Digital health autonomy for people with communication or swallowing disability and the Sustainable Development Goal 10 of reducing inequalities and Goal 3 of good health and well-being.

PURPOSE: The purpose of this article is to explore the Sustainable Development Goal of reduced inequalities (SDG 10) in relation to the experiences of people with communication disability with lived experiences and their access to self-determined healthcare. As such, the article also informs the goal of good health and well-being (SDG 3). METHOD: In preparing this article the authors reviewed recent literature on digital health records and digital autonomy as a means to improving equity of access and explored the experiences of two of the authors as people with severe communication disability who use a wide range of digital health technologies in pursuing safe and quality health care. The literature and their experiences highlight a need for improved co-design and usage across disability and health service systems management if e-health records are to be used to reduce inequalities in accessing healthcare. RESULT: Recent research and the lived experiences of the first two authors reflect that e-health information systems, designed to improve the consumer's ability to access and share their own health information, are not used to full advantage in disability and healthcare environments. CONCLUSION: Increased access to multimodal communication strategies and communication technologies, along with user-centred co-design that enables digital health autonomy will further progress towards reduced inequalities (SDG 10) and good health and well-being (SDG 3) and for people with communication or swallowing disability.

The E-health Literacy Demands of Australia's My Health Record: A Heuristic Evaluation of Usability.

Background: My Health Record is Australia's electronic personal health record system, which was introduced in July 2012. As of August 2017, approximately 21 percent of Australia's total population was registered to use My Health Record. Internationally, usability issues have been shown to negatively influence the uptake and use of electronic health record systems, and this scenario may particularly affect people who have low e-health literacy. It is likely that usability issues are negatively affecting the uptake and use of My Health Record in Australia. Objective: To identify potential e-health literacy-related usability issues within My Health Record through a heuristic evaluation method. Methods: Between September 14 and October 12, 2016, three of the authors conducted a heuristic evaluation of the two consumer-facing components of My Health Record-the information website and the electronic health record itself. These two components were evaluated against two sets of heuristics-the Health Literacy Online checklist and the Monkman Heuristics. The Health Literacy Online checklist and Monkman Heuristics are evidence-based checklists of web design elements with a focus on design for audiences with low health literacy. During this heuristic evaluation, the investigators individually navigated through the consumer-facing components of My Health Record, recording instances where the My Health Record did not conform to the checklist criteria. After the individual evaluations were completed, the investigators conferred and aggregated their results. From this process, a list of usability violations was constructed. Results: When evaluated against the Health Literacy Online Checklist, the information website demonstrated violations in 12 of 35 criteria, and the electronic health record demonstrated violations in 16 of 35 criteria. When evaluated against the Monkman Heuristics, the information website demonstrated violations in 7 of 11 criteria, and the electronic health record demonstrated violations in 9 of 11 criteria. The identified violations included usability issues with the reading levels used within My Health Record, the graphic design elements, the layout of web pages, and a lack of images and audiovisual tools to support learning. Other important usability issues included a lack of translated resources, difficulty using accessibility tools, and complexity of the registration processes. Conclusion: My Health Record is an important piece of technology that has the potential to facilitate better communication between consumers and their health providers. However, this heuristic evaluation demonstrated that many usability-related elements of My Health Record cater poorly to users at risk of having low e-health literacy. Usability issues have been identified as an important barrier to use of personal health records internationally, and the findings of this heuristic evaluation demonstrate that usability issues may be substantial barriers to the uptake and use of My Health Record.

Atención a la salud en América Latina y el Caribe en el siglo XXI. Perspectivas para lograr salud para todos / 21st Century health care in Latin America and the Carribean. Prospects for achieving Health for All

Explora las posibilidades de lograr cambios favorables en los sistemas de atención a la salud de América Latina y el Caribe y de alcanzar una Salud para Todos en el siglo XXI. Contenido: Futuros de la salud : herramientas para una mejor toma de decisiones; Desarrollo económico y social y Salud para Todos; La revolución informativa y la atención a la salud en Chile; El futuro de terapéutica; Tendencias futuras de la vacunología; La genómica: promesas y las precauciones a tomar en la aceleración de la calidad de la prevención; el diagnóstico, el tratamiento y la curación; El futuro de los fármacos y de su regulación en América Latina; Los sistemas de salud latinoamericanos en transición: una visión para el futuro; El futuro de la atención gerenciada en América Latina; Salud para Todos en las Américas: el escenario preferido; ¿Qué significa todo esto? El sector privado, el sector público y Salud para Todos