20 articles found

A Qualitative Assessment of the Feasibility, Usability, and Clinical Impact of the Keva365 Remote Patient Monitoring Platform for Asthma Management

Original Research

A Qualitative Assessment of the Feasibility, Usability, and Clinical Impact of the Keva365 Remote Patient Monitoring Platform for Asthma Management

30 October 2025

Background Remote Patient Monitoring (RPM) has emerged as a promising approach to managing chronic conditions like asthma, particularly during the COVID-19 pandemic. However, limited research exists on the use of qualitative analysis to capture patient feedback and experiences in RPM programs. This study extends a quantitative observational study that explored the impact of RPM on patients with moderate-to-severe asthma. Objective The aim of this study was to evaluate the feasibility and usability of Keva365, a digital therapeutic platform designed for remote asthma management, and to explore its impact on patient-provider relationships, asthma management, patient compliance, and engagement. Methods A purposeful sample of six patients with moderate-to-severe persistent asthma participated in the study. Over a nine-month period, participants were interviewed once using an open-ended question guide to collect qualitative data. The interviews were recorded, transcribed, and analyzed thematically using NVivo software. Data were used to assess the feasibility of the RPM intervention, its usability, and its impact on patient experiences. Written consent to publish these details has been obtained from all participants that were included in this research. Results Thematic analysis identified key themes related to patients' experiences with the app, their compliance and engagement with the program, their relationships with providers, and asthma management. All participants reported positive experiences with the program, noting the app’s usability, efficiency, and impact on their relationships with healthcare providers. Participants expressed high levels of satisfaction and a willingness to recommend the program to others. Feedback from the interviews contributed to near real-time modifications of the RPM application, enhancing its usability and navigation. Conclusions The study found that integrating patient feedback is essential for improving the usability of RPM platforms. Continuous iterative refinement based on patient experiences can lead to more patient-centered digital health solutions, enhancing both patient compliance and the overall care experience. The findings suggest that RPM programs can effectively support asthma management while fostering positive patient-provider relationships. make a scope statement for Conduct Science journal that focuses on current and latest research that focuses on shaping the future of medicine.

Naomi Rajput

Jyotsna Mehta

Denzil Reid

+1

Humanizing Critical Care: Transforming ICUs Through Empathy and Innovation

Original Research

Humanizing Critical Care: Transforming ICUs Through Empathy and Innovation

2 September 2025

Background: Intensive Care Units (ICUs) in resource-limited settings face persistent challenges, including high infection rates, staffing shortages, and inconsistent patient-family engagement. Standardized ICU audits provide a structured approach to assessing and improving infection control, staff preparedness, and patient-centered care. This study evaluates CritiCore, a structured ICU audit framework innovation piloted and applied longitudinally over three sequential cycles at a single center, designed to drive iterative, evidence-based quality improvements through targeted intervention cycles. Methods: CritiCore was implemented at Evercare Hospital Lahore, Pakistan, across three cycles: baseline audit (November 2024), first re-audit (January 2025), and second re-audit (April 2025). Each cycle included structured observational assessments, infection-surveillance review, and multidisciplinary stakeholder interviews with ~20 ICU professionals (physicians, nurses, infection control specialists, and administrative staff). Findings from each audit informed targeted interventions focusing on real-time infection surveillance, simulation-based staff training, and standardized patient-family engagement strategies (Empatheon). Results: The initial audit revealed elevated hospital-acquired infection rates (≈40–50%), linked to inconsistent hand hygiene and ventilation gaps. Staffing continuity was affected by reliance on locum personnel and limited simulation-based training. Patient-family engagement was inconsistent, with unclear visitation policies and fragmented communication. By the first re-audit, adherence to infection-control protocols improved, simulation training participation increased, and structured family communication and visitation protocols were adopted. By the second re-audit, most improvements were sustained, with additional gains in simulation training coverage, consistency of family engagement, and environmental control measures. Infection control adherence remained markedly higher than baseline, and staffing continuity improvements were maintained. Conclusion: This three-cycle ICU audit from Lahore demonstrates the feasibility and sustained impact of a structured, iterative quality-improvement framework in an LMIC private hospital. The same CritiCore approach was subsequently rolled out at Evercare hospitals in Nigeria (twice) and Kenya (once), supporting adaptability across diverse settings; a formal multi-site analysis is planned. Keywords: critical care transformation; Evercare hospitals; ICU audit; infection surveillance; LMICs; patient-family engagement; quality improvement; staff training; Empatheon.

Asad I Mian

Muhammad Taha Anver

Mahreen Sulaiman

+4

Empathy-Driven Innovation: Human-Centered Design Thinking for Transforming Healthcare Delivery

Original Research

Empathy-Driven Innovation: Human-Centered Design Thinking for Transforming Healthcare Delivery

23 August 2025

Empathy-Driven Innovation: Human-Centered Design Thinking for Transforming Healthcare Delivery Sulaiman M¹, Amran H², Tarar K3, Pervaiz S³, Lalani D³, Shonibare A⁴, Khan I⁵, Mian A 1,5 ¹Innovly, ²Rashid Latif Medical College, ³Evercare Hospital Lahore, ⁴Evercare Hospital Lekki, ⁵Evercare Group, Background/Rationale/Purpose Healthcare systems in LMICs face unique systemic challenges, particularly in high-stakes areas like Emergency Medicine (EM) and Intensive Care Units (ICUs). Resource limitations, fragmented workflows, and communication gaps exacerbate inefficiencies, compromising patient care and operational outcomes. These challenges necessitate innovative approaches tailored to address the specific needs of critical care environments. Human-Centered Design Thinking (HCDT) offers a transformative methodology to tackle such issues by prioritizing empathy, collaboration, and iterative problem-solving. By aligning systemic improvements with the needs of patients, families, and care teams, HCDT can enhance both clinical outcomes and operational efficiency. In this context, HCDT workshops were conducted in 2024 at Evercare hospitals in Lekki, Lagos, Nigeria, and Lahore, Pakistan, focusing on identifying and resolving critical issues in emergency and intensive care management. Objectives The workshops aimed to: 1. Identify critical pain points within emergency and intensive care operations, including specific units such as the Emergency Department, PICU, NICU, MICU, SICU, CCU, and Special Care Units. 2. Co-create actionable solutions through multidisciplinary collaboration among participants from diverse professional backgrounds. 3. Foster a culture of empathy-driven innovation to enhance patient care, team dynamics, and operational efficiency. 4. Empower participants to integrate design thinking principles into their daily workflows, encouraging sustainable and innovative practices. Methodology The workshops employed Stanford d.school’s five-step HCDT framework: Empathy, Problem Definition, Ideation, Prototyping, and Testing (see Fig. 1). Each step was implemented in a structured manner, as listed below briefly. • During the Empathy phase, participants reflected on patient and staff interactions to create detailed empathy maps. • Problem Definition sessions used the PICO framework to dissect identified challenges, encouraging participants to craft "how might we" questions. PICO is a structured problem-dissection tool designed to guide teams in identifying and analyzing challenges by breaking them into four key components: Problem/Population (P) to define the issue and those affected, Ideation (I) to explore why the problem exists and its underlying causes, Context (C) to understand its relevance to local or global settings, and Outcome (O) to define the desired impact, feasibility, and sustainability of potential solutions. • The Ideation phase involved brainstorming sessions using divergent and convergent thinking techniques to generate and refine solutions. • Prototyping activities encouraged participants to create tangible models, such as digital tools or workflow processes. • The Testing phase involved conceptualizing success metrics and feedback loops for real-world application. Figure 1. Evercare Group 2.0 workshops on HCDT as a 5-step process (see text for details). Workshop Structure (Operations and format shown in Table 1 below as an example) • The workshops, conducted at Lekki and Lahore in January and April of 2024, respectively, were between two to two and a half days long. • They were designed to be contextually relevant for LMIC settings, emphasizing low-cost, scalable, and inclusive approaches to foster innovative problem-solving. • Activities included empathy mapping, assumption-storming, PICO-guided problem dissection, and collaborative brainstorming. • Facilitators used a mix of lectures, role-playing, and hands-on problem-solving exercises. • All sessions were led by Evercare-based co-facilitators under the supervision and support of Prof. Dr. Asad Mian (senior author) as team lead. Date Module Details/Activities Facilitator(s) 01/25/24 Introduction Introduction to HCDT: discuss need for complex problem solving; hack process AM 01/25/24 Five steps of design thinking Pre-thinking exercise: Break the ice; Recap HCDT in small groups; choose a specific topic within the theme to be hacked; E.g.: I would like to work on XYZ Assumption-storm: Pen down assumptions on a paper regarding the selected topic AM/team Step I: Empathy Looking through the lens of empathy: Participants will: • Observe: what the learner is doing • Engage: talk to them • Watch: look at them, observe the pattern • Listen: what are they saying • Unpack: Create an empathy map at the end AM/team Step II: Problem Identification and Dissection State the problem: Ask participants to write a problem statement, followed by a brief intro to PICO guidelines for problem dissection. • Create multiple “how might we” questions • Choose one problem and dissect it using the PICO guidelines AM/team 01/26/24 Step III: Ideation Low hanging fruit ideas to moonshots: Process of divergent and convergent thinking; ask participants to: • Through divergent thinking, pen down 15-20 ideas, using “anything goes” approach • through convergent thinking, shortlist the three innovative, yet doable ideas AM/team time permitting Step IV: Prototyping Embrace experimentation Ask participants to: • Think of a prototype and create something too (for their identified solution) • Common examples: Sketch, meeting, tool, activity, google form, plan • Doodle it • Have a hypothesis, the questions they’re trying to answer, pass/fail conditions AM/team time permitting Step V: Testing Testing: Reflect on testing ; think of a testing paradigm for their favorite solution identified AM/team Table 1. Schedule breakdown for the HCDT workshop at Lekki, Lagos, Nigeria. Total time ~ 5 hours over 2 days. • Participants represented diverse professional roles, including clinicians, paramedics, nurses, and administrators, ensuring multidisciplinary collaboration throughout the workshops. • Evaluations were collected from the participants at the end of each workshop. • True to the low-cost and low fidelity nature of HCDT, other than PowerPoint/projection, laptops, Wi-Fi, the requirement was to be non-judgmental and non-hierarchical. • This structured methodology empowered participants to generate actionable, context-specific solutions for critical care challenges. The outcomes of these workshops, including the innovative prototypes and their potential impact, are detailed in the following sections. Results Participant Demographics: A total of 41 participants attended the sessions in Lekki, and 45 in Lahore, with completed evaluations from 23 participants at each site. The majority of respondents were aged 31-40 years (52.2% in Lekki and 56.5% in Lahore), with a slightly higher proportion of males at both locations. Key Findings 1. Lekki (Emergency and Acute Care): o Pain Points: Inefficient referrals, delayed emergency responses, and fragmented communication. o Solutions: Referral coordinators, standardized checklists, and digital tools for communication. o Metrics: Potential to reduce delays and improve patient satisfaction. 2. Lahore (ICU Management): o Pain Points: Delayed triage protocols and lack of empathy in patient care. o Solutions: Empathy training leading to the establishment of Empatheon and revised triage protocols. o Metrics: Improved staff confidence, triage accuracy, and patient satisfaction. Satisfaction Levels Lekki The HCDT workshop in Lekki demonstrated high participant satisfaction, as illustrated in the Educational Value and Logistical Factors graphs in Fig. 2A & B. Most participants rated inspiration (65% giving a score of 5) and knowledge enhancement (57% rating 5) very positively. The practicality of solutions also stood out, with 65% rating it 5. Team diversity and plans for further development were similarly well-rated, with the majority assigning scores of 4 or 5. For logistical factors, the workshop's relaxed and fun atmosphere received overwhelmingly positive ratings (74% scoring 5). However, adequacy of time received slightly more mixed feedback, with 43% rating it 5 and 35% rating it 4. Fig. 2A. Likert score distributions for Education Value for the HCDT workshop at Lekki, Jan 2024. Fig. 2B. Likert score distributions for Logistical Factors for the HCDT workshop at Lekki, Jan 2024. Lahore The HCDT workshop in Lahore also received strong feedback, as seen in the Educational Value and Logistical Factors graphs in Fig. 3A & B. Inspiration and knowledge enhancement were highly rated, with 70% of participants giving a score of 5 for each. Confidence in the practicality of solutions and team diversity were also notable, with the majority assigning ratings of 4 or 5. For logistical factors, while time adequacy received mixed ratings (43% rating 5, 39% rating 4), the relaxed and enjoyable workshop atmosphere was a highlight, with 57% scoring it 5. Fig. 3A. Likert score distributions for Education Value for the HCDT workshop at Lahore, April 2024. Fig. 3B. Likert score distributions for Logistical Factors for the HCDT workshop at Lahore, April 2024. Fig 4. Participant brainstorming sessions, role-playing activities, and empathy-mapping exercises demonstrate the high level of engagement and collaboration throughout the workshops (shown here for Lekki, Nigeria). Post HCDT Incubation: Lekki, Lagos, Nigeria Four teams—DEC-I, ERA, TalkLine, and Communications Hub—developed targeted prototypes addressing key challenges in emergency medicine, including referral inefficiencies, emergency response delays, and communication gaps among interdisciplinary teams (see Table 2). Prototypes ranged from referral pathways and pre-ED care improvements to communication training programs tailored to acute care and paramedic operations. While the teams advanced to the prototyping phase, no real-world testing has been conducted yet. Team/Startup Name Team Composition Empathy/Pain Point/Problem Statement Ideation (Convergent Thinking) Prototyping Stage DEC-I (Referral System Improvement) 11 members (paramedic, nurses, admin, orthopedic technician, etc.) Poor referral system causing delays, miscommunication, staff burnout, and increased morbidity/mortality. Policies/protocols, referral coordinator role, and centralized referral platform. Focus on ED policies; paper-based solutions; metrics like reduced wait times and improved satisfaction. ERA (Emergency Response Enhancement) 9 members (paramedics, intensivist, medical administrator, nurse, etc.) Emergency response delays affecting patients, staff, Evercare reputation, and economic productivity. Training/retraining emergency response team on communication and empathy. Focus on paramedics and pre-ED care; develop training; measure reduced response times and patient feedback. TalkLine (Communication Improvement) 11 members (ED staff, ICU staff, OBGYN, dialysis, business development, etc.) Communication gaps among caregivers and with patients, leading to poor satisfaction and patient experience. Workshops on communication, feedback template use, and conflict resolution. Training on communication practices; conflict resolution; feedback mechanisms integrated into processes. Communications Hub (Communication Improvement) 10 members (physiotherapists, medical officers, admin, interns, radiographers, etc.) Poor interdisciplinary staff communication impacting operations and patient experience. Training on communication ethics, respect, and task documentation. Merge with TalkLine; focus on communication ethics; use feedback mechanisms and reflective practices. Table 2. Lekki, Nigeria: Summary of each team's composition, problem focus, and proposed solutions. Post-HCDT Incubation: Lahore, Pakistan The HCDT workshop in Lahore resulted in the formation of five teams focused on addressing challenges in ICUs and Critical Care Medicine, including staff turnover, communication gaps, and humanizing care. While there were five teams in total, detailed information could only be curated for three teams (see Table 3): Health Heroes, SHAFAA, and Empathy Listeners. These teams developed innovative solutions addressing critical issues such as improving staff well-being, enhancing communication in high-stakes ICU environments, and creating compassionate care models. Their prototypes reflect a commitment to improving outcomes in critical care settings, aligning with Evercare’s mission of patient-centered excellence. Team/Startup Name Team Composition Empathy/Pain Point/Problem Statement Ideation (Convergent Thinking) Prototyping Stage Health Heroes (ICU Staff Turnover Reduction) 5 members (nurses, ICU physicians, admin, patient experience staff) High nurse turnover in a 30-bed ICU, leading to reduced care quality, staff burnout, and recruitment costs. Flexible scheduling, wellness programs, recognition and rewards, and professional development. Tested shift options, wellness events, recognition initiatives, and training programs; feedback loops to refine prototypes. SHAFAA (ICU Communication Improvement) 4 members (ICU nurses, admin, communication specialists) Ineffective communication in ICU impacting treatment timelines, trust, and financial and emotional costs. Setup of counseling rooms, interactive patient education, and communication training for ICU teams. Created counseling rooms, modules for patient/family education, and introduced communication training; focused on measurable patient feedback. Empathy Listeners (Humanization of ICU Care) 6 members (nurses, occupational therapist, ICU admin, patient care team) Dehumanization of ICU environments affecting emotional and psychological well-being of patients, families, and staff. Training on humanization protocols, empowerment of stakeholders, and open communication policies. Implemented competency evaluations, family engagement strategies, and humanization-focused communication; used patient feedback tools to refine. Table 3. Lahore, Pakistan: Summary of three teams’ composition, problem focus, and proposed solutions. Empatheon: Transforming ICU Care A standout result from Lahore was the evolution of the Empathy Listeners initiative into Empatheon, a program dedicated to redefining ICU care through a human-centered and iterative approach (see Table 4). Leveraging PDSA (Plan-Do-Study-Act) cycles, Empatheon systematically tests and refines interventions to address key challenges and ensure sustainable improvements. Area of Focus Key Actions/Initiatives Outcomes/Updates Next Steps Psychological Support -Initiated psychology consults with four sessions conducted. - Addressing burnout and mental health gaps. - Expand access to psychological support services. - Incorporate structured mental health training for staff. Focused Group Sessions - Held three sessions with ICU SMOs, nursing, housekeeping, and pharmacy staff. - Identified issues and co-developed solutions, including: Formalized consultant rounds in HDU; Reinforced security and attendant policies; Enhanced pharmacy-nursing collaboration. - Adjusted timing of educational sessions to better suit nursing staff schedules. - Key systemic issues resolved. - Greater staff engagement and collaboration. - Continue focused group sessions to identify new challenges. - Establish routine follow-ups on implemented solutions. Mid-Intervention Analysis - Assessed communication and employee well-being challenges: - 47% reported handover challenges. - 57% highlighted gaps in burnout support. - 60% indicated a lack of psychological support. - Data-driven insights guiding targeted actions for improvement. - Use insights to prioritize staff training and system-level interventions. - Leverage trends for sustained progress. Communication Training - Introduced training to improve interactions across teams and with patients and families. - Enhanced collaboration and patient-family engagement. - Conduct periodic training refreshers. - Develop scenario-based workshops to strengthen practical skills. Feedback Mechanisms - Established tools to track progress and monitor outcomes. - Focus on reducing complaints and improving satisfaction scores. - Use PDSA cycles to refine feedback tools. - Request a dedicated budget for scaling the initiative. Table 4. Summary of Empatheon’s recent progress and next steps. Empatheon’s impact on the double bottom line Empatheon is redefining ICU care by addressing systemic challenges such as communication gaps, staff well-being, and patient-family dynamics. The program emphasizes the double bottom line, creating both social value through improved care quality, staff morale, and patient-family engagement, and financial impact by reducing inefficiencies, minimizing staff turnover, and fostering operational excellence. Through its iterative approach and focus on continuous improvement, Empatheon serves as a model for human-centered, scalable critical care innovation in resource-constrained environments. Discussion The workshops demonstrated the transformative potential of Human-Centered Design Thinking (HCDT) in addressing systemic challenges in healthcare delivery, particularly in resource-constrained settings. By leveraging empathy-driven insights and practical, low-cost solutions, participants co-created innovative approaches to complex problems in emergency medicine and intensive care. Key Insights 1. Empathy as the Foundation: Empathy mapping uncovered critical systemic challenges, fostering a deeper understanding of the needs of patients, families, and healthcare teams. 2. Collaborative Problem-Solving: The inclusion of diverse, multidisciplinary participants bridged clinical and administrative workflows, enriching the problem-solving process. 3. Scalable Innovation: Solutions such as referral coordinators, communication protocols, and empathy-driven ICU improvements laid the groundwork for broader implementation and system-wide transformation. By emphasizing empathy, collaboration, and resourcefulness, the workshops showcased how practical, adaptive innovation—rooted in Jugaar innovation principles—can be tailored to the unique realities of low- and middle-income countries (LMICs). Conclusion and Next Steps The success of these workshops highlights the potential of HCDT to foster a culture of empathetic and innovative healthcare delivery. By addressing critical pain points with resourceful and scalable solutions, HCDT provides a replicable framework for sustainable transformation in healthcare systems. Strategic Outcomes • Enhanced Quality of Care: Strengthened patient and employee experiences through empathy-driven design. • Innovation and Diversification: Solutions developed during the workshops demonstrate the potential for broader application and adaptation across varying healthcare settings. • Scalability and Adaptability: The methodologies emphasize feasibility in resource-constrained environments while remaining adaptable to diverse healthcare contexts. • Skill Development and Sustainability: Training initiatives and iterative processes create a foundation for continuous improvement and measurable impact. Future Directions 1. Prototype validation: Testing solutions in real-world settings with a focus on measurable outcomes such as patient satisfaction and operational efficiency. 2. Scaling training programs: Expanding HCDT workshops to other regions, tailoring modules to address unique challenges and opportunities. 3. Integrating HCDT into broader frameworks: HCDT’s methodology aligns with broader innovation management frameworks, such as those exemplified by Innovly, which emphasize scalable, context-driven solutions for sustainable transformation in healthcare. HCDT’s structured approach not only fosters empathetic and innovative solutions but also addresses inefficiencies that directly impact hospital operations. By optimizing workflows, reducing communication gaps, and improving staff engagement, HCDT has the potential to enhance operational efficiency, indirectly supporting financial sustainability in healthcare systems. By embedding human-centered design principles into healthcare systems, organizations can create solutions that are empathetic, sustainable, and impactful—setting new benchmarks for innovation and resilience in addressing complex challenges. References 1. Mian, A. I. (2021). #C2i-Create-2-Innovate: Expansion From The Merely Technical To The Metaphorical. In A. I. Mian (Ed.), MEDJACK: The Extraordinary Journey of an Ordinary Hack (Kindle Edition). SEED Pvt Ltd. 2. Dam, R. F. (2023). The 5 Stages in the Design Thinking Process. Interaction Design Foundation. Retrieved from https://www.interaction-design.org 3. Saeed, N., Sulaiman, M., & Mian, A. I. (2023). Human-Centered Design Thinking in the Emergency Department: Channeling the Chaos Together. ACEP Newsroom. 4. Salim, Y. (2024). Healthcare Innovation Powered by AI. The Express Tribune. 5. World Health Organization. (2022). Trauma Care Manual. Geneva: World Health Organization. 6. Kelley, T. (2016). The Art of Innovation: Lessons in Creativity from IDEO. Profile Books. 7. Thiel, P. (2014). From Zero to One: Notes on Startups, or How to Build the Future. Crown Currency.

Mahreen Sulaiman

Hira Amran Chowdhry

Kazim Ali Tarar

+5

From Boarding to Breakthrough: Tailored Interventions for Vulnerable Patients

Original Research

From Boarding to Breakthrough: Tailored Interventions for Vulnerable Patients

22 August 2025

Emergency Department (ED) boarding–prolonged stays in the ED while awaiting inpatient placement–is a crisis exacerbating crowding, increasing costs, and negatively impacting health outcomes. Vulnerable populations, including individuals with low socioeconomic status (SES), medically-complex older adults, and psychiatric patients are disproportionately affected. Yet, solutions tailored to their needs remain underexplored. This discussion examines root causes of boarding and proposes innovative, scalable interventions to mitigate its harms, specifically for marginalized groups. We highlight three strategies: (1) Patient Navigators, who assist low-SES patients navigating healthcare systems, (2) Community Paramedicine, which delivers in-home care to complex patients, and (3) Emergency Psychiatric Assessment, Treatment and Healing (EmPATH) Units, which provide targeted care for psychiatric patients. All three are associated with reduced ED visits. Traditional approaches to boarding have fallen short, particularly for vulnerable populations. Patient navigation, Community Paramedicine, and EmPATH units represent feasible, evidence-based solutions that health systems can implement. Broader adoption of these models can alleviate crowding, enhance care quality, and promote health equity. Future efforts must align these innovations with policy and funding mechanisms to ensure sustainable, system-wide improvements.

Alister Martin

Timothy Scheinert

Amelia Papadimitriou

+1

Innovation Skills Assessment in Healthcare: Benchmarking Capacities in Low-Resource Settings

Original Research

Innovation Skills Assessment in Healthcare: Benchmarking Capacities in Low-Resource Settings

17 August 2025

ABSTRACT Background: Innovation is a key driver of healthcare transformation, particularly in low-resource settings where systemic constraints often hinder service delivery. Assessing innovation capacities among healthcare employees can inform workforce development strategies. This study applies the previously validated Innovation Skills Assessment (ISA) tool to examine workforce innovation potential at a tertiary care hospital in Pakistan, offering insights for targeted capacity-building interventions. Methods: A cross-sectional survey was conducted at Mukhtar A. Sheikh Hospital in Multan, Pakistan, using the ISA tool adapted from the General Innovation Skills Aptitude Test. The survey captured demographic data and assessed innovation skills across four pillars: idea generation, risk-taking, interpersonal relationships, and idea implementation. A total of 250 electronic surveys were distributed via hospital communication channels, with 161 responses (64% response rate). Responses were rated on a 5-point Likert scale, and mean scores with standard deviations were calculated for each pillar. Descriptive statistics were used to explore observable trends across age, gender, education level, and job designation, without formal hypothesis testing. Results: Participants aged 36–45 years had the highest overall mean scores (4.48 ± 0.31), with notable strengths in idea generation (4.48 ± 0.31) and implementation (4.53 ± 0.33). Males showed higher average scores across all pillars, with interpersonal relationships as the strongest domain (4.49 ± 0.42). Participants with intermediate education reported higher mean scores in creativity and risk-taking (4.36 ± 0.45 and 4.20 ± 0.57, respectively). These patterns suggest potential demographic influences on innovation capacities. Conclusion: The ISA tool can be feasibly applied to map innovation skills within healthcare workforces in low-resource contexts. The identified trends may help guide workforce development through tailored training and institutional policies that promote a culture of innovation. Keywords: Innovation Skills Assessment, Healthcare Workforce, Low-Resource Settings, Human-Centered Design, Capacity-Building, Pakistan, Benchmarking, Workforce Innovation

Ahmed Raheem

Hasan N Tahir

Zeeshan Ahsan Allana

+5

Human Drugs & Veterinary Drugs - A Cost Comparison

Original Research

Human Drugs & Veterinary Drugs - A Cost Comparison

16 August 2025

Objective: The aim of this study was to provide an updated comparison of veterinary drug costs with human pharmacy equivalents. Design: A cross-sectional study was conducted by identifying the 50 most common drugs from Medicare Part D spending data, and obtaining the costs of these drugs, in addition to select antidepressants and ophthalmic medications, from human retail (GoodRx, DiRx, and Cost Plus Drugs) and veterinary pharmacy websites (Chewy and Pet Meds). Main outcome measures: Drug costs per tablet were calculated using 30-, 60-, and 90-count quantities. Drug cost data was normalized, and costs were compared via Student’s T-test. Results: 41 drugs were analyzed between human and veterinary pharmacy alternatives. For 90-day supply costs, Cost Plus Drugs provided the cheapest price for 30/41 cases. The lowest normalized drug cost per unit 90-day supply was 0.4406 for Cost Plus Drugs, with DiRx second at 0.5789 (p < .05). For 30-day supply costs, Chewy provided the cheapest price for 30/41 cases. The lowest normalized drug cost per unit for a 30-day supply was 0.4665 for Chewy, with no significant difference to Cost Plus Drugs at 0.5270 (p > .05). Conclusion: These results demonstrate that home-delivery pharmaceutical services offer more affordable options and address the high cost of human medications compared to equivalent veterinary medications. This represents a step forward in identifying solutions to reduce healthcare expenditures and pharmaceutical costs.

Paul Chong

Kevin Shannon

Julian Fine

+2

Leveraging Text-Based Outreach to Improve Enrollment in Federal Benefit Programs and Address Broadband Internet Access

Original Research

Leveraging Text-Based Outreach to Improve Enrollment in Federal Benefit Programs and Address Broadband Internet Access

13 August 2025

Background: Federal benefit programs form the backbone of a social safety-net that provides access to essential services for millions of Americans. However, access to these programs is hampered by complex application processes and administrative barriers. Link Health is a Boston-based nonprofit organization that, through strategic community partnerships, has developed a framework to streamline benefit program enrollment, resulting in the disbursal of over $4 million in benefits. We evaluate the effectiveness of embedding benefits access within existing private messaging frameworks as a strategy for reducing systemic barriers to federal program utilization and improve broadband internet access. Methods: In this prospective observational study of data from June 2024 through December 2024, Link Health conducted a targeted Massachusetts-based text-messaging campaign aimed at enrolling patients from partner community health centers in the Lifeline program, a broadband phone and internet access discount. DaisyChain, a web-based communication platform, enabled Link Health’s multilingual digital navigator team to collect patient responses and conduct follow-ups. Results: The campaign reached 68,529 patients, with 2.15% (n=1,470) engaging with the initial message. Among those who engaged, 41.84% identified as Hispanic, 35.58% as White, 10.61% as Black or African American, and 2.79% as Asian. 62.59% of participants preferred English, 32.31% preferred Spanish, and 5.10% preferred another language. 68.91% of sign-ups were female. Applicants were predominantly working and middle-age adults, with 24.15% of applicants between the ages of 35-44 years and 24.15% between 45-54 years. Patients primarily qualified for Lifeline through SNAP (64.97%), Medicare (37.21%), or Medicaid (41.16%). Conclusion: This study describes the effectiveness and feasibility of text-based initiatives in connecting patients from racially and linguistically diverse communities with the Lifeline benefit program. The campaign successfully and predominantly engaged Hispanic, publicly-insured groups, with an especially high enrollment rate among working and middle-age adults. By integrating digital technology with public health, Link Health’s text-messaging campaign provides a scalable and replicable framework to improve access to federal benefits.

Abhi Jain

Timothy Scheinert

Sammer Marzouk

+3

A Three-Pillar Approach to Benefit Enrollment Reaches Underserved Communities

Original Research

A Three-Pillar Approach to Benefit Enrollment Reaches Underserved Communities

31 July 2025

Background. The Affordable Connectivity Program (ACP), established in 2021, provided eligible low-income households a monthly $30 internet subsidy. Despite its role in reducing digital disparities, only 40% of eligible households enrolled nationally. Link Health (LH), a Boston-based grassroots initiative, implemented a three-pillar (active, passive, and digital) outreach model to increase ACP uptake in Massachusetts and Texas. Methods. From November 2022 to May 2024, LH partnered with community health centers in Boston and Houston to deliver on-site sign-up clinics (active approach), distribute multilingual printed materials (passive approach), and provide personalized text-message support (digital approach). Multilingual volunteers led screening and application filing, with follow-up via a dedicated helpline. Enrollment data were collected across 17 clinics and analyzed descriptively. Results. Of approximately 9,774 individuals screened, 1,086 (11.1%) enrolled in the ACP. Enrollees were predominantly racial/ethnic minorities (78.9%), with 55.4% Hispanic/Latinx and 23.5% Black/African American. 68.4% of enrollees qualified for the ACP through current Medicaid enrollment, and 29.2% qualified through current SNAP enrollment. Digital sign-ups constituted 33.8% of enrollments. LH’s efforts distributed an estimated $390,960 in annual subsidies. Conclusion. LH’s community-driven, three-pillar strategy bridged barriers to ACP enrollment. This model may inform future initiatives aimed at closing the digital divide and advancing health equity through targeted benefit enrollment.

Nicholos P Joseph

Timothy Scheinert

Ashley K Roth

+4

Leveraging Network Analysis for Global Connectivity in Emergency Medicine

Original Research

Leveraging Network Analysis for Global Connectivity in Emergency Medicine

29 July 2025

Introduction: In the field of international emergency medicine (IEM), navigating the vast and often fragmented online resources can be a challenge. This abstract explores how network analysis, a method examining connections within a system, can be applied to improve online accessibility and navigability of these resources. By focusing on the International Federation for Emergency Medicine (IFEM), the study aims to utilize network analysis to understand the current digital landscape of IEM stakeholders and their connections. This will ultimately lead to recommendations for improved information sharing within the IEM community. Methods: We focused our data collection on the IFEM website (www.ifem.cc), a central node connected to global emergency medicine organizations. Using an automated network analysis pipeline, we crawled the IFEM website to three levels deep with the Screaming Frog SEO Spider tool, mapping its structure and extracting pertinent data. The BeautifulSoup library was then used to parse the HTML content, while the Gemini 1.0 Pro language model helped filter and identify relevant information about global emergency medicine organizations. This results were then compared with the official IFEM member list for validation. Finally, Geographical details were pinpointed using the Geopy library and Nominatim tool to convert names and countries into exact coordinates. An interactive global map of these organizations was created with the Folium library, enhancing our understanding of the global emergency medicine network and its interconnections. Results: We identified 4,775 external links, narrowing down to 156 unique base URLs for further content analysis. On the IFEM website, of 55 countries listed, only 41 had accessible links; 10 were non-functional, and 3 were missing. Our automated pipeline pinpointed 41 pertinent multilingual URLs from the available ones, achieving 100% accuracy rate. Our analysis also revealed 28 additional URLs, potentially linked to EM organizations not listed on their member page. Conclusion: By leveraging an automated network analysis pipeline, we gained valuable insights into the digital connections between emergency medicine organizations. This approach not only identified key organizations and their connections but also potentially improved the accessibility and navigation of online information in emergency medicine

Norawit Kijpaisalratana

Abdel badih El Ariss

Jeffrey Yuan

+6

LipidLlama: A Multilingual AI Chatbot for Personalized Cardiovascular Risk Assessment

Original Research

LipidLlama: A Multilingual AI Chatbot for Personalized Cardiovascular Risk Assessment

23 July 2025

Background Cardiovascular disease is the leading cause of death worldwide. Many patients with cardiovascular disease struggle to understand their risk factors and medical test results due to health literacy limitations and/or inadequate resources for personalized education. Existing digital solutions often provide generic, one-size-fits-all information with varying degrees of medical accuracy. Methods LipidLlama addresses this gap by integrating a rule-based AI system—adapted from a validated cardiovascular risk assessment tool—and a chatbot powered by a Large Language Model (LLM) enhanced with retrieval augmented generation (RAG). To improve document retrieval, a custom query-only adapter was trained on synthetic query corpus document pairs. Response quality was independently evaluated by three board-certified physicians (two cardiologists and one internist) who rated 30 responses to synthetically generated, realistic patient queries using a 5-point Likert scale across four dimensions: correctness, conciseness, comprehensiveness, and comprehensibility. Rater reliability was assessed using generalizability theory. Results The trained adapter improved top-k document retrieval accuracy from 67% to 80%. Responses received consistently high clinical ratings across all dimensions (mean composite score = 18.21, 95% CI: 17.80-18.62) and demonstrated strong reliability metrics across raters (generalizability coefficient E⍴² = 0.88; dependability coefficient Φ = 0.84). Conclusion LipidLlama provides clinically grounded, personalized explanations in response to cardiovascular health questions. With further clinical validation, this mobile health application has the potential to enhance health literacy and minimize provider burden, significantly improving access to preventive cardiovascular care, particularly in underserved communities.

Tyler J Smith

Amogh Karnik

Jonathan Hourmozdi

+2

Transforming Emergency Care: Scalable Clinical Audit Innovations for Emerging Markets

Original Research

Transforming Emergency Care: Scalable Clinical Audit Innovations for Emerging Markets

22 July 2025

Resource constraints, staff brain drain, operational inefficiencies, and incidents of workplace violence undermine emergency care outcomes in emerging markets. The Emergency and Trauma Excellence (EmTEx) framework, a structured and human-centered approach, was implemented at Evercare Hospital Lahore to address these systemic challenges. A two-day clinical audit, led by a senior emergency physician, pediatrician, and innovation consultant, evaluated resuscitation readiness, triage efficiency, infection control, staffing adequacy, and staff safety using JCIA-inspired checklists, staff interviews, and facility walkthroughs. Findings revealed insufficient resuscitation spaces, poor separation of pediatric and adult patients, inconsistent triage protocols during peak hours, staffing shortages, and reports of aggression toward healthcare staff during high patient volumes of up to 190 daily. Additional gaps in infection control practices and variability in triage accuracy highlighted operational inefficiencies. Recommendations included tablet-based triage systems for real-time data capture, enhanced isolation zones for infection control, structured staff training programs, and robust safety measures such as de-escalation training and security protocols. Projected outcomes include a 20–30% reduction in patient wait times, improved workflows, and enhanced staff safety and engagement. These findings underscore the scalability of the EmTEx framework, demonstrating its ability to deliver empathy-driven solutions for transforming emergency care in resource-limited settings.

Asad I Mian

Muhammad Taha Anver

Mahreen Sulaiman

+5

Evaluating Pediatric Healthcare Spaces: Evidence-Based Recommendations for Design and Engagement

Original Research

Evaluating Pediatric Healthcare Spaces: Evidence-Based Recommendations for Design and Engagement

22 July 2025

Background Hospital environments significantly impact pediatric patients’ physical and emotional well-being. However, conventional hospital designs often fail to integrate child-friendly engagement strategies, leading to increased anxiety, reduced caregiver satisfaction, and operational inefficiencies. The HackPeds clinical audit, grounded in a continuous quality improvement framework, evaluated pediatric healthcare spaces at Evercare Hospital Lahore to identify systemic gaps and implement targeted interventions over a structured audit cycle. Methods A two-phase clinical audit was conducted at Evercare Hospital Lahore, with an initial assessment in November 2024, followed by a structured re-audit in January 2025, allowing for approximately three months of intervention implementation. The assessment was inspired by Joint Commission International and similar global pediatric care standards while also incorporating human-centered design principles. A checklist-based facility evaluation, structured staff interviews, and real-time benchmarking against best practices were used. The auditor, a pediatrician, emergency medicine consultant, and health innovation expert, assessed spatial utilization, caregiver engagement, and pediatric emergency preparedness, among other factors. Results The initial audit identified underutilized pediatric spaces, lack of interactive play zones, inconsistent emergency preparedness, and inadequate staff training in play therapy. Over the three-month intervention period, structured play areas were introduced, pediatric emergency response protocols were strengthened, and caregiver education initiatives were expanded. The January 2025 re-audit showed improvements in the use of engagement spaces, staff preparedness, and caregiver participation in pediatric care activities, although gaps remained in optimizing space utilization and embedding structured storytelling interventions. Conclusion By embedding continuous quality improvement strategies and structured re-audit cycles, HackPeds provides a scalable framework for pediatric healthcare transformation. The model is positioned for multi-site validation across Evercare Group hospitals in Nigeria and Kenya, with potential for broader adaptation in global pediatric healthcare settings. Future audits will assess longitudinal impact and sustainability to optimize pediatric patient experience, caregiver engagement, and emergency preparedness. Keywords: Pediatric hospital design, clinical audit, quality improvement, human-centered design, play therapy, storytelling in healthcare, pediatric emergency care, caregiver engagement, healthcare innovation, global health scalability.

Asad I Mian

Muhammad Taha Anver

Mahreen Sulaiman

+4

Zalsa: A Contextualized Low-cost and Low-tech Wellness and Well-being Innovation for University Students

Original Research

Zalsa: A Contextualized Low-cost and Low-tech Wellness and Well-being Innovation for University Students

13 June 2025

Introduction: Zalsa, an amalgamation of Zumba and Salsa, represents a dynamic and culturally rich form of physical and psychological activity that has shown promise in building wellness and well-being at the community level. This study explored the effects of Zalsa participation on physical fitness, mental health, and social integration at a comprehensive university in a Low-Middle Income Country (LMIC) setting. Method: Through a mixed-methods, quasi-experimental approach, the Zalsa intervention was performed through open houses at the Aga Khan University Hospital (AKUH) in Karachi, Pakistan. The intervention was open to all AKUH students, spanning July to Sept 2023. Immediately following the intervention, an online Google survey was conducted based on 20 questions in subcategories self-assessing physical/mental health, stress, social interaction, concentration, and work-life balance. Results: Of the 107 participants, the vast majority (80%) were women in their 20s and 30s; 41% were medical students. Likert scores were high across the board, with up to 90% of respondents falling within the moderate to significant satisfaction range. The intervention was associated with high mean aggregate scores for psychological well-being (72%), work-life balance (73%), overall quality of life (80%), and future intention (75%), but lower for physical well-being (67%). The mean % score tended to be significantly higher in the over 35 years age group for all categories tested. Conclusion: Data supports positive influence on burnout mitigation potential, physical, mental, and social wellness and well-being, and personal/professional growth through community building, amongst university students. These findings have implications for incorporating Zalsa-like wellness and well-being programs to build novel core competencies for 21st-century learners in their higher education pursuit.

Syed Waqas

Zeeshan Ahsan

Aisha Pervaiz

+4

HackAway! Innovating Mental Wellness for Students of Higher Education through a Comprehensive Brain-Mind Hackathon

Original Research

HackAway! Innovating Mental Wellness for Students of Higher Education through a Comprehensive Brain-Mind Hackathon

15 May 2025

Background The growing recognition of mental health challenges has prompted the need for appropriate and sustainable technologies to address these issues. Among vulnerable populations, students face unique stressors, making their mental well-being a pressing concern. Recognizing the urgent need to address these issues, we organized 'The Brain and Mind Institute: Student Mental Health Hackathon.' This event aimed to foster innovative solutions and multidisciplinary engagement in the field of student mental health. Methods: The study utilized a quantitative analysis to examine the impact and outcomes of the seventh Hackathon, the "Brain-Mind Hackathon" held at Aga Khan University in Pakistan in October 2021. Participants from diverse backgrounds collaborated to devise innovative solutions for medical education. Data analysis involved descriptive statistics, to assess the hackathon's effectiveness in fostering collaboration and generating practical solutions. Results: In the BMI Hackathon event, 74 participants took part, with a majority being females (62.16%) and falling within the age range of 21 to 30 years (64.86%). Over half were students (70.27%), with 59.4% from healthcare backgrounds. The evaluations provided by hackers were positive overall with a mean score of 4.41 out of 5 on a Likert Scale. Participants' feedback revealed that the hackathon positively impacted empathy towards student mental health issues and provided valuable opportunities for progress and incubation-related activities. Time constraints were noted as a significant challenge. Conclusion: This dynamic Hackathon offered innovative solutions for pressing student mental health challenges, promoting collaboration, and fostering empathy. Despite time constraints, practical ideas emerged, highlighting the importance of interdisciplinary interactions and the need for more incubation time. The event underscores the significance of hackathons in driving positive change in student mental health and paves the way for future research and interventions in this critical area

Ume-e-Aiman Chhipa

Ayesha Memon

Zeeshan Ahsan Allana

+6

Innovating Emergency Medicine: Generative AI, Narrative Medicine, and Human-Centered Design

Original Research

Innovating Emergency Medicine: Generative AI, Narrative Medicine, and Human-Centered Design

26 April 2025

Introduction: Emergency medicine in less resourceful areas struggles with the rising burden of disease and disability. Recognizing the limitations of conventional problem-solving has prompted reevaluating our approach to leverage AI capabilities. This article presents the introduction of a masterclass called ‘Create to Innovate’ (C2i) built using Human Centered Design Thinking. We explore narrative medicine through storytelling as an innovative method of promoting emotional engagement and clinical decision making in emergency medicine. Methods: The 'C2i' masterclasses were held at Aga Khan University Hospital in Karachi, Pakistan in December 2023 and at Evercare Hospital in Lagos, Nigeria in March 2024. This study used an explanatory mixed methods approach, collecting quantitative data from a post-intervention 'MoodBoard' survey and qualitative data from the AI-generated children's stories, with a total sample size of 60 participants. Results: The pilot study included 22 participants from the Karachi cohort and 38 from the Lagos cohort. A five-point validated visual analog scale, the MoodBoard, assessed the impact of the masterclasses. A significant difference was observed in the overall mean score between the two cohorts (Karachi 3.74 vs. Lagos 3.96; p < 0.05, C.I: -0.42 to -0.01). Qualitative analysis revealed three specific themes within the generated stories: prosocial behavior, resourcefulness and health awareness. Conclusion: The masterclass achieved its goal of fostering innovative solutions through storytelling. The MoodBoard survey highlighted its effectiveness and enjoyment. The imaginative stories offered educational insights into healthcare challenges, highlighting their potential for broader applications in healthcare education and professional training, while enhancing problem-solving and emotional engagement.

Syed Waqas

Zunaira Namal

Ahmed Raheem

+1

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

Original Research

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

27 March 2025

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

Reese Joy Fields Green

Timothy Scheinert

Sudarshan Krishnamurthy

+3

Utilization of Structured Data to Improve Visibility of Digital Health Websites

Original Research

Utilization of Structured Data to Improve Visibility of Digital Health Websites

24 February 2025

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

Suhanee Mitragotri

David Chen

Jarone Lee

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

Original Research

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

24 February 2025

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

Reese Green

Max von Franque

Melissa Martinez

+1

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

Original Research

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

22 February 2025

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

Joshua M Faber

Chad Teven

Arturo Francisco Balaguer Townsend

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

Original Research

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

23 December 2024

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

Ian Miers

David Chen

Colin McSwiggen

+8

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