Jelena Mirkovic

Secure solution for mobile access to patient's health care record

Mobile devices are today widely accepted and their capability to provide access to services independent of user time and location make them well suited for provision of healthcare services to both patients and healthcare personnel. However, mobile services are still not generally allowed to operate with highly sensitive and personal data, mainly due to the lack of a defined security standard, low protection of data transferred through the mobile and wireless network and no standard and widely accepted user authentication method that ensure confidentiality. In this paper we propose a secure solution for mobile access to Electronic Health Record (EHR) systems. The proposed solution enables secure authentication and communication between a mobile device and a healthcare service provider through usage of a two-factor authentication method on a mobile phone and encryption. The proposed solution is independent of mobile network provider and type of the mobile device the application is running on, and provides multifactor authentication without the traditional requirement that the user has an additional authentication token. This simplifies use without compromising security. In the paper we present the usage scenarios, discuss the feasibility of the proposed solution together with its limitations, and present results from a prototype test bed.

Patient Insights Into the Design of Technology to Support a Strengths-Based Approach to Health Care.

Background An increasing number of research studies in the psychological and biobehavioral sciences support incorporating patients’ personal strengths into illness management as a way to empower and activate the patients, thus improving their health and well-being. However, lack of attention to patients’ personal strengths is still reported in patient–provider communication. Information technology (IT) has great potential to support strengths-based patient–provider communication and collaboration, but knowledge about the users’ requirements and preferences is inadequate. Objective This study explored the aspirations and requirements of patients with chronic conditions concerning IT tools that could help increase their awareness of their own personal strengths and resources, and support discussion of these assets in consultations with health care providers. Methods We included patients with different chronic conditions (chronic pain, morbid obesity, and chronic obstructive pulmonary disease) and used various participatory research methods to gain insight into the participants’ needs, values, and opinions, and the contexts in which they felt strengths-based IT tools could be used. Results Participants were positive toward using technology to support them in identifying and discussing their personal strengths in clinical consultation, but also underlined the importance of fitting it to their specific requirements and the right contexts of use. Participants recommended that technology be designed for use in preconsultation settings (eg, at home) and felt that it should support them in both identifying strengths and in finding out new ways how strengths can be used to attain personal health-related goals. Participants advocated use of technology to support advance preparation for consultations and empower them to take a more active role. IT tools were suggested to be potentially useful in specific contexts, including individual or group consultations with health care providers (physician, nurse, specialist, care team) in clinical consultations but also outside health care settings (eg, as a part of a self-management program). Participants’ requirements for functionality and design include, among others: providing examples of strengths reported by other patients with chronic conditions, along with an option to extend the list with personal examples; giving an option to briefly summarize health-related history; using intuitive, easy-to-use but also engaging user interface design. Additionally, the findings are exemplified with a description of a low-fidelity paper prototype of a strengths-based tool, developed with participants in this study. Conclusions Users requirements for IT support of a strengths-based approach to health care appear feasible. The presented findings reflect patients’ values and lists potential contexts where they feel that technology could facilitate meaningful patient–provider communication that focuses not just on symptoms and problems, but also takes into account patients’ strengths and resources. The findings can be used to inform further development of IT tools for use in clinical consultations.

Security and privacy legislation guidelines for developing personal health records

Personal Health Records (PHR) open new opportunities for enhancing delivery of standard health care services and health information to general population and supporting individuals to take more active role in health management and decision making processes. However, while utilization of PHR as part of a health management process brings much more flexibility, and advanced options to individuals, it also introduces questions related to responsibility and authority for creation, processing, maintenance and ensuring privacy and security of personal health related data. This paper summarizes the issues related to EU legal-regulatory requirements for developing PHR that enable storage, sharing and management of health data between different stakeholders (patient and healthcare institutions on different levels of care). We present a list of guidelines that outline which security and privacy issues must be taken into consideration and be addressed when developing PHR, and discuss them in the context of one European country (Norway). In the discussion we raise the issues that are not addressed in the existing regulations, but play an important role in developing secure PHR systems. We also propose a direction for further development of policies and legislations in Europe to facilitate further development and utilization of PHR systems.

Utilizing emerging technologies to promote more efficient face-to-face patient-clinician communication

In literature there are different projects showing how new information and communications technology (ICT) systems can be used for enhancing communication between and among patients and clinicians over Internet. Besides advantages these systems offer to both patients and clinicians there is also great concern that utilizing new technologies can limit and negatively influence patient-clinician face-to-face communication. This paper underlines these concerns and describes two projects in our research center that promote more effective offline patient-clinician communication.

eHealth Use Among First-Generation Immigrants From Pakistan in the Oslo Area, Norway, With Focus on Diabetes: Survey Protocol

Background A variety of eHealth services are available and commonly used by the general public. eHealth has the potential to engage and empower people with managing their health. The prerequisite is, however, that eHealth services are adapted to the sociocultural heterogeneity of the user base and are available in a language and with contents that fit the users’ preference, skills, and abilities. Pakistani immigrants in the Oslo area, Norway, have a much higher risk of Type-2 diabetes (T2D) than their Norwegian counterparts do. In spite of having access to information and communication technology (ICT) and the Internet, ICT skills in this population are reported to be relatively low. Further, there is insufficient information about their use of and attitudes toward eHealth services, necessitating investigation of this group in particular. Objective This study targets first-generation immigrants from Pakistan living in the Oslo area and examines their use of and attitudes toward eHealth services, specifically: information searches, communication using ICT, and use of ICT for self-management or decision making, all concerning T2D. Methods Due to a high prevalence of low literacy among the target population, we employed questionnaire-based individual interviews. The questionnaire was developed by implementing potentially relevant theoretical constructs (technology acceptance model (TAM) and health belief model (HBM)) as measures. To explore issues around language, culture, and general ICT skills, we also implemented questions that we assume were particularly relevant in the context studied but do not appear in any theoretical frameworks. The questionnaire was revised to reflect results of a pilot study involving 10 participants. We employed culturally sensitive sampling methods to reach informants who could otherwise fail to be included in the survey. Results This paper presents a survey protocol. The data collection is ongoing. The aim is to collect 200 responses in total by March 2016. Conclusions For eHealth to become an influential social innovation, equal access to eHealth services regardless of users’ language, culture, and ICT skills is a prerequisite. Results from this study will be of importance for understanding how people who may not maximally benefit from eHealth services today could be targeted in the future.

Personal strengths reported by people with chronic illness: A qualitative study

Self‐management of chronic illness can be highly demanding and people need to mobilize their personal strengths to live well with their condition. More knowledge is needed about how people with chronic illness perceive and use their personal strengths as a basis for better integrating empowering person‐centred approaches into health care.

eHealth Literacy as a Mediator of Health Behaviors

eHealth literacy names a set of core literacies involved in the meaningful and productive use of health technologies. In this chapter, we present an integrative theoretical and methodological cognitive framework for elucidating the nature of these barriers and for fashioning design solutions. The Chan–Kaufman analytic framework differs from other frameworks in that the goals are to develop a diagnostic approach rather than a screening tool. The framework can be used to classify task demands and characterize the barriers encountered in users’ task performance. The methods are illustrated in the context of a health information seeking problem. We then review the research pertaining to the challenges in each of the consumer health domains including information seeking, patient portals, mHealth, social media, and telemedicine. The chapter discusses implications that need to be addressed when developing new health related programs and tools. eHealth tools afford an almost infinite number of new means to achieve health behavior change in the promotion of wellness and in the monitoring and management of chronic illness. The essential question is how do we tune these technologies such that they better address the needs of patients and health consumers at varying levels of eHealth literacy.

Game experience preferences of people with chronic illnesses.

To increase the adherence to eHealth and mHealth tools gameful designs are becoming commonplace, and to be successful, these designs need to both be suitable for and meet the needs and expectations of its users. As a group, people living with chronic illnesses has challenges not experienced by the general population. This study presents early findings from an activity in a co-design workshop, done with three different groups of chronic patients, investigating what games the participants like or dislike and what they find engaging and motivating when playing these.

A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing

Background Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB)

User and Stakeholder Requirements of eHealth Support Tool Viewed In a Self-Determination Theory Lens

This paper presents preliminary results of an analysis of user requirements for an eHealth tool supporting chronic patients to use their personal strengths in health management. We conclude that Self-Determination Theory can be applied to view and categorize identified user requirements, and provide a framing for the analysis grounded in motivational theory. The final model will lay the foundation for our future design and implementation of gameful designs in an eHealth tool in order to enhance user engagement, motivation, and adherence.