The Digital Determinants of Health: A Guide for Competency Development in Digital Care Delivery for Health Professions Trainees.

Health care delivery is undergoing an accelerated period of digital transformation, spurred in part by the COVID-19 pandemic and the use of "virtual-first" care delivery models such as telemedicine. Medical education has responded to this shift with calls for improved digital health training, but there is as yet no universal understanding of the needed competencies, domains, and best practices for teaching these skills. In this paper, we argue that a "digital determinants of health" (DDoH) framework for understanding the intersections of health outcomes, technology, and training is critical to the development of comprehensive digital health competencies in medical education.

How to design equitable digital health tools: A narrative review of design tactics, case studies, and opportunities.

With a renewed focus on health equity in the United States driven by national crises and legislation to improve digital healthcare innovation, there is a need for the designers of digital health tools to take deliberate steps to design for equity in their work. A concrete toolkit of methods to design for health equity is needed to support digital health practitioners in this aim. This narrative review summarizes several health equity frameworks to help digital health practitioners conceptualize the equity dimensions of importance for their work, and then provides design approaches that accommodate an equity focus.

Leveraging Machine Learning to Develop Digital Engagement Phenotypes of Users in a Digital Diabetes Prevention Program: Evaluation Study.

Background: Digital diabetes prevention programs (dDPPs) are effective "digital prescriptions" but have high attrition rates and program noncompletion. To address this, we developed a personalized automatic messaging system (PAMS) that leverages SMS text messaging and data integration into clinical workflows to increase dDPP engagement via enhanced patient-provider communication. Preliminary data showed positive results.

ChatGPT as a Tool for Medical Education and Clinical Decision-Making on the Wards: Case Study.

Background: Large language models (LLMs) are computational artificial intelligence systems with advanced natural language processing capabilities that have recently been popularized among health care students and educators due to their ability to provide real-time access to a vast amount of medical knowledge. The adoption of LLM technology into medical education and training has varied, and little empirical evidence exists to support its use in clinical teaching environments.

Objective: The aim of the study is to identify and qualitatively evaluate potential use cases and limitations of LLM technology for real-time ward-based educational contexts.

Leveraging Generative AI Tools to Support the Development of Digital Solutions in Health Care Research: Case Study.

Background: Generative artificial intelligence has the potential to revolutionize health technology product development by improving coding quality, efficiency, documentation, quality assessment and review, and troubleshooting.

Objective: This paper explores the application of a commercially available generative artificial intelligence tool (ChatGPT) to the development of a digital health behavior change intervention designed to support patient engagement in a commercial digital diabetes prevention program.

Methods: We examined the capacity, advantages, and limitations of ChatGPT to support digital product idea conceptualization, intervention content development, and the software engineering process, including software requirement generation, software design, and code production.

Association Between Types of Family Support and Glycemic Control for Adults With Cognitive Impairment.

Background: Family support is important in assisting with diabetes self-management for individuals with cognitive impairment, but what types of family support are most effective remain unknown.

Objectives: We aimed to examine the association between the types of family support in diabetes self-management with glycemic control in middle-aged and older adults with cognitive impairment.

Methods: A total of 267 individuals were included with diabetes and cognitive impairment (27-point Telephone Interview for Cognitive Status score <12), using the data of 2003 Health and Retirement Study (HRS) Diabetes Study and 2004 wave of the HRS.

Operational Implementation of Remote Patient Monitoring Within a Large Ambulatory Health System: Multimethod Qualitative Case Study.

Background: Remote patient monitoring (RPM) technologies can support patients living with chronic conditions through self-monitoring of physiological measures and enhance clinicians' diagnostic and treatment decisions. However, to date, large-scale pragmatic RPM implementation within health systems has been limited, and understanding of the impacts of RPM technologies on clinical workflows and care experience is lacking.

Objective: In this study, we evaluate the early implementation of operational RPM initiatives for chronic disease management within the ambulatory network of an academic medical center in New York City, focusing on the experiences of "early adopter" clinicians and patients.

Equity and bias in electronic health records data.

Embedded pragmatic clinical trials (ePCTs) are conducted during routine clinical care and have the potential to increase knowledge about the effectiveness of interventions under real world conditions. However, many pragmatic trials rely on data from the electronic health record (EHR) data, which are subject to bias from incomplete data, poor data quality, lack of representation from people who are medically underserved, and implicit bias in EHR design. This commentary examines how the use of EHR data might exacerbate bias and potentially increase health inequities.

Evidence for Telemedicine's Ongoing Transformation of Health Care Delivery Since the Onset of COVID-19: Retrospective Observational Study.

Background: The surge of telemedicine use during the early stages of the COVID-19 pandemic has been well documented. However, scarce evidence considers the use of telemedicine in the subsequent period.

Objective: This study aims to evaluate use patterns of video-based telemedicine visits for ambulatory care and urgent care provision over the course of recurring pandemic waves in 1 large health system in New York City (NYC) and what this means for health care delivery.

A framework for digital health equity.

We present a comprehensive Framework for Digital Health Equity, detailing key digital determinants of health (DDoH), to support the work of digital health tool creators in industry, health systems operations, and academia. The rapid digitization of healthcare may widen health disparities if solutions are not developed with these determinants in mind. Our framework builds on the leading health disparities framework, incorporating a digital environment domain.

Building Virtual Health Training Tools for Residents: A Design Thinking Approach.

The COVID-19 pandemic drove a rapid transition to virtual care experiences for graduate medical trainees. Core training competencies have expanded to incorporate virtual contexts, however there is limited knowledge of the optimal design of virtual care training tools for learners. In this study, we describe the application of a Design Thinking approach to the identification and co-design of novel training tools to support residents and precepting attending physicians in virtual ambulatory care practice.

Reimagining Connected Care in the Era of Digital Medicine.

The COVID-19 pandemic accelerated the adoption of remote patient monitoring technology, which offers exciting opportunities for expanded connected care at a distance. However, while the mode of clinicians' interactions with patients and their health data has transformed, the larger framework of how we deliver care is still driven by a model of episodic care that does not facilitate this new frontier. Fully realizing a transformation to a system of continuous connected care augmented by remote monitoring technology will require a shift in clinicians' and health systems' approach to care delivery technology and its associated data volume and complexity.

Chinese Americans' Use of Patient Portal Systems: Scoping Review.

Background: Electronic patient portals are increasingly used in health care systems as communication and information-sharing tools and show promise in addressing health care access, quality, and outcomes. However, limited research exists on portal use patterns and practices among diverse patient populations, resulting in the lack of culturally and contextually tailored portal systems for these patients.

Objective: This study aimed to summarize existing evidence on the access and use patterns, barriers, and facilitators of patient portals among Chinese Americans, who represent a growing patient population in the United States with unique health care and health technology needs.

Preferences and patterns of response to public health advice during the COVID-19 pandemic.

With recurring waves of the Covid-19 pandemic, a dilemma facing public health leadership is whether to provide public advice that is medically optimal (e.g., most protective against infection if followed), but unlikely to be adhered to, or advice that is less protective but is more likely to be followed.

Development of a computer-aided text message platform for user engagement with a digital Diabetes Prevention Program: a case study.

Digital Diabetes Prevention Programs (dDPP) are novel mHealth applications that leverage digital features such as tracking and messaging to support behavior change for diabetes prevention. Despite their clinical effectiveness, long-term engagement to these programs remains a challenge, creating barriers to adherence and meaningful health outcomes. We partnered with a dDPP vendor to develop a personalized automatic message system (PAMS) to promote user engagement to the dDPP platform by sending messages on behalf of their primary care provider.

Effectiveness of an Integrated Engagement Support System to Facilitate Patient Use of Digital Diabetes Prevention Programs: Protocol for a Randomized Controlled Trial.

Background: Digital diabetes prevention programs (dDPPs) are effective behavior change tools to prevent disease progression in patients at risk for diabetes. At present, these programs are poorly integrated into existing health information technology infrastructure and clinical workflows, resulting in barriers to provider-level knowledge of, interaction with, and support of patients who use dDPPs. Tools that can facilitate patient-provider interaction around dDPPs may contribute to improved patient engagement and adherence to these programs and improved health outcomes.

Climate Migration And The Future Of Health Care.

A physician treats two patients who were forced from their home countries by extreme weather associated with climate change.

Evaluating underpinning, complexity and implications of ethical situations in humanitarian operations: qualitative study through the lens of career humanitarian workers.

Introduction: Data regarding underpinning and implications of ethical challenges faced by humanitarian workers and their organisations in humanitarian operations are limited.

Methods: We conducted comprehensive, semistructured interviews with 44 experienced humanitarian aid workers, from the field to headquarters, to evaluate and describe ethical conditions in humanitarian situations.

Results: 61% were female; average age was 41.

Telemedicine and healthcare disparities: a cohort study in a large healthcare system in New York City during COVID-19.

Objective: Through the coronavirus disease 2019 (COVID-19) pandemic, telemedicine became a necessary entry point into the process of diagnosis, triage, and treatment. Racial and ethnic disparities in healthcare have been well documented in COVID-19 with respect to risk of infection and in-hospital outcomes once admitted, and here we assess disparities in those who access healthcare via telemedicine for COVID-19.

Materials And Methods: Electronic health record data of patients at New York University Langone Health between March 19th and April 30, 2020 were used to conduct descriptive and multilevel regression analyses with respect to visit type (telemedicine or in-person), suspected COVID diagnosis, and COVID test results.