Qatar Diabetes Mobile Application Trial (QDMAT): an open-label randomised controlled trial to examine the impact of using a mobile application to improve diabetes care in type 2 diabetes mellitus-a study protocol.

BACKGROUND: Mobile health (mHealth) is increasingly advocated for diabetes management. It is unclear if mobile applications are effective in improving glycaemic control, clinical outcomes, quality of life and overall patient satisfaction in patients with type 2 diabetes (T2DM). A new mobile application was specifically built for people with T2DM with the help of the local expertise. The objective of the study was to evaluate the effectiveness of the mobile app. METHODS: The planned study is an ongoing open-label randomised controlled trial in which adults living with T2DM treated with insulin will be randomised 1:1 to the use of this diabetes application versus current standard care. The primary outcome will be the difference in mean HbA1c from baseline to 6 months. Other outcome measures include anthropometric measures, hypoglycaemic events, medication adjustments, number of clinical interactions and missed appointments and patient perceptions of their disease and diabetes self-management. The study will randomise 180 subjects for assessment of the primary outcome. DISCUSSION: We hypothesise that the diabetes-specific mobile application will improve glycaemic control, increase patient empowerment for self-management of diabetes and improve interaction between patients and healthcare providers. If the Qatar Diabetes Mobile Application Trial (QDMAT) demonstrates this, it will inform clinical services for the future self-management of T2DM. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03998267 . Registered on 26 June 2019.

Reasons For Physicians Not Adopting Clinical Decision Support Systems: Critical Analysis.

BACKGROUND: Clinical decision support systems (CDSSs) are an integral component of today's health information technologies. They assist with interpretation, diagnosis, and treatment. A CDSS can be embedded throughout the patient safety continuum providing reminders, recommendations, and alerts to health care providers. Although CDSSs have been shown to reduce medical errors and improve patient outcomes, they have fallen short of their full potential. User acceptance has been identified as one of the potential reasons for this shortfall. OBJECTIVE: The purpose of this paper was to conduct a critical review and task analysis of CDSS research and to develop a new framework for CDSS design in order to achieve user acceptance. METHODS: A critical review of CDSS papers was conducted with a focus on user acceptance. To gain a greater understanding of the problems associated with CDSS acceptance, we conducted a task analysis to identify and describe the goals, user input, system output, knowledge requirements, and constraints from two different perspectives: the machine (ie, the CDSS engine) and the user (ie, the physician). RESULTS: Favorability of CDSSs was based on user acceptance of clinical guidelines, reminders, alerts, and diagnostic suggestions. We propose two models: (1) the user acceptance and system adaptation design model, which includes optimizing CDSS design based on user needs/expectations, and (2) the input-process-output-engagemodel, which reveals to users the processes that govern CDSS outputs. CONCLUSIONS: This research demonstrates that the incorporation of the proposed models will improve user acceptance to support the beneficial effects of CDSSs adoption. Ultimately, if a user does not accept technology, this not only poses a threat to the use of the technology but can also pose a threat to the health and well-being of patients.

Interoperable electronic patient records for health care improvement.

Pressing needs of cost-effectiveness in healthcare and opportunities of emerging electronic health record technologies offer unprecedented chance for progress. Ongoing health care improvement and patient safety initiatives demand new information collection and communication technologies (e.g., Centers for Medicaid and Medicare Services, Joint Commission, National Patient Safety Foundation, public health surveillance). Particularly, desire for faster action and cost-effective health care drive unprecedented investments in electronic patient records worldwide. Recognizing these opportunities, many countries and the World Health Organization have launched several major health care improvement initiatives that are driven by new electronic record technologies. In the United States, historic $19 billion investment is provided through the American Recovery and Reinvestment Act of 2009. Models of sharing electronic patient data and citizen expectations for personal electronic health records will be reviewed. Regional health information networks and other information sharing initiatives depend on the interoperability of systems. Ultimately, the recent flood of health information standards needs to be balanced with actual interoperability opportunities. It is anticipated that the current policy discussions on the "meaningful use" of electronic health records will have major beneficial technical and also reimbursement implications.