Exploring Patient Journey Mapping and the Learning Health System: Scoping Review.

BACKGROUND: Journey 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. OBJECTIVE: The 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? METHODS: A 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. RESULTS: The 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. CONCLUSIONS: This 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.

Digital Vaccine Passports and digital health diplomacy: an online Model WHO simulation.

In the wake of COVID -19, several nations have sought to implement digital vaccine passports (DVPs) to enable the resumption of international travel. Comprising a minimum dataset for each unique individual, DVPs have the makings of a global electronic health record, broaching key issues involved in building a global digital health ecosystem. Debate simulations offer a safe, interactive space to foster participatory policy discussions for advancing digital health diplomacy. This study used an online simulation of a Model World Health Assembly to critically analyse the sociotechnical issues associated with the global implementation of DVPs, and to generate useful insights and questions about the role of diplomacy in global digital health. The debate arguments addressed and provided insights into the technological, scientific, ethical, legal, policy & societal aspects of DVPs. Reflecting on the simulation, we discuss its opportunities and challenges for the digitalization, decolonization, decentralization, and democratisation of participatory policymaking.

Understanding the social determinants of health and genetic factors contributing to the differences observed in COVID-19 incidence and mortality between underrepresented and other communities.

COVID-19 has been a devastating disease, especially in underserved communities. Data has shown that Indigenous peoples, Latinx communities, and Black Americans have a 3.3, 2.4, and 2 times higher mortality rate than White communities, respectively, due to COVID-19. Therefore, in this paper, we sought to understand how Social Determinants of Health and genetic factors influence COVID-19 incidence, mortality rates, and complications by assessing existing literature. Studies showed that identifying with a racial/ethnic minority, being homeless, housing insecurity, lower household median income, and living in an area with decreased air quality were associated with higher incidence and mortality from COVID-19. Analyses of these studies also showed a lack of resources to collect patients' social determinants of health, revealing an urgent need to create databases with information on local support programs and operationalize the referral and tracking outcomes to address the health inequities for Black, Indigenous, and Latinx communities.

A Proposed Patient-Inclusive Methodology for Developing and Validating Telehealth Surveys that Include Social Determinants of Health

This paper discusses a method to develop and validate telehealth surveys that include social determinants of health domains. We performed a scoping review of literature on measuring social determinants of health and extracted 50 social determinants of health domains. We evaluated 14 validated telehealth surveys for questions associated with social determinants of health. We categorized the questions from the validated telehealth surveys using our extracted social determinants of health. We found that current validated telehealth-specific surveys only cover 16 (32%) of social determinants of health domains, with the most commonly evaluated domains being "Medical Needs" and "Social Connections/Isolation". Telehealth services are a valuable modality to provide care to patients. Surveying patients is integral to performing quality improvement and improving patient outcomes. Social determinants of health are important factors in determining patient outcomes. We propose an approach to validating the missing domains and evaluating survey validity.

"Digital Health Diplomacy" in Global Digital Health? A call for critique and discourse.

Actualizing the vision of Global Digital Health is a central issue on the Global Health Diplomacy agenda. The COVID-reinforced need for accelerated digital health progress will require political structures and processes to build a foundation for Global Digital Health. Simultaneously, Global Health Diplomacy uses digital technologies in its enactment. Both phenomena have driven interest in the term "Digital Health Diplomacy." A review of the literature revealed 2 emerging but distinct definitions that have been published very recently, each with its associated discourse and practice. This multiplicity of ideas demonstrates the myriad ways in which global digital and political systems are becoming increasingly entangled. Untangling these, this paper proposes and discusses 3 dimensions of Digital Health Diplomacy: "Diplomacy for digital health," "Digital health for diplomacy," and "Digital health in diplomacy." It calls upon digital health professionals, diplomats, political and social scientists, epidemiologists, and clinicians to discuss, critique, and advance this emerging domain.

A Proposed Framework on Integrating Health Equity and Racial Justice into the Artificial Intelligence Development Lifecycle

The COVID-19 pandemic has created multiple opportunities to deploy artificial intelligence (AI)-driven tools and applied interventions to understand, mitigate, and manage the pandemic and its consequences. The disproportionate impact of COVID-19 on racial/ethnic minority and socially disadvantaged populations underscores the need to anticipate and address social inequalities and health disparities in AI development and application. Before the pandemic, there was growing optimism about AI's role in addressing inequities and enhancing personalized care. Unfortunately, ethical and social issues that are encountered in scaling, developing, and applying advanced technologies in health care settings have intensified during the rapidly evolving public health crisis. Critical voices concerned with the disruptive potentials and risk for engineered inequities have called for reexamining ethical guidelines in the development and application of AI. This paper proposes a framework to incorporate ethical AI principles into the development process in ways that intentionally promote racial health equity and social justice. Without centering on equity, justice, and ethical AI, these tools may exacerbate structural inequities that can lead to disparate health outcomes.

Enhancing Safety During a Pandemic Using Virtual Care Remote Monitoring Technologies and UML Modeling.

OBJECTIVES: This paper describes a methodology for gathering requirements and early design of remote monitoring technology (RMT) for enhancing patient safety during pandemics using virtual care technologies. As pandemics such as COrona VIrus Disease (COVID-19) progress there is an increasing need for effective virtual care and RMT to support patient care while they are at home. METHODS: The authors describe their work in conducting literature reviews by searching PubMed.gov and the grey literature for articles, and government websites with guidelines describing the signs and symptoms of COVID-19, as well as the progression of the disease. The reviews focused on identifying gaps where RMT could be applied in novel ways and formed the basis for the subsequent modelling of use cases for applying RMT described in this paper. RESULTS: The work was conducted in the context of a new Home of the Future laboratory which has been set up at the University of Victoria. The literature review led to the development of a number of object-oriented models for deploying RMT. This modeling is being used for a number of purposes, including for education of students in health infomatics as well as testing of new use cases for RMT with industrial collaborators and projects within the smart home of the future laboratory. CONCLUSIONS: Object-oriented modeling, based on analysis of gaps in the literature, was found to be a useful approach for describing, communicating and teaching about potential new uses of RMT.