Adapting Clinical Guidelines for the Digital Age: Summary of a Holistic and Multidisciplinary Approach.

The Centers for Disease Control and Prevention's Adapting Clinical Guidelines for the Digital Age initiative aims to redesign and improve guideline development, implementation, and standardization. Historically, aspects of guideline development and implementation have been siloed. This leads to long lag times for guidelines to reach patient care, unnecessary redundancy, and potential for misinterpretation, leading to inconsistencies in how the recommendations are applied. A multidisciplinary, multiorganizational holistic approach brought together experts in guideline development, informatics, communication, implementation, and evaluation to understand and identify problems in guideline development and implementation, define an ideal state with no constraints, and then design a future state that advances the process close to the ideal state. The Adapting Clinical Guidelines for the Digital Age workgroups each worked on one focus area and included experts from the other areas to help analyze the current state and develop holistic solutions for the future state. Each workgroup produced interrelated standards, processes, and tools that can be used across the continuum of guideline development and implementation.

Successfully Implementing Digital Health to Ensure Future Global Health Security During Pandemics: A Consensus Statement.

Importance: COVID-19 has highlighted widespread chronic underinvestment in digital health that hampered public health responses to the pandemic. Recognizing this, the Riyadh Declaration on Digital Health, formulated by an international interdisciplinary team of medical, academic, and industry experts at the Riyadh Global Digital Health Summit in August 2020, provided a set of digital health recommendations for the global health community to address the challenges of current and future pandemics. However, guidance is needed on how to implement these recommendations in practice. Objective: To develop guidance for stakeholders on how best to deploy digital health and data and support public health in an integrated manner to overcome the COVID-19 pandemic and future pandemics. Evidence Review: Themes were determined by first reviewing the literature and Riyadh Global Digital Health Summit conference proceedings, with experts independently contributing ideas. Then, 2 rounds of review were conducted until all experts agreed on the themes and main issues arising using a nominal group technique to reach consensus. Prioritization was based on how useful the consensus recommendation might be to a policy maker. Findings: A diverse stakeholder group of 13 leaders in the fields of public health, digital health, and health care were engaged to reach a consensus on how to implement digital health recommendations to address the challenges of current and future pandemics. Participants reached a consensus on high-priority issues identified within 5 themes: team, transparency and trust, technology, techquity (the strategic development and deployment of technology in health care and health to achieve health equity), and transformation. Each theme contains concrete points of consensus to guide the local, national, and international adoption of digital health to address challenges of current and future pandemics. Conclusions and Relevance: The consensus points described for these themes provide a roadmap for the implementation of digital health policy by all stakeholders, including governments. Implementation of these recommendations could have a significant impact by reducing fatalities and uniting countries on current and future battles against pandemics.

We can also do online - evaluation of the accompanying digital seminar of the elective subject "General Practice" during intership (PJ) at Ruhr-University Bochum.

Aim: Due to the lockdown caused by the Corona pandemic, the internship (PJ=practical year) seminars of the elective subject "General Practice" at Ruhr-University Bochum had to be transferred on short notice into online teaching formats via a digital platform. At the end of these new online course, the four students evaluated the comprising 16 teaching units. Methods: The seminars, each comprising four teaching units, took place in online blended-learning units and online events. After completing the seminar program, the four participants filled out a written questionnaire regarding the implementation of digital teaching, quality of teaching content, acceptance as well as advantages and disadvantages of the teaching format. Results: The acceptance of digital teaching was very high among students. Advantages and disadvantages of this teaching format compared to the previous face-to-face events became apparent; a positive assessment of the possibilities of the online format clearly prevailed, as competence-oriented, interactive aspects were very well implemented. Conclusion: Due to the need of switching to digital teachings formats, new, innovative perspectives have arisen for PJ teaching in Bochum as well as for the more distant second location Ostwestfalen-Lippe. This is particularly true with regard to centralised seminar offers despite decentralised training centres. When implementing "new" licensing regulations this creates an opportunity for general practice to include teaching practices in training throughout the country.

Health data poverty: an assailable barrier to equitable digital health care.

Data-driven digital health technologies have the power to transform health care. If these tools could be sustainably delivered at scale, they might have the potential to provide everyone, everywhere, with equitable access to expert-level care, narrowing the global health and wellbeing gap. Conversely, it is highly possible that these transformative technologies could exacerbate existing health-care inequalities instead. In this Viewpoint, we describe the problem of health data poverty: the inability for individuals, groups, or populations to benefit from a discovery or innovation due to a scarcity of data that are adequately representative. We assert that health data poverty is a threat to global health that could prevent the benefits of data-driven digital health technologies from being more widely realised and might even lead to them causing harm. We argue that the time to act is now to avoid creating a digital health divide that exacerbates existing health-care inequalities and to ensure that no one is left behind in the digital era.

IT support in emergency remote teaching in response to COVID-19.

Background: The COVID-19 pandemic hit the German education system unexpectedly and forced its universities to shift to Emergency Remote Teaching (ERT). The Data Integration Center (DIC) of the University Hospital Magdeburg and the Institute of Biometry and Medical Informatics (IBMI) has developed a concept based on existing structures that can be quickly implemented and used by the Medical Faculty at Otto von Guericke University. This manuscript focuses on the IT support for lecturers, which allows them to concentrate on teaching their lessons, although the authors are aware that this is only a small part of the entire subject. Additionally, there is a great awareness that ERT can never replace well-structured in-person classes. Concept: The key feature of the concept uses the well-working management system for all physical rooms of the university by designing a virtual video conference room for every physical room. This allows high interactivity for lectures and seminars while applying proven teaching methods. Additionally, a collaboration software system to document all lessons learned and a technical support team have been available for the teaching staff. Courses with a hands-on approach require more personal interaction than lectures. Therefore, the issues of practical trainings have not been solved with this concept, but been tackled by using questionnaires and minimizing contacts during attestations. Applied IT tools: The concept's requirements were met by Zoom Meetings, Confluence, HIS/LSF and Moodle. Discussion and Conclusion: The concept helped the lecturers to provide high-quality teaching for students at universities. Additionally, it allows for a dynamic response to new needs and problems. The concept will be reviewed as part of a higher Universal Design for Learning concept and may support lecturers in the following semesters in hybrid meetings with real and virtual attendees.

Trends and Predictors of Use of Digital Health Technology in the United States.

BACKGROUND: Digital health technology is becoming central to health care. A better understanding of the trends and predictors of its use could reflect how people engage with the health care system and manage their health care needs. METHODS: Using data from the National Health Interview Survey for years 2011 to 2018, we assessed the use of digital health technology among individuals aged ≥18 years in the United States across 2 domains: 1) search for health information online and 2) interaction with health care providers (eg, fill a prescription, schedule a medical appointment, or communicate with health care providers). RESULTS: Our study included 253,829 individuals; representing nearly 237 million adults in the United States annually; mean age 49.6 years (SD 18.4); 51.8% women; and 65.9% non-Hispanic white individuals. Overall, 49.2% of individuals reported searching for health information online and 18.5% reported at least 1 technology-based interaction with the health care system. Between 2011 and 2018, the proportion who searched for health information online increased from 46.5% to 55.3% (P < .001), whereas the proportion who used technology to interact with the health care system increased from 12.5% to 27.4% (P < .001). Although technology-based interaction with the health care system increased across most subgroups, there were significant disparities in the extent of increase across clinical and sociodemographic subgroups. CONCLUSIONS: The use of digital health technologies increased between 2011 and 2018, however, the uptake of these technologies has been unequal across subgroups. Future innovations and strategies should focus on expanding the reach of digital heath technology across all subgroups of society to ensure that its expansion does not exacerbate the existing health inequalities.

Digital PCR is a sensitive new technique for SARS-CoV-2 detection in clinical applications.

The global coronavirus disease 2019 (COVID-19) pandemic has posed great challenges in people's daily lives. Highly sensitive laboratory techniques played a critical role in clinical COVID-19 diagnosis and management. In this study the feasibility of using a new digital PCR-based detection assay for clinical COVID-19 diagnosis was investigated by comparing its performance with that of RT-PCR. Clinical patient samples and samples obtained from potentially contaminated environments were analyzed. The study included 10 patients with confirmed COVID-19 diagnoses, 32 validated samples of various types derived from different clinical timepoints and sites, and 148 environmentally derived samples. SARS-CoV-2 nucleic acids were more readily detected in respiratory tract samples (35.0%). In analyses of environmentally derived samples, the positivity rate of air samples was higher than that of surface samples, probably due to differences in virus concentrations. Digital PCR detected SARS-CoV-2 in several samples that had previously been deemed negative, including 3 patient-derived samples and 5 environmentally derived samples. In this study digital PCR exhibited higher sensitivity than conventional RT-PCR, suggesting that it may be a useful new method for clinical SARS-CoV-2 detection. Improvement of SARS-CoV-2 detection would substantially reduce the rates of false-negative COVID-19 test results, in particular those pertaining to asymptomatic carriers.

Personalized medicine, digital technology and trust: a Kantian account.

Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information 'noise' and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant's ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust.

Health Policy and Privacy Challenges Associated With Digital Technology.

Importance: Digital technology is part of everyday life. Digital interactions generate large amounts of data that can reveal information about the health of individual consumers (the digital health footprint). Objective: Τo describe health privacy challenges associated with digital technology. Design, Setting, and Participants: For this qualitative study, In-depth, semistructured, qualitative interviews were conducted with 26 key experts from diverse fields in the US between January 1 and July 31, 2018. Open-ended questions and hypothetical scenarios were used to identify sources of digital information that contribute to consumers' health-relevant digital footprints and challenges for health privacy. Participants also completed a survey instrument on which they rated the health relatedness of digital data sources. Main Outcomes and Measures: Health policy challenges associated with digital technology based on qualitative responses to expert interviews. Results: Although experts' ratings of digital data sources suggested a possible distinction between health and nonhealth data, qualitative interviews uniformly indicated that all data can be health data, particularly when aggregated across sources and time. Five key characteristics of the digital health footprint were associated with health privacy policy challenges: invisibility (people are unaware of how their data are tracked), inaccuracy (data in the digital health footprint can be inaccurate), immortality (data have no expiration date and are aggregated over time), marketability (data have immense commercial value and are frequently bought and sold), and identifiability (individuals can be readily reidentified and anonymity is nearly impossible to achieve). There are virtually no regulatory structures in the US to protect health privacy in the context of the digital health footprint. Conclusions and Relevance: The findings suggest that a sector-specific approach to digital technology privacy in the US may be associated with inadequate health privacy protections.

Use of high-sensitivity digital ELISA improves the diagnostic performance of circulating brain-specific proteins for detection of traumatic brain injury during triage.

Background: Historically, limited sensitivity associated with traditional immunoassay methods has prevented the use of brain-specific proteins as blood biomarkers of traumatic brain injury (TBI) during triage, as these proteins exhibit low circulating concentrations. Digital ELISA is a newly-developed technique that is up to 1000 times more sensitive than conventional ELISA methods. The purpose of this study was to determine whether the use of digital ELISA over conventional ELISA improves the performance of brain-specific proteins as blood biomarkers of TBI during triage.Methods: Blood was sampled from TBI patients (n = 13) at emergency department admission, as well as from neurologically normal controls (n = 72). Serum levels of two brain-specific proteins, neurofilament light chain (NfL) and Tau, were measured via digital ELISA. Estimated conventional ELISA measures were generated by adjusting values according to the lower limits of detection achievable with commercially available conventional ELISA assays, and receiver operating characteristic (ROC) analysis was used to compare the diagnostic performance of digital ELISA measures to estimated conventional ELISA measures in terms of their ability to discriminate between TBI patients and controls.Results: Used in combination, digital ELISA measures of NfL and Tau could discriminate between groups with 100% sensitivity and 91.7% specificity. Estimated conventional ELISA measures could only discriminate between groups with 7.7% sensitivity and 94.4% specificity. This difference in diagnostic performance was statistically significant when comparing areas under ROC curves.Conclusions: The use of digital ELISA over conventional ELISA methods improves the diagnostic performance of circulating brain-specific proteins for detection of TBI during triage.