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Digital Health Research in COVID-19 Era

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (31 January 2023) | Viewed by 25493

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Dr. William Yu Chung Wang

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Digital Business and Supply Chain Management Department, Waikato Management School, University of Waikato, Hamilton 3210, New Zealand
Interests: business intelligence and data management; digital-heath research; enterprise systems and supply chain management
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Dear Colleagues,

There have been massive amounts of digital health data stored in the medical information systems. They could be a valuable source of supporting healthcare organizations’ clinical practices and operations, public health management, and medical research if it is analyzed in meaningful ways. Particularly, during the pandemic, there is an increasing needs to understand the developments of digital technologies such as big data analytics and Artificial Intelligence (AI) that they are advocated as the emerging technologies in health care to fill this new situations. This could be the new initiatives in online health counsultation, prescription nad diagnosis. The demand to better plan and forecast the inventory of medical supplies become even more important since the Covid19 pandemic. The adoption of digital technologies, their associated management in health care usually lags behind other industries, as some major technological and managerial obstacles still remain.

There can be the lack of health data integration, human bevaviour, policy and legislation, data privacy and security, and limited insufficient resources. As a result, there is an urgent need for further research to technologically explore how to utilize digital health research to support public health, clinical actions, and health management and demonstrate how thse new initiatives, approaches, and technologies can enable healthcare practitioners and policymakers to sufficiently address societal health concerns and challenges.

Dr. William Yu Chung Wang
Guest Editor

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Keywords

digital health
healthcare systems and management
diagnosis
Covid-19
pandemic
emerging health technology
health policy

Published Papers (12 papers)

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Research

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19 pages, 3273 KiB

Open AccessArticle

Spatial Concentration of Health Industry under COVID-19

by An-Ting Cheng

Int. J. Environ. Res. Public Health 2023, 20(5), 4444; https://doi.org/10.3390/ijerph20054444 - 02 Mar 2023

Viewed by 1154

Abstract

The COVID-19 pandemic has impacted the industry immensely and, in some cases, irreversibly. This research pioneers in studying how the pandemic have influenced the survival and spatial distribution of the health-related manufacturing industry (HRMI) in Taiwan. Eight categories of HRMI are examined, with their change in survival performances and spatial concentration between 2018 and 2020. Average Nearest Neighbour and Local Indicators of Spatial Association are conducted, to visualise the distribution of industrial clusters. We found the pandemic did not shock the HRMI in Taiwan, but actually induced its growth and spatial concentration to a certain extent. Additionally, due to it being a knowledge-intensive industry, the HRMI mainly concentrate in metropolitan areas with which universities and science parks may have largely supported. However, the spatial concentration and cluster scope growth do not necessarily accompany the improvement of spatial survival, which may be resulted from the different life cycle stages an industry category is in. This research fills in the gap of medical studies with literatures and data from the field of spatial studies. It provides interdisciplinary insights under the condition of pandemic. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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14 pages, 5200 KiB

Open AccessArticle

Deep Learning Algorithms with LIME and Similarity Distance Analysis on COVID-19 Chest X-ray Dataset

by Kuan-Yung Chen, Hsi-Chieh Lee, Tsung-Chieh Lin, Chih-Ying Lee and Zih-Ping Ho

Int. J. Environ. Res. Public Health 2023, 20(5), 4330; https://doi.org/10.3390/ijerph20054330 - 28 Feb 2023

Cited by 2 | Viewed by 1435

Abstract

In the last few years, many types of research have been conducted on the most harmful pandemic, COVID-19. Machine learning approaches have been applied to investigate chest X-rays of COVID-19 patients in many respects. This study focuses on the deep learning algorithm from the standpoint of feature space and similarity analysis. Firstly, we utilized Local Interpretable Model-agnostic Explanations (LIME) to justify the necessity of the region of interest (ROI) process and further prepared ROI via U-Net segmentation that masked out non-lung areas of images to prevent the classifier from being distracted by irrelevant features. The experimental results were promising, with detection performance reaching an overall accuracy of 95.5%, a sensitivity of 98.4%, a precision of 94.7%, and an F1 score of 96.5% on the COVID-19 category. Secondly, we applied similarity analysis to identify outliers and further provided an objective confidence reference specific to the similarity distance to centers or boundaries of clusters while inferring. Finally, the experimental results suggested putting more effort into enhancing the low-accuracy subspace locally, which is identified by the similarity distance to the centers. The experimental results were promising, and based on those perspectives, our approach could be more flexible to deploy dedicated classifiers specific to different subspaces instead of one rigid end-to-end black box model for all feature space. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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11 pages, 613 KiB

Open AccessArticle

Understanding Physicians’ Motivation to Provide Healthcare Service Online in the Digital Age

by Tingting Zhang, Qin Chen, William Yu Chung Wang and Yuhan Wei

Int. J. Environ. Res. Public Health 2022, 19(22), 15135; https://doi.org/10.3390/ijerph192215135 - 16 Nov 2022

Viewed by 1356

Abstract

This study aims to investigate the factors that affect physicians’ healthcare service provision behavior on healthcare service platforms. A research model was proposed based on the related literature and uses and gratifications theory and self-determination theory. The empirical data were collected from a popular Chinese healthcare service platform, and negative binomial regression was employed to test the proposed research model. The results indicate that competence satisfaction, autonomy satisfaction, and economic benefit have positive impacts on their service provision behavior and that when physicians have a higher level of offline status, they would be less likely to provide consultation service online if they have a higher level of competence satisfaction. This study contributes to the existing literature by integrating intrinsic and extrinsic motivations to investigate how they affect physicians’ healthcare service provision behavior online. Findings from this study may derive recommendations for improving the features and design of healthcare service platforms. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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16 pages, 2123 KiB

Open AccessArticle

Accelerated Digitalization of the Epidemiological Measures: Overcoming the Technological and Process Complexities of Establishing the EU Digital COVID Certificate in Slovenia

by Dalibor Stanimirovic and Lucija Tepej Jocic

Int. J. Environ. Res. Public Health 2022, 19(21), 14322; https://doi.org/10.3390/ijerph192114322 - 02 Nov 2022

Cited by 3 | Viewed by 1378

Abstract

Objective: In order to facilitate free movement of EU citizens during the COVID-19 pandemic, in early 2021 the European Commission proposed the establishment of an EU Digital COVID Certificate. By 1 July 2021, all EU Member States have successfully implemented the EU Digital COVID Certificate. The technological and procedural complexities encountered while establishing the EU Digital COVID Certificate in Slovenia are reviewed in this article. Methods: This research employs a case study methodology. Controlled focus group sessions comprising eighteen eminent experts (not including medical and other expert groups involved in the epidemiological measures) in charge of the EU Digital COVID Certificate and other national eHealth services in Slovenia were used as the primary data collection technique. Focus group discussions were preceded by an all-encompassing review of the literature and the examination of numerous materials covering the EU Digital COVID Certificate-related content. Results: The study findings reveal that the technological and process complexities are associated with the fragmented data sources and complicated and abundant business rules used for the generation and verification of the EU Digital COVID Certificate. However, despite the technological, process and other impediments that arose during the establishment of the EU Digital COVID Certificate in Slovenia, it can be argued that the approach used and stakeholder commitment, especially in critical pandemic conditions, offered the much-desired harmonisation and application of this digital service at the EU level. Conclusions: The study highlights the importance of a sound and coherent model for the impending establishment of cross-border eHealth services and suggests that the ad hoc implementation of such challenging and delicate digital solutions in the future will only be feasible with the prior construction of robust and interoperable digital health infrastructures across the EU Member States. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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22 pages, 2897 KiB

Open AccessArticle

The German COVID-19 Digital Contact Tracing App: A Socioeconomic Evaluation

by Stephan Ellmann, Markus Maryschok, Oliver Schöffski and Martin Emmert

Int. J. Environ. Res. Public Health 2022, 19(21), 14318; https://doi.org/10.3390/ijerph192114318 - 02 Nov 2022

Cited by 5 | Viewed by 3222

Abstract

The COVID-19 pandemic posed challenges to governments in terms of contact tracing. Like many other countries, Germany introduced a mobile-phone-based digital contact tracing solution (“Corona Warn App”; CWA) in June 2020. At the time of its release, however, it was hard to assess how effective such a solution would be, and a political and societal debate arose regarding its efficiency, also in light of its high costs. This study aimed to analyze the effectiveness of the CWA, considering prevented infections, hospitalizations, intensive care treatments, and deaths. In addition, its efficiency was to be assessed from a monetary point of view, and factors with a significant influence on the effectiveness and efficiency of the CWA were to be determined. Mathematical and statistical modeling was used to calculate infection cases prevented by the CWA, along with the numbers of prevented complications (hospitalizations, intensive care treatments, deaths) using publicly available CWA download numbers and incidences over time. The monetized benefits of these prevented cases were quantified and offset against the costs incurred. Sensitivity analysis was used to identify factors critically influencing these parameters. Between June 2020 and April 2022, the CWA prevented 1.41 million infections, 17,200 hospitalizations, 4600 intensive care treatments, and 7200 deaths. After offsetting costs and benefits, the CWA had a net present value of EUR 765 m in April 2022. Both the effectiveness and efficiency of the CWA are decisively and disproportionately positively influenced by the highest possible adoption rate among the population and a high rate of positive infection test results shared via the CWA. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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13 pages, 701 KiB

Open AccessArticle

Clusters of Pregnant Women with Severe Acute Respiratory Syndrome Due to COVID-19: An Unsupervised Learning Approach

by Isadora Celine Rodrigues Carneiro, Sofia Galvão Feronato, Guilherme Ferreira Silveira, Alexandre Dias Porto Chiavegatto Filho and Hellen Geremias dos Santos

Int. J. Environ. Res. Public Health 2022, 19(20), 13522; https://doi.org/10.3390/ijerph192013522 - 19 Oct 2022

Viewed by 1320

Abstract

COVID-19 has been widely explored in relation to its symptoms, outcomes, and risk profiles for the severe form of the disease. Our aim was to identify clusters of pregnant and postpartum women with severe acute respiratory syndrome (SARS) due to COVID-19 by analyzing data available in the Influenza Epidemiological Surveillance Information System of Brazil (SIVEP-Gripe) between March 2020 and August 2021. The study’s population comprised 16,409 women aged between 10 and 49 years old. Multiple correspondence analyses were performed to summarize information from 28 variables related to symptoms, comorbidities, and hospital characteristics into a set of continuous principal components (PCs). The population was segmented into three clusters based on an agglomerative hierarchical cluster analysis applied to the first 10 PCs. Cluster 1 had a higher frequency of younger women without comorbidities and with flu-like symptoms; cluster 2 was represented by women who reported mainly ageusia and anosmia; cluster 3 grouped older women with the highest frequencies of comorbidities and poor outcomes. The defined clusters revealed different levels of disease severity, which can contribute to the initial risk assessment of the patient, assisting the referral of these women to health services with an appropriate level of complexity. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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19 pages, 1111 KiB

Open AccessArticle

The Acceptance Behavior of Smart Home Health Care Services in South Korea: An Integrated Model of UTAUT and TTF

by Hyo-Jin Kang, Jieun Han and Gyu Hyun Kwon

Int. J. Environ. Res. Public Health 2022, 19(20), 13279; https://doi.org/10.3390/ijerph192013279 - 14 Oct 2022

Cited by 11 | Viewed by 2779

Abstract

With the COVID-19 pandemic, the importance of home health care to manage and monitor one’s health status in a home environment became more crucial than ever. This change raised the need for smart home health care services (SHHSs) and their extension to everyday life. However, the factors influencing the acceptance behavior of SHHSs have been inadequately investigated and failed to address why users have the intention to use and adopt the services. This study aimed to analyze the influential factors and measure the behavioral acceptance of SHHSs in South Korea. This study adopted the integrated model of the unified theory of acceptance and use of technology (UTAUT) and task–technology fit (TTF) to understand the behavioral acceptance of SHHSs from users’ perceptions and task–technology fit. Multiple-item scales were established based on validated previous measurement scales and adjusted in accordance with SHHS context. Data from 487 valid samples were analyzed statistically, applying partial least square structural equation modeling. The results indicated that the integrated acceptance model explained 55.2% of the variance in behavioral intention, 44.9% of adoption, and 62.5% of the continuous intention to use SHHSs, supporting 11 of the 13 proposed hypotheses. Behavioral intention was positively influenced by users’ perceptions on performance expectancy, effort expectancy, social influence, and functional conditions. Task–technology fit significantly influenced performance expectancy and behavioral intention, validating the linkage between the two models. Meanwhile, task characteristics were insignificant to determine task–technology fit, which might stem from complex home health care needs due to the COVID-19 pandemic, but were not sufficiently resolved by current service technologies. The findings implied that the acceptance of SHHSs needs to be evaluated according to both the user perceptions of technologies and the matching fit of task and technology. Theoretically, this study supports the applicability of the integrated model of UTAUT and TTF to the domain of SHHS, and newly proposed the measurement items of TTF reflecting the domain specificity of SHHS, providing empirical evidence during the pandemic era in South Korea. Practically, the results could suggest to the planners and strategists of home health care services how to promote SHHS in one’s health management. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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11 pages, 1706 KiB

Open AccessArticle

Trends in the Volume and Types of Primary Care Visits during the Two Years of the COVID-19 Pandemic in Israel

by Oren Miron, Yael Wolff Sagy, Shlomit Yaron, Noga Ramot and Gil Lavie

Int. J. Environ. Res. Public Health 2022, 19(17), 10601; https://doi.org/10.3390/ijerph191710601 - 25 Aug 2022

Cited by 4 | Viewed by 1198

Abstract

Background: The outbreak of the COVID-19 pandemic led to a decrease in primary health care in-person visits and a simultaneous increase in virtual encounters. Objective: To quantify the change in the total volume of primary care visits and mix of visit types during the two years of the pandemic in Israel. Design: Cross-sectional study. Participants: All primary care visits by members of the largest healthcare organization in Israel, during three one-year periods: the pre-COVID-19 year (March 2019–February 2020), the first year of COVID-19 (March 2020–February 2021), and the second year of COVID-19 (March 2021–February 2022). Main measures: Total volume of primary care visits and mix of visit types. Results: More than 112 million primary care visits were included in the study. The total visit rate per 1000 members did not change significantly between the pre-COVID year (19) and the first COVID year (19.8), but was 21% higher in the second COVID-19 year (23). The rate of in-person visits per 1000 members decreased from 12.0 in the pre-COVID year to 7.7 in the first COVID year and then increased to 9.6 in the second. The rate of phone visits and asynchronous communication increased from 0.7 and 6.3, respectively, in the pre-COVID year, to 4.1 and 8, respectively, in the first COVID year, and remained unchanged in the second. There was substantial variation across age groups and sectors in the adoption of virtual platforms. Conclusions: The rapid introduction of virtual encounters in primary care tended to displace in-person visits in the first year of the pandemic, but they appear to have been additive in the second. This transition should be monitored, with the goal of ensuring appropriate planning efforts and resource allocation to deal with the potential added burden on medical staff. Efforts should be invested in encouraging the use of virtual platforms in patient groups that currently underutilize it, such as minorities. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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11 pages, 373 KiB

Open AccessArticle

Nomophobia and Its Associated Factors in Peruvian Medical Students

by Cesar Copaja-Corzo, Carlos Jesús Aragón-Ayala, Alvaro Taype-Rondan and Nomotest-Group

Int. J. Environ. Res. Public Health 2022, 19(9), 5006; https://doi.org/10.3390/ijerph19095006 - 20 Apr 2022

Cited by 14 | Viewed by 4251

Abstract

Nomophobia is the discomfort caused by not being in contact with a cell phone. Few studies have addressed nomophobia in university students. The study aimed to evaluate nomophobia and its associated factors in Peruvian medical students. We conducted an analytical cross-sectional study on Peruvian medical students between June 2020 and March 2021, using an online survey disseminated through social networks. We analyzed 3139 responses (females: 61.1%, median age: 22 years): 25.7% presented moderate nomophobia and 7.4% severe nomophobia. In the adjusted model, the nomophobia score was lower in students ≥24 years (β: −4.1, 95% CI: −7.2 to −1.0) and was higher in those who had a mobile internet data plan (β: 2.9, 0.8 to 5.0), used the cell phone >4 h (β: 4.5, 2.3 to 6.7), used a smartphone mainly for education (β: 2.5, 0.2 to 4.8), social networks (β: 8.2, 5.8 to 10.6) and entertainment (β: 3.3, 0.5 to 6.1), and those who presented possible anxious (β: 6.6, 4.3 to 8.9) or depressive (β: 19.5, 5.2 to 9.6) symptomatology. In conclusion, nomophobia in university students is a frequent and emerging problem, present mainly at younger ages and associated with symptoms of anxiety or depression. Implementing evaluation and early intervention strategies would favor the mental health of university students. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

10 pages, 2228 KiB

Open AccessArticle

Developing a Stacked Ensemble-Based Classification Scheme to Predict Second Primary Cancers in Head and Neck Cancer Survivors

by Chi-Chang Chang, Tse-Hung Huang, Pei-Wei Shueng, Ssu-Han Chen, Chun-Chia Chen, Chi-Jie Lu and Yi-Ju Tseng

Int. J. Environ. Res. Public Health 2021, 18(23), 12499; https://doi.org/10.3390/ijerph182312499 - 27 Nov 2021

Cited by 12 | Viewed by 1942

Abstract

Despite a considerable expansion in the present therapeutic repertoire for other malignancy managements, mortality from head and neck cancer (HNC) has not significantly improved in recent decades. Moreover, the second primary cancer (SPC) diagnoses increased in patients with HNC, but studies providing evidence to support SPCs prediction in HNC are lacking. Several base classifiers are integrated forming an ensemble meta-classifier using a stacked ensemble method to predict SPCs and find out relevant risk features in patients with HNC. The balanced accuracy and area under the curve (AUC) are over 0.761 and 0.847, with an approximately 2% and 3% increase, respectively, compared to the best individual base classifier. Our study found the top six ensemble risk features, such as body mass index, primary site of HNC, clinical nodal (N) status, primary site surgical margins, sex, and pathologic nodal (N) status. This will help clinicians screen HNC survivors before SPCs occur. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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14 pages, 1504 KiB

Open AccessArticle

Challenges of Using Instant Communication Technology in the Emergency Department during the COVID-19 Pandemic: A Focus Group Study

by Yuh-Shin Kuo, Chien-Hsin Lu, Po-Wei Chiu, Hung-Chieh Chang, Yu-Yuan Lin, Shao-Peng Huang, Pei-Yu Wang, Cheng-Jen Chen, I-Chen Lin, Jing-Shia Tang, Ying-Hsin Chang, Ray Hsienho Chang and Chih-Hao Lin

Int. J. Environ. Res. Public Health 2021, 18(23), 12463; https://doi.org/10.3390/ijerph182312463 - 26 Nov 2021

Cited by 5 | Viewed by 2217

Abstract

A record outbreak of community-spread COVID-19 started on 10 May 2021, in Taiwan. In response to the COVID-19 pandemic, care facilities have adopted various protocols using instant communication technology (ICT) to provide remote yet timely healthcare while ensuring staff safety. The challenges of patient evaluation in the emergency department (ED) using ICT are seldom discussed in the literature. The objective of this study was to investigate the factors influencing the utility of ICT for patient assessment in emergency settings during the pandemic. The patient flow protocol and the ED layout were modified and regionalized into different areas according to the patient’s risk of COVID-19 infection. Nine iPads were stationed in different zones to aid in virtual patient assessment and communication between medical personnel. A focus group study was performed to assess and analyze the utility of the ICT module in the ED. Eight emergency physicians participated in the study. Of them, four (50%) had been directly involved in the development of the ICT module in the study hospital. Three main themes that influenced the application of the ICT module were identified: setting, hardware, and software. The setting theme included six factors: patient evaluation, subspecialty consultation, patient privacy and comfortableness, sanitation, cost, and patient acceptability. The hardware theme included six factors: internet connection, power, quality of image and voice, public or personal mode, portable or fixed mode, and maintenance. The software theme included six factors: platform choices, security, ICT accounts, interview modes, video/voice recording, and time limitation. Future studies should focus on quantifying module feasibility, user satisfaction, and protocol adjustment for different settings. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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Review

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13 pages, 2181 KiB

Open AccessReview

Insights from Review and Content Analysis of Current COVID-19 Mobile Apps and Recommendations for Future Pandemics

by Yeongju Kim, Jihye Choi, Young-A Ji and Hyekyung Woo

Int. J. Environ. Res. Public Health 2022, 19(22), 14652; https://doi.org/10.3390/ijerph192214652 - 08 Nov 2022

Viewed by 1378

Abstract

A number of mobile health apps related to coronavirus infectious disease 2019 (COVID-19) have been developed, but research into app content analytics for effective surveillance and management is still in its preliminary stages. The present study aimed to identify the purpose and functions of the currently available COVID-19 apps using content analysis. The secondary aim was to propose directions for the future development of apps that aid infectious disease surveillance and control with a focus on enhancing the app content and quality. Prior to conducting an app search in the App Store and the Google Play Store, we reviewed previous studies on COVID-19 apps found in Google Scholar and PubMed to examine the main purposes of the apps. Using the five selected keywords based on the review, we searched the two app stores to retrieve eligible COVID-19 apps including those already addressed in the reviewed literature. We conducted descriptive and content analyses of the selected apps. We classified the purpose types of the COVID-19 apps into the following five categories: Information provision, tracking, monitoring, mental health management, and engagement. We identified 890 apps from the review articles and the app stores: 47 apps met the selection criteria and were included in the content analysis. Among the selected apps, iOS apps outnumbered Android apps, 27 apps were government-developed, and most of the apps were created in the United States. The most common function for the iOS apps (63.6%) and Android apps (62.5%) was to provide COVID-19-related knowledge. The most common function among the tracking apps was to notify users of contact with infected people by the iOS apps (40.9%) and Android apps (37.5%). About 29.5% of the iOS apps and 25.0% of the Android apps were used to record symptoms and self-diagnose. Significantly fewer apps targeted mental health management and engagement. Six iOS apps (6/44, 13.6%) and four Android apps (4/24, 16.7%) provided behavioral guidelines about the pandemic. Two iOS apps (2/44, 4.5%) and two Android apps (2/24, 8.3%) featured communication functions. The present content analysis revealed that most of the apps provided unilateral information and contact tracing or location tracking. Several apps malfunctioned. Future research and development of COVID-19 apps or apps for other emerging infectious diseases should address the quality and functional improvements, which should begin with continuous monitoring and actions to mitigate any technical errors. Full article

(This article belongs to the Special Issue Digital Health Research in COVID-19 Era)

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