A scoping review of telehealth.

OBJECTIVES: This scoping review of the telehealth literature over the past year was conducted to provide a snapshot of some of the current developments in the field. As with any scoping review, only a subset of papers was examined, and the rigorous methods of a systematic review are not applied. METHODS: We surveyed selected dimensions of the current literature, specifically targeting telehealth or eHealth interventions at the patient (or micro) level in this scoping review. Considering the lack of clarity around the terms like mHealth, eHealth, telehealth, and telemedicine, efforts were made understand and harmonize the terminology as part of the review process. RESULTS: A total of 171 papers that matched the search criteria were culled from the literature. After discussion and debate, a total of 26 papers were retained and classified into at least one of 5 conceptual categories that were derived form a concept analysis. The five categories are Preventive and Therapeutic Effects; Health Service Utilization; Challenges & Opportunities for Enhanced User Centered Design; Low-powered studies/inconclusive evidence; and Future trends in telehealth. Each of these 5 concept categories are discussed to provide a better understanding of present opportunities, challenges, and the overall prospects for telehealth advancement. CONCLUSIONS: The field is expanding and maturing rapidly. There is a need for larger scale studies that balance rigor while reducing translational latency. Additional attention to implementation science methods is recommended as global telehealth projects accelerate.

Usability characteristics of self-administered computer-assisted interviewing in the emergency department: factors affecting ease of use, efficiency, and entry error.

OBJECTIVE: Self-administered computer-assisted interviewing (SACAI) gathers accurate information from patients and could facilitate Emergency Department (ED) diagnosis. As part of an ongoing research effort whose long-range goal is to develop automated medical interviewing for diagnostic decision support, we explored usability attributes of SACAI in the ED. METHODS: Cross-sectional study at two urban, academic EDs. Convenience sample recruited daily over six weeks. Adult, non-level I trauma patients were eligible. We collected data on ease of use (self-reported difficulty, researcher documented need for help), efficiency (mean time-per-click on a standardized interview segment), and error (self-report age mismatched with age derived from electronic health records) when using SACAI on three different instruments: Elo TouchSystems ESY15A2 (finger touch), Toshiba M200 (with digitizer pen), and Motion C5 (with digitizer pen). We calculated descriptive statistics and used regression analysis to evaluate the impact of patient and computer factors on time-per-click. RESULTS: 841 participants completed all SACAI questions. Few (<1%) thought using the touch computer to ascertain medical information was difficult. Most (86%) required no assistance. Participants needing help were older (54 ± 19 vs. 40 ± 15 years, p<0.001) and more often lacked internet at home (13.4% vs. 7.3%, p = 0.004). On multivariate analysis, female sex (p<0.001), White (p<0.001) and other (p = 0.05) race (vs. Black race), younger age (p<0.001), internet access at home (p<0.001), high school graduation (p = 0.04), and touch screen entry (vs. digitizer pen) (p = 0.01) were independent predictors of decreased time-per-click. Participant misclick errors were infrequent, but, in our sample, occurred only during interviews using a digitizer pen rather than a finger touch-screen interface (1.9% vs. 0%, p = 0.09). DISCUSSION: Our results support the facility of interactions between ED patients and SACAI. Demographic factors associated with need for assistance or slower interviews could serve as important triggers to offering human support for SACAI interviews during implementation. CONCLUSION: Understanding human-computer interactions in real-world clinical settings is essential to implementing automated interviewing as means to a larger long-term goal of enhancing clinical care, diagnostic accuracy, and patient safety.

E-learning for health-care workforce development.

OBJECTIVES: To summarize advances in informatics that contribute to scaling-up the health care workforce. METHOD: A review of projects and methods in information and communication technologies (ICT) that are having an impact on educating frontline health care workers. RESULTS AND CONCLUSIONS: e-learning is providing innovative approaches for health workforce development, especially in underserved areas.

The new millennium brings nursing informatics into the OR.

Will the perioperative arena step out of the dark ages and into the new millennium with informatics? A paradigm shift must occur in both the perioperative arena and health care organizations. Health care organizations must realize the value of informatics and the importance of integrating the informatics nurse into the organizational information system's team. This article discusses how the informatics nurse can accelerate the paradigm shift in the perioperative arena if given the opportunity. The informatics nurse's proactive involvement in the perioperative environment will ensure that information handling technologies benefit the perioperative specialty and, ultimately, enhance patient care.

A clinic on wheels. A paradigm shift in the provision of care and the challenges of information infrastructure.

The implementation of nontraditional healthcare delivery increases the need for information technology innovation, not only in use of computer-based patient records, but also in enabling infrastructures to support health information exchange. This is very apparent in mobile health clinics where care is provided to vulnerable community populations at locations far removed from academic and tertiary care settings. Several challenges of designing a computerized system for the University of Maryland School of Nursing's Wellmobile will be addressed in this article, as well as possible solutions to these challenges. It is the authors' belief that implications for further study will become apparent as these constraints and challenges are described.

Can the US minimum data set be used for predicting admissions to acute care facilities?

This paper is intended to give an overview of Knowledge Discovery in Large Datasets (KDD) and data mining applications in healthcare particularly as related to the Minimum Data Set, a resident assessment tool which is used in US long-term care facilities. The US Health Care Finance Administration, which mandates the use of this tool, has accumulated massive warehouses of MDS data. The pressure in healthcare to increase efficiency and effectiveness while improving patient outcomes requires that we find new ways to harness these vast resources. The intent of this preliminary study design paper is to discuss the development of an approach which utilizes the MDS, in conjunction with KDD and classification algorithms, in an attempt to predict admission from a long-term care facility to an acute care facility. The use of acute care services by long term care residents is a negative outcome, potentially avoidable, and expensive. The value of the MDS warehouse can be realized by the use of the stored data in ways that can improve patient outcomes and avoid the use of expensive acute care services. This study, when completed, will test whether the MDS warehouse can be used to describe patient outcomes and possibly be of predictive value.

No direct clinical relevance of the human leucocyte antigen (HLA) system in clozapine-induced agranulocytosis.

The clinical use of clozapine in psychiatry is restricted by the associated risk of agranulocytosis. This risk is significantly higher than that associated with conventional antipsychotic medications. In order to identify a possible parameter to detect susceptible individuals before treatment, 103 patients with a history of clozapine-induced granulocytopenia or agranulocytosis and 95 matched control patients were typed for human leucocyte antigen (HLA)-A, -B, -C, -DR, -DQ and for a number of neutrophil-specific alloantigens. No significant association between certain HLA alleles or neutrophil antigens and susceptibility to clozapine-induced granulocytopenia or agranulocytosis was observed.