Search

Purpose: Digital health evaluation frameworks are needed to guide the development, implementation and evaluation of innovative, integrated systems of digital care. In this paper we describe a framework that was developed to evaluate the implementation of digital health technologies at a regional level. Materials and Methods: The framework was developed in a series of iterative phases beginning with a review of digital health frameworks used in Canada, which was followed by a scoping review focused on frameworks, models and theories used internationally to evaluate digital health technologies. Data extracted from articles were analyzed thematically to arrive at factors, concepts and measures that were incorporated in the final version of the framework following researcher discussions. Results: A range of themes and concepts emerged in the areas of: (1) organizational and context factors, (2) system, (3) use and process, and (4) outcomes. Conclusions: Several new themes and concepts were identified and incorporated into the new digital health evaluation framework.

BackgroundOver the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment. ObjectiveWe aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety. MethodsA web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed. ResultsParticipants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention. ConclusionsThere are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety.

BackgroundJourney maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies may exist between journey maps and the concept of a learning health system (LHS). The overarching goal of an LHS is to use health care data to inform clinical practice and improve service delivery processes and patient outcomes. ObjectiveThe purpose of this review was to assess the literature and establish a relationship between journey mapping techniques and LHSs. Specifically, in this study, we explored the current state of the literature to answer the following research questions: (1) Is there a relationship between journey mapping techniques and an LHS in the literature? (2) Is there a way to integrate the data from journey mapping activities into an LHS? (3) How can the data gleaned from journey map activities be used to inform an LHS? MethodsA scoping review was conducted by querying the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost). Two researchers applied the inclusion criteria and assessed all articles by title and abstract in the first screen, using Covidence. Following this, a full-text review of included articles was done, with relevant data extracted, tabulated, and assessed thematically. ResultsThe initial search yielded 694 studies. Of those, 179 duplicates were removed. Following this, 515 articles were assessed during the first screening phase, and 412 were excluded, as they did not meet the inclusion criteria. Next, 103 articles were read in full, and 95 were excluded, resulting in a final sample of 8 articles that satisfied the inclusion criteria. The article sample can be subsumed into 2 overarching themes: (1) the need to evolve service delivery models in health care, and (2) the potential value of using patient journey data in an LHS. ConclusionsThis scoping review demonstrated the gap in knowledge regarding integrating the data from journey mapping activities into an LHS. Our findings highlighted the importance of using the data from patient experiences to enrich an LHS and provide holistic care. To satisfy this gap, the authors intend to continue this investigation to establish the relationship between journey mapping and the concept of LHSs. This scoping review will serve as phase 1 of an investigative series. Phase 2 will entail the creation of a holistic framework to guide and streamline data integration from journey mapping activities into an LHS. Lastly, phase 3 will provide a proof of concept to demonstrate how patient journey mapping activities could be integrated into an LHS.

The Canadian prescription process requires a person to go through several steps. Prescription medications have associated risks and benefits and it is important for people to be aware of these before and while they are taking medications. One of the approaches to informing people about new prescription medications is that they are provided Consumer Medication Information (CMI). CMI is given to Canadians at the pharmacy when they pick up prescriptions, they will be taking for the first time. This study used semi-structured interviews to examine the lived experiences of a sample of Canadians (N = 36) to identify opportunities for improvement in how and when they are informed about new prescription medications. The findings were synthesized into a journey map. Generally, participants wanted to receive CMI digitally and earlier in the prescription process. Adopting these changes could have several benefits which include loss prevention and increased accessibility to CMI as well as more participatory decision making and opportunities to ask questions. Future research is warranted to explore similar topics with a larger sample and determine what method (e.g., email, website, mobile application) would be most suitable.

An interdisciplinary team of educators from medicine, design, and informatics piloted an online journey map (JM) exercise targeting 48 medical students and physicians assistants students. The JM exercise was designed to teach about patient empathy skills, person-centred care, and the socio-ecologic determinants of health. Prior to the exercise, the students were given a sample patient archetype introducing Ms. Diaz, a person with diabetes visiting a virtual clinic. Students worked in small groups to create a JM from Ms. Diaz’ perspective about, and experiences with, a telemedicine clinic. Our preliminary qualitative analysis of the JMs from the exercise showed that learners were able to create JMs that included all key sections including process phases, user perceptions, pain points, and design opportunities. Almost half of the responses focused upon socio-cultural and socio-technical issues as opposed to strictly clinical concerns. We believe this pilot shows the potential for journey maps to be used in health professional education to empathize with patients, identify societal problems in healthcare delivery, and design responsive solutions. Furthermore, the virtual classroom format highlights the scalability and extensibility of this strategy to a broad range of educational goals.

(1) Background: To facilitate optimal prescription medication benefits and safety, it is important that people are informed about their prescription medications. As we shift towards using the digital medium to communicate medication information, it is important to address the needs and preferences of different user groups so that they are more likely to read and use this information. In this study, we examined what digital medication information (DMI) format Canadian University students want and why. (2) Methods: This study was a qualitative investigation of young (aged 18–35) Canadian University students’ (N = 36) preferences and rationale supporting these preferences with respect to three potential formats for providing DMI: email, a mobile application (app), and online. Reported advantages and disadvantages of each of the three DMI formats were identified and categorized into unique themes. (3) Results: Findings from this study suggest that Canadian University Students most want to receive DMI by email, followed by a mobile app, and finally they were least receptive to online DMI. Participants provided diverse themes of reasons supporting their preferences. (4) Conclusions: Different user groups may have different needs with respect to receiving DMI. The themes from this study suggest that using a formative evaluation framework for assessing different DMI formats may be useful in future research. Email may be the best way to share DMI with younger, generally healthy, Canadian University students who are on few medications. Further research is required to explore whether other mediums for DMI are more appropriate for users with other characteristics (e.g., older and less educated) and contexts (e.g., polypharmacy and complex conditions). Given the flexibility of digital information, DMI could plausibly be provided in multiple formats and could allow users to choose the option they like best and would be most likely to use.

The concept of eHealth literacy is beginning to be recognized as a being of key importance in the design and adoption of effective and efficient health information systems and applications targeted to lay people and patients. Indeed, many systems such as patient portals and personal health records have not been adopted due to a mismatch between the level of eHealth literacy demanded by a system and the level of eHealth literacy possessed by end users. The purpose of this paper is to present an overview of important concepts related to eHealth literacy, as well as how the notion of eHealth literacy can be applied to improve the design and adoption of consumer health information systems. This paper begins with describing the importance of eHealth literacy with respect to design of health applications for the general public paired with examples of consumer health information systems whose limited success and adoption has been attributed to the lack of consideration for eHealth literacy. This is followed by definitions of what eHealth literacy is and how it emerged from the related concept of health literacy. A model for conceptualizing the importance of aligning consumers’ eHealth literacy skills and the demands systems place on their skills is then described. Next, current tools for assessing consumers’ eHealth literacy levels are outlined, followed by an approach to systematically incorporating eHealth literacy in the deriving requirements for new systems is presented. Finally, a discussion of evolving approaches for incorporating eHealth literacy into usability engineering methods is presented.