Search

BackgroundTimely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province. ObjectiveThe aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption. MethodsThis multimethod study included semistructured interviews with physicians and administrative stakeholders and descriptive analysis of the current DICS usage data. ResultsIn this study, 41 participants were interviewed, that is, 34 physicians and 7 administrative stakeholders. The following 4 key themes emerged: (1) utilization of the DICS depended on the awareness of the technology and the preferred channels for accessing images, which varied widely, (2) clinical responsibilities and available institutional resources were the drivers of utilization (or lack thereof), (3) centralized image repositories were perceived to offer value at the patient, clinician, and health care system levels, and (4) the enabling factors to realize value included aspects of technology infrastructure (ie, available functionality) alongside policy supports. High-volume DICS usage was not evenly distributed throughout the province. ConclusionsSuboptimal adoption of the DICS was driven by poor awareness and variations in the clinical workflow. Alignment with physician workflow, policy supports, and investment in key technological features and infrastructure would improve functionality and data comprehensiveness, thereby optimizing health system performance, patient and provider experience, population health, and health care costs.

The COVID-19 pandemic offered Canadians a glimpse of the digital healthcare system we could have here if we are willing to clear away the traditional roadblocks that stand in the way. However, as the pandemic slowly recedes, the opportunity to keep moving forward, with a health-care system that fully embraces digital, will likely require the federal government asserting itself as a leader in a policy area that falls within provincial jurisdiction, despite the controversy and contention that federal intervention would arouse. The pandemic's urgent demands on the health system forced jurisdictions to clear many barriers that have impeded digital-health innovation until now. Within weeks of the onset of the pandemic, virtual care exploded to previously unimaginable levels, with health-related telephone and video calls rapidly rising from less than two per cent of all ambulatory visits at the beginning of 2020, to as high as 70 per cent by mid-May the same year. The bureaucracy around procurement, privacy and security was reduced, while digital-health innovators were given the opportunity to take a larger role in the health system. Digital health care is much more than just a doctor making a Zoom call, however. Seizing the momentum to realize broader change will require a national approach. This should include several policies, many requiring federal leadership, such as enshrining digital care within the definition of "medically necessary" care, insured under the Canada Health Act. Digital health also includes giving patients ownership of their personal health data, while ensuring data interoperability across Canada. The current, fragmented, provincial approach to health care is a drag on innovation, creating barriers to the efficient procurement of technologies, interoperability and data sharing. Our heavily siloed system disadvantages not only the health-care system and patients, but Canadian digital-health companies who, because they are unable to scale up in Canada, will find it hard to compete in the growing global digital-health industry. The federal government can show leadership by innovating with digital health policy for those citizens that fall under its health-care purview, such as Indigenous Canadians and members of the Canadian Armed Forces. Ensuring that Canadians everywhere realize the benefits of digital health care, however, will require Ottawa taking a more active role in breaking down barriers between provinces and territories, making it clear that our slow-to-innovate health-care silos are no longer sustainable in a digital world. [ABSTRACT FROM AUTHOR]

Background: Digital health interventions (DHIs) are a central focus of health care transformation efforts, yet their uptake in practice continues to fall short of their potential. In order to achieve their desired outcomes and impact, DHIs need to reach their target population and need to be used. Many factors can rapidly intersect between this dynamic of users and interventions. The application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of the complex interactions between users, practices, technology, and health system factors that underpin research questions. There remains a gap in our understanding of how TMFs have been applied to guide the evaluation of DHIs with real-world health system operations., Objective: This study aims to map TMFs used in studies to guide the evaluation of DHIs. The objectives are to (1) describe the TMFs and the constructs they target, (2) identify how TMFs have been prospectively used (ie, their roles) in primary studies to evaluate DHIs, and (3) to reflect on the relevance and utility of our findings for knowledge users., Methods: This scoping review was conducted in partnership with knowledge users using an integrated knowledge translation approach. We included papers (eg, reports; empirical quantitative, qualitative, and mixed methods studies; conference proceedings; and dissertations) if primary insights resulting from the application of TMFs were presented. Any type of DHI was eligible. Papers published from 2000 and onward were mainly identified from the following databases: MEDLINE (Ovid), CINAHL Complete (EBSCOhost), PsycINFO (Ovid), EBM Reviews (Ovid), and Embase (Ovid)., Results: A total of 156 studies published between 2000 and 2022 were included. A total of 68 distinct TMFs were identified across 85 individual studies. In more than half (85/156, 55%) of the included studies, 1 of following 6 prevailing TMFs were reported: Consolidated Framework for Implementation Research (n=39); the Reach, Effectiveness, Adoption, Implementation, and Maintenance Framework (n=17); the Technology of Acceptance Model (n=16); the Unified Theory on Acceptance and Use of Technology (n=12); the Diffusion of Innovation Theory (n=10); and Normalization Process Theory (n=9). The most common intended roles of the 6 TMFs were to inform data collection (n=86), to inform data analysis (n=69), and to identify key constructs that may serve as barriers and facilitators (n=52)., Conclusions: As TMFs are most often reported to be applied to support data collection and analysis, researchers should consider more clearly synthesizing key insights as practical use cases to both increase the relevance and digestibility of their findings. There is also a need to adapt or develop guidelines for better reporting DHIs and the use of TMFs to guide evaluation. Hence, it would contribute to ensuring ongoing technology transformation efforts are evidence and theory informed rather than anecdotally driven., (©Geneviève Rouleau, Kelly Wu, Karishini Ramamoorthi, Cherish Boxall, Rebecca H Liu, Shelagh Maloney, Jennifer Zelmer, Ted Scott, Darren Larsen, Harindra C Wijeysundera, Daniela Ziegler, Sacha Bhatia, Vanessa Kishimoto, Carolyn Steele Gray, Laura Desveaux. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 05.02.2024.)

Background: COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women's College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity., Objective: The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health., Methods: This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H., Results: In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system., Conclusions: Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams., (©Celia Laur, Payal Agarwal, Kelly Thai, Vanessa Kishimoto, Shawna Kelly, Kyle Liang, R Sacha Bhatia, Onil Bhattacharyya, Danielle Martin, Geetha Mukerji. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 28.06.2022.)