Will Generative Artificial Intelligence Deliver on Its Promise in Health Care?

Importance: Since the introduction of ChatGPT in late 2022, generative artificial intelligence (genAI) has elicited enormous enthusiasm and serious concerns. Observations: History has shown that general purpose technologies often fail to deliver their promised benefits for many years ("the productivity paradox of information technology"). Health care has several attributes that make the successful deployment of new technologies even more difficult than in other industries; these have challenged prior efforts to implement AI and electronic health records. However, genAI has unique properties that may shorten the usual lag between implementation and productivity and/or quality gains in health care. Moreover, the health care ecosystem has evolved to make it more receptive to genAI, and many health care organizations are poised to implement the complementary innovations in culture, leadership, workforce, and workflow often needed for digital innovations to flourish. Conclusions and Relevance: The ability of genAI to rapidly improve and the capacity of organizations to implement complementary innovations that allow IT tools to reach their potential are more advanced than in the past; thus, genAI is capable of delivering meaningful improvements in health care more rapidly than was the case with previous technologies.

Health System Change in the Wake of COVID-19.

This JAMA Forum discusses resiliency, telehealth, the health care labor force, and public health in the context of the health system changes occurring since the start of the COVID-19 pandemic.

Mapping Factors That Affect the Uptake of Digital Therapeutics Within Health Systems: Scoping Review.

BACKGROUND: Digital therapeutics are patient-facing digital health interventions that can significantly alter the health care landscape. Despite digital therapeutics being used to successfully treat a range of conditions, their uptake in health systems remains limited. Understanding the full spectrum of uptake factors is essential to identify ways in which policy makers and providers can facilitate the adoption of effective digital therapeutics within a health system, as well as the steps developers can take to assist in the deployment of products. OBJECTIVE: In this review, we aimed to map the most frequently discussed factors that determine the integration of digital therapeutics into health systems and practical use of digital therapeutics by patients and professionals. METHODS: A scoping review was conducted in MEDLINE, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar. Relevant data were extracted and synthesized using a thematic analysis. RESULTS: We identified 35,541 academic and 221 gray literature reports, with 244 (0.69%) included in the review, covering 35 countries. Overall, 85 factors that can impact the uptake of digital therapeutics were extracted and pooled into 5 categories: policy and system, patient characteristics, properties of digital therapeutics, characteristics of health professionals, and outcomes. The need for a regulatory framework for digital therapeutics was the most stated factor at the policy level. Demographic characteristics formed the most iterated patient-related factor, whereas digital literacy was considered the most important factor for health professionals. Among the properties of digital therapeutics, their interoperability across the broader health system was most emphasized. Finally, the ability to expand access to health care was the most frequently stated outcome measure. CONCLUSIONS: The map of factors developed in this review offers a multistakeholder approach to recognizing the uptake factors of digital therapeutics in the health care pathway and provides an analytical tool for policy makers to assess their health system's readiness for digital therapeutics.

Revolutionizing Healthcare with Foundation AI Models.

ChatGPT is a foundation Artificial Intelligence (AI) model that has opened up new opportunities in digital healthcare. Particularly, it can serve as a co-pilot tool for doctors in the interpretation, summarization, and completion of reports. Furthermore, it can build upon the ability to access the large literature and knowledge on the internet. So, chatGPT could generate acceptable responses for the medical examination. Hence. It offers the possibility of enhancing healthcare accessibility, expandability, and effectiveness. Nonetheless, chatGPT is vulnerable to inaccuracies, false information, and bias. This paper briefly describes the potential of Foundation AI models to transform future healthcare by presenting ChatGPT as an example tool.

How point-of-care testing could drive innovation in global health

The investment in health services in low- and middle-income countries has increased substantially in recent years.1 Such investment has been led by unprecedented efforts to combat major diseases, enabled by the availability of lower-cost and effective drug regimens for treatment and prophylaxis, along with improved vector control. As health services have expanded, so has the demand for diagnostic tests that are essential in identifying patients, determining prognosis, monitoring treatment, and assessing the efficacy of prevention.

Innovations in clinical documentation integrity practice: Continual adaptation in a data-intensive healthcare organisation.

BACKGROUND: Numbers of clinical documentation integrity specialists (CDIS) and CDI programs have increased rapidly. CDIS review patient records concurrently with patient admissions and visits to ensure that information is accurate, complete and non-ambiguous, and query clinicians when they see opportunities for improving data. The occupation was initially focused on improving data for reimbursement, but rapid changes to clinical coding requirements, technologies and payment systems led to a quickly evolving role for CDI programs and changes in CDIS practice. OBJECTIVE: This case study seeks to uncover the ongoing innovation and adaptation occurring in a CDI program by tracing the evolution of a single CDI program over time. METHOD: We present a case study of the CDI program at the HonorHealth hospital system in Arizona. RESULTS: The HonorHealth CDI program holds a unique hybrid expertise and role within the healthcare organisation that allows it to rapidly adapt to support emergent demands both internal and external to the organisation, such as supporting accurate data collection for the COVID-19 pandemic. CONCLUSION: CDIS are a vital component in present data-intensive resourcing efforts. The hybrid expertise of CDIS and capacity for adaption and relationship building has enabled the HonorHealth CDI program to adapt rapidly to meet a growing array of clinical documentation integrity needs, including emergent needs during the COVID-19 pandemic. IMPLICATIONS: The HonorHealth case study can guide other CDI programs in adaptation of the CDI role and practices in response to changing organisational needs.

Dealing with Unexpected Crises: Organizational Resilience and Its Discontents.

The chapter summarizes key literature, including emerging ideas, that is pertinent to the question of how organizations and their leadership deal with and are resilient through crises - highlighting what works in surviving unexpected crises. The chapter presents an illustration of organizational response; it concludes with an analysis of what is missing from the literature and recommends a path forward to expanding actionable knowledge in this area. Multiple, interdependent factors that foster resilience are identified including (1) being sensitive to possible threats - even seemingly small failures, (2) not relying on simple interpretations of events but rather seeking diversity to create a complete view of the environment, (3) leadership that embraces communication, transparency, and continuous learning, (4) valuing expertise and allowing expert staff to make decisions during a crisis, and (5) a cultural commitment to a resiliency mindset that accepts failures as opportunities to learn and improve. Emerging concepts that may foster resilience but require more research include managing paradox, emotional ambivalence and diversity. Additional areas for fruitful research include: the impact of short-term versus long-term, or successive, crises; external versus internal shocks and the framing of the source of shocks; how crisis affect the pace of innovation and change; the role of diversity in organizational responses to crises; and a set of methodological opportunities to leverage natural experiments or simulations in ways that allow for longitudinal data illuminating the full cycle of crises across organizations from anticipation, to response, to longer-term adaptation to the new normal.

Optimising the delivery of sexual health services in Australia: a qualitative study.

BACKGROUND: With a rise in sexually transmitted infections in Australia, it is important to evaluate and optimise current sexual health services to reduce barriers to access and increase testing. We aimed to describe the range of sexual health services in Australia, focusing on strategies to improve testing among priority populations, and any future strategies participants believed would improve service delivery. METHODS: We conducted 20 semi-structured interviews with key informants working in Australian sexual health services from July to December 2020, and collected data on service characteristics and strategies to improve access. We used content analysis, then coded and categorised the data into recurring themes and sub-themes. RESULTS: We identified two major themes: 'Expanding Traditional Service Delivery' and 'Thinking Outside the Box'. The first theme outlines strategies that build upon pre-existing service delivery models, such as express clinics and an increased focus on confidentiality. The second theme outlines new strategies introduced to fill gaps in service delivery, such as self-testing and outreach. CONCLUSIONS: To improve access to HIV/STI testing, there is a need for multiple access points to cater for a range of populations and their preferences. Establishing strategies to accomplish this involves utilising a combination of expanding traditional service models and implementing new approaches to service delivery.

Biblioteconomía y trabajo social: una combinación estratégica para enfrentar pandemias / Library science and social work: a strategic combination to face pandemics

Las intervenciones profesionales de los trabajadores sociales y los bibliotecarios durante la pandemia por COVID-19 convergieron en el empleo de las tecnologías de la información para satisfacer necesidades de información tanto de personal médico como de los pacientes y sus familias. La colaboración de estos dos profesionales reforzaría significativamente el equipo multidisciplinario de la salud a partir de la mejora de los canales de flujo de información que se llevan a cabo en el ámbito hospitalario, el fomento a la atención humanizada en salud y las acciones de inclusión social en las bibliotecas para brindar mayores y mejores oportunidades, así como recursos a población vulnerable.

The professional interventions of social workers and librarians during the COVID-19 pandemic converged in the use of information technologies to meet the information needs of both medical personnel and patients and their families. The collaboration of these two professionals would significantly strengthen the multidisciplinary health team by improving the information flow channels that are carried out in the hospital, promoting humanized health care and carrying out social inclusion actions in libraries to provide greater and better opportunities and resources for the vulnerable population.

Usability Assessment of Conversational Agents in Healthcare: A Literature Review.

Conversational agents (CA) are chatbot-based systems supporting the interaction with users through text, speech, or other modalities. They are used in an increasing number of medical use cases. Even though usability is considered a prerequisite for the success of mHealth apps using CA, there is still no standard procedure to study usability of health CA. In this paper, we report the results from a systematic literature review aiming at identifying study designs, tools, and metrics used to assess usability in health CA. We searched three bibliographic databases (PubMed, Scopus, IEEE Xplore) for papers reporting on CA in healthcare to extract information on the usability assessment of those CA. From 273 retrieved results, we included 66 papers for full text review. 34 of them reported on usability assessments. A broad range of tools is used (e.g. SUS, UEQ), but also individual questionnaires are exploited. The examined studies use scenario-based setups but assess also real-world usage. Exploratory setups are rarely reported. Due to the differences in the study designs and assessment tools, it is impossible to compare usability among CA. Thus, we recommend to develop a standardised procedure that can be always applied and which can be enriched by assessments needed for evaluating usability of CA-specific features.

Digital Health Education: Determining Competences and Piloting Innovative Study Course.

Digital technology for health services plays a critical role in the delivery of health services. In order to move towards universal healthcare, improvement of patient outcomes and better health, one must make use of the advantages of Digital Health tools and recognition of the role of the health ICT worker. Therefore, it is necessary to have a workforce that is competent to use these tools. Uniquely positioned at the intersection of healthcare and information technology, the domain of Digital Health builds on a variety of disciplines termed biomedical and health informatics, and other allied fields. With the increasing need to have a knowledgeable, skilled and competent workforce, it is necessary to concentrate efforts towards the provision of education modules in Digital Health. While continuing medical education, certificate courses and other similar courses attempt to bridge the gap in the delivery of Digital Health education, it is also paramount to establish dedicated and standalone courses. Streamlining approaches to Digital Health Education across disciplinary, cultural and national boundaries, is key to address the challenges of firmly embedding Digital Health courses in the fabric of university education. In the effort to provide the necessary knowledge, skills and competencies (KSCs) to the current health ICT worker, the Deggendorf Institute of Technology, European Campus Rottal-Inn (DIT-ECRI) is in the process of piloting a virtual course in Global Digital Health. With the ability to provide core competencies in Digital heath, this virtual course is a step towards advancing Global Digital Health Education.