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      Personalized Telehealth in the Future: A Global Research Agenda

      , MS, PhD , 1 , , MS, PhD 2 , , MSW, PhD 2 , , DSc, MD 3 , , MS (Econ), PhD 4 , , MD, MPH 5 , , RN, PhD 6 , , MSc, PhD 7 , , MS (Econ) 1 , 8 , , MD 9 , , MPH 10 , , PhD 11 , , RN, PhD 12 , , MD 13 , , MD, MPH 2 , 13

      (Reviewer), (Reviewer), (Reviewer)

      Journal of Medical Internet Research

      JMIR Publications Inc.

      telehealth, research, individualized medicine, telemonitoring, prevention, mobile phone

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          Abstract

          As telehealth plays an even greater role in global health care delivery, it will be increasingly important to develop a strong evidence base of successful, innovative telehealth solutions that can lead to scalable and sustainable telehealth programs. This paper has two aims: (1) to describe the challenges of promoting telehealth implementation to advance adoption and (2) to present a global research agenda for personalized telehealth within chronic disease management. Using evidence from the United States and the European Union, this paper provides a global overview of the current state of telehealth services and benefits, presents fundamental principles that must be addressed to advance the status quo, and provides a framework for current and future research initiatives within telehealth for personalized care, treatment, and prevention. A broad, multinational research agenda can provide a uniform framework for identifying and rapidly replicating best practices, while concurrently fostering global collaboration in the development and rigorous testing of new and emerging telehealth technologies. In this paper, the members of the Transatlantic Telehealth Research Network offer a 12-point research agenda for future telehealth applications within chronic disease management.

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          Most cited references 70

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          A systematic review of patient acceptance of consumer health information technology.

          A systematic literature review was performed to identify variables promoting consumer health information technology (CHIT) acceptance among patients. The electronic bibliographic databases Web of Science, Business Source Elite, CINAHL, Communication and Mass Media Complete, MEDLINE, PsycArticles, and PsycInfo were searched. A cited reference search of articles meeting the inclusion criteria was also conducted to reduce misses. Fifty-two articles met the selection criteria. Among them, 94 different variables were tested for associations with acceptance. Most of those tested (71%) were patient factors, including sociodemographic characteristics, health- and treatment-related variables, and prior experience or exposure to computer/health technology. Only ten variables were related to human-technology interaction; 16 were organizational factors; and one was related to the environment. In total, 62 (66%) were found to predict acceptance in at least one study. Existing literature focused largely on patient-related factors. No studies examined the impact of social and task factors on acceptance, and few tested the effects of organizational or environmental factors on acceptance. Future research guided by technology acceptance theories should fill those gaps to improve our understanding of patient CHIT acceptance, which in turn could lead to better CHIT design and implementation.
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            Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.

            Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings.
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              A model for assessment of telemedicine applications: mast.

              Telemedicine applications could potentially solve many of the challenges faced by the healthcare sectors in Europe. However, a framework for assessment of these technologies is need by decision makers to assist them in choosing the most efficient and cost-effective technologies. Therefore in 2009 the European Commission initiated the development of a framework for assessing telemedicine applications, based on the users' need for information for decision making. This article presents the Model for ASsessment of Telemedicine applications (MAST) developed in this study. MAST was developed through workshops with users and stakeholders of telemedicine. Based on the workshops and using the EUnetHTA Core HTA Model as a starting point a three-element model was developed, including: (i) preceding considerations, (ii) multidisciplinary assessment, and (iii) transferability assessment. In the multidisciplinary assessment, the outcomes of telemedicine applications comprise seven domains, based on the domains in the EUnetHTA model. MAST provides a structure for future assessment of telemedicine applications. MAST will be tested during 2010-13 in twenty studies of telemedicine applications in nine European countries in the EC project Renewing Health.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                J. Med. Internet Res
                JMIR
                Journal of Medical Internet Research
                JMIR Publications Inc. (Toronto, Canada )
                1439-4456
                1438-8871
                March 2016
                01 March 2016
                : 18
                : 3
                Affiliations
                1Laboratory of Assistive Technologies - Telehealth & Telerehabilitation, SMI Department of Health Science and Technology Aalborg University AalborgDenmark
                2Center for Information Technology Research in the Interest of Society (CITRIS) UC Berkeley Berkeley, CAUnited States
                3Faculty of Medicine Qatar University QatarQatar
                4Center for Innovative Medical Technologies (CIMT) Odense University Hospital University of Southern Denmark OdenseDenmark
                5Connected Health Innovation Partners HealthCare Harvard Medical School Boston, MAUnited States
                6Betty Irene Moore Nursing School Davis Health System University of California Sacramento, CAUnited States
                7Department of Psychology and Behavioral Sciences Aarhus University AarhusDenmark
                8Citizens & Labor Market Esbjerg Municipality EsbjergDenmark
                9Division of Cardiovascular Medicine University of California Davis Medical Center Sacramento, CAUnited States
                10Center for Connected Health Policy Sacramento, CAUnited States
                11Department of Public Health Sciences School of Medicine University of California Sacramento, CAUnited States
                12Cleveland Clinic Health System Cleveland, OHUnited States
                13Center for Health and Technology Davis Health System UC Berkeley Sacramento, CAUnited States
                Author notes
                Corresponding Author: Birthe Dinesen bid@ 123456hst.aau.dk
                Article
                v18i3e53
                10.2196/jmir.5257
                4795318
                26932229
                ©Birthe Dinesen, Brandie Nonnecke, David Lindeman, Egon Toft, Kristian Kidholm, Kamal Jethwani, Heather M Young, Helle Spindler, Claus Ugilt Oestergaard, Jeffrey A Southard, Mario Gutierrez, Nick Anderson, Nancy M Albert, Jay J Han, Thomas Nesbitt. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.03.2016.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

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                Medicine

                research, individualized medicine, telemonitoring, mobile phone, prevention, telehealth

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