Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Engaging patients in the delivery of healthcare has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement; by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. Objective: The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on healthcare delivery in order to identify factors and best practices for successful implementation of this technology, and areas that require further research. Methods: A systematic search for articles in the PubMed, CINAHL and Embase databases was conducted, using keywords associated with patient engagement, electronic health records and patient portals, and their respective subject headings in each database. Articles for inclusion were evaluated for quality using ‘A MeaSurement Tool to Assess systematic Reviews’ (AMSTAR 2) for systematic review articles and the ‘Quality Assessment Tool for Studies with Diverse Designs’ (QATSDD) for empirical studies. Included studies were categorized by their focus on input factors (e.g., portal design), process factors (e.g., portal usage), and output factors (e.g., benefits), and by the valence of their findings regarding patient portals (i.e., positive, negative, or mixed). Results: The systematic search identified 58 articles for inclusion. The ‘inputs’ category was addressed by 40 articles, while the ‘processes’ and ‘outputs’ categories were addressed by 36 and 46 articles, respectively; 47 articles addressed multiple themes across the three categories and 11 addressed only a single theme. Nineteen articles had high to very high quality, 21 had medium quality and 18 had low to very low quality. Findings in the ‘inputs’ category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement were among portal adoption barriers while information access and communication were facilitators. Several methods were used to train portal users with varying success. In the ‘processes’ category, socio-demographic characteristics and medical conditions of patients were predictors of portal usage; some patients wanted unlimited access to their EMRs, personalized medical education and non-clinical information; and patients were keen to use portals for communicating with their healthcare teams. In the ‘outputs’ category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions inadequate but others useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, patient-provider communication but had no impact on objective health outcomes. Conclusions: While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications and patient-provider communication, etc. High-quality studies are needed to fully understand, improve and evaluate their impact.

Academic integrity is important to universities and students must abide by codes of academic conduct around assessment. Students are, however, subject to multiple pressures around assessment, some of which can push them to cheat. Modern contract cheating websites are the fronts for sophisticated, commercial operations that offer individually written assessment items for a fee; to combat their use we need a better understanding of the tools they use to persuade students to become customers. In this study we examined the persuasive features of 11 highly-visible contract cheating websites and mapped these features to a previously used persuasiveness framework. We find that contract-cheating websites use a variety of credibility, interactive and informative features designed to persuade students to use their services. In addition, the sites offer low-cost, customisable products available in very short timeframes. We suggest ways in which educators can encourage academic integrity by talking with their students about how the websites promulgate their ‘just turn to us’ message.

The highest estimates of the prevalence of commercial contract cheating in Australia come from self-report surveys, which suggest that around 2% of students engage in commercial contract cheating during their higher education studies. However, self-report surveys are limited in that participants under-report socially-undesirable behaviours. In this study, we used an incentivised truth-telling method and surveyed 4098 students from six universities and six independent higher education providers in Australia. We found that 2.46 times more students admitted to commercial contract cheating, via submitting ghost-written assessments, when truth-telling was incentivised (via a Bayesian Truth Serum methodology) rather than when normal self-report survey instructions were used. Using prevalence estimation formulae that are combined with the incentivised truth-telling method, we estimate that 7.9% of students buy and submit assignments from commercial contract cheating services. Additionally, 11.4% outsource assessments via obtaining pre-written work from commercial file-sharing sites. These are substantially higher percentages of commercial contract cheating than self-reports suggest. Furthermore, having a first language other than English was the strongest demographic predictor of Australian students’ engagement in commercial contract cheating. We conclude that commercial contract cheating is a more common problem than suggested by self-report surveys. We argue that academic integrity researchers should consider methods beyond standard self-reports to estimate the prevalence of academic misconduct and that efforts to curb commercial contract cheating must be increased.

COVID-19 caused substantial change in learning and teaching in higher education. In this article we explore how assessment changed in the initial semester of emergency remote teaching in an Australian university. Seventy academics responsible for courses (unit of study), representing a wide array of disciplines, completed an online survey at the end of the semester in June 2020. They answered questions regarding their experiences and actions in shifting their course online from face-to-face delivery at the point of the pivot online. A mixed methods approach identified that most academics did not change the composition and relative weighting of their assessment in response to the pivot. The dominant strategy was to translate existing on-campus assessment into an online format. The research provides insight into disciplinary norms for assessment and, we argue, signals how forms of assessment are valued based on their retention during a time of consequential change in pedagogy. For academics in our study, assessment was an afterthought to the more pressing focus on pedagogical interactions with students. Academic integrity matters were not a factor in their decision-making process during that initial move to remote emergency teaching. Linking assessment with pedagogy, whether online, on-campus and both, matters moving forward.

Background: The digital transformation of health care is advancing rapidly. A well-accepted framework for health care improvement is the Quadruple Aim: improved clinician experience, improved patient experience, improved population health, and reduced health care costs. Hospitals are attempting to improve care by using digital technologies, but the effectiveness of these technologies is often only measured against cost and quality indicators, and less is known about the clinician and patient experience. Objective: This study aims to conduct a systematic review and qualitative evidence synthesis to assess the clinician and patient experience of digital hospitals. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and ENTREQ (Enhancing the Transparency in Reporting the Synthesis of Qualitative Research) guidelines were followed. The PubMed, Embase, Scopus, CINAHL, and PsycINFO databases were searched from January 2010 to June 2022. Studies that explored multidisciplinary clinician or adult inpatient experiences of digital hospitals (with a full electronic medical record) were included. Study quality was assessed using the Mixed Methods Appraisal Tool. Data synthesis was performed narratively for quantitative studies. Qualitative evidence synthesis was performed via (1) automated machine learning text analytics using Leximancer (Leximancer Pty Ltd) and (2) researcher-led inductive synthesis to generate themes. Results: A total of 61 studies (n=39, 64% quantitative; n=15, 25% qualitative; and n=7, 11% mixed methods) were included. Most studies (55/61, 90%) investigated clinician experiences, whereas few (10/61, 16%) investigated patient experiences. The study populations ranged from 8 to 3610 clinicians, 11 to 34,425 patients, and 5 to 2836 hospitals. Quantitative outcomes indicated that clinicians had a positive overall satisfaction (17/24, 71% of the studies) with digital hospitals, and most studies (11/19, 58%) reported a positive sentiment toward usability. Data accessibility was reported positively, whereas adaptation, clinician-patient interaction, and workload burnout were reported negatively. The effects of digital hospitals on patient safety and clinicians’ ability to deliver patient care were mixed. The qualitative evidence synthesis of clinician experience studies (18/61, 30%) generated 7 themes: inefficient digital documentation, inconsistent data quality, disruptions to conventional health care relationships, acceptance, safety versus risk, reliance on hybrid (digital and paper) workflows, and patient data privacy. There was weak evidence of a positive association between digital hospitals and patient satisfaction scores. Conclusions: Clinicians’ experience of digital hospitals appears positive according to high-level indicators (eg, overall satisfaction and data accessibility), but the qualitative evidence synthesis revealed substantive tensions. There is insufficient evidence to draw a definitive conclusion on the patient experience within digital hospitals, but indications appear positive or agnostic. Future research must prioritize equitable investigation and definition of the digital clinician and patient experience to achieve the Quadruple Aim of health care.

In 2019, the Australian higher education regulator, the Tertiary Education Quality and Standards Agency (TEQSA), commissioned a team of academic integrity experts to design and facilitate a series of national workshops, with the aim of increasing academic integrity knowledge and building a culture of integrity across the higher education sector. As a team, we investigated whether these three-hour workshops would make a measurable difference to workshop participants’ awareness of academic integrity issues and their confidence in their own institutions’ practices. Three hundred and forty-two (342) workshop participants (representing 75.7% of attendees) completed pre-workshop and post-workshop surveys regarding their awareness of academic integrity issues and their confidence in their institutions’ academic integrity practices. Results from the post-workshop surveys showed that the participants expressed significantly increased awareness about the Model Statement of Commitment to Academic Integrity, Australian and international academic integrity research, and ways to promote academic integrity. In addition, the participants expressed increased confidence in their institutions’ risk-mitigation strategies and staff members’ ability to detect contract cheating. However, these results were moderated by institution size and institution type (university vs. independent higher education provider). The evaluation data indicates that even a short staff development workshop can make a difference to participants’ understanding and knowledge of academic integrity. We conclude that this type of focused and evidence-based professional development can make an important contribution to the development of a culture of academic integrity across the higher education sector, and can provide participants with avenues for subsequent professional development and institutional policy improvement.