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Mobile phones and short message service texts to collect situational awareness data during simulated public health critical events
Abstract
Text messages are useful for timely communication during public health emergencies and for transmitting health data in infrastructure-limited settings. Little is known about the feasibility of two-way short message service (SMS) communication to collect public health preparedness and surveillance data. The authors aimed to determine the feasibility and acceptability of using two-way SMS texts to collect situational assessment (SA) data in simulated disaster events during a university-based pilot study.
Eligible participants included university students with a mobile phone and messaging plan. Enrollment began in September 2009, and was open until the end of the study in May 2010. Participants attended a training session and provided demographic and phone use information using a baseline survey. Participants responded to SMS SAs that were sent directly to their phones throughout the study period. Frequency, completeness, and time to reporting were recorded for each procedure using an online commercial software package.
Sixty-three participants enrolled; median age was 25 years, most were female (74.6 percent), lived off campus (76.2 percent), and were graduate students (76.2 percent). Most participants had a family/joint mobile phone account (73.0 percent) with unlimited messaging (60.3 percent). The median daily number of texts sent and received was 8 and 9, respectively. During five SAs, 194 (76.7 percent) of 253 prompted text surveys were completed. Nearly 60 percent of surveys were completed within 20 minutes of text deployment.
Using two-way SMS communication for surveillance and reporting was feasible among a group of motivated students. Similar methods may provide timely data during public health critical events.
... Additionally, Bolle et al. [63] found that visual contact and supervision through video calls improve layperson rescuers' confidence in stressful emergencies. Looking boarder, Magee et al. [64] investigates possibility of using citizens' smartphones to get necessary actions on healthcare side, as well as policy side along public health critical events. ...
The article provides an overview of current trends in personal sensor, signal and imaging informatics, that are based on emerging mobile computing and communications technologies enclosed in a smartphone and enabling the provision of personal, pervasive health informatics services.
The article reviews examples of these trends from the PubMed and Google scholar literature search engines, which, by no means claim to be complete, as the field is evolving and some recent advances may not be documented yet.
There exist critical technological advances in the surveyed smartphone technologies, employed in provision and improvement of diagnosis, acute and chronic treatment and rehabilitation health services, as well as in education and training of healthcare practitioners. However, the most emerging trend relates to a routine application of these technologies in a prevention/wellness sector, helping its users in self-care to stay healthy.
Smartphone-based personal health informatics services exist, but still have a long way to go to become an everyday, personalized healthcare-provisioning tool in the medical field and in a clinical practice. Key main challenge for their widespread adoption involve lack of user acceptance striving from variable credibility and reliability of applications and solutions as they a) lack evidence- based approach; b) have low levels of medical professional involvement in their design and content; c) are provided in an unreliable way, influencing negatively its usability; and, in some cases, d) being industry-driven, hence exposing bias in information provided, for example towards particular types of treatment or intervention procedures.
Background
Reducing avoidable nursing home (NH)–to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes.
Objective
Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization.
Methods
This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)–funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD.
ResultsAfter accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025.
Conclusions
To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care.
International Registered Report Identifier (IRRID)DERR1-10.2196/50231
Background
To compare text messaging and face-to-face interviews to conduct a survey on childhood diarrhoea and pneumonia.
Methods
Caregivers of young children able to send text messages in Zhao County in rural China were included in this crossover study. Villages (clusters) were randomized into two groups using the ratio 1:1.6 to account for an expected higher drop-out in group 2. In group 1, participants first completed the face-to-face and then text messaging survey; this order was reversed in group 2. We determined data equivalence of 17 questions that were answered by participants who were the same person in both surveys. For the text messaging survey, we assessed the overall and item response rate.
Results
We included 1014 participants between 16 and 28 March 2013: 371 in 15 villages in group 1 and 643 in 27 villages in group 2. A total of 662 (65.3%) out of 1014 participants responded (first text message question) and a significantly higher proportion who did not respond were from rural areas (P = 0.005). Of 651 participants willing to participate, 356 (54.7%) completed the text messaging survey, which was marginally significantly different between the groups (P = 0.05). In total, 409 participants took part in both surveys: 183 in group 1 and 226 in group 2. There was a significantly higher proportion of caregivers from rural areas in Zhao County in the non-responder group compared to the responder group (P = 0.004). Kappas were substantial for six (0.61–0.80), moderate for two (0.58 and 0.60), and fair for three questions (0.31, 0.35 and 0.37). The proportion of agreement was >90% for five questions; 80.0%-90.0% for five questions; 70.0%, 65.0% and 45.5%. The remaining questions had too small numbers to calculate these values.
Conclusions
This study shows that text messaging data collection produces data similar to data from face-to-face interviews in a middle-income setting, but the response rate was insufficient for use in public health surveys. Improving the response rate is important, because text message surveys could be of greater value in rural remote areas due to the cost-saving potential.
Healthcare is of central importance to all communities and generally has a high political profile. Access and availability of care, rising costs, and emerging new relationships between experts (doctors and nurses) and users (patients, citizens) pose new challenges. ICT-based innovation is often proposed as a solution, accompanied by optimistic accounts of its transformative potential, both for the developing world and the developed. These ambitions also implicitly endorse new social agreements and business models. In this respect, as in others, technology is not neutral or simple in the service of modernization; it has its own politics. This paper discusses ICT innovation in healthcare in these terms focused on issues of sustainability and responsibility adapting two economic concepts: redistribution and externalities. The analysis reveals ICT innovation in health care as essentially raising 'trans-scientific' questions - matters of policy and intergenerational ethics rather than narrow science. © 2012 IFIP International Federation for Information Processing.
In 2008, at the request of the Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM) prepared a report identifying knowledge gaps in public health systems preparedness and emergency response and recommending near-term priority research areas. In accordance with the Pandemic and All-Hazards Preparedness Act mandating new public health systems research for preparedness and emergency response, CDC provided competitive awards establishing nine Preparedness and Emergency Response Research Centers (PERRCs) in accredited U.S. schools of public health. The PERRCs conducted research in four IOM-recommended priority areas: (1) enhancing the usefulness of public health preparedness and response (PHPR) training, (2) creating and maintaining sustainable preparedness and response systems, (3) improving PHPR communications, and (4) identifying evaluation criteria and metrics to improve PHPR for all hazards. The PERRCs worked closely with state and local public health, community partners, and advisory committees to produce practice-relevant research findings. PERRC research has generated more than 130 peer-reviewed publications and nearly 80 practice and policy tools and recommendations with the potential to significantly enhance our nation's PHPR to all hazards and that highlight the need for further improvements in public health systems.
Background:
A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation.
Objective:
The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care.
Methods:
The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review.
Results:
A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1%), and in particular the United States (81/271, 29.9%), United Kingdom (31/271, 11.4%), and Canada (14/271, 5.2%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These applications generally have modest benefits and may be appropriate for implementation. Integration of health data using GIS technology also exhibit modest benefits such as improved understanding of the interplay of psychological, social, environmental, area-level, and sociodemographic influences on physical activity. The studies evaluated showed promising results in helping patients treating different illnesses and managing their condition effectively. However, most studies use small sample sizes and short intervention periods, which means limited clinical or statistical significance.
Conclusions:
A vast majority of the papers report positive results, including retention rate, benefits for patients, and economic gains for the health care provider. However, implementation issues are little discussed, which means the reasons for the scarcity of large-scale implementations, which might be expected given the overwhelmingly positive results, are yet unclear. There is also little combination between GIS and mobile technologies. In order for health care processes to be effective they must integrate different kinds of existing technologies and data. Further research and development is necessary to provide integration and better understand implementation issues.
Hypertension as the primary reason for hospitalization is often used to indicate failure of the outpatient health-care system to prevent and control high blood pressure. Investigators have reported increased rates of these preventable hospitalizations for black people compared with white people; however, none have mapped them nationally by race.
We used Medicare Part A data to estimate preventable hypertension hospitalizations from 2004-2009 using technical specifications published by the Agency for Healthcare Research and Quality. Rates per 100,000 beneficiaries were age- and sex-standardized to 2000 U.S. Census data. We mapped county-level rates by race and identified clusters of counties with extreme rates.
Black people had higher crude rates of these hospitalizations than white people for every year studied, and the test for an increasing linear time trend for the standardized rates was significant for both black and white people; that is, the gap between the races increased over time. For both races, clusters of high-rate counties occurred primarily in parts of Oklahoma, Texas, Southern Alabama, and Louisiana. High rates for white people were also found in parts of Appalachia. Large differences in rates among black and white people were found in a number of large urban areas and in parts of Florida and Alabama.
Racial disparities in preventable hospitalizations for hypertension persisted through 2009. The gap between black and white people is increasing, and these inequities exist unevenly across the country. Although this study was intended to be purely descriptive, future studies should use multivariate analyses to examine reasons for these unequal distributions.
Abstract A biobank is a biorepository that stores biological samples (usually of human origin) for use in research. Since the late 1990s, biobanks have become a key resource, supporting contemporary research in many fields, including genomics and personalized medicine. The ethical requirement for anonymity currently results in irreversible severing of the link between patients and their biobank samples. However, the maintenance of an anonymous link would increase patients' control over their samples and the efficacy of sample management. We propose a system for anonymous, real-time communication between the biobank and the patients providing samples based on the short message service (SMS) of mobile telephones. The patient and the biobank communicate via a cryptographic protocol, using a trusted third-party server. The biobank-SMS (BioK-SMS) communication system provides answers to certain persistent ethical questions relating to biobanking. BioK-SMS makes it easier to obtain renewed consent when required, gives patients more control over their samples, and protects their privacy.
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