17 articles found

Project VITAL: Telehealth Innovation for Healthcare Equity in Africa

Abstract

2 October 2024

Globally, an estimated 148.4 million people require humanitarian aid due to conflict and climate-related disasters, with approximately 89.3 million displaced individuals lacking access to essential healthcare services 1,2. Heightened attacks on healthcare facilities and workers exacerbate these challenges, particularly in Africa, where a severe shortage of health workers is anticipated to reach 6.1 million by 2030 3,4. In 2015, the region faced significant deficits, with only 1.30 health workers per 1000 people compared to the 4.5 needed to meet UN Sustainable Development Goals (SDGs) 5,6. Conflict-ridden areas like Cameroon/Sahel, home to over 30 million people in need of humanitarian assistance and mental health support, grapple with the highest maternal mortality rates globally amidst climate change impacts and security concerns 7. West and Central African regions have the highest maternal mortality rates globally while suffering from the effects of climate change, including extreme heat, droughts, degradation of agriculture, and security challenges 8,9. Overall, this leads to displaced populations with poor and worsening access to healthcare. In response, Project VITAL pledges to establish a sustainable, culturally sensitive telehealth program for the Cameroon/Sahel region, anchored in the 3S pillars model: sustainability, safety, and security. Sustainability involves forming a steering committee, conducting needs assessments, and empowering local programmers and healthcare providers with technology-focused training and resources. Collaborations with local entities like iDocta, Pasteur Institute of Bangui, and Reach Out Cameroon aim to ensure contextual understanding and long-term viability, supported by a revenue model and governmental compliance. Safety will prioritize safe, quality care, Project VITAL will implement robust review systems aligned with best practices and WHO guidelines. Security means partnering with technology experts, the initiative will ensure secure platforms and devices, adhering to cybersecurity protocols and local regulations. In a closely coordinated effort, Health Tech Without Borders, iDocta, and VSee established a steering committee in the fourth quarter of 2023. Early in 2024, iDocta and the team in Yaoundé, Cameroon, successfully conducted a targeted pilot program using the VSee telehealth platform. Insights gleaned from this pilot are now being meticulously applied to refine and tailor the VSee platform, customizing it to meet the specific needs of local clinicians and patients (Figure 1). Additionally, the Project VITAL team is expanding its workforce, hiring new staff, including clinicians and technical experts, to support project growth and implementation. Strategic outreach efforts have been outlined, engaging key community stakeholders to expand the platform's capabilities, encompassing telehealth, home health visits, laboratory scheduling, prescription refills, and pharmacy requests. Project VITAL is currently on schedule to commence a larger pilot later this year. Presently, the team consists of 4 innovators, including 6 full-time staff (2 female), 1 temporary employee, 3 doctors, 5 developers (1 female), 2 pharmacists, 1 lab technician, and an estimated 50-100 nurses. Additionally, 10 patients are currently participating in the trial phase. After a pilot in Yaoundé, expansion to remote North/Northwest regions will follow, addressing legal, financial, technological, and cultural barriers. Telehealth emerges as a promising solution, offering specialist access, peer consultations, education, triage, and epidemic monitoring, aligning with WHO's vision of equitable, efficient healthcare. With a focus on sustainable partnerships and adherence to equity principles like the Douala Equity Checklist, Project VITAL aims to advance healthcare access, bolster health systems, foster innovation, and empower communities in line with UN SDGs and African Union 2063 Agenda (Figure 2).

Mary Showstark

Yap Boum

Martin Joseph Lubowa

Milton Chen

Robert Arnot

Stella Nam

Marianna Petrea-Imenokhoeva

Lundi-Anne Omam

Annalicia Pickering

Karl G. Njuwa Fai

Inės Obolo

Rachel Essaka

Yannick Mbarga Etoundi

Achille Mvogo

Yves Wasnyo

Jarone Lee

The Development of Urgent Care Telemedicine in Pakistan

Abstract

2 October 2024

While 61% of Pakistan’s population lives in rural areas, per the 2023 Pakistan Census Report, there remains a deficiency in access to healthcare in these rural areas (Figure 1) 1. There are only 3.6 physicians per 10,000 people in rural areas when compared to 14.5 physicians per 10,000 people in urban areas 2. Challenges such as violence against healthcare workers, poor infrastructure, lack of employment opportunities, and inadequate facilities deter urban healthcare workers from practicing in rural areas 3. Many rural healthcare centers lack hygiene, infrastructure, and equipment. This results in limited access to care, especially for time-sensitive illnesses 3,4. This is compounded by a shortage of emergency medicine-trained physicians in Pakistan as there are only thirteen emergency medicine residency programs in the country 5. More recently, multiple asynchronous and synchronous telemedicine initiatives have been implemented in Pakistan, with several focusing on care for rural areas. However, there is no current initiative to close the gap between the need for emergency medical services and the lack of providers in rural areas. Our mission at Health Tech Without Borders (HTWB) is to close this gap by connecting urban providers to rural patients requiring urgent care. Given the lack of emergency medicine-trained providers, we created a telemedicine curriculum targeted to train Pakistan-based physicians of all backgrounds and specialties on practicing urgent care. Our telemedicine course consists of a twenty-question pre-test, an introduction to telemedicine primer video including how to set up for a telemedicine visit, and videos focused on four common chief complaints that are appropriate for telemedicine, including diarrhea, cough and respiratory tract infections, fever, and back pain. The course concludes with a twenty question post-test followed by a course survey (Figure 2). Course participants have to score 80% or higher on the post-test to pass the course and receive their certificate. Our course is located on the platform Teachable, and is free for all participants. Our organization, Health Tech Without Borders, is a non-profit organization dedicated to expanding the reach of healthcare globally through innovative and digital means. We partnered with a local Pakistani telemedicine company, Oladoc, to distribute our course with their physician employees. Oladoc is providing HTWB with an encrypted telemedicine platform through which we can provide synchronous video and audio telemedicine. This company operates in all major cities in Pakistan. There are three parts to our project. The first step of our project is to distribute our course through Oladoc to physicians interested in learning more about/ practicing urgent care telemedicine. The second step of our project is to pilot encounters between physicians and patients in medium to large city settings. Once this phase is complete, we plan to expand our reach to connect urban providers with patients in rural settings. Our goal is to provide a mode of healthcare for rural populations, focusing on those who do not currently have any access to care in their geographical regions. We hope to allow for a robust yet efficient and more standardized method of providing urgent care while promoting digital approaches to medicine in Pakistan. As of May 4, 2024, 157 physicians are actively enrolled in the curriculum. Initial findings indicate that while the majority are general practitioners, the participant pool has a diverse array of backgrounds. Remarkably, 72% of them have never received formal training in telemedicine. Feedback from the participants has been overwhelmingly positive: 96% reported that the course met their expectations, 92% acknowledged its role in enhancing their comprehension of virtual healthcare delivery, and all respondents agreed that it deepened their understanding of urgent care principles (Figure 3). Considering that most participants lack specialized training in urgent care, these findings are promising, suggesting the efficacy of standardized telemedicine education for future practitioners. In conclusion, the current telemedicine initiatives mark just the beginning of our journey towards equitable healthcare access in rural Pakistan. Moving forward, we are committed to expanding our reach, refining our curriculum, and fostering partnerships to ensure timely and quality access to healthcare.

Rmaah Memon

Stella Nam

Mary Showstark

Marianna Petrea-Imenokhoeva

Sakina B Naqvi

Jarone Lee

An Innovative Integrated Geospatial Information Systems & Quality Improvement Residency Research Training Program

Abstract

2 October 2024

Introduction Participation in scholarly activity during residency has posed barriers to departments that include: research mentorship, an active and supportive research community, formal research infrastructure and programming, and diverse and accessible opportunities for scholarly activity with faculty, staff and communities in our service region. In response to these barriers our team has created a formal QI research training program for psychiatry residents.2 Our solutions include: assembling a dedicated team, which contains both department leadership and a GIS faculty expert, an expanded interdisciplinary team which includes research librarians and grant support, GIS as a tool and science to best orient residents to the regional landscape and needs of our service populations, formal research training covering GIS, Cultural Psychiatry, and Psychometrics in Psychiatry as curricular themes, and a Chief Resident for Research role to facilitate bridges between residents and faculty and to promote a continuous research community. Methods An inquiry-based approach is applied to our formal research curriculum. Year 1 is an inquiry theme focused on basing resident QI research on the needs of our service region. Year 2 is themed research wherein literature reviews, dashboards and Storymaps are the emphasized outputs. Year 3 is themed implementation and residents are supported to use their dashboards with community to aid community organizations in making decisions for and with populations they serve. Lastly, year 4 is themed construct wherein residents are supported to complete and submit manuscripts and grants. Results Our pre-pilot phase was underway as of July 1st, 2023. To begin integrating within the Psychiatry & Neuroscience department as a formal program our team targeted core departmental programming; Grand Rounds, Journal Club, and didactics. We presented our curriculum to department staff, faculty, leadership and some residents during Grand Rounds in a detailed PowerPoint presentation. We worked with the faculty and staff directors of Journal Club to have our 2nd year deliverable of a StoryMap or Dashboard become the presentation for each PGY2. We presented it to all residents at a didactic session. As a follow-up to the didactic presentation we sent residents a QI attitudes and interest survey, which was an adaptation from the BASiC-QI. An estimated 20% of residents responded to the survey. From the residents who responded to the survey, the majority have followed-up with starting regular research mentor meetings with the Vice Chair for Research and advancing their projects. Findings/Conclusions Our pre-pilot year is nearing an end. Our full pilot year will begin on July 1st 2024. Thus far we have accomplished increasing buy-in for the program, and selecting a Chief Resident for Research and Wellness. We have also invited our new cohort of residents to our first annual QI/GIS conference showcase enabling a group of interns to begin a new year within our formal curriculum. We will also formalize the tracking of our increases in scholarly activities and our effectiveness with promoting and supporting scholarly activities within our department. Results from the integration of this program into the department and residency training program will be more evident in phases to come.

Margarita Monge

Angela Reyes

Kendrick A. Davis

MedicAid Disaster Estimator (MADE): A Digital Tool for Humanitarian Relief Material Demand Estimations

Abstract

2 October 2024

When disaster strikes, relief organizations experience an immediate need to supply necessities such as food, water, and medical supplies. Resource demand calculation is vital for relief organizations to efficiently mitigate the impact of disasters. Although large humanitarian organizations have private demand estimators, a plethora of local organizations that respond to disasters worldwide lack access to a demand calculator. Academic articles have introduced mathematical models for disaster needs analysis, but their findings and resulting calculators have remained largely limited to the academic community due to the lack of applicable technology. To address this gap between research and technology, the MedicAid Disaster Estimator (MADE), a user-friendly and accessible website was created to forecast the demand for water, food, and medicine in a natural disaster. The website utilizes static calculations to scale per person/ per day recommendations of water, food, and medication to the user’s specified number of people and days. The scale factors, or per person/per day recommendations, were informed by credible industry leaders such as the World Health Organization, Sphere, the European Association of Hospital Pharmacists, the World Food Program, and the United Nations International Children's Emergency Fund to ensure that calculations are reliable. HTML and CSS were used for front-end web development, and Python was used for back-end development. Industry experts were interviewed to inform the scope and future directions.

Verda Rose Annan

Lauren Kim

Omolivie Eboreime

Himani Yarlagadda

Ryan Liu

Agustin Garcia Lopez

Marianna Petrea-Imenokhoeva

Jarone Lee

Aurelia Huiwen Chen

Maxine Park

Network Analysis in Global Emergency Medicine: Mapping Collaborative Structures and Enhancing Connectivity

Abstract

2 October 2024

Introduction Network analysis, which draws from fields including mathematics, sociology, and public health, is essential for interpreting complex data relationships within healthcare information systems. This approach not only highlights intricate care patterns but also enhances the navigability of systems, making complex healthcare information more accessible [1]. Our study builds on previous applications of network analysis in healthcare, specifically examining its use in structuring academic health center websites in the U.S. to improve user-oriented spaces. Our research explores the digital ecosystem of emergency medicine organizations globally, focusing on the International Federation for Emergency Medicine (IFEM). By employing a systematic, automated approach to network mapping, we aim to uncover collaborative patterns and enhance the online presence of emergency resources. This effort supports greater global collaboration and information sharing among emergency medicine organizations, leveraging the strong networks and insights provided by IFEM to ensure universal access to high-quality emergency services. Methodology We utilized a four-step process for mapping and analyzing the global network of emergency medicine organizations: Web Crawling: We collected data from the IFEM website using the Screaming Frog SEO Spider tool. The crawl depth was set to three to ensure comprehensive data capture from IFEM and its connected links. Content Filtering: BeautifulSoup was used to parse HTML content. We filtered the extracted data for relevance to emergency medicine organizations. The data was further refined using the Gemini 1.0 Pro model to isolate pertinent information about the organizations' names and locations. Geolocation Resolution: Location data extracted from the web pages was converted into geographical coordinates using the Geopy library’s Nominatim tool to accurately map of each organization's position. Network Visualization: We constructed a directed network graph using the NetworkX library, with nodes representing organizations and edges representing their interconnections. This graph was visualized with Matplotlib to illustrate the relationships and distribution patterns among the organizations. Results We identified 4,775 external links on the IFEM website and refined them to 156 unique base URLs for in-depth content analysis. Out of 55 countries listed, there were 41 functional links, 10 non-functional, and 4 missing. We effectively isolated 41 relevant multilingual URLs from the functional links, achieving a 100% accuracy rate in identifying pertinent content. Additionally, our analysis uncovered 30 URLs linked to emergency medicine organizations not listed on the IFEM member page, including the American College of Osteopathic Emergency Physicians and the Swiss Society for Emergency and Rescue Medicine. Discussion Our study highlights the utility of network analysis in understanding the digital networks of emergency medicine organizations globally, revealing essential connectivity patterns and their implications for healthcare systems. The methodology used is adaptable for other healthcare areas, enhancing collaboration and addressing language barriers. Findings indicate dynamic changes in digital connectivity, pointing to evolving collaboration and resource sharing. This research provides a foundation for exploring digital connectivity's broader impacts across various sectors. References Niyirora J, Aragones O. Network analysis of medical care services. Health Informatics J. 2020 Sep;26(3):1631-1658. doi: 10.1177/1460458219887047. Epub 2019 Nov 18. PMID: 31735109.

Norawit Kijpaisalratana

Abdul Badih El Ariss

Prem Menon

Jeffrey Yuan

David Chen

Kevin Shannon

Rmaah Memon

Nicole Danaher-Garcia

Sean Kivlehan

Shuhan He

The Healthcare Leadership Program: Assessing the Past, Present, and Future Impact in the Inland Empire

Abstract

4 October 2024

Background Formal leadership training opportunities are limited at many medical schools.2 The Healthcare Leadership Program (HLP) at UCR School of Medicine was an initial solution to this gap in leadership training, and our resulting project provides an innovative solution for assessing the impact of a program of this nature. HLP supports medical students in building a foundation of knowledge rooted in leadership and advocacy to utilize in the community as healthcare leaders. The major foci of the program include: Leadership Lecture Series, Leadership Development (i.e. Strengths Finder Assessments), Mentorship in the Community, and continuous Quality Improvement Projects (resulting in a capstone project).1 Since its inception, it has transitioned from a selective program to a designated emphasis that spans 4 years of medical school. As a result, HLP members have been heavily involved in the community. This project will assess the program’s activities, understand the leadership experiences gained by students, and explore the program’s past, present, and future impact in the Inland Empire utilizing GIS. Methods In an aim to best collect data on current HLP current students, alumni, and faculty, a group of 30 students were divided into the multiple phases of the program. The three teams included: Student Outreach and Community Engagement, Database and Analytics, and GIS mapping and visualization. The Student Outreach and Community Engagement team reached out to all (current and past) members of HLP, gathering information on any projects they participated in as well as current positions in community organizations. Short, 10 to 15-minute interviews were conducted via various modalities to make it as feasible as possible. The modalities included: phone, zoom, in-person and email- based questions. The Database and Analytics group joined in after data collection and organized the data. Themes from interviews were identified and grouped accordingly. The GIS and Visualization team then stepped in and created a map to illustrate the impact of the program as well as to identify areas where future efforts will be targeted. Results A total of 16 students responded and 2 of the founding faculty members. Of the students’ responses, 10 students identified as female and 6 as male. Of the student responses, 5 identified as Asian, 2 as white/ Caucasian, 5 as Middle Eastern, 2 as Indian/Asian Indian and 2 as Hispanic/Mixed. Of faculty responses, both identified as male. One of the faculty members identified as African American/ Black and one as Caucasian. Leadership categories were divided into: Clinical researchers, clinical administrators, clinical teachers and clinical educators. Of the student responses, 2 identified as clinical teachers, 1 as a clinical administrator and 13 as clinical researchers. Of the faculty responses, 1 identified as a clinical administrator and the other as a clinical researcher. Leadership roles among students and alumni included, COO, founders of Unheard cries and breast milk bank projects, chief residents, free clinical managers, and class representatives. Faculty leadership roles included President and Dean of CUSM and Vice Chair of Research for the Psychiatry and Neuroscience Residency Program. After a month of data collection, we found that the highest non- response rates were in third year students, past students, and students on leave. Discussion Our program is based upon a 4-year, up to 20 hours per year requirement, that is largely facilitated via clinical volunteers. HLP scholars partner with clinical volunteers for our guest speaker series, leadership speaker series, and mentorship. Our present project provided a data driven basis for connecting with clinical leaders across the spectrums of clinical researchers, clinical teachers, clinical educators, and clinical administrators to ensure our program has identified past, present and future clinical volunteers central to our success. Ultimately, our HLP Designated Emphasis is not only leadership focused but also community-based. Our network of program participants, HLP Scholars, and clinical volunteers represent our footprint within and across our service communities, and the foundation of our program. Conclusion Through the years, HLP has provided medical students with several community experiences and learning opportunities to develop leadership skills and education. However, there hasn’t been an assessment of the program’s impact on students and the community. Through the utilization of GIS, we demonstrate a “story map” of HLP’s past and current involvement in the community, illustrating student’s commitment to leadership endeavors in the Inland Empire. Additionally, we analyzed areas of improvement and future expansion in order to further support HLP’s goals and sustainability of the program.. Overall, HLP has positively impacted student leadership development and community enrichment. Citations

Kendrick A. Davis

Aliyah Qurashi

Angela Reyes

Christine Khanbijian

Chelsea Nwonwu

Persistent Global Health Threats: The Impact of Infectious Diseases in Resource-Limited Regions

Abstract

4 October 2024

Abstract Topic: Global Health Introduction: Global health focuses on improving global health equity, involving interdisciplinary collaboration, addressing transnational health issues, and combining population-based prevention with individual-level clinical care. Problem Statement: Infectious diseases like HIV/AIDS, malaria, tuberculosis, and emerging illnesses such as COVID-19 persist as substantial risks to global health, especially in regions with limited healthcare resources where infrastructure may be lacking. Overview: In an increasingly interconnected world, global health stands as a paramount concern, striving to improve health outcomes and realize health equity for all individuals worldwide. This multifaceted endeavor necessitates a comprehensive strategy, integrating efforts to tackle transnational health issues, their determinants, and potential solutions through collaborative interdisciplinary approaches. Key facets of this approach include robust initiatives in disease prevention and control, ensuring universal access to healthcare services and essential medicines, particularly in underserved regions, and addressing the intricate web of social determinants that shape health outcomes, including poverty, education, and access to basic amenities like clean water and sanitation. Effective governance structures are Central to advancing global health, exemplified by institutions such as the World Health Organization, which play pivotal roles in orchestrating coordinated action and setting strategic priorities. Collaboration among diverse stakeholders, including governments, international organizations, non-governmental organizations, and civil society, forms the bedrock of successful global health initiatives. Technology Stack: The integration of technology emerges as a crucial factor in advancing global health. Technological innovations facilitate the dissemination of healthcare information, enable telemedicine services to reach remote populations, and enhance disease surveillance and monitoring capabilities. Technology plays a transformative role in improving healthcare delivery and outcomes worldwide, from mobile health applications to advanced diagnostic tools. Moreover, sustained investment in research and innovation is imperative, driving progress by deepening our understanding of diseases and fostering the development of innovative treatments and technologies. Equally critical is the prioritization of preparedness for health emergencies, characterized by the strengthening of surveillance systems, rapid response capabilities, and the fostering of international cooperation. Conclusion: The persistence of infectious diseases like HIV/AIDS, malaria, tuberculosis, and emerging illnesses such as COVID-19 underscores the ongoing threat to global health, particularly in regions with limited healthcare resources and inadequate infrastructure. Addressing these challenges requires concerted efforts to strengthen healthcare systems, enhance disease surveillance and prevention measures, and improve access to essential healthcare services worldwide. Only through collaborative and proactive approaches we can effectively mitigate the impact of infectious diseases and safeguard the health and well-being of populations across the globe.

Avani Ghanhasham Juvekar

Anish Hegde

The Emergency Leadership Dashboard: A Comprehensive System for Visualizing Operations across Educational, Administrative, and Research Sectors

Abstract

4 October 2024

Introduction Managing patient care and fulfilling administrative tasks are challenges facing healthcare systems (1). Particularly at university hospitals, emergency departments (EDs) must carry out research and fulfill educational responsibilities. As a result of these responsibilities, educators can develop educator burnout (2). Providers must additionally maintain accreditation by completing continuous education and certification. Using new technology and automation, clinicians can focus on patient care and quality service, reducing administrative burdens. The goal of this study is to introduce an ED leadership dashboard that optimizes ED operational efficiency across the administrative, educational, and research areas. Methodology The digital dashboard was developed with Microsoft Teams, Forms, Excel, and Power BI. The system combines multiple datasets to create a comprehensive visual dashboard. The first database queries information about ED physicians and updates the related datasets, including ED research, administrative tasks, student evaluations, and performance metrics. The real-time updates and visualization on the dynamic Power BI dashboard facilitate the shift from the current paper-based data collection to an electronic workflow. Implementation includes utilizing standardized forms for data inputs about research projects, educational assessments, and administrative tasks, such as complaint management and credential monitoring. These inputs cause updates in the respective datasets and dashboard output in real time, which enhances the decision-making process by providing immediate access to performance metrics such as patient throughput. The dashboard ensures consistency, improves administrative efficiency, and supports a proactive approach to management and educational evaluations within the ED. Results The research dashboard monitors research activities, allows users to select by year and quarter, and displays interactive visualizations. Projects are categorized into "Original Research" and "Case Report," with Original Research being more common. The stages of research (Writing, Analysis, and Data Collection) are depicted in a donut chart, where Data Collection was found to be the most prevalent. The status of the projects is shown as "On Track," "Completed," or "Delayed," with most projects currently on track. An analysis of research types showed that Retrospective studies were the most frequent (Figure 1). The physician's involvement in each project is also tracked to distribute the project load among faculty. The training and certification dashboard shows completion rates for certifications such as Basic Life Support and Advanced Cardiovascular Life Support, with most completion rates near perfect. Safety training showed a low completion rate of 35%. 574 certifications were completed, and 10 were pending, for an overall 98% completion rate. (Figure 2) Figure 1: Research Dashboard Figure 2: Certification Dashboard Conclusion The implementation of an ED leadership dashboard in university hospital emergency departments has markedly enhanced operational efficiency across administrative, educational, and research functions. Utilizing technologies like Microsoft Teams, Forms, Excel, and Power BI, the dashboard has transitioned from paper-based systems to a streamlined electronic workflow, enabling real-time data visualization and updates. This has improved decision-making processes, optimally distributed faculty workloads, and maintained high certification completion rates, while also highlighting areas for improvement such as safety training. Overall, the dashboard has effectively managed patient care and administrative tasks, reducing burdens and supporting proactive management within the emergency department.

Tareq Al Salamah

Abdul Badih El Ariss

Norawit Kijpaisalratana

Jeffrey Yuan

Fahad Abuguyan

Shuhan He

NexusGraph: NLP Innovation for Scientific Methodology Replication

Abstract

4 October 2024

Biomedical research emphasizes the reproducibility of scientific research by independent researchers, as the results have direct effects on human health. The increasing complexity of modern research, along with inadequate documentation, equipment and resource limitations, and environmental variability, has contributed to a “reproducibility crisis”. NexusGraph offers an advanced Natural Language Processing (NLP) solution to this crisis. It synthesizes a comprehensive, accessible inventory of reagents, equipment, and other materials to allow for standardization to replicate studies. Furthermore, NexusGraph extracts additional elements, including author and material suppliers, along with synthesizing instructional guidance to increase reproducibility.

Abdul Badih El Ariss

Norawit Kijpaisalratana

Jeffrey Yuan

Abdelrahman Mohamed

Louise Corscadden

A Cryptographic Method for Reproducible, Transparent Randomization of Clinical Trial Design

Original Research

23 December 2024

There remains difficulty in creating adequate and equitable protocols and mechanisms to guide the use of randomization to assign participants to different treatment arms in a randomized clinical trial. A trustworthy randomization system should be correct, reproducible, confidential, and transparent, to ensure fairness, secure public trust, and protect both the recruited participants and the trial supervisors. We propose the design and implementation of an accountable and trustworthy randomization approach using a verifiable pseudorandom shuffling mechanism for the purposes of simple randomization in clinical trials. The solution has been deployed in the form of a user-accessible, no-download website for ready access to the public.

Ian Miers

David Chen

Colin McSwiggen

Yan yan

Sammer Marzouk

Deborah Lai

Matthew Green

Norawit Kijpaisalratana

Abdul Badih El Ariss

Ali Raja

Jarone Lee

A Scoping Review of Health AI Controversies in the Grey Literature from 2013-2022

Original Research

22 February 2025

Objective This study aimed to 1) quantify the number of controversies related to health artificial intelligence (AI) development and deployment over the past 10 years, and 2) categorize health AI controversies by theme. Materials and Methods This study is a scoping review. We queried GoogleNews for articles meeting pre-specified inclusion and exclusion criteria related to health AI controversies. A total of 7508 articles were queried, with 76 articles ultimately meeting criteria. Articles were quantitatively evaluated for timing and coded according to both organizational involvement and the themes of the controversies described in the article. Results Of the 76 articles, 55% were published in 2019 and 2022. No articles were published before 2016. Privacy, AI accuracy, and AI bias were the most common themes. Oversight and conflict of interest were the least common themes. Google, Babylon, and Optum were the most discussed companies. Conclusions The results demonstrate concrete evidence for many of the theoretical concerns highlighted by patient and physician surveys as well as scholarly ethics research. However, the volume of articles over the past 10 years was small. It is possible that this study was too narrow in scope, that health AI has actually not yielded a large volume of controversial events, or that news organizations have insufficiently investigated potential health AI controversies. Further research is required to develop a more complete understanding of controversial activities in health AI.

Joshua M Faber

Chad Teven

Arturo Francisco Balaguer Townsend

Broadband Access and Health Outcomes in FCC Priority Counties: A Longitudinal Analysis

Original Research

24 February 2025

Background: The relationship between broadband access and health outcomes is an emerging field of interest within public health research. In an increasingly digital world, it is important to understand how to best allocate broadband resources to maximize health impact and decrease health disparities. This study specifically investigates how levels of broadband connectivity are associated with health metrics for conditions such as diabetes, obesity, and preventable hospitalizations in counties identified as ‘priority’ by the Federal Communications Commission (FCC) due to their low broadband access and high rates of chronic disease. Objective: To understand the longitudinal relationship between broadband access and health outcomes in priority counties, specifically focusing on diabetes, obesity, and preventable hospitalizations. Methods: This study analyzes data from 171 FCC priority counties from 2013-2020. Using regression models, we explore how broadband metrics, including broadband subscriptions and download speed, along with county characteristics such as rurality and persistent poverty, predict health outcomes. Health outcomes of interest include diabetes prevalence, obesity rates, and preventable hospitalizations. Results: A 1 percentage point increase in broadband subscriptions was associated with a 0.5% decrease in the odds of diabetes prevalence (odds ratio [OR] 0.995, 95% Confidence Interval [CI] 0.992-0.997). No significant relationship was found between broadband and obesity rates and preventable hospitalizations. County disparities were evident, with counties experiencing persistent poverty showing a 10% increase in the odds of diabetes prevalence (OR 1.100, 95% CI 1.062-1.140) and a 20.3% increase in preventable hospitalizations (β=1.203, 95% CI 1.131-1.280, P<.001). Rural counties were predicted to have a 17.6% increase in the odds of obesity prevalence (OR 1.176, 95% CI 1.127-1.228) and a 15.1% increase in the odds of diabetes prevalence (OR 1.151, 95% CI 1.111-1.191). Conclusions: Our data suggests that increased access to broadband may be correlated with decreased rates of diabetes in FCC priority counties. The study highlights the variable relationship between broadband access and health outcomes and acknowledges health disparities in rural, persistent poverty counties. This analysis provides a baseline for understanding the dynamics between broadband and health in critical need areas. Such insights highlight how expanding broadband infrastructure, especially rural and impoverished regions where disease burden is high, may help reduce health disparities and improve healthcare service access. Future data can be incorporated to clarify causality and model how the adoption of broadband infrastructure may take time to facilitate telehealth usage and ultimately support improved health outcomes, and how these dynamics may differ depending on county characteristics.

Reese Green

Max von Franque

Melissa Martinez

Alister Martin

Utilization of Structured Data to Improve Visibility of Digital Health Websites

Original Research

24 February 2025

Objective This article proposes a framework to design, organize, and implement structured data, a standardized format to embed metadata into websites, to improve visibility of information from digital health websites. Methods We described the utility of structured data to improve visibility of websites and a proposed framework to design and evaluate context-specific structured data using existing structured data schemas. Results To motivate the increased use of structured data of health websites, we 1) highlight the considerations of implementing structured data in websites, 2) outline a framework and case study to build structured data, and 3) describe practical methods to implement structured data into healthcare websites. Discussion The use of structured data in healthcare websites can increase the visibility of health resources through search engine optimization (SEO), show rich, personalized results to target users, and allow the website to serve as a living digital directory of resource information for patients. Conclusion Further quality improvement and implementation science research is needed to promote the systematic uptake of structured data as a tool to deliver personalized healthcare information to patients.

Suhanee Mitragotri

David Chen

Jarone Lee

Advocating for a White Blood Cell Emoji: A Novel Approach to Enhancing Public Health Communication.

Perspective

24 February 2025

Amidst the COVID-19 pandemic and recent rise in monkeypox cases globally, infectious disease has become a major topic of public attention. However, there still remains a public stigma associated with infectious disease, limiting public understanding of the subject and leading to overall resistance to seek medical assistance for illness. Emojis, which are universally used symbols to communicate important topics, could play an important role in encouraging conversation surrounding infectious disease online. Specifically, white blood cells (WBCs) are a vital part of the immune system and could play an important part in the communication of infectious disease online. Hence, we encourage the infectious disease community to come together and advocate for the inclusion of the WBC emoji into Unicode, the corporation that is responsible for the standardization of emojis across all devices.

Suhanee Mitragotri

Allison Goff

Welcome Letter from the Editor | Open Access

Letter from the Editorial team

3 March 2025

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Shuhan He

Removing Barriers to Government Benefits: Link Health’s Role in Advancing Health Equity Through Expanded Enrollment

Original Research

27 March 2025

Objectives. To evaluate Link Health’s role in improving federal benefit program enrollment by analyzing application trends and impact from 2022-2024. Methods. Link Health connects eligible populations to federal benefits through in-person and digital ethods. Using data from clinics in Massachusetts and Texas and digital sign-ups, we analyze enrollment trends, funding disbursed, and demographics. Results. From 2022-2024, Link Health supported 2,362 applicants, disbursing over $2.8 million to eligible families. Application methods differed significantly by language (𝛸2=97.4, P<0.001, v=0.4), age (W=589819, P=0.03, r=0.05), state (𝛸2=11.5, P<0.001, v=0.1), and race (𝛸2=138.1, P<0.001). Conclusions. Link Health’s hybrid approach and community partnerships may reduce barriers and optimize benefit enrollment, supporting marginalized communities across several health determinants. In the context of diminishing federal support and the postpandemic benefits cliff era, organizations like Link Health are critical to help individuals access resources. Policy Implications. Targeted, community-based digital enrollment models like Link Health’s could be applied to enhance access to vital resources across the country.

Reese Joy Fields Green

Timothy Scheinert

Sudarshan Krishnamurthy

Nicole Nyamongo

Steven Lauterwasser

Alister Martin

Publishing with Purpose: How Clinical Research Drives Better Patient Outcomes

Letter from the Editorial team

24 April 2025

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Ahmad Hassan

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