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E-health as a new industrial phenomenon and a field of research integrates medical informatics, public health and healthcare business, aiming to facilitate the provision of more accessible healthcare services, such as remote health monitoring, reducing healthcare costs and enhancing patient experience [...]

Patient flow describes the progression of patients along a pathway of care such as the journey from hospital inpatient admission to discharge. Poor patient flow has detrimental effects on health outcomes, patient satisfaction and hospital revenue. There has been an increasing adoption of health information systems (HISs) in various healthcare settings to address patient flow issues, yet there remains limited evidence of their overall impacts. To systematically review evidence on the impacts of HISs on patient flow management including what HISs have been used, their application scope, features, and what aspects of patient flow are affected by the HIS adoption. A systematic search for English-language, peer-review literature indexed in MEDLINE and EMBASE, CINAHL, INSPEC, and ACM Digital Library from the earliest date available to February 2022 was conducted. Two authors independently scanned the search results for eligible publications, and reporting followed the PRISMA guidelines. Eligibility criteria included studies that reported impacts of HIS on patient flow outcomes. Information on the study design, type of HIS, key features and impacts was extracted and analysed using an analytical framework which was based on domain-expert opinions and literature review. Overall, 5996 titles were identified, with 44 eligible studies, across 17 types of HIS. 22 studies (50%) focused on patient flow in the department level such as emergency department while 18 studies (41%) focused on hospital-wide level and four studies (9%) investigated network-wide HIS. Process outcomes with time-related measures such as 'length of stay' and 'waiting time' were investigated in most of the studies. In addition, HISs were found to address flow problems by identifying blockages, streamlining care processes and improving care coordination. HIS affected various aspects of patient flow at different levels of care; however, how and why they delivered the impacts require further research.

Digital health (DH) and the benefits of related services are fairly well understood. However, it still is critical to map the digital health care landscape including the key elements that define it as an ecosystem. Particularly, knowing the perspectives of citizens on this digital transformation is an important angle to capture. In this review we aim to analyze the relevant studies to identify how DH is understood and experienced by Australian citizens and what they may require from DH platforms. A scoping literature review was conducted across several electronic databases (ACM Digital Library, OVID, PubMed, Scopus, IEEE, Science Direct, SAGE), as well as grey literature. Additionally, citation mining was conducted to identify further relevant studies. Identified studies were subjected to eligibility criteria and the final set of articles was independently reviewed, analyzed, discussed and interpreted by three reviewers. Of 3811 articles, 98 articles met the inclusion criteria with research-based articles-as opposed to review articles or white papers- comprising the largest proportion (72%) of the selected literature. The qualitative analysis of the literature revealed five key elements that capture the essence of the digital health ecosystem interventions from the viewpoint of the Australian citizens. The identified elements were \"consumer/user\", \"health care\", \"technology\", \"use and usability\", \"data and information\". These elements were further found to be associated with 127 subcategories. This study is the first of its kind to analyze and synthesize the relevant literature on DH ecosystems from the citizens' perspective. Through the lens of two research questions, this study defines the key components that were found crucial to understanding citizens' experiences with DH. This understanding lays a strong foundation for designing and fostering DH ecosystem. The results provide a solid ground for empirical testing.

Length of Stay (LOS) is an important performance metric in Australian Emergency Departments (EDs). Recent evidence suggests that an LOS in excess of 4 h may be associated with increased mortality, but despite this, the average LOS continues to remain greater than 4 h in many EDs. Previous studies have found that Data Mining (DM) can be used to help hospitals to manage this metric and there is continued research into identifying factors that cause delays in ED LOS. Despite this, there is still a lack of specific research into how DM could use these factors to manage ED LOS. This study adds to the emerging literature and offers evidence that it is possible to predict delays in ED LOS to offer Clinical Decision Support (CDS) by using DM. Sixteen potentially relevant factors that impact ED LOS were identified through a literature survey and subsequently used as predictors to create six Data Mining Models (DMMs). An extract based on the Victorian Emergency Minimum Dataset (VEMD) was used to obtain relevant patient details and the DMMs were implemented using the Weka Software. The DMMs implemented in this study were successful in identifying the factors that were most likely to cause ED LOS > 4 h and also identify their correlation. These DMMs can be used by hospitals, not only to identify risk factors in their EDs that could lead to ED LOS > 4 h, but also to monitor these factors over time.

Background: A nanomaterial-based electronic-skin (E-Skin) wearable sensor has been successfully used for detecting and measuring body movements such as finger movement and foot pressure. The ultrathin and highly sensitive characteristics of E-Skin sensor make it a suitable alternative for continuously out-of-hospital lumbar–pelvic movement (LPM) monitoring. Monitoring these movements can help medical experts better understand individuals’ low back pain experience. However, there is a lack of prior studies in this research area. Therefore, this paper explores the potential of E-Skin sensors to detect and measure the anatomical angles of lumbar–pelvic movements by building a linear relationship model to compare its performance to clinically validated inertial measurement unit (IMU)-based sensing system (ViMove). Methods: The paper first presents a review and classification of existing wireless sensing technologies for monitoring of body movements, and then it describes a series of experiments performed with E-Skin sensors for detecting five standard LPMs including flexion, extension, pelvic tilt, lateral flexion, and rotation, and measure their anatomical angles. The outputs of both E-Skin and ViMove sensors were recorded during each experiment and further analysed to build the comparative models to evaluate the performance of detecting and measuring LPMs. Results: E-Skin sensor outputs showed a persistently repeating pattern for each movement. Due to the ability to sense minor skin deformation by E-skin sensor, its reaction time in detecting lumbar–pelvic movement is quicker than ViMove by ~1 s. Conclusions: E-Skin sensors offer new capabilities for detecting and measuring lumbar–pelvic movements. They have lower cost compared to commercially available IMU-based systems and their non-invasive highly stretchable characteristic makes them more comfortable for long-term use. These features make them a suitable sensing technology for developing continuous, out-of-hospital real-time monitoring and management systems for individuals with low back pain.

Background: Low back pain (LBP) remains the leading cause of disability worldwide. A better understanding of the beliefs regarding LBP and impact of LBP on the individual is important in order to improve outcomes. Although personal experiences of LBP have traditionally been explored through qualitative studies, social media allows access to data from a large, heterogonous, and geographically distributed population, which is not possible using traditional qualitative or quantitative methods. As data on social media sites are collected in an unsolicited manner, individuals are more likely to express their views and emotions freely and in an unconstrained manner as compared to traditional data collection methods. Thus, content analysis of social media provides a novel approach to understanding how problems such as LBP are perceived by those who experience it and its impact. Objective: The objective of this study was to identify contextual variables of the LBP experience from a first-person perspective to provide insights into individuals’ beliefs and perceptions. Methods: We analyzed 896,867 cleaned tweets about LBP between January 1, 2014, and December 31, 2018. We tested and compared latent Dirichlet allocation (LDA), Dirichlet multinomial mixture (DMM), GPU-DMM, biterm topic model, and nonnegative matrix factorization for identifying topics associated with tweets. A coherence score was determined to identify the best model. Two domain experts independently performed qualitative content analysis of the topics with the strongest coherence score and grouped them into contextual categories. The experts met and reconciled any differences and developed the final labels. Results: LDA outperformed all other algorithms, resulting in the highest coherence score. The best model was LDA with 60 topics, with a coherence score of 0.562. The 60 topics were grouped into 19 contextual categories. “Emotion and beliefs” had the largest proportion of total tweets (157,563/896,867, 17.6%), followed by “physical activity” (124,251/896,867, 13.85%) and “daily life” (80,730/896,867, 9%), while “food and drink,” “weather,” and “not being understood” had the smallest proportions (11,551/896,867, 1.29%; 10,109/896,867, 1.13%; and 9180/896,867, 1.02%, respectively). Of the 11 topics within “emotion and beliefs,” 113,562/157,563 (72%) had negative sentiment. Conclusions: The content analysis of tweets in the area of LBP identified common themes that are consistent with findings from conventional qualitative studies but provide a more granular view of individuals’ perspectives related to LBP. This understanding has the potential to assist with developing more effective and personalized models of care to improve outcomes in those with LBP.

Digital health technology tools (DHTTs) have the potential to transform health care delivery by enabling new forms of participatory and personalized care that fit into patients’ daily lives. However, realizing this potential requires careful navigation of numerous challenges. This viewpoint presents the authors’ experiences and perspectives on the development and implementation of DHTTs, addressing both established practices and controversial topics. This article offers a practical guide organized into 10 recommendations derived from a multidisciplinary lecture series and associated workshop discussions on “Digital Health and Digital Biomarkers” held at the University of Luxembourg in 2023-2024. Key messages include the need to understand specific health care challenges, form interdisciplinary teams, incorporate patient feedback, select appropriate measurement technologies, ensure data integration and interoperability, apply advanced data science techniques, use scalable designs and open standards, comply with regulatory requirements, and maintain continuous evaluation and improvement. While the guide highlights essential practices, it also addresses contentious issues such as balancing innovation with regulatory compliance, addressing ethical concerns in artificial intelligence adoption, managing privacy versus the need for comprehensive data integration and open science, and managing the financial sustainability of DHTTs. The authors argue that digital health’s greatest potential lies in its ability to provide participatory and personalized care, but this requires a delicate balance between technological advances and ethical, legal, and social implications. Overall, this workshop-derived viewpoint aims to help health care professionals, engineers, developers, and researchers not only adopt best practices but also address and resolve the controversial aspects inherent in the development of DHTTs.

Open biomedical repositories, such as PubMed Central (PMC), are a means to make research discoverable and permanently accessible. Assessing the potential interest of key stakeholders in an Australasia PubMed Central was the objective of this research. The investigation is novel, assisting in the development of open science infrastructure through its systematic analysis of the potential interest in, and viability of a biomedical repository for managing openly accessible research outputs for the Australasia region. The research adopted a qualitative approach based on semi-structured interviews and a focus group. Forty-four stakeholders located throughout Australia and New Zealand participated in the research. Participants expanded upon their experience of PubMed, MEDLINE, PMC and their use of information resources for research and clinical practice. The Evidence Based Healthcare (EBHC) pyramid was the theoretical model adopted to explain open biomedical repository processes. A strengths, weaknesses, opportunities and threats (SWOT) analysis identified support for exploring membership of an international PMC system, in particular Europe PMC. Lessons learnt from PMC US, Europe PMC and PMC Canada (collectively known as PubMed Central International) informed the investigation. A major strength identified was that PubMed Central International has been able to achieve high levels of compliance way beyond that of most institutional repositories. A great threat faced is overcoming the difficulties of working together with other major world bodies and financially sustaining an Australasia PMC. Improving Australasian biomedical knowledge management processes may be possible from adopting a PMC for retrieving and transferring research, linked to the data underlying the research. This in turn could help put regional research under a brighter spotlight, potentially leading to improvements in research quality. There is an opportunity for a potential Australasia PMC to harvest biomedical research from the National Library of Australia's aggregator database, Trove and work closely with Europe PMC to avoid duplication of effort. Overall, establishment of an Australasia permanent biomedical digital open repository is perceived as important, with significant potential flow-on benefits to healthcare, industry and society.

Open biomedical repositories, such as PubMed Central (PMC), are a means to make research discoverable and permanently accessible. Assessing the potential interest of key stakeholders in an Australasia PubMed Central was the objective of this research. The investigation is novel, assisting in the development of open science infrastructure through its systematic analysis of the potential interest in, and viability of a biomedical repository for managing openly accessible research outputs for the Australasia region. The research adopted a qualitative approach based on semi-structured interviews and a focus group. Forty-four stakeholders located throughout Australia and New Zealand participated in the research. Participants expanded upon their experience of PubMed, MEDLINE, PMC and their use of information resources for research and clinical practice. The Evidence Based Healthcare (EBHC) pyramid was the theoretical model adopted to explain open biomedical repository processes. A strengths, weaknesses, opportunities and threats (SWOT) analysis identified support for exploring membership of an international PMC system, in particular Europe PMC. Lessons learnt from PMC US, Europe PMC and PMC Canada (collectively known as PubMed Central International) informed the investigation. A major strength identified was that PubMed Central International has been able to achieve high levels of compliance way beyond that of most institutional repositories. A great threat faced is overcoming the difficulties of working together with other major world bodies and financially sustaining an Australasia PMC. Improving Australasian biomedical knowledge management processes may be possible from adopting a PMC for retrieving and transferring research, linked to the data underlying the research. This in turn could help put regional research under a brighter spotlight, potentially leading to improvements in research quality. There is an opportunity for a potential Australasia PMC to harvest biomedical research from the National Library of Australia's aggregator database, Trove and work closely with Europe PMC to avoid duplication of effort. Overall, establishment of an Australasia permanent biomedical digital open repository is perceived as important, with significant potential flow-on benefits to healthcare, industry and society.

Background Ward rounds are an important and ubiquitous element of hospital care with a history extending well over a century. Although originally intended as a means of educating medical trainees and junior doctors, over time they have become focused on supporting clinical practice. Surprisingly, given their ubiquity and importance, they are under-researched and inadequately understood. This study aims to contribute knowledge in human reasoning within medical teams, meeting a pressing need for research concerning the reasoning occurring in rounds. Methods The research reported here aimed to improve the understanding of ward round reasoning by conducting a critical realist case study exploring the collaborative group reasoning mechanisms in the ward rounds of two hospitals in Victoria, Australia. The data collection involved observing rounds, interviewing medical practitioners and holding focus group meetings. Results Nine group reasoning mechanisms concerning sharing, agreeing and recording information in the categories of information accumulation, sense-making and decision-making were identified, together forming a program theory of ward round reasoning. In addition, themes spanning across mechanisms were identified, further explaining ward round reasoning and suggesting avenues for future exploration. Themes included the use of various criteria, tensions involving mechanisms, time factors, medical roles and hierarchies. Conclusions This paper contributes to the literature by representing rounds in a manner that strengthens understanding of the form of the group reasoning occurring within, thus supporting theory-based evaluation strategies, redesigned practices and training enhancements.