, functions and corresponding policy needs. It also ensures that digital technologies are understood as a means to an end. As a result, this definition also anchors Digital Health to matters linked to its practical application and demonstrated, measurable outcomes for improvements in health. The following Global Strategy on Digital Health is designed to help countries achieve this objective. It sets out a vision, strategic objectives and a framework for action to advance digital health. The Global Strategy is developed in collaboration with countries and other stakeholders, considering their cultures, values and interests. The Strategy leads to concrete actions within the proposed timeframe of four years, from 2020 to 2024. However, the strategic objectives aim to set the actions for a longer period and can be reviewed and revised after the proposed timeframe.The Strategy builds on previous WHA resolutions4 WHO global and regional reports on digital health, eHealth, mHealth, telehealth and other digital health related areas5,6,7 and a two-part ISO TC 215 Technical Specification8 . In particular, the National eHealth Strategy Toolkit9 , co-published by WHO and ITU, is an essential source of inspiration and methods. It provides an excellent and easy to use operational model, with step-by-step instructions that systematizes a simple but comprehensive framework for preparing and implementing National Digital Health Strategies