Accelerating Strategic Changes for Digital Transformation in the Healthcare Industry

By Xi Zhang

Accelerating Strategic Changes for Digital Transformation in the Healthcare Industry discusses innovative conceptual frameworks, tools and solutions to tackle the challenges of mitigating major disruption caused by COVID-19 in the healthcare sector and society. It emphasizes global case studies and empirical studies, providing a comprehensive view of best lessons on digital tools to manage the health crisis. The book focuses on the role of advances in digital and collaborative technologies to offer rapid and effective tools for better health solutions for new and emerging health problems. Researchers, students, policymakers and members of the biomedical and medical fields will find this information invaluable.

Specially, it pays attention to how information technologies help us in the current global health emergency and the coronavirus epidemic response, gaining more understanding of the new coronavirus and helping to contain the outbreak. In addition, it explores how these new tools and digital health solutions can support the economic and social recovery in the post-pandemic world.

• Discusses best experiences, tools and solutions provided by IT to solve the global disruption caused by the COVID-19 pandemic in societies, healthcare infrastructures and health workers
• Presents case studies with experiences of applications of digital healthcare solutions from around the world
• Encompasses the point of views of renown researchers and academics globally that are working collaboratively to explore new views and frameworks to develop solutions for emergent problems in the healthcare sector

• Language: English
• Publisher: Academic Press
• Release date: May 30, 2023
• ISBN: 9780443153006

Book preview

9780443153006_FC

Accelerating Strategic Changes for Digital Transformation in the Healthcare Industry

First Edition

Patricia Ordóñez de Pablos

Faculty of Economics and Business, The University of Oviedo, Oviedo, Spain

Xi Zhang

Department of Information Management and Management Science, College of Management and Economics, Tianjin University, Tianjin, China

Table of Contents

Cover image

Title page

Copyright

Contributors

Preface

Introduction

Contents of the book

Bibliography

Acknowledgments

Section I: The impact of COVID-19 on the healthcare industry: Challenges and trends

Chapter 1: Impact of COVID-19 on healthcare in Qatar: Initiation and operations of the Urgent Consultation Center (UCC) hotline, virtual transformation of healthcare services, and accelerated data sharing solutions—Challenges and opportunities

Abstract

Introduction

Aim of the chapter

Creation of the urgent consultation center (UCC)

Steps involved in the creation of the UCC

Workflow at UCC

Quality assurance

Changes in UCC services in response to challenges

Discussion

Conclusions

References

Further reading

Chapter 2: Challenges, innovation opportunities, and lessons learned from a prolonged organizational crisis: A case exemplar of the National Health Service Wales

Abstract

Introduction

Research design

Findings and implications

Recommendations

Conclusions and research directions

References

Chapter 3: Accelerating pathology education through virtual learning to address global health needs

Abstract

Introduction

Previous methods to increase PALM capacity in LMICs

The promise of virtual learning

Virtual learning in LMICs

Conclusions and future needs

References

Further reading

Section II: Digital transformation of healthcare services

Chapter 4: Mobile health applications: Variables influencing user's perception and adoption intentions

Abstract

Conflict of interest

Introduction

Theoretical background

Methodology

Results

Discussion

Practical implications

Conclusions

References

Chapter 5: Balancing patient empowerment and online security considerations from impact of social media promotion of prescription drugs: Physician perception

Abstract

Introduction

Background

Methodology

Result and discussion

Implication

Conclusions

Implications for digital health-care/digital policy

References

Chapter 6: Social media health communication: A cursory examination of hospitals in India with Facebook presence during the COVID-19 pandemic

Abstract

Conflict of interest

Introduction

Research setting: The role and relevance of social media tools

Methodology

Analysis of findings and discussion

Conclusions, policy imperatives, and recommendations

References

Chapter 7: Development and usability testing of an air disinfection robot to reduce air clearance times following aerosol-generating procedures (AGPs)

Abstract

Introduction

Theory

Design of a robotic procedure for reducing fallow times after AGPs

Hospital evaluation

Discussion

Conclusions

References

Section III: AI and the Internet of Things in the healthcare industry

Chapter 8: Trustworthy artificial intelligence in healthcare

Abstract

Introduction

Needs of trustworthy artificial intelligence

Trustworthy artificial intelligence in healthcare

Discussion, challenges, and opportunities

Conclusions

References

Chapter 9: Artificial intelligence-based brain hemorrhage detection

Abstract

Introduction

Literature survey

Machine learning techniques

Results and discussion

Conclusions

Future scope

References

Chapter 10: A systems approach to implementing ethics in a COVID-19 AI application: A qualitative study

Abstract

Introduction

The wicked issue of implementing ethics in medical AI

Systems approach—A primer

Study design

Study key findings

Discussion

Conclusions

Limitations

References

Chapter 11: Automation of depression detection in texts to identify possible cases during COVID-19 pandemic

Abstract

Introduction

Related work

Methodology

Results

Discussion

Conclusions

References

Chapter 12: Review of using machine learning in secure IoT healthcare

Abstract

Acknowledgment

Introduction

Telehealth system under consideration

ML-based authentication schemes for telehealth

Literature review of ML-based authentication schemes for telehealth

Attacks to healthcare system

ML-based attack detection in telehealth

Conclusions and future work

References

Section IV: Data sharing for accelerating solutions in the healthcare industry

Chapter 13: Health infrastructure, data sharing, and strategic changes for innovative transformation: Evolution of patient appointment registration call center for urology services in Qatar

Abstract

Introduction

Evolution of patient appointment registration system

Discussion

Conclusions

References

Chapter 14: Heterogeneous cardiological data communication in telecardiology with music-key generation scheme

Abstract

Introduction

Literature survey

Research methodology

Experimental results

Conclusions and future scope of work

References

Further reading

Section V: Health emergency preparedness and response

Chapter 15: Early warning for emerging infectious disease outbreaks: Digital disease surveillance for public health preparedness and response

Abstract

Introduction

Public health surveillance and the emergence of digital disease surveillance

Limitations and challenges of digital disease surveillance

Conclusions

References

Section VI: Conclusions and implications for the healthcare research agenda and policymakers

Chapter 16: Digital health policies and participation for digital transformation in German-speaking countries: A critical approach

Abstract

Introduction

Methods

Results

Discussion

Conclusions

References

Chapter 17: Ethical challenges and dilemmas of online psychotherapy

Abstract

The era of digital healthcare

What is online psychotherapy?

History

Types of online psychotherapy

Advantages of online psychotherapy

Challenges of online psychotherapy

Tools for online psychotherapy: Use and challenges

Ethical dilemmas of online psychotherapy

Guidelines for addressing ethical challenges of online psychotherapy

Conclusions

References

Index

Copyright

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Contributors

Vibhav Agrawal     Department of Electrical and Computer Engineering, University of Victoria, BC, Canada

Abdulla Al-Ansari

Urology Department, Hamad Medical Corporation

Weill Cornell Medicine—Qatar

College of Medicine, Qatar University

Department of Surgery, Hamad Medical Corporation, Doha, Qatar

Khalid AlRumaihi

Urology Department, Hamad Medical Corporation

Weill Cornell Medicine—Qatar

College of Medicine, Qatar University, Doha, Qatar

Mohamed Arafa

Urology Department, Hamad Medical Corporation

Weill Cornell Medicine—Qatar, Doha, Qatar

Andrology Department, Cairo University, Cairo, Egypt

Elizabeth Austin     Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

Babatunde Abiodun Balogun

Amrita School for Sustainable Development, Amrita Vishwa Vidyapeetham University, Amritapuri

Amrita School of Business, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India

Anirban Bhowmik     Department of Computer Science, M.U.C. Women's College, Burdwan, India

Hannah Bradwell     Faculty of Health, University of Plymouth, Plymouth, United Kingdom

Zahid Ahmad Butt     School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada

Bappaditya Chowdhury     Department of Psychiatry, AMRI, Salt Lake, Kolkata, India

Robyn Clay-Williams     Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

Leonie Cooper     Faculty of Health, University of Plymouth, Plymouth, United Kingdom

Michael F. Cullinan

School of Engineering, Trinity College Dublin

Akara Robotics, Dublin, Ireland

Gareth H. Davies     School of Management, Swansea University, Swansea, United Kingdom

Avinash De Sousa     Consultant Psychiatrist and Research Associate, Department of Psychiatry, Lokmanya Tilak Municipal General Hospital, Mumbai, India

Joydeep Dey     Department of Computer Science, M.U.C. Women's College, Burdwan, India

Manayath Dhanya     Amrita School of Business, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India

Daniele Doneddu     School of Management, Swansea University, Swansea, United Kingdom

Walid El Ansari

Weill Cornell Medicine—Qatar

College of Medicine, Qatar University

Department of Surgery, Hamad Medical Corporation, Doha, Qatar

Haytham Elmiligi

Department of Electrical and Computer Engineering, University of Victoria, BC

Faculty of Business and Information Technology, OntarioTech University, ON, Canada

Sk. Samim Ferdows     Department of Mathematics, M.U.C. Women's College, Burdwan, India

Florian Fischer     Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany

Fayez Gebali     Department of Electrical and Computer Engineering, University of Victoria, BC, Canada

Magali Goirand     Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, Australia

Lewis Hassell     University of Oklahoma Medical Center, Oklahoma City, OK, United States

Mehdi Hazratifard     Department of Electrical and Computer Engineering, University of Victoria, BC, Canada

Thomas E. Howson     Bevan Commission, School of Management, Swansea University, Swansea, United Kingdom

Thomas James     Life Sciences and Innovation Division, Health and Social Services Group, Welsh Government, Cardiff, United Kingdom

Shubhangi Jangle     Symbiosis Institute of Health Sciences, A Constituent of Symbiosis International (Deemed University), Pune, Maharashtra, India

Ajeya K. Jha     Sikkim Manipal Institute of Technology, Sikkim Manipal University, Majhitar, Sikkim, India

L. Tina Joshi     School of Biomedical Sciences, University of Plymouth, Plymouth, United Kingdom

Naomi S. Joyce     Accelerate Health Technology Centre, Swansea University Medical School, Swansea, United Kingdom

Sunil Karforma     Department of Computer Science, The University of Burdwan, Burdwan, India

Jitendra Kumar     Sikkim Manipal Institute of Technology, Sikkim Manipal University, Majhitar, Sikkim, India

Joe Linogao     School of Engineering, Trinity College Dublin, Dublin, Ireland

Pragya Lodha     Consultant Psychologist and Independent Researcher, Mumbai, India

Mohammad Mamun     National Research Council of Canada, Government of Canada, Ottawa, ON, Canada

Conor McGinn

School of Engineering, Trinity College Dublin

Akara Robotics, Dublin, Ireland

Arka Mitra     Department of Information Technology and Electrical Engineering, ETH Zurich, Zürich, Switzerland

Marco Moreno-Ibarra     Centro de Investigación en Computación, Instituto Politécnico Nacional, CDMX, Mexico

Samrat Kumar Mukherjee     Sikkim Manipal Institute of Technology, Sikkim Manipal University, Majhitar, Sikkim, India

Oznur Ozaltin     Department of Mathematics, Faculty of Science, Ataturk University, Erzurum, Turkey

Carolina Palma-Preciado     Centro de Investigación en Computación, Instituto Politécnico Nacional, CDMX, Mexico

Liron Pantanowitz     University of Michigan Health, Ann Arbor, MI, United States

Fadi Qasem     Urology Department, Hamad Medical Corporation, Doha, Qatar

Timothy Ramseyer     University of Oklahoma Medical Center, Oklahoma City, OK, United States

Marie-Christin Redlich     Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany

Daniel J. Rees     School of Management, Swansea University, Swansea, United Kingdom

Abdiel Reyes-Vera     Centro de Investigación en Computación, Instituto Politécnico Nacional, CDMX, Mexico

Kim Roberts     Department of Microbiology, Trinity College Dublin, Dublin, Ireland

Magdalena Saldana-Perez     Centro de Investigación en Computación, Instituto Politécnico Nacional, CDMX, Mexico

Akila Sarirete     Department of Computer Science, College of Engineering, Effat University, Jeddah, Saudi Arabia

Abhijit Sarkar     Sikkim Manipal Institute of Technology, Sikkim Manipal University, Majhitar, Sikkim, India

Michael Schaller     Bavarian Research Center for Digital Health and Social Care, Kempten University of Applied Sciences, Kempten, Germany

Robert Scott     Akara Robotics, Dublin, Ireland

Grigori Sidorov     Centro de Investigación en Computación, Instituto Politécnico Nacional, CDMX, Mexico

Ankit Singh     Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India

Abdulhamit Subasi

Institute of Biomedicine, Faculty of Medicine, University of Turku, Turku, Finland

Department of Computer Science, College of Engineering, Effat University, Jeddah, Saudi Arabia

Muhammed Enes Subasi     Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey

Joanne Taylor     Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom

P.K. Viswanathan     Amrita School of Business, Amrita Vishwa Vidyapeetham University, Amritapuri, Kerala, India

Ozgur Yeniay     Department of Statistics, Faculty of Science, Hacettepe University, Ankara, Turkey

Rajiv Yeravdekar     Faculty of Medical and Health Sciences, Symbiosis International (Deemed University), Pune, Maharashtra, India

Preface

Introduction

COVID-19 caused a global disruption in national healthcare systems, economies, and societies around the world. Governments need to learn from the responses to the coronavirus pandemic and its socioeconomic impact, reduce or eliminate the social inequalities exacerbated by the pandemic, intensify scientific collaboration in research and innovation (including personalized medicine and data sharing), launch actions for preparedness and response to new health emergencies, invest heavily in healthcare plans and infrastructures and research and innovation in healthcare, and develop digital tools and solutions for healthcare (European Commission, 2022; Ordóñez de Pablos et al., 2022).

In the case of the European Union, Horizon Europe—the European research and innovation framework program for 2021–27—will continue to invest in research and innovation to address health challenges and risks. Some main areas of intervention include health throughout the life course; healthcare systems; and tools, technologies, and digital solutions for health and care (European Commission, 2023a). Some research and innovation areas are preparedness and response, society, economy and behavior, diagnostics, gender equality, treatments, global cooperation, vaccines, equipment and manufacturing, data, regulations and guidelines, medical technologies and tools, and infrastructures and resources (European Commission, 2023b). With the goal of quickly responding to future health crises, the European Commission has launched the European Health and Emergency Preparedness and Response Authority (HERA) (European Commission, 2023c).

The Elsevier book series Information Technologies in Healthcare Industry offers a unique collection of books on innovative and emerging topics focused on the healthcare industry (products, services, processes, etc.) and the aging society. It will shed light on the latest developments in the field of innovation and science in the healthcare industry and the opportunities for the future of digital healthcare. The book series explores the deployment of digital solutions for person-centered integrated care in the health industry, security issues in health data access, ethical and compliant use and sharing of health data, and the power of artificial intelligence to deal with disease outbreaks, among other themes. International leading experts from around the world will contribute to the books in this collection, sharing their valuable knowledge and insights in the field of digital health.

As editor in chief of this book series, I am extremely proud to present the second volume titled Accelerating Strategic Changes for Digital Transformation in the Healthcare Industry. This book will foster international dialogue and cooperation on digital health challenges and digital tools among researchers, research institutions, scientific networks, policymakers, and other relevant stakeholders. New medical technologies and digital tools for the healthcare industry can contribute to human health and the well-being of citizens worldwide, improve the resilience of national healthcare systems, promote inclusiveness, and support the transition toward a green and more resilient economy. Additionally, new advanced digital skills and competencies will be required for the healthcare workforce of the future.

Contents of the book

The book presents a collection of 17 chapters structured in six main sections: Section I, The impact of COVID-19 on the healthcare industry: Challenges and trends; Section II, Digital transformation of healthcare services; Section III, AI and the Internet of Things in the healthcare industry; Section IV, Data sharing for accelerating solutions in the healthcare industry; Section V, Health emergency preparedness and response; and Section VI, Conclusions and implications for the healthcare research agenda and policymakers."

Section I, The impact of COVID-19 on the healthcare industry: Challenges and trends, comprises three chapters. Chapter 1, titled Impact of COVID-19 on healthcare in Qatar: Initiation and operations of the Urgent Consultation Center (UCC) hotline, virtual transformation of healthcare services, and accelerated data sharing solutions—Challenges and opportunities by Khalid AlRumaihi, Walid El Ansari, Mohamed Arafa, Fadi Qasem, and Abdulla Al-Ansari, offers examples of our experience in the healthcare system in Qatar, describing the role telehealth hotline played in transforming healthcare delivery and enabling remote care for thousands of patients during the different phases of the COVID-19 pandemic, including the stay-at-home outpatient care, and initial COVID-19 hospital surge. The rising disease prevalence early during the COVID-19 pandemic in the State of Qatar led to stoppage of all nonemergency healthcare services. To maintain continuity of care and information exchanges for nonemergency patients, a physician-operated telephone hotline was set up that involved triage followed by immediate consultation with a specialized physician.

Chapter 2, titled Challenges, innovation opportunities, and lessons learned from a prolonged organizational crisis: A case exemplar of the National Health Service Wales by Daniele Doneddu, Gareth H. Davies, Thomas James, Thomas E. Howson, Naomi S. Joyce, and Daniel J. Rees, affirms that the COVID-19 pandemic has dramatically impacted the traditional approaches to work. Within the healthcare sector, new and changed ways have created disruptions and challenges; however, opportunities to innovate and disrupt the status quo have also arisen. Our experiences of conducting the independent pan-Wales Welsh Government/NHS Wales COVID-19 Innovation and Transformation Study offer the opportunity to reflect on and evaluate the coronavirus-related challenges within the NHS Wales (NHS-W) and nationally, and how these have been tackled through the multifaceted response and innovation opportunities generated by the health and social care staff of the National Health Service in Wales. Our work has encompassed a multistage design for data collection and analysis, with extensive access to the entirety of the National Health Service in Wales. We also discuss and reflect on the digital transformation of health services and health infrastructure, as well as the many product and process innovation solutions that were devised in the NHS in response to the pandemic.

Chapter 3, titled Accelerating pathology education through virtual learning to address global health needs by Timothy Ramseyer, Liron Pantanowitz, and Lewis Hassell, states that there is a growing deficit of trained pathologists worldwide, which is particularly pronounced in low- and middle-income nations. Large projected demographic and disease trends, coupled with the risk of future infectious disease outbreaks and healthcare disruptions, will only increase the need for more pathologists. The social distancing mandated during the COVID-19 pandemic raised awareness of the potential for remote and virtual learning. Virtual teaching is a burgeoning method to train pathologists using many resources already available on various websites and through a variety of organizations, but these online resources are of varying quality, disorganized, and in some cases too expensive for trainees in resource-poor settings. Awareness of these tools is also still limited. This chapter reviews prior and emerging approaches for addressing pathology workforce and healthcare capacity shortages and discusses the increasing role of digital tools and virtual learning to solve these issues in the setting of the post-COVID-19 pandemic.

Section II, Digital transformation of healthcare services, includes four chapters. Chapter 4, titled Mobile health applications: Variables influencing user's perception and adoption intentions by Shubhangi Jangle, Rajiv Yeravdekar, Ankit Singh, Samrat Kumar Mukherjee, and Ajeya K. Jha, affirms that mobile phone users have increased exponentially in the past decade. Present-day mobile phones can serve several functions with the help of applications, also known as apps. There is limited research on mobile application usage for healthcare delivery and health promotion. This study evaluates the users’ perception of individuals using m-health apps to identify the reasons for using m-health apps, barriers preventing m-health adoption, and the type of rewards provided by application developers to encourage users. Additionally, this study tests the hypothesis model to assess the effects of social media influence, performance expectancy, and price on behavioral intentions to adopt m-health apps.

Chapter 5, titled Balancing patient empowerment and online security considerations from impact of social media promotion of prescription drugs: Physician perception by Samrat Kumar Mukherjee, Abhijit Sarkar, Jitendra Kumar, Ankit Singh, and Ajeya K. Jha, observes that social media promotion (SMP) of prescription drugs has increased dramatically in the past two decades. The impact of this new phenomenon (although it is illegal in most countries) of promotion on patient’s behavior has not been properly researched. This study aims to understand physician’s perception of the impact of SMP on patient’s behavior. The sample size is 389. For analysis, Pearson correlation and regression have been used. It is clear from the study that SMP has an impact on both patient’s negative behavior and the patient-physician relationship. Governments and physicians should be aware that proper guidelines are required to guide patients. Also, patients need to understand that physicians and their expertise are key to their treatment.

Chapter 6, titled Social media health communication: A cursory examination of hospitals in India with Facebook presence during the COVID-19 pandemic by Babatunde Abiodun Balogun, Manayath Dhanya, and P.K. Viswanathan, proposes that social media is fast becoming a gateway for hospitals to engage in and interact with their customers and patients. This provides unprecedented real-time opportunities to improve access to quality and timely health information. This cross-sectional case study examined the adoption of Facebook for health communication during the COVID-19 pandemic. We focused our search on the Facebook activities of hospitals in the city of Raipur, Chhattisgarh, India. Further, we interpreted the generated data under the guidance of the Honeycomb Framework, a theoretical model used to appraise social media communication strategies. We found that 96 hospitals had Facebook accounts but with varying degrees of follower engagement. Hospitals with dedicated COVID-19 care services engaged more with their followers than those that did not have dedicated COVID-19 care services. There was also an observable positive impact on the COVID-19 status of Raipur. We deduced that stakeholders could benefit immensely if hospitals harness the potentials of social media for health communication.

Chapter 7, titled Development and usability testing of an air disinfection robot to reduce air clearance times following aerosol-generating procedures (AGPs) by Conor McGinn, Robert Scott, Joe Linogao, Kim Roberts, Michael F. Cullinan, Hannah Bradwell, Leonie Cooper, Joanne Taylor, and L. Tina Joshi, affirms that the potential for pathogenic respiratory particles, including SARS-CoV-2, to become suspended in the air is elevated during clinical procedures that involve aerosol generation. To mitigate this risk, it is often necessary to leave rooms fallow for prolonged periods to facilitate air replenishment, leading to disrupted workflow and reduced capacity. Building on established mathematical theory, we propose an innovative way to accelerate the rate that contaminants are removed from the air, enabling fallow periods after AGPs to be shortened considerably. We present the development of a novel air disinfecting robot and describe key aspects of an operating procedure that enables more efficient air exchange. We share findings from a case study conducted at a large hospital in the United Kingdom where fallow times were reduced from 27 to 10 min using our approach. A usability survey indicated a high rate of acceptance among users and revealed that staff perceived the device improved the quality of care.

Section III, AI and the Internet of Things in the healthcare industry, comprises five chapters. Chapter 8, titled Trustworthy artificial intelligence in healthcare by Abdulhamit Subasi, Oznur Ozaltin, Arka Mitra, Muhammed Enes Subasi, and Akila Sarirete, states that in addition to several chances to enhance people’s lives and the development of communities, economies, and healthcare, artificial intelligence (AI) similarly presents a number of brand-new social, legal, ethical, and technological issues. Since trust is the cornerstone of communities, economies, healthcare, and sustainable development, trustworthy AI (TAI) is based on the premise that people, organizations, and society can only ever use AI to its full potential if trust can be created in its design, implementation, and application. AI has the potential to significantly enhance the provision of healthcare and other services, which promote the health and welfare of the population. However, there are also potential risks related to utilizing AI in healthcare, which might result in accidental damage.

Chapter 9, titled Artificial intelligence-based brain hemorrhage detection by Oznur Ozaltin, Ozgur Yeniay, and Abdulhamit Subasi, affirms that the classification of brain hemorrhage computed tomography (CT) images provides a better diagnostic implementation for emergency patients. Each brain CT image must be examined attentively by doctors. This situation takes time and sometimes leads to making errors. Hence, we aim to find the best algorithm owing to a requirement for automated brain hemorrhage detection. In this chapter, we utilized artificial intelligence for brain hemorrhage detection by using different machine learning and deep learning architectures. Although pretrained deep learning models achieve reasonable classification results, we utilize them for deep feature extraction by combining them with neighborhood component analysis (NCA) and classical machine learning techniques to achieve better performance. In these models, transfer learning models are utilized to extract features. These features are reduced to significant features with minimum loss by NCA. Eventually, we use different machine learning techniques to classify these significant features. Finally, experimental results reveal that the best-performing framework with a ResNet-18 feature extractor, NCA dimension reduction, and k-NN classifier achieves 96% accuracy with a brain hemorrhage CT dataset.

Chapter 10, titled A systems approach to implementing ethics in a COVID-19 AI application: A qualitative study by Magali Goirand, Elizabeth Austin, and Robyn Clay-Williams, states that during the COVID-19 crisis, a range of artificial intelligence (AI) applications have been developed from case identification to population monitoring. The need to develop and deploy AI solutions rapidly because of the urgency of the situation should not come at the expense of ethical considerations or make them an afterthought. Implementing ethics in medical AI is a complex endeavor calling for a systems approach. Such an approach includes a participatory process involving a diverse group of stakeholders. The process needs to be transparent and inclusive and aims to capture the different worldviews at the inception of AI design and development. Using a fictitious scenario based on an aggregation of real COVID-19 apps, we engaged a diverse group of stakeholders such as clinicians, patients, and AI developers in a consultative process. The app included individual self-monitoring of symptoms, physicians’ remote monitoring of symptoms for COVID-19 patients, and tracking of infection clusters by health agencies.

Chapter 11, titled Automation of depression detection in texts to identify possible cases during COVID-19 pandemic by Magdalena Saldana-Perez, Abdiel Reyes-Vera, Carolina Palma-Preciado, Marco Moreno-Ibarra, and Grigori Sidorov, proposes that the COVID-19 pandemic was more than a medical problem; it also caused social problems such as unemployment, business closure, and delivery services collapse; also, there is a human factor that was seriously damaged, mental health. Since secondary human activities such as work and school were transformed from physical to virtual modalities, people started to present problems related to their emotions and the lack of contact with other people. From one day to the next, human interactions were avoided in trying to preserve people’s health, but for mental health, this was not the case. It was observed that throughout 2020 major depressive disorders as well as anxiety disorders increased due to the combined challenge of changing life routines and the fear of being infected. In this chapter, we analyze the evolution of the research on depression and anxiety done during and after the pandemic. Also, a natural language processing technique is implemented to identify depression in short texts of their daily life written by people, with a view to automate depression detection in such text and to refer possible cases to mental health experts.

Chapter 12, titled Review of using machine learning in secure IoT healthcare by Mehdi Hazratifard, Vibhav Agrawal, Fayez Gebali, Haytham Elmiligi, and Mohammad Mamun, affirms that the healthcare industry is experiencing a digital transformation through telehealth. As a result, users’ information is at risk of being compromised by intruders. Machine learning can provide the sector with reliable protection against potential threats to address security and privacy concerns. In this chapter, we explore possible machine-learning solutions to two security challenges in the telehealth system: continuous authentication and detecting insider attacks. Authentication is the process of confirming the identity of a device or a person before connecting to the system. One of the most effective authentication techniques in telehealth is to verify IoT devices constantly to enhance cybersecurity protection on an ongoing basis.

Section IV, Data sharing for accelerating solutions in the healthcare industry, includes two chapters. Chapter 13, titled Health infrastructure, data sharing, and strategic changes for innovative transformation: Evolution of patient appointment registration call center for urology services in Qatar by Khalid AlRumaihi, Walid El Ansari, and Mohamed Arafa, studies telephone management practices in improving patient access to the urology outpatient department (OPD) at the Hamad Medical Corporation in Qatar. The chapter narrates the evolution of the OPD booking system in three phases. It starts with the initial paper-based booking system (Phase I) and goes on to describe how it was converted to a computer-based call center (Phase II), and then further progressed to a fully coordinated service call center integrating data sharing, information technology (IT), and continuous real-time monitoring (Phase III). The chapter identifies the infrastructure and operations at each phase, information technologies required, and the system deficits and challenges that prompted the evolution to the next phase. It outlines the range of system changes, solutions, and innovative transformations that were proposed, and how they were prioritized, selected, and implemented. The chapter then progresses to compare a range of patient-level and utilization outcomes, as well as the extent of patient satisfaction before and after the changes implemented to convert the urology OPD booking system into a full-fledged state-of-the-art service. Finally, the chapter concludes with a set of implications and recommendations for others who wish to establish similar innovative healthcare projects.

Chapter 14, titled Heterogeneous cardiological data communication in telecardiology with music-key generation scheme by Joydeep Dey, Anirban Bhowmik, Sk. Samim Ferdows, Bappaditya Chowdhury, and Sunil Karforma, affirms that the novel coronavirus had entirely changed the health sector. A parallel wing of telemedicine had blossomed rapidly in this critical phase to treat noninvasive and nonemergency patients. In the field of COVID-19 telehealth, Internet technology and nature-motivated innovations help to transmit the private and confidential information present in multiple cardiological reports. These reports can be sent to different cardiologists for better treatments, opinions, and research purposes. These cardiac reports must be protected against intruders in order to maintain patients’ confidentiality. The cardiac reports should be converted into nonreadable text for the intruders, which is the main objective of this paper. Music-key has been derived through a nature-motivated harmony search metaheuristic algorithm followed by classical AES cryptography. Cardiovascular diseases (CVDs) are one of the cardiac diseases connected to the blockage of arteries and veins in the human body.

Section V, Health emergency preparedness and response includes one chapter. Chapter 15, titled Early warning for emerging infectious disease outbreaks: Digital disease surveillance for public health preparedness and response by Zahid Ahmad Butt, states that emerging infectious diseases such as SARS, Ebola virus, and COVID-19 are a significant threat to health globally. These global epidemics result in increased media consumption by the public for information and expressing their thoughts and ideas through internet search engines and social media. Analyzing people’s internet search behavior regarding health-related information and social media use can guide real-time surveillance and early warning systems for emerging diseases and help in health preparedness and response by public health authorities and hospitals. There have been studies using social media and other digital data for the detection of infectious disease outbreaks. However, there are several methodological challenges with digital disease surveillance, such as confounding, nonrepresentativeness, nonindependence of data, sampling bias, and changes in search algorithms. There is a need for robust research methods to address these challenges and design digital disease surveillance systems that could help in the early response and containment of emerging epidemics.

Finally, Section VI, Conclusions and implications for the healthcare research agenda and policymakers comprises two chapters.Chapter 16, titled Digital health policies and participation for digital transformation in German-speaking countries: A critical approach by Michael Schaller, Marie-Christin Redlich, and Florian Fischer, considers that the COVID-19 pandemic is a disruption at the global level with far-reaching consequences, particularly in social and health contexts. In addition to various serious problems that this crisis brought with it, e.g., shortcomings in national health policies and healthcare systems, it simultaneously unleashed digital potentialities and promises. Although there are several opportunities associated with digital transformation, there are various issues that need to be considered, e.g., the participation of vulnerable groups. On a national level as well as in transnational entities, there are normative frameworks and political strategies that have the potential to contain unleashed forces and to include and consider all population groups. Thus, digital transformation is part of health policy agendas all over the world. Germany, Austria, and Switzerland are no exception to this and aspire to benefit from the positive aspects of digitalization.

The last chapter of the collection, Chapter 17, titled Ethical challenges and dilemmas of online psychotherapy by Pragya Lodha and Avinash De Sousa, states that psychotherapy, as a model of psychological intervention, has undergone several changes with respect to its focus of content to medium of delivery. The digital medium of mental healthcare, which has been widely popularized post the COVID-19 pandemic, has existed since the 1960s. However, the 21st century has brought a renewed perspective to mental health well-being and care. Digital mental healthcare covers various pillars of care including psychotherapy and psychiatric care being delivered through the telephonic medium, digital and web platforms, smartphone applications, robot-assisted care, and artificial intelligence. With the digitalization of mental healthcare, although several new avenues of mental well-being and care have been explored on the one hand, the pressing issues of ethical dilemmas and challenges remain afloat on the other. This chapter highlights these dilemmas and challenges to equip the practitioner of the 21st century in the world of digitalization to practice with care and caution.

Bibliography

European Commission. COVID-19 – Sustaining EU Preparedness and Response: Looking Ahead. Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions. 2022. https://health.ec.europa.eu/system/files/2022-04/covid-19_com_2022_190_en_0.pdf.

European Commission. Health, Research and Innovation.https://research-and-innovation.ec.europa.eu/research-area/health_en. 2023.

European Commission. Coronavirus Research and Innovation.https://research-and-innovation.ec.europa.eu/research-area/health/coronavirus_en. 2023.

European Commission. European Health Emergency Preparedness and Response Authority (HERA): Getting Ready for Future Health Emergencies.https://ec.europa.eu/commission/presscorner/detail/en/ip_21_4672. 2023.

Ordóñez de Pablos P., Chui K.T., Lytras M.D. Digital Innovation for Healthcare in Covid-19 Pandemic: Strategies and Solutions. Elsevier; 2022.

Acknowledgments

I thank Elsevier and especially Rafael Teixeira, Linda Buschman, and Pat Gonzalez for their continuous support and help with the development of the book series and the second volume. Finally, I also thank the authors of all the chapters for their research contributions.

Patricia Ordóñez de Pablos

The University of Oviedo, Spain

Book Series Editor

Section I

The impact of COVID-19 on the healthcare industry: Challenges and trends

Chapter 1: Impact of COVID-19 on healthcare in Qatar: Initiation and operations of the Urgent Consultation Center (UCC) hotline, virtual transformation of healthcare services, and accelerated data sharing solutions—Challenges and opportunities

Khalid AlRumaihia,b,c; Walid El Ansarib,c,d; Mohamed Arafaa,b,e; Fadi Qasema; Abdulla Al-Ansaria,b,c,d    a Urology Department, Hamad Medical Corporation, Doha, Qatar

b Weill Cornell Medicine—Qatar, Doha, Qatar

c College of Medicine, Qatar University, Doha, Qatar

d Department of Surgery, Hamad Medical Corporation, Doha, Qatar

e Andrology Department, Cairo University, Cairo, Egypt

Abstract

The rising disease prevalence early during the COVID-19 pandemic in the State of Qatar led to stoppage of all nonemergency healthcare services. To maintain continuity of care and information exchanges for nonemergency patients, a physician-operated telephone hotline was set up that involved triage followed by immediate consultation with a specialized physician. The Urgent Consultation Center (UCC) was implemented at Hamad Medical Corporation, the public health provider in Qatar. This chapter describes the initiation and operations of UCC as the first hotline manned exclusively by physicians. It depicts a range of issues in terms of patient privacy, the flow of work at UCC from receiving the call to solving the patient's problem, along with quality assurance processes and the documentation of calls. The chapter then moves on to highlight the steps taken to refine the UCC service emphasizing the challenges related to interpretation, document/photo sharing, bringing additional medical specialties and additional staff on board, and dealing with medical store requests. It then proceeds to narrate the contests encountered during issuing prescriptions, repeat prescriptions, referrals to outpatient department, emergency department/pediatric emergency center, and primary healthcare centers, as well as the delivery of medications to patients’ homes. As a virtual service, 150 physicians manned the UCC hotline aimed at urgent nonlife-threatening consultations and triaged inbound patient calls related to 15 medical and surgical specialties averaging about 394 calls/day. The chapter advances to conclude with the resources required, lessons learned, and the coordination spectrum needed to ensure a smooth transition and continuity of care during such or future similar epidemics.

Keywords

COVID-19; Healthcare; Qatar; Hotline; Virtual transformation; Data sharing; Digital

Introduction

Information and communication technologies (ICTs) have great potential to address many of the challenges faced by developed and developing countries in providing accessible, cost-effective, high-quality healthcare services. Telemedicine, a term coined in the 1970s, which literally means healing at a distance (Strehle and Shabde, 2006), signifies the use of ICT to improve patient outcomes by increasing access to care and medical information. Telemedicine uses ICTs to overcome geographical barriers and increase access to healthcare services (WHO, 2010). Some authors distinguish telemedicine from telehealth (TH) with the former restricted to service delivery by physicians only, and the latter signifying services provided by health professionals in general, including nurses, pharmacists, and others (WHO, 2010).

Telemedicine has been evolving over the last two decades with improvements in telecommunication. Telehealth provides a reliable solution, and advancements in telehealth services present clinical resources otherwise typically unavailable to rural communities (Ward et al., 2022). With the advent of the COVID-19 pandemic, its utility and acceptance have drastically increased (Kumar et al., 2022a,b). Globally, the novel coronavirus disease-2019 (COVID-19) pandemic altered the economy, society, and healthcare systems (Wosik et al., 2020). Such a radical change in the manner of practice enabled clinicians across a wide range of settings to quickly adopt virtual care in order to provide critical ongoing mental health support to existing and new patients struggling with the pandemic's impact (Chen et al., 2020). The COVID-19 pandemic has certainly impacted access to healthcare services, and there was higher use of telehealth services as an alternate way of accessing healthcare (Ivancic et al., 2022). Unsurprisingly, TH has become a common care modality spanning all branches of care services (Vimalananda et al., 2022; Ali and El Ansari, 2022a,b; Ali et al., 2022), and the evolution and role of telemedicine and E-health represented in multiple informatics mobile applications have sprinted exponentially (Alkhalifah et al., 2022).

Telemedicine has technologically revolutionized the medical sciences worldwide (Kumar et al., 2022a,b). The increasing focus on digital health technologies in care (Shi et al., 2022) is probably attributed to the notable benefits that include robust clinical care despite social distancing mandates, reduced logistical barriers to care for many patients, and decreased no-show rates. Conducting a teleconsultation is cost-effective and time-saving (Álvarez et al., 2021); good patient satisfaction rates have been reported for teleconsultation (Raad et al., 2021), and the medication adherence rate for telehealth visits was higher than that for inpatient visits (Kim et al., 2022). Interventions using TH to improve chronic disease care, outcomes, and self-management are useful, and monthly TH visits can improve patient outcomes, reduce complications, and enhance the patient-provider relationship (Momin et al., 2022). The need to avoid patient crowds in health services and offer alternative ways for patient assistance, while preserving physical distancing and isolation, as well as the prioritization of emergency departments and intensive care units, have proven to be important drivers for the urgent need and quick adoption of telemedicine (Marcolino et al., 2022). Indeed, telehealth has been a long-awaited advancement with the potential to improve efficiency, convenience, and quality in healthcare (Hull et al., 2022). In addition, telemedicine also reduced missed appointments; these averted missed appointments translated into cost savings (Adepoju et al., 2022). Nevertheless, adopting telemedicine requires an integrated approach, including a combination of technical knowledge, management abilities, soft skills, and communication skills (Isidori et al., 2022).

Aim of the chapter

This chapter provides examples of our experience in the healthcare system in Qatar, describing the role that the telehealth hotline has played in transforming healthcare delivery and enabling remote care for thousands of patients during the different phases of the COVID-19 pandemic, including the stay-at-home outpatient care, and initial COVID-19 hospital surge. The rising disease prevalence early during the COVID-19 pandemic in the State of Qatar led to stoppage of all nonemergency healthcare services. To maintain continuity of care and information exchanges for nonemergency patients, a physician-operated telephone hotline was set up that involved triage followed by immediate consultation with a specialized physician.

Healthcare landscape in Qatar

The Ministry of Public Health (MOPH) is the supreme healthcare authority in Qatar. Hamad Medical Corporation (HMC) is the largest public healthcare provider and oversees 12 public hospitals covering all medical and surgical specialties and subspecialties. The second main part of the public healthcare in Qatar is primary healthcare service under the supervision of the MOPH. There are 27 primary healthcare centers (PHCCs) in Qatar. Other health service providers include military hospitals as well as many private clinics and hospitals. The Urgent Consultation Center (UCC) was implemented at HMC.

We describe the initiation and operations of UCC as the first hotline manned exclusively by physicians. It depicts a range of issues in terms of patient privacy, the flow of work at UCC from receiving the call to solving the patient's problem, along with quality assurance processes and the documentation of calls. The chapter then moves on to highlight the steps taken to refine the UCC service, emphasizing the challenges related to interpretation, document/photo sharing, bringing additional medical specialties and additional staff on board, and dealing with medical store requests. It then proceeds to narrate the contests encountered during issuing prescriptions, repeat prescriptions, referrals to outpatient department, emergency department/pediatric emergency center, and primary healthcare centers, as well as the delivery of medications to patients’ homes. As a virtual service, 150 physicians manned the UCC hotline aimed at urgent nonlife-threatening consultations and triaged inbound patient calls related to 15 medical and surgical specialties averaging about 394 calls/day. The chapter advances to conclude with the resources required, lessons learned, and the coordination spectrum needed to ensure a smooth transition and continuity of care during such or future similar epidemics.

Creation of the urgent consultation center (UCC)

In March 2020, with the declaration of the COVID-19 pandemic in the state of Qatar, the MOPH decided on the stoppage of physical attendance of patients in the outpatient departments across all public and private hospitals with the complete shift to virtual consultation through telehealth to avoid spread of infection among patients as well as medical staff. Also, all elective surgeries were canceled except for oncology surgeries. This step was crucial as a first line for controlling the pandemic and to maintain medical resources to fight the rapidly spreading disease.

The medical administration at HMC recognized the risk of disruption of work in its facilities and anticipated the negative repercussions of such disruption on patients including: (1) failure of patients’ access to medical care in cases complaining of nonemergency conditions that still necessitate some medical attention; (2) failure of reaching a patient via telehealth due to a wrong or unupdated mobile number; (3) failure of refill of medication for chronic disease in case the patient missed his virtual consultation; (4) failure to access medical service in cases where patients missed their OPD appointment. These patients will be left without medical support and will only have access to emergency to solve their problems. Thus, the medical administration in HMC decided to create a healthcare hotline, the Urgent Consultation Center (UCC).

The aim of the UCC service was to: (1) avoid unnecessary visits to hospitals in order to reduce the risk of COVID-19 transmission for healthcare providers and patients; (2) provide safe access to care for patients with urgent nonlife-threatening conditions; and, more importantly, (3) identify high-risk patients who need emergency intervention/s but are afraid to leave their home due to fear of risk of infection. A steering committee was assigned to create the UCC. Due to the short time window to start the project (9 days from the initial instructions to go-live day), condensed meetings and communications were conducted with support services, such as human resources, Communication, I.T. department, and Media department, to launch the project as soon as possible. All hospital facilities were instructed to fully cooperate with the committee to facilitate this task.

Steps involved in the creation of the UCC

Workspace

The steering committee decided to create a dedicated workspace that could accommodate the triage physicians and attending specialist physicians covering most medical and surgical specialties. The decision was made to find a space in an administrative building to be distant from patient areas to avoid staff exposure to infection. Since 80% of administrative staff were mandated to work from home, a perfect location was found suitable for the project in one of the administrative buildings (Barwa towers) and was allocated to the UCC. It consisted of three office spaces present on the same floor, and each office was 100 m².

The workspace was organized in accordance with COVID-19 regulations to decrease any risks of infection among staff, including:

−Each work area was staffed with a maximum of eight persons. Staff were instructed to stick to their own office and avoid intermingling with others from neighboring office areas. This had the benefit of social distancing and distribution of the staff to different offices creating three quarantine bubbles, thus further reducing the mass spread of infection.

−A distance of at least 2 m was maintained between staff at all times. This was done through physical distribution of workstations across the office area.

−Fiberglass sheets were used to separate the desk spaces/work areas to further decrease the droplet spread of infection.

−Thorough cleaning and sanitization of the desk areas and computers, etc. was undertaken before each shift.

−Allocation of personal equipment for each doctor (headphones with speaker) to avoid infection from using each other’s.

−Personal protection equipment (face masks, face shields, and gloves), 90% alcohol hand sanitizers, and hand wash were available in each office area. Staff were encouraged to clean hands before and after using computers and telephones.

−COVID-19 screening (asking about symptoms) and temperature measuring were conducted before entrance into the office area before every shift. Any person suspected of potential infection was prevented from entering the work area until proven negative of infection by PCR test.

Communication and information technology (IT) support

A hotline number was provided by the Ministry of Communications to be used by this newly created service. The hotline was part of a national hotline created for all governmental health services in Qatar.

HMC has an electronic database (Cerner) for the past decade which necessitates access to the HMC intranet to be able to serve patients. The IT department at HMC installed computers with access to the hospitals’ patient electronic medical records database system Cerner. It also connected landline telephones to all the work desks to allow bilateral communication between patients and physicians. Telephones were equipped with a Cisco system, a computer-based call connection and monitoring system to facilitate tracking of phone calls.

Staffing

The steering committee decided on the medical pathway for the UCC service which included triage of incoming calls followed by transfer to the concerned specialty for proper consultation. This necessitated recruitment of the following staff:

Triage physicians: It was decided that triage would be undertaken by physicians to ensure proper triage of patients’ calls in a timely and accurate manner. For this task, 15 physicians were selected, hired, and trained. These were newly graduated physicians who had completed their internship. Training included: (1) communication skills for the proper answering of calls including proper patient identification, identification of the problem, and maintaining a decent and ethical way of communication through using a preset template of communication; (2) technical training on the use of the Cerner system, Cisco system, and other hospital resources; and (3) infection control to avoid spread of infection.

Attending physicians: Each department at HMC was contacted to assign a group of senior physicians (consultants or specialists) to attend to the patients’ calls that would be refereed from the triage physicians. Senior staff were chosen due to their long experience; thus they will be able to accurately assess the urgency of the received calls and serve patients in the most clinically appropriate manner through teleconsultation.

Clerks: six clerks were relocated from OPD to UCC. Each shift, one clerk was assigned to each office area to aid in administrative support for patients including creation of patient encounter or health card.

Nurses: six nurses were relocated from OPD to UCC. Each shift, a nurse was assigned to an office to do COVID screening, assist in translation, and help physicians.

Popularizing the new service: Advertising and promotion

The Communications Department at HMC initiated a wide-ranging campaign across all media outlets (newspapers, television, and radio), as well as different social media platforms, in order to advertise and popularize the new service