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Purpose This study seeks to understand the key inhibitors for health information exchange (HIE) by ambulatory (outpatient) clinics. We examine the key technological, organizational and environmental factors that inhibit an ambulatory clinic from electronically exchanging health information with external clinics and hospitals. Methods We utilize survey data from 1285 ambulatory clinics in the US state of Minnesota. Using logistic regressions, we assess if the ambulatory clinic’s HIE with external clinics and external hospitals are associated with fourteen inhibitors from technological, organizational and environmental contexts in which ambulatory clinics operate. Results Among the technological inhibitors, we find lack of adequate technological infrastructure, difficulties in integrating external data with electronic medical record systems, and security concerns to inhibit ambulatory clinics’ HIE with both clinics and hospitals. Inadequate technical support was a barrier for HIE with hospitals, whereas inadequate training of staff was an inhibitor for clinic-to-clinic HIE. Of the environmental variables, legal concerns and complexity in framing HIE agreements with partners were found to inhibit ambulatory clinics’ HIE with both external clinics and hospitals. Lack of partner readiness and ability was an inhibiting factor for clinic-to-hospital HIE whereas issues in patient consent, and problems in choosing the right vendor with a good fit were inhibiting ambulatory clinics’ HIE with other clinics. Among the organizational variables, lack of adequate senior leadership support and complexity of workflow changes inhibited clinic-to-clinic health data sharing, whereas unclear return on investment (ROI) for HIE was a deterrent for ambulatory clinics’ HIE with hospitals. Conclusions This study throws light on electronic HIE practices and its key inhibitors in ambulatory clinics, an understudied area in digital health. This paper provides unique insights into specific inhibitors that deter clinic-to-clinic health information sharing versus those that affect and clinic-to-hospital health information exchange.

Wearable healthcare devices offer tremendous promise to effectively track and improve the well-being of older adults. Yet, little is known about the use of wearable devices by older adults. Drawing upon a national survey in US with 1481 older adults, we examine the use of wearable healthcare devices and the key predictors of use viz. sociodemographic factors, health conditions, and technology self-efficacy. We also examine if the predictors are associated with elders’ willingness to share health data from wearable devices with healthcare providers. We find low level of wearable use (17.49%) among US older adults. We find significant positive associations between technology self-efficacy, health conditions, and demographic factors (gender, race, education, and annual household income) and use of wearable devices. Men were less likely (OR = 0.62, 95% CI 0.36–1.04) and Asians were more likely (OR = 2.60, 95% CI 0.89–7.64) to use wearables, as did healthy adults (OR = 1.98, 95% CI 1.37–2.87). Those who electronically communicated with their doctors (OR = 1.86, 95% CI 1.16–2.97), and those who searched online for health information (OR = 1.79, 95% CI 1.03–3.10) were more likely to use wearables. Though 80.15% of wearable users are willing to share health data with providers, those with greater technology self-efficacy and favorable attitudes toward exercise are more willing.

BackgroundWith restrictions on movement and stay-at-home orders in place due to the COVID-19 pandemic, social media platforms such as Twitter have become an outlet for users to express their concerns, opinions, and feelings about the pandemic. Individuals, health agencies, and governments are using Twitter to communicate about COVID-19.ObjectiveThe aims of this study were to examine key themes and topics of English-language COVID-19–related tweets posted by individuals and to explore the trends and variations in how the COVID-19–related tweets, key topics, and associated sentiments changed over a period of time from before to after the disease was declared a pandemic.MethodsBuilding on the emergent stream of studies examining COVID-19–related tweets in English, we performed a temporal assessment covering the time period from January 1 to May 9, 2020, and examined variations in tweet topics and sentiment scores to uncover key trends. Combining data from two publicly available COVID-19 tweet data sets with those obtained in our own search, we compiled a data set of 13.9 million English-language COVID-19–related tweets posted by individuals. We use guided latent Dirichlet allocation (LDA) to infer themes and topics underlying the tweets, and we used VADER (Valence Aware Dictionary and sEntiment Reasoner) sentiment analysis to compute sentiment scores and examine weekly trends for 17 weeks.ResultsTopic modeling yielded 26 topics, which were grouped into 10 broader themes underlying the COVID-19–related tweets. Of the 13,937,906 examined tweets, 2,858,316 (20.51%) were about the impact of COVID-19 on the economy and markets, followed by spread and growth in cases (2,154,065, 15.45%), treatment and recovery (1,831,339, 13.14%), impact on the health care sector (1,588,499, 11.40%), and governments response (1,559,591, 11.19%). Average compound sentiment scores were found to be negative throughout the examined time period for the topics of spread and growth of cases, symptoms, racism, source of the outbreak, and political impact of COVID-19. In contrast, we saw a reversal of sentiments from negative to positive for prevention, impact on the economy and markets, government response, impact on the health care industry, and treatment and recovery.ConclusionsIdentification of dominant themes, topics, sentiments, and changing trends in tweets about the COVID-19 pandemic can help governments, health care agencies, and policy makers frame appropriate responses to prevent and control the spread of the pandemic.

Background Despite the growing popularity of wearable health care devices (from fitness trackes such as Fitbit to smartwatches such as Apple Watch and more sophisticated devices that can collect information on metrics such as blood pressure, glucose levels, and oxygen levels), we have a limited understanding about the actual use and key factors affecting the use of these devices by US adults. Objective The main objective of this study was to examine the use of wearable health care devices and the key predictors of wearable use by US adults. Methods Using a national survey of 4551 respondents, we examined the usage patterns of wearable health care devices (use of wearables, frequency of their use, and willingness to share health data from a wearable with a provider) and a set of predictors that pertain to personal demographics (age, gender, race, education, marital status, and household income), individual health (general health, presence of chronic conditions, weight perceptions, frequency of provider visits, and attitude towards exercise), and technology self-efficacy using logistic regression analysis. Results About 30% (1266/4551) of US adults use wearable health care devices. Among the users, nearly half (47.33%) use the devices every day, with a majority (82.38% weighted) willing to share the health data from wearables with their care providers. Women (16.25%), White individuals (19.74%), adults aged 18-50 years (19.52%), those with some level of college education or college graduates (25.60%), and those with annual household incomes greater than US $75,000 (17.66%) were most likely to report using wearable health care devices. We found that the use of wearables declines with age: Adults aged >50 years were less likely to use wearables compared to those aged 18-34 years (odds ratios [OR] 0.46-0.57). Women (OR 1.26, 95% CI 0.96-1.65), White individuals (OR 1.65, 95% CI 0.97-2.79), college graduates (OR 1.05, 95% CI 0.31-3.51), and those with annual household incomes greater than US $75,000 (OR 2.6, 95% CI 1.39-4.86) were more likely to use wearables. US adults who reported feeling healthier (OR 1.17, 95% CI 0.98-1.39), were overweight (OR 1.16, 95% CI 1.06-1.27), enjoyed exercise (OR 1.23, 95% CI 1.06-1.43), and reported higher levels of technology self-efficacy (OR 1.33, 95% CI 1.21-1.46) were more likely to adopt and use wearables for tracking or monitoring their health. Conclusions The potential of wearable health care devices is under-realized, with less than one-third of US adults actively using these devices. With only younger, healthier, wealthier, more educated, technoliterate adults using wearables, other groups have been left behind. More concentrated efforts by clinicians, device makers, and health care policy makers are needed to bridge this divide and improve the use of wearable devices among larger sections of American society.

The paper draws on information processing theory to propose that national diversity creates barriers to the integration of information among members of global software development teams, negatively impacting software quality and development speed. However, the effect of such relationships was expected to be contingent upon the amount of time that team members had worked together in the past (i.e., previous working ties). Hypotheses were tested in a field study involving 62 global software development teams distributed across Europe and Central and South America. Teams with high levels of previous working ties developed greater quality software at a faster pace. National diversity had a positive effect on software quality in teams with high levels of previous working ties, but a negative effect in teams with low levels of previous working ties. National diversity also had a negative impact on software development speed, but the effect was less pronounced among teams with high levels of previous working ties than on teams low in previous working ties.

Background Despite the potential benefits of electronic health information exchange (HIE) to improve the quality and efficiency of care, HIE use by ambulatory providers remains low. Ambulatory providers can greatly improve the quality of care by electronically exchanging health information with affiliated providers within their health care network as well as with unaffiliated, external providers. Objective This study aimed to examine the extent of electronic HIE use by ambulatory clinics with affiliated providers within their health system and with external providers, as well as the key technological, organizational, and environmental factors affecting the extent of HIE use within and outside the health system. Methods A Web-based survey of 320 ambulatory care providers was conducted in the state of Illinois. The study examined the extent of HIE usage by ambulatory providers with hospitals, clinics, and other facilities within and outside their health care system–encompassing seven kinds of health care data. Ten factors pertaining to technology (IT [information technology] Compatibility, External IT Support, Security & Privacy Safeguards), organization (Workflow Adaptability, Senior Leadership Support, Clinicians Health-IT Knowledge, Staff Health-IT Knowledge), and environment (Government Efforts & Incentives, Partner Readiness, Competitors and Peers) were assessed. A series of multivariate regressions were used to examine predictor effects. Results The 6 regressions produced adjusted R-squared values ranging from 0.44 to 0.63. We found that ambulatory clinics exchanged more health information electronically with affiliated entities within their health system as compared with those outside their health system. Partner readiness emerged as the most significant predictor of HIE usage with all entities. Governmental initiatives for HIE, clinicians’ prior familiarity and knowledge of health IT systems, implementation of appropriate security, and privacy safeguards were also significant predictors. External information technology support and workflow adaptability emerged as key predictors for HIE use outside a clinic’s health system. Differences based on clinic size, ownership, and specialty were also observed. Conclusions This study provides exploratory insights into HIE use by ambulatory providers within and outside their health care system and differential predictors that impact HIE use. HIE use can be further improved by encouraging large-scale interoperability efforts, improving external IT support, and redesigning adaptable workflows.