DeMuro Pr

mHealth: Don't Forget All the Stakeholders in the Business Case.

Mobile health (mHealth) facilitates linking patient-generated data with electronic health records with clinical decision support systems. mHealth can transform health care, but to realize this potential it is important to identify the relevant stakeholders and how they might be affected. Such stakeholders include primary stakeholders, such as patients, families and caregivers, clinicians, health care facilities, researchers, payors and purchasers, employers, and miscellaneous secondary stakeholders, such as vendors, suppliers, distributors, and consultants, policy makers and legislators. The breadth and depth of the mHealth market make it possible for mHealth to have a considerable effect on people’s health. However, many concerns exist, including privacy, data security, funding, and the lack of case studies demonstrating efficacy and cost-effectiveness. Many American and European initiatives to address these concerns are afoot.

Samantha Adams Festschrift: Adamsian Discourse—The Patient, and Everything Else

Samantha Ashley Adams, PhD, was a beloved teacher, PhD supervisor, and researcher. She represented the perspective of patients throughout her career. As early as 2002, Dr. Adams conducted research on reviewing and producing information reliability on theWeb as part of her doctoral work.1 In one of the earlier works that she coauthored, she explored the use of “trust marks” which she defined as hyperlinked icons or seals that are placed on Web sites to denote review by an independent third party.2 She was concerned that many of the writings about trust marks at the time were critical of them. Dr. Adams noted many of these criticisms did not address the positive role of the review processes, and was concerned about how research in this area was not focused on the patient as the end user. She also was interested in the various approaches Web sites used to guide patients to health Web sites, recognizing that the process and pathway followed by patients could significantly influence their experience as well as their understanding of the information they received.3 Reliability of online health information was another key theme winding through her work.4 As part of her patient-focused work, Dr. Adams noted that informatics and published academic literature regarded patients as acting reflexively and proceeding with very specific information needs and views.5 However, she believed that individuals need help in developing skills for reflexive consumerism. Her work examined the role of the state and other political actors in the reliability ofWeb-based information within the context of existing relationships among technologies and users, nations and individuals, and individuals and their skill development. She noted that when patients describe their care experiences in online venues, the experience of writing about their care stimulates additional analysis of the health care process they and others have experienced.6 In addition, patients’ reasons for sharing personal narratives may differ greatly from those of the organizations encouraging them to share these experiences, and that patients may be unaware of how organizations use patients’ perceptions to frame conversations and shape other patients’ expectations. In 2008, Dr. Adams addressed blog-based applications and health information in the context of consumer health informatics.7 She was concerned that insufficient time was spent on applications available to the public and how blogs and other tools were being used. A pioneer in this area, Dr. Adams introduced the idea of health goal-oriented blogging. She considered how patients act as both information producers and information users within the blogosphere, and how these actions affect and are affected by health care-related organizations and policymakers. She noted that a lackof user experiences made it difficult to meaningfully assess health blogging from the patient’s perspective. Dr. Adams recognized the importance of qualitative research in health informatics, particularly in the evaluation of information technology and its impacts.8 She focused on diseasemanagement projects and chronic care in the context of technology and translated these notions from ones of global considerations of diseasemanagement to the local and individual patient level. In writing on the Dutch health system, she noted the work of disease management project leaders, suggesting that their work “not only guides the overall project, but impacts the interaction of one clinician with one patient, as well as traveling to the broader disease management arena through participation in research, through the development of care consortiums, and through the honing of standards and protocols within the Dutch health care system.”9 She worked to describe the variability in development and implementation of diseasemanagement programs in theNetherlands, looking particularly at thewide variation in their development and implementation costs.10 In one study, she described eight cardiovascular disease