Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges.

The use of artificial intelligence (AI) and big data in medicine has increased in recent years. Indeed, the use of AI in mobile health (mHealth) apps could considerably assist both individuals and health care professionals in the prevention and management of chronic diseases, in a person-centered manner. Nonetheless, there are several challenges that must be overcome to provide high-quality, usable, and effective mHealth apps. Here, we review the rationale and guidelines for the implementation of mHealth apps and the challenges regarding quality, usability, and user engagement and behavior change, with a special focus on the prevention and management of noncommunicable diseases. We suggest that a cocreation-based framework is the best method to address these challenges. Finally, we describe the current and future roles of AI in improving personalized medicine and provide recommendations for developing AI-based mHealth apps. We conclude that the implementation of AI and mHealth apps for routine clinical practice and remote health care will not be feasible until we overcome the main challenges regarding data privacy and security, quality assessment, and the reproducibility and uncertainty of AI results. Moreover, there is a lack of both standardized methods to measure the clinical outcomes of mHealth apps and techniques to encourage user engagement and behavior changes in the long term. We expect that in the near future, these obstacles will be overcome and that the ongoing European project, Watching the risk factors (WARIFA), will provide considerable advances in the implementation of AI-based mHealth apps for disease prevention and health promotion.

Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study.

BACKGROUND: Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient's health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. OBJECTIVE: The aim of this study was to explore Norwegian FACT teams' experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. METHODS: We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. RESULTS: A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. CONCLUSIONS: Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar.

Use of e-Health in Norwegian FACT Teams: A User Perspective.

Flexible assertive community treatment (FACT) is a model for delivering long-term, integrated and comprehensive treatment and follow-up for patients with severe mental illness. The objective of this study was to examine ICT challenges of Norwegian FACT teams. Doing observations in 3 teams and interviews with 5 teams we examined use of ICT systems, identifying challenges with the use of the electronic whiteboards, electronic health records, and team calendars. Better ICT systems and infrastructure are needed to support Norwegian FACT teams.

Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study.

BACKGROUND: Flexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway. OBJECTIVE: The objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams. METHODS: We have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway. RESULTS: FACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams. CONCLUSIONS: Weaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers.

Design and Prestudy Assessment of a Dashboard for Presenting Self-Collected Health Data of Patients With Diabetes to Clinicians: Iterative Approach and Qualitative Case Study.

BACKGROUND: Introducing self-collected health data from patients with diabetes into consultation can be beneficial for both patients and clinicians. Such an initiative can allow patients to be more proactive in their disease management and clinicians to provide more tailored medical services. Optimally, electronic health record systems (EHRs) should be able to receive self-collected health data in a standard representation of medical data such as Fast Healthcare Interoperability Resources (FHIR), from patients systems like mobile health apps and display the data directly to their users-the clinicians. However, although Norwegian EHRs are working on implementing FHIR, no solution or graphical interface is available today to display self-collected health data. OBJECTIVE: The objective of this study was to design and assess a dashboard for displaying relevant self-collected health data from patients with diabetes to clinicians. METHODS: The design relied on an iterative participatory process involving workshops with patients, clinicians, and researchers to define which information should be available and how it should be displayed. The assessment is based on a case study, presenting an instance of the dashboard populated with data collected from one patient with diabetes type 1 (in-house researcher) face-to-face by 14 clinicians. We performed a qualitative analysis based on usability, functionality, and expectation by using responses to questionnaires that were distributed to the 14 clinicians at the end of the workshops and collected before the participants left. The qualitative assessment was guided by the Standards for Reporting Qualitative Research. RESULTS: We created a dashboard permitting clinicians to assess the reliability of self-collected health data, list all collected data including medical calculations, and highlight medical situations that need to be investigated to improve the situation of the patients. The dashboard uses a combination of tables, graphs, and other visual representations to display the relevant information. Clinicians think that this type of solution will be useful during consultations every day, especially for patients living in remote areas or those who are technologically interested. CONCLUSIONS: Displaying self-collected health data during consultations is not enough for clinicians; the data reliability has to be assured and the relevant information needs to be extracted and displayed along with the data to ease the introduction during a medical encounter. The prestudy assessment showed that the system provides relevant information to meet clinicians' need and that clinicians were eager to start using it during consultations. The system has been under testing in a medical trial since November 2018, and the first results of its assessment in a real-life situation are expected in the beginning of next year (2020).

Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature.

BACKGROUND: eHealth has an enormous potential to improve healthcare cost, effectiveness, and quality of care. However, there seems to be a gap between the foreseen benefits of research and clinical reality. OBJECTIVE: Our objective was to systematically review the factors influencing the outcome of eHealth interventions in terms of success and failure. METHODS: We searched the PubMed database for original peer-reviewed studies on implemented eHealth tools that reported on the factors for the success or failure, or both, of the intervention. We conducted the systematic review by following the patient, intervention, comparison, and outcome framework, with 2 of the authors independently reviewing the abstract and full text of the articles. We collected data using standardized forms that reflected the categorization model used in the qualitative analysis of the outcomes reported in the included articles. RESULTS: Among the 903 identified articles, a total of 221 studies complied with the inclusion criteria. The studies were heterogeneous by country, type of eHealth intervention, method of implementation, and reporting perspectives. The article frequency analysis did not show a significant discrepancy between the number of reports on failure (392/844, 46.5%) and on success (452/844, 53.6%). The qualitative analysis identified 27 categories that represented the factors for success or failure of eHealth interventions. A quantitative analysis of the results revealed the category quality of healthcare (n=55) as the most mentioned as contributing to the success of eHealth interventions, and the category costs (n=42) as the most mentioned as contributing to failure. For the category with the highest unique article frequency, workflow (n=51), we conducted a full-text review. The analysis of the 23 articles that met the inclusion criteria identified 6 barriers related to workflow: workload (n=12), role definition (n=7), undermining of face-to-face communication (n=6), workflow disruption (n=6), alignment with clinical processes (n=2), and staff turnover (n=1). CONCLUSIONS: The reviewed literature suggested that, to increase the likelihood of success of eHealth interventions, future research must ensure a positive impact in the quality of care, with particular attention given to improved diagnosis, clinical management, and patient-centered care. There is a critical need to perform in-depth studies of the workflow(s) that the intervention will support and to perceive the clinical processes involved.

On the Development of a Hospital-Patient Web-Based Communication Tool: A Case Study From Norway.

Surgery cancellations are undesirable in hospital settings as they increase costs, reduce productivity and efficiency, and directly affect the patient. The problem of elective surgery cancellations in a North Norwegian University Hospital is addressed. Based on a three-step methodology conducted at the hospital, the preoperative planning process was modeled taking into consideration the narratives from different health professions. From the analysis of the generated process models, it is concluded that in order to develop a useful patient centered web-based communication tool, it is necessary to fully understand how hospitals plan and organize surgeries today. Moreover, process reengineering is required to generate a standard process that can serve as a tool for health ICT designers to define the requirements for a robust and useful system.

An optimization based on simulation approach to the patient admission scheduling problem: diagnostic imaging department case study.

The growing influx of patients in healthcare providers is the result of an aging population and emerging self-consciousness about health. In order to guarantee the welfare of all the healthcare stakeholders, it is mandatory to implement methodologies that optimize the healthcare providers' efficiency while increasing patient throughput and reducing patient's total waiting time. This paper presents a case study of a conventional radiology workflow analysis in a Portuguese healthcare provider. Modeling tools were applied to define the existing workflow. Re-engineered workflows were analyzed using the developed simulation tool. The integration of modeling and simulation tools allowed the identification of system bottlenecks. The new workflow of an imaging department entails a reduction of 41 % of the total completion time.