@Article{info:doi/10.2196/57679, author="Norberg, L{\o}nnebakke B{\o}rge and Austad, Bjarne and Kristiansen, Eli and Zanaboni, Paolo and Getz, Okkenhaug Linn", title="The Dynamics of Doctor-Patient Communication During Remote Consultations: Qualitative Study Among Norwegian Contract General Practitioners", journal="J Med Internet Res", year="2025", month="Mar", day="27", volume="27", pages="e57679", keywords="remote consultations", keywords="digital consultations", keywords="telemedicine", keywords="eHealth", keywords="communication", keywords="safety", keywords="general practice", keywords="family medicine", keywords="focus groups", keywords="telehealth", keywords="digital health", keywords="relationship", keywords="patient-physician", keywords="general practitioner", keywords="thematic analysis", keywords="qualitative analysis", abstract="Background: Patient consultations in general practice are undergoing a digital transformation, embracing diverse modalities such as video, text-based, and telephone consultations. The quality of communication in medical consultations is pivotal for successful outcomes, necessitating a comprehensive assessment of the impact of this transformation on doctor-patient communication and interaction. Objective: This study aims to explore general practitioners' (GPs') perspectives on how the communication between Norwegian contract GPs and patients has been affected by the large-scale implementation of remote consultations following the onset of the COVID-19 pandemic. Methods: Five focus groups, comprising 18 purposefully recruited GPs from diverse settings and geographical regions in Norway, were carried out in 2022. We applied thematic analysis guided by the framework proposed by Braun and Clarke. Results: Six themes resulted from the analysis. First, suitability regarding remote communication is context-dependent: knowing the characteristics of the patient as a person and the clinical relationship is more important than the reason for contact or type of health problem---even more so than during ordinary physical consultations. Second, remote consultations favor a demarcated communication style, ``keeping things simple---the one-problem approach,'' which can increase work effectiveness. Third, a downside of such effective minimalism is that the uncritical use of remote consultations may undermine the quality of care. Communication becomes too transactional, limiting the chances of addressing more implicit and complex issues, with the risk of missing vital information. Fourth, remote modalities can help engage hesitant and vulnerable patients. Fifth, GPs make communicative trade-offs in the name of continuity to be able to maintain relationships with patients they see as vulnerable or fugitive. Finally, there are advantages and dilemmas stemming from text-based consultations. Although they offer benefits such as multimedia-enabled patient expression and sharing of digital information, some concerns include the risk of information loss through triage errors, managing informal language, and ending chat-like interactions between patients and doctors. Conclusions: The implementation of remote consultations has many effects on clinical interaction and communication. Although these modalities can enhance efficiency, there is a discernible risk of compromised retrieval of essential information and unvoiced problems, potentially resulting in unintended consequences. The preservation of continuity of care emerges as a pivotal strategy to mitigate some of these challenges. ", doi="10.2196/57679", url="https://www.jmir.org/2025/1/e57679" } @Article{info:doi/10.2196/57847, author="Bamgboje-Ayodele, Adeola and Boscolo, Adrian and Burger, Mitchell and Hutchings, Owen and Shaw, Miranda and Shaw, Tim and Tariq, Amina and Naicker, Sundresan and McPhail, Steven and Baysari, Melissa", title="Health IT Implementation and the Impact of the COVID-19 Pandemic on Clinician-IT Dynamics: Qualitative Study", journal="J Med Internet Res", year="2025", month="Feb", day="11", volume="27", pages="e57847", keywords="health IT", keywords="implementation", keywords="COVID-19 pandemic", keywords="process evaluation", keywords="sociotechnical factors", keywords="virtual hospital", keywords="COVID-19", abstract="Background: The COVID-19 pandemic necessitated the rapid development and implementation of health ITs to support health care delivery. Health IT implementation is difficult at the best of times, due to complex sociotechnical challenges that vary across contexts and settings; however, it is currently unclear how the pandemic impacted health IT implementation processes. The aim of this study was to explore the impact of the pandemic on health IT implementation processes, including pre- and postimplementation phases, and identify the sociotechnical factors that shaped health IT implementation during an unprecedented circumstance. Objective: This study aimed to explore the impact of the pandemic on HIT implementation processes, including pre- and postimplementation phases, and identify the socio-technical factors that shaped health IT implementation during an unprecedented circumstance. Methods: Participants were from one of two teams: (1) health care staff members (doctors, nurses, nurse unit managers, and support staff members) from a virtual hospital in Australia; and (2) IT professionals within the broader health care organization assigned to the hospital. Participants took part in an interview or focus group from July to November 2022. Participants were asked to describe the process used for rapid health IT design and implementation during the COVID-19 pandemic. Qualitative data were analyzed thematically. Results: A total of 15 participants took part in the study. Both internal and external team structures, and the communication pathways that underpinned these, were reported to influence the health IT lifecycle, which in turn impacted outcomes, particularly when perceived normal ways of working were challenged during the pandemic. Across the pre-post lifecycle, preimplementation processes were viewed to be most impacted by the COVID-19 pandemic. Participants reported that their roles and responsibilities changed during health IT implementations in the pandemic, impacting co-design processes and highlighting the need for health IT implementation processes to cater for new work and the redistribution of existing work. Conclusions: Our study uncovered the negative impact of the COVID-19 pandemic on team structures, communication pathways, and health IT preimplementation processes (project management and co-design). While health care organizations are keen to transition beyond the ways of working during the pandemic, it is imperative to learn from the health IT implementation successes and failures that occurred in the pandemic via process evaluations. Our evaluation offers learnings for research (an adapted interdisciplinary team communication framework), practice (the need for health care organizations to review their communication structures, IT staff skills, and proposed processes), and education (the need for better education and training of IT professionals working in clinical settings on health concepts) on health IT implementations as the world transitions to the ``new norm.'' ", doi="10.2196/57847", url="https://www.jmir.org/2025/1/e57847" } @Article{info:doi/10.2196/67263, author="Gil-Hern{\'a}ndez, Eva and Carrillo, Irene and Martin-Delgado, Jimmy and Garc{\'i}a-Torres, Daniel and Mira, Joaqu{\'i}n Jos{\'e}", title="Development of a Web-Based Intervention for Middle Managers to Enhance Resilience at the Individual, Team, and Organizational Levels in Health Care Systems: Multiphase Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="5", volume="12", pages="e67263", keywords="resilience", keywords="health care professionals", keywords="web-based intervention", keywords="middle management", keywords="well-being", keywords="patient safety", abstract="Background: Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams. Objective: This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience. Methods: An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador. Results: The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65\%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2\%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3\%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points. Conclusions: The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings. ", doi="10.2196/67263", url="https://humanfactors.jmir.org/2025/1/e67263" } @Article{info:doi/10.2196/55753, author="Backman, Chantal and Papp, Rosie and Tonjock Kolle, Aurelie and Papp, Steve and Visintini, Sarah and Schaefer Ferreira de Mello, L{\'u}cia Ana and de Melo Lanzoni, Marcellino Gabriela and Harley, Anne", title="Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e55753", keywords="platform based", keywords="patient-clinician", keywords="digital health intervention", keywords="care transition", keywords="mobile phone", abstract="Background: Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients. Objective: The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs. Methods: A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods. Results: We screened 8322 articles, of which 97 (1.17\%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61\%), a web-based platform (28/97, 29\%), or a combination of both (10/97, 10\%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23\%) and stroke (11/97, 11\%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13\%) and time constraints to use the DHIs (10/97, 10\%), and the top 2 enablers were the ability to use the DHIs (17/97, 18\%) and their ease of use (11/97, 11\%). The main conflicting theme was access (enabler; 28/97, 29\%) or limited access (barrier; 15/97, 15\%) to technology or the internet. Conclusions: Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes. ", doi="10.2196/55753", url="https://www.jmir.org/2024/1/e55753" } @Article{info:doi/10.2196/60176, author="Benjamin, Ellen and Giuliano, K. Karen", title="Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="10", volume="11", pages="e60176", keywords="patient flow", keywords="throughput", keywords="emergency department", keywords="nursing", keywords="emergency nursing", keywords="organizing work", keywords="cognitive work", keywords="human factors", keywords="ergonomics", keywords="SEIPS model", abstract="Background: Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes. Objective: The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model. Methods: This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system. Results: Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department's physical and socio-organizational environment. Participants raised concerns about the available technology's functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments' staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management's enforcement of timing metrics. Conclusions: There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems. ", doi="10.2196/60176", url="https://humanfactors.jmir.org/2024/1/e60176" } @Article{info:doi/10.2196/60830, author="Dixon, Eric and Pannu, Jayden and Dhaliwal, Kabir and Cheng, Rachel and Deol, Gurpal and Frangos, Sophie and Tawil, Emma and Oliveira, Ana and Wojkowski, Sarah and Quach, Shirley", title="Effects of Interprofessional Education on Readiness for Interprofessional Learning in Rehabilitation Science Students From Professional Health Care Programs: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="20", volume="13", pages="e60830", keywords="interprofessional education", keywords="rehabilitation science", keywords="health care students", keywords="interprofessional collaboration", keywords="prelicensure health care professionals", keywords="patient care", keywords="interdisciplinary education", keywords="rehabilitation education", keywords="curriculum development", keywords="team-based learning", abstract="Background: The World Health Organization defines interprofessional education (IPE) as a process in which students from different health care programs work together to provide effective care while deepening their knowledge of each other's roles. Previous literature shows a strong argument for early exposure to IPE as a facilitator for high quality patient care. The goal of IPE is to improve interprofessional collaboration (IPC), the ``gold standard'' of care to enhance patients' quality of life, functional ability, and health status, especially for patients who require expertise from a variety of health care professionals. IPC has shown improvements in quality of life, functional ability, and health status. IPE can occur in the form of structured interventions or spontaneously in student placements. Literature has demonstrated that IPE facilitates skill, knowledge development, teamwork, communication skills, and mutual respect among health care professional students. Objective: This systematic review aims to examine IPE outcomes, including readiness for IPC, IPE perceptions, attitudes toward collaborative learning, student confidence, practice efficiency, and team dynamics after IPE interventions in rehabilitation science students. Methods: The study will be conducted as outlined by the Cochrane Handbook for Systematic Reviews and will be reported per the PRISMA (Preferred Reporting of Items for Systematic Reviews and Meta-Analyses) 2015 guidelines. Students have performed literature searches across the databases MEDLINE, Embase, CINAHL, ERIC, Web of Science, and AMED. Studies will be included if their IPE intervention included multiple prelicensure health care professional students in a health care or health care education setting. Based on timelines presented in the Institute of Medicine's report on the impacts of IPE, relevant studies from 2016 to the present will be included. The Risk of Bias 2 tool will be used to study sources of bias. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) working group's methods will be used to evaluate the quality of the evidence presented. The final 3 authors are assisting as supervisors, providing oversight and feedback as needed. Any deviations from this protocol will be reported in the final paper. Results: The search strategy was finalized and searched across the databases by March 8, 2024. The systematic review was registered with PROSPERO on March 31, 2024. A total of 10,692 citations were retrieved for abstract and title screening, beginning in March 2024, and 756 were eligible for full-text screening in April 2024. Six articles were considered for inclusion and data extraction, which began in July 2024. Finalization of the extracted data and paper will occur in September 2024. Conclusions: This systematic review will provide a summary of the effects of IPE interventions in prelicensure rehabilitation science students. It will provide educators, health care providers, and students with valuable information for understanding the relevance of IPE. It will also shed light on research gaps and highlight areas for further study. Trial Registration: PROSPERO CRD42024506081; https://tinyurl.com/3tf2h9er International Registered Report Identifier (IRRID): PRR1-10.2196/60830 ", doi="10.2196/60830", url="https://www.researchprotocols.org/2024/1/e60830" } @Article{info:doi/10.2196/50235, author="Jefferson, Emily and Milligan, Gordon and Johnston, Jenny and Mumtaz, Shahzad and Cole, Christian and Best, Joseph and Giles, Charles Thomas and Cox, Samuel and Masood, Erum and Horban, Scott and Urwin, Esmond and Beggs, Jillian and Chuter, Antony and Reilly, Gerry and Morris, Andrew and Seymour, David and Hopkins, Susan and Sheikh, Aziz and Quinlan, Philip", title="The Challenges and Lessons Learned Building a New UK Infrastructure for Finding and Accessing Population-Wide COVID-19 Data for Research and Public Health Analysis: The CO-CONNECT Project", journal="J Med Internet Res", year="2024", month="Nov", day="20", volume="26", pages="e50235", keywords="COVID-19", keywords="infrastructure", keywords="trusted research environments", keywords="safe havens", keywords="feasibility analysis", keywords="cohort discovery", keywords="federated analytics", keywords="federated discovery", keywords="lessons learned", keywords="population wide", keywords="data", keywords="public health", keywords="analysis", keywords="CO-CONNECT", keywords="challenges", keywords="data transformation", doi="10.2196/50235", url="https://www.jmir.org/2024/1/e50235" } @Article{info:doi/10.2196/54022, author="Naicker, Sundresan and Tariq, Amina and Donovan, Raelene and Magon, Honor and White, Nicole and Simmons, Joshua and McPhail, M. Steven", title="Patterns and Perceptions of Standard Order Set Use Among Physicians Working Within a Multihospital System: Mixed Methods Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e54022", keywords="medical informatics", keywords="adoption and implementation", keywords="behavior", keywords="health systems", keywords="testing", keywords="electronic medical records", keywords="behavioral model", keywords="quantitative data", keywords="semistructured interview", keywords="clinical practice", keywords="user preference", keywords="user", keywords="user experience", abstract="Background: Electronic standard order sets automate the ordering of specific treatment, testing, and investigative protocols by physicians. These tools may help reduce unwarranted clinical variation and improve health care efficiency. Despite their routine implementation within electronic medical records (EMRs), little is understood about how they are used and what factors influence their adoption in practice. Objective: This study aims to (1) describe the patterns of use of standard order sets implemented in a widely used EMR (PowerPlans and Cerner Millennium) within a multihospital digital health care system; (2) explore the experiences and perceptions of implementers and users regarding the factors contributing to the use of these standard order sets; and (3) map these findings to the Capability, Opportunity, and Motivation Behavior (COM-B) model of behavior change to assist those planning to develop, improve, implement, and iterate the use of standard order sets in hospital settings. Methods: Quantitative data on standard order set usage were captured from 5 hospitals over 5-month intervals for 3 years (2019, 2020, and 2021). Qualitative data, comprising unstructured and semistructured interviews (n=15), were collected and analyzed using a reflexive thematic approach. Interview themes were then mapped to a theory-informed model of behavior change (COM-B) to identify determinants of standard order set usage in routine clinical practice. The COM-B model is an evidence-based, multicomponent framework that posits that human actions result from multiple contextual influences, which can be categorized across 3 dimensions: capability, opportunity, and motivation, all of which intersect. Results: The total count of standard order set usage across the health system during the 2019 observation period was 267,253, increasing to 293,950 in 2020 and 335,066 in 2021. There was a notable shift toward using specialty order sets that received upgrades during the study period. Four emergent themes related to order set use were derived from clinician interviews: (1) Knowledge and Skills; (2) Perceptions; (3) Technical Dependencies; and (4) Unintended Consequences, all of which were mapped to the COM-B model. Findings indicate a user preference for customized order sets that respond to local context and user experience. Conclusions: The study findings suggest that ongoing investment in the development and functionality of specialty order sets has the potential to enhance usage as these sets continue to be customized in response to local context and user experience. Sustained and continuous uptake of appropriate Computerized Provider Order Entry use may require implementation strategies that address the capability, opportunity, and motivational influencers of behavior. ", doi="10.2196/54022", url="https://formative.jmir.org/2024/1/e54022" } @Article{info:doi/10.2196/58068, author="Gorban, Carla and McKenna, Sarah and Chong, K. Min and Capon, William and Battisti, Robert and Crowley, Alison and Whitwell, Bradley and Ottavio, Antonia and Scott, M. Elizabeth and Hickie, B. Ian and Iorfino, Frank", title="Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study", journal="JMIR Ment Health", year="2024", month="Nov", day="6", volume="11", pages="e58068", keywords="digital navigator", keywords="digital coach", keywords="clinical technology specialist", keywords="mental health services", keywords="shared decision-making", keywords="lived experience", keywords="implementation", keywords="poor engagement", keywords="decision-making", keywords="mental health", keywords="digital mental health", keywords="digital mental health technology", doi="10.2196/58068", url="https://mental.jmir.org/2024/1/e58068" } @Article{info:doi/10.2196/57117, author="Neher, N. Andrea and Wespi, Rafael and Rapphold, D. Benjamin and Sauter, C. Thomas and K{\"a}mmer, E. Juliane and Birrenbach, Tanja", title="Interprofessional Team Training With Virtual Reality: Acceptance, Learning Outcome, and Feasibility Evaluation Study", journal="JMIR Serious Games", year="2024", month="Nov", day="4", volume="12", pages="e57117", keywords="medical education", keywords="simulation", keywords="virtual reality", keywords="VR", keywords="emergency medicine", keywords="interprofessional team training", keywords="nursing students", keywords="medical students", keywords="evaluation study", keywords="assessment", keywords="effectiveness", keywords="patient care", keywords="simulation-based training", keywords="hemorrhage", keywords="epileptic seizure", keywords="headache", abstract="Background: Effective interprofessional teamwork is vital for ensuring high-quality patient care, especially in emergency medicine. However, interprofessional education often fails to facilitate meaningful interaction among health care disciplines. It is therefore imperative to afford early opportunities for cultivating interprofessional teamwork skills. While in-person simulation-based training has been shown to improve performance, this is resource-intensive, especially if it involves multiple professions. Virtual reality (VR)--based training is an innovative instructional approach that demands fewer resources and offers the flexibility of location-independent learning. Objective: This study aimed to develop and evaluate the acceptance, learning outcome, and feasibility of an interprofessional team (INTEAM) training course that included a VR simulation of a neurological emergency case. Methods: This 1-group study used a pre- and posttest design to evaluate the 2-hour INTEAM training course for nursing and medical students. The course included an e-learning part, VR simulation, and debriefing. The main learning objectives were derived from the entrustable professional activity 6, namely to handle a common problem in emergency medicine (headache due to subarachnoid hemorrhage and epileptic seizure) that requires interprofessional collaboration, including a structured handover. We used validated and self-constructed questionnaires, pre- and posttests, and open questions to assess the acceptance, learning outcome, and feasibility of the course. Results: The data of 42 students (21 nursing and 21 medical students) were analyzed and showed good usability in the System Usability Scale (median 72.5, IQR 65?80). The perception of usefulness (median 6, IQR 5.8?6.9) and ease of use (median 5.9, IQR 5.1?6.3) was good among all students. There was a significant increase in the handover performance from pre- (median 8, IQR 6?9) to posttraining (median 8, IQR 7?9; z=?2.01; P=.045; r=0.33) and of the confidence in caring for patients with seizures (median 3, IQR 2?3 and median 3.5, IQR 3?4, respectively; z=?3.8; P<.001; r=0.60). In 67\% (14/21) of the simulations, technical issues occurred, but all simulations could be carried out completely. Conclusions: The new INTEAM training course was well received by nursing and medical students. The handover skills and confidence in caring for patients with seizures were improved after the course. Despite technical challenges with the VR simulations, none required termination, and this demonstrates that our approach is feasible. These promising results encourage the use of VR simulations for team training in the education of nursing and medical students. ", doi="10.2196/57117", url="https://games.jmir.org/2024/1/e57117" } @Article{info:doi/10.2196/63951, author="Wiertz, H. Carolina M. and van Meulenbroek, Thijs and Lamper, Cynthia and Hemmen, Bea and Sep, Simone and Huijnen, Ivan and Goossens, B. Marielle E. J. and Burgers, Jako and Verbunt, Jeanine", title="Effectiveness of a Person-Centered Interdisciplinary Rehabilitation Treatment of Post--COVID-19 Condition: Protocol for a Single-Case Experimental Design Study", journal="JMIR Res Protoc", year="2024", month="Oct", day="11", volume="13", pages="e63951", keywords="rehabilitation medicine", keywords="postacute COVID-19 syndrome", keywords="quality of life", keywords="long COVID", keywords="COVID-19", keywords="multidisciplinary care", keywords="interdisciplinary care", abstract="Background: Patients with post--COVID-19 condition (PCC) experience a wide range of complaints (physical, cognitive, and mental), sometimes with high levels of disability in daily activities. Evidence of effective interdisciplinary rehabilitation treatment is lacking. A person-centered, biopsychosocial, interdisciplinary rehabilitation program, adapted to expert opinions and the patient's needs, was therefore developed. Objective: This study aims to present a study protocol for a clinical trial to evaluate the effect of a new, person-centered, interdisciplinary rehabilitation treatment for PCC. It is aimed at improving participation in society and health-related quality of life in patients with PCC who perceive a high level of disability in daily activities or participation. Methods: A total of 20 Dutch adults, aged 18 years or older, with high levels of disability in daily activities and participation in society will be included in this replicated and randomized single-case experimental design study, from October 2023 onward. The replicated and randomized single-case experimental design consists of 3 phases. The baseline phase is the observational period, in which no specific treatment will be given. In the intervention phase, patients will receive the new outpatient treatment 3 times a week for 12 weeks, followed by a 12-week follow-up phase. During the intervention phase, the treatment will be personalized according to the patient's physical, mental, and cognitive symptoms and goals. The treatment team can consist of a rehabilitation physician, physiotherapist, occupational therapist, speech therapist, and psychologist. The primary outcomes of the study are daily diaries, which consist of 8 questions selected from validated questionnaires (Utrecht Scale for Evaluation of Rehabilitation-Participation, EQ-5D-5L, and the Hospital Anxiety and Depression Scale). The other primary outcome measurements are participation in society (Utrecht Scale for Evaluation of Rehabilitation-Participation) and health-related quality of life (EQ-5D-5L). The secondary outcomes are physical tests and validated questionnaires aimed at physical, mental, and cognitive complaints. Effect evaluation based on daily assessments will include visual analysis, calculation of effect sizes (Nonoverlap of All Pairs), randomization tests, and multilevel analysis. In addition, other analyses will be based on ANOVA or a 2-tailed Student t test. Results: Data collection for this study started in October 2023 and is planned to be completed in July 2024. The results will be published in peer-reviewed journals and presented at international conferences. Conclusions: This is the first study investigating the effect of an interdisciplinary rehabilitation treatment with a person-centered, biopsychosocial approach in patients with PCC. Our findings will help to improve the treatment and support of patients with PCC. Trial Registration: German Clinical Trials Register DRKS00032636; https://drks.de/search/en/trial/DRKS00032636 International Registered Report Identifier (IRRID): DERR1-10.2196/63951 ", doi="10.2196/63951", url="https://www.researchprotocols.org/2024/1/e63951" } @Article{info:doi/10.2196/57784, author="Overstreet, Morgan and Culpepper, Hannah and DeHoff, Deanna and Gebregziabher, Mulugeta and Posadas Salas, Aurora Maria and Su, Zemin and Chandler, Jessica and Bartlett, Felicia and Dunton, Paige and Carcella, Taylor and Taber, David", title="Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT Study): Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2024", month="Oct", day="10", volume="13", pages="e57784", keywords="kidney transplant", keywords="mobile health", keywords="medication adherence", keywords="mHealth", keywords="nephrology", keywords="transplant surgery", keywords="postoperative monitoring", keywords="telemedicine", keywords="eHealth", abstract="Background: The outcome disparities for African American recipients of kidney transplant is a public health issue that has plagued the field of transplant since its inception. Based on national data, African American recipients have nearly twice the risk of graft loss at 5 years after transplant, when compared with White recipients. Evidence demonstrates that medication nonadherence and high tacrolimus variability substantially impact graft outcomes and racial disparities, most notably late (>2 years) after the transplant. Nonadherence is a leading cause of graft loss. Prospective multicenter data demonstrate that one-third of all graft loss are directly attributed to nonadherence. We have spent 10 years of focused research to develop a comprehensive model explaining the predominant risk factors leading to disparities in African American kidney recipients. However, there are still gaps in patient-level data that hinder the deeper understanding of the disparities. Lack of data from the patient often lead to provider biases, which will be addressed with this intervention. Culturally competent, pharmacist-led interventions in medication therapy management will also address therapeutic inertia. Pharmacist interventions will mitigate medication access barriers as well (cost and insurance denials). Thus, this multidimensional intervention addresses patient, provider, and structural factors that drive racial disparities in African American kidney recipients. Objective: This prospective, randomized controlled trial aimed to determine the impact of multimodal health services intervention on health outcomes disparities in African American recipients of kidney transplant. The aims of this study are to improve adherence and control of late clinical issues, which are predominant factors for racial disparities in kidney recipients, through a technology-enabled, telehealth-delivered, 4-level intervention. Methods: The Multifaceted Intervention to Improve Graft Outcome Disparities in African American Kidney Transplants (MITIGAAT) study is a 24-month, 2-arm, single-center (Medical University of South Carolina), 1:1 randomized controlled trial involving 190 participants (95 in each arm), measuring the impact on adherence and control of late clinical issues for racial disparities in kidney recipients, through a technology-enabled, telehealth-delivered, 4-level intervention. The key clinical issues for this study include tacrolimus variability, blood pressure, and glucose control (in those with diabetes mellitus). We will also assess the impact of the intervention on health care use (hospitalizations and emergency department visits) and conduct a cost-benefit analysis. Finally, we will assess the impact of the intervention on acute rejection and graft survival rates as compared with a large contemporary national cohort. Results: This study was funded in July 2023. Enrolled began in April 2024 and is expected to be complete in 2026. All patients will complete the study by the end of 2028. Conclusions: In this protocol, we describe the study design, methods, aims, and outcome measures that will be used in the ongoing MITIGAAT clinical trials. Trial Registration: ClinicalTrials.gov NCT06023615; https://www.clinicaltrials.gov/study/NCT06023615 International Registered Report Identifier (IRRID): PRR1-10.2196/57784 ", doi="10.2196/57784", url="https://www.researchprotocols.org/2024/1/e57784" } @Article{info:doi/10.2196/57685, author="Knox, Liam and Coates, Elizabeth and Griffiths, Alys and Ali, Yasmin and Hobson, Esther and McDermott, Christopher", title="Development and Evaluation of the Telehealth in Motor Neuron Disease System: The TIME Study Protocol", journal="JMIR Res Protoc", year="2024", month="Oct", day="8", volume="13", pages="e57685", keywords="motor neuron disease", keywords="amyotrophic lateral sclerosis", keywords="telehealth", keywords="digital health", keywords="process evaluation", keywords="implementation", keywords="co-production", keywords="digital technology", keywords="mhealth", keywords="eHealth", keywords="virtual medicine", abstract="Background: For more responsive care provision for motor neuron disease and caregivers, a digital system called Telehealth in MND-Care (TiM-C) was created. TiM-C sends regular symptom questionnaires to users; their responses are sent to health care professionals (HCPs). To enable people with motor neuron disease to participate in research studies more easily, a parallel platform was developed from TiM-C, called Telehealth in MND-Research (TiM-R). TiM-R can advertise studies, collect data, and make them available to MND researchers. Objective: This study has 4 work packages (WPs) to facilitate service approval, codevelop the TiM systems, and evaluate the service. Each WP aims to understand (1) what helps and hinders the approval of the TiM-C system as a National Health Service; (2) what aspects of MND care and research are currently unmet and can be addressed through the TiM-C and TiM-R systems; (3) how TiM-C influences MND care, from the perspective of people with motor neuron disease, their caregivers, and HCPs; and (4) the costs and benefits associated with TiM-C. Methods: WP1 will use semistructured interviews with 10-15 people involved in the approval of TiM-C to understand the barriers and facilitators to governance processes. WP2 will use individual and group interviews with 25-35 users (people with motor neuron disease, caregivers, HCPs, MND researchers, and industry) of TiM-C and TiM-R to understand the current unmet needs of these user groups and how TiM services can be developed to meet these needs. WP3 will use a process evaluation involving 5 elements; local context, engagement, user experiences, service impact, and mechanisms of action. A range of methods, including audits, analysis of routine data, questionnaires, interviews, and observations will be used with people with motor neuron disease, caregivers, and HCPs, both those using the system and those who declined the service when invited. WP4 will use data collected through the process evaluation and known costs to conduct a cost-consequence and budget impact analysis to explore the cost-benefit of the TiM-C service. Most data collected will be qualitative, with thematic and framework analysis used to develop themes from transcripts and observations. Descriptive statistics or t tests and chi-square tests will be used to describe and analyze quantitative data. Results: This study has received ethical approval and has begun recruitment in 1 site. Further, 13 specialist MND centers will adopt TiM-C and the TIME study, beginning in July 2024. The study will conclude in November 2026 and a final report will be produced 3 months after the completion date. Conclusions: This study will facilitate the implementation and development of TiM-C and TiM-R and fully evaluate the TiM-C service, enabling informed decision-making among health care providers regarding continued involvement and contribute to the wider literature relating to how technology-enabled care services can affect clinical care. International Registered Report Identifier (IRRID): DERR1-10.2196/57685 ", doi="10.2196/57685", url="https://www.researchprotocols.org/2024/1/e57685" } @Article{info:doi/10.2196/64125, author="Carrillo, Irene and Skoumalov{\'a}, Ivana and Bruus, Ireen and Klemm, Victoria and Guerra-Paiva, Sofia and Kne?evi{\'c}, Bojana and Jankauskiene, Augustina and Jocic, Dragana and Tella, Susanna and Buttigieg, C. Sandra and Srulovici, Einav and Madarasov{\'a} Geckov{\'a}, Andrea and P{\~o}lluste, Kaja and Strametz, Reinhard and Sousa, Paulo and Odalovic, Marina and Mira, Joaqu{\'i}n Jos{\'e}", title="Psychological Safety Competency Training During the Clinical Internship From the Perspective of Health Care Trainee Mentors in 11 Pan-European Countries: Mixed Methods Observational Study", journal="JMIR Med Educ", year="2024", month="Oct", day="7", volume="10", pages="e64125", keywords="psychological safety", keywords="speaking up", keywords="professional competence", keywords="patient safety", keywords="education", keywords="adverse event", abstract="Background: In the field of research, psychological safety has been widely recognized as a contributing factor to improving the quality of care and patient safety. However, its consideration in the curricula and traineeship pathways of residents and health care students is scarce. Objective: This study aims to determine the extent to which health care trainees acquire psychological safety competencies during their internships in clinical settings and identify what measures can be taken to promote their learning. Methods: A mixed methods observational study based on a consensus conference and an open-ended survey among a sample of health care trainee mentors from health care institutions in a pan-European context was conducted. First, we administered an ad hoc questionnaire to assess the perceived degree of acquisition or implementation and significance of competencies (knowledge, attitudes, and skills) and institutional interventions in psychological safety. Second, we asked mentors to propose measures to foster among trainees those competencies that, in the first phase of the study, obtained an average acquisition score of <3.4 (scale of 1-5). A content analysis of the information collected was carried out, and the spontaneity of each category and theme was determined. Results: In total, 173 mentors from 11 pan-European countries completed the first questionnaire (response rate: 173/256, 67.6\%), of which 63 (36.4\%) participated in the second consultation. The competencies with the lowest acquisition level were related to warning a professional that their behavior posed a risk to the patient, managing their possible bad reaction, and offering support to a colleague who becomes a second victim. The mentors' proposals for improvement of this competency gap referred to training in communication skills and patient safety, safety culture, work climate, individual attitudes, a reference person for trainees, formal incorporation into the curricula of health care degrees and specialization pathways, specific systems and mechanisms to give trainees a voice, institutional risk management, regulations, guidelines and standards, supervision, and resources to support trainees. In terms of teaching methodology, the mentors recommended innovative strategies, many of them based on technological tools or solutions, including videos, seminars, lectures, workshops, simulation learning or role-playing with or without professional actors, case studies, videos with practical demonstrations or model situations, panel discussions, clinical sessions for joint analysis of patient safety incidents, and debriefings to set and discuss lessons learned. Conclusions: This study sought to promote psychological safety competencies as a formal part of the training of future health care professionals, facilitating the translation of international guidelines into practice and clinical settings in the pan-European context. ", doi="10.2196/64125", url="https://mededu.jmir.org/2024/1/e64125", url="http://www.ncbi.nlm.nih.gov/pubmed/39374073" } @Article{info:doi/10.2196/54638, author="Liu, Jingkun and Tai, Jiaojiao and Han, Junying and Zhang, Meng and Li, Yang and Yang, Hongjuan and Yan, Ziqiang", title="Constructing a Hospital Department Development--Level Assessment Model: Machine Learning and Expert Consultation Approach in Complex Hospital Data Environments", journal="JMIR Form Res", year="2024", month="Sep", day="4", volume="8", pages="e54638", keywords="machine algorithms", keywords="hospital management", keywords="model construction", keywords="support vector machine", keywords="clustering", abstract="Background: Every hospital manager aims to build harmonious, mutually beneficial, and steady-state departments. Therefore, it is important to explore a hospital department development assessment model based on objective hospital data. Objective: This study aims to use a novel machine learning algorithm to identify key evaluation indexes for hospital departments, offering insights for strategic planning and resource allocation in hospital management. Methods: Data related to the development of a hospital department over the past 3 years were extracted from various hospital information systems. The resulting data set was mined using neural machine algorithms to assess the possible role of hospital departments in the development of a hospital. A questionnaire was used to consult senior experts familiar with the hospital to assess the actual work in each hospital department and the impact of each department's development on overall hospital discipline. We used the results from this questionnaire to verify the accuracy of the departmental risk scores calculated by the machine learning algorithm. Results: Deep machine learning was performed and modeled on the hospital system training data set. The model successfully leveraged the hospital's training data set to learn, predict, and evaluate the working and development of hospital departments. A comparison of the questionnaire results with the risk ranking set from the departments machine learning algorithm using the cosine similarity algorithm and Pearson correlation analysis showed a good match. This indicates that the department development assessment model and risk score based on the objective data of hospital systems are relatively accurate and objective. Conclusions: This study demonstrated that our machine learning algorithm provides an accurate and objective assessment model for hospital department development. The strong alignment of the model's risk assessments with expert opinions, validated through statistical analysis, highlights its reliability and potential to guide strategic hospital management decisions. ", doi="10.2196/54638", url="https://formative.jmir.org/2024/1/e54638", url="http://www.ncbi.nlm.nih.gov/pubmed/39230941" } @Article{info:doi/10.2196/55571, author="Mosch, Lina and S{\"u}mer, Meltem and Flint, Rike Anne and Feufel, Markus and Balzer, Felix and M{\"o}rike, Frauke and Poncette, Akira-Sebastian", title="Alarm Management in Intensive Care: Qualitative Triangulation Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="18", volume="11", pages="e55571", keywords="digital health", keywords="transdisciplinary research", keywords="technological innovation", keywords="patient-centered care", keywords="qualitative", keywords="ethnographic", keywords="ethnography", keywords="intensive care unit", keywords="ICU", keywords="intensive care", keywords="German", keywords="Germany", keywords="Europe", keywords="European", keywords="interview", keywords="interviews", keywords="alarm", keywords="alarms", keywords="intelligent", keywords="artificial intelligence", keywords="grounded theory", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="opinions", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", abstract="Background: The high number of unnecessary alarms in intensive care settings leads to alarm fatigue among staff and threatens patient safety. To develop and implement effective and sustainable solutions for alarm management in intensive care units (ICUs), an understanding of staff interactions with the patient monitoring system and alarm management practices is essential. Objective: This study investigated the interaction of nurses and physicians with the patient monitoring system, their perceptions of alarm management, and smart alarm management solutions. Methods: This explorative qualitative study with an ethnographic, multimethods approach was conducted in an ICU of a German university hospital. Using triangulation in data collection, 102 hours of field observations, 12 semistructured interviews with ICU staff members, and the results of a participatory task were analyzed. The data analysis followed an inductive, grounded theory approach. Results: Nurses and physicians reported interacting with the continuous vital sign monitoring system for most of their work time and tasks. There were no established standards for alarm management; instead, nurses and physicians stated that alarms were addressed through ad hoc reactions, a practice they viewed as problematic. Staff members' perceptions of intelligent alarm management varied, but they highlighted the importance of understandable and traceable suggestions to increase trust and cognitive ease. Conclusions: Staff members' interactions with the omnipresent patient monitoring system and its alarms are essential parts of ICU workflows and clinical decision-making. Alarm management standards and workflows have been shown to be deficient. Our observations, as well as staff feedback, suggest that changes are warranted. Solutions for alarm management should be designed and implemented with users, workflows, and real-world data at the core. ", doi="10.2196/55571", url="https://humanfactors.jmir.org/2024/1/e55571", url="http://www.ncbi.nlm.nih.gov/pubmed/38888941" } @Article{info:doi/10.2196/52830, author="Der-Martirosian, Claudia and Hou, Cynthia and Hovsepian, Sona and Diarra Carter, Maia and Heyworth, Leonie and Dobalian, Aram and Leung, Lucinda", title="Implementation of Video-Based Care in Interdisciplinary Primary Care Settings at the Veterans Health Administration: Qualitative Study", journal="JMIR Form Res", year="2024", month="Apr", day="9", volume="8", pages="e52830", keywords="interdisciplinary primary care team members", keywords="NASSS framework", keywords="nonadoption, abandonment, scale-up, spread, and sustainability", keywords="primary care", keywords="telehealth", keywords="video-based care", abstract="Background: With the rapid shift to telehealth, there remains a knowledge gap in how video-based care is implemented in interdisciplinary primary care (PC) settings. Objective: The objective of this study was to gain an in-depth understanding of how video telehealth services were implemented in PC from the perspectives of patients and interdisciplinary PC team members at the Veterans Health Administration (VHA) 2 years after the onset of the COVID-19 pandemic. Methods: We applied a positive and negative deviance approach and selected the 6\% highest (n=8) and the 6\% lowest (n=8) video-using PC sites in 2022 from a total of 130 VHA medical centers nationally. A total of 12 VHA sites were included in the study, where 43 PC interdisciplinary team members (August-October 2022) and 25 patients (February-May 2023) were interviewed. The 5 domains from the diffusion of innovation theory and the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework guided the development of the 2 study interview guides (provider and patient). We identified themes that emerged across all interviews that were associated with the implementation of video-based care in interdisciplinary PC settings, using directed-content rapid analysis of the interview transcripts. The analysis was guided by 5 a priori NASSS domains: (1) patient condition or characteristic, (2) technology, (3) adopter system, (4) health care organization, and (5) adaptation over time. Results: The study findings include the following common themes and factors, organized by the 5 NASSS domains: (1) patient condition or characteristic---visit type or purpose (eg, follow-up visits that do not require physical examination), health condition (eg, homebound or semihomebound patients), and sociodemographic characteristic (eg, patients who have a long commute time); (2) technology---key features (eg, access to video-enabled devices), knowledge (eg, how to use videoconferencing software), and technical support for patients and providers; (3) adopter system---changes in staff roles and clinical practice (eg, coordination of video-based care), provider and patient preference or comfort to use video-based care, and caregiver's role (eg, participation of caregivers during video visits); (4) health care organization---leadership support and access to resources, scheduling for video visits (eg, schedule or block off digital half or full days), and training and telehealth champions (eg, hands-on or on-site training for staff, patients, or caregivers); (5) adaptation over time---capacity to improve all aspects of video-based care and provide continued access to resources (eg, effective communication about updates). Conclusions: This study identified key factors associated with the implementation of video-based services in interdisciplinary PC settings at the VHA from the perspectives of PC team members and patients. The identified multifaceted factors may inform recommendations on how to sustain and improve the provision of video-based care in VHA PC settings as well as non-VHA patient-centered medical homes. ", doi="10.2196/52830", url="https://formative.jmir.org/2024/1/e52830", url="http://www.ncbi.nlm.nih.gov/pubmed/38592760" } @Article{info:doi/10.2196/52920, author="Acharya, Harshdeep and Sykes, J. Kevin and Neira, Mir{\'a}s Ton and Scott, Angela and Pacheco, M. Christina and Sanner, Matthew and Ablah, Elizabeth and Oyowe, Kevin and Ellerbeck, F. Edward and Greiner, Allen K. and Corriveau, A. Erin and Finocchario-Kessler, Sarah", title="A Novel Electronic Record System for Documentation and Efficient Workflow for Community Health Workers: Development and Usability Study", journal="JMIR Form Res", year="2024", month="Apr", day="1", volume="8", pages="e52920", keywords="public health", keywords="database", keywords="community health worker", keywords="social determinants of health", keywords="health worker", keywords="health workers", keywords="CHW", keywords="CHWs", keywords="community-based", keywords="data collection", keywords="functionality", keywords="develop", keywords="development", keywords="EHR", keywords="EHRs", keywords="EMR", keywords="EMRs", keywords="dashboard", keywords="dashboards", keywords="health record", keywords="health records", keywords="documentation", keywords="medical record", keywords="medical records", keywords="equity", keywords="inequity", keywords="inequities", abstract="Background: The COVID-19 pandemic added to the decades of evidence that public health institutions are routinely stretched beyond their capacity. Community health workers (CHWs) can be a crucial extension of public health resources to address health inequities, but systems to document CHW efforts are often fragmented and prone to unneeded redundancy, errors, and inefficiency. Objective: We sought to develop a more efficient data collection system for recording the wide range of community-based efforts performed by CHWs. Methods: The Communities Organizing to Promote Equity (COPE) project is an initiative to address health disparities across Kansas, in part, through the deployment of CHWs. Our team iteratively designed and refined the features of a novel data collection system for CHWs. Pilot tests with CHWs occurred over several months to ensure that the functionality supported their daily use. Following implementation of the database, procedures were set to sustain the collection of feedback from CHWs, community partners, and organizations with similar systems to continually modify the database to meet the needs of users. A continuous quality improvement process was conducted monthly to evaluate CHW performance; feedback was exchanged at team and individual levels regarding the continuous quality improvement results and opportunities for improvement. Further, a 15-item feedback survey was distributed to all 33 COPE CHWs and supervisors for assessing the feasibility of database features, accessibility, and overall satisfaction. Results: At launch, the database had 60 active users in 20 counties. Documented client interactions begin with needs assessments (modified versions of the Arizona Self-sufficiency Matrix and PRAPARE [Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences]) and continue with the longitudinal tracking of progress toward goals. A user-specific automated alerts-based dashboard displays clients needing follow-up and upcoming events. The database contains over 55,000 documented encounters across more than 5079 clients. Available resources from over 2500 community organizations have been documented. Survey data indicated that 84\% (27/32) of the respondents considered the overall navigation of the database as very easy. The majority of the respondents indicated they were overall very satisfied (14/32, 44\%) or satisfied (15/32, 48\%) with the database. Open-ended responses indicated the database features, documentation of community organizations and visual confirmation of consent form and data storage on a Health Insurance Portability and Accountability Act--compliant record system, improved client engagement, enrollment processes, and identification of resources. Conclusions: Our database extends beyond conventional electronic medical records and provides flexibility for ever-changing needs. The COPE database provides real-world data on CHW accomplishments, thereby improving the uniformity of data collection to enhance monitoring and evaluation. This database can serve as a model for community-based documentation systems and be adapted for use in other community settings. ", doi="10.2196/52920", url="https://formative.jmir.org/2024/1/e52920", url="http://www.ncbi.nlm.nih.gov/pubmed/38557671" } @Article{info:doi/10.2196/49696, author="Jensen, H{\o}pfner Lili Worre and Rahbek, Ole and Lauritsen, Kildahl Rikke Emilie and Kold, S{\o}ren and Dinesen, Birthe", title="Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study", journal="JMIR Hum Factors", year="2024", month="Mar", day="29", volume="11", pages="e49696", keywords="digital communication", keywords="patient-provider communication", keywords="continuity of care", keywords="interdisciplinary communication", keywords="hospital discharge", keywords="orthopedic surgery", keywords="postoperative care", keywords="text messaging", keywords="mobile phone", abstract="Background: The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. Objective: This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). Methods: A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. Results: Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84\% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. Conclusions: In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery. ", doi="10.2196/49696", url="https://humanfactors.jmir.org/2024/1/e49696", url="http://www.ncbi.nlm.nih.gov/pubmed/38551641" } @Article{info:doi/10.2196/54344, author="Rohatgi, Nidhi", title="JMIR Perioperative Medicine: A Global Journal for Publishing Interdisciplinary Innovations, Research, and Perspectives", journal="JMIR Perioper Med", year="2023", month="Nov", day="21", volume="6", pages="e54344", keywords="JMIR Perioperative Medicine", keywords="innovation", keywords="technology", keywords="digital health", keywords="research", keywords="interdisciplinary", keywords="perioperative medicine", doi="10.2196/54344", url="https://periop.jmir.org/2023/1/e54344", url="http://www.ncbi.nlm.nih.gov/pubmed/37988142" } @Article{info:doi/10.2196/45006, author="Latuapon, Elizabeth and Hochstenbach, Laura and Mahr, Dominik and Scheenstra, Bart and Kietselaer, Bas and Spreeuwenberg, Marieke", title="Cocreation to Facilitate Communication and Collaboration Between Multidisciplinary Stakeholders in eHealth Research and Development: Case Study of the CARRIER (Coronary Artery Disease: Risk Estimations and Interventions for Prevention and Early Detection) Consortium", journal="JMIR Hum Factors", year="2023", month="Oct", day="24", volume="10", pages="e45006", keywords="eHealth", keywords="cocreation", keywords="stakeholder involvement", keywords="multidisciplinary collaboration", keywords="multidisciplinary", keywords="team dynamic", keywords="group dynamic", keywords="collaborate", keywords="collaboration", keywords="cardiovascular", keywords="personalized", keywords="personalization", keywords="cardiology", keywords="organizational", keywords="co-design", keywords="atherosclerosis", abstract="Background: Collaboration with diverse stakeholders in eHealth research is fundamental yet complex. Stakeholders from various disciplines do not ``speak the same language'' and have different levels of power and interest, resulting in contrasting objectives, priorities, and expectations. An approach to constructive communication and collaboration is necessary to overcome this complex dynamic. Cocreation, known in the field of eHealth most often to involve end users, may also be suitable for facilitating stakeholder engagement and alignment. Objective: This paper provides insights into the application of cocreation, specifically in the early phases of research that focus on involving and aligning relevant stakeholders from different academic and professional backgrounds. Methods: The case for this study was a group discussion with members of a multidisciplinary consortium that works on developing a personalized eHealth intervention for atherosclerotic cardiovascular disease. Using stakeholder mapping, health and medicine experts, big data scientists, software developers, and an innovation manager (N=8) were invited to participate. The discussion was based on a user scenario and structured according to the Six Thinking Hats of de Bono, representing 6 different types of thinking. The discussion was recorded, transcribed verbatim, and analyzed thematically with the use of ATLAS.ti software. Results: First, informative and intuitive thinking served the preparatory purpose of familiarization with the project details and other participants. Second, positive and critical thinking constituted the body of the discussion and resulted in an in-depth conversation. Third, creative and organizational thinking were action oriented and focused on solutions and planning to safeguard future progress. The participants repeatedly reflected on various intervention-related themes, ranging from intervention content to technical functionalities and from legal requirements to implementation in practice. Moreover, project-related matters were discussed, including stakeholder management and time and budget constraints. Conclusions: This paper demonstrates how cocreation can be of value for multidisciplinary stakeholder engagement and alignment. Based on stakeholder mapping (with whom to discuss), a dream user scenario (what to discuss), and the Six Thinking Hats of de Bono (how to discuss), the participants shared information, discussed differences, searched for solutions, and moved toward a collective approach regarding intervention development. The lessons learned may further improve the understanding of how cocreation can contribute to multidisciplinary collaboration. ", doi="10.2196/45006", url="https://humanfactors.jmir.org/2023/1/e45006", url="http://www.ncbi.nlm.nih.gov/pubmed/37874629" } @Article{info:doi/10.2196/39051, author="Nie, Xin Jason and Heidebrecht, Christine and Zettler, Andrea and Pearce, Jacklyn and Cunha, Rafael and Quan, Sherman and Mansfield, Elizabeth and Tang, Terence", title="The Perceived Ease of Use and Perceived Usefulness of a Web-Based Interprofessional Communication and Collaboration Platform in the Hospital Setting: Interview Study With Health Care Providers", journal="JMIR Hum Factors", year="2023", month="Jan", day="23", volume="10", pages="e39051", keywords="health information technology", keywords="communication and collaboration", keywords="teamwork", keywords="design", keywords="technology acceptance model", keywords="qualitative method", keywords="communication", keywords="collaboration", keywords="hospital", keywords="care", keywords="team", keywords="professional", keywords="support", keywords="health information", keywords="technology", keywords="clinician", keywords="members", keywords="complex", keywords="lesson", keywords="education", abstract="Background: Hospitalized patients with complex care needs require an interprofessional team of health professionals working together to support their care in hospitals and during discharge planning. However, interprofessional communication and collaboration in inpatient settings are often fragmented and inefficient, leading to poor patient outcomes and provider frustration. Health information technology can potentially help improve team communication and collaboration; however, to date, evidence of its effectiveness is lacking. There are also concerns that current implementations might further fragment communication and increase the clinician burden without proven benefits. Objective: In this study, we aimed to generate transferrable lessons for future designers of health information technology tools that facilitate team communication and collaboration. Methods: A secondary analysis of the qualitative component of the mixed methods evaluation was performed. The electronic communication and collaboration platform was implemented in 2 general internal medicine wards in a large community teaching hospital in Mississauga, Ontario, Canada. Fifteen inpatient clinicians in those wards, including nurses, physicians, and allied health care providers, were recruited to participate in semistructured interviews about their experience with a co-designed electronic communication and collaboration tool. Data were analyzed using the Technology Acceptance Model, and themes related to the constructs of perceived ease of use (PEOU) and perceived usefulness (PU) were identified. Results: A secondary analysis guided by the Technology Acceptance Model highlighted important points. Intuitive design precluded training as a barrier to use, but lack of training may hinder participants' PEOU if features designed for efficiency are not discovered by users. Organized information was found to be useful for creating a comprehensive clinical picture of each patient and facilitating improved handovers. However, information needs to be both comprehensive and succinct, and information overload may negatively impact PEOU. The mixed paper and electronic practice environment also negatively impacted PEOU owing to unavoidable double documentation and the need for printing. Participants perceived the tool to be useful as it improved efficiency in information retrieval and documentation, improved the handover process, afforded another mode of communication when face-to-face communication was impractical, and improved shared awareness. The PU of this tool depends on its optimal use by all team members. Conclusions: Electronic tools can support communication and collaboration among interprofessional teams caring for patients with complex needs. There are transferable lessons learned that can improve the PU and PEOU of future systems. ", doi="10.2196/39051", url="https://humanfactors.jmir.org/2023/1/e39051", url="http://www.ncbi.nlm.nih.gov/pubmed/36689261" } @Article{info:doi/10.2196/38009, author="van Peppen, Lara and Faber, E. Tjitske J. and Erasmus, Vicki and Dankbaar, W. Mary E.", title="Teamwork Training With a Multiplayer Game in Health Care: Content Analysis of the Teamwork Principles Applied", journal="JMIR Serious Games", year="2022", month="Dec", day="9", volume="10", number="4", pages="e38009", keywords="teamwork", keywords="skills training", keywords="serious games", keywords="multiplayer game", keywords="medical students", keywords="content-analysis", keywords="health care", keywords="interprofessional teamwork", abstract="Background: In health care, teamwork skills are critical for patient safety; therefore, great emphasis is placed on training these skills. Given that training is increasingly designed in a blended way, serious games may offer an efficient method of preparing face-to-face simulation training of these procedural skills. Objective: This study aimed to investigate the teamwork principles that were used during gameplay by medical students and teamwork experts. Findings can improve our understanding of the potential of serious games for training these complex skills. Methods: We investigated a web-based multiplayer game designed for training students' interprofessional teamwork skills. During gameplay, 4 players in different roles (physician, nurse, medical student, and student nurse) had to share information, prioritize tasks, and decide on next steps to take in web-based patient scenarios, using one-to-one and team chats. We performed a qualitative study (content analysis) on these chats with 144 fifth-year medical students and 24 health care teamwork experts (as a benchmark study) playing the game in groups of 4. Game chat data from 2 scenarios were analyzed. For the analysis, a deductive approach was used, starting with a conceptual framework based on Crew Resource Management principles, including shared situational awareness, decision-making, communication, team management, and debriefing. Results: Results showed that most teamwork principles were used during gameplay: shared situational awareness, decision-making (eg, re-evaluation), communication (eg, closed loop), and team management (eg, distributing the workload). Among students, these principles were often used on a basic level. Among experts, teamwork principles were used with more open forms of speak up and more justification of decisions. Some specific Crew Resource Management principles were less observed among both groups, for example, prevention of fixation errors and use of cognitive aids. Both groups showed relatively superficial debriefing reflections. Conclusions: Playing a multiplayer game for interprofessional teamwork appears to facilitate the application of teamwork principles by students in all important teamwork domains on a basic level. Expert players applied similar teamwork principles on a moderately high complexity level. Some teamwork principles were less observed among both students and expert groups, probably owing to the artifacts of the game environment (eg, chatting instead of talking). A multiplayer game for teamwork training can elicit the application of important, basic teamwork principles, both among novices and experts, and provides them with a flexible, accessible, and engaging learning environment. This may create time for exercising more complex skills during face-to-face training. ", doi="10.2196/38009", url="https://games.jmir.org/2022/4/e38009", url="http://www.ncbi.nlm.nih.gov/pubmed/36485016" } @Article{info:doi/10.2196/35929, author="Singh, Hardeep and Tang, Terence and Steele Gray, Carolyn and Kokorelias, Kristina and Thombs, Rachel and Plett, Donna and Heffernan, Matthew and Jarach, M. Carlotta and Armas, Alana and Law, Susan and Cunningham, V. Heather and Nie, Xin Jason and Ellen, E. Moriah and Thavorn, Kednapa and Nelson, LA Michelle", title="Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review", journal="JMIR Aging", year="2022", month="May", day="19", volume="5", number="2", pages="e35929", keywords="transitions", keywords="health", keywords="medical informatics", keywords="aged", keywords="mobile phone", abstract="Background: Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective: To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods: This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results: In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions: This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045596 ", doi="10.2196/35929", url="https://aging.jmir.org/2022/2/e35929", url="http://www.ncbi.nlm.nih.gov/pubmed/35587874" } @Article{info:doi/10.2196/36448, author="Archer, Jessica and Robinson, Luke and Brown, Ted", title="The Impact of Health Care Funding on Interprofessional Collaboration and Integrated Service Delivery in Primary and Allied Care: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="May", day="13", volume="11", number="5", pages="e36448", keywords="allied health", keywords="healthcare funding", keywords="interprofessional collaboration", keywords="integrated healthcare", keywords="primary health", keywords="primary care", abstract="Background: Improving funding models and implementing policies that facilitate greater interprofessional collaboration and integration at the primary and allied health level could improve the ongoing quality and safety and future sustainability of the wider health care system by reducing inefficiencies and inequalities. Defining these key health care funding--related models, policies, and concepts, identifying research gaps, and systematically mapping the associated literature will inform future research on this topic. Objective: The aim of this scoping review is to provide a descriptive overview of contemporary health care funding models and the key policies involved in the delivery of primary and allied health care. Further, it will investigate the impact these models and policies have on interprofessional collaboration and integrated service delivery at the primary and allied health care levels. Methods: A search of published and grey literature will be conducted using the following databases: the Allied and Complementary Medicine Database, CINAHL, Embase, Emcare, MEDLINE, PsycINFO, Scopus, Open Access Theses and Dissertations, and Web of Science. The search will be limited to resources available in the English language and published since 2011. Following the search, an independent screening of titles and abstracts will be undertaken by 2 independent reviewers, with a third reviewer available to resolve any potential disagreements. Full-text resources will then be assessed against the inclusion criteria following the same process. Extracted data will be presented using a convergent narrative approach, accompanied by tables and figures. Results: Electronic database searches have retrieved 8013 articles. The results of this scoping review are expected in May 2022. Conclusions: The findings from this review will be used to inform future research projects investigating the role of primary health care funding, interprofessional collaboration, and service integration in improving health care access, efficiency, effectiveness, and sustainability. International Registered Report Identifier (IRRID): DERR1-10.2196/36448 ", doi="10.2196/36448", url="https://www.researchprotocols.org/2022/5/e36448", url="http://www.ncbi.nlm.nih.gov/pubmed/35559853" } @Article{info:doi/10.2196/36579, author="Krause-J{\"u}ttler, Grit and Weitz, J{\"u}rgen and Bork, Ulrich", title="Interdisciplinary Collaborations in Digital Health Research: Mixed Methods Case Study", journal="JMIR Hum Factors", year="2022", month="May", day="4", volume="9", number="2", pages="e36579", keywords="team science", keywords="interdisciplinary", keywords="research collaboration", keywords="digital health", keywords="team processes", abstract="Background: Digital innovations in medicine are disruptive technologies that can change the way diagnostic procedures and treatments are delivered. Such innovations are typically designed in teams with different disciplinary backgrounds. This paper concentrates on 2 interdisciplinary research teams with 20 members from the medicine and engineering sciences working jointly on digital health solutions. Objective: The aim of this paper was to identify factors on the individual, team, and organizational levels that influence the implementation of interdisciplinary research projects elaborating on digital applications for medicine and, based on the results, to draw conclusions for the proactive design of the interdisciplinary research process to make these projects successful. Methods: To achieve this aim, 2 interdisciplinary research teams were observed, and a small case study (response rate: 15/20, 75\%) was conducted using a web-based questionnaire containing both closed and open self-report questions. The Spearman rank correlation coefficient was calculated to analyze the quantitative data. The answers to the open-ended questions were subjected to qualitative content analysis. Results: With regard to the interdisciplinary research projects investigated, the influencing factors of the three levels presented (individual, team, and organization) have proven to be relevant for interdisciplinary research cooperation. Conclusions: With regard to recommendations for the future design of interdisciplinary cooperation, management aspects are addressed, that is, the installation of a coordinator, systematic definition of goals, required resources, and necessary efforts on the part of the involved interdisciplinary research partners. As only small groups were investigated, further research in this field is necessary to derive more general recommendations for interdisciplinary research teams. Trial Registration: German Clinical Trials Register, DRKS00023909, https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00023909?; German Clinical Trials Register, DRKS00025077, https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00025077 ", doi="10.2196/36579", url="https://humanfactors.jmir.org/2022/2/e36579", url="http://www.ncbi.nlm.nih.gov/pubmed/35507400" } @Article{info:doi/10.2196/31720, author="Milne-Ives, Madison and Shankar, Rohit and Goodley, Dan and Lamb, Kirsten and Laugharne, Richard and Harding, Tracey and Meinert, Edward", title="Humanizing Health and Social Care Support for People With Intellectual and Developmental Disabilities: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2022", month="May", day="4", volume="11", number="5", pages="e31720", keywords="developmental disabilities", keywords="intellectual disability", keywords="delivery of health care", keywords="patient care management", keywords="social work", keywords="social support", keywords="patient-centered care", keywords="empathy", keywords="respect", keywords="social care", abstract="Background: Health care is shifting toward a more person-centered model; however, people with intellectual and developmental disabilities can still experience difficulties in accessing equitable health care. Given these difficulties, it is important to consider how humanizing principles, such as empathy and respect, can be best incorporated into health and social care practices for people with intellectual and developmental disabilities to ensure that they are receiving equitable treatment and support. Objective: The purpose of our scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the development and implementation of interventions based on humanizing principles that aim to improve health and social care practices for people with intellectual and developmental disabilities. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) and PICOS (Population, Intervention, Comparator, Outcome, and Study) frameworks will be used to structure the review. A total of 6 databases (PubMed, MEDLINE, Embase, CINAHL, PsycINFO, and Web of Science) will be searched for English articles published in the previous 10 years that describe or evaluate health and social care practice interventions underpinned by the humanizing principles of empathy, compassion, dignity, and respect. Two reviewers will screen and select references based on the eligibility criteria and extract the data into a predetermined form. A descriptive analysis will be conducted to summarize the results and provide an overview of interventions in the following three main care areas: health care, social care, and informal social support. Results: The results will be included in the scoping review, which is expected to begin in October 2022 and be completed and submitted for publication by January 2023. Conclusions: Our scoping review will summarize the state of the field of interventions that are using humanizing principles to improve health and social care for adults with intellectual and developmental disabilities. International Registered Report Identifier (IRRID): PRR1-10.2196/31720 ", doi="10.2196/31720", url="https://www.researchprotocols.org/2022/5/e31720", url="http://www.ncbi.nlm.nih.gov/pubmed/35507388" } @Article{info:doi/10.2196/36948, author="Ayivi-Vinz, Gloria and Bakwa Kanyinga, Felly and Bergeron, Lysa and D{\'e}cary, Simon and Adisso, Lionel {\'E}v{\`e}hou{\'e}nou and Zomahoun, Vignon Herv{\'e} Tchala and Daniel, J. Sam and Tremblay, Martin and Plourde, V. Karine and Guay-B{\'e}langer, Sabrina and L{\'e}gar{\'e}, France", title="Use of the CPD-REACTION Questionnaire to Evaluate Continuing Professional Development Activities for Health Professionals: Systematic Review", journal="JMIR Med Educ", year="2022", month="May", day="2", volume="8", number="2", pages="e36948", keywords="CPD-REACTION", keywords="behavior", keywords="intention", keywords="education medical", keywords="continuing", keywords="health care professionals", keywords="questionnaire", keywords="web-based", keywords="continuing professional development", abstract="Background: Continuing professional development (CPD) is essential for physicians to maintain and enhance their knowledge, competence, skills, and performance. Web-based CPD plays an essential role. However, validated theory--informed measures of their impact are lacking. The CPD-REACTION questionnaire is a validated theory--informed tool that evaluates the impact of CPD activities on clinicians' behavioral intentions. Objective: We aimed to review the use of the CPD-REACTION questionnaire, which measures the impact of CPD activities on health professionals' intentions to change clinical behavior. We examined CPD activity characteristics, ranges of intention, mean scores, score distributions, and psychometric properties. Methods: We conducted a systematic review informed by the Cochrane review methodology. We searched 8 databases from January 1, 2014, to April 20, 2021. Gray literature was identified using Google Scholar and Research Gate. Eligibility criteria included all health care professionals, any study design, and participants' completion of the CPD-REACTION questionnaire either before, after, or before and after a CPD activity. Study selection, data extraction, and study quality evaluation were independently performed by 2 reviewers. We extracted data on characteristics of studies, the CPD activity (eg, targeted clinical behavior and format), and CPD-REACTION use. We used the Mixed Methods Appraisal Tool to evaluate the methodological quality of the studies. Data extracted were analyzed using descriptive statistics and the Student t test (2-tailed) for bivariate analysis. The results are presented as a narrative synthesis reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Overall, 65 citations were eligible and referred to 52 primary studies. The number of primary studies reporting the use of CPD-REACTION has increased continuously since 2014 from 1 to 16 publications per year (2021). It is available in English, French, Spanish, and Dutch. Most of the studies were conducted in Canada (30/52, 58\%). Furthermore, 40 different clinical behaviors were identified. The most common CPD format was e-learning (34/52, 65\%). The original version of the CPD-REACTION questionnaire was used in 31 of 52 studies, and an adapted version in 18 of 52 studies. In addition, 31\% (16/52) of the studies measured both the pre- and postintervention scores. In 22 studies, CPD providers were university-based. Most studies targeted interprofessional groups of health professionals (31/52, 60\%). Conclusions: The use of CPD-REACTION has increased rapidly and across a wide range of clinical behaviors and formats, including a web-based format. Further research should investigate the most effective way to adapt the CPD-REACTION questionnaire to a variety of clinical behaviors and contexts. Trial Registration: PROSPERO CRD42018116492; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=116492 ", doi="10.2196/36948", url="https://mededu.jmir.org/2022/2/e36948", url="http://www.ncbi.nlm.nih.gov/pubmed/35318188" } @Article{info:doi/10.2196/32657, author="Beverly, Elizabeth and Rigot, Brooke and Love, Carrie and Love, Matt", title="Perspectives of 360-Degree Cinematic Virtual Reality: Interview Study Among Health Care Professionals", journal="JMIR Med Educ", year="2022", month="Apr", day="29", volume="8", number="2", pages="e32657", keywords="virtual reality", keywords="qualitative", keywords="medical education", keywords="health care", keywords="digital learning", keywords="learning platform", keywords="health care providers", abstract="Background: The global market for medical education is projected to increase exponentially over the next 5 years. A mode of delivery expected to drive the growth of this market is virtual reality (VR). VR simulates real-world objects, events, locations, and interactions in 3D multimedia sensory environments. It has been used successfully in medical education for surgical training, learning anatomy, and advancing drug discovery. New VR research has been used to simulate role-playing and clinical encounters; however, most of this research has been conducted with health professions students and not current health care professionals. Thus, more research is needed to explore how health care professionals experience VR with role-playing and clinical encounters. Objective: The aim of this study was to explore health care professionals' experiences with a cinematic VR (cine-VR) training program focused on role-playing and clinical encounters addressing social determinants of health, Appalachian culture, and diabetes. Cine-VR leverages 360-degree video with the narrative storytelling of cinema to create an engaging educational experience. Methods: We conducted in-depth telephone interviews with health care professionals who participated in the cine-VR training. The interviews were audio recorded and transcribed verbatim. A multidisciplinary team coded and analyzed the data using content and thematic analyses with NVivo software. Results: We conducted 24 in-depth interviews with health care professionals (age=45.3, SD 11.3, years; n=16, 67\%, women; n=22, 92\%, White; and n=4, 17\%, physicians) to explore their experiences with the cine-VR training. Qualitative analysis revealed five themes: immersed in the virtual world: seeing a 360-degree sphere allowed participants to immerse themselves in the virtual world; facilitated knowledge acquisition: all the participants accurately recalled the culture of Appalachia and listed the social determinants of health presented in the training; empathized with multiple perspectives: the cine-VR provided a glimpse into the real life of the main character, and participants described thinking about, feeling, and empathizing with the character's frustrations and disappointments; perceived ease of use of cine-VR: 96\% (23/24) of the participants described the cine-VR as easy to use, and they liked the 360-degree movement, image resolution, and sound quality but noted limitations with the buttons on the headsets and risk for motion sickness; and perceived utility of cine-VR as a teaching tool: participants described cine-VR as an effective teaching tool because it activated visual and affective learning for them. Conclusions: Participants emphasized the realism of the cine-VR training program. They attributed the utility of the cine-VR to visual learning in conjunction with the emotional connection to the VR characters. Furthermore, participants reported that the cine-VR increased their empathy for people. More research is needed to confirm an association between the level of immersion and empathy in cine-VR training for health care professionals. ", doi="10.2196/32657", url="https://mededu.jmir.org/2022/2/e32657", url="http://www.ncbi.nlm.nih.gov/pubmed/35486427" } @Article{info:doi/10.2196/36346, author="Gordon, Kayleigh and Dainty, N. Katie and Steele Gray, Carolyn and DeLacy, Jane and Shah, Amika and Seto, Emily", title="Normalizing Telemonitoring in Nurse-Led Care Models for Complex Chronic Patient Populations: Case Study", journal="JMIR Nursing", year="2022", month="Apr", day="28", volume="5", number="1", pages="e36346", keywords="telemonitoring", keywords="TM", keywords="nurse practitioner", keywords="NP-led care", keywords="models of care", keywords="integrated care", keywords="disease care model", keywords="disease", keywords="nurse", keywords="nurse-led implementation", keywords="complex chronic conditions", keywords="CCC", keywords="clinical team", keywords="mobile phone", abstract="Background: The implementation of telemonitoring (TM) has been successful in terms of the overall feasibility and adoption in single disease care models. However, a lack of available research focused on nurse-led implementations of TM that targets patients with multiple and complex chronic conditions (CCC) hinders the scale and spread to these patient populations. In particular, little is known about the clinical perspective on the implementation of TM for patients with CCC in outpatient care. Objective: This study aims to better understand the perspective of the clinical team (both frontline clinicians and those in administrative positions) on the implementation and normalization of TM for complex patients in a nurse-led clinic model. Methods: A pragmatic, 6-month implementation study was conducted to embed multicondition TM, including heart failure, hypertension, and diabetes, into an integrated nurse-led model of care. Throughout the study, clinical team members were observed, and a chart review was conducted of the care provided during this time. At the end of the study, clinical team members participated in qualitative interviews and completed the adapted Normalization Measure Development questionnaires. The Normalization Process Theory guided the deductive data analysis. Results: Overall, 9 team members participated in the study as part of a larger feasibility study of the TM program, of which 26 patients were enrolled. Team members had a shared understanding of the purpose and value of TM as an intervention embedded within their practice to meet the diverse needs of their patients with CCC. TM aligned well with existing chronic care practices in several ways, yet it changed the process of care delivery (ie, interactional workability subconstruct). Effective TM normalization in nurse-led care requires rethinking of clinical workflows to incorporate TM, relationship development between the clinicians and their patients, communication with the interdisciplinary team, and frequent clinical care oversight. This was captured well through the subconstructs of skill set workability, relational integration, and contextual integration of the Normalization Process Theory. Conclusions: Clinicians successfully adopted TM into their everyday practice such that some providers felt their role would be significantly and negatively affected without TM. This study demonstrated that smartphone-based TM systems complemented the routine and challenging clinical work caring for patients with CCC in an integrated nurse-led care model. ", doi="10.2196/36346", url="https://nursing.jmir.org/2022/1/e36346", url="http://www.ncbi.nlm.nih.gov/pubmed/35482375" } @Article{info:doi/10.2196/35083, author="Ewais, Tatjana and Hunt, Georgia and Munro, Jonathan and Pun, Paul and Hogan, Christy and William, Leeroy and Teodorczuk, Andrew", title="Schwartz Rounds for Staff in an Australian Tertiary Hospital: Protocol for a Pilot Uncontrolled Trial", journal="JMIR Res Protoc", year="2022", month="Apr", day="27", volume="11", number="4", pages="e35083", keywords="Schwartz Rounds", keywords="compassionate care", keywords="health care staff well-being", abstract="Background: Schwartz Rounds are a unique, organization-wide interdisciplinary intervention aimed at enhancing staff well-being, compassionate care, teamwork, and organizational culture in health care settings. They provide a safe space wherein both clinical and nonclinical health staff can connect and share their experiences about the social and emotional aspects of health care. Objective: Although Schwartz Rounds have been assessed and widely implemented in the United States and United Kingdom, they are yet to be formally evaluated in Australian health care settings. The purpose of this study is to evaluate the feasibility and impact of Schwartz Rounds on staff well-being, compassionate care, and organizational culture, in a tertiary metropolitan hospital in Brisbane, Australia. Methods: This mixed methods repeated measures pilot study will recruit 24 participants in 2 groups from 2 departments, the intensive care unit and the gastroenterology department. Participants from each group will take part in 3 unit-based Schwartz Rounds. Primary outcomes will include the study and intervention feasibility measures, while secondary outcomes will include scores on the Maslach Burnout Inventory--Human Services Survey, the Schwartz Centre Compassionate Care Scale, and the Culture of Care Barometer. Primary and secondary outcomes will be collected at baseline, after the Rounds, and 3-month follow-up. Two focus groups will be held approximately 2 months after completion of the Schwartz Rounds. Descriptive statistics, paired t tests, chi-square tests, and analysis of variance will be used to compare quantitative data across time points and groups. Qualitative data from focus groups and free-text survey questions will be analyzed using an inductive thematic analysis approach. Results: The study was approved by the Mater Hospital Human Research Ethics Committee (reference number: HREC/MML/71868) and recruitment commenced in July 2021; study completion is anticipated by May 2022. Conclusions: The study will contribute to the assessment of feasibility and preliminary efficacy of the Schwartz Rounds in a tertiary Australian hospital during the COVID-19 pandemic. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001473853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382769\&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/35083 ", doi="10.2196/35083", url="https://www.researchprotocols.org/2022/4/e35083", url="http://www.ncbi.nlm.nih.gov/pubmed/35475785" } @Article{info:doi/10.2196/35058, author="Chua, Ling Wei and Ooi, Leng Sim and Chan, Han Gene Wai and Lau, Ching Tang and Liaw, Ying Sok", title="The Effect of a Sepsis Interprofessional Education Using Virtual Patient Telesimulation on Sepsis Team Care in Clinical Practice: Mixed Methods Study", journal="J Med Internet Res", year="2022", month="Apr", day="18", volume="24", number="4", pages="e35058", keywords="sepsis", keywords="interprofessional education", keywords="team training", keywords="nurse-physician communication", keywords="simulation", keywords="telesimulation", abstract="Background: Improving interprofessional communication and collaboration is necessary to facilitate the early identification and treatment of patients with sepsis. Preparing undergraduate medical and nursing students for the knowledge and skills required to assess, escalate, and manage patients with sepsis is crucial for their entry into clinical practice. However, the COVID-19 pandemic and social distancing measures have created the need for interactive distance learning to support collaborative learning. Objective: This study aimed to evaluate the effect of sepsis interprofessional education on medical and nursing students' sepsis knowledge, team communication skills, and skill use in clinical practice. Methods: A mixed methods design using a 1-group pretest-posttest design and focus group discussions was used. This study involved 415 undergraduate medical and nursing students from a university in Singapore. After a baseline evaluation of the participants' sepsis knowledge and team communication skills, they underwent didactic e-learning followed by virtual telesimulation on early recognition and management of sepsis and team communication strategies. The participants' sepsis knowledge and team communication skills were evaluated immediately and 2 months after the telesimulation. In total, 4 focus group discussions were conducted using a purposive sample of 18 medical and nursing students to explore their transfer of learning to clinical practice. Results: Compared with the baseline scores, both the medical and nursing students demonstrated a significant improvement in sepsis knowledge (P<.001) and team communication skills (P<.001) in immediate posttest scores. At the 2-month follow-up, the nursing students continued to have statistically significantly higher sepsis knowledge (P<.001) and communication scores (P<.001) than the pretest scores, whereas the medical students had no significant changes in test scores between the 2-month follow-up and pretest time points (P=.99). A total of three themes emerged from the qualitative findings: greater understanding of each other's roles, application of mental models in clinical practice, and theory-practice gaps. The sepsis interprofessional education---particularly the use of virtual telesimulation---fostered participants' understanding and appreciation of each other's interprofessional roles when caring for patients with sepsis. Despite noting some incongruities with the real-world clinical practice and not encountering many sepsis scenarios in clinical settings, participants shared the application of mental models using interprofessional communication strategies and the patient assessment framework in their daily clinical practice. Conclusions: Although the study did not show long-term knowledge retention, the use of virtual telesimulation played a critical role in facilitating the application of mental models for learning transfer and therefore could serve as a promising education modality for sepsis training. For a greater clinical effect, future studies could complement virtual telesimulation with a mannequin-based simulation and provide more evidence on the long-term retention of sepsis knowledge and clinical skills performance. ", doi="10.2196/35058", url="https://www.jmir.org/2022/4/e35058", url="http://www.ncbi.nlm.nih.gov/pubmed/35436237" } @Article{info:doi/10.2196/32784, author="Odom, J. Krista and Ottosson, Amanda and Draru, Joyce and Komujuni, Harriet and Karamagi Nkolo, Karungi Esther and Faramand, Harb Taroub", title="Improving Viral Load Suppression Among Men and Children Active in Care Through Community-Designed and Led Solutions: Protocol for Retrospective Closed Cohort Study in Eastern Uganda", journal="JMIR Res Protoc", year="2022", month="Apr", day="13", volume="11", number="4", pages="e32784", keywords="HIV/AIDS", keywords="viral load suppression", keywords="Uganda", keywords="people living with HIV", keywords="95-95-95", keywords="social and behavior change", keywords="USAID", keywords="gender, youth, and social inclusion", keywords="virus", keywords="HIV", keywords="AIDS", keywords="antiretroviral therapy", keywords="behavioral science", keywords="implementation science", keywords="behavior change", keywords="men", keywords="children", keywords="community design", keywords="methodology", abstract="Background: In collaboration with facilities, communities, district local government, and the United States Agency for International Development (USAID) implementing partners, the iDARE methodology was implemented at the community level to address root causes of low HIV antiretroviral therapy adherence among men and children actively enrolled in care, resulting in low viral load suppression (VLS) in two districts in the eastern region of Uganda. The methodology encourages the use of cocreated sustainable solutions addressing gender, youth, and social inclusion issues to reduce barriers to care and reach the 95-95-95 Joint United Nations Programme on HIV/AIDS target for HIV epidemic control. We aim to measure the impact of iDARE on VLS for men and children active in care and investigate the practical scale up of the solutions designed using the iDARE methodology. Objective: The primary objective of this study will be to measure the implementation impact of the iDARE methodology at the facility and community levels on VLS for people living with HIV. The secondary objective is to investigate the practical scale up of the iDARE methodology using evidence-based gender, youth, and social inclusion social behavior change packages to rapidly meet the Ugandan Ministry of Health targets for VLS. Methods: A retrospective cohort study design will be used to analyze program data that aims to increase the rates of VLS in men and children who are classified as active in care using community engagement and quality improvement techniques. We will examine 3 pilot health centers' data from a USAID-funded program aimed at social behavior change to increase health-seeking behavior in Uganda. Based on the iDARE process and results, change packages were developed to highlight lessons learned and best practices in order to share with subsequent implementation sites. Results: The USAID-funded Social and Behavior Change Activity began implementation of iDARE in September 2020, with baseline data collected in August 2020. Conclusions: Data on viral load suppression was collected from facilities on a monthly basis to record progress toward the 95-95-95 goal. The expected primary outcome is an increase in actively enrolled men and children reaching VLS in order to meet the Ugandan Ministry of Health target of 95\% VLS among those active in care. International Registered Report Identifier (IRRID): DERR1-10.2196/32784 ", doi="10.2196/32784", url="https://www.researchprotocols.org/2022/4/e32784", url="http://www.ncbi.nlm.nih.gov/pubmed/35416790" } @Article{info:doi/10.2196/35490, author="Shan, Rongzi and Chandra, V. Neha and Hsu, J. Jeffrey and Fraschilla, Stephanie and Moore, Melissa and Ardehali, Abbas and Nsair, Ali and Parikh, V. Rushi", title="The Impact of Transitioning From In-Person to Virtual Heart Transplantation Selection Committee Meetings: Observational Study", journal="JMIR Cardio", year="2022", month="Mar", day="30", volume="6", number="1", pages="e35490", keywords="telemedicine", keywords="transplantation", keywords="heart failure", keywords="physician", keywords="heart transplant", keywords="virtual meeting", keywords="interprofessional relations", keywords="health systems", keywords="selection committee", abstract="Background: Heart transplant selection committee meetings have transitioned from in-person to remote video meetings during the COVID-19 pandemic, but how this impacts committee members and patient outcomes is unknown. Objective: The aim of this study is to determine the perceived impact of remote video transplant selection meetings on usability and patient care and to measure patient selection outcomes during the transition period from in-person to virtual meetings. Methods: A 35-item anonymous survey was developed and distributed electronically to the heart transplant selection committee. We reviewed medical records to compare the outcomes of patients presented at in-person meetings (January-March 2020) to those presented during video meetings (March-June 2020). Results: Among 83 committee members queried, 50 were regular attendees. Of the 50 regular attendees, 24 (48\%) were physicians and 26 (52\%) were nonphysicians, including nurses, social workers, and coordinators; 46 responses were received, 23 (50\%) from physicians and 23 (50\%) from nonphysicians, with 41 responses fully completed. Overall, respondents were satisfied with the videoconference format and felt that video meetings did not impact patient care and were an acceptable alternative to in-person meetings. However, 54\% (22/41) preferred in-person meetings, with 71\% (15/21) of nonphysicians preferring in-person meetings compared to only 35\% (7/20) of physicians (P=.02). Of the 46 new patient evaluations presented, there was a statistically nonsignificant trend toward fewer patients initially declined at video meetings compared with in-person meetings (6/24, 25\% compared to 10/22, 45\%; P=.32). Conclusions: The transition from in-person to video heart transplant selection committee meetings was well-received and did not appear to affect committee members' perceived ability to deliver patient care. Patient selection outcomes were similar between meeting modalities. ", doi="10.2196/35490", url="https://cardio.jmir.org/2022/1/e35490", url="http://www.ncbi.nlm.nih.gov/pubmed/35353041" } @Article{info:doi/10.2196/33046, author="Blijleven, Vincent and Hoxha, Florian and Jaspers, Monique", title="Workarounds in Electronic Health Record Systems and the Revised Sociotechnical Electronic Health Record Workaround Analysis Framework: Scoping Review", journal="J Med Internet Res", year="2022", month="Mar", day="15", volume="24", number="3", pages="e33046", keywords="electronic health records", keywords="electronic medical records", keywords="framework", keywords="patient safety", keywords="unintended consequences", keywords="usability", keywords="workarounds", keywords="workflow", abstract="Background: Electronic health record (EHR) system users devise workarounds to cope with mismatches between workflows designed in the EHR and preferred workflows in practice. Although workarounds appear beneficial at first sight, they frequently jeopardize patient safety, the quality of care, and the efficiency of care. Objective: This review aims to aid in identifying, analyzing, and resolving EHR workarounds; the Sociotechnical EHR Workaround Analysis (SEWA) framework was published in 2019. Although the framework was based on a large case study, the framework still required theoretical validation, refinement, and enrichment. Methods: A scoping literature review was performed on studies related to EHR workarounds published between 2010 and 2021 in the MEDLINE, Embase, CINAHL, Cochrane, or IEEE databases. A total of 737 studies were retrieved, of which 62 (8.4\%) were included in the final analysis. Using an analytic framework, the included studies were investigated to uncover the rationales that EHR users have for workarounds, attributes characterizing workarounds, possible scopes, and types of perceived impacts of workarounds. Results: The SEWA framework was theoretically validated and extended based on the scoping review. Extensive support for the pre-existing rationales, attributes, possible scopes, and types of impact was found in the included studies. Moreover, 7 new rationales, 4 new attributes, and 3 new types of impact were incorporated. Similarly, the descriptions of multiple pre-existing rationales for workarounds were refined to describe each rationale more accurately. Conclusions: SEWA is now grounded in the existing body of peer-reviewed empirical evidence on EHR workarounds and, as such, provides a theoretically validated and more complete synthesis of EHR workaround rationales, attributes, possible scopes, and types of impact. The revised SEWA framework can aid researchers and practitioners in a wider range of health care settings to identify, analyze, and resolve workarounds. This will improve user-centered EHR design and redesign, ultimately leading to improved patient safety, quality of care, and efficiency of care. ", doi="10.2196/33046", url="https://www.jmir.org/2022/3/e33046", url="http://www.ncbi.nlm.nih.gov/pubmed/35289752" } @Article{info:doi/10.2196/30810, author="Moon, Khatiya and Sobolev, Michael and Kane, M. John", title="Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review", journal="JMIR Ment Health", year="2022", month="Feb", day="16", volume="9", number="2", pages="e30810", keywords="collaborative care", keywords="integrated care", keywords="augmented care", keywords="digital health", keywords="mobile health", keywords="behavioral health", keywords="review", abstract="Background: The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective: This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods: This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results: A total of 3982 nonduplicate reports were identified, of which 20 (0.5\%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35\%), there were no differences between groups, or the differences were modest. Conclusions: The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials. ", doi="10.2196/30810", url="https://mental.jmir.org/2022/2/e30810", url="http://www.ncbi.nlm.nih.gov/pubmed/35171105" } @Article{info:doi/10.2196/30512, author="P{\'e}rez-Mart{\'i}, Montserrat and Casad{\'o}-Mar{\'i}n, Lina and Guill{\'e}n-Villar, Abraham", title="Electronic Records With Tablets at the Point of Care in an Internal Medicine Unit: Before-After Time Motion Study", journal="JMIR Hum Factors", year="2022", month="Feb", day="10", volume="9", number="1", pages="e30512", keywords="electronic health records", keywords="nursing", keywords="computer handheld", keywords="equipment and supplies (devices tablets mobile phones, devices and technologies)", keywords="workflow", abstract="Background: There are many benefits of nursing professionals being able to consult electronic health records (EHRs) at the point of care. It promotes quality and patient security, communication, continuity of care, and time dedicated to records. Objective: The aim of this study was to evaluate whether making EHRs available at the point of care with tablets reduces nurses' time spent on records compared with the current system. The analysis included sociodemographic and qualitative variables, time spent per patient, and work shift. This time difference can be used for direct patient care. Methods: A before-after time motion study was carried out in the internal medicine unit. There was a total of 130 observations of 2 hours to 3 hours in duration of complete patient records that were carried out at the beginning of the nurses' work shifts. We calculated the time dedicated to measuring vital signs, patient evaluation, and EHR recording. The main variable was time spent per patient. Results: The average time spent per patient (total time/patients admitted) was lower with the tablet group (mean 4.22, SD 0.14 minutes) than with the control group (mean 4.66, SD 0.12 minutes); there were statistically significant differences (W=3.20, P=.001) and a low effect (d=.44) between groups. The tablet group saved an average of 0.44 (SD 0.13) minutes per patient. Similar results were obtained for the afternoon shift, which saved an average of 0.60 (SD 0.15) minutes per patient (t34=3.82, P=.01) and high effect (d=.77). However, although there was a mean difference of 0.26 (SD 0.22) minutes per patient for the night shift, this was not statistically significant (t29=1.16, P=.25). The ``nonparticipating'' average age was higher (49.57, SD 2.92 years) compared with the ``afternoon shift participants'' and ``night shift participants'' (P=.007). ``Nonparticipants'' of the night shift had a worse perception of the project. Conclusions: This investigation determined that, with EHRs at the point of care, the time spent for registration by the nursing staff decreases, because of reduced movements and avoiding data transcription. It eliminates unnecessary work that does not add value, and therefore, care is improved. So, we think EHRs at the point of care should be the future or natural method for nursing to undertake. However, variables that could have a negative effect include age, night shift, and nurses' perceptions. Therefore, it is proposed that training in the different work platforms and the participation of nurses are fundamental axes that any institution should consider before their implementation. ", doi="10.2196/30512", url="https://humanfactors.jmir.org/2022/1/e30512", url="http://www.ncbi.nlm.nih.gov/pubmed/35142624" } @Article{info:doi/10.2196/25983, author="Devriendt, Thijs and Borry, Pascal and Shabani, Mahsa", title="Credit and Recognition for Contributions to Data-Sharing Platforms Among Cohort Holders and Platform Developers in Europe: Interview Study", journal="J Med Internet Res", year="2022", month="Jan", day="13", volume="24", number="1", pages="e25983", keywords="information dissemination", keywords="qualitative research", keywords="ethics", keywords="database management systems", keywords="cohort studies", keywords="science policy", keywords="incentives", keywords="rewards", abstract="Background: The European Commission is funding projects that aim to establish data-sharing platforms. These platforms are envisioned to enhance and facilitate the international sharing of cohort data. Nevertheless, broad data sharing may be restricted by the lack of adequate recognition for those who share data. Objective: The aim of this study is to describe in depth the concerns about acquiring credit for data sharing within epidemiological research. Methods: A total of 17 participants linked to European Union--funded data-sharing platforms were recruited for a semistructured interview. Transcripts were analyzed using inductive content analysis. Results: Interviewees argued that data sharing within international projects could challenge authorship guidelines in multiple ways. Some respondents considered that the acquisition of credit for articles with extensive author lists could be problematic in some instances, such as for junior researchers. In addition, universities may be critical of researchers who share data more often than leading research. Some considered that the evaluation system undervalues data generators and specialists. Respondents generally looked favorably upon alternatives to the current evaluation system to potentially ameliorate these issues. Conclusions: The evaluation system might impede data sharing because it mainly focuses on first and last authorship and undervalues the contributor's work. Further movement of crediting models toward contributorship could potentially address this issue. Appropriate crediting mechanisms that are better aligned with the way science ought to be conducted in the future need to be developed. ", doi="10.2196/25983", url="https://www.jmir.org/2022/1/e25983", url="http://www.ncbi.nlm.nih.gov/pubmed/35023849" } @Article{info:doi/10.2196/28896, author="Keith, J. Mark and Dean, L. Douglas and Gaskin, James and Anderson, Greg", title="Team Building Through Team Video Games: Randomized Controlled Trial", journal="JMIR Serious Games", year="2021", month="Dec", day="14", volume="9", number="4", pages="e28896", keywords="team video gaming", keywords="team building", keywords="flow", keywords="team cohesion", keywords="video games", keywords="gamification", keywords="team", keywords="teamwork", keywords="cohesion", keywords="theory", keywords="framework", keywords="performance", abstract="Background: Organizations of all types require the use of teams. Poor team member engagement costs billions of US dollars annually. Objective: This study aimed to explain how team building can be accomplished with team video gaming based on a team cohesion model enhanced by team flow theory. Methods: In this controlled experiment, teams were randomly assigned to a team video gaming treatment or a control treatment. Team productivity was measured during both pretreatment and posttreatment team tasks. After the pretest, teams who were involved in the team video gaming treatment competed against other teams by playing the Halo or Rock Band video game for 45 minutes. After the pretest, teams in the control treatment worked alone for 45 minutes. Then, all teams completed the posttest team activity. This same experimental protocol was conducted on 2 different team tasks. Results: For both tasks, teams in the team video gaming treatment increased their productivity significantly more (F1=8.760, P=.004) on the posttest task than teams in the control treatment. Our flow-based theoretical model explained team performance improvement more than twice as well (R2=40.6\%) than prior related research (R2=18.5\%). Conclusions: The focused immersion caused by team video gaming increased team performance while the enjoyment component of flow decreased team performance on the posttest. Both flow and team cohesion contributed to team performance, with flow contributing more than cohesion. Team video gaming did not increase team cohesion, so team video gaming effects are independent of cohesion. Team video gaming is a valid practical method for developing and improving newly formed teams. ", doi="10.2196/28896", url="https://games.jmir.org/2021/4/e28896", url="http://www.ncbi.nlm.nih.gov/pubmed/34904954" } @Article{info:doi/10.2196/33144, author="Jaccard, Dominique and Suppan, Laurent and Bielser, F{\'e}licia", title="Contribution of the co.LAB Framework to the Collaborative Design of Serious Games: Mixed Methods Validation Study", journal="JMIR Serious Games", year="2021", month="Nov", day="24", volume="9", number="4", pages="e33144", keywords="serious game", keywords="educational game", keywords="education", keywords="simulation game", keywords="gaming", keywords="design", keywords="framework", keywords="methodology", keywords="mixed method", keywords="validation", abstract="Background: Multidisciplinary collaboration is essential to the successful development of serious games, albeit difficult to achieve. In a previous study, the co.LAB serious game design framework was created to support collaboration within serious game multidisciplinary design teams. Its use has not yet been validated in a real usage context. Objective: The objective of this study was to perform a first assessment of the impact of the co.LAB framework on collaboration within multidisciplinary teams during serious game design and development. Methods: A mixed methods study was conducted, based on 2 serious game design projects in which the co.LAB framework was used. The first phase was qualitative and carried out using a general inductive approach. To this end, all members of the first serious game project team who used the co.LAB framework were invited to take part in a focus group session (n=6). In a second phase, results inferred from qualitative data were used to define a quantitative instrument (questionnaire) that was designed according to the Checklist for Reporting Results of Internet E-Surveys. Members of both project teams (n=11) were then asked to answer the questionnaire. Quantitative results were reported as median (Q1, Q3), and appropriate nonparametric tests were used to assess between-group differences. Finally, results gathered through the qualitative and quantitative phases were integrated. Results: In both phases, the participation rate was 100\% (6/6 and 11/11). Verbatim transcripts were classified into 4 high level themes: (1) influence on collaborative dimensions; (2) impact on project course, monitoring, and efficiency; (3) qualitative perceptions of the framework; and (4) influence of team composition on the use of the framework. The web-based questionnaire was then developed according to the 7 dimensions of collaboration by Burkhardt et al. In both projects, the co.LAB framework had a positive impact on most dimensions of collaboration during the multidisciplinary design and development of serious games. When all collaborative dimensions were aggregated, the overall impact of the framework was rated on a scale from --42 to 42 (very negative to very positive). The overall median score was 23 (Q1, Q3: 20, 27), with no significant difference between groups (P=.58). Most respondents also believed that all serious game design teams should include a member possessing significant expertise in serious game design to guide the development process. Conclusions: The co.LAB framework had a positive impact on collaboration within serious game design and development teams. However, expert guidance seems necessary to maximize development efficiency. Whether such guidance can be provided by means of a collaborative web platform remains to be determined. ", doi="10.2196/33144", url="https://games.jmir.org/2021/4/e33144", url="http://www.ncbi.nlm.nih.gov/pubmed/34822336" } @Article{info:doi/10.2196/27261, author="Mannering, Hannah and Yan, Chao and Gong, Yang and Alrifai, Wael Mhd and France, Daniel and Chen, You", title="Assessing Neonatal Intensive Care Unit Structures and Outcomes Before and During the COVID-19 Pandemic: Network Analysis Study", journal="J Med Internet Res", year="2021", month="Oct", day="20", volume="23", number="10", pages="e27261", keywords="neonatal intensive care unit", keywords="collaboration", keywords="health care organization structures", keywords="intensive care", keywords="length of stay", keywords="discharge dispositions", keywords="electronic health records", keywords="network analysis", keywords="COVID-19", keywords="temporal network analysis", abstract="Background: Health care organizations (HCOs) adopt strategies (eg. physical distancing) to protect clinicians and patients in intensive care units (ICUs) during the COVID-19 pandemic. Many care activities physically performed before the COVID-19 pandemic have transitioned to virtual systems during the pandemic. These transitions can interfere with collaboration structures in the ICU, which may impact clinical outcomes. Understanding the differences can help HCOs identify challenges when transitioning physical collaboration to the virtual setting in the post--COVID-19 era. Objective: This study aims to leverage network analysis to determine the changes in neonatal ICU (NICU) collaboration structures from the pre-- to the intra--COVID-19 era. Methods: In this retrospective study, we applied network analysis to the utilization of electronic health records (EHRs) of 712 critically ill neonates (pre--COVID-19, n=386; intra--COVID-19, n=326, excluding those with COVID-19) admitted to the NICU of Vanderbilt University Medical Center between September 1, 2019, and June 30, 2020, to assess collaboration between clinicians. We characterized pre--COVID-19 as the period of September-December 2019 and intra--COVID-19 as the period of March-June 2020. These 2 groups were compared using patients' clinical characteristics, including age, sex, race, length of stay (LOS), and discharge dispositions. We leveraged the clinicians' actions committed to the patients' EHRs to measure clinician-clinician connections. We characterized a collaboration relationship (tie) between 2 clinicians as actioning EHRs of the same patient within the same day. On defining collaboration relationship, we built pre-- and intra--COVID-19 networks. We used 3 sociometric measurements, including eigenvector centrality, eccentricity, and betweenness, to quantify a clinician's leadership, collaboration difficulty, and broad skill sets in a network, respectively. We assessed the extent to which the eigenvector centrality, eccentricity, and betweenness of clinicians in the 2 networks are statistically different, using Mann-Whitney U tests (95\% CI). Results: Collaboration difficulty increased from the pre-- to intra--COVID-19 periods (median eccentricity: 3 vs 4; P<.001). Nurses had reduced leadership (median eigenvector centrality: 0.183 vs 0.087; P<.001), and neonatologists with broader skill sets cared for more patients in the NICU structure during the pandemic (median betweenness centrality: 0.0001 vs 0.005; P<.001). The pre-- and intra--COVID-19 patient groups shared similar distributions in sex ({\textasciitilde}0 difference), race (4\% difference in White, and 3\% difference in African American), LOS (interquartile range difference in 1.5 days), and discharge dispositions ({\textasciitilde}0 difference in home, 2\% difference in expired, and 2\% difference in others). There were no significant differences in the patient demographics and outcomes between the 2 groups. Conclusions: Management of NICU-admitted patients typically requires multidisciplinary care teams. Understanding collaboration structures can provide fine-grained evidence to potentially refine or optimize existing teamwork in the NICU. ", doi="10.2196/27261", url="https://www.jmir.org/2021/10/e27261", url="http://www.ncbi.nlm.nih.gov/pubmed/34637393" } @Article{info:doi/10.2196/28998, author="Li, Patrick and Chen, Bob and Rhodes, Evan and Slagle, Jason and Alrifai, Wael Mhd and France, Daniel and Chen, You", title="Measuring Collaboration Through Concurrent Electronic Health Record Usage: Network Analysis Study", journal="JMIR Med Inform", year="2021", month="Sep", day="3", volume="9", number="9", pages="e28998", keywords="collaboration", keywords="electronic health records", keywords="audit logs", keywords="health care workers", keywords="neonatal intensive care unit", keywords="network analysis", keywords="clustering", keywords="visualization", keywords="concurrent interaction", keywords="human-computer interaction", keywords="survey instrument", keywords="informatics framework", keywords="secondary data analysis", abstract="Background: Collaboration is vital within health care institutions, and it allows for the effective use of collective health care worker (HCW) expertise. Human-computer interactions involving electronic health records (EHRs) have become pervasive and act as an avenue for quantifying these collaborations using statistical and network analysis methods. Objective: We aimed to measure HCW collaboration and its characteristics by analyzing concurrent EHR usage. Methods: By extracting concurrent EHR usage events from audit log data, we defined concurrent sessions. For each HCW, we established a metric called concurrent intensity, which was the proportion of EHR activities in concurrent sessions over all EHR activities. Statistical models were used to test the differences in the concurrent intensity between HCWs. For each patient visit, starting from admission to discharge, we measured concurrent EHR usage across all HCWs, which we called temporal patterns. Again, we applied statistical models to test the differences in temporal patterns of the admission, discharge, and intermediate days of hospital stay between weekdays and weekends. Network analysis was leveraged to measure collaborative relationships among HCWs. We surveyed experts to determine if they could distinguish collaborative relationships between high and low likelihood categories derived from concurrent EHR usage. Clustering was used to aggregate concurrent activities to describe concurrent sessions. We gathered 4 months of EHR audit log data from a large academic medical center's neonatal intensive care unit (NICU) to validate the effectiveness of our framework. Results: There was a significant difference (P<.001) in the concurrent intensity (proportion of concurrent activities: ranging from mean 0.07, 95\% CI 0.06-0.08, to mean 0.36, 95\% CI 0.18-0.54; proportion of time spent on concurrent activities: ranging from mean 0.32, 95\% CI 0.20-0.44, to mean 0.76, 95\% CI 0.51-1.00) between the top 13 HCW specialties who had the largest amount of time spent in EHRs. Temporal patterns between weekday and weekend periods were significantly different on admission (number of concurrent intervals per hour: 11.60 vs 0.54; P<.001) and discharge days (4.72 vs 1.54; P<.001), but not during intermediate days of hospital stay. Neonatal nurses, fellows, frontline providers, neonatologists, consultants, respiratory therapists, and ancillary and support staff had collaborative relationships. NICU professionals could distinguish high likelihood collaborative relationships from low ones at significant rates (3.54, 95\% CI 3.31-4.37 vs 2.64, 95\% CI 2.46-3.29; P<.001). We identified 50 clusters of concurrent activities. Over 87\% of concurrent sessions could be described by a single cluster, with the remaining 13\% of sessions comprising multiple clusters. Conclusions: Leveraging concurrent EHR usage workflow through audit logs to analyze HCW collaboration may improve our understanding of collaborative patient care. HCW collaboration using EHRs could potentially influence the quality of patient care, discharge timeliness, and clinician workload, stress, or burnout. ", doi="10.2196/28998", url="https://medinform.jmir.org/2021/9/e28998", url="http://www.ncbi.nlm.nih.gov/pubmed/34477566" } @Article{info:doi/10.2196/27291, author="Abensur Vuillaume, Laure and Laudren, Garry and Bosio, Alexandre and Th{\'e}venot, Pauline and Pelaccia, Thierry and Chauvin, Anthony", title="A Didactic Escape Game for Emergency Medicine Aimed at Learning to Work as a Team and Making Diagnoses: Methodology for Game Development", journal="JMIR Serious Games", year="2021", month="Aug", day="31", volume="9", number="3", pages="e27291", keywords="training techniques", keywords="educational technique", keywords="game theories", keywords="emergency medicine", keywords="games", keywords="education", keywords="escape game", keywords="simulation-based training", keywords="pedagogical", keywords="serious games", keywords="emergency medicine training", abstract="Background: In the health care environment, teamwork is paramount, especially when referring to patient safety. We are interested in recent and innovative solutions such as escape games, which is a type of adventure game that may be highly useful as an educational tool, potentially combining good communication skills with successful gamification. They involve teams of 5 to 10 individuals who are ``locked'' in the same room and must collaborate to solve puzzles while under pressure from a timer. Objective: The purpose of this paper was to describe the steps involved in creating and implementing an educational escape game. This tool can then be put into service or further developed by trainers who wish to use it for learning interprofessional collaboration. Therefore, we started with an experience of creating an educational escape game for emergency medicine teams. Methods: We chose to develop an educational escape game by using 6 successive steps. First, we built a team. Second, we chose the pedagogical objectives. Third, we gamified (switched from objectives to scenario). Next, we found the human and material resources needed. Thereafter, we designed briefing and debriefing. Lastly, we tested the game. Results: By following these 6 steps, we created the first ambulant educational escape game that teaches people, or nurses, doctors, and paramedics, working in emergency medicine to work as a team. Conclusions: From a pedagogic point of view, this game may be a good tool for helping people in multidisciplinary fields (medical and paramedical teams) to learn how to work collaboratively and to communicate as a group. Above all, it seems to be an innovative tool that complements medical simulation--based learning and thus consolidates traditional education. ", doi="10.2196/27291", url="https://games.jmir.org/2021/3/e27291", url="http://www.ncbi.nlm.nih.gov/pubmed/34463628" } @Article{info:doi/10.2196/28151, author="Knop, Michael and Mueller, Marius and Niehaves, Bjoern", title="Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-Based Primary Care: Mixed Methods Study", journal="J Med Internet Res", year="2021", month="Aug", day="26", volume="23", number="8", pages="e28151", keywords="digital health", keywords="digital health care technologies", keywords="telemedicine", keywords="user perceptions", keywords="delegation", keywords="primary care", keywords="ambulant health care", keywords="medical assistants", keywords="general practitioners", keywords="COVID-19", keywords="mixed method study", keywords="multidimensional scaling", keywords="mobile phone", abstract="Background: Owing to the shortage of medical professionals, as well as demographic and structural challenges, new care models have emerged to find innovative solutions to counter medical undersupply. Team-based primary care using medical delegation appears to be a promising approach to address these challenges; however, it demands efficient communication structures and mechanisms to reinsure patients and caregivers receive a delegated, treatment-related task. Digital health care technologies hold the potential to render these novel processes effective and demand driven. Objective: The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. Methods: We conducted a combination of 19 individual and group interviews with 12 GPs and 14 MAs, seeking to identify relevant technologies for delegation purposes as well as stakeholders' perceptions of their effectiveness. Furthermore, a web-based survey was conducted asking the interviewees to order identified technologies based on their assessed applicability in multi-actor patient care. Interview data were analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize the survey data, leading to a triangulation of the results. Results: Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed to improve the development and distribution of innovative technologies and to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultations, portable electrocardiograms, or telemedical stethoscopes, can counteract current challenges in primary care because of its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. Conclusions: Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance of such innovative approaches increases with the tremendous need for differentiated and effective care, such as during the ongoing COVID-19 pandemic. For the successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role as mediators between GPs and patients, MAs are potentially able to counteract patients' resistance toward using innovative technology and compensate for patients' limited access to technology and care facilities. ", doi="10.2196/28151", url="https://www.jmir.org/2021/8/e28151", url="http://www.ncbi.nlm.nih.gov/pubmed/34435959" } @Article{info:doi/10.2196/24555, author="Zhang, Lu and McLeod, L. Howard and Liu, Ke-Ke and Liu, Wen-Hui and Huang, Hang-Xing and Huang, Ya-Min and Sun, Shu-Sen and Chen, Xiao-Ping and Chen, Yao and Liu, Fang-Zhou and Xiao, Jian", title="Effect of Physician-Pharmacist Participation in the Management of Ambulatory Cancer Pain Through a Digital Health Platform: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2021", month="Aug", day="16", volume="9", number="8", pages="e24555", keywords="cancer pain", keywords="self-management", keywords="ambulatory setting", keywords="digital health", keywords="physician-pharmacist", abstract="Background: Self-management of ambulatory cancer pain is full of challenges. Motivated by the need for better pain management, we developed a WeChat-supported platform, Medication Housekeeper (MediHK), to enhance communication, optimize outcomes, and promote self-management in the home setting. Objective: We conducted a randomized controlled trial to assess whether the joint physician-pharmacist team through MediHK would provide better self-management of ambulatory patients with cancer pain. Methods: Patients were randomly assigned to either an intervention group or control group. During the 4-week study period, the pharmacist would send 24-hour pain diaries daily, adverse drug reaction (ADR) forms every 3 days, and the Brief Pain Inventory form every 15 days to patients in the intervention group via MediHK. If a patient needed a change in drug/dosage or treatment of an ADR after the comprehensive review, the pharmacist would propose pharmacological interventions to the attending physician, who was then responsible for prescribing or adjusting pain medications. If no adjustments were needed, the pharmacist provided appropriate targeted education based on knowledge deficits. Patients in the control group received conventional care and did not receive reminders to fill out the forms. However, if the control group patients filled out a form via MediHK, the pain management team would review and respond in the same way as for the intervention group. The primary outcomes included pain intensity and pain interference in daily life. Secondary outcomes included patient-reported outcome measures, medication adherence, ADRs, and rehospitalization rates. Results: A total of 100 patients were included, with 51 (51\%) in the intervention group and 49 (49\%) in the control group. The worst pain scores, least pain scores, and average pain scores in the intervention group and the control group were statistically different, with median values of 4 (IQR 3-7) vs 7 (IQR 6-8; P=.001), 1 (IQR 0-2) vs 2 (IQR 1-3; P=.02), and 2 (IQR 2-4) vs 4 (IQR 3-5; P=.001), respectively, at the end of the study. The pain interference on patients' general activity, mood, relationships with others, and interests was reduced, but the difference was not statistically significant compared with the control group (Ps=.10-.76). The medication adherence rate increased from 43\% to 63\% in the intervention group, compared with an increase of 33\% to 51\% in the control group (P<.001). The overall number of ADRs increased at 4 weeks, and more ADRs were monitored in the intervention group (P=.003). Rehospitalization rates were similar between the 2 groups. Conclusions: The joint physician-pharmacist team operating through MediHK improved pain management. This study supports the feasibility of integrating the internet into the self-management of cancer pain. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023075; https://www.chictr.org.cn/showproj.aspx?proj=36901 ", doi="10.2196/24555", url="https://mhealth.jmir.org/2021/8/e24555", url="http://www.ncbi.nlm.nih.gov/pubmed/34398796" } @Article{info:doi/10.2196/28245, author="Hettiachchi, Danula and Hayes, Lachie and Goncalves, Jorge and Kostakos, Vassilis", title="Team Dynamics in Hospital Workflows: An Exploratory Study of a Smartphone Task Manager", journal="JMIR Med Inform", year="2021", month="Aug", day="16", volume="9", number="8", pages="e28245", keywords="task assignment", keywords="smartphones", keywords="hospital communication", keywords="clinical workflows", keywords="mobile app", keywords="clinical platform", keywords="mHealth", abstract="Background: Although convenient and reliable modern messaging apps like WhatsApp enable efficient communication among hospital staff, hospitals are now pivoting toward purpose-built structured communication apps for various reasons, including security and privacy concerns. However, there is limited understanding of how we can examine and improve hospital workflows using the data collected through such apps as an alternative to costly and challenging research methods like ethnography and patient record analysis. Objective: We seek to identify whether the structure of the collected communication data provides insights into hospitals' workflows. Our analysis also aims to identify ways in which task management platforms can be improved and designed to better support clinical workflows. Methods: We present an exploratory analysis of clinical task records collected over 22 months through a smartphone app that enables structured communication between staff to manage and execute clinical workflows. We collected over 300,000 task records between July 2018 and May 2020 completed by staff members including doctors, nurses, and pharmacists across all wards in an Australian hospital. Results: We show that important insights into how teams function in a clinical setting can be readily drawn from task assignment data. Our analysis indicates that predefined labels such as urgency and task type are important and impact how tasks are accepted and completed. Our results show that both task sent-to-accepted (P<.001) and sent-to-completed (P<.001) times are significantly higher for routine tasks when compared to urgent tasks. We also show how task acceptance varies across teams and roles and that internal tasks are more efficiently managed than external tasks, possibly due to increased trust among team members. For example, task sent-to-accepted time (minutes) is significantly higher (P<.001) for external assignments (mean 22.10, SD 91.45) when compared to internal assignments (mean 19.03, SD 82.66). Conclusions: Smartphone-based task assignment apps can provide unique insights into team dynamics in clinical settings. These insights can be used to further improve how well these systems support clinical work and staff. ", doi="10.2196/28245", url="https://medinform.jmir.org/2021/8/e28245", url="http://www.ncbi.nlm.nih.gov/pubmed/34398797" } @Article{info:doi/10.2196/29582, author="Kim, Jin Yun and Qian, Linchao and Aslam, Shahzad Muhammad", title="Cyberbullying Among Traditional and Complementary Medicine Practitioners in the Workplace: Protocol for a Cross-sectional Descriptive Study", journal="JMIR Res Protoc", year="2021", month="Aug", day="12", volume="10", number="8", pages="e29582", keywords="cyberbullying", keywords="traditional medicine", keywords="workplace", keywords="practitioners", keywords="medical professional", abstract="Background: Cyberbullying is becoming prevalent among health care professionals and may cause a variety of mental health issues. Traditional and complementary medicine practitioners remain an important pillar of the health care system in Malaysia. Objective: This paper presents a study protocol for an online survey (Cyberbullying Among Traditional and Complementary Medicine Practitioner [TCMPs]) that will collect the first nationwide representative data on cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia. The objectives of the survey are to (1) evaluate the cyberbullying behavior among traditional and complementary medicine practitioners in Malaysia, (2) identify sociodemographic and social factors related to cyberbullying, and (3) evaluate the association between cyberbullying behavior, sociodemographic, and social factors. Methods: A snowball sampling strategy will be applied. Traditional and complementary medicine practitioners who are permanent Malaysian residents will be randomly selected and invited to participate in the survey (N=1023). Cyberbullying behavior will be measured using the Cyberbullying Behavior Questionnaire (CBQ). Data on the following items will be collected: work-related bullying, person-related bullying, aggressively worded messages, distortion of messages, sending offensive photos/videos, hacking computers or sending a virus or rude message, and threatening messages about personal life or family members. We will also collect data on participants' sociodemographic characteristics, social factors, and substance abuse behavior. Results: This cross-sectional descriptive study was registered with Research Registry (Unique Identifying Number 6216; November 05, 2020). This research work (substudy) is planned under a phase 1 study approved by the Research Management Centre, Xiamen University Malaysia. This substudy has been approved by the Research Ethics Committee of Xiamen University Malaysia (REC-2011.01). The cross-sectional survey will be conducted from July 01, 2021, to June 30, 2022. Data preparation and statistical analyses are planned from January 2022 onward. Conclusions: The current research can contribute to identify the prevalence of workplace cyberbullying among Malaysian traditional and complementary medicine practitioners. The results will help government stakeholders, health professionals, and education professionals to understand the psychological well-being of Malaysian traditional and complementary medicine practitioners. Trial Registration: Research Registry Unique Identifying Number 6216; https://tinyurl.com/3rsmxs7u International Registered Report Identifier (IRRID): PRR1-10.2196/29582 ", doi="10.2196/29582", url="https://www.researchprotocols.org/2021/8/e29582", url="http://www.ncbi.nlm.nih.gov/pubmed/34387559" } @Article{info:doi/10.2196/24179, author="Steinkamp, Jackson and Kantrowitz, Jacob and Sharma, Abhinav and Bala, Wasif", title="Beyond Notes: Why It Is Time to Abandon an Outdated Documentation Paradigm", journal="J Med Internet Res", year="2021", month="Apr", day="20", volume="23", number="4", pages="e24179", keywords="electronic medical records", keywords="health informatics", keywords="information chaos", keywords="medical documentation", keywords="clinicians", keywords="medical notes", keywords="electronic medical notes", keywords="medical team", doi="10.2196/24179", url="https://www.jmir.org/2021/4/e24179", url="http://www.ncbi.nlm.nih.gov/pubmed/33877053" } @Article{info:doi/10.2196/25724, author="Yan, Chao and Zhang, Xinmeng and Gao, Cheng and Wilfong, Erin and Casey, Jonathan and France, Daniel and Gong, Yang and Patel, Mayur and Malin, Bradley and Chen, You", title="Collaboration Structures in COVID-19 Critical Care: Retrospective Network Analysis Study", journal="JMIR Hum Factors", year="2021", month="Mar", day="8", volume="8", number="1", pages="e25724", keywords="COVID-19", keywords="intensive care unit", keywords="collaboration structure", keywords="critically ill patient", keywords="health care worker", keywords="network analysis", keywords="electronic health record", keywords="collaboration", keywords="critical care", keywords="relationship", keywords="safety", keywords="teamwork", abstract="Background: Few intensive care unit (ICU) staffing studies have examined the collaboration structures of health care workers (HCWs). Knowledge about how HCWs are connected to the care of critically ill patients with COVID-19 is important for characterizing the relationships among team structures, care quality, and patient safety. Objective: We aimed to discover differences in the teamwork structures of COVID-19 critical care by comparing HCW collaborations in the management of critically ill patients with and without COVID-19. Methods: In this retrospective study, we used network analysis methods to analyze the electronic health records (EHRs) of 76 critically ill patients (with COVID-19: n=38; without COVID-19: n=38) who were admitted to a large academic medical center, and to learn about HCW collaboration. We used the EHRs of adult patients who were admitted to the COVID-19 ICU at the Vanderbilt University Medical Center (Nashville, Tennessee, United States) between March 17, 2020, and May 31, 2020. We matched each patient according to age, gender, and their length of stay. Patients without COVID-19 were admitted to the medical ICU between December 1, 2019, and February 29, 2020. We used two sociometrics---eigencentrality and betweenness---to quantify HCWs' statuses in networks. Eigencentrality characterizes the degree to which an HCW is a core person in collaboration structures. Betweenness centrality refers to whether an HCW lies on the path of other HCWs who are not directly connected. This sociometric was used to characterize HCWs' broad skill sets. We measured patient staffing intensity in terms of the number of HCWs who interacted with patients' EHRs. We assessed the statistical differences in the core and betweenness statuses of HCWs and the patient staffing intensities of COVID-19 and non--COVID-19 critical care, by using Mann-Whitney U tests and reporting 95\% CIs. Results: HCWs in COVID-19 critical care were more likely to frequently work with each other (eigencentrality: median 0.096) than those in non--COVID-19 critical care (eigencentrality: median 0.057; P<.001). Internal medicine physicians in COVID-19 critical care had higher core statuses than those in non--COVID-19 critical care (P=.001). Nurse practitioners in COVID-19 care had higher betweenness statuses than those in non--COVID-19 care (P<.001). Compared to HCWs in non--COVID-19 settings, the EHRs of critically ill patients with COVID-19 were used by a larger number of internal medicine nurse practitioners (P<.001), cardiovascular nurses (P<.001), and surgical ICU nurses (P=.002) and a smaller number of resident physicians (P<.001). Conclusions: Network analysis methodologies and data on EHR use provide a novel method for learning about differences in collaboration structures between COVID-19 and non--COVID-19 critical care. Health care organizations can use this information to learn about the novel changes that the COVID-19 pandemic has imposed on collaboration structures in urgent care. ", doi="10.2196/25724", url="https://humanfactors.jmir.org/2021/1/e25724", url="http://www.ncbi.nlm.nih.gov/pubmed/33621187" } @Article{info:doi/10.2196/25505, author="Husain, Amna and Cohen, Eyal and Dubrowski, Raluca and Jamieson, Trevor and Kurahashi, Miyoshi Allison and Lokuge, Bhadra and Rapoport, Adam and Saunders, Stephanie and Stasiulis, Elaine and Stinson, Jennifer and Subramaniam, Saranjah and Wegier, Pete and Barwick, Melanie", title="A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study", journal="J Med Internet Res", year="2021", month="Mar", day="3", volume="23", number="3", pages="e25505", keywords="coordination of care", keywords="complexity", keywords="internet communication technology", keywords="collaborative care", keywords="implementation science", keywords="theory of behavior", keywords="interprofessional team", keywords="patient engagement", keywords="social networking technology", keywords="user-centered design", keywords="Consolidated Framework for Implementation Research", keywords="Quality Improvement Framework", keywords="Implementation Outcome Taxonomy", abstract="Background: Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. Objective: The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. Methods: The study was a hybrid type II mixed methods design to simultaneously evaluate Loop's clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. Results: We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop's potential value for engaging the patient and caregiver, and for improving communication within the patient's circle of care, Loop's relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. Conclusions: Fundamental structural and implementation challenges persist toward realizing Loop's potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication. ", doi="10.2196/25505", url="https://www.jmir.org/2021/3/e25505", url="http://www.ncbi.nlm.nih.gov/pubmed/33656445" } @Article{info:doi/10.2196/23370, author="Guinez-Molinos, Sergio and Gonzalez D{\'i}az, Jaime and Gomar Sancho, Carmen and Espinoza, Paulina and Constenla, Gustavo", title="A Web Platform (MOSAICO) to Design, Perform, and Assess Collaborative Clinical Scenarios for Medical Students: Viewpoint", journal="JMIR Med Educ", year="2021", month="Jan", day="26", volume="7", number="1", pages="e23370", keywords="collaborative clinical simulation", keywords="electronic simulation record", keywords="medical students", keywords="medical education", keywords="MOSAICO", abstract="Background: The collaborative clinical simulation (CCS) model is a structured method for the development and assessment of clinical competencies through small groups working collaboratively in simulated environments. From 2016 onward, the CCS model has been applied successfully among undergraduate and graduate medical students from the Universidad de Talca, Chile; the Universit{\"a}t de Barcelona, Spain; and the Universidad de Vic-Manresa, Spain. All the templates for building the clinical cases and the assessment instruments with CCS were printed on paper. Considering the large number of CCS sessions and the number of participating students that are required throughout the medical degree curriculum, it is impossible to keep an organized record when the instruments are printed on paper. Moreover, with the COVID-19 pandemic, web platforms have become important as safe training environments for students and medical faculties; this new educational environment should include the consolidation and adaptation of didactic sessions that create and use available virtual cases and use different web platforms. Objective: The goal of this study is to describe the design and development of a web platform that was created to strengthen the CCS model. Methods: The design of the web platform aimed to support each phase of the CCS by incorporating functional requirements (ie, features that the web platform will be able to perform) and nonfunctional requirements (ie, how the web platform should behave) that are needed to run collaborative sessions. The software was developed under the Model-View-Controller architecture to separate the views from the data model and the business logic. Results: MOSAICO is a web platform used to design, perform, and assess collaborative clinical scenarios for medical students. MOSAICO has four modules: educational design, students' collaborative design, collaborative simulation, and collaborative debriefing. The web platform has three different user profiles: academic simulation unit, teacher, and student. These users interact under different roles in collaborative simulations. MOSAICO enables a collaborative environment, which is connected via the internet, to design clinical scenarios guided by the teacher and enables the use of all data generated to be discussed in the debriefing session with the teacher as a guide. The web platform is running at the Universidad de Talca in Chile and is supporting collaborative simulation activities via the internet for two medical courses: (1) Semiology for third-year students (70 students in total) and (2) Medical Genetics for fifth-year students (30 students in total). Conclusions: MOSAICO is applicable within the CCS model and is used frequently in different simulation sessions at the Universidad de Talca, where medical students can work collaboratively via the internet. MOSAICO simplifies the application and reuse of clinical simulation scenarios, allowing its use in multiple simulation centers. Moreover, its applications in different courses (ie, a large part of the medical curriculum) support the automatic tracking of simulation activities and their assessment. ", doi="10.2196/23370", url="http://mededu.jmir.org/2021/1/e23370/", url="http://www.ncbi.nlm.nih.gov/pubmed/33496676" } @Article{info:doi/10.2196/23184, author="Kawamoto, Eiji and Ito-Masui, Asami and Esumi, Ryo and Ito, Mami and Mizutani, Noriko and Hayashi, Tomoyo and Imai, Hiroshi and Shimaoka, Motomu", title="Social Network Analysis of Intensive Care Unit Health Care Professionals Measured by Wearable Sociometric Badges: Longitudinal Observational Study", journal="J Med Internet Res", year="2020", month="Dec", day="31", volume="22", number="12", pages="e23184", keywords="wearable", keywords="interprofessional communication", keywords="clinician interaction", keywords="social network analysis", abstract="Background: Use of wearable sensor technology for studying human teamwork behavior is expected to generate a better understanding of the interprofessional interactions between health care professionals. Objective: We used wearable sociometric sensor badges to study how intensive care unit (ICU) health care professionals interact and are socially connected. Methods: We studied the face-to-face interaction data of 76 healthcare professionals in the ICU at Mie University Hospital collected over 4 weeks via wearable sensors. Results: We detail the spatiotemporal distributions of staff members' inter- and intraprofessional active face-to-face interactions, thereby generating a comprehensive visualization of who met whom, when, where, and for how long in the ICU. Social network analysis of these active interactions, concomitant with centrality measurements, revealed that nurses constitute the core members of the network, while doctors remain in the periphery. Conclusions: Our social network analysis using the comprehensive ICU interaction data obtained by wearable sensors has revealed the leading roles played by nurses within the professional communication network. ", doi="10.2196/23184", url="http://www.jmir.org/2020/12/e23184/", url="http://www.ncbi.nlm.nih.gov/pubmed/33258785" } @Article{info:doi/10.2196/11968, author="Opipari-Arrigan, Lisa and Dykes, H. Dana M. and Saeed, A. Shehzad and Thakkar, Sunny and Burns, Lisa and Chini, A. Barbara and McPhail, L. Gary and Eslick, Ian and Margolis, A. Peter and Kaplan, C. Heather", title="Technology-Enabled Health Care Collaboration in Pediatric Chronic Illness: Pre-Post Interventional Study for Feasibility, Acceptability, and Clinical Impact of an Electronic Health Record--Linked Platform for Patient-Clinician Partnership", journal="JMIR Mhealth Uhealth", year="2020", month="Nov", day="26", volume="8", number="11", pages="e11968", keywords="health services research", keywords="mHealth", keywords="eHealth", keywords="patient engagement", keywords="chronic illness", keywords="mobile phone", abstract="Background: Mobile health (mHealth) technology has the potential to support the Chronic Care Model's vision of closed feedback loops and patient-clinician partnerships. Objective: This study aims to evaluate the feasibility, acceptability, and short-term impact of an electronic health record--linked mHealth platform (Orchestra) supporting patient and clinician collaboration through real-time, bidirectional data sharing. Methods: We conducted a 6-month prospective, pre-post, proof-of-concept study of Orchestra among patients and parents in the Cincinnati Children's Hospital inflammatory bowel disease (IBD) and cystic fibrosis (CF) clinics. Participants and clinicians used Orchestra during and between visits to complete and view patient-reported outcome (PRO) measures and previsit plans. Surveys completed at baseline and at 3- and 6-month follow-up visits plus data from the platform were used to assess outcomes including PRO completion rates, weekly platform use, disease self-efficacy, and impact on care. Analyses included descriptive statistics; pre-post comparisons; Pearson correlations; and, if applicable, effect sizes. Results: We enrolled 92 participants (CF: n=52 and IBD: n=40), and 73\% (67/92) completed the study. Average PRO completion was 61\%, and average weekly platform use was 80\%. Participants reported improvement in self-efficacy from baseline to 6 months (7.90 to 8.44; P=.006). At 6 months, most participants reported that the platform was useful (36/40, 90\%) and had a positive impact on their care, including improved visit quality (33/40, 83\%), visit collaboration (35/40, 88\%), and visit preparation (31/40, 78\%). PRO completion was positively associated with multiple indicators of care impact at 3 and 6 months. Conclusions: Use of an mHealth tool to support closed feedback loops through real-time data sharing and patient-clinician collaboration is feasible and shows indications of acceptability and promise as a strategy for improving pediatric chronic illness management. ", doi="10.2196/11968", url="https://mhealth.jmir.org/2020/11/e11968", url="http://www.ncbi.nlm.nih.gov/pubmed/33242014" } @Article{info:doi/10.2196/19267, author="Hauser, G. Ronald and Bhargava, Ankur and Talmage, Ronald and Aslan, Mihaela and Concato, John", title="Data Object Exchange (DOEx) as a Method to Facilitate Intraorganizational Collaboration by Managed Data Sharing: Viewpoint", journal="JMIR Med Inform", year="2020", month="Oct", day="27", volume="8", number="10", pages="e19267", keywords="information-seeking behavior", keywords="information services", keywords="communication media", keywords="database", keywords="database management system", abstract="Background: To help reduce expenses, shorten timelines, and improve the quality of final deliverables, the Veterans Health Administration (VA) and other health care systems promote sharing of expertise among informatics user groups. Traditional barriers to time-efficient sharing of expertise include difficulties in finding potential collaborators and availability of a mechanism to share expertise. Objective: We aim to describe how the VA shares expertise among its informatics groups by describing a custom-built tool, the Data Object Exchange (DOEx), along with statistics on its usage. Methods: A centrally managed web application was developed in the VA to share informatics expertise using database objects. Visitors to the site can view a catalog of objects published by other informatics user groups. Requests for subscription and publication made through the site are routed to database administrators, who then actualize the resource requests through modifications of database object permissions. Results: As of April 2019, the DOEx enabled the publication of 707 database objects to 1202 VA subscribers from 758 workgroups. Overall, over 10,000 requests are made each year regarding permissions on these shared database objects, involving diverse information. Common ``flavors'' of shared data include disease-specific study populations (eg, patients with asthma), common data definitions (eg, hemoglobin laboratory results), and results of complex analyses (eg, models of anticipated resource utilization). Shared database objects also enable construction of community-built data pipelines. Conclusions: To increase the efficiency of informatics user groups, a method was developed to facilitate intraorganizational collaboration by managed data sharing. The advantages of this system include (1) reduced duplication of work (thereby reducing expenses and shortening timelines) and (2) higher quality of work based on simplifying the adoption of specialized knowledge among groups. ", doi="10.2196/19267", url="http://medinform.jmir.org/2020/10/e19267/", url="http://www.ncbi.nlm.nih.gov/pubmed/33107829" } @Article{info:doi/10.2196/20848, author="Lee, Seohyun and Kim, Eunji and Desta, Birhane Tekaligne", title="Gaps in Team Communication About Service Statistics Among Health Extension Workers in Ethiopia: Secondary Data Analysis", journal="JMIR Mhealth Uhealth", year="2020", month="Sep", day="8", volume="8", number="9", pages="e20848", keywords="team communication", keywords="health extension workers", keywords="mobile communication", keywords="mobile data collection", keywords="Ethiopia", keywords="health worker", keywords="communication", keywords="data", abstract="Background: In Ethiopia, health extension workers (HEWs) are deployed across the country by the government to meet public health needs. Team communication is important for effective teamwork, but community health workers in low-resource settings like Ethiopia may face challenges in carrying out team meetings to compile service statistics. This is due to the nature of their outreach activities, which requires extensive travel. Objective: This study aimed to identify gaps in team communication about service statistics among HEWs in Ethiopia. Considering mobile communication and data collection as tools for bridging these gaps, we examined disparities in access to electricity, which has been identified as one of the major barriers to this approach. Methods: Data from the most recent Performance Monitoring and Accountability 2020 service delivery point survey were used for our analysis. Logistic regression analysis was performed to identify disparities in team communication on service statistics for family planning, which is a major component of the HEW's job. Disparities were examined across health facilities with different levels of HEW integration in their staffing structure (ie, no HEWs, at least one HEW, or only HEWs). Additionally, a chi-square test was conducted to examine disparities in access to electricity to explore the potential of mobile communication and data collection integration. Results: In total, 427 health facilities of four different types (ie, hospitals, health centers, health posts, and health clinics) were included in our analysis. At most health posts (84/95, 88\%), only HEWs were employed; none of the health clinics integrated the HEW model into their staffing structure. Among the 84 health posts, the odds of having team meetings on family planning service statistics in the past 12 months were 0.48 times the odds of those without HEWs (P=.02). No statistically significant differences were found between HEW-only facilities and facilities with at least one HEW. Most health facilities (69/83, 83.13\%) with HEWs as the only staff had no electricity at the time of the survey while 71.25\% (57/80) had intermittent access (ie, service disruption lasting 2 or more hours that day). There were statistically significant differences in electricity access among health facilities with different levels of HEW integration (P<.001). Conclusions: Facilities employing only HEWs were less likely to have regular team meetings to discuss service statistics. Since their responsibilities involve extensive outreach activities, travel, and paper-based recordkeeping, empowering HEWs with mobile communication and data collection can be a workable solution. The empirical evidence regarding disparities in electricity access also supports the need for and the feasibility of this approach. ", doi="10.2196/20848", url="http://mhealth.jmir.org/2020/9/e20848/", url="http://www.ncbi.nlm.nih.gov/pubmed/32897231" } @Article{info:doi/10.2196/17279, author="Liaw, Ying Sok and Ooi, Win Sim and Rusli, Bin Khairul Dzakirin and Lau, Ching Tang and Tam, San Wilson Wai and Chua, Ling Wei", title="Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes", journal="J Med Internet Res", year="2020", month="Apr", day="8", volume="22", number="4", pages="e17279", keywords="interprofessional education", keywords="team training", keywords="nurse-physician communication", keywords="virtual reality", keywords="simulation", abstract="Background: Interprofessional team training is needed to improve nurse-physician communication skills that are lacking in clinical practice. Using simulations has proven to be an effective learning approach for team training. Yet, it has logistical constraints that call for the exploration of virtual environments in delivering team training. Objective: This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students' communication skill performances and teamwork attitudes. Methods: In June 2018, the authors implemented nurse-physician communication team training using communication tools. A randomized controlled trial study was conducted with 120 undergraduate medical and nursing students who were randomly assigned to undertake team training using virtual reality or live simulations. The participants from both groups were tested on their communication performances through team-based simulation assessments. Their teamwork attitudes were evaluated using interprofessional attitude surveys that were administered before, immediately after, and 2 months after the study interventions. Results: The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups. Both groups reported significant increases in the interprofessional attitudes posttest scores from the baseline scores, with no significant differences found between the groups over the 3 time points. Conclusions: Our study outcomes did not show an inferiority of team training using virtual reality when compared with live simulations, which supports the potential use of virtual reality to substitute conventional simulations for communication team training. Future studies can leverage the use of artificial intelligence technology in virtual reality to replace costly human-controlled facilitators to achieve better scalability and sustainability of team-based training in interprofessional education. Trial Registration: ClinicalTrials.gov NCT04330924; https://clinicaltrials.gov/ct2/show/NCT04330924 ", doi="10.2196/17279", url="https://www.jmir.org/2020/4/e17279", url="http://www.ncbi.nlm.nih.gov/pubmed/32267235" } @Article{info:doi/10.2196/17131, author="Hilt, D. Alexander and Kaptein, A. Ad and Schalij, J. Martin and van Schaik, Jan", title="Teamwork and Safety Attitudes in Complex Aortic Surgery at a Dutch Hospital: Cross-Sectional Survey Study", journal="JMIR Hum Factors", year="2020", month="Apr", day="8", volume="7", number="2", pages="e17131", keywords="human factors", keywords="organizational culture", keywords="SAQ", keywords="SAQ-NL", keywords="safety assessment", keywords="vascular surgery", abstract="Background: Improving teamwork in surgery is a complex goal and difficult to achieve. Human factors questionnaires, such as the Safety Attitudes Questionnaire (SAQ), can help us understand medical teamwork and may assist in achieving this goal. Objective: This paper aimed to assess local team and safety culture in a cardiovascular surgery setting to understand how purposeful teamwork improvements can be reached. Methods: Two cardiovascular surgical teams performing complex aortic treatments were assessed: an endovascular-treatment team (ETT) and an open-treatment team (OTT). Both teams answered an online version of the SAQ Dutch Edition (SAQ-NL) consisting of 30 questions related to six different domains of safety: teamwork climate, safety climate, job satisfaction, stress recognition, perceptions of management, and working conditions. In addition, one open-ended question was posed to gain more insight into the completed questionnaires. Results: The SAQ-NL was completed by all 23 ETT members and all 13 OTT members. Team composition was comparable for both teams: 57\% and 62\% males, respectively, and 48\% and 54\% physicians, respectively. All participants worked for 10 years or more in health care. SAQ-NL mean scores were comparable between both teams, with important differences found between the physicians and nonphysicians of the ETT. Nonphysicians were less positive about the safety climate, job satisfaction, and working climate domains than were the physicians (P<.05). Additional education on performed procedures, more conjoined team training, as well as a hybrid operating room were suggested by participants as important areas of improvement. Conclusions: Nonphysicians of a local team performing complex endovascular aortic aneurysm surgery perceived safety climate, job satisfaction, and working conditions less positively than did physicians from the same team. Open-ended questions suggested that this is related to a lack of adequate conjoined training, lack of adequate education, and lack of an adequate operating room. With added open-ended questions, the SAQ-NL appears to be an assessment tool that allows for developing strategies that are instrumental in improving quality of care. ", doi="10.2196/17131", url="https://humanfactors.jmir.org/2020/2/e17131", url="http://www.ncbi.nlm.nih.gov/pubmed/32267238" } @Article{info:doi/10.2196/16047, author="Roosan, Don and Law, V. Anandi and Karim, Mazharul and Roosan, Moom", title="Improving Team-Based Decision Making Using Data Analytics and Informatics: Protocol for a Collaborative Decision Support Design", journal="JMIR Res Protoc", year="2019", month="Nov", day="27", volume="8", number="11", pages="e16047", keywords="informatics", keywords="health care team", keywords="data science", keywords="decision support techniques", keywords="decision-making, computer-assisted", keywords="data display", keywords="diagnosis, computer-assisted", abstract="Background: According to the September 2015 Institute of Medicine report, Improving Diagnosis in Health Care, each of us is likely to experience one diagnostic error in our lifetime, often with devastating consequences. Traditionally, diagnostic decision making has been the sole responsibility of an individual clinician. However, diagnosis involves an interaction among interprofessional team members with different training, skills, cultures, knowledge, and backgrounds. Moreover, diagnostic error is prevalent in the interruption-prone environment, such as the emergency department, where the loss of information may hinder a correct diagnosis. Objective: The overall purpose of this protocol is to improve team-based diagnostic decision making by focusing on data analytics and informatics tools that improve collective information management. Methods: To achieve this goal, we will identify the factors contributing to failures in team-based diagnostic decision making (aim 1), understand the barriers of using current health information technology tools for team collaboration (aim 2), and develop and evaluate a collaborative decision-making prototype that can improve team-based diagnostic decision making (aim 3). Results: Between 2019 to 2020, we are collecting data for this study. The results are anticipated to be published between 2020 and 2021. Conclusions: The results from this study can shed light on improving diagnostic decision making by incorporating diagnostics rationale from team members. We believe a positive direction to move forward in solving diagnostic errors is by incorporating all team members, and using informatics. International Registered Report Identifier (IRRID): DERR1-10.2196/16047 ", doi="10.2196/16047", url="http://www.researchprotocols.org/2019/11/e16047/", url="http://www.ncbi.nlm.nih.gov/pubmed/31774412" } @Article{info:doi/10.2196/humanfactors.9891, author="Mercer, Kathryn and Burns, Catherine and Guirguis, Lisa and Chin, Jessie and Dogba, Joyce Maman and Dolovich, Lisa and Gu{\'e}nette, Line and Jenkins, Laurie and L{\'e}gar{\'e}, France and McKinnon, Annette and McMurray, Josephine and Waked, Khrystine and Grindrod, A. Kelly", title="Physician and Pharmacist Medication Decision-Making in the Time of Electronic Health Records: Mixed-Methods Study?", journal="JMIR Hum Factors", year="2018", month="Sep", day="25", volume="5", number="3", pages="e24", keywords="shared decision-making", keywords="electronic health records", keywords="collaboration", keywords="interprofessional collaboration", keywords="medication management", abstract="Background: Primary care needs to be patient-centered, integrated, and interprofessional to help patients with complex needs manage the burden of medication-related problems. Considering the growing problem of polypharmacy, increasing attention has been paid to how and when medication-related decisions should be coordinated across multidisciplinary care teams. Improved knowledge on how integrated electronic health records (EHRs) can support interprofessional shared decision-making for medication therapy management is necessary to continue improving patient care. Objective: The objective of our study was to examine how physicians and pharmacists understand and communicate patient-focused medication information with each other and how this knowledge can influence the design of EHRs. Methods: This study is part of a broader cross-Canada study between patients and health care providers around how medication-related decisions are made and communicated. We visited community pharmacies, team-based primary care clinics, and independent-practice family physician clinics throughout Ontario, Nova Scotia, Alberta, and Quebec. Research assistants conducted semistructured interviews with physicians and pharmacists. A modified version of the Multidisciplinary Framework Method was used to analyze the data. Results: We collected data from 19 pharmacies and 9 medical clinics and identified 6 main themes from 34 health care professionals. First, Interprofessional Shared Decision-Making was not occurring and clinicians made decisions based on their understanding of the patient. Physicians and pharmacists reported indirect Communication, incomplete Information specifically missing insight into indication and adherence, and misaligned Processes of Care that were further compounded by EHRs that are not designed to facilitate collaboration. Scope of Practice examined professional and workplace boundaries for pharmacists and physicians that were internally and externally imposed. Physicians decided on the degree of the Physician-Pharmacist Relationship, often predicated by colocation. Conclusions: We observed limited communication and collaboration between primary care providers and pharmacists when managing medications. Pharmacists were missing key information around reason for use, and physicians required accurate information around adherence. EHRs are a potential tool to help clinicians communicate information to resolve this issue. EHRs need to be designed to facilitate interprofessional medication management so that pharmacists and physicians can move beyond task-based work toward a collaborative approach. ", doi="10.2196/humanfactors.9891", url="http://humanfactors.jmir.org/2018/3/e24/", url="http://www.ncbi.nlm.nih.gov/pubmed/30274959" } @Article{info:doi/10.2196/resprot.7106, author="Ramirez, Magaly and Wu, Shinyi and Ryan, Gery and Towfighi, Amytis and Vickrey, G. Barbara", title="Using Beta-Version mHealth Technology for Team-Based Care Management to Support Stroke Prevention: An Assessment of Utility and Challenges", journal="JMIR Res Protoc", year="2017", month="May", day="23", volume="6", number="5", pages="e94", keywords="community health workers", keywords="stroke", keywords="patient care management", keywords="patient care team", keywords="mobile devices", keywords="mobile applications", keywords="health care information systems", abstract="Background: Beta versions of health information technology tools are needed in service delivery models with health care and community partnerships to confirm the key components and to assess the performance of the tools and their impact on users. We developed a care management technology (CMT) for use by community health workers (CHWs) and care managers (CMs) working collaboratively to improve risk factor control among recent stroke survivors. The CMT was expected to enhance the efficiency and effectiveness of the CHW-CM team. Objective: The primary objective was to describe the Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities (SUCCEED) CMT and investigate CM and CHW perceptions of the CMT's usefulness and challenges for team-based care management. Methods: We conducted qualitative interviews with all users of the beta-version SUCCEED CMT, namely two CMs and three CHWs. They were asked to demonstrate and describe their perceptions of the CMT's ease of use and usefulness for completing predefined key care management activities. They were also probed about their general perceptions of the CMT's information quality, ease of use, usefulness, and impact on CM and CHW roles. Interview transcripts were coded using a priori codes. Coded excerpts were grouped into broader themes and then related in a conceptual model of how the CMT facilitated care management. We also conducted a survey with 14 patients to obtain their perspective on CHW tablet use during CHW-patient interactions. Results: Care managers and community health workers expressed that the CMT helped them keep track of patient interactions and plan their work. It guided CMs in developing and sharing care plans with CHWs. For CHWs, the CMT enabled electronic collection of clinical assessment data, provided decision support, and provided remote access to patients' risk factor values. Long loading times and downtimes due to outages were the most significant challenges encountered. Additional issues included extensive use of free-text responses and manual data transfer from the electronic medical record. Despite these challenges, patients overall did not perceive the tablet as interfering with CHW-patient interactions. Conclusions: Our findings suggest useful functionalities of CMTs supporting health care and community partners in collaborative chronic care management. However, usability issues need to be addressed during the development process. The SUCCEED CMT is an initial step toward the development of effective health information technology tools to support collaborative, team-based models of care and will need to be modified as the evidence base grows. Future research should assess the CMT's effects on team performance. ", doi="10.2196/resprot.7106", url="http://www.researchprotocols.org/2017/5/e94/", url="http://www.ncbi.nlm.nih.gov/pubmed/28536094" } @Article{info:doi/10.2196/humanfactors.6642, author="Abraham, Joanna and Kannampallil, G. Thomas and Patel, L. Vimla and Patel, Bela and Almoosa, F. Khalid", title="Impact of Structured Rounding Tools on Time Allocation During Multidisciplinary Rounds: An Observational Study", journal="JMIR Hum Factors", year="2016", month="Dec", day="09", volume="3", number="2", pages="e29", keywords="teaching rounds", keywords="communication", keywords="intensive care units", abstract="Background: Recent research has shown evidence of disproportionate time allocation for patient communication during multidisciplinary rounds (MDRs). Studies have shown that patients discussed later during rounds receive lesser time. Objective: The aim of our study was to investigate whether disproportionate time allocation effects persist with the use of structured rounding tools. Methods: Using audio recordings of rounds (N=82 patients), we compared time allocation and communication breakdowns between a problem-based Subjective, Objective, Assessment, and Plan (SOAP) and a system-based Handoff Intervention Tool (HAND-IT) rounding tools. Results: We found no significant linear dependence of the order of patient presentation on the time spent or on communication breakdowns for both structured tools. However, for the problem-based tool, there was a significant linear relationship between the time spent on discussing a patient and the number of communication breakdowns (P<.05)----with an average of 1.04 additional breakdowns with every 120 seconds in discussion. Conclusions: The use of structured rounding tools potentially mitigates disproportionate time allocation and communication breakdowns during rounds, with the more structured HAND-IT, almost completely eliminating such effects. These results have potential implications for planning, prioritization, and training for time management during MDRs. ", doi="10.2196/humanfactors.6642", url="http://humanfactors.jmir.org/2016/2/e29/", url="http://www.ncbi.nlm.nih.gov/pubmed/27940423" } @Article{info:doi/10.2196/publichealth.3381, author="Kaphle, Sangya and Matheke-Fischer, Michael and Lesh, Neal", title="Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial", journal="JMIR Public Health Surveill", year="2016", month="Dec", day="07", volume="2", number="2", pages="e169", keywords="community health workers", keywords="performance feedback", keywords="motivation", keywords="supportive supervision", keywords="mHealth apps", abstract="Background: Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective: The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods: In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results: We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass's delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass's delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions: Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation. ", doi="10.2196/publichealth.3381", url="http://publichealth.jmir.org/2016/2/e169/", url="http://www.ncbi.nlm.nih.gov/pubmed/27927607" } @Article{info:doi/10.2196/humanfactors.5640, author="Percival, Jennifer and McGregor, Carolyn", title="An Evaluation of Understandability of Patient Journey Models in Mental Health", journal="JMIR Hum Factors", year="2016", month="Jul", day="28", volume="3", number="2", pages="e20", keywords="patient-journey modeling", keywords="process modeling", keywords="technology integration", keywords="health information technology", abstract="Background: There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives: This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method: Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results: The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions: The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot case study to a more diversified group of clinicians and health care support workers. ", doi="10.2196/humanfactors.5640", url="http://humanfactors.jmir.org/2016/2/e20/", url="http://www.ncbi.nlm.nih.gov/pubmed/27471006" }