Effects of Covid 19 on Health status and Quality of life among Software Professionals in a Home based work setting - A Questionnaire based Cross Sectional Study

Introduction: Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in December 2019 in Wuhan city, China. Following the outbreak of COVID-19 pandemic, to restrict the spread of virus, the Government has imposed strict measures with subsequent lockdowns as a result the home environment has become a workplace for many. Of all sectors the software domain is the most affected. Limited resource facility, work - engagement, work-life balance, family conflicts, stress management have been the challenges faced by these IT professionals working from home Aim: To analyze the impact of Covid 19 on health status and quality of life among software professionals in Covid pandemic through validated online questionnaires using google forms. Materials and Methods: This cross-sectional e-survey was conducted using validated questionnaires through google forms following approval of the Institutional Ethics Committee. The questionnaire consisted of 4 open ended and 21 close ended questions.Job-stress, physical and mental well-being, work life balance, work engagement was assessed.The google form was posted in social media channel groups of software professionals for a period of 2 weeks following which the data was collected.Statistical analysis was done using SPSS software version 22.0. Results: A total of 154 software professionals participated in the study. Of which 80 were females and belonged to the 26-30 years age group. 83% software professionals preferred working in hybrid mode. This study shows that working hours increased with increased work pressure in a home-based work setting (61%). Both work life balance and work engagement were fair in a home-based work setting (p-0.0001). Anxiety, depression and emotional problems affected work engagement and work life balance. Some professionals developed physical ailments such as hair fall, vision problems and back ache in a home-based work set up. Conclusion: The findings of this study suggests that emotional well-being, sleep quality,decision latitude,limited resource facilities and job stress affected work engagement and work life balance. Hence undertaking appropriate measures proactively to enhance these factors under crisis conditions may mitigate the negative consequences of home-based work setting and improve the quality of life of software developers in the covid pandemic. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Electronic Medical Record System Use and Determinants in Ethiopia: Systematic Review and Meta-Analysis.

BACKGROUND: The strategic plan of the Ethiopian Ministry of Health recommends an electronic medical record (EMR) system to enhance health care delivery and streamline data systems. However, only a few exhaustive systematic reviews and meta-analyses have been conducted on the degree of EMR use in Ethiopia and the factors influencing success. This will emphasize the factors that make EMR effective and increase awareness of its widespread use among future implementers in Ethiopia. OBJECTIVE: This study aims to determine the pooled estimate of EMR use and success determinants among health professionals in Ethiopia. METHODS: We developed a protocol and searched PubMed, Web of Sciences, African Journals OnLine, Embase, MEDLINE, and Scopus to identify relevant studies. To assess the quality of each included study, we used the Joanna Briggs Institute quality assessment tool using 9 criteria. The applicable data were extracted using Microsoft Excel 2019, and the data were then analyzed using Stata software (version 11; StataCorp). The presence of total heterogeneity across included studies was calculated using the index of heterogeneity I2 statistics. The pooled size of EMR use was estimated using a random effect model with a 95% CI. RESULTS: After reviewing 11,026 research papers, 5 papers with a combined total of 2439 health workers were included in the evaluation and meta-analysis. The pooled estimate of EMR usage in Ethiopia was 51.85% (95% CI 37.14%-66.55%). The subgroup study found that the northern Ethiopian region had the greatest EMR utilization rate (58.75%) and that higher (54.99%) utilization was also seen in publications published after 2016. Age groups <30 years, access to an EMR manual, EMR-related training, and managerial support were identified factors associated with EMR use among health workers. CONCLUSIONS: The use of EMR systems in Ethiopia is relatively low. Belonging to a young age group, accessing an EMR manual, receiving EMR-related training, and managerial support were identified as factors associated with EMR use among health workers. As a result, to increase the use of EMRs by health care providers, it is essential to provide management support and an EMR training program and make the EMR manual accessible to health professionals.

Information Technology in Health-Care Systems and Primary Health Care

BACKGROUND: Health information technology (HIT) is being increasingly necessary to manage the ever-increasing amount of data generate by the health system in general, including primary health care (PHC). AIM: This study aimed to provide an overview of HIT being currently use in the health systems and PHC as well as to highlight the advantages and disadvantages of HIT options. METHOD(S): This is a narrative literature review of papers, documents, and websites that address and discuss HIT for the health systems. The analysis of the retrieved materials provided an overview of the importance of HIT for the health system, the various options of health technology currently available, as well as the future trends. Strengths and weaknesses have been highlighted as well. RESULT(S): HIT is being increasingly used in the health sector, as an indispensable tool to handle the extraordinary amount of data being generated by the health system but also as an instrument to improve the quality of health care through the reduction of medical errors and health care-associated costs, improvement of patient follow-up and monitoring, and also as a tool that informs and guides clinical decision-making. A large variety of HIT options is available, including telehealth, telemedicine, mobile health, electronic medical records, electronic health records, personal health records, electronic prescriptions (e-prescriptions), wearables, metadata, and even artificial intelligence. Each HIT option has its own advantages and disadvantages. PHC could benefit from the implementation of various HIT options. CONCLUSION(S): The decision which HIT option(s) to employ will depend on many factors, but the process needs to employ small steps, strong political will, cooperation, and coordination between all stakeholders. Copyright © 2022 Erion Dasho, Loreta Kuneshka, Ervin Toci.

Health Information Technology Adoption at U.S. Home Health Care Agencies: Results from a Multi-Methods Study

Health information technology (HIT) holds potential to transform Home Health Care (HHC), yet, little is known about its adoption in this setting. In the context of infection prevention and control, we aimed to: (1) describe challenges associated with the adoption of HIT, for example, electronic health records (EHR) and telehealth and (2) examine HHC agency characteristics associated with HIT adoption. We conducted in-depth interviews with 41 staff from 13 U.S. HHC agencies (May-October 2018), then surveyed a stratified random sample of 1506 agencies (November 2018-December 2019), of which 35.6% participated (N = 536 HHC agencies). We applied analytic weights, generating nationally-representative estimates, and computed descriptive statistics, bivariate and multivariable analyses. Four themes were identified: (1) Reflections on providing HHC without EHR;(2) Benefits of EHR;(3) Benefits of other HIT;(4) Challenges with HIT and EHR. Overall, 10% of the agencies did not have an EHR;an additional 2% were in the process of acquiring one. Sixteen percent offered telehealth, and another 4% were in the process of acquiring telehealth services. In multivariable analysis, EHR use varied significantly by geographic location and ownership, and telehealth use varied by geographic location, ownership, and size. Although HIT use has increased, our results indicate that many HHC agencies still lack the HIT needed to implement technological solutions to improve workflow and quality of care. Future research should examine the impact of HIT on patient outcomes and the impact of the COVID-19 pandemic on HIT use in HHC.

Disparities in patient portal access by US adults before and during the COVID-19 pandemic.

Objective: Online patient portals become important during disruptions to in-person health care, like when cases of coronavirus disease 2019 (COVID-19) and other respiratory viruses rise, yet underlying structural inequalities associated with race, socio-economic status, and other socio-demographic characteristics may affect their use. We analyzed a population-based survey to identify disparities within the United States in access to online portals during the early period of COVID-19 in 2020. Materials and Methods: The National Cancer Institute fielded the 2020 Health and Information National Trends Survey from February to June 2020. We conducted multivariable analysis to identify socio-demographic characteristics of US patients who were offered and accessed online portals, and reasons for nonuse. Results: Less than half of insured adult patients reported accessing an online portal in the prior 12 months, and this was less common among patients who are male, are Hispanic, have less than a college degree, have Medicaid insurance, have no regular provider, or have no internet. Reasons for nonuse include: wanting to speak directly to a provider, not having an online record, concerns about privacy, and discomfort with technology. Discussion: Despite the rapid expansion of digital health technologies due to COVID-19, we found persistent socio-demographic disparities in access to patient portals. Ensuring that digital health tools are secure, private, and trustworthy would address some patient concerns that are barriers to portal access. Conclusion: Expanding the use of online portals requires explicitly addressing fundamental inequities to prevent exacerbating existing disparities, particularly during surges in cases of COVID-19 and other respiratory viruses that tax health care resources.

The Implementation of Measurement-Based Care in the Context of Telemedicine: Qualitative Study.

BACKGROUND: The Measurement Based Care in Mental Health Initiative launched by the Department of Veterans Affairs in 2016 is an example of an evidence-based practice that uses patient-reported outcome measures (PROMs) to improve patient outcomes. The acceptance of measurement-based care (MBC) among Veterans Affairs providers is relatively high. However, there are barriers to MBC for telehealth providers. Health information technologies might afford opportunities to address some of the barriers related to the uptake of MBC. OBJECTIVE: This paper reports on an implementation effort to integrate MBC into mental health care telehealth practice using eHealth solutions. METHODS: Qualitative data were generated from 22 semistructured interviews with psychiatrists (n=4), psychologists (n=3), social workers (n=3), nurses (n=6), a pharmacist (n=1), and administrative staff (n=5) who provide telemental health care through a community-based outpatient clinic in the rural Midwestern United States. The interviews were conducted during the pilot phase of an implementation initiative to increase the adoption of MBC by revising clinic workflows to integrate the use of eHealth technologies. Data were analyzed using thematic analysis. RESULTS: Time burden and workflow issues were the most common barrier to provider adoption of MBC; sharing and reviewing pencil-and-paper measures and results in the same room was no longer possible in novel telehealth workflows necessitated by the COVID-19 pandemic. Providers voiced concerns about how long it would take to collect, adequately score, interpret, share, and document the PROMs during the telehealth visit. Concerns about time might also correspond to a gap in providers' familiarity with these assessments, greater comfort in assessing symptoms through clinical interviews, and being accustomed to using the assessments as screening tools more so than longitudinal outcome measures. Capacities associated with eHealth technologies may address workflow concerns and promote providers' understanding and use of the measures as tracking tools. CONCLUSIONS: The need to use limited appointment time well was a top priority for telemental health providers. eHealth technologies provided operative supports that protect time in appointments by shifting when and how PROMs are collected. Bolstering providers' familiarity with how to use PROMs in the course of treatment may impact providers' buy-in by encouraging them to reconsider how sharing and acting on PROMs could be time well spent.

Examining Structural Disparities in US Nursing Homes: National Survey of Health Information Technology Maturity.

BACKGROUND: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. OBJECTIVE: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. METHODS: NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. RESULTS: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. CONCLUSIONS: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes.

Human-centered design of clinical decision support for management of hypertension with chronic kidney disease.

BACKGROUND: Primary care providers face challenges in recognizing and controlling hypertension in patients with chronic kidney disease (CKD). Clinical decision support (CDS) has the potential to aid clinicians in identifying patients who could benefit from medication changes. This study designed an alert to control hypertension in CKD patients using an iterative human-centered design process. METHODS: In this study, we present a human-centered design process employing multiple methods for gathering user requirements and feedback on design and usability. Initially, we conducted contextual inquiry sessions to gather user requirements for the CDS. This was followed by group design sessions and one-on-one formative think-aloud sessions to validate requirements, obtain feedback on the design and layout, uncover usability issues, and validate changes. RESULTS: This study included 20 participants. The contextual inquiry produced 10 user requirements which influenced the initial alert design. The group design sessions revealed issues related to several themes, including recommendations and clinical content that did not match providers' expectations and extraneous information on the alerts that did not provide value. Findings from the individual think-aloud sessions revealed that participants disagreed with some recommended clinical actions, requested additional information, and had concerns about the placement in their workflow. Following each step, iterative changes were made to the alert content and design. DISCUSSION: This study showed that participation from users throughout the design process can lead to a better understanding of user requirements and optimal design, even within the constraints of an EHR alerting system. While raising awareness of design needs, it also revealed concerns related to workflow, understandability, and relevance. CONCLUSION: The human-centered design framework using multiple methods for CDS development informed the creation of an alert to assist in the treatment and recognition of hypertension in patients with CKD.

Remote Follow-up of Self-isolating Patients With COVID-19 Using a Patient Portal: Protocol for a Mixed Methods Pilot Study (Opal-COVID Study).

BACKGROUND: People with COVID-19 are instructed to self-isolate at home. During self-isolation, they may experience anxiety and insufficient care. Patient portals can allow patients to self-monitor and remotely share their health status with health care professionals, but little data are available on their feasibility. OBJECTIVE: This paper presents the protocol of the Opal-COVID Study. Its objectives are to assess the implementation of the Opal patient portal for distance monitoring of self-isolating patients with COVID-19, identify influences on the intervention's implementation, and describe service and patient outcomes of this intervention. METHODS: This mixed methods pilot study aims to recruit 50 patient participants with COVID-19 tested at the McGill University Health Centre (Montreal, Canada) for 14 days of follow-up. With access to an existing patient portal through a smartphone app, patients will complete a daily self-assessment of symptoms, vital signs, and mental health monitored by a nurse, and receive teleconsultations as needed. Study questionnaires will be administered to collect data on sociodemographic characteristics, medical background, implementation outcomes (acceptability, usability, and respondent burden), and patient satisfaction. Coordinator logbook entries will inform on feasibility outcomes, namely, on recruitment, retention, and fidelity, as well as on the frequency and nature of contacts with health care professionals. The statistical analyses for objectives 1 (implementation outcomes), 3 (service outcomes), and 4 (patient outcomes) will evaluate the effects of time and sociodemographic characteristics on the outcomes. For objectives 1 (implementation outcomes) and 4 (patient outcomes), the statistical analyses will also examine the attainment of predefined success thresholds. As for the qualitative analyses, for objective 2 (influences on implementation), semistructured qualitative interviews will be conducted with 4 groups of stakeholders (ie, patient participants, health care professionals, technology developers, and study administrators) and submitted for content analysis, guided by the Consolidated Framework for Implementation Research to help identify barriers to and facilitators of implementation. For objective 3 (service outcomes), reasons for contacting health care professionals through Opal will also be submitted for content analysis. RESULTS: Between December 2020 and March 2021, a total of 51 patient participants were recruited. Qualitative interviews were conducted with 39 stakeholders from April to September 2021. Delays were experienced owing to measures taken at the McGill University Health Centre to address COVID-19. The quantitative and qualitative analyses began in May 2022. As of June 2022, a total of 2 manuscripts (on the implementation and the patient outcomes) were being prepared, and 3 conference presentations had been given on the study's methods. CONCLUSIONS: This protocol is designed to generate multidisciplinary knowledge on the implementation of a patient portal-based COVID-19 care intervention and will lead to a comprehensive understanding of feasibility, stakeholder experience, and influences on implementation that may prove useful for scaling up similar interventions. TRIAL REGISTRATION: ClinicalTrials.gov NCT04978233; https://clinicaltrials.gov/ct2/show/NCT04978233. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/35760.

A User Interface Informing Medical Staff on Continuous Indoor Environmental Quality to Support Patient Care and Airborne Disease Mitigation

This project seeks to investigate the under addressed issue of indoor environmental quality (IEQ) and the impacts these factors can have on human health. The recent COVID-19 pandemic has once again brought to the forefront the importance of maintaining a healthy indoor environment. Specifically, the improvement of indoor air flow has shown to reduce the risk of airborne virus exposure. This is extremely important in the context of hospitals, which contain high concentrations of at-risk individuals. Thus, the need to create a healthy indoor space is critical to improve public health and COVID-19 mitigation efforts. To create knowledge and provide insight on environmental qualities in the hospital setting, the authors have designed and built an interface to deploy in the University of Virginia Hospital Emergency Department (ED). The interface will display room-specific light, noise, temperature, CO2, humidity, VOC, and PM2.5 levels measured by the low-cost Awair Omni sensor. These insights will assist ED clinicians in mitigating disease-spread and improving patient health and satisfaction while reducing caregiver burden. The team addressed the problem through agile development involving localized sensor deployment and analysis, discovery interviews with hospital clinicians and data scientists throughout, and the implementation of a human-design centered Django interface application. Furthermore, a literature survey was conducted to ascertain appropriate thresholds for the different environmental factors. Together, this work demonstrates opportunities to assist and improve patient care with environmental data.

Views of Care at End of Life: A Secondary Analysis of Online Feedback Using Care Opinion.

Although there are studies on the use of social media and palliative and end-of-life care (PEOLC), there are no studies specifically investigating the content of online public feedback about PEOLC services. This study sought to understand experiences of end-of-life care provided in hospitals in the West of Scotland by exploring the main themes within the content of stories posted on a nationally endorsed nonprofit feedback online platform, Care Opinion, within a 2-year period. We used "Appreciative Inquiry" as a theoretical framework for this study to determine what works well in end-of-life care, while also identifying areas for further improvement. Of the 1428 stories published on "Care Opinion" from March 2019 to 2021 regarding hospitals in the West of Scotland, 48 (3.36%) were related to end-of-life care, of which all were included in data analysis. Using the software package NVivo and thematic analysis, we identified 4 key themes. We found that people overwhelmingly posted positive feedback about their experiences with end-of-life care. People reported positively about staff professionalism in providing compassionate and person-centered care to meet their loved ones needs at end of life. Other experiences of care related to challenges facing healthcare services, particularly during the COVID-19 pandemic. Quality appraisal of staff responses highlighted areas for improving feedback. This study can add to the aim of improving staff response to people's concerns about end-of-life care. This study has provided a novel perspective of patients' experiences of end-of-life care in hospitals in the West of Scotland. Novel insights were the appreciation of quality of care, staff professionalism, effective communication, and meeting patient's needs at end-of-life particularly by nursing staff.

The Spanish Society of Clinical, Family and Community Pharmacy position statement on telepharmacy: telepharmaceutical care (TPC)

The new information and communication technologies (ICT) have been evolving for many years, but the COVID-19 pandemic has accelerated the digital transformation of society. In the healthcare field, new activities have emerged and terms such as telemedicine, telecare and teleconsultation are becoming common. They are undoubtedly a step forward, but they risk dehumanizing the contact between healthcare providers and patients. In the pharmacy-field, Telepharmacy has emerged with undeniable logistical and commercial connotations. The preferred term of the Spanish Society of Clinical, Family and Community Pharmacy is Telepharmaceutical care (TPC) which defines it as the practice of Pharmaceutical Care using ICT in order to complement the face-to face required by the patient. TPC includes the remote provision of some community pharmacy services (CPS). TPC should help the community pharmacist to provide CPS, thus improving clinical pharmaceutical practice without the dehumanizing effects that the indiscriminate application of ICT can have.

Evaluation of an Electronic Consultation Service for COVID-19 Care.

PURPOSE: COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS: This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS: A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS: This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input.

Understanding Whole-Person Health and Resilience During the COVID-19 Pandemic and Beyond: A Cross-sectional and Descriptive Correlation Study.

BACKGROUND: The COVID-19 pandemic has prompted an interest in whole-person health and emotional well-being. Informatics solutions through user-friendly tools such as mobile health apps offer immense value. Prior research developed a consumer-facing app MyStrengths + MyHealth using Simplified Omaha System Terms (SOST) to assess whole-person health. The MyStrengths + MyHealth app assesses strengths, challenges, and needs (SCN) for 42 concepts across four domains (My Living, My Mind and Networks, My Body, My Self-care; eg, Income, Emotions, Pain, and Nutrition, respectively). Given that emotional well-being was a predominant concern during the COVID-19 pandemic, we sought to understand whole-person health for participants with/without Emotions challenges. OBJECTIVE: This study aims to use visualization techniques and data from attendees at a Midwest state fair to examine SCN overall and by groups with/without Emotions challenges, and to explore the resilience of participants. METHODS: This cross-sectional and descriptive correlational study surveyed adult attendees at a 2021 Midwest state fair. Data were visualized using Excel and analyzed using descriptive and inferential statistics using SPSS. RESULTS: The study participants (N=182) were primarily female (n=123, 67.6%), aged ≥45 years (n=112, 61.5%), White (n=154, 84.6%), and non-Hispanic (n=177, 97.3%). Compared to those without Emotions challenges, those with Emotions challenges were aged 18-44 (P<.001) years, more often female (P=.02), and not married (P=.01). Overall, participants had more strengths (mean 28.6, SD 10.5) than challenges (mean 12, SD 7.5) and needs (mean 4.2, SD 7.5). The most frequent needs were in Emotions, Nutrition, Income, Sleeping, and Exercising. Compared to those without Emotions challenges, those with Emotions challenges had fewer strengths (P<.001), more challenges (P<.001), and more needs (P<.001), along with fewer strengths for Emotions (P<.001) and for the cluster of health-related behaviors domain concepts, Sleeping (P=.002), Nutrition (P<.001), and Exercising (P<.001). Resilience was operationalized as correlations among strengths for SOST concepts and visualized for participants with/without an Emotions challenge. Those without Emotions challenges had more positive strengths correlations across multiple concepts/domains. CONCLUSIONS: This survey study explored a large community-generated data set to understand whole-person health and showed between-group differences in SCN and resilience for participants with/without Emotions challenges. It contributes to the literature regarding an app-aided and data-driven approach to whole-person health and resilience. This research demonstrates the power of health informatics and provides researchers with a data-driven methodology for additional studies to build evidence on whole-person health and resilience.

A Multimetric Readability Analysis of Online Patient Educational Materials for Submental Fat Reduction.

BACKGROUND: Patients often utilize the Internet to seek information related to their care. This study assesses the readability of online patient educational materials for submental fat reduction. METHODS: Patient educational materials from the 12 most popular websites related to submental fat reduction were downloaded and assessed for readability grade level using 10 unique scales. RESULTS: Analysis of the 12 most popular websites (and corresponding 47 articles) revealed that patient educational materials were written, on average, at an 11th grade reading level. The Flesch Reading Ease score was 48.9 (range 39.8-59.2), representing a "difficult" level of reading. Mean readability grade levels (range 9-13th grade for individual websites) were as follows: Coleman-Liau, 11.1; Flesch-Kincaid, 10.8; FORCAST, 10.8; Fry Graph, 10.1; Gunning Fog, 12.7; New Dale-Chall, 10.1; New Fog Count, 11.8; Simple Measure of Gobbledygook, 11.7; Raygor, 6.7. No website was at the 6th grade reading level for patient educational materials recommended by the American Medical Association and National Institutes of Health. CONCLUSIONS: Online patient educational materials for submental fat reduction are written well above the recommended reading level. Recognition of disparities in health literacy is necessary to enable patients to make informed decisions and become active participants in their own care. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.

Reimagining Connected Care in the Era of Digital Medicine.

The COVID-19 pandemic accelerated the adoption of remote patient monitoring technology, which offers exciting opportunities for expanded connected care at a distance. However, while the mode of clinicians' interactions with patients and their health data has transformed, the larger framework of how we deliver care is still driven by a model of episodic care that does not facilitate this new frontier. Fully realizing a transformation to a system of continuous connected care augmented by remote monitoring technology will require a shift in clinicians' and health systems' approach to care delivery technology and its associated data volume and complexity. In this article, we present a solution that organizes and optimizes the interaction of automated technologies with human oversight, allowing for the maximal use of data-rich tools while preserving the pieces of medical care considered uniquely human. We review implications of this "augmented continuous connected care" model of remote patient monitoring for clinical practice and offer human-centered design-informed next steps to encourage innovation around these important issues.

Utilising an automated medication inventory management system for emergency crash carts during the COVID-19 pandemic.

The high acuity of patients with COVID-19 during the pandemic in the city of New York correlated with an increased incidence of cardiac arrests and other emergent resuscitation scenarios requiring life-sustaining treatment. A spike in the utilisation of emergency crash cart medications was to be expected. The department of pharmacy at SUNY Downstate Health Sciences University optimised the use of an automated medication inventory management system with radio-frequency identification to assess usage and turnover of emergency crash carts; improve efficiency and turnaround times for crash cart dispatches; track drug consumption; and manage ongoing medication shortages during the peak of the COVID-19 pandemic. By capitalising on the utility and functionality of technology and automation, the institution was able to keep pace with acute patient care demands to prevent gaps in pharmaceutical care and medication management during emergency responses.

DOES IT HAVE TO BE HUMAN TO BE CREDIBLE? PERCEPTION OF DIGITAL AVATARS COMMUNICATION IN HEALTHCARE SECTOR

IN THE CONTEXT OF THE COVID-19 PANDEMIC, THE USE OF DIGITAL TECHNOLOGY IN THE HEALTHCARE SECTOR HAS BECOME CRUCIAL, ESPECIALLY BECAUSE OF INCREASED HEALTH EXPENDITURES AND MEDICAL STAFF SHORTAGES. DIGITAL INNOVATIONS IN HEALTHCARE CONTINUE TO GROW IN POPULARITY, ARTIFICIAL INTELLIGENCE, VIRTUAL REALITY, AND AVATAR TECHNOLOGIES ARE TRANSFORMING THE RELATIONSHIP BETWEEN PATIENTS AND DOCTORS. IN THIS ARTICLE, WE WANT TO ADDRESS THE RELATIVE SCARCITY IN THE RESEARCH ON THE PERCEPTION OF DIGITAL AVATARS USED IN TRANSMISSION OF HEALTH MESSAGESAND THEIR USE IN HEALTHCARE SECTOR. ONE OF THE CONCERNS FOR EMERGING MEDIA STUDIES REMAINS TO ESTABLISH THE CONDITIONS IN WHICH AVATARS COULD IMPROVE THE HEALTH COMMUNICATION AND MESSAGE DELIVERY IN ORDER TO ENSURE A GREATER COMPLIANCE FROM THE PUBLIC. TO DISCOVER THESE CONDITIONS, THIS STUDY AIMS TO EXPLORE THE USE OF AVATARS IN HEALTHCARE SYSTEM, HOW THEY ARE PERCIEVED AS STAND-ALONE COMMUNICATORS AND IN COMPARISON WITH THEIR HUMAN COUNTERPARTS AND IF THEY ARE A RELIABLE ALTERNATIVE FOR P UBLIC HEAL TH MESSA GES TRANSMISSION IN THIS PANDEMIC PERIOD.. AS PEOPLE TEND TO NEED ORDER, CONTROL, AND STRUCTURE IN UNCERTAIN TIMES, THE PERCEPTION OF DIGITAL AVATARS COULD CHANGE THE WAY OF HOW PATIENTS UNDERSTAND AND INTERNALIZE MEDICAL INFORMATION AND TREATMENTS AND ALSO HOW THEY ACCEPT THE INFORMATION IN MEDICAL CRISIS.

Ethics, Guidelines, Standards, and Policy: Telemedicine, COVID-19, and Broadening the Ethical Scope.

The coronavirus crisis is causing considerable disruption and anguish. However, the COVID-19 pandemic and consequent explosion of telehealth services also provide an unparalleled opportunity to consider ethical, legal, and social issues (ELSI) beyond immediate needs. Ethicists, informaticians, and others can learn from experience, and evaluate information technology practices and evidence on which to base policy and standards, identify significant values and issues, and revise ethical guidelines. This paper builds on professional organizations' guidelines and ELSI scholarship to develop emerging concerns illuminated by current experience. Four ethical themes characterized previous literature: quality of care and the doctor-patient relationship, access, consent, and privacy. More attention is needed to these and to expanding the scope of ethical analysis to include health information technologies. An applied ethics approach to ELSI would addresses context-specific issues and the relationships between people and technologies, and facilitate effective and ethical institutionalization of telehealth and other health information technologies.

Online patient portal-based management of medication renewal and refill pickup in ambulatory care settings: A retrospective utilization study at tertiary care hospital in Saudi Arabia.

BACKGROUND: The prescription pickup and renewal process in ambulatory care settings requires numerous steps, such as making an appointment with a physician to renew prescriptions and direct pharmacy visits to pick up medications. This process can be difficult or cumbersome for some patients; however, digital health-associated patient portals can reduce the burden on both patients and healthcare professionals. METHODS: A retrospective study was conducted in an ambulatory care setting of Johns Hopkins Aramco Healthcare. We analyzed the utilization pattern of MyChart for medication renewal and refill pickup services for ambulatory care patients of all specialties from October 1, 2018, to September 30, 2020. The data were extracted electronically from the Epic-Hyperspace EHR system, and the effects of factors such as year of access and COVID-19 on MyChart utilization were analyzed. RESULTS: A total of 125,538 patients were registered using MyChart. In the first and second year of this study, MyChart was utilized by 44,063 (8.7%) and 59,622 (13.6%) patients, respectively, for medication pickup. Additionally, in these two years, 92,997 (21.6%) and 156,020 (38.9%) medication refills were requested through MyChart (with no direct pharmacy visit) and collected from different pickup locations, respectively. In two years, there were 363,159 medications sent to physicians for renewal through Epic-MyChart, of which 347,244 (95.6%) were approved and 15,915 (4.4%) were denied. A significant increasing (p less than 0.05) trend in utilization, medication requests, and renewal requests using the MyChart were observed over a period of 24 months and during quarantine due to COVID-19. Although there was a decrease in physicians denying renewal request, these were not significantly affected by time or COVID-19. CONCLUSION: The high and consistent utilization of the patient portal MyChart indicates its broad acceptance, significantly minimizing the barriers to medication pickup and renewal processes in ambulatory care settings. The year of access and COVID-19 were significantly associated with an increasing trend in MyChart utilization. With increased utilization and higher acceptability, the internet-based patient portal MyChart continues to hold great potential for providing quality healthcare services by increasing access and making patients decision-makers in their healthcare.