Thursday, August 26, 2010

JMIR Journal - Sharing Medical Data for Health Research: The Early Personal Health Record Experience

Adopted from the journal's abstract with some modifications:

Background: Improving care and advancing public health are the goals of federal Health Information Technology for Economic and Clinical Health (HITECH) Act. Engaging consumers in sharing their health information for health research may accomplish these goals. Understanding consumer willingness to share data from personally controlled health records (PCHRs) can help to advance this model.

Objective: The objective was to characterize consumer willingness to share PCHR data for health research and the conditions and contexts bearing on the willingness to share.

Methods: A mixed method approach integrating survey and narrative data was used. Survey data were collected about attitudes toward sharing PCHR information for health research from early adopters (n = 151) of a live PCHR populated with medical records and self-reported behavioral and social data. Data were analyzed using descriptive statistics and logistic regression to characterize willingness, conditions for sharing, and variations by sociodemographic factors. Narrative data were collected through semistructured focus group and one-on-one interviews with a separate sample of community members (n = 30) following exposure to PCHR demonstrations. Two independent analysts coded narrative data for major and minor themes using a shared rubric of a priori defined codes and an iterative inductive process. Findings were triangulated with survey results to identify patterns.

Results: Of PHCR users, 138 out of 151 (91%) were willing to share medical information for health research with 89 (59%) favoring an opt-in sharing model. Willingness to share was conditioned by anonymity, research use, engagement with a trusted intermediary, transparency around PCHR access and use, and payment. Consumer-determined restrictions on content and timing of sharing may be prerequisites to sharing. Select differences in support for sharing under different conditions were observed across social groups. No gender differences were observed; however differences in age, role, and self-rated health were found. For example, students were more likely than nonstudents to favor an opt-out sharing default (unadjusted odds ratio [OR] = 2.89, 95% confidence interval [CI] 1.10 - 7.62, P = .03). Participants over age 50 were less likely than younger participants to report that payment would increase willingness to share (unadjusted OR = 0.94, 95% CI 0.91 - 0.96, P < .001). Students were more likely than nonstudents to report that payment would increase their willingness to share (unadjusted OR 9.62, 95% CI 3.44 - 26.87, P < .001). Experiencing a public health emergency may increase willingness to share especially among persons over 50 (unadjusted OR 1.03, 95% CI 1.01 - 1.05, P = .02); however, students were less likely than non-students to report this attitude (unadjusted OR 0.13, 95% CI 0.05 - 0.36, P < .001). Finally, subjects with fair or poor self-rated health were less likely than those with good to excellent self-rated health to report that willingness to share would increase during a public health emergency (unadjusted OR 0.61, 95% CI 0.38 - 0.97, P = .04).

Conclusions: Strong support for sharing of PCHR information for health research existed among early adopters and focus group participants, with support varying by social group under different conditions and contexts. Allowing users to select their preferred conditions for sharing may be vital to supporting sharing and fostering trust as may be development of safety monitoring mechanisms.

Author's Comments: This article gives a glimpse on the willingness of the consumers in sharing their medical data for health research. The responses are generally positive. However, the article doesn't mention on how this study can be applied to any specific health research project. For instance, if advanced cancer treatment is the health research project in question, then some consumers might be more willing to share their medical data than other research projects because they are more concerned about it. It might be interesting to know if consumers are more willing to share medical data for some health researches over the other.

References:

Wednesday, August 25, 2010

JMIR Journal - Sharing Health Data for Better Outcomes on PatientsLikeMe

Adopted from the journal's abstract with some modifications:

Background: PatientsLikeMe [website] is an online quantitative personal research platform for patients with life-changing illnesses.
The goal of the website is to help patients answer the question: “Given my status, what is the best outcome I can hope to achieve, and how do I get there?”. T
he website provides 3 primary functions for patients t
o answer this question
: 1)
share their experience using patient-reported outcomes, 2) find other patients like them matched on demographic and clinical characteristics, and 3) learn from the aggregated data reports of other patients to improve their outcomes.

Objective: Using a cross-sectional online survey [as an empirical research], we sought to describe the potential benefits of PatientsLikeMe in terms of treatment decisions, symptom management, clinical management, and outcomes.

Methods: Almost 7,000 members from six PatientsLikeMe communities (amyotrophic lateral sclerosis [ALS], Multiple Sclerosis [MS], Parkinson’s Disease, human immunodeficiency virus [HIV], fibromyalgia, and mood disorders) were sent a survey invitation using an internal survey tool (PatientsLikeMe Lens).

Results: Complete responses were received from 1323 participants (19% of invited members). Between-group demographics varied according to disease community. Users perceived the greatest benefit in learning about a symptom they had experienced; 72% (952 of 1323) rated the site “moderately” or “very helpful.” Patients also found the site helpful for understanding the side effects of their treatments (n = 757, 57%). Nearly half of patients (n = 559, 42%) agreed that the site had helped them find another patient who had helped them understand what it was like to take a specific treatment for their condition. More patients found the site helpful with decisions to start a medication (n = 496, 37%) than to change a medication (n = 359, 27%), change a dosage (n = 336, 25%), or stop a medication (n = 290, 22%). Almost all participants (n = 1,249, 94%) were diagnosed when they joined the site. Most (n = 824, 62%) experienced no change in their confidence in that diagnosis or had an increased level of confidence (n = 456, 34%). Use of the site was associated with increasing levels of comfort in sharing personal health information among those who had initially been uncomfortable. Overall, 12% of patients (n = 151 of 1320) changed their physician as a result of using the site; this figure was doubled in patients with fibromyalgia (21%, n = 33 of 150). Patients reported community-specific benefits: 41% of HIV patients (n = 72 of 177) agreed they had reduced risky behaviors and 22% of mood disorders patients (n = 31 of 141) agreed they needed less inpatient care as a result of using the site. Analysis of the Web access logs showed that participants who used more features of the site (eg, posted in the online forum) perceived greater benefit.

Conclusions: We have established that members of the community reported a range of benefits, and that these may be related to the extent of site use. Third party validation and longitudinal evaluation is an important next step in continuing to evaluate the potential of online [patient] data-sharing platforms.

Author's Comments: There are two points I would like to highlight in the article: 1) Medical Management and 2) Sharing Medical Data. From the study, the communication between healthcare professionals and patient can be improved using the medical data collected from the PatientsLikeMe website. The healthcare professionals understand better the effect of the treatment to the patient's daily life and might influence their upcoming treatment decision. Since the medical data is useful to the patient in some ways as described in the article, it is not very surprising that the people who decided to try out PatientsLikeMe will be even more opened on sharing their medical data later on.

Tuesday, August 24, 2010

JMIR Journal - Definition of Health 2.0 and Medicine 2.0: A Systematic Review

Adopted from the journal's abstract with some modifications:

Background: When “Web 2.0” technologies are used in health care, the terms “Health 2.0" or "Medicine 2.0” may be used. The meaning of the terms change with time due to the fact that the Web 2.0 is by itself a rapidly evolving technology.

Objective: The objective was to identify unique definitions of Health 2.0/Medicine 2.0 and recurrent topics within the definitions.

Methods: The constant comparison method is used as a systematic literature review methodology to assess all literature, extracted unique definitions and selected recurrent topics in order to find unique definitions of Health 2.0/Medicine 2.0. The literature primarily comes from 2 sources: the medical journal literature (i.e. PubMed, Scopus, CINAHL) and the "gray" literature (i.e. articles from the Internet using some search engines).

Results: We found a total of 1937 articles, 533 in scientific databases and 1404 in the gray literature. We selected 46 unique definitions for further analysis and identified 7 main topics.

Conclusions: Health 2.0/Medicine 2.0 are still developing areas. Many articles concerning this subject were found, primarily on the Internet. However, there is still no general consensus regarding the definition of Health 2.0/Medicine 2.0. We hope that this study will contribute to building the concept of Health 2.0/Medicine 2.0 and facilitate discussion and further research.

Author Comments: Great effort by the author of the article! It helps people to understand that 1) the definition of Health 2.0 is not settle yet. 2) the reason why it is never too clear about what Health 2.0 is about. While you read the articles regarding Health 2.0, bear in mind that the terms are really just like a signpost rather than a description of what it is. At the end of the day, what is important is it tells you about how Web is been used in Healthcare. Hope you enjoy it!