International Journal of Electronic Healthcare (5 papers in press)

Regular Issues

• Did coal mine closure increase deaths of despair in the rural United States?  
  by Adam Mayer 
  Abstract: In the U.S., the coal industry has undergone significant contraction over the last several years as renewables and unconventional oil and gas have been more widely deployed. At the same time, life expectancy has declined for working-age non-Hispanic white Americans, particularly those without a college education and living in rural areasthis decline in life expectancy has been linked to deaths of despair related to alcohol and drug abuse, and suicide. Changes in traditional economic sectors like manufacturing and mining may be a root cause of this surprising rise in mortality. In this analysis, we examine how coal mine closures have impacted deaths of despair from 2002-2015. Results suggest that coal mine closure does not increase mortality due to alcohol, drugs or suicide at the county level, implying that the rise of deaths of despair may be less rooted in changes in the mining sector than previously theorized. More broadly, these results suggest that accounts that point to the poor economic fortunes of rural America as the primary cause of deaths of despair are over-simplified.
  Keywords: mortality; coal; causal inference.
  
  
• Equity and access to care: the role of out-of-pocket spending in OECD countries  
  by Lynn A. Blewett, Jiani Yu, Megan Lahr 
  Abstract: Rising medical out-of-pocket (OOP) spending burdens has increased concerns of equity and fairness in healthcare systems. Limited empirical evidence exists examining the impact of OOP spending on barriers to needed care and the increasing role of private supplemental health insurance. Our study uses pooled panel data on country healthcare expenditures from the Organization for Economic Co-operation and Development (OECD) to assess associations between OOP spending growth and measures of healthcare utilisation. Using both fixed effects and random effects regression models, we found a significant increase of 24.8% in OOP spending as a proportion of household income from 2000-2014. OOP spending was negatively associated with breast cancer screening (p < 0.05) and the percentage of individuals over age 65 immunised against influenza (p < 0.05). As countries continue to pursue healthcare system reforms, policymakers must pay close attention to impacts of OOP spending on goals of equity and cost containment.
  Keywords: health equity; health systems financing; OECD.
  DOI: 10.1504/IJHP.2020.10035971
   
  
• Diabetes medication trials using deep learning techniques  
  by Dalal Nawfal Hamid, Mohammed Chachan Younis 
  Abstract: Efficiently selecting participants for diabetes medication trials is crucial but challenging due to the time-consuming and error-prone manual screening of electronic health records (EHR). This study explores deep learning’s potential in healthcare, particularly in patient selection, aiming to advance precision medicine and enhance diabetes treatment outcomes. The methodology involved evaluating various neural network architectures, including fully connected neural network (FCNN), recurrent neural networks (RNN), deep belief networks (DBNs), and long short-term memory (LSTM), on handling EHR data. Results demonstrate that while LSTM networks excel in modelling extended dependencies in sequential data, FCNN architecture exhibits superior performance across multiple metrics, including area under the curve (AUC), F1 score, precision, recall, and accuracy metrics. assessment using Kappa score reveals a fair level of agreement for FCNN and LSTM architectures, contrasting with poor agreement levels observed with RNN and DBNs. These findings highlight the potential of deep learning methods, particularly FCNN architectures, in revolutionising patient selection processes for diabetes drug trials and advancing precision medicine initiatives.
  Keywords: clinical trials; diabetes medication; deep learning; data analysis; electronic health records; EHR.
  DOI: 10.1504/IJEH.2024.10067173
   
  
• Factors influencing technology-enabled monitoring of patientcare in public healthcare centres in Botswana  
  by Joseph Ephraim Khengere, Indira Padayachee, Prabhakar Rontala Subramaniam 
  Abstract: Patient care delivery in public healthcare centres in the Southern Africa Development Community region is facing enormous pressure due to inadequate institutional arrangements, demonstrating the need for innovative technologies to monitor healthcare delivery. There is limited literature on issues affecting monitoring of healthcare delivery and how this problem could be ameliorated through a technology- based monitoring solution. Accordingly, this article aims to ascertain the factors that influence technology-based healthcare monitoring of patients in public healthcare centres in Botswana. A mixed methods research design was adopted to conduct the study. Questionnaires and semi-structured interviews were used for the identification of factors that influence patient care service delivery. The combined findings revealed significant agreement that Technology Organisation Environment (TOE) factors, namely Available Basic Technology, Connectivity, Available Advanced Technology, Training, Technical Proficiency, Management Support, Vendor Support, Government Regulatory and Financial Support influence technology-based monitoring of patient care delivery in public healthcare centres in Botswana.
  Keywords: technology-based monitoring; patient care; healthcare centres; technology factors; organisational factors; environmental factors; healthcare service delivery; Botswana; technology organisation environment; TOE.
  DOI: 10.1504/IJEH.2024.10068539
   
  
• Privacy concerns of IoT medical applications: an empirical analysis of the current privacy policies under the GDPR  
  by Fatma Alshuhoumi 
  Abstract: Recently, significant privacy concerns have arisen with the integration of IoT in healthcare. Healthcare data is vulnerable to threats in ubiquitous computing, where data is processed across clouds, fogs, and external servers, including unauthorised third-party access, which negatively impacts the acceptance and sustainability of IoT. The study examines whether the privacy policies of 25 US-based IoT medical applications comply with the General Data Protection Regulation (GDPR) by mapping their data collection practices against GDPR principles such as data transparency, purpose limitation, user control, security, and data retention. Results reveal strong compliance in transparency and data collection but notable shortcomings in security measures and data retention practices. Only 56% of the companies explicitly mention GDPR in their policies, suggesting a predominant focus on US legislation. The paper presents three scenarios illustrating varied GDPR compliance, emphasising the necessity of enhancing alignment with GDPR to ensure sufficient protection of EU residents’ personal data.
  Keywords: data privacy; IoT; personal information; General Data Protection Regulation; GDPR.
  DOI: 10.1504/IJEH.2025.10071654