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Conversational assistants, such as Siri, Alexa, and Google Assistant, are ubiquitous and are beginning to be used as portals for medical services. However, the potential safety issues of using conversational assistants for medical information by patients and consumers are not understood. To determine the prevalence and nature of the harm that could result from patients or consumers using conversational assistants for medical information. Participants were given medical problems to pose to Siri, Alexa, or Google Assistant, and asked to determine an action to take based on information from the system. Assignment of tasks and systems were randomized across participants, and participants queried the conversational assistants in their own words, making as many attempts as needed until they either reported an action to take or gave up. Participant-reported actions for each medical task were rated for patient harm using an Agency for Healthcare Research and Quality harm scale. Fifty-four subjects completed the study with a mean age of 42 years (SD 18). Twenty-nine (54%) were female, 31 (57%) Caucasian, and 26 (50%) were college educated. Only 8 (15%) reported using a conversational assistant regularly, while 22 (41%) had never used one, and 24 (44%) had tried one \"a few times.\" Forty-four (82%) used computers regularly. Subjects were only able to complete 168 (43%) of their 394 tasks. Of these, 49 (29%) reported actions that could have resulted in some degree of patient harm, including 27 (16%) that could have resulted in death. Reliance on conversational assistants for actionable medical information represents a safety risk for patients and consumers. Patients should be cautioned to not use these technologies for answers to medical questions they intend to act on without further consultation from a health care provider.

Nowadays, a number of mechanisms and tools are being used by health care organizations and physicians to electronically exchange the personal health information of patients. The main objectives of different methods of health information exchange (HIE) are to reduce health care costs, minimize medical errors, and improve the coordination of interorganizational information exchange across health care entities. The main challenges associated with the common HIE systems are privacy concerns, security risks, low visibility of system transparency, and lack of patient control. Blockchain technology is likely to disrupt the current information exchange models utilized in the health care industry. Little is known about patients' perceptions and attitudes toward the implementation of blockchain-enabled HIE networks, and it is still not clear if patients (as one of the main HIE stakeholders) are likely to opt in to the applications of this technology in HIE initiatives. Thus, this study aimed at exploring the core value of blockchain technology in the health care industry from health care consumers' views. To recognize the potential applications of blockchain technology in health care practices, we designed 16 information exchange scenarios for controlled Web-based experiments. Overall, 2013 respondents participated in 16 Web-based experiments. Each experiment described an information exchange condition characterized by 4 exchange mechanisms (ie, direct, lookup, patient-centered, and blockchain), 2 types of health information (ie, sensitive vs nonsensitive), and 2 types of privacy policy (weak vs strong). The findings show that there are significant differences in patients' perceptions of various exchange mechanisms with regard to patient privacy concern, trust in competency and integrity, opt-in intention, and willingness to share information. Interestingly, participants hold a favorable attitude toward the implementation of blockchain-based exchange mechanisms for privacy protection, coordination, and information exchange purposes. This study proposed the potentials and limitations of a blockchain-based attempt in the HIE context. The results of this research should be of interest to both academics and practitioners. The findings propose potential limitations of a blockchain-based HIE that should be addressed by health care organizations to exchange personal health information in a secure and private manner. This study can contribute to the research in the blockchain area and enrich the literature on the use of blockchain in HIE efforts. Practitioners can also identify how to leverage the benefit of blockchain to promote HIE initiatives nationwide.

The exchange and use of health information can help healthcare professionals and policymakers make informed decisions on ways of improving patient and population health. Many low-and middle-income countries (LMICs) have however failed to embrace the approaches and technologies to facilitate health information exchange (HIE). We sought to understand the barriers and facilitators to the implementation and adoption of HIE in LMICs. Two reviewers independently searched 11 academic databases for published and on-going qualitative, quantitative and mixed-method studies and searched for unpublished work through the Google search engine. The searches covered the period from January 1990 to July 2014 and were not restricted by language. Eligible studies were independently, critically appraised and then thematically analysed. The searches yielded 5461 citations after de-duplication of results. Of these, 56 articles, three conference abstracts and four technical reports met the inclusion criteria. The lack of importance given to data in decision making, corruption and insecurity, lack of training and poor infrastructure were considered to be major challenges to implementing HIE, but strong leadership and clear policy direction coupled with the financial support to acquire essential technology, improve the communication network, and provide training for staff all helped to promote implementation. The body of work also highlighted how implementers of HIE needed to take into account local needs to ensure that stakeholders saw HIE as relevant and advantageous. HIE interventions implemented through leapfrog technologies such as telehealth/telemedicine and mHealth in Brazil, Kenya, and South Africa, provided successful examples of exchanging health information in LMICs despite limited resources and capability. It is important that implementation of HIE is aligned with national priorities and local needs. L’échange et l’utilisation des informations sur la santé peuvent aider les professionnels de la santé et les décideurs à prendre des décisions éclairées sur les moyens d’améliorer la santé des patients et des populations. De nombreux pays à revenu faible ou intermédiare (PRF-PRI) n’ont cependant pas su adopter les approches et technologies permettant de faciliter l’échange des informations sur la santé (HIE). Nous avons cherché à comprendre les éléments qui entravent ou facilitent la mise en œuvre et l’adoption des informations sur la santé dans les PRF-PRI. Deux auteurs ont indépendamment parcouru 11 bases de données universitaires à la recherche d’études qualitatives, quantitatives et mixtes, publiées et en cours de publication; ils sont également allés à la recherche de travaux non publiés par le biais du moteur de recherche Google. Les recherches portaient sur la période de janvier 1990 à juillet 2014 et n’étaient pas restreintes à une seule langue. Les études retenues ont été évaluées, puis analysées par thème de manière indépendante et critique. Les recherches ont donné 5461 citations après déduplication des résultats. Parmi celles-ci, 56 articles, trois résumés de conférences et quatre rapports techniques répondaient aux critères d’inclusion. Le peu d’importance accordée aux données dans la prise de décision, la corruption et l’insécurité, le manque de formation et l’insuffisance des infrastructures sont apparus comme des défis majeurs à la mise en œuvre des informations sur la santé; mais par contre des éléments comme un solide leadership et une orientation politique claire assortis d’un soutien financier permettant d’acquérir la technologie essentielle, d’améliorer le réseau de communication et de former le personnel, contribuent tous à la promotion de la mise en œuvre. L’ensemble des travaux a également relevé le fait que les responsables de la mise en œuvre des informations sur la santé doivent tenir compte des besoins locaux afin de s’assurer que les intervenants considèrent les informations sur la santé comme pertinentes et fructueuses. Les interventions HIE mises en œuvre grâce à des technologies efficaces comme la télésanté/télémédecine et la santé mobile au Brésil, au Kenya et en Afrique du Sud, sont des exemples de réussite en matière d’échange d’informations sur la santé dans les PRF-PRI en dépit des ressources et des capacités limitées. Il est important que la mise en œuvre des informations sur la santé soit conforme aux priorités nationales et aux besoins locaux. El intercambio y uso de la información de salud puede ayudar a los profesionales de la salud y formuladores de políticas a tomar decisiones informadas sobre las formas de mejorar la salud del paciente y la población. Muchos países de ingresos bajos y medios (PIBMs) han sin embargo fracasado en acoger las estrategias y tecnologías para facilitar el intercambio de información de salud (IIS). Tuvimos como objetivo entender las barreras y facilitadores para la implementación y adopción del IIS en PIBMs. Dos investigadores independientemente utilizaron 11 bases de datos académicas para buscar estudios cualitativos, cuantitativos y de métodos mixtos publicados y en desarrollo, y buscaron trabajos no publicados a través del motor de búsqueda Google. Las búsquedas cubrieron el periodo entre enero de 1990 y julio de 2014 y no se restringieron por idioma. Los estudios elegibles fueron evaluados de manera independiente y crítica, y luego analizados temáticamente. Las búsquedas produjeron 5461 citas después de la deduplicación de los resultados. De estos, 56 artículos, tres abstractos de conferencias y cuatro reportes técnicos cumplieron los criterios de inclusión. La falta de importancia dada a los datos en el proceso de toma de decisiones, la corrupción y la inseguridad, la falta de entrenamiento y la pobre infraestructura fueron considerados como retos importantes para implementar el ISS, pero el liderazgo fuerte y una dirección de políticas clara, junto con el apoyo financiero para adquirir tecnología esencial, mejoran la red de comunicación y proveen entrenamiento para los trabajadores, lo cual ayuda a promover la implementación. El trabajo también destaca como los implementadores del ISS deben tener en cuenta las necesidades locales para asegurar que las partes interesadas perciban el ISS como relevante y ventajoso. Las intervenciones del ISS implementadas a través de estrategias para sobreponer barreras como la telesalud/tele-medicina y la mSalud en Brasil, Kenia y Suráfrica, son ejemplos exitosos del intercambio de información de salud en PIBMs a pesar de los recursos y capacidad limitada. Es importante que la implementación del ISS esté alineada con prioridades naciones y necesidades locales. 医疗信息的交换和使用能够帮助医疗健康专业人士和政策制定 者形成关于提高病人和人口健康方式的有效决策。然而, 许多 中低收入国家没有采用促进医疗信息交换的方式和技术。我们 致力于了解中低收入国家医疗信息交换的障碍和促进因素的实 施和应用。2名文献回顾者各自搜寻11个已出版和正在进行的 定性研究、定量研究和混合研究方法的学术数据库, 并且通过 谷歌搜索引擎搜寻未出版的研究。研究覆盖了1990年1月至 2014年7月间各类语言的文献。我们各自批判性地评估并且有 目的地分析合格的研究。在去除重复研究结果后, 本研究涵盖 了5461个引用。在这些之中, 56篇文章、3个会议纪要和4个技 术报告符合内部标准。我们认为关于决策制定、腐败和不安全 性数据重要性的缺乏, 培训匮乏和低质量基础设施是实施医疗 信息互换的主要挑战, 但是强大的领导力、明确的政策方向以 及取得重要技术的财政支持能够提升沟通系统, 为员工提供培 训, 从而帮助提升医疗信息互换的实施。研究主体同时强调医 疗信息互换的实施者如何考虑当地需求从而保证利益相关者将 医疗信息互换看做是相关的和有益的。通过交替前进技术 （例 如巴西的远程医疗、肯尼亚的远程药物和南非的远程健康） 实 施的医疗信息互换干预行为展现出中低收入国家交换医疗信息 的成功例子, 尽管各国资源和能力有限。医疗信息互换的应用 与国家有效性和当地需求联系在一起十分重要。

Hospital-based health promotion resources to assist pregnant women in adopting a healthy lifestyle and optimizing gestational weight gain are important, but with limited effects. Increasingly, women are using mobile apps to access health information during the antenatal period. The aims of the study were to investigate app-usage by Chinese women during pregnancy and to gain a better understanding of their views and attitudes toward apps containing health information. A mixed methods study design was applied. Study participants were recruited from 2 maternity hospitals in Shanghai, China, between March and July 2018. A self-administered Web-based survey was conducted with 535 pregnant Chinese women on their sources of health information and reasons for using apps during pregnancy. A total of 4 semistructured focus groups were also conducted with the pregnant women (n=28). The use of pregnancy-related apps and the internet was common among the respondents. Almost half of the women had used pregnancy-related apps. Specifically, the use of apps for health information declined as pregnancy progressed from 70% (35/50) in the first trimester to 41.3% (143/346) in the third trimester. The main reason for using an app was to monitor fetal development (436/535, 81.5%), followed by learning about nutrition and recording diet in pregnancy (140/535, 26.2%). The women found that the apps were useful and convenient and can support lifestyle modifications during pregnancy. However, some apps also contained misinformation or incorrect information that could cause anxiety as reported by the participants. Many women expressed the need for developing an app containing evidence-based, well-informed, and tailored health information to support them during pregnancy. The study suggests that apps were widely used by many Chinese women during pregnancy to monitor fetal development, to obtain diet and physical activity information, and to track their body changes. The women highly appreciated the evidence-based information, expert opinions, and tailored advice available on apps. Smartphone apps have the potential to deliver health information for pregnant women.

A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as \"a compromise between two desirable but incompatible features.\" This review's primary research question was: \"What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?\" Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies-of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. RR2-10.2196/10994.

The diffusion of health information exchange (HIE), in which clinical data are electronically linked to patients in many different care settings, is a top priority for policy makers. To drive HIE, community and state efforts were federally funded to broadly engage providers in exchanging data in ways that improved patient care. To assess the current landscape, we conducted a national survey of community and state HIE efforts soon after federal funding ended. We found 106 operational HIE efforts that, as a group, engaged more than one-third of all US providers in 2014. However, the number of operational HIE efforts is down from 119 in 2012, representing the first decline observed since the tracking of these efforts began in 2006. Only half of operational efforts reported being financially viable, and all efforts reported a variety of barriers to continuation. These findings raise important questions about whether the current vision for HIE efforts will allow for the broad exchange of clinical data, or whether alternative approaches would be more successful.

Context: Although the clinical benefits of exchanging patients' health information electronically across providers have long been recognized, participation in health information exchange (HIE) has lagged behind adoption of electronic health records. Barriers erected by federal and state health information privacy law have been cited as a leading reason for the slow progress. A comprehensive assessment of these issues has not been undertaken for nearly a decade, despite a number of salient legal developments. Methods: Analysis of federal and state health information privacy statutes and regulations and secondary materials. Findings: Although some legal barriers to HIE persist, many have been ameliorated—in some cases, simply through improved understanding of what the law actually requires. It is now clear that the Health Insurance Portability and Accountability Act presents no obstacles to electronically sharing protected health information for treatment purposes and does not hold providers who properly disclose information liable for privacy breaches by recipients. The failure of federal efforts to establish a unique patient identifier number does slow HIE by inhibiting optimal matching of patient records, but other action to facilitate matching will be taken under the 21st Century Cures Act. The Cures Act also creates the legal architecture to begin to combat \"information blocking.\" Varying patient consent requirements under federal and state law are the most important remaining legal barrier to HIE progress. However, federal rules relating to disclosure of substance-abuse treatment information were recently liberalized, and development of a technical standard, Data Segmentation for Privacy, or DS4P, now permits sensitive data requiring special handling to be segmented within a patient's record. Even with these developments, state-law requirements for patient consent remain daunting to navigate. Conclusions: Although patient consent requirements make HIE challenging, providers' expressed worries about legal barriers to participating in HIE likely primarily reflect concerns that are economically motivated. Lowering the cost of HIE or increasing financial incentives may boost provider participation more than further reducing legal barriers.

Health information exchange (HIE), which is the transfer of electronic information such as laboratory results, clinical summaries, and medication lists, is believed to boost efficiency, reduce health care costs, and improve outcomes for patients. Stimulated by federal financial incentives, about two-thirds of hospitals and almost half of physician practices are now engaged in some type of HIE with outside organizations. To determine how HIE has affected such health care measures as cost, service use, and quality, we identified twenty-seven scientific studies, extracted selected characteristics from each, and meta-analyzed these characteristics for trends. Overall, 57 percent of published analyses reported some benefit from HIE. However, articles employing study designs having strong internal validity, such as randomized controlled trials or quasi-experiments, were significantly less likely than others to associate HIE with benefits. Among six articles with strong internal validity, one study reported paradoxical negative effects, three studies found no effect, and two studies reported that HIE led to benefits. Furthermore, these two studies had narrower focuses than the others. Overall, little generalizable evidence currently exists regarding benefits attributable to HIE.

Information exchange regarding the scope and content of health studies is becoming increasingly important. Digital methods, including study websites, can facilitate such an exchange. This scoping review aimed to describe how digital information exchange occurs between the public and researchers in health studies. This scoping review was prospectively registered and adheres to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Eligibility was defined using the population (public and researchers), concept (digital information exchange), and context (health studies) framework. Bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science), bibliographies of the included studies, and Google Scholar were searched up to February 2024. Studies published in peer-reviewed journals were screened for inclusion based on the title, abstract, and full text. Data items charted from studies included bibliographic and PCC (Population, Concept, and Context) characteristics. Data were processed into categories that inductively emerged from the data and were synthesized into main themes using descriptive statistics. Overall, 4072 records were screened, and 18 studies published between 2010 and 2021 were included. All studies evaluated or assessed the preferences for digital information exchange. The target populations included the public (mainly adults with any or specific diseases), researchers, or both. The digital information exchange methods included websites, emails, forums, platforms, social media, and portals. Interactivity (ie, if digital information exchange is or should be active or passive) was addressed in half of the studies. Exchange content included health information or data with the aim to inform, recruit, link, or gather innovative research ideas from participants in health studies. We identified 7 facilitators and 9 barriers to digital information exchange. The main facilitators were the consideration of any stakeholder perspectives and needs to clarify expectations and responsibilities, the use of modern or low-cost communication technologies and public-oriented language, and continuous communication of the health study process. The main barriers were that information exchange was not planned or not feasible due to inadequate resources, highly complex technical language was used, and ethical concerns (eg, breach of anonymity if study participants are brought together) were raised. Evidence gaps indicate that new studies should assess the methods and the receiver (ie, public) preferences and needs that are required to deliver and facilitate interactive digital information exchange. Few studies addressing digital information exchange in health studies could be identified in this review. There was little focus on interactivity in such an exchange. Digital information exchange was associated with more barriers than facilitators, suggesting that more effort is required to improve such an exchange between the public and researchers. Future studies should investigate interactive digital methods and the receiver preferences and needs required for such an exchange.

PurposeThis paper aims to identify a generic set of information requirements for facilities management (FM) systems, which should be included in BIM as-built models for efficient information exchange between BIM and FM systems, and to propose a process to identify, verify and collect the required information for use in FM systems during the project’s lifecycle.Design/methodology/approachBoth qualitative and quantitative approaches were applied at different stages of the study’s sequential design. The collection and analysis of qualitative data was based on an extensive literature review of similar studies, standards, best practices and case study documentation. This was followed by a questionnaire survey of 191 FM practitioners in the UK. This formed the background of the third stage, which was the development of the information management process to streamline information exchange between building information models and FM systems.FindingsThe study identifies a generic list of information requirements of building information models to support FM systems. In addition, the study presents an information management process that generates a specific database for FM systems using an open data format.Originality/valueThe existing literature focuses on specific building types (educational buildings) or specific information requirements related to particular systems (mechanical systems). The existing standards, guidelines and best practices focus on the information requirements to support the operations and maintenance (O&M) phase in general. This study is different from previous studies because it develops a set of specific information requirements for building information models to support FM systems. FM organisations and owners can use the proposed list of information requirements as a base to generate specific data output for their FM systems’ input, to decrease the redundant activity of manual data entry and focus their efforts on key activities.