Background: The high demand for health care services and the growing capability of artificial intelligence have led to the development of conversational agents designed to support a variety of health-related activities, including behavior change, treatment support, health monitoring, training, triage, and screening support. Automation of these tasks could free clinicians to focus on more complex work and increase the accessibility to health care services for the public. An overarching assessment of the acceptability, usability, and effectiveness of these agents in health care is needed to collate the evidence so that future development can target areas for improvement and potential for sustainable adoption. Objective: This systematic review aims to assess the effectiveness and usability of conversational agents in health care and identify the elements that users like and dislike to inform future research and development of these agents. Methods: PubMed, Medline (Ovid), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, and the Association for Computing Machinery Digital Library were systematically searched for articles published since 2008 that evaluated unconstrained natural language processing conversational agents used in health care. EndNote (version X9, Clarivate Analytics) reference management software was used for initial screening, and full-text screening was conducted by 1 reviewer. Data were extracted, and the risk of bias was assessed by one reviewer and validated by another. Results: A total of 31 studies were selected and included a variety of conversational agents, including 14 chatbots (2 of which were voice chatbots), 6 embodied conversational agents (3 of which were interactive voice response calls, virtual patients, and speech recognition screening systems), 1 contextual question-answering agent, and 1 voice recognition triage system. Overall, the evidence reported was mostly positive or mixed. Usability and satisfaction performed well (27/30 and 26/31), and positive or mixed effectiveness was found in three-quarters of the studies (23/30). However, there were several limitations of the agents highlighted in specific qualitative feedback. Conclusions: The studies generally reported positive or mixed evidence for the effectiveness, usability, and satisfactoriness of the conversational agents investigated, but qualitative user perceptions were more mixed. The quality of many of the studies was limited, and improved study design and reporting are necessary to more accurately evaluate the usefulness of the agents in health care and identify key areas for improvement. Further research should also analyze the cost-effectiveness, privacy, and security of the agents. International Registered Report Identifier (IRRID): RR2-10.2196/16934

The lack of interoperability in Britain’s medical records systems precludes the realisation of benefits generated by increased spending elsewhere in healthcare. Growing concerns regarding the security of online medical data following breaches, and regarding regulations governing data ownership, mandate strict parameters in the development of efficient methods to administrate medical records. Furthermore, consideration must be placed on the rise of connected devices, which vastly increase the amount of data that can be collected in order to improve a patient’s long-term health outcomes. Increasing numbers of healthcare systems are developing Blockchain-based systems to manage medical data. A Blockchain is a decentralised, continuously growing online ledger of records, validated by members of the network. Traditionally used to manage cryptocurrency records, distributed ledger technology can be applied to various aspects of healthcare. In this manuscript, we focus on how Electronic Medical Records in particular can be managed by Blockchain, and how the introduction of this novel technology can create a more efficient and interoperable infrastructure to manage records that leads to improved healthcare outcomes, while maintaining patient data ownership and without compromising privacy or security of sensitive data.

Background: With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps—their target patient group, health behavior, and behavioral change strategies—has resulted in a large but incohesive body of literature. Objective: This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods: PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results: A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis—37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive—only one app was rated as less helpful and satisfactory than the control—and the studies that measured engagement and usability found relatively high study completion rates (mean 83%; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70%). However, there was little evidence of changed behavior or health outcomes. Conclusions: There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias.

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: The scattered nature of sensitive health information can bring about situations where timely information is unavailable, worsening health outcomes. Furthermore, as patient involvement in healthcare increases, there is a growing need for patients to access and control their data. Blockchain is a secure decentralised online ledger that could be used to manage electronic health records efficiently, and so improve health outcomes by enabling interoperability. Objective: To perform a systematic review to assess the feasibility of blockchain as a method of managing healthcare records efficiently. Methods: Reviewers identified studies via systematic searches of databases including Pubmed, Medline, Scopus, Embase, Proquest and Cochrane Library. Suitability for inclusion of each was assessed independently. Results: Of 71 included studies, the majority discuss potential benefits and limitations without evaluation of their effectiveness, although some systems were tested on live data. Conclusions: Blockchain can efficiently manage access to electronic health records stored on the cloud. Using a blockchain can increase interoperability without compromising privacy and security of data. It contains inherent integrity, and conforms to strict legal regulations. Increased interoperability would be beneficial for health outcomes. While this technology is currently unfamiliar to most, investments into creating a sufficiently user-friendly interface and educating users on how best to take advantage of it would also improve health outcomes. Clinical Trial: International Prospective Register for Systematic Reviews (PROSPERO) number CRD42018096947.

Mental health conditions can have significant negative impacts on wellbeing and healthcare systems. Despite their high prevalence worldwide, there is still insufficient recognition and accessible treatments. Many mobile apps are available to the general population that aim to support mental health needs; however, there is limited evidence of their effectiveness. Mobile apps for mental health are beginning to incorporate artificial intelligence and there is a need for an overview of the state of the literature on these apps. The purpose of this scoping review is to provide an overview of the current research landscape and knowledge gaps regarding the use of artificial intelligence in mobile health apps for mental health. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Population, Intervention, Comparator, Outcome, and Study types (PICOS) frameworks were used to structure the review and the search. PubMed was systematically searched for randomised controlled trials and cohort studies published in English since 2014 that evaluate artificial intelligence- or machine learning-enabled mobile apps for mental health support. Two reviewers collaboratively screened references (MMI and EM), selected studies for inclusion based on the eligibility criteria and extracted the data (MMI and CL), which were synthesised in a descriptive analysis. 1,022 studies were identified in the initial search and 4 were included in the final review. The mobile apps investigated incorporated different artificial intelligence and machine learning techniques for a variety of purposes (risk prediction, classification, and personalisation) and aimed to address a wide range of mental health needs (depression, stress, and suicide risk). The studies’ characteristics also varied in terms of methods, sample size, and study duration. Overall, the studies demonstrated the feasibility of using artificial intelligence to support mental health apps, but the early stages of the research and weaknesses in the study designs highlight the need for more research into artificial intelligence- and machine learning-enabled mental health apps and stronger evidence of their effectiveness. This research is essential and urgent, considering the easy availability of these apps to a large population.