Use of Patient-Generated Health Data From Consumer-Grade Devices by Health Care Professionals in the Clinic: Systematic Review.

BACKGROUND: Mobile health (mHealth) uses mobile technologies to promote wellness and help disease management. Although mHealth solutions used in the clinical setting have typically been medical-grade devices, passive and active sensing capabilities of consumer-grade devices like smartphones and activity trackers have the potential to bridge information gaps regarding patients' behaviors, environment, lifestyle, and other ubiquitous data. Individuals are increasingly adopting mHealth solutions, which facilitate the collection of patient-generated health data (PGHD). Health care professionals (HCPs) could potentially use these data to support care of chronic conditions. However, there is limited research on real-life experiences of HPCs using PGHD from consumer-grade mHealth solutions in the clinical context. OBJECTIVE: This systematic review aims to analyze existing literature to identify how HCPs have used PGHD from consumer-grade mobile devices in the clinical setting. The objectives are to determine the types of PGHD used by HCPs, in which health conditions they use them, and to understand the motivations behind their willingness to use them. METHODS: A systematic literature review was the main research method to synthesize prior research. Eligible studies were identified through comprehensive searches in health, biomedicine, and computer science databases, and a complementary hand search was performed. The search strategy was constructed iteratively based on key topics related to PGHD, HCPs, and mobile technologies. The screening process involved 2 stages. Data extraction was performed using a predefined form. The extracted data were summarized using a combination of descriptive and narrative syntheses. RESULTS: The review included 16 studies. The studies spanned from 2015 to 2021, with a majority published in 2019 or later. Studies showed that HCPs have been reviewing PGHD through various channels, including solutions portals and patients' devices. PGHD about patients' behavior seem particularly useful for HCPs. Our findings suggest that PGHD are more commonly used by HCPs to treat conditions related to lifestyle, such as diabetes and obesity. Physicians were the most frequently reported users of PGHD, participating in more than 80% of the studies. CONCLUSIONS: PGHD collection through mHealth solutions has proven beneficial for patients and can also support HCPs. PGHD have been particularly useful to treat conditions related to lifestyle, such as diabetes, cardiovascular diseases, and obesity, or in domains with high levels of uncertainty, such as infertility. Integrating PGHD into clinical care poses challenges related to privacy and accessibility. Some HCPs have identified that though PGHD from consumer devices might not be perfect or completely accurate, their perceived clinical value outweighs the alternative of having no data. Despite their perceived value, our findings reveal their use in clinical practice is still scarce. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/39389.

Impact of Digital Interventions on the Treatment Burden of Patients With Chronic Conditions: Protocol for a Systematic Review.

BACKGROUND: There is great potential for delivering cost-effective, quality health care for patients with chronic conditions through digital interventions. Managing chronic conditions often includes a substantial workload required for adhering to the treatment regimen and negative consequences on the patient's function and well-being. This treatment burden affects adherence to treatment and disease outcomes. Digital interventions can potentially exacerbate the burden but also alleviate it. OBJECTIVE: The objective of this review is to identify, summarize, and synthesize the evidence of how digital interventions impact the treatment burden of people with chronic conditions. METHODS: The search, selection, and data synthesis processes were designed according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015. A systematic search was conducted on October 16, 2023, from databases PubMed, Scopus, Web of Science, ACM, PubMed Central, and CINAHL. RESULTS: Preliminary searches have been conducted, and screening has been started. The review is expected to be completed in October 2024. CONCLUSIONS: As the number of patients with chronic conditions is increasing, it is essential to design new digital interventions for managing chronic conditions in a way that supports patients with their treatment burden. To the best of our knowledge, the proposed systematic review will be the first review that investigates the impact of digital interventions on the treatment burden of patients. The results of this review will contribute to the field of health informatics regarding knowledge of the treatment burden associated with digital interventions and practical implications for developing better digital health care for patients with chronic conditions. TRIAL REGISTRATION: PROSPERO CRD42023477605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477605. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54833.

The Use of Patient-Generated Health Data From Consumer-Grade Mobile Devices in Clinical Workflows: Protocol for a Systematic Review.

BACKGROUND: With the rapid advancement of mobile technology, the scope of mobile health (mHealth) has expanded to include consumer-grade devices such as smartphones and wearable sensors. These solutions have typically been used for fitness purposes; however, due to their ubiquitous capabilities for data collection, they have the potential to bridge information gaps and supplement data from clinical visits. Patient-generated health data (PGHD) can be derived from mHealth solutions and be used by health care professionals (HCPs) as complementary tools in the care process, yet their integration into clinical workflows presents a myriad of challenges. PGHD might be a new and unfamiliar source of information for most HCPs, and the majority of mHealth solutions have not been designed to be used by HCPs as active reviewers. As mHealth solutions become more available and attractive to patients, HCPs may see an increase in the influx of data and related inquiries from their patients. This mismatch in expectations can result in disruptions to clinical workflows and negatively impact patient-clinician relationships. For PGHD to be integrated into clinical workflows, its use should be proven beneficial for both patients and HCPs. However, so far, only limited research has been done on the concrete experiences of HCPs as active reviewers of PGHD from consumer-grade mobile devices. OBJECTIVE: We aimed to systematically guide the review of existing literature to identify what types of PGHD from consumer-grade mobile devices are currently being used by HCPs as complementary tools in the care process. METHODS: The PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 was followed for the design of the search, selection, and data synthesis processes. Electronic searches will be done on PubMed, ACM Digital Library, IEEE Xplore, and Scopus. RESULTS: Preliminary searches have been conducted, and previous related systematic and scoping reviews have been found and evaluated. The review is expected to be completed in February 2023. CONCLUSIONS: This protocol will guide the review of existing literature on the use of PGHD produced by consumer-grade mobile devices. Although there have been previous reviews related to this topic, our proposed approach seeks to understand the specific opinions and experiences of different types of HCPs who are already using PGHD in their clinical practice and the motives for deeming these data useful and worth reviewing. Depending on the studies that will be included, there may be an opportunity to provide a wider understanding of what types of HCPs trust PGHD, despite the possible challenges that its use might convey, potentially contributing with the knowledge to support the design strategies of mHealth tools that could be integrated into clinical workflows. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/39389.

Experiences Using Patient and Public Involvement in Digital Health Research for Multiple Sclerosis.

Patient and public involvement (PPI) is increasingly used for improving quality of the research. There are many barriers in translating PPI into practice, including lacking examples of good practices. Frameworks that have been developed in one setting do not readily transfer to other settings. In this paper, we examine the implementation of PPI in the context of a digital health research project that explores the design, development and use of mHealth for persons with Multiple Sclerosis taking an iterative user-centered design approach. Methods: Instrumental case study to describe the PPI process on a digital health research project. Results: Overall experience was positive. We found 3 roles for PPI involvement: strategic members; design and development partners; and expert members. Challenges lay on unclear PPI terminology; managing roles and expectations; and ensuring accessibility.

Health Care Professionals' Perspectives on the Uses of Patient-Generated Health Data.

Integration of digital self-management solutions into health care processes requires the involvement of health care professionals in the adoption and use of the solutions as part of the care pathway. We conducted 23 interviews with diverse profiles of health care professionals participating in the treatment of chronic patients in three different countries. Our results indicate that health care professionals appeared relatively motivated at the prospect of having access to patient-generated data. Nevertheless, they appeared less confident in weighing what types of data could be collected efficiently through mobile devices and how it could be presented in ways that would provide value to the care process. Our results identify four broad categories for how patient-generated health data could be useful: monitoring, prevention, research, and transparency of condition parameters.

A Conceptual Framework to Design Connected Mental Health Solutions in the United Arab Emirates: Questionnaire Study.

BACKGROUND: Connected mental health (CMH) is a field presenting information and communications technology-based mental care interventions that could help overcome many mental care delivery barriers. Culture and background influence people's attitudes, preferences, and acceptance of such solutions. Therefore, the suitability of CMH solutions to the targeted population is an important factor in their successful adoption. OBJECTIVE: The aim of this study is to develop a framework for the design and creation of CMH solutions suitable for the UAE context. The framework is based on investigating enablers and barriers of CMH adoption in the United Arab Emirates, from the mental health professional's (MHP) perspective and from related literature. METHODS: A survey of literature on relevant studies addressing the use of technology for mental care in Arab countries, and a web-based questionnaire-based survey with 17 MHPs practicing in the United Arab Emirates investigating their attitudes and views toward CMH was conducted. Results from the questionnaire and from related studies were analyzed to develop the design framework. RESULTS: On the basis of findings from the literature survey and analyzing MHP answers to the web-based survey, a framework for the design of CMH solutions for the UAE population was developed. The framework presents four types of recommendation categories: favorable criteria, which included blended care, anonymity, and ease of use; cultural factors including availability in multiple languages, mainly Arabic and English, in addition to religious and cultural considerations; technical considerations, including good-quality communication, availability in formats compatible with mobile phones, and providing technical support; and users' health and data safety considerations, including users' suitability testing, confidentiality, and ensuring MHP integrity. CONCLUSIONS: CMH has the potential to help overcome many mental care barriers in the United Arab Emirates in particular and in the Arab world in general. CMH adoption in the United Arab Emirates has a potential for success. However, many factors should be taken into account, mainly cultural, religious, and linguistic aspects.

The effect of Covid-19 in digital media use of Finnish physicians - Four wave longitudinal panel survey.

BACKGROUND: Covid-19 pandemic has boosted digitalization in healthcare, as mobility restrictions and social distancing rules have made healthcare providers to adopt digital tools to replace or complement face-to-face interactions. PURPOSE: We discuss the effects of Covid-19 pandemic on physicians' use of digital media. We examine whether Covid-19 conditions have changed how physicians use internet resources for information search, how they engage in social media, and their attitude towards online events. BASIC PROCEDURES: The study was done as a longitudinal panel survey in four waves. The sample was a panel including active physicians in Finland. The panel was updated annually. Identical surveys were administered in 2018, 2019, 2020 and 2021. Spring 2020 was the time when Finland executed mobility restrictions and re-organization of healthcare because of pandemic. Comparing results of the survey before and after Covid-19 restrictions gives us a unique opportunity to do comparative analysis of Covid-19 effects. MAIN FINDINGS: Our results show that the use of digital media for information search stayed relatively stable without statistically significant change during the four-year period covered in the study. The use of social media rose steadily from 2018 to 2021 with no significant difference in the trend. However, there was a significant change in the attitude of Finnish physicians on online events. Year 2021, the attitude remained in this more positive level. PRINCIPAL CONCLUSIONS: As use of digital media including social media was already high prior Covid-19 in Finland, our results do not show significant change because of special circumstances introduced in 2020. However, our results show that the attitudes towards online events turned more positive during Covid-19 related restrictions. This could indicate that Covid-19 era has triggered a change that might continue also when pandemic related restrictions will be removed.

Rehabilitation Needs of Head and Neck Cancer Patients and Stakeholders: Case Study.

BACKGROUND: The incidents of Head and Neck Cancer (HNC) are rising worldwide, suggesting that this type of cancer is becoming more common. The foreseen growth of incidents signifies that future rehabilitation services will have to meet the needs of a wider population. OBJECTIVE: The aim of this paper is to explore the needs of patients, caregivers and healthcare professionals during HNC rehabilitation. METHODS: This paper reports the empirical findings from a case study that was conducted in a cancer rehabilitation center in Copenhagen to elicit the needs of HNC cancer patients, informal caregivers and healthcare professionals. RESULTS: Four areas of needs during the rehabilitation process were identified: service delivery, emotional, social and physical needs. Service delivery needs and emotional needs have been identified as the most prevalent. CONCLUSIONS: Stakeholders' needs during the rehabilitation process were found to be interrelated. All stakeholders faced service delivery challenges in the form of provision and distribution of information, including responsibilities allocation between municipalities, hospitals and rehabilitation services. Emotional and social needs have been reported by HNC patients and informal caregivers, underlining the importance of inclusion of all actors in the design of future healthcare interventions. Connected Health (CH) solutions could be valuable in provision and distribution of information.

Challenges and opportunities for telehealth in the management of chronic obstructive pulmonary disease: a qualitative case study in Greece.

BACKGROUND: Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services. METHODS: Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges. RESULTS: Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully. CONCLUSIONS: The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.

Data-Driven Personalization of a Physiotherapy Care Pathway: Case Study of Posture Scanning.

BACKGROUND: Advanced sensor, measurement, and analytics technologies are enabling entirely new ways to deliver health care. The increased availability of digital data can be used for data-driven personalization of care. Data-driven personalization can complement expert-driven personalization by providing support for decision making or even by automating some parts of decision making in relation to the care process. OBJECTIVE: The aim of this study was to analyze how digital data acquired from posture scanning can enhance physiotherapy services and enable more personalized delivery of physiotherapy. METHODS: A case study was conducted with a company that designed a posture scan recording system (PSRS), which is an information system that can digitally record, measure, and report human movement for use in physiotherapy. Data were collected through interviews with different stakeholders, such as health care professionals, health care users, and the information system provider, and were analyzed thematically. RESULTS: Based on the results of our thematic analysis, we propose three different types of support that posture scanning data can provide to enhance and enable more personalized delivery of physiotherapy: 1) modeling the condition, in which the posture scanning data are used to detect and understand the health care user's condition and the root cause of the possible pain; 2) visualization for shared understanding, in which the posture scanning data are used to provide information to the health care user and involve them in more collaborative decision-making regarding their care; and 3) evaluating the impact of the intervention, in which the posture scanning data are used to evaluate the care progress and impact of the intervention. CONCLUSIONS: The adoption of digital tools in physiotherapy has remained low. Physiotherapy has also lacked digital tools and means to inform and involve the health care user in their care in a person-centered manner. In this study, we gathered insights from different stakeholders to provide understanding of how the availability of digital posture scanning data can enhance and enable personalized physiotherapy services.

Insurance Customers' Expectations for Sharing Health Data: Qualitative Survey Study.

BACKGROUND: Insurance organizations are essential stakeholders in health care ecosystems. For addressing future health care needs, insurance companies require access to health data to deliver preventative and proactive digital health services to customers. However, extant research is limited in examining the conditions that incentivize health data sharing. OBJECTIVE: This study aimed to (1) identify the expectations of insurance customers when sharing health data, (2) determine the perceived intrinsic value of health data, and (3) explore the conditions that aid in incentivizing health data sharing in the relationship between an insurance organization and its customer. METHODS: A Web-based survey was distributed to randomly selected customers from a Finnish insurance organization through email. A single open-text answer was used for a qualitative data analysis through inductive coding, followed by a thematic analysis. Furthermore, the 4 constructs of commitment, power, reciprocity, and trust from the social exchange theory (SET) were applied as a framework. RESULTS: From the 5000 customers invited to participate, we received 452 surveys (response rate: 9.0%). Customer characteristics were found to reflect customer demographics. Of the 452 surveys, 48 (10.6%) open-text responses were skipped by the customer, 57 (12.6%) customers had no expectations from sharing health data, and 44 (9.7%) customers preferred to abstain from a data sharing relationship. Using the SET framework, we found that customers expected different conditions to be fulfilled by their insurance provider based on the commitment, power, reciprocity, and trust constructs. Of the 452 customers who completed the surveys, 64 (14.2%) customers required that the insurance organization meets their data treatment expectations (commitment). Overall, 4.9% (22/452) of customers were concerned about their health data being used against them to profile their health, to increase insurance prices, or to deny health insurance claims (power). A total of 28.5% (129/452) of customers expected some form of benefit, such as personalized digital health services, and 29.9% (135/452) of customers expected finance-related compensation (reciprocity). Furthermore, 7.5% (34/452) of customers expected some form of empathy from the insurance organization through enhanced transparency or an emotional connection (trust). CONCLUSIONS: To aid in the design and development of digital health services, insurance organizations need to address the customers' expectations when sharing their health data. We established the expectations of customers in the social exchange of health data and explored the perceived values of data as intangible goods. Actions by the insurance organization should aim to increase trust through a culture of transparency, commitment to treat health data in a prescribed manner, provide reciprocal benefits through digital health services that customers deem valuable, and assuage fears of health data being used to prevent providing insurance coverage or increase costs.

Connected Health User Willingness to Share Personal Health Data: Questionnaire Study.

BACKGROUND: Connected health has created opportunities for leveraging health data to deliver preventive and personalized health care services. The increasing number of personal devices and advances in measurement technologies contribute to an exponential growth in digital health data. The practices for sharing data across the health ecosystem are evolving as there are more opportunities for using such data to deliver responsive health services. OBJECTIVE: The objective of this study was to explore user attitudes toward sharing personal health data (PHD). The study was executed within the first year after the implementation of the new General Data Protection Regulation (GDPR) legal framework. METHODS: The authors analyzed the results of an online questionnaire survey to explore the willingness of 8004 people using connected health services across four European countries to share their PHD and the conditions under which they would be willing to do so. RESULTS: Our findings indicate that the majority of users are willing to share their personal PHD for scientific research (1811/8004, 22.63%). Age, education level, and occupation of the participants, in addition to the level of digitalization in their country were found to be associated with data sharing attitudes. CONCLUSIONS: Positive attitudes toward data sharing for scientific research can be perceived as an indication of trust established between users and academia. Nevertheless, the interpretation of data sharing attitudes is a complex process, related to and influenced by various factors.

The Extent and Coverage of Current Knowledge of Connected Health: Systematic Mapping Study.

BACKGROUND: This study examines the development of the connected health (CH) research landscape with a view to providing an overview of the existing CH research. The research field of CH has experienced rapid growth coinciding with increasing pressure on health care systems to become more proactive and patient centered. OBJECTIVE: This study aimed to assess the extent and coverage of the current body of knowledge in CH. In doing so, we sought to identify specific topics that have drawn the attention of CH researchers and to identify research gaps, in particular those offering opportunities for further interdisciplinary research. METHODS: A systematic mapping study that combined scientific contributions from research in the disciplines of medicine, business, computer science, and engineering was used. Overall, seven classification criteria were used to analyze the papers, including publication source, publication year, research type, empirical type, contribution type, research topic, and the medical condition studied. RESULTS: The search resulted in 208 papers that were analyzed by a multidisciplinary group of researchers. The results indicated a slow start for CH research but showed a more recent steady upswing since 2013. The majority of papers proposed health care solutions (77/208, 37.0%) or evaluated CH approaches (49/208, 23.5%). Case studies (59/208, 28.3%) and experiments (55/208, 26.4%) were the most popular forms of scientific validation used. Diabetes, cancer, multiple sclerosis, and heart conditions were among the most prevalent medical conditions studied. CONCLUSIONS: We conclude that CH research has become an established field of research that has grown over the last five years. The results of this study indicate a focus on technology-driven research with a strong contribution from medicine, whereas the business aspects of CH have received less research attention.

Developing a Smartphone Application to Support Smoking Behavior Change through Social Comparison.

The growing field of mHealth has often dealt with the modification of harmful behaviors, such as smoking, that are associated with medical conditions. Smoking behavior has been targeted by numerous mHealth smoking cessation interventions with the help of a wide range of behavior change support (BCS) techniques. However, the exploitation of the established BCS technique of social comparison by mHealth research on smoking cessation has been limited. Based on up-to-date BCS theory and following a user-centered design, we have developed a novel smartphone application, namely QuitIT!, for smoking behavior modification with the help of social comparison. This paper presents the development of QuitIT! as well as its preliminary evaluation through a small pilot study. The latter has yield encouraging initial results concerning the feasibility and the effectiveness of QuitIT! as an mHealth tool for smoking BCS.

Personal health data: A systematic mapping study.

BACKGROUND: Personal health data (PHD) research has been intensified over the last years, attracting the attention of scientists from different fields, such as software engineers, computer scientists and medical professionals. The increasing interest of researchers can be attributed to the exponential growth of the available PHD due to the widespread adoption of ubiquitous technology in everyday life, as well as to the potential of the ongoing digital transformation in healthcare. This increasing interest requires that academia has an overview of the published scientific literature to plan future endeavors. OBJECTIVE: The main objective of this study is to identify and address research gaps in literature regarding PHD. METHOD: This paper conducts a systematic mapping study to summarize the existing PHD approaches in literature and to organize the selected studies according to six classification criteria: publication source, publication year, research types, empirical types, contribution types and research topic. RESULTS: In total 79 papers have been included after fulfilling the inclusion criteria and have been classified accordingly. There is an increasing amount of attention that has been paid to PHD since 2014. The majority of papers is published in journals. The two main research types found were solution proposals and evaluation research. The majority of the selected papers were empirically evaluated. The main contribution types were methods and frameworks. Data privacy is the most frequently addressed topic in PHD literature, followed by data sharing. CONCLUSIONS: The findings of this systematic mapping study have implications for both researchers who are planning new studies in PHD and for practitioners who are working in connected health and would like to have an overview on the existent studies on PHD research area.

Feasibility of digital footprint data for health analytics and services: an explorative pilot study.

BACKGROUND: As a result of digitalization, data is available about almost every aspect of our lives. Personal data collected by individuals themselves or stored by organizations interacting with people is known as a digital footprint. The purpose of this study was to identify prerequisites for collecting and using digital data that could be valuable for health data analytics and new health services. METHODS: Researchers and their contacts involved in a nationwide research project focusing on digital health in Finland were asked to participate in a pilot study on collecting their own personal data from various organizations of their own choice, such as retail chains, banks, insurance companies, and healthcare providers. After the pilot, a qualitative inquiry was adopted to collect semi-structured interview data from twelve active participants in the pilot. Interviews comprised themes such as the experiences of collecting personal data, as well as the usefulness of the data in general and for the participants themselves. Interview data was then analyzed thematically. RESULTS: Even if the participants had an academic background and were highly motivated to collect and use their data, they faced many challenges, such as quite long delays in the provision of the data, and the unresponsiveness of some organizations. Regarding the usefulness of the acquired personal data, our results show that participants had high expectations, but they were disappointed with the small amount of data and its irrelevant content. For the most part, the data was not in a format that would be useful for health data analytics and new health services. Participants also found that there were actual mistakes in their health data reports. CONCLUSIONS: The study revealed that collecting and using digital footprint data, even by knowledgeable individuals, is not an easy task. As the usefulness of the acquired personal health data mainly depended on its form and usability for services or solutions relevant to an individual, rather than on the data being valuable as such, more emphasis should be placed on providing the data in a reusable form.

Collecting a citizen's digital footprint for health data mining.

This paper describes a case study for collecting digital footprint data for the purpose of health data mining. The case study involved 20 subjects residing in Finland who were instructed to collect data from registries which they evaluated to be useful for understanding their health or health behaviour, current or past. 11 subjects were active, sending 100 data requests to 49 distinct organizations in total. Our results indicate that there are still practical challenges in collecting actionable digital footprint data. Our subjects received a total of 75 replies (reply rate of 75.0%) and 61 datasets (reception rate of 61%). Out of the received data, 44 datasets (72.1%) were delivered in paper format, 4 (6.6%) in portable document format and 13 (21.3%) in structured digital form. The time duration between the sending of the information requests and reception of a reply was 26.4 days on the average.