journal of medical internet research impact factor

Journal of Medical Internet Research

Subject Area and Category

• Health Informatics

JMIR Publications Inc.

Publication type

14388871, 14394456

Information

How to publish in this journal

[email protected]

The set of journals have been ranked according to their SJR and divided into four equal groups, four quartiles. Q1 (green) comprises the quarter of the journals with the highest values, Q2 (yellow) the second highest values, Q3 (orange) the third highest values and Q4 (red) the lowest values.

The SJR is a size-independent prestige indicator that ranks journals by their 'average prestige per article'. It is based on the idea that 'all citations are not created equal'. SJR is a measure of scientific influence of journals that accounts for both the number of citations received by a journal and the importance or prestige of the journals where such citations come from It measures the scientific influence of the average article in a journal, it expresses how central to the global scientific discussion an average article of the journal is.

Evolution of the number of published documents. All types of documents are considered, including citable and non citable documents.

This indicator counts the number of citations received by documents from a journal and divides them by the total number of documents published in that journal. The chart shows the evolution of the average number of times documents published in a journal in the past two, three and four years have been cited in the current year. The two years line is equivalent to journal impact factor ™ (Thomson Reuters) metric.

Evolution of the total number of citations and journal's self-citations received by a journal's published documents during the three previous years. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal.

Evolution of the number of total citation per document and external citation per document (i.e. journal self-citations removed) received by a journal's published documents during the three previous years. External citations are calculated by subtracting the number of self-citations from the total number of citations received by the journal’s documents.

International Collaboration accounts for the articles that have been produced by researchers from several countries. The chart shows the ratio of a journal's documents signed by researchers from more than one country; that is including more than one country address.

Not every article in a journal is considered primary research and therefore "citable", this chart shows the ratio of a journal's articles including substantial research (research articles, conference papers and reviews) in three year windows vs. those documents other than research articles, reviews and conference papers.

Ratio of a journal's items, grouped in three years windows, that have been cited at least once vs. those not cited during the following year.

Evolution of the percentage of female authors.

Evolution of the number of documents cited by public policy documents according to Overton database.

Evoution of the number of documents related to Sustainable Development Goals defined by United Nations. Available from 2018 onwards.

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Journal of Medical Internet Research

Journal Abbreviation: J MED INTERNET RES Journal ISSN: 1438-8871

About Journal of Medical Internet Research

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Journal Impact

JMIR Publications is the leading open access digital health research publisher.

Announcing JMIRx - a new series of overlay journals for preprint repositories. Submit your paper today.

Welcome to JMIR Publications

JMIR Publications helps scientists to disseminate innovations, ideas, protocols, and research results to the widest possible audience. This includes not only other researchers, but also patients/consumers and other knowledge users.

We do so in a timely manner, adding value to the quality of the work and adhering to the highest ethical and quality standards.

Openness is at the heart of what we do. As one of the first open access publishers in the world, we have over 20 years of experience in scholarly communication . We use the internet and latest available technologies, organize conferences, create social media content, and develop other innovative knowledge translation products.

We also innovate in the scholarly communication space itself, experimenting with novel metrics, new business models, new models of peer review and dissemination, and new technologies.

We envision a world where people are empowered by health research and technology to make effective, informed decisions, take control of their health and well-being, and live happier and healthier lives.

Our mission

Through leading-edge thinking, community involvement, and continuous innovation, we help leaders in the health technology space to collaborate and disseminate their ideas and research results. We connect vetted, quality research outputs in novel, effective, and timely ways with those who need it.

Meet the team

The JMIR Publications team comprises a talented group of individuals in their respective fields. They have come together to work toward the JMIR mission and vision.

Simply put, we love what we do and who we do it for.

Our journals

Explore the latest research in the field of digital health, including innovations in health care technologies, patient and caregiver education, participatory medicine, biomedical engineering and medical informatics.

Journal of Medical Internet Research

The leading peer-reviewed journal for digital medicine and health and health care in the internet age. June 2023 - Journal Impact Factor: 7.4. Q1 journal in “Medical Informatics” and “Health Care Science & Services” categories.(Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR Public Health and Surveillance

A multidisciplinary journal that focuses on the intersection of public health and technology, public health informatics, mass media campaigns, surveillance, participatory epidemiology, and innovation in public health practice and research. June 2023 - Journal Impact Factor: 8.5. Q1 journal in “Public, Environmental & Occupational Health” category (Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR Mental Health

A journal focused on Internet interventions, technologies, and digital innovations for mental health and behavior change. Official journal of the Society for Digital Psychiatry. June 2023 - Journal Impact Factor: 5.2 (Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR mHealth and uHealth

Focused on health and biomedical applications in mobile and tablet computing, pervasive and ubiquitous computing, wearable computing and domotics. June 2023 - Journal Impact Factor: 5.0. Q1 journal in “Health Care Science & Services” category. (Source: Journal Citation Reports™ 2023 from Clarivate™)

Digital health technologies, apps, and informatics for patient education, medicine and nursing, preventative interventions, and clinical care / home care for elderly populations. June 2023 - Journal Impact Factor: 4.9 (Source: Journal Citation Reports™ 2023 from Clarivate™)

JMIR Serious Games

A multidisciplinary journal on gaming and gamification including simulation and immersive virtual reality for health education/promotion, teaching, medicine, rehabilitation, and social change. June 2023 - Journal Impact Factor: 4.0 (Source: Journal Citation Reports™ 2023 from Clarivate™)

What people think about us

I was very impressed with the efficient system that was used for submission and reviewing of our manuscripts. Feedback from the editor was also very clear and helpful. Thanks JMIR!

Mandy Cassimatis

University of Southern Queensland, Brisbane, Australia

"Excellent"

"Very professional"

"Very fast"

"Extremely positive experience"

"Manuscript greatly improved"

I had an excellent experience submitting my manuscript to JMIR Medical Informatics. I received valuable feedback from editors that strengthen the paper. The review process was very clear and straightforward. I definitely recommend this journal to my colleagues.

I am very satisfied with their turnaround time in the review process. It is fast and precise. I also like the quality of the reviews. The reviewers carefully read the manuscript and provided very detailed and crucial comments to consider.

Park SungKyu Shaun

Turnaround and review process were very constructive, friendly and swift. Very good journal (JRP) to publish study protocols!

Esther Rind

Great publisher. The reviewer comments were very helpful and the process was fast. From submission to initial review to revised submission to final acceptance took less than 4 months.

The review process was very fair transparent and prompt. I wish other journals were like this.

Cornelia A. Pechmann

Fantastic turnaround on my paper and very efficient. I would highly recommend publishing with this journal and I hope to do so again in the near future.

Kareem Khan

A very forward-thinking publication with tough reviewers who are much appreciated. A true beacon of light for the digital health industry.

Jessica Shull

JMIR is an interesting and socially engaged enterprise worthed to publish with.

Alberto J. Revolware

Working with the Journal of Medical Internet Research as an author is always a top-level experience!

Bradford Hesse

JMIR has completely optimized the process of reviewing and publishing manuscripts. Other journals should follow suit.

Jereme Wilroy

We are working in partnership with.

JMIR Infodemiology

Focusing on determinants and distribution of health information and misinformation on the internet, and its effect on public and individual health..

Tim Ken Mackey, MAS, PhD, University of California San Diego, USA

JMIR Infodemiology (JI, ISSN 2564-1891, Editor-in-Chief: Tim Ken Mackey) launched in 2021, is a PubMed Central /PubMed, MEDLINE , Scopus , DOAJ , Web of Science , EBSCO/EBSCO Essentials, and CABI-indexed, peer-reviewed journal, focusing on infodemiology, the study of determinants and the distribution of health information and misinformation on the internet, and its effect on public and individual health. The new scientific discipline of " Infodemiology ," first introduced in 2002, has been gaining momentum due to the COVID-19 infodemic, with the  WHO  recognizing it as an important pillar to manage public health emergencies.  JMIR Publications is proud to have been spearheading the advancement of this new scientific discipline for more than a decade . We are now accelerating the development of this new interdisciplinary discipline with the first and only journal devoted to this rapidly evolving field, by bringing together thought leaders in research, data science, and policy. Areas of interest include information monitoring (infoveillance, including social listening); ehealth literacy and science literacy; knowledge refinement and quality improvement processes and policies; and the influence of political and commercial interests on effective knowledge translation. 

Recent Articles

TikTok is one of the most-used and fastest-growing social media platforms in the world, and recent reports indicate that it has become an increasingly popular source of news and information in the United States. These trends have important implications for public health because an abundance of health information exists on the platform. Women are among the largest group of TikTok users in the United States and may be especially affected by the dissemination of health information on TikTok. Prior research has shown that women are not only more likely to look for information on the internet but are also more likely to have their health-related behaviors and perceptions affected by their involvement with social media.

Attitudes toward the human papillomavirus (HPV) vaccine and accuracy of information shared about this topic in web-based settings vary widely. As real-time, global exposure to web-based discourse about HPV immunization shapes the attitudes of people toward vaccination, the spread of misinformation and misrepresentation of scientific knowledge contribute to vaccine hesitancy.

Abortion (also known as termination of pregnancy) is an essential element of women’s reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women’s needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience.

Health misinformation on social media can negatively affect knowledge, attitudes, and behaviors, undermining clinical care and public health efforts. Therefore, it is vital to better understand the public’s experience with health misinformation on social media.

Lupus erythematosus (LE) is an autoimmune condition that is associated with significant detriments to quality of life and daily functioning. TikTok, a popular social networking platform for sharing short videos, provides a unique opportunity to understand experiences with LE within a nonclinical sample, a population that is understudied in LE research. This is the first qualitative study that explores LE experiences using the TikTok platform.

Despite being a pandemic, the impact of the spread of COVID-19 extends beyond public health, influencing areas such as the economy, education, work style, and social relationships. Research studies that document public opinions and estimate the long-term potential impact after the pandemic can be of value to the field.

Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide–related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content.

Social media posts by clinicians are not bound by the same rules as peer-reviewed publications, raising ethical concerns that have not been extensively characterized or quantified.

The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion.

Despite challenges related to the data quality, representativeness, and accuracy of artificial intelligence–driven tools, commercially available social listening platforms have many of the attributes needed to be used for digital public health surveillance of human papillomavirus vaccination misinformation in the online ecosystem.

Throughout the COVID-19 pandemic, social media has served as a channel of communication, a venue for entertainment, and a mechanism for information dissemination.

The COVID-19 pandemic prompted global behavioral restrictions, impacting public mental health. Sentiment analysis, a tool for assessing individual and public emotions from text data, gained importance amid the pandemic. This study focuses on Japan’s early public health interventions during COVID-19, utilizing sentiment analysis in infodemiology to gauge public sentiment on social media regarding these interventions.

Preprints Open for Peer-Review

There are no preprints available for open peer-review at this time. Please check back later.

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About the Journal

About the Journal

About the publisher.

At JMIR Publications w e envision a world where people are empowered by health research and technology to make effective, informed decisions, take control of their health and well-being, and live happier and healthier lives.

Mission Statement

Through leading-edge thinking, community involvement, and continuous innovation, we help leaders in the health technology space to collaborate and disseminate their ideas and research results. We connect vetted, quality research outputs in novel, effective, and timely ways with those who need it.

JMIR Publications is a rapidly growing, leading open access publisher. The company was built on the success of JMIR (Journal of Medical Internet Research), which started in 1998 as a pioneering, small independent open access project hosted at a university, which subsequently grew into the most influential journal in medical informatics (ranked in Q1 by Impact Factor by Thomson Reuters as well as Scimago) and e-health services research. Due to the growth in influence and submissions, and to make the operations more sustainable and professional, the journal was incorporated as a company in 2011. Shortly after incorporation, several sister journals were launched. Currently, JMIR Publications Inc. publishes more than 3,500 articles annually in more than 30 journals. See the JMIR Publications site for more details.

Vol. 24 (2022)

Vol 24, no 1 (2022): january.

Download Issue Citations: END BibTex RIS | View PDF

Clinical Information and Decision Making

A Deep Residual U-Net Algorithm for Automatic Detection and Quantification of Ascites on Abdominopelvic Computed Tomography Images Acquired in the Emergency Department: Model Development and Validation

Hoon Ko , Jimi Huh , Kyung Won Kim , Heewon Chung , Yousun Ko , Jai Keun Kim , Jei Hee Lee , Jinseok Lee

Download Citation: END BibTex RIS

Developing a Machine Learning Model to Predict Severe Chronic Obstructive Pulmonary Disease Exacerbations: Retrospective Cohort Study

Siyang Zeng , Mehrdad Arjomandi , Yao Tong , Zachary C Liao , Gang Luo

Demographics of Users, Social & Digital Divide

The Contribution of the Internet to Reducing Social Isolation in Individuals Aged 50 Years and Older: Quantitative Study of Data From the Survey of Health, Ageing and Retirement in Europe

Patrícia Silva , Alice Delerue Matos , Roberto Martinez-Pecino

Chatbots and Conversational Agents

An Artificial Intelligence Chatbot for Young People’s Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study

Hua Wang , Sneha Gupta , Arvind Singhal , Poonam Muttreja , Sanghamitra Singh , Poorva Sharma , Alice Piterova

Digital Health Reviews

Evaluating the Effectiveness of Gamification on Physical Activity: Systematic Review and Meta-analysis of Randomized Controlled Trials

Alexandre Mazeas , Martine Duclos , Bruno Pereira , Aïna Chalabaev

Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review

Clemens Kruse , Katharine Heinemann

Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review

Karoliina Paalimäki-Paakki , Mari Virtanen , Anja Henner , Miika T Nieminen , Maria Kääriäinen

Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis

Roman Keller , Sven Hartmann , Gisbert Wilhelm Teepe , Kim-Morgaine Lohse , Aishah Alattas , Lorainne Tudor Car , Falk Müller-Riemenschneider , Florian von Wangenheim , Jacqueline Louise Mair , Tobias Kowatsch

Technology Acceptance of Home-Based Cardiac Telerehabilitation Programs in Patients With Coronary Heart Disease: Systematic Scoping Review

Hadassah Joann Ramachandran , Ying Jiang , Jun Yi Claire Teo , Tee Joo Yeo , Wenru Wang

Social Media and Health Care (Part II): Narrative Review of Social Media Use by Patients

Deema Farsi , Hector R Martinez-Menchaca , Mohammad Ahmed , Nada Farsi

Web-based and Mobile Health Interventions

A Mobile Intervention to Link Young Female Entertainment Workers in Cambodia to Health and Gender-Based Violence Services: Randomized Controlled Trial

Carinne Brody , Pheak Chhoun , Sovannary Tuot , Anne E Fehrenbacher , Alexander Moran , Dallas Swendeman , Siyan Yi

New Methods

A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study

Victoria Leong , Kausar Raheel , Jia Yi Sim , Kriti Kacker , Vasilis M Karlaftis , Chrysoula Vassiliu , Kastoori Kalaivanan , S H Annabel Chen , Trevor W Robbins , Barbara J Sahakian , Zoe Kourtzi

JMIR Theme Issue: COVID-19 Special Issue

Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey

Minjung Lee , Myoungsoon You

Personal Health Records, Patient-Accessible Electronic Health Records, Patient Portals

Exploring the COVID-19 Pandemic as a Catalyst for Behavior Change Among Patient Health Record App Users in Taiwan: Development and Usability Study

Chinyang Henry Tseng , Ray-Jade Chen , Shang-Yu Tsai , Tsung-Ren Wu , Woei-Jiunn Tsaur , Hung-Wen Chiu , Cheng-Yi Yang , Yu-Sheng Lo

Data Science

Sequential Data–Based Patient Similarity Framework for Patient Outcome Prediction: Algorithm Development

Ni Wang , Muyu Wang , Yang Zhou , Honglei Liu , Lan Wei , Xiaolu Fei , Hui Chen

Public (e)Health, Digital Epidemiology and Public Health Informatics

Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men

Arjee Restar , Anthony Surace , Alexander Adia , William Goedel , Adedotun Ogunbajo , Harry Jin , Alberto Edeza , Laufred Hernandez , Susan Cu-Uvin , Don Operario

Viewpoints and Perspectives

Designing Effective eHealth Interventions for Underserved Groups: Five Lessons From a Decade of eHealth Intervention Design and Deployment

Edmund WJ Lee , Rachel F McCloud , Kasisomayajula Viswanath

The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic

Quynh Pham , Noor El-Dassouki , Raima Lohani , Aravinth Jebanesan , Karen Young

Electronic/Mobile Data Capture, Internet-based Survey & Research Methodology

Unit Response and Costs in Web Versus Face-To-Face Data Collection: Comparison of Two Cross-sectional Health Surveys

Elise Braekman , Stefaan Demarest , Rana Charafeddine , Sabine Drieskens , Finaba Berete , Lydia Gisle , Johan Van der Heyden , Guido Van Hal

Telehealth and Telemonitoring

The Impact of Synchronous Telehealth Services With a Digital Platform on Day-by-Day Home Blood Pressure Variability in Patients with Cardiovascular Diseases: Retrospective Cohort Study

Ying-Hsien Chen , Chi-Sheng Hung , Ching-Chang Huang , Jen-Kuang Lee , Jiun-Yu Yu , Yi-Lwun Ho

A new peer reviewed journal focused on research and applications for the health artificial intelligence (AI) community.

Khaled El Emam, PhD,   Canada Research Chair in Medical AI, University of Ottawa; Senior Scientist, Children’s Hospital of Eastern Ontario Research Institute: Professor, School of Epidemiology and Public Health, University of Ottawa, Canada

Bradley Malin, PhD, Accenture Professor of Biomedical Informatics, Biostatistics, and Computer Science; Vice Chair for Research Affairs, Department of Biomedical Informatics: Affiliated Faculty, Center for Biomedical Ethics & Society, Vanderbilt University Medical Center, Nashville, Tennessee, USA

JMIR AI is a new journal that focuses on the applications of AI in health settings. This includes contemporary developments as well as historical examples, with an emphasis on sound methodological evaluations of AI techniques and authoritative analyses. It is intended to be the main source of reliable information for health informatics professionals to learn about how AI techniques can be applied and evaluated. 

The journal has been approved for indexing in PubMed Central and PubMed and is indexed in DOAJ .

Recent Articles

The integration of artificial intelligence (AI), particularly deep learning models, has transformed the landscape of medical technology, especially in the field of diagnosis using imaging and physiological data. In otolaryngology, AI has shown promise in image classification for middle ear diseases. However, existing models often lack patient-specific data and clinical context, limiting their universal applicability. The emergence of GPT-4 Vision (GPT-4V) has enabled a multimodal diagnostic approach, integrating language processing with image analysis.

Leveraging free smartphone apps can help expand the availability and use of evidence-based smoking cessation interventions. However, there is a need for additional research investigating how the use of different features within such apps impacts their effectiveness.

Passive mobile sensing provides opportunities for measuring and monitoring health status in the wild and outside of clinics. However, longitudinal, multimodal mobile sensor data can be small, noisy, and incomplete. This makes processing, modeling, and prediction of these data challenging. The small size of the data set restricts it from being modeled using complex deep learning networks. The current state of the art (SOTA) tackles small sensor data sets following a singular modeling paradigm based on traditional machine learning (ML) algorithms. These opt for either a user-agnostic modeling approach, making the model susceptible to a larger degree of noise, or a personalized approach, where training on individual data alludes to a more limited data set, giving rise to overfitting, therefore, ultimately, having to seek a trade-off by choosing 1 of the 2 modeling approaches to reach predictions.

Health care–associated infections due to multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (CDI), place a significant burden on our health care infrastructure.

Large language models (LLMs) have the potential to support promising new applications in health informatics. However, practical data on sample size considerations for fine-tuning LLMs to perform specific tasks in biomedical and health policy contexts are lacking.

There are a wide range of potential adverse health effects, ranging from headaches to cardiovascular disease, associated with long-term negative emotions and chronic stress. Because many indicators of stress are imperceptible to observers, the early detection of stress remains a pressing medical need, as it can enable early intervention. Physiological signals offer a noninvasive method for monitoring affective states and are recorded by a growing number of commercially available wearables.

Widespread misinformation in web resources can lead to serious implications for individuals seeking health advice. Despite that, information retrieval models are often focused only on the query-document relevance dimension to rank results.

Medical self-diagnostic tools (or symptom checkers) are becoming an integral part of digital health and our daily lives, whereby patients are increasingly using them to identify the underlying causes of their symptoms. As such, it is essential to rigorously investigate and comprehensively report the diagnostic performance of symptom checkers using standard clinical and scientific approaches.

The world has witnessed increased adoption of large language models (LLMs) in the last year. Although the products developed using LLMs have the potential to solve accessibility and efficiency problems in health care, there is a lack of available guidelines for developing LLMs for health care, especially for medical education.

Synthetic electronic health record (EHR) data generation has been increasingly recognized as an important solution to expand the accessibility and maximize the value of private health data on a large scale. Recent advances in machine learning have facilitated more accurate modeling for complex and high-dimensional data, thereby greatly enhancing the data quality of synthetic EHR data. Among various approaches, generative adversarial networks (GANs) have become the main technical path in the literature due to their ability to capture the statistical characteristics of real data. However, there is a scarcity of detailed guidance within the domain regarding the development procedures of synthetic EHR data. The objective of this tutorial is to present a transparent and reproducible process for generating structured synthetic EHR data using a publicly accessible EHR data set as an example. We cover the topics of GAN architecture, EHR data types and representation, data preprocessing, GAN training, synthetic data generation and postprocessing, and data quality evaluation. We conclude this tutorial by discussing multiple important issues and future opportunities in this domain. The source code of the entire process has been made publicly available.

Biobehavioral rhythms are biological, behavioral, and psychosocial processes with repeating cycles. Abnormal rhythms have been linked to various health issues, such as sleep disorders, obesity, and depression.

The COVID-19 pandemic has led to the rapid proliferation of artificial intelligence (AI), which was not previously anticipated; this is an unforeseen development. The use of AI in health care settings is increasing, as it proves to be a promising tool for transforming health care systems, improving operational and business processes, and efficiently simplifying health care tasks for family physicians and health care administrators. Therefore, it is necessary to assess the perspective of family physicians on AI and its impact on their job roles.

Preprints Open for Peer-Review

There are no preprints available for open peer-review at this time. Please check back later.

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JMIR Research Protocols

Ongoing trials and protocols, grant proposals, and current methods and approaches. , xiaomeng (simone) ma, phdc, ms, bs, scientific editor at jmir publications, ontario, canada.

JMIR Research Protocols   (JRP, ISSN 1929-0748) is a unique  PubMed  and  Scopus -indexed journal, publishing peer-reviewed, openly accessible research ideas and grant proposals, study and trial protocols, reports of ongoing research, current methods and approaches, and preliminary results from pilot studies or formative research informing the design of medical and health-related research and technology innovations.

In 2023,  JMIR Research Protocols  received an inaugural Journal  Impact Factor™: 1.7  (Source: Journal Citation Reports™ from Clarivate, 2023).

With a Scopus Citescore of 2.6, the journal ranks in the higher Q2 61% (317/830) in the General Medicine category.

It should be stressed however that most authors do not publish their protocols for "impact" or citations, rather to document their ideas to how to design experiments, to document their successful grant proposals, or to publish (and maybe brag a little about) their already funded protocols (which do not require additional peer-review). We offer this platform for scientists to publish peer-reviewed protocols for a very low APF, and unfunded protocols for a reasonable fee that includes peer-review. 

While the original focus was on eHealth studies,  JRP  now publishes protocols and grant proposals  in all areas of medicine,  and their peer-review reports, if available (preliminary results from pilot studies, early results, and formative research should now be published in  JMIR Formative Research ).

While the original focus was on the design of medical and health-related research and technology innovations, JRP publishes research protocols, proposals, feasibility studies, methods and early results  in all areas of medical and health research .

JRP  is fully open access, with full-text articles deposited in PubMed Central.

Publishing research protocols, grant proposals, pilot/feasibility studies and early reports of ongoing and planned work encourages collaboration and early feedback, and reduces duplication of effort.

JRP  is compatible with the concept of "Registered Reports" and since May 2018, published protocols receive a Registered Report Identifier ( What is a Registered Report Identifier? ) and acceptance of the subsequent results paper is "in principle" guaranteed in any JMIR journal and partner journals - see  What is a Registered Report? . 

JRP  will be a valuable resource for researchers who want to learn about current research methodologies and how to write a winning grant proposal.

JRP  creates an early scientific record for researchers who have developed novel methodologies, software, innovations or elaborate protocols.

JRP  provides a "dry-run" for peer-review of the final results paper, and allows feedback/critique of the methods, often while they still can be fixed.

JRP  facilitates subsequent publication of results demonstrating that the methodology has already been reviewed, and reduces the effort of writing up the results, as the protocol can be easily referenced.

JRP  demonstrates to reviewers of subsequent results papers that authors followed and adhered to carefully developed and described a-priori methods.

Studies whose protocols or grant proposals have been accepted in  JRP  are "in principle accepted" for subsequent publication of results in other JMIR journals as long as authors adhere to their original protocol - regardless of study results (even if they are negative), reducing publication bias in medicine.

Authors publishing their protocols in JRP will receive a 20% discount on the article processing fee if they publish their results in another journal of the  JMIR journal family  (for example,  JMIR  for e-health studies,  i-JMR  for others).

Need more reasons? Read the Knowledge Base article on " Why should I publish my protocol/grant proposal "!

JMIR Research Protocols  is indexed in  PubMed,   PubMed Central (PMC),   Sherpa Romeo,   DOAJ,   Scopus,   Web of Science(WoS)/ESCI/SCIE,  and EBSCO. 

Recent Articles

Cancer-related cognitive impairment (CRCI) is commonly experienced by patients with cancer during treatment, and 35% of patients experience cognitive impairment after treatment completion. Impairments in memory, attention, executive functioning, and information processing speed are most reported and often negatively impact daily functioning and quality of life (QoL). Despite the large scale of reports, this adverse side effect is underinvestigated across common cancer types, and there is a lack of insight into the CRCI experience.

Lesbian, gay, bisexual, transgender, intersex, queer, and allied (LGBTQIA+) individuals encounter challenges with access and engagement with health services. Studies have reported that LGBTQIA+ individuals experience stigma, discrimination, and health workers’ microaggression when accessing health care. Compelling evidence suggests that the LGBTQIA+ community faces disproportionate rates of HIV infection, mental health disorders, substance abuse, and other noncommunicable diseases. The South African National Strategic Plan for HIV or AIDS, tuberculosis, and sexually transmitted infections, 2023-2028 recognizes the need for providing affirming LGBTQIA+ health care as part of the country’s HIV or AIDS response strategy. However, current anecdotal evidence suggests paucity of LGBTQIA+ and key populations’ health content in the undergraduate health science curricula in South Africa. Moreover, literature reveals a general lack of health worker training regarding the health needs of LGBTQIA+ persons and other key populations such as sex workers, people who inject drugs, and men who have sex with men.

The results of telemedicine intervention studies in patients with heart failure (HF) to reduce rehospitalization rate and mortality by early detection of HF decompensation are encouraging. However, the benefits are lower than expected. A possible reason for this could be the fact that vital signs, including blood pressure, heart rate, heart rhythm, and weight changes, may not be ideal indicators of the early stages of HF decompensation but are more sensitive for acute events triggered by ischemic episodes or rhythm disturbances. Preliminary results indicate a potential role of ambient sensor–derived digital biomarkers in this setting.

The gender gap in time use and its impact on health and well-being are still prevalent. Women work longer hours than men when considering both paid and unpaid (eg, childcare and chores) work, and this gender disparity is particularly visible among parents. Less is known about factors that could potentially mediate or moderate this relationship (eg, work-family conflict and gender role beliefs). Ecological momentary assessment (EMA) allows for the documentation of changes in momentary internal states, such as time use, stress, or mood. It has shown particular validity to measure shorter-term activities (eg, unpaid work) and is thus useful to address gender differences.

The population is constantly aging, and most older adults will experience many potential physiological changes as they age, leading to functional decline. Urinary and bowel dysfunction is the most common obstacle in older people. At present, the analysis of pelvic floor histological changes related to aging has not been fully elucidated, and the mechanism of improving intestinal control ability in older people is still unclear.

A dietary supplement containing Pelargonium sidoides extract, propolis, zinc, and honey has been recently developed and proven to be an effective adjuvant in clinical practice for seasonal diseases and the treatment of respiratory tract disorders.

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Critical to efforts to end the HIV epidemic is the identification of persons living with HIV who have yet to be diagnosed and engaged in care. Expanded HIV testing outreach efforts need to be both efficient and ambitious, targeting the social networks of persons living with HIV and those at above-average risk of undiagnosed HIV infection. The ubiquity of mobile phones across many high HIV prevalence settings has created opportunities to leverage mobile health (mHealth) technologies to engage social networks for HIV testing outreach, prevention, and treatment.

Sodium-glucose-cotransporter 2 inhibitors (SGLT2is) have revolutionized the treatment of type 2 diabetes mellitus (DM2) and chronic kidney disease (CKD), reducing the risk of cardiovascular and renal end points by up to 40%. The underlying mechanisms are not fully understood.

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Advancements in technology have enhanced education, training, and application in health care. However, limitations are present surrounding the accessibility and use of simulation technology (eg, simulators) for health profession education. Improving the accessibility of technology developed in university-based research centers by nonprofit organizations (NPOs; eg, hospitals) has the potential to benefit the health of populations worldwide. One example of such technology is 3D-printed simulators.

Single-lead, smartphone-based mobile electrocardiograms (ECGs) have the potential to provide a noninvasive, rapid, and cost-effective means of screening for atrial fibrillation (AFib) in outpatient settings. AFib has been associated with various comorbid diseases that prompt further investigation and screening methodologies for at-risk populations. A simple 30-second sinus rhythm strip from the KardiaMobile ECG (AliveCor) can provide an effective screen for cardiac rhythm abnormalities.

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Title: Donor-funded procurement determinants and effectiveness of procurement in the public health medical laboratory services: examining the mediating factors

Authors : Crossman Mayavo; Fanny Saruchera

Addresses : School of Business Sciences, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, 2000, Johannesburg, South Africa ' School of Business Sciences, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, 2000, Johannesburg, South Africa

Abstract : This study examines the role of mediating factors in the relationship between donor-funded procurement determinants and their effectiveness in public health medical laboratory services, specifically targeting operational efficiency improvements. Data for this comprehensive analysis were gathered using a mixed-method approach from 221 participants, including healthcare professionals and administrative personnel within the Ministry of Health and Childcare's laboratory services in a developing African country. Employing advanced statistical tools, including structural equation modelling (SEM), this study clarifies the substantial influence of the donation recipient planning process (DRPP) as a mediating factor that significantly enhances the effectiveness of donor-funded procurement (EDFP). In contrast, the results indicate that the donation implementation process (DIP) does not significantly impact the determinants of donor-funded procurement (DDFP). These findings not only highlight the critical importance of strategic planning in donor-funded procurement but also suggest areas for policy and operational enhancements to sustain essential government health institutions. The implications of this study are particularly relevant to similar healthcare settings in developing countries, offering a pathway to refine and optimise procurement processes for improved operational outcomes.

Keywords : donor-funded procurement; procurement; public health laboratories; operational efficiency; mediating factors; structural equation modelling; SEM.

DOI : 10.1504/IJPM.2024.138755

International Journal of Procurement Management, 2024 Vol.20 No.5, pp.1 - 19

Received: 25 Sep 2023 Accepted: 28 Sep 2023 Published online: 30 May 2024 *

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This paper is in the following e-collection/theme issue:

Published on 31.5.2024 in Vol 26 (2024)

A Taxonomy for Health Information Systems

Authors of this article:

• Anna Janssen, BA, MA, PhD   ; 
• Candice Donnelly, BSc, MPH   ; 
• Tim Shaw, BSc, PhD  

Faculty of Medicine and Health, The University of Sydney, Sydney, Australia

Corresponding Author:

Anna Janssen, BA, MA, PhD

Faculty of Medicine and Health

The University of Sydney

Level 2, Charles Perkins Centre D17

Sydney, 2066

Phone: 61 02 9036 9406

Email: [email protected]

The health sector is highly digitized, which is enabling the collection of vast quantities of electronic data about health and well-being. These data are collected by a diverse array of information and communication technologies, including systems used by health care organizations, consumer and community sources such as information collected on the web, and passively collected data from technologies such as wearables and devices. Understanding the breadth of IT that collect these data and how it can be actioned is a challenge for the significant portion of the digital health workforce that interact with health data as part of their duties but are not for informatics experts. This viewpoint aims to present a taxonomy categorizing common information and communication technologies that collect electronic data. An initial classification of key information systems collecting electronic health data was undertaken via a rapid review of the literature. Subsequently, a purposeful search of the scholarly and gray literature was undertaken to extract key information about the systems within each category to generate definitions of the systems and describe the strengths and limitations of these systems.

The collection and use of electronic health data (EHD) is common in contemporary society due to the high level of digitization. As the amount of electronic data continually increases, many sectors refer to the phenomenon as a data revolution [ 1 ]. The health sector mirrors this trend and is increasingly digitized, particularly in response to the COVID-19 pandemic [ 2 , 3 ]. Information and communication technologies (ICTs) that are enabling EHD collection include, but are not limited to, electronic health records (EHRs), patient administrative systems, web-based information from social media and other sources, data collected within apps, and data from wearable devices [ 4 ].

The widespread use of these ICTs enables the development of a rich health data ecosystem, which has great potential to enhance existing approaches to patient self-management, service delivery, and new care models. Different types of EHD and their potential have been investigated in several contexts. This includes how EHD is used to improve health and well-being [ 5 , 6 ], manage chronic conditions [ 7 , 8 ], identify and respond to public health concerns [ 9 ], and support quality improvement activities [ 10 - 12 ].

Despite the large amount of EHD collected, it continues to be underused by many health care organizations and providers [ 13 ]. There is a gap in understanding what constitutes actionable data. Actionable data have been described as data that enable the user to make an informed decision to solve a specific problem [ 14 , 15 ]. In the health sector, actionable data have been described as data that can improve the quality, outcomes, or cost of care [ 16 ]. Another challenge in using EHD is the increasingly large amount of data held by private industry, as the organizations that develop the technology often retain custody of its data [ 17 , 18 ].

To transform EHD into actionable data, unique challenges need to be overcome. One of the most widely acknowledged challenges is adequate infrastructure for EHD use. Infrastructure challenges include (1) the inability to access qualified and experienced technical experts for extracting and analyzing data and (2) deeply ingrained interoperability issues between existing data sources [ 19 ]. A further challenge is that EHD is incredibly complicated and fragmented within individual departments and health care organizations [ 19 ]. Data are often not centralized within organizations, and a cultural change is required [ 20 , 21 ]. Extracting data from these silos brings new challenges related to privacy and the safety of data transmission within a connected health system [ 16 ]. Finally, many health care organizations only have small data, which have significant potential for real-time analytics and presentation in digestible formats, that is, dashboards [ 13 ]. However, much of the literature has focused on big data use [ 22 , 23 ], with limited research or understanding of the value of small health data sets for generating meaningful insights.

There are many benefits to increasing the actionability of health data. It can provide a foundation for learning health systems. Such systems transform routinely collected EHD into useful information to improve health care quality and outcomes and support timely decision-making [ 24 ]. Another benefit is the increased accessibility and value of EHD for health professionals and organizations. It is particularly important that health professionals see value from their data input. Since the implementation of EHRs, health professionals have been increasingly required to take an active role in data entry. Such data entry has been repeatedly noted as adding a significant workload burden [ 25 ]. Although there is a workload burden, it is also postulated that health professional–collected data will be of higher quality than other sources [ 26 ]. Demonstrating the benefits of EHD to health professionals will also likely increase their buy-in to data collection, which is essential in improving the completeness and quality of EHD. Expanding the utility of EHD would also benefit consumers in supporting new care models such as virtual care [ 27 ]. Furthermore, actionable and transparent EHD can support personalized and patient-centered care [ 28 ].

This paper aims to present a classification of health information systems used in health care and describe how the information collected by these systems contributes to the health data ecosystem. Furthermore, the paper aims to better explore what constitutes actionable data in health care and contextualize the role of different data sources for this purpose. A key contribution of this study is the development of a health information system taxonomy to help classify the breadth of data collected about health ( Table 1 ) and a visualization of how the different ICTs that collect EHD can be categorized ( Figure 1 ).

This paper addresses a gap in the current literature by providing an overarching description of the health data ecosystem. Recent research has focused on describing certain types of EHD, that is, imaging, administrative, and genomic data [ 29 ], or classifying subcategories of health information systems, particularly clinical information systems [ 30 , 31 ].

a EHR: electronic health record.

b EMR: electronic medical record.

c AI: artificial intelligence.

d WPR: web-based patient review.

e EHD: electronic health data.

Developing the Taxonomy

The EHD ecosystem underpins much of digital health, but it is complex and difficult to navigate. To tackle this issue, the authors have created a comprehensive taxonomy that categorizes essential health information systems. This taxonomy serves as a valuable resource for the numerous individuals in the digital health workforce who may lack extensive informatics expertise but are bound to encounter such systems in their roles. These individuals in the digital health workforce may regularly interact with health data and use actionable insights from the data to inform aspects of their job, or they may be interacting with computer scientists, data analysts, informaticians, or other data analysts regularly [ 32 ]. The taxonomy is for these individuals who need a nontechnical overview of key systems and the reasons the systems were designed to understand the strengths and limitations of the data they collect.

A taxonomy is an approach for specifying the characteristics of objects and categorizing them to help understand complex domains [ 33 ]. A wide range of methodologies can be used for developing taxonomies, and the literature indicates that inductive, deductive, and intuitive approaches can all be used to good effect [ 34 ]. Methodologies for developing taxonomies vary across disciplines. The inherently multidisciplinary nature of digital health means there is not a single, widely recognized methodology for developing taxonomies in this space. The taxonomy development described in this paper was guided by a modified version of design science research and an improved method for taxonomy development [ 33 ]. This was done by applying the following steps: (1) problem definition, (2) definition of objectives for the taxonomy, (3) specifying end conditions, and (4) design and development.

The problem definition (step 1) and objectives for the taxonomy (step 2) are outlined in earlier sections of this paper. The end conditions for the taxonomy (step 3) were chosen to be the point of adequate conciseness [ 34 ], that is, the point at which the taxonomy had become meaningful without becoming unwieldy or overwhelming to end users. Finally, the design and development process for the taxonomy (step 4) was undertaken via a rapid review of existing taxonomies or classifications of EHD systems. This review was used to create an initial categorization for the objects in the taxonomy, the key information systems for inclusion in the taxonomy, and the higher-level categorizations for these systems. This initial categorization was discussed by the researchers (AJ and CD) and augmented with missing systems. A purposeful search of the scholarly and gray literature was subsequently undertaken to extract key information about the EHD systems within each category, generate definitions, and describe the strengths and limitations of these systems.

A limitation of this taxonomy is that it did not undergo an evaluation process. However, it has been noted in the literature that this is a common limitation of taxonomies, which frequently go through iterative development but do not have a final evaluation stage [ 33 ].

Health Information Systems

Summary of ehd sources.

EHD can be broadly classified into 3 categories, described in depth in subsequent sections of this study. Refer to Table 1 for the taxonomy of key health information systems. Figure 1 visualizes the higher-level categorizations of these systems. The three categories are as follows:

• Clinical data sources: digital technologies that are used by health care organizations to collect EHD. It includes technologies such as electronic health and medical records, registries, practice management software, patient-reported measures, and bespoke databases collecting information from various medical devices used in the clinical setting.
• Consumer and community data sources: consumer technologies that collect data about the health and well-being of the individuals using the technology. It includes technologies such as desktop and smartphone apps, social media, and web-based communities.
• Technology-collected data sources: systems that passively collect data about people with digital technology. It largely describes data collected by wearables and other devices.

Clinical Information Systems

There are a variety of definitions of clinical data. At the highest level, clinical data can be defined as data collected during the care delivery process of health care organizations [ 35 ]. Although clinical data mostly refers to data about patients, the data are used for a wide range of applications beyond the delivery of care, including billing [ 36 ] and research [ 37 ]. The systems that collect clinical data are typically those used by organizations to deliver health services or to monitor processes and outcomes of care. Data in this category are commonly entered by a member of the health workforce. However, some systems may also passively collect metrics on end-user interactions with the technology.

Electronic Health and Medical Records

The terms EHR and electronic medical record (EMR) are frequently used interchangeably, but there are subtle differences between the 2 technologies. EMRs are repositories of patient health information created by health professionals to capture data related to specific clinical encounters [ 38 ]. EHRs include EMR functions but also have additional ones. The crucial difference is that EHRs are designed to share information across different health care settings and potentially between health professionals and patients [ 39 ]. Typically, EHRs are designed to collect both structured and unstructured data. Data collected by EHRs can be beneficial in many contexts, including at the clinical, organizational, and societal levels [ 40 ]. Clinical benefits include a reduction in medical errors and improving the completeness and accuracy of data [ 41 ]. EHR and EMR data have also been useful for supporting quality improvement activities such as audits and feedback [ 42 ] and can potentially enable workplace learning and reflective practice [ 43 ].

Clinical registries are information systems that collect uniform data to evaluate specified outcomes for a population, disease, condition, or exposure [ 44 ]. Registries can be implemented for a range of purposes, including quality improvement [ 37 ], disease monitoring [ 10 ], device surveillance, and health care services monitoring [ 10 ]. Registries are generally designed to collect structured data. Health professionals usually input data retrospectively using strict definitions aligned with informatics infrastructure [ 45 ]. However, there is growing interest in the use of e-registries, which use ICTs to enable systematic, automated, and longitudinal collection, retrieval, and analysis of data [ 46 ].

Practice Management Software

Practice management software is designed to manage the everyday activities of a medical practice [ 47 ]. Historically, practice management software was largely focused on supporting billing [ 48 ]. Contemporary systems often incorporate a range of administrative functions such as patient scheduling and registrations, financial reporting, and collections management as well as elements such as patient records and potentially patient communications functionality [ 48 ]. Practice management software usually collects a combination of structured and unstructured data. Some practice management software has started incorporating more sophisticated tools for supporting clinical care, such as tracking vaccinations and recording test results.

Consumer Complaints and Incident Reports

Consumer complaints and incident data can include problems as diverse as organization parking issues to physical harms and sentinel events [ 49 ]. These data can be captured on a range of different platforms. As such, there is variation in the data collected across organizations, which can influence what data points are captured. Generally, the data collected by these systems are unstructured.

Hospital Administrative Information Systems

Health care organizations use a variety of platforms to collect data about administrative aspects of care and clinical billing [ 36 ]. One of the most common types are patient administration systems (PASs), which capture a range of data, including demographic information about patients and interactions between the health care organization and the patient [ 50 ]. These administrative data systems indirectly capture information about care delivered, but it is not their primary purpose [ 51 ]. PAS data are often carefully structured, particularly data related to payments, as they may need to be provided by health care organizations with different PAS to health insurance companies with different processing software [ 52 ]. This is done by coding PAS and other data collected within a health care organization and providing the coded data to payers, commonly called claims data, for reimbursement purposes [ 53 ].

Patient-Reported Outcome Measures

Patient-reported outcome measures are data collected using questionnaires that measure patients’ perceptions of disease management and outcomes [ 54 ]. They do not have to be collected electronically, but they often are. These data are particularly valuable for assessing the patient-centeredness of care and how effectively care responds to patient needs [ 55 ]. They can be reported as individual data or in an aggregated form [ 56 ]. These types of information systems are increasingly designed to collect structured data, but this can vary depending on the design of the individual data collection tool.

Diagnostic Information Systems

These systems are designed to collect data generated by diagnostic results, including imaging, radiology, and pathology test results, and to report genomic data to inform diagnosis and guide therapeutic approaches [ 57 ]. Data from these systems are often integrated into EHR, EMR, or PAS within health care organizations and practice management software in primary care in addition to being stored in independent information systems [ 21 ]. Radiology information systems and their equivalents collect reports on test results for use by the health workforce [ 58 ].

Electronic Prescribing

Electronic prescribing systems are used by pharmacies to generate digital prescriptions instead of paper-based documents [ 59 ]. These systems can enable the uploading and exchange of dispensed script data [ 59 , 60 ] and support monitoring the dispensing of controlled medicines to minimize misuse of pharmaceuticals [ 60 ].

Remote Monitoring

Remote monitoring describes a range of digital technologies that can passively monitor, assess, and potentially manage patient care regardless of whether they are with a health professional [ 61 ]. They include technologies such as cardiac devices implanted into a patient on the recommendation of a health professional, but also devices such as pulse oximeters that consumers can access regardless health professional input [ 62 ].

Bespoke Databases

In addition to more formalized repositories of clinical information, a portion of EHD is collected by bespoke databases. This can include databases of patient information set up by individual health professionals using free electronic capture tools such as REDCap (Research Electronic Data Capture; Vanderbilt University) [ 63 ] to collect data on care quality and outcomes [ 64 , 65 ]. It can also include data from specialized medical devices and hardware such as bioimpedance spectroscopy machines [ 66 , 67 ] and surgical robots [ 68 , 69 ]. The type of data collected by medical hardware and devices varies depending on the machine. These data frequently include metrics on how end users are interacting with the device. As the data collection tools are often custom built, they can also often be flexible and adaptable to the data collection needs of the organization or specialty area [ 70 ].

Consumer and Community Data Sources

The widespread access to digital technologies such as smartphones and internet access has created a plethora of potential sources of EHD generated by consumers and the public. Many of these data sources were not explicitly designed to collect data on the health and well-being of individuals, but researchers and other stakeholders have sought to understand their value. There is still a recognized challenge in harnessing these data, particularly integrating them with clinical data sources [ 71 ]. The data in this category are generally input into these ICTs by consumers or individuals in the community rather than the health workforce.

Smartphone, Web, and Desktop Applications

Smartphone, web, and desktop apps can be defined as self-contained programs optimized for these platforms. In health care, these applications are designed to improve health and well-being using different designs and functions [ 71 ]. The use of health applications is still mostly community and consumer driven, limiting the potential of these technologies to transform health care [ 71 ]. Due to the diversity of health conditions applications have been developed for, there is considerable breadth to the data they could collect. Data collection fits across four broad categories: (1) automatic collection using smartphone features such as GPS to track distance traveled and cameras to collect photo diaries; (2) linkage with Internet of Things devices that collect, record, and transmit data such as weight scales and blood pressure monitors; and (3) manual input of data by users, including recording calories, menstrual cycles, medication compliance, and blood glucose [ 71 ]. Despite the breadth of data that could be collected, researchers have noted that most users are using them to collect data on things such as fitness activities, daily activity levels, and tracking sleep [ 72 ].

Web-Based Patient Reviews

A diverse array of websites on the internet let consumers publish reviews and provide web-based ratings about clinical encounters with individual health professionals or health care organizations. Feedback provided via web-based patient reviews (WPRs) is unsolicited by the health professional. These data can be structured (ie, ratings) or unstructured (ie, free text comments) [ 73 ]. WPRs have been shown to influence health care consumers’ health professional selection and decision-making [ 74 ]. In addition, some research suggests that specialist clinicians have used WPR data to improve patient communication and workflows [ 75 , 76 ].

Appointment Booking Systems

Appointment booking systems allow patients to book and manage their medical appointments on the web [ 77 ]. While traditionally these systems were developed and managed by individual health care practices, they are increasingly being developed and maintained by software companies. Health care practices often embed the booking application into their website, and structured data collected within the system are often stored on the cloud [ 28 ].

Web-Based Communities

These data describe various sources of information on health, including social media data and data from forums and other web-based communities. Web-based communities are peer-to-peer communities where people with common interests can gather virtually to share experiences, ask questions, and provide emotional support [ 78 ]. The data collected by web-based communities are typically unstructured and text based but can vary based on the platform. Social media describes internet-based applications with a social dimension, typically by enabling users to post content and interact with the content of others almost synchronously [ 79 ]. Data collected by social media platforms are varied but include the content in individual posts, metrics on engagement with the content, and information on the network individuals choose to follow [ 18 ]. Data generated from web-based sources possess distinct characteristics compared to other web-based information, such as patient reviews. This is because the main objective of the web-based platform is not specifically to gather health data. However, there are many web-based communities for discussion of health conditions, including diabetes management [ 80 ], cancer management [ 81 ], and general health and wellness [ 82 ].

Web-Based Search Engines

Web-based search engine data describe information on specific terms individuals input into search engines to find results relevant to their queries. Data collected by search engines are primarily terms users input into an individual search engine. A widely used source for such information is Google Trends, which provides a database of terms frequently searched on their platform. It allows for comparing individual terms across different regions and languages [ 83 ]. This is among the earliest web-based sources of health information, with initial research using this data to monitor public health trends dating as far back as 2008 [ 84 ].

Technological Data Sources

The high level of digitization in contemporary society means that individuals interact with a significant amount of ICT daily. Some of these ICTs are actively sought out by individuals, such as purchasing a smartphone or an activity tracker. Other ICTs in this category are interacted with less overtly, such as search engines. Typically, data in this category are passively collected by technology as end users interact with it rather than actively input by consumers or the health workforce.

Wearables and Devices

Wearable devices are digital technologies that an individual wears as an accessory and that may also use sensors to track health information [ 7 ]. The data they collect are typically structured. Although used to collect health data, wearable devices were not originally developed to support health care. They were developed by the fitness industry to track activity to support individual health and well-being [ 85 ]. Wearable devices are increasing in popularity in the community [ 86 ], translating into an increased interest in their use in health care.

Direct Digital Health Care

Technology is increasingly used to enable direct consumer health care models, which may entirely digitize care delivery. These systems include health check stations that enable individuals to monitor their health without interaction with a traditional health care organization [ 87 ]. In addition, there are systems that integrate artificial intelligence (AI) technologies with human expertise, serving as digital-first entry points to care. They offer AI-based triage and referral services to deliver preventative care [ 88 - 90 ]. Finally, large non–health organizations are also entering this space to offer end-to-end health and wellness management services, including home installation of apps and devices and dedicated teams of virtual clinicians and managers [ 88 ].

Challenges and Limitations of the Current Digital Health Information Systems

Quality, completeness, and interoperability.

Ensuring data input into health information systems is complete, of high quality, and able to be linked and shared across different systems within and across organizations is a major challenge with the current digital health information systems. In practice, management software data completeness issues are common, particularly on older systems where administrative and patient records are not linked, potentially leading to loss of information when data are transferred between systems [ 48 ]. Similarly, PAS used in hospitals have been shown to be inaccurate for reporting care outcomes [ 51 ]. The data can have limitations due to varied coding systems across organizations, data quality and completeness, and other issues [ 52 ]. In EMRs and EHRs, interoperability can be a major challenge, particularly a lack of integration across care contexts such as primary and acute care [ 46 ]. Registries have also had issues with interoperability due to instances of variation in standards used to define common data elements across different registries [ 44 ].

Interoperability is also a major challenge for emerging consumer health information repositories such as smartphone apps. Many apps do not include functionality that allows users to easily export data from apps and share it with health professionals [ 5 ]. In addition, the breadth of data collected by these apps could prevent integration into clinical informatics systems [ 71 ].

Data quality issues are also a significant limitation of different repositories of web-based patient health information, though the quality issues are different from clinical information systems. WPR data may not be representative, are often skewed toward a small number of health professionals, and therefore may not be sufficient for consumers to make an informed decision about a provider [ 91 ]. There is little research to show that these data can be used to measure clinical quality for individual health care providers, and the results of research in this area show mixed [ 91 ] association [ 73 ]. Coupled with this, health care organizations and health professionals have reservations about the validity of WPR data [ 74 ] and the ability of a single bad review to reach a wide audience [ 92 ]. These concerns may limit health professionals’ uptake of these data to understand the quality of care.

Social media provides a rich source of real-time health data, although it also has many limitations. These include collecting a large amount of irrelevant data, challenges in standardizing and validating data, and potential biases in the demographics and geographic location of social media users and identifying these biases in the data [ 84 , 93 ]. A noted limitation of search engine data is its potential to dilute cultural differences that shape web-based search behaviors or completely exclude data sets from geographic regions where those search engines are unavailable [ 93 ]. As with smartphone apps, wearables have significant data quality issues, with noted inconsistencies in data accuracy [ 85 , 94 ]. Wearable devices also encounter quality and completeness issues, compounded by interfaces that may not effectively highlight these gaps [ 95 ], leaving users unaware when data are not being collected [ 96 ].

Data Security and Privacy

Data security and privacy are a major concern with contemporary information systems and are often top of mind for health care organizations. When implementing EMRs and EHRs, ensuring data stored within and shared across organizations are governed in a way that provides private and secure data exchange can be challenging [ 25 ]. In consumer-facing systems such as appointment booking engines, data have been misappropriated for financial gain [ 97 , 98 ], suggesting issues to be resolved about the privacy and security of these data and the social license for its secondary use.

Complexity of Implementation and Ongoing Maintenance

Implementing any new technology in existing workflows can be challenging, and digital health information systems are no exception. Resistance to changes in workflow can be a notable barrier to the adoption of clinical information systems [ 28 , 56 ]. In the context of certain types of data collection, such as patient-reported outcome measures, inadequate infrastructure to support the collection of these data [ 99 ] is a major challenge. System maintenance after implementation can also be a challenge for health information systems. Limitations associated with clinical registries include the expenses related to maintenance, which often require staff with specialized skills to operate [ 44 ], and the necessity for sustained funding to support the registry in the long term [ 10 ].

Another challenge of modern information systems such as wearable devices is a lack of guidelines or tools to inform the best practice use of remote monitoring devices in clinical care [ 61 ]. Currently, very few wearable devices are subject to regulatory standards that govern other medical equipment [ 86 ], making it challenging to know which wearables are safe to use in the context of health care. Integration of these devices and the data they produce into health care remains challenging [ 100 ], as they currently do not integrate with clinical workflows or other information systems such as EHRs [ 86 ]. This same challenge occurs with health data gathered by apps, as there are currently few pathways for use in the clinical setting by health professionals [ 101 ].

Impact on Workloads

One of the major limitations of the current digital health information systems is their impact on the workloads of health professionals. The digitization of health data collection parallels an increased administrative load for health professionals. This issue is particularly pronounced with EHRs, as health professionals typically enter data. This has been shown to increase the workloads of health professionals and contribute to burnout [ 25 ].

Secondary Use

While considerable time and effort is spent inputting data into contemporary digital health information systems and given the vast amount of data collected, extracting and accessing these data for secondary purposes is notably difficult. Even when data can be extracted, secondary use of data from health information systems has several limitations. In the context of EMRs and EHRs, it can be challenging to obtain longitudinal insights from data as information is captured at each time point a patient interacts with the health system, which for many individuals occurs as sporadic or occasional visits [ 102 ]. Similarly, data from consumer complaints and incident reporting have limitations because they capture individual incidents not holistic care [ 103 ]. This can make it challenging to identify a strategy for improving quality and can also be an issue for determining whether a complaint is attributed to an individual or a system issue.

Another challenge supporting the secondary use of many digital health information systems is scaffolding the information or supporting end users to interpret it in different contexts from those in which it was collected. For example, registries are often primarily designed for research purposes, and they are not intended to make data readily accessible for use by health services [ 37 ]. Patient-reported outcome measure data have a similar limitation. The data are not routinely used by many health care organizations [ 56 ]. Health professionals may not use patient-reported measures due to not feeling like they have the capacity to use them, not seeing their value [ 56 ], or a lack of knowledge regarding how to meaningfully interpret the data [ 99 ]. When using these data for quality improvement, barriers include a lack of timeliness of the data, limitations in determining the cause of a poor outcome, and implementing change based on a poor outcome [ 104 ]. It has also been noted that patient-reported outcome measures are only 1 piece of performance data that health professionals have access to, and the data may be ignored if individual providers do not see themselves as outliers in the data set [ 104 ].

Data Ownership and Consent

As health information systems increase the amount of EHD collected and move toward better interoperability, patient consent for secondary use of data becomes an increasing concern. In the context of health data, consumers freely share about themselves, such as that on social media and web-based communities, which is another challenge related to consent exists. Although individuals choose to share this content publicly, it remains unclear if users are comfortable having their data used for research and other secondary applications [ 84 ].

Another major challenge with contemporary digital health information systems is data ownership. While all the data collected belongs to patients, the data are housed in information systems that consumers do not have access to. The value of these data is being increasingly recognized, and this is acting as a barrier to access. For example, the device manufacturer often controls access to data from remote monitoring devices, which can raise complex legal and ethical concerns [ 62 ]. These technologies collect large amounts of data that may be vulnerable to privacy breaches or be coopted for commercial purposes [ 105 ], and custodianship of these data is widely contested [ 18 ]. Data collected by bespoke databases in devices has value as a commercial asset [ 17 , 18 ], and vendors may not want to make it available to end users. Furthermore, the data collection architecture in these systems is not governed by any standards, so linking and comparing data, even if it can be accessed, is difficult.

Actioning EHD in Practice

EHD has great potential to transform many aspects of the health sector. There is a growing body of research exploring how data can be used to predict patient outcomes [ 64 , 68 , 106 ], understand care quality [ 51 , 55 , 107 ], and personalize treatments [ 21 ]. Approaches such as those described in learning health system processes can increase the actionability of the EHD to ensure it improves care processes and outcomes [ 24 ]. There are also a growing number of ICTs designed to increase the actionability of EHD from different sources. Much research has been undertaken into visualizing EHD from clinical sources such as PAS and EMRs to uncover insights for end users of the tools [ 66 , 108 ] and how approaches such as learning health system processes can increase the actionability of the EHD. Electronic patient portals use digital technology, such as a website or a smartphone application, to provide patients access to personal health information [ 109 ]. These platforms are often linked to EHRs to increase accessibility to data, help involve patients and caregivers in clinical decision-making, and improve communication between patients and their health care team [ 110 , 111 ]. Similarly, initiatives such as OpenNotes, which makes clinical notes available to patients and caregivers, improve transparency and patient-centered care [ 112 , 113 ].

In the following subsections, 4 use cases describe how ICT supports existing care models and how the data collected might be harnessed to transform service provision, health, and well-being. Some of these use cases describe scenarios increasingly realized in the health sector, partly due to the rapid adoption of digital platforms in response to the COVID-19 pandemic. Other use cases are informed by the research but describe hypothetical scenarios requiring evidence to be translated into practice before they can be fully realized by the health sector. These scenarios are designed to illustrate and prompt reflection on how EHD can be harnessed to generate actionable insights and transform health care in the future. Figure 2 presents a visualization of the 4 different use cases.

Use Case 1: Informing Decision-Making in Consultations

Digital technologies and the EHD they collect can be used to strengthen patient consultations with health professionals. The value of technology to support patient interactions both within and outside of the consultation is increasingly being recognized as virtual care. Virtual care describes non–face-to-face clinical care professionally enabled through digital mechanisms [ 27 ]. In the current clinical practice, health professionals have limited access to clinical decision support tools that harness EHD and support shared decision-making [ 114 ]. Genomics data are increasingly available to health professionals to support precision medicine [ 57 ] and are likely to be more prominent in future clinical decisions. EHD from patient applications and wearable devices can be challenging for health professionals to access in consultations. When data are available, there is limited guidance on how to incorporate these data [ 115 , 116 ]. In addition to data access challenges, there is some evidence that the use of digital technologies during the consultation may impact patient-provider communication and rapport [ 117 , 118 ].

In the future, access to EHD during consultations may enable shared decision-making between patients and health professionals. This could be achieved by visualizing cohort data within an organization to help patients understand their likely outcomes for a given procedure at that specific care center [ 66 ]. It can also support more personalized decision-making in the consultation, such as by harnessing visual interfaces presenting EHD to help patients assess the risk of undergoing a specific procedure [ 43 ], supporting more informed consent processes. Finally, patients could consent to sharing health application and wearable device data with their health professional so that the data can be reviewed and discussed in the consultation to understand patient compliance with treatment plans and tailor care to align best with the patient’s lifestyle. Alongside this, the increasing application of disruptive technologies such as AI to EHD could streamline administrative processes in health care. Although not directly beneficial in the consultation, the actionability of EHD for such applications should reduce the administrative burden on health professionals and allow more time for service delivery.

Use Case 2: Health Professional to Health Professional Interactions

Health care teams currently underuse EHD. While digital technologies such as videoconferencing have been successfully adopted as tools to support team meetings [ 119 ], the uptake of ICTs for visualizing data has been slower. There may be a need to modify physical meeting spaces to better incorporate technologies for presenting these data [ 120 ].

In the future, there will undoubtedly be greater access to EHD by individual health professionals and teams. Given the considerable time health professionals spend on data entry [ 25 ], there will likely be an increasing expectation that they will have access to these data in return for the workload burden. Access to technologies to visualize and scaffold EHD will provide health teams with a holistic view of each patient’s care journey, transforming all aspects of team interactions, including clinical decision-making, quality improvement, research, and learning. Furthermore, ready access to data by health care teams will likely have an important role in ensuring quality control as health professionals incorporate visualization tools into team meetings to review processes and outcomes of care. As part of these team reviews or as individuals, health professionals will likely use digital technologies presenting these data to review the quality of information, annotate points of interest, and edit and improve data in real time. As the application of AI in health data becomes more reliable, there will also likely be an increase in prompts and scaffolds provided by advanced analytics tools that can support decision-making within health professional teams.

Use Case 3: Personalized Training and Reflective Practice

Health professionals regularly dedicate considerable time to engaging in education and training activities to stay up to date on the latest evidence [ 121 , 122 ]. Health professionals have limited access to EHD to reflect on their practice and inform decisions about professional development. Despite this, regulatory bodies expect that EHD will be used in training and professional development to maintain registration to practice [ 123 , 124 ]. Research suggests that health professionals would like greater access to electronic data for educational purposes [ 125 ].

In the future, health professionals, teams, and organizations will be able to leverage the plethora of EHD to understand care delivery and outcomes and enable personalized reflective practice and learning. A new range of educational technologies will be available to engage health professionals in their data to develop a rich understanding of how their behavior can change care quality. This learning approach could create authentic clinical narratives and link it with evidence-based approaches to technology enabled learning. This would focus efforts in health professional knowledge and skill development and enable accreditation bodies to recognize quality in learning experiences rather than quantity of time spent engaging in learning.

Use Case 4: People Using Their data for Preventative Care and Health and Wellness Management

Patients have limited access to data collected by health care organizations about their treatment pathway. While technologies such as patient portals [ 109 ] and open notes [ 113 ] are making these data more available to patients and their caregivers, uptake of these solutions is limited. However, there may be an increase in patient portal adoption as regulation requires health care providers to increase the accessibility of EHD for individual patients [ 57 ]. Coupled with this, vendors from outside of health care are increasingly entering the sector to provide direct-to-consumer care by harnessing AI to enable services to be delivered when and where the consumer desires [ 88 , 89 ].

The health care transparency movement has also explored the value of making cost and quality information about health services available to the public [ 126 , 127 ], but these data are not consistently published for all organizations. There is also a plethora of consumer-centric apps and wearable devices collecting extensive data on individual activities, both general and health-specific, that enable the self-management of health and wellness [ 6 , 71 , 72 ]. Some of these innovations are beginning to be used to improve patient self-efficacy in managing chronic conditions. The increasing availability of diverse data sets also opens up exciting research opportunities. It will undoubtedly unlock new knowledge about human health and support the discovery of more personalized and adaptive approaches to maintaining health and delivering care. In the future, EHD has the potential to enable personalized preventative health and well-being solutions for members of the public. Digital technologies will increasingly make health care available outside of clinical settings, at home, in the workplace, or in whatever location suits the patient.

Conclusions

The health sector is collecting an ever-increasing quantity of EHD. Navigating the ICTs in health care and the siloed data they collect is an ongoing challenge for stakeholders. A classification system for these data could enable stakeholders to get a high-level understanding of the complex health data ecosystem. EHD could be classified into three broad categories: (1) clinical data, (2) consumer and community data, and (3) technology-enabled data.

Understanding the complex health data ecosystem is essential if EHD is going to be leveraged to generate actionable insights that can be harnessed by ICTs to support new care models. In the last 2 years, health care has undergone considerable accelerated digital disruption as part of the COVID-19 pandemic response, which has expanded the types of EHD the sector collects. This includes a growing repository of EHD collected by new non–health corporations entering health care with direct-to-consumer products that support e-prescribing and other synchronous and asynchronous communications, which collect large volumes of health data. While these services add a rich source of information to the EHD ecosystem, they also bring challenges, including increasing the amount of data in commercial vendors’ custody.

Considerable focus to date has been placed on the value of aggregating large data sets into single repositories, which represents a significant infrastructure achievement.

However, moving forward, it is as important to understand why data are being collected as how they will be collected to ensure the correct information is available to benefit the health system and support public health and well-being.

Acknowledgments

AJ is undertaking a postdoctoral research fellowship that is funded through the Digital Health Cooperative Research Centre. The Digital Health Cooperative Research Centre is established and supported under the Australian Government’s Cooperative Research Centres Program.

Conflicts of Interest

None declared.

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Abbreviations

Edited by T Leung; submitted 29.03.23; peer-reviewed by M Glöggler, Z Zandesh, R Taggart; comments to author 23.07.23; revised version received 05.10.23; accepted 31.01.24; published 31.05.24.

©Anna Janssen, Candice Donnelly, Tim Shaw. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 31.05.2024.

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