An economic evaluation of the expansion of electronic case reporting in an academic healthcare setting.

Objectives: Determine the economic cost or benefit of expanding electronic case reporting (eCR) for 29 reportable conditions beyond the initial eCR implementation for COVID-19 at an academic health center. Materials and methods: The return on investment (ROI) framework was used to quantify the economic impact of the expansion of eCR from the perspective of an academic health system over a 5-year time horizon. Sensitivity analyses were performed to assess key factors such as personnel cost, inflation, and number of expanded conditions. Results: The total implementation costs for the implementation year were estimated to be $5031.46. The 5-year ROI for the expansion of eCR for the 29 conditions is expected to be 142% (net present value of savings: $7166). Based on the annual ROI, estimates suggest that the savings from the expansion of eCR will cover implementation costs in approximately 4.8 years. All sensitivity analyses yielded a strong ROI for the expansion of eCR. Discussion and conclusion: Our findings suggest a strong ROI for the expansion of eCR at UHealth, with the most significant cost savings observed implementing eCR for all reportable conditions. An early effort to ensure data quality is recommended to expedite the transition from parallel reporting to production to improve the ROI for healthcare organizations. This study demonstrates a positive ROI for the expansion of eCR to additional reportable conditions beyond COVID-19 in an academic health setting, such as UHealth. While this evaluation focuses on the 5-year time horizon, the potential benefit could extend further.

Evidence-based clinical engineering: Health information technology adverse events identification and classification with natural language processing.

The primary goal of this project is to create a framework to extract Real-World Evidence to support Health Technology Assessment, Health Technology Management, Evidence-Based Maintenance, and Post Market Surveillance (as outlined in the EU Medical Device Regulation 2017/745) of medical devices using Natural Language Processing (NLP) and Artificial Intelligence. An initial literature review on Spontaneous Reporting System databases, Health Information Technologies (HIT) fault classification, and Natural Language Processing has been conducted, from which it clearly emerges that adverse events related to HIT are increasing over time. The proposed framework uses NLP techniques and Explainable Artificial Intelligence models to automatically identify HIT-related adverse event reports. The designed model employs a pre-trained version of ClinicalBERT that has been fine-tuned and tested on 3,075 adverse event reports extracted from the FDA MAUDE database and manually labelled by experts.

Healthcare Information Technology: A Systematic Mapping Study.

OBJECTIVES: This paper presents a systematic mapping of studies related to information systems and technology in the field of healthcare, enabling a visual mapping of the different lines of knowledge that can provide an overview of the scientific literature in this field. This map can help to clarify critical aspects of healthcare informatics, such as the main types of information systems, the ways in which they integrate with each other, and the technological trends in this field. METHODS: Systematic mapping refers to a process of classifying information in a given area of knowledge. It provides an overview of the state of the art in a particular discipline or area of knowledge, establishing a map that describes how knowledge is structured in that particular area. In this study, we proposed and carried out a specific implementation of the methodology for mapping. In total, 1,619 studies that combine knowledge related to information systems, computer science, and healthcare were selected and compiled from prestigious publications. RESULTS: The results established a distribution of the available literature and identified papers related to certain research questions, thereby providing a map of knowledge that structures the different trends and main areas of research, making it possible to address the research questions and serving as a guide to deepen specific aspects of the field of study. CONCLUSIONS: We project and propose future research for the trends that stand out because of their interest and the possibility of exploring these topics in greater depth.

Identifying Potential Gamification Elements for A New Chatbot for Families With Neurodevelopmental Disorders: User-Centered Design Approach.

BACKGROUND: Chatbots have been increasingly considered for applications in the health care field. However, it remains unclear how a chatbot can assist users with complex health needs, such as parents of children with neurodevelopmental disorders (NDDs) who need ongoing support. Often, this population must deal with complex and overwhelming health information, which can make parents less likely to use a software that may be very helpful. An approach to enhance user engagement is incorporating game elements in nongame contexts, known as gamification. Gamification needs to be tailored to users; however, there has been no previous assessment of gamification use in chatbots for NDDs. OBJECTIVE: We sought to examine how gamification elements are perceived and whether their implementation in chatbots will be well received among parents of children with NDDs. We have discussed some elements in detail as the initial step of the project. METHODS: We performed a narrative literature review of gamification elements, specifically those used in health and education. Among the elements identified in the literature, our health and social science experts in NDDs prioritized five elements for in-depth discussion: goal setting, customization, rewards, social networking, and unlockable content. We used a qualitative approach, which included focus groups and interviews with parents of children with NDDs (N=21), to assess the acceptability of the potential implementation of these elements in an NDD-focused chatbot. Parents were asked about their opinions on the 5 elements and to rate them. Video and audio recordings were transcribed and summarized for emerging themes, using deductive and inductive thematic approaches. RESULTS: From the responses obtained from 21 participants, we identified three main themes: parents of children with NDDs were familiar with and had positive experiences with gamification; a specific element (goal setting) was important to all parents, whereas others (customization, rewards, and unlockable content) received mixed opinions; and the social networking element received positive feedback, but concerns about information accuracy were raised. CONCLUSIONS: We showed for the first time that parents of children with NDDs support gamification use in a chatbot for NDDs. Our study illustrates the need for a user-centered design in the medical domain and provides a foundation for researchers interested in developing chatbots for populations that are medically vulnerable. Future studies exploring wide range of gamification elements with large number of potential users are needed to understand the impact of gamification elements in enhancing knowledge mobilization.

Information and Communication Technologies in Lung Transplantation: Perception of Patients and Medical Teams.

Optimal therapeutic management is a major determinant of patient prognosis and healthcare costs. Information and communication technologies (ICTs) represent an opportunity to enhance therapeutic management in complex chronic diseases, such as lung transplantation (LT). The objective of this study was to assess the preferences of LT patients and healthcare professionals regarding ICTs in LT therapeutic management. A cross-sectional opinion survey was conducted among lung transplant patients and healthcare professionals from the French lung transplantation centers. Five ICTs were defined (SMS, email, phone, internet, and smartphone application) in addition to face-to-face communication. An unsupervised approach by Principal Component Analysis (PCA) identified lung transplant patient profiles according to their preferences for ICTs. Fifty-three lung transplant patients and 15 healthcare professionals of the French LT centers were included. Both expected ICTs for treatment management and communication. Phone call, face-to-face, and emails were the most preferred communication tools for treatment changes and initiation. PCA identified four ICTs-related profiles ("no ICT", "email", "SMS", and "oral communication"). "Email" and "oral communication" profiles are mainly concerned with treatment changes and transmission of new prescriptions. The "SMS" profile expected reminders for healthcare appointments and optimizing therapeutic management. This study provides practical guidance to enhance LT therapeutic management by ICT intervention. The type of ICT used should take into account patient profiles to improve adherence and thereby the prognosis. A combination of strategies including information, education by a multidisciplinary team, and reminders is a promising approach to ensure an optimal management of our patients.

Health information technology adoption and acceptance of Turkish physicians-A model proposal and empirical assessment.

Health Information Technology (HIT) systems are receiving increasing attention in recent years. Yet, individual adoption research in health care settings, especially in developing countries are quite limited. Moreover, large body of Information Systems research has focused on user perceptions to form intentions to use a particular technology. However, the antecedents and consequences of perceptions remained largely unanswered in existing research. This study aims to fill this gap by proposing and testing a research model based on a modified Technology Acceptance Model (m - TAM) which incorporates socio psychological and cognitive factors to assess the HIT's adoption level of Turkish physicians. To do so, two different methods were used to collect data from head physicians, assistant head physicians, and physicians: face to face and online survey. Total 212 useful responses were returned. 174 of them were face-to-face surveys which were administrated to all the first level and some second and third level health organizations. The rest of the surveys were administrated to the second and third level healthcare organizations via online participation. Data were analyzed by Structural Equation Modelling via SmartPLS software program. Results present that commitment is a strong predictor of HIT usage, whereas neither motivation nor resistance has a significant impact on HIT usage.

Privacy and Health Practices in the Digital Age.

Increasing privacy concerns are arising from expanding use of aggregated personal information in health practices. Conversely, in light of the promising benefits of data driven healthcare, privacy is being frequently dismissed as outdated, costly and ultimately egotistical. This paper aims to review the theoretical framework on privacy in order to overcome the often simplistic debate between the primacy of individual or collective interests. As a result, it is argued that although privacy can be understood as freedom of personal choice in matters of sharing intimacy, it is foundational to both community belonging and to social and political organizations at large. Ethical decisions on the use of data analytics technologies in health practices should also take into account the social effects of violating privacy.

Tecnologías de la información y la comunicación al servicio de la atención farmacéutica: “Tu farmacéutico de guardia”, una web por y para los pacientes / Information and communication technologies at the service of pharmaceutical care: «Your pharmacist on duty», a website by and for patients

Objetivo: Alineado con la recomendación de la OMS de incorporar a la atención sanitaria diferentes estrategias de salud digital, el objetivo es doble: describir las funcionalidades y recursos de una página web creada para formar e informar a los pacientes y analizar la actividad de la herramienta tras un periodo de funcionamiento de seis años.Material y métodos: Los pasos que se siguieron en la creación de la web fueron: 1) desarrollo del logotipo y sistema de marca; 2) creación de contenidos tanto escritos como audiovisuales y 3) campaña de lanzamiento. Para evaluar su uso se realizó un estudio descriptivo retrospectivo (septiembre 2015 – noviembre 2021) en el que se recogieron los indicadores clave de rendimiento.Resultados: La web se estructuró en 11 grupos de patologías disponiendo de información escrita (179 fichas) y audiovisual (61 videos) sobre medicamentos y un repositorio de temas actuales sobre la salud a modo de noticias (515 reseñas publicadas). Desde su lanzamiento se han registrado un total de 176.530 visitas por 150.004 usuarios diferentes. En noviembre de 2020 se rediseñó la web, optimizándola para móviles con un diseño de marca renovado; hecho que reportó un importante crecimiento de las visitas, siendo el móvil (74,9%) el dispositivo de visualización más utilizado en este último periodo. (AU)

Objectives: To write the functionalities and resources of a web page created to train and inform patients and to analyze the activity of the tool after a six-year operating period. These two objectives are aligned with the WHO recommendation to incorporate different digital health strategies into health care.Material and methods: To create the web page we followed the next steps: 1) development of the logo and brand system; 2) creation of written and audiovisual content and 3) launch campaign. To evaluate the use of the web page, a retrospective descriptive study was carried out (September 2015 – November 2021) and key performance indicators were collected.Results: The website was structured into 11 groups of pathologies, including written information (179 files) and audiovisual information (61 videos) about drugs and a repository of current health topics shown as news (515 published reviews). Since its launch, a total of 176,530 visits have been registered by 150,004 different users. In November 2020 the web was redesigned, optimizing it for mobile devices and with a renewed brand design. This update reported a significant growth in visits, with mobile phones being the most used display (74.9%) in this last period. (AU)

Willingness to use telemedicine during COVID-19 among health professionals in a low income country.

INTRODUCTION: The coronavirus disease 2019 pandemic has prompted rapid restructuring of the health-care system in an effort to stop the spread of the pandemic. Thus, telemedicine is more preferable in order to prevent the COVID-19 pandemic when face to face meeting is forbidden, allowing provision of health service over a distance. This study aimed to assess willingness to use telemedicine and factors that will determine their extent of willingness during COIVID-19 among healthcare providers working in south west of Ethiopia. METHODS: Institutional based cross-sectional study design was applied to assess willingness to use telemedicine among healthcare providers working at public health hospitals in south west of Ethiopia. Self-administered questionnaires were used. We have used Epi-info for data entry and Analysis of Moment Structure (AMOS) for analysis. A structural equation modeling was performed to identify factors associated with willingness to use telemedicine at 95% confidence interval (CI). RESULT: In this study, less than half of respondents had high willingness to use telemedicine. Ease of use (ß = 0.79, 95% CI: [0.72, 0.86], p < 0.01), attitude (ß = 0.91, 95% CI: [0.87, 0.95], p < 0.01) and patient-physician relationships (ß = 0.67, 95% CI: [0.54, 0.70], p < 0.01) were variables associated with willingness to use telemedicine. Anxiety towards technology (ß = 0.74, 95% CI: [0.69, 0.79], p < 0.01) and patient-physician relationships (ß = 0.87, 95% CI: [0.81, 0.92], p < 0.01) were determinant factors of attitude to use telemedicine. CONCLUSIONS: The overall willingness to use telemedicine during COVID-19 in this setting is 46.5%. Addressing the problem related with ease of use, attitude and patient-physician relationships will help to increase the overall willingness to use telemedicine during COVID-19. An attempt to improving patient-physician relationship, provision of technical training for ease of use and working on healthcare providers' attitude will help to improve the willingness to use telemedicine.

Right Care, First Time: Developing a Theory-Based Automated Protocol to Help Clinically Stage Young People Based on Severity and Persistence of Mental Illness.

Most mental disorders emerge before the age of 25 years and, if left untreated, have the potential to lead to considerable lifetime burden of disease. Many services struggle to manage high demand and have difficulty matching individuals to timely interventions due to the heterogeneity of disorders. The technological implementation of clinical staging for youth mental health may assist the early detection and treatment of mental disorders. We describe the development of a theory-based automated protocol to facilitate the initial clinical staging process, its intended use, and strategies for protocol validation and refinement. The automated clinical staging protocol leverages the clinical validation and evidence base of the staging model to improve its standardization, scalability, and utility by deploying it using Health Information Technologies (HIT). Its use has the potential to enhance clinical decision-making and transform existing care pathways, but further validation and evaluation of the tool in real-world settings is needed.

Developing an infrastructure for secure patient summary exchange in the EU context: Lessons learned from the KONFIDO project.

BACKGROUND: The increase of healthcare digitalization comes along with potential information security risks. Thus, the EU H2020 KONFIDO project aimed to provide a toolkit supporting secure cross-border health data exchange. METHODS: KONFIDO focused on the so-called "User Goals", while also identifying barriers and facilitators regarding eHealth acceptance. Key user scenarios were elaborated both in terms of threat analysis and legal challenges. Moreover, KONFIDO developed a toolkit aiming to enhance the security of OpenNCP, the reference implementation framework. RESULTS: The main project outcomes are highlighted and the "Lessons Learned," the technical challenges and the EU context are detailed. CONCLUSIONS: The main "Lessons Learned" are summarized and a set of recommendations is provided, presenting the position of the KONFIDO consortium toward a robust EU-wide health data exchange infrastructure. To this end, the lack of infrastructure and technical capacity is highlighted, legal and policy challenges are identified and the need to focus on usability and semantic interoperability is emphasized. Regarding technical issues, an emphasis on transparent and standards-based development processes is recommended, especially for landmark software projects. Finally, promoting mentality change and knowledge dissemination is also identified as key step toward the development of secure cross-border health data exchange services.

Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran.

BACKGROUND: The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system's clinical needs. OBJECTIVE: We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. METHODS: Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. RESULTS: The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43%), followed by having less face-to-face time with patients (n=140, 38%). Positive perceptions about the EHR's ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. CONCLUSIONS: The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians' and nurses' well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout.

Adoption of Electronic Health Records (EHRs) in China During the Past 10 Years: Consecutive Survey Data Analysis and Comparison of Sino-American Challenges and Experiences.

BACKGROUND: The adoption rate of electronic health records (EHRs) in hospitals has become a main index to measure digitalization in medicine in each country. OBJECTIVE: This study summarizes and shares the experiences with EHR adoption in China and in the United States. METHODS: Using the 2007-2018 annual hospital survey data from the Chinese Health Information Management Association (CHIMA) and the 2008-2017 United States American Hospital Association Information Technology Supplement survey data, we compared the trends in EHR adoption rates in China and the United States. We then used the Bass model to fit these data and to analyze the modes of diffusion of EHRs in these 2 countries. Finally, using the 2007, 2010, and 2014 CHIMA and Healthcare Information and Management Systems Services survey data, we analyzed the major challenges faced by hospitals in China and the United States in developing health information technology. RESULTS: From 2007 to 2018, the average adoption rates of the sampled hospitals in China increased from 18.6% to 85.3%, compared to the increase from 9.4% to 96% in US hospitals from 2008 to 2017. The annual average adoption rates in Chinese and US hospitals were 6.1% and 9.6%, respectively. However, the annual average number of hospitals adopting EHRs was 1500 in China and 534 in the US, indicating that the former might require more effort. Both countries faced similar major challenges for hospital digitalization. CONCLUSIONS: The adoption rates of hospital EHRs in China and the United States have both increased significantly in the past 10 years. The number of hospitals that adopted EHRs in China exceeded 16,000, which was 3.3 times that of the 4814 nonfederal US hospitals. This faster adoption outcome may have been a benefit of top-level design and government-led policies, particularly the inclusion of EHR adoption as an important indicator for performance evaluation and the appointment of public hospitals.

Recommendations for Designing Health Information Technologies for Mental Health Drawn From Self-Determination Theory and Co-design With Culturally Diverse Populations: Template Analysis.

BACKGROUND: Culturally diverse populations (including Aboriginal and Torres Strait Islander people, people of diverse genders and sexualities, and culturally and linguistically diverse people) in nonurban areas face compounded barriers to accessing mental health care. Health information technologies (HITs) show promising potential to overcome these barriers. OBJECTIVE: This study aims to identify how best to improve a mental health and well-being HIT for culturally diverse Australians in nonurban areas. METHODS: We conducted 10 co-design workshops (N=105 participants) in primary youth mental health services across predominantly nonurban areas of Australia and conducted template analysis on the workshop outputs. Owing to local (including service) demographics, the workshop participants naturalistically reflected culturally diverse groups. RESULTS: We identified 4 main themes: control, usability, affirmation, and health service delivery factors. The first 3 themes overlap with the 3 basic needs postulated by self-determination theory (autonomy, competence, and relatedness) and describe participant recommendations on how to design an HIT. The final theme includes barriers to adopting HITs for mental health care and how HITs can be used to support care coordination and delivery. Hence, it describes participant recommendations on how to use an HIT. CONCLUSIONS: Although culturally diverse groups have specific concerns, their expressed needs fall broadly within the relatively universal design principles identified in this study. The findings of this study provide further support for applying self-determination theory to the design of HITs and reflect the tension in designing technologies for complex problems that overlap multiple medical, regulatory, and social domains, such as mental health care. Finally, we synthesize the identified themes into general recommendations for designing HITs for mental health and provide concrete examples of design features recommended by participants.

Using Digital Technologies to Facilitate Care Coordination Between Youth Mental Health Services: A Guide for Implementation.

Enhanced care coordination is essential to improving access to and navigation between youth mental health services. By facilitating better communication and coordination within and between youth mental health services, the goal is to guide young people quickly to the level of care they need and reduce instances of those receiving inappropriate care (too much or too little), or no care at all. Yet, it is often unclear how this goal can be achieved in a scalable way in local regions. We recommend using technology-enabled care coordination to facilitate streamlined transitions for young people across primary, secondary, more specialised or hospital-based care. First, we describe how technology-enabled care coordination could be achieved through two fundamental shifts in current service provisions; a model of care which puts the person at the centre of their care; and a technology infrastructure that facilitates this model. Second, we detail how dynamic simulation modelling can be used to rapidly test the operational features of implementation and the likely impacts of technology-enabled care coordination in a local service environment. Combined with traditional implementation research, dynamic simulation modelling can facilitate the transformation of real-world services. This work demonstrates the benefits of creating a smart health service infrastructure with embedded dynamic simulation modelling to improve operational efficiency and clinical outcomes through participatory and data driven health service planning.

Electronic palliative care coordination system (EPaCCS) in practice: A useful tool?

OBJECTIVES: First, to assess if Electronic Palliative Care Coordination Systems (EPaCCS) was used by different organisations as a tool to share information; second, to assess whether there was a measurable benefit with patients dying at their preferred place of death. METHODS: A retrospective analysis of the 65 decedents from last 12 months in the registered list of a single practice in Leeds was conducted. RESULTS: EPaCCS was present in 24 patients (36.9%). It was used by more than one organisation in 17 cases (70.9%). It facilitated death at the preferred place in 19 of the 20 cases (95%) were preferences were recorded. CONCLUSIONS: EPaCCS within the organisation was not used as widely as it could have been presumed. Having a patient with an EPaCCS in the electronic medical records did not imply there was sharing of information among the different organisations involved. Although there was a clear impact on individuals dying at their preferred place of death, preferences were not necessarily recorded in EPaCCS.

Can caregivers trust information technology in the care of their patients? A systematic review.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that healthcare providers allow patients to engage in their healthcare by allowing access to their health records. Often patients need informal caregivers including family members or others to help them with their care. This paper explores whether trust is a key factor for informal caregivers' decision to use health information technologies (HIT) including electronic health records (EHR), patient portals, mobile apps, or other devices to care for their patient. Six reviewers conducted a comprehensive search of four literature databases using terms that pertained to a caregiver and trust to investigate the role trust plays when caregivers use HIT. While trust is a key factor for the use of HIT, it the researchers only identified ten articles that met the research question thresholds. Four main topics of trust surfaced including perceived confidentiality, perceived security, technological malfunction, and trustworthiness of the information. Trust is a critical factor for informal caregivers when using HIT to assist in the care of their patient (child, loved one, parent, or acquaintance). Based on the findings, it is clear that more research on the use of HIT by caregivers is needed.

Recommendations for Implementing Gamification for Mental Health and Wellbeing.

Gamification is increasingly being proposed as a strategy to increase engagement for mental health and wellbeing technologies. However, its implementation has been criticized as atheoretical, particularly in relation to behavior change theory and game studies theories. Definitions of the term "gamification" vary, sometimes widely, between and within academic fields and the effectiveness of gamification is yet to be empirically established. Despite this, enthusiasm for developing gamified mental health technologies, such as interventions, continues to grow. There is a need to examine how best to implement gamification in mental health and wellbeing technologies in a way that takes quick production cycles into account while still emphasizing empirical investigation and building a rigorous evidence base. With reference to game studies and the medical (eHealth/mHealth) literature, this article interrogates gamification for mental health and wellbeing by examining core properties of the game form. It then explores how gamification can best be conceptualized and implemented for mental health and wellbeing goals from conceptualization through to iterative co-development and evaluation that accommodates software development schedules. Finally, it summarizes its conceptual analysis into recommendations for researchers and designers looking to do so. These recommendations are: (1) assess suitability, (2) implement to support, (3) assess acceptability, (4) evaluate impact, and (5) document comprehensively. These recommendations aim to encourage clear language, unified terminology, the application and evaluation of theory, comprehensive and constant documentation, and transparent evaluation of outcomes.

Flip the Clinic: A Digital Health Approach to Youth Mental Health Service Delivery During the COVID-19 Pandemic and Beyond.

The demand for mental health services is projected to rapidly increase as a direct and indirect result of the COVID-19 pandemic. Given that young people are disproportionately disadvantaged by mental illness and will face further challenges related to the COVID-19 pandemic, it is crucial to deliver appropriate mental health care to young people as early as possible. Integrating digital health solutions into mental health service delivery pathways has the potential to greatly increase efficiencies, enabling the provision of "right care, first time." We propose an innovative digital health solution for demand management intended for use by primary youth mental health services, comprised of (1) a youth mental health model of care (ie, the Brain and Mind Centre Youth Model) and (2) a health information technology specifically designed to deliver this model of care (eg, the InnoWell Platform). We also propose an operational protocol of how this solution could be applied to primary youth mental health service delivery processes. By "flipping" the conventional service delivery models of majority in-clinic and minority web-delivered care to a model where web-delivered care is the default, this digital health solution offers a scalable way of delivering quality youth mental health care both in response to public health crises (such as the COVID-19 pandemic) and on an ongoing basis in the future.

Understanding the Intention to Use Telehealth Services in Underserved Hispanic Border Communities: Cross-Sectional Study.

BACKGROUND: Despite the United States having one of the leading health care systems in the world, underserved minority communities face significant access challenges. These communities can benefit from telehealth innovations that promise to improve health care access and, consequently, health outcomes. However, little is known about the attitudes toward telehealth in these communities, an essential first step toward effective adoption and use. OBJECTIVE: The purpose of this study is to assess the factors that shape behavioral intention to use telehealth services in underserved Hispanic communities along the Texas-Mexico border and examine the role of electronic health (eHealth) literacy in telehealth use intention. METHODS: We used cross-sectional design to collect data at a community health event along the Texas-Mexico border. The area is characterized by high poverty rates, low educational attainment, and health care access challenges. Trained bilingual students conducted 322 in-person interviews over a 1-week period. The survey instrument assessed sociodemographic information and telehealth-related variables. Attitudes toward telehealth were measured by asking participants to indicate their level of agreement with 9 statements reflecting different aspects of telehealth use. For eHealth literacy, we used the eHealth Literacy Scale (eHEALS), an 8-item scale designed to measure consumer confidence in finding, evaluating, and acting upon eHealth information. To assess the intention to use telehealth, we asked participants about the likelihood that they would use telehealth services if offered by a health care provider. We analyzed data using univariate, multivariate, and mediation statistical models. RESULTS: Participants were primarily Hispanic (310/319, 97.2%) and female (261/322, 81.1%), with an average age of 43 years. Almost three-quarters (219/298) reported annual household incomes below $20,000. Health-wise, 42.2% (136/322) self-rated their health as fair or poor, and 79.7% (255/320) were uninsured. The overwhelming majority (289/319, 90.6%) had never heard of telehealth. Once we defined the term, participants exhibited positive attitudes toward telehealth, and 78.9% (254/322) reported being somewhat likely or very likely to use telehealth services if offered by a health care provider. Based on multivariate proportional odds regression analysis, a 1-point increase in telehealth attitudes reduced the odds of lower versus higher response in the intention to use telehealth services by 23% (OR 0.77, 95% CI 0.73-0.81). Mediation analysis revealed that telehealth attitudes fully mediated the association between eHealth literacy and intention to use telehealth services. For a 1-point increase in eHEALS, the odds of lower telehealth use decreased by a factor of 0.95 (5%; OR 0.95, 95% CI 0.93-0.98; P<.001) via the increase in the score of telehealth attitudes. CONCLUSIONS: Telehealth promises to address many of the access challenges facing ethnic and racial minorities, rural communities, and low-income populations. Findings underscore the importance of raising awareness of telehealth and promoting eHealth literacy as a key step in fostering positive attitudes toward telehealth and furthering interest in its use.