Motivations and Barriers Toward Implementation of a Rectal Cancer Synoptic Operative Report: A Process Evaluation.

BACKGROUND: The use of synoptic reporting has been shown to improve documentation of critical information and provide added value related to data access and extraction, data reliability, relevant detail, and completeness of information. Surgeon acceptance and adoption of synoptic reports has lagged behind other specialties. OBJECTIVE: This study aimed to evaluate the process of implementing a synoptic operative report. DESIGN: This study was a mixed-methods process evaluation including surveys and qualitative interviews. SETTINGS: This study focused on colorectal surgery practices across the United States. PATIENTS: Twenty-eight board-certified colorectal surgeons were included. INTERVENTIONS: The synoptic operative report for rectal cancer was implemented. MAIN OUTCOME MEASURES: Acceptability, feasibility, and usability were measured by Likert-type survey questions and followed up with individual interviews to elicit experiences with implementation as well as motivations and barriers to use. RESULTS: Among all study participants, 28 surgeons completed the electronic survey (76% response rate) and 21 (57%) completed the telephone interview. Mean usability was 4.14 (range, 1-5; SE, 0.15), mean feasibility was 3.90 (SE, 0.15), and acceptability was 3.98 (SE, 0.18). Participants indicated that substantial administrative and technical support were necessary but not always available for implementation, and many were frustrated by the need to change their workflow. LIMITATIONS: Most surgeon participants were male, white, had >12 years in practice, and used Epic electronic medical record systems. Therefore, they may not represent the perspectives of all US colon and rectal surgeons. In addition, as the synoptic operative report is implemented more broadly across the United States, it will be important to consider variations in the process by electronic medical record system. CONCLUSIONS: The synoptic operative report for rectal cancer was easy to implement and incorporate into workflow, in general, but surgeons remained concerned about additional burden without immediate and tangible value. Despite recognizing benefits, many participants indicated they only implemented the synoptic operative report because it was mandated by the National Accreditation Program for Rectal Cancer. See Video Abstract at http://links.lww.com/DCR/B735MOTIVACIONES Y BARRERAS HACIA LA IMPLEMENTACIÓN DE UN INFORME OPERATIVO SINÓPTICO DE CÁNCER RECTAL: UNA EVALUACIÓN DEL PROCESOANTECEDENTES:Se ha demostrado que el uso de informes sinópticos mejora la documentación de información crítica y proporciona un valor agregado relacionado con el acceso y extracción de datos, la confiabilidad de los datos, los detalles relevantes y la integridad de la información. La aceptación y adopción de informes sinópticos por parte de los cirujanos se ha quedado rezagada con respecto a otras especialidades.OBJETIVO:Evaluar el proceso de implementación de un informe operativo sinóptico.DISEÑO:Evaluación de procesos de métodos mixtos que incluyen encuestas y entrevistas cualitativas.AJUSTES:Prácticas de cirugía colorrectal en los Estados Unidos.PACIENTES:Veintiocho cirujanos colorrectales certificados por la junta.INTERVENCIONES:Implementación del informe operatorio sinóptico de cáncer de recto.PRINCIPALES MEDIDAS DE RESULTADO:Aceptabilidad, viabilidad y usabilidad medidas por preguntas de encuestas tipo Likert y seguidas con entrevistas individuales para obtener experiencias con la implementación, así como motivaciones y barreras para el uso.RESULTADOS:Entre todos los participantes del estudio, 28 cirujanos completaron la encuesta electrónica (tasa de respuesta del 76%) y 21 (57%) completaron la entrevista telefónica. La usabilidad media fue 4,14 (rango = 1-5, error estándar (EE) = 0,15), la factibilidad media fue 3,90 (EE = 0,15) y la aceptabilidad fue 3,98 (EE = 0,18). Los participantes indicaron que se necesitaba un apoyo administrativo y técnico sustancial, pero que no siempre estaba disponible para la implementación y muchos se sintieron frustrados por la necesidad de cambiar su flujo de trabajo.LIMITACIONES:La mayoría de los cirujanos participantes eran hombres, blancos, tenían >12 años en la práctica y usaban sistemas de registros médicos electrónicos de Epic. Por lo tanto, es posible que no representen las perspectivas de todos los cirujanos de colon y recto de EE. UU. Además, a medida que el informe operativo sinóptico se implemente de manera más amplia en los EE. UU., Será importante considerar las variaciones en el proceso por sistema EMR.CONCLUSIONES:El informe quirúrgico sinóptico para el cáncer de recto fue en general fácil de implementar e incorporar en el flujo de trabajo, pero los cirujanos seguían preocupados por la carga adicional sin valor inmediato y tangible. A pesar de reconocer los beneficios, muchos participantes indicaron que solo implementaron el informe operativo sinóptico porque era un mandato del Programa Nacional de Acreditación para el Cáncer de Recto. Consulte Video Resumen en http://links.lww.com/DCR/B735 (Traducción-Dr. Xavier Delgadillo).

Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality.

Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic's onset to June 12th, 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient's encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.

Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals' Challenges with Data Exchange.

Policy Points Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges. Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues. Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies. CONTEXT: The novel coronavirus 2019 (COVID-19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management. METHODS: This study uses cross-sectional data of acute-care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology-organization-environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges. FINDINGS: Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge. CONCLUSIONS: Our findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.

Trends in user-initiated health information exchange in the inpatient, outpatient, and emergency settings.

Prior research on health information exchange (HIE) typically measured provider usage through surveys or they summarized the availability of HIE services in a healthcare organization. Few studies utilized user log files. Using HIE access log files, we measured HIE use in real-world clinical settings over a 7-year period (2011-2017). Use of HIE increased in inpatient, outpatient, and emergency department (ED) settings. Further, while extant literature has generally viewed the ED as the most relevant setting for HIE, the greatest change in HIE use was observed in the inpatient setting, followed by the ED setting and then the outpatient setting. Our findings suggest that in addition to federal incentives, the implementation of features that address barriers to access (eg, Single Sign On), as well as value-added services (eg, interoperability with external data sources), may be related to the growth in user-initiated HIE.

Realizing 5G- and AI-based doctor-to-doctor remote diagnosis: opportunities, challenges, and prospects.

Fifth Generation (5G) mobile communications technology became available in Japan as of the end of March 2020. The Ministry of Internal Affairs and Communications (MIC) is proceeding with a plan to use 5G for a doctor-to-doctor remote diagnosis system. This remote diagnosis offers patients the benefit of receiving advanced medical care without having to travel long distances. The provision of a remote diagnosis will provide elderly patients in rural areas with an earlier diagnosis without burdening patients in Japan where the aging population and the uneven distribution of doctors are increasing. However, the system will increase the burden on specialists by expanding the doctor's catchment area. As a solution to that problem, deep learning-based artificial intelligence (AI) is expected to reduce the burden on doctors. In order to realize 5G- and AI-based real-time diagnostic support, diagnostic imaging using AI and an AI model that provides instructions are required. This is because ultrasonography and endoscopy, which can be used for remote diagnosis, do not acquire data on fixed areas like a CT or MRI scan. The AI model needs to instruct the doctor at the patient's home in order to collect appropriate information in accordance with the patient's symptoms and status. In order to build an interactive AI model, the interactions between doctors who are making a remote diagnosis should be recorded as training data and a 5G-based remote diagnosis system should be created. A remote diagnostic support system incorporating 5G and interactive diagnostic imaging incorporating AI will result in a system that places less of a burden on patients and doctors.

Dissemination of Information During Public Health Crises: Early COVID-19 Data From The Laryngoscope.

OBJECTIVES: During a public health crisis, it is important for medical journals to share information in a timely manner while maintaining a robust peer-review process. This review reports and analyzes The Laryngoscope's publication trends and practices during the COVID-19 pandemic, before the COVID-19 pandemic, and during previous pandemics. METHODS: Comprehensive review of two databases (PubMed and The Laryngoscope) was performed. COVID-19 manuscripts (published in The Laryngoscope during the first 4 months of the pandemic) were identified and compared to manuscripts pertaining to historic pandemics (published in The Laryngoscope during the first 2 years of each outbreak). Keywords included "Laryngoscope", "flu", "pandemic", "influenza", "SARS", "severe acute respiratory syndrome", "coronavirus", "COVID-19", and "SARS-CoV-2". Data were obtained from The Laryngoscope to characterize publication trends during and before the COVID-19 pandemic. RESULTS: From March 1, 2020 to June 30, 2020, The Laryngoscope had 203 COVID-19 submissions. As of July 8, 2020, 20 (9.9%) were accepted, 117 (57.6%) under review, and 66 (32.5%) rejected. During the first 4 months of the pandemic, 18 COVID-19 manuscripts were published. The mean number of days from submission to online publication was 45, compared to 170 in 2018 and 196 in 2019. A total of 4 manuscripts concerning previous pandemics were published during the initial 2 years of each outbreak. CONCLUSIONS: The Laryngoscope rapidly disseminated quality publications during the COVID-19 pandemic by upholding a robust peer-review process while expediting editorial steps, highlighting relevant articles online, and providing open access to make COVID-19-related publications available as quickly as possible. Laryngoscope, 130:2508-2515, 2020.

How to keep up to date with medical information using web-based resources: a systematised review and narrative synthesis.

BACKGROUND: Keeping up to date with the latest medical information using Web-based resources has been sparsely described, and a comprehensive up-to-date review is needed. OBJECTIVES: To summarise the Web-based 'channels' that may assist the actors of the health care system (clinicians, medical researchers and students) to keep up to date with medical information. METHODS: We searched PubMed and Scopus for English language articles published between January 1990 and February 2019 that investigated ways for keeping up with medical information. We used the results from our search and relevant information from other sources to conduct a narrative synthesis. RESULTS: We found that resources that push information (e.g. web alerts, medical newsletters, listservs), resources that rely on the active information seeking (e.g. access to health librarians and electronic databases, podcasts, mobile apps), collaborative resources (e.g. web conferences, online journal clubs, web social media) and resources that synthesise information (e.g. bibliometrics, living systematic reviews) can contribute in keeping up with new findings and can enhance evidence-based medicine. Clinicians, medical researchers and students can benefit from the proper use of such Internet-based technological innovations. CONCLUSION: Internet provides many resources that can help the actors of the health care system stay up to date with the latest scientific findings.

Cybersecurity in Science and Medicine: Threats and Challenges.

Technology offers opportunities to revolutionize medicine and research but can threaten privacy and patient confidentiality. As the scale of patient data explodes, the safety and integrity of medical information are increasingly at stake. We highlight security and privacy issues associated with genomic research, medical devices, and wearable technology.

Leveraging health information exchange for clinical research: Extreme underreporting of hospital service utilization among patients with substance use disorders.

BACKGROUND: Substance use disorders are associated with inefficient and fragmented use of healthcare services. The Chesapeake Regional Information System for Our Patients, Inc. (CRISP) is a Health Information Exchange (HIE) linking disparate systems of care in the mid-Atlantic region. METHODS: This article describes applications of HIE for tracking hospital service utilization in substance use disorder clinical and services research, drawing upon data from one of the first studies approved to access the CRISP HIE. Participants were 200 medical/surgical inpatients with comorbid opioid, cocaine, and/or alcohol use disorder (45.5 % female; 56.5 % black; 77.5 % opioid use disorder; 42.0 % homeless). This study compared HIE-identified hospital service utilization with conventional methods of participant self-report during in-person research follow-ups (3-, 6-, and 12-months post-discharge) and electronic health record (EHR) review from the hospital system of the index admission. RESULTS: This sample exhibited high levels of hospital utilization, which would have been underestimated using conventional methods. Relying exclusively on self-report in the 12-month observation period would have identified only 33.8 % of 429 inpatient hospitalizations and 9.0 % of 1,287 ED visits, due to both loss-to-follow-up and failure to report events. Even combining self-report with single-system EHR review identified only 66.2 % of inpatient hospitalizations and 59.8 % of ED visits. CONCLUSIONS: CRISP HIE data were superior to conventional methods for ascertaining hospital service utilization in this sample of patients exhibiting high-volume and fragmented care. The use of HIE holds implications for improving rigor, safety, and efficiency in research studies.

Infertility influencers: an analysis of information and influence in the fertility webspace.

PURPOSE: To examine fertility-related social media accounts and influencers on two social media platforms. METHODS: The search function of Twitter (TW) and Instagram (IG) was used to generate a list of accounts with the terms: fertility, infertility, ttc, egg freezing, ivf, endometriosis, and reproductive. Accounts not in English, in private, with no posts in > 1 year, or with content unrelated to search terms were excluded. Accounts were assessed for author type; REI board certification (REI-BC); influencer (INF) status (> 10 K followers on IG; verified check mark on TW); account demographics; and content in last 5 posts. Statistical analysis included unpaired t tests, a classification and regression tree (CART) analysis, and stepwise multiple logistic regression. RESULTS: Seven hundred ten accounts were identified and 537 (278 TW, 259 IG) were included. Account types included societies, clinics, physicians, patients, groups, and "other." Instagram content (1290 posts reviewed) was primarily personal stories (31.7%) or inspiration/support (23.7%). Twitter content (1390 posts reviewed) was mostly promotion (28.2%) and research/education (20.2%). Thirty-nine accounts (12.5%) were influencers. Fertility influencers were most often awareness/support accounts (59.8% TW, 25.0% IG), patients (12.8% TW, 25% IG), or other (17.9% TW, 21.0% IG). Only 7.7% TW and 7.1% IG INFs were board-certified REI physicians. The best predictor for classification as an influencer was high activity (> 50 posts/month TW, > 10 posts/month IG). CONCLUSION: As patients increasingly utilize social media to obtain and engage with health information, it is critical to understand the fertility-related SM landscape. This understanding may help to successfully enhance relationships with patients and ensure dissemination of accurate information.

Hospital adoption of multiple health information exchange approaches and information accessibility.

OBJECTIVE: Hospital engagement in electronic health information exchange (HIE) has increased over recent years. We aimed to 1) determine the change in adoption of 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and 2) to assess if growth in each approach corresponded to increased ability to access and integrate patient information from outside providers. METHODS: Panel analysis of all nonfederal, acute care hospitals in the United States using hospital- and year-fixed effects. The sample consisted of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016. RESULTS: Adoption of each approach increased by 9-15 percentage points over the study period. The average number of HIE approaches used by each hospital increased from 1.0 to 1.4. Adoption of each approach was associated with increased likelihood that providers routinely had necessary outside information of 4.2-12.7 percentage points and 4.5-13.3 percentage points increase in information integration. Secure messaging was associated with the largest increase in both. Adoption of 1 approach increased the likelihood of having outside information by 10.3 percentage points, while adopting a second approach further increased the likelihood by 9.5 percentage points. Trends in number of approaches and integration were similar. DISCUSSION/CONCLUSION: No single HIE tool provided high levels of usable, integrated health information. Instead, hospitals benefited from adopting multiple tools. Policy initiatives that reduce the complexity of enabling high value HIE could result in broader adoption of HIE and use of information to inform care.

An International Perspective on Health Information Exchange: Adoption in OECD Countries With Different Health Care System Configurations.

The sharing of information among various care providers is becoming an essential feature of health care systems, and many countries are now adopting policies to foster health information exchange, defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. Given the increasing adoption of this type of policy in several Organization for Economic Cooperation and Development countries, it is important to compare experiences from different countries, because policy adoption in one country can be explained more comprehensively and coherently through comparison with similar policies adopted in other nations. To make a more meaningful cross-country comparison, this article identifies a taxonomy of health systems, and it analyzes institutional and resource-based factors related to health information exchange adoption and how they differ in three main types of health systems: the National Health Service, social health insurance, and private health insurance.

Ebola-Related Health Information Wanted and Obtained by Nurses and Public Health Department Employees: Effects of Formal and Informal Communication Channels.

OBJECTIVES: The aim of this study was to (1) understand types and amounts of Ebola-related information that health organization employees wanted and obtained through formal, informal, internal, and external organizational communication channels; (2) determine potential discrepancies between information wanted and obtained; and (3) investigate how organizational structure might affect information wanted and obtained through these communication channels. METHODS: Primary data were collected from 526 health workers in 9 hospitals and 13 public health departments in Texas from June to November 2015. Survey data were collected for 7 types of Ebola-related information health organization employees wanted and obtained through various types of organizational communication channels. Descriptive statistical analyses, mixed design analysis of variance, regression analyses, and multilevel analyses were used to analyze the data. RESULTS: Hospital employees (mostly nurses in our sample) received more self-care information than they wanted from every communication channel. However, they received less about all other types of information than they wanted from every communication channel separately and combined. Public health department employees wanted more information than they received from every communication channel separately and combined for all 7 types of information. CONCLUSIONS: Discrepancies existed between the types of Ebola-related information wanted and obtained by employees of hospitals and public health departments.

Potential of technology to improve the availability and use of health information on cancer subjects for clergy from rural communities.

BACKGROUND: Cancer is a leading cause of death around the world and often is a chronic long term disease. This calls for an expanded workforce to include non-traditional health care providers. OBJECTIVE: To determine effectiveness of a cancer information training project with clergy from selected rural Appalachian areas to improve comfort and willingness to work as part of the cancer health care team. METHODS: Clergy were trained in the consumer health database of the National Library of Medicine MedlinePlus.gov. Exercises were required that were done using an iPad tablet with an online curriculum. They were also taught how to do a population health assessment of their particular area and develop a health ministry for their church. RESULTS: Three key elements were confirmed that would enable replication of the pilot: access to medlineplus, programmed learning modules using mobile technology such as iPads, and staff support including librarians and medical staff. With these key elements, the cancer project is potentially replicable with other groups beyond clergy. CONCLUSION: Knowledge about population health, built on new awareness and topical health knowledge, and using new skills to identify relevant information and library resources, could open minds and enhance community support for preventive and medical interventions.

A Parser to Support the Definition of Access Control Policies and Rules Using Natural Languages.

As a consequence of the epidemiological transition towards non-communicable diseases, integrated care approaches are required, not solely focused on medical purposes, but also on a range of essential activities for the maintenance of the individuals' quality of life. In order to allow the exchange of information, these integrated approaches might be supported by digital platforms, which need to provide trustful environments and to guarantee the integrity of the information exchanged. Therefore, together with mechanisms such as authentication, logging or auditing, the definition of access control policies assumes a paramount importance. This article focuses on the development of a parser as a component of a platform to support the care of community-dwelling older adults, the SOCIAL platform, to allow the definition of access control policies and rules using natural languages.

Discovering Clinical Information Models Online to Promote Interoperability of Electronic Health Records: A Feasibility Study of OpenEHR.

BACKGROUND: Clinical information models (CIMs) enabling semantic interoperability are crucial for electronic health record (EHR) data use and reuse. Dual model methodology, which distinguishes the CIMs from the technical domain, could help enable the interoperability of EHRs at the knowledge level. How to help clinicians and domain experts discover CIMs from an open repository online to represent EHR data in a standard manner becomes important. OBJECTIVE: This study aimed to develop a retrieval method to identify CIMs online to represent EHR data. METHODS: We proposed a graphical retrieval method and validated its feasibility using an online CIM repository: openEHR Clinical Knowledge Manager (CKM). First, we represented CIMs (archetypes) using an extended Bayesian network. Then, an inference process was run in the network to discover relevant archetypes. In the evaluation, we defined three retrieval tasks (medication, laboratory test, and diagnosis) and compared our method with three typical retrieval methods (BM25F, simple Bayesian network, and CKM), using mean average precision (MAP), average precision (AP), and precision at 10 (P@10) as evaluation metrics. RESULTS: We downloaded all available archetypes from the CKM. Then, the graphical model was applied to represent the archetypes as a four-level clinical resources network. The network consisted of 5513 nodes, including 3982 data element nodes, 504 concept nodes, 504 duplicated concept nodes, and 523 archetype nodes, as well as 9867 edges. The results showed that our method achieved the best MAP (MAP=0.32), and the AP was almost equal across different retrieval tasks (AP=0.35, 0.31, and 0.30, respectively). In the diagnosis retrieval task, our method could successfully identify the models covering "diagnostic reports," "problem list," "patients background," "clinical decision," etc, as well as models that other retrieval methods could not find, such as "problems and diagnoses." CONCLUSIONS: The graphical retrieval method we propose is an effective approach to meet the uncertainty of finding CIMs. Our method can help clinicians and domain experts identify CIMs to represent EHR data in a standard manner, enabling EHR data to be exchangeable and interoperable.

Health information in the digital age: an empirical study of the perceived benefits and costs of seeking and using health information from online sources.

OBJECTIVE: This paper aims to explore the determinants of the online health information seeking (OHIS) and usage (OHIU) behaviours of consumers based on the perceived benefits and costs of such activities. METHODS: This study applies questionnaires and empirical research methods. A questionnaire is designed according to the hypothesis model. A total of 282 questionnaires are obtained from patients and their accompanying families in two large hospitals, and the SPSS 17.0 and AMOS 17.0 (IBM, Almond, NY, USA) software are used to analyse the sample data and to test the research models. RESULTS: Three key findings are obtained from the analysis. Firstly, functional, learning, social and personal integrative benefits positively affect the OHIS intent of consumers. Secondly, cognitive costs negatively influence the OHIU behaviour of consumers. Thirdly, personal integrative benefits and OHIS behaviour significantly influence the OHIU behaviour of consumers. CONCLUSION: This paper highlights the differences between OHIS and OHIU based on their impact factors and applies social exchange theory to understand such factors. Online health information providers must improve the ease of use of their websites or applications, enhance the quality of their health information and focus on their functionality.

Evaluating the Quality of Health Information in a Changing Digital Ecosystem.

BACKGROUND: Critical evaluation of online health information has always been central to consumer health informatics. However, with the emergence of new Web media platforms and the ubiquity of social media, the issue has taken on a new dimension and urgency. At the same time, many established existing information quality evaluation guidelines address information characteristics other than the content (eg, authority and currency), target information creators rather than users as their main audience, or do not address information presented via novel Web technologies. OBJECTIVE: The aim of this formative study was to (1) develop a methodological approach for analyzing health-related Web pages and (2) apply it to a set of relevant Web pages. METHODS: This qualitative study analyzed 25 type 2 diabetes pages, which were derived from the results of a Google search with the keywords "diabetes," "reversal," and "natural." The coding scheme, developed via a combination of theory- and data-driven approaches, includes 5 categories from existing guidelines (resource type, information authority, validity of background information sources, objectivity, and currency) and 7 novel categories (treatment or reversal method, promises and certainty, criticisms of establishment, emotional appeal, vocabulary, rhetoric and presentation, and use of science in argumentation). The coding involves both categorical judgment and in-depth narrative characterization. On establishing satisfactory level of agreement on the narrative coding, the team coded the complete dataset of 25 pages. RESULTS: The results set included "traditional" static pages, videos, and digitized versions of printed newspapers or magazine articles. Treatments proposed by the pages included a mixture of conventional evidence-based treatments (eg, healthy balanced diet exercise) and unconventional treatments (eg, dietary supplements, optimizing gut flora). Most pages either promised or strongly implied high likelihood of complete recovery. Pages varied greatly with respect to the authors' stated background and credentials as well as the information sources they referenced or mentioned. The majority included criticisms of the traditional health care establishment. Many sold commercial products ranging from dietary supplements to books. The pages frequently used colloquial language. A significant number included emotional personal anecdotes, made positive mentions of the word cure, and included references to nature as a positive healing force. Most pages presented some biological explanations of their proposed treatments. Some of the explanations involved the level of complexity well beyond the level of an educated layperson. CONCLUSIONS: Both traditional and data-driven categories of codes used in this work yielded insights about the resources and highlighted challenges faced by their users. This exploratory study underscores the challenges of consumer health information seeking and the importance of developing support tools that would help users seek, evaluate, and analyze information in the changing digital ecosystem.