Health Information Technology Commons^™

Bio-Cybersecurity: Securing The Healthcare Industry, Amanda D. Coleman

Cybersecurity Undergraduate Research Showcase

Bio-cybersecurity refers to the aspect of cybersecurity that applies to the biological sciences and the protection of digital biomedical information. Today’s healthcare industry has evolved with the enhancement of internet and biomedical technology. While hospitals and private medical providers remain compliant with the Health Information Portability and Accountability Act (HIPAA) through traditional means of securing documented patient information, the emergence of beneficial internet-based healthcare services like virtual appointments and digital patient records requires new policies and healthcare cybersecurity frameworks to protect sensitive information from unauthorized access. This paper examines the role of cybersecurity in healthcare, the vulnerabilities that exist and …

Exploring The Relationship Between Behavioral Health Early Prediction Model And Patient Outcomes In The Emergency Department, Karen M. Richendollar, Kathie M. Zimbro

Knowledge and Creativity Expo

Problem: Emergency departments (EDs) are increasingly utilized for mental health (MH) care, often resulting in overcrowding and delayed access to specialized services. A significant proportion of MH patients are discharged without a psychiatric consult, raising concerns about safety and readmission rates. This trend places additional strain on already limited behavioral health resources and contributes to care delays for patients in acute crisis. Moreover, the lack of standardized discharge criteria for MH patients increases variability in care and may compromise patient outcomes. Purpose: This study evaluates the effectiveness of the Behavioral Health Early Discharge Prediction Model (BHEDPM) in identifying MH patients …

Call To Action: A Telebehavioral Health Framework For Counselor Development, Brittany G. Suggs, Brittany J. Bice-Urbach, Marlene M. Maheu, Kenneth P. Drude, Donna Ford, Jocelyn Novella, Bradford Felker, Donald M. Hilty

Counseling & Human Services Faculty Publications

The widespread implementation of telebehavioral health (TBH) services, accelerated by the COVID-19 pandemic, created an urgent need for standardized competencies in counselor education. Many practitioners report minimal formal training, leading to significant variability in competence and a concerning gap between their confidence and actual preparedness. This article issues a call to action for counseling programs to adopt the interprofessional TBH competency framework from the Coalition for Technology in Behavioral Science (CTiBS). This structured, evidence-based roadmap outlines knowledge and skills for competent, ethical TBH practice across seven domains and three progressive levels: novice, proficient, and authority. Adopting this framework will enhance …

Adjunctive Technologies To Electronic Fetal Monitoring: Promise, Pitfalls, And Lessons Learned, Rebecca Horgan, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Despite widespread use, electronic fetal monitoring (EFM) has not demonstrably reduced perinatal morbidity or mortality, and likely contributed to the rise in cesarean delivery. To improve its utility, a number of adjunctive approaches have been introduced over the past three decades, including fetal pulse oximetry, ST segment analysis (STAN), and maternal oxygen supplementation. Each intervention was supported by strong physiologic rationale, yet none achieved widespread clinical adoption due to inconsistent evidence of benefit and, in some cases, potential harm. This review critically evaluates landmark studies on EFM adjuncts, highlights the limitations that have impeded progress, and outlines emerging innovations, including …

Integrating Telehealth Into Advanced Health Assessment: A Bimodal Approach, Heather M. Jones, Tracy Alam, Beth A. Ammerman, John Jardine, Carolyn Rutledge

Ellmer School of Nursing Faculty Publications

The expansion of telehealth emphasizes the need for advanced practice registered nurses (APRNs) to develop competencies in telehealth technology and techniques. Limitations in physical assessments and the lack of comprehensive telehealth curricula in APRN programs have been identified as barriers to students' preparedness and confidence in performing telehealth assessments in clinical practice. This project evaluated integrating telehealth content into an advanced health assessment course with both in-person and online laboratories. Presurveys and postsurveys showed increased student confidence and competency in telehealth skills across both modalities. These findings support incorporating standardized telehealth education into APRN curricula to enhance telehealth clinical readiness.

Acceptability, Usability, And Clinical Integration Of A Clinic-Based Digital Game For Hpv Education: Qualitative Perspectives From Adolescents, Parents, And Healthcare Providers, Elizabeth Reifsnider, Satya Subedi, Nouran Ghonaim, Megan Whaley, Angela Chia-Chen Chen

Ellmer School of Nursing Faculty Publications

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and …

Mobile Health Intervention Tools Promoting Hiv Pre-Exposure Prophylaxis Among Adolescent Girls And Young Women In Sub-Saharan Africa: Scoping Review, Alex Emilio Fischer, Homaira Hanif, Jacob B. Stocks, Aimee E. Rochelle, Karen Dominguez, Eliana Gabriela Armora Langoni, H. Luz Mcnaughton Reyes, Gustavo F. Doncel, Kathryn E. Muessig

Department of Obstetrics & Gynecology Faculty Publications

Background:

In 2022, 3100 adolescent girls and young women in sub-Saharan Africa experienced new HIV infections each week. HIV pre-exposure prophylaxis (PrEP) is effective at preventing HIV but has limited uptake and persistence. Mobile health (mHealth) interventions can improve medication adherence; however, their utility to improve PrEP adherence among adolescent girls and young women is not well established.

Objective:

This scoping review synthesizes evidence supporting mHealth for PrEP among adolescent girls and young women in sub-Saharan Africa and identifies strategies for further evaluation.

Methods:

We searched PubMed and Google Scholar databases, expert referrals, and reference lists using the following eligibility …

Predicting Mental Health Disparities Using Machine Learning For African Americans In Southeastern Virginia, Ismail El Moudden, Michael C. Bittner, Matvey V. Karpov, Isaac O. Osunmakinde, Akosua Acheamponmaa, Breshell J. Nevels, Mamadou T. Mbaye, Tonya L. Fields, Karthiga Jordan, Messaoud Bahoura

Department of Obstetrics & Gynecology Faculty Publications

This study examined mental health disparities among African Americans using AI and machine learning for outcome prediction. Analyzing data from African American adults (18–85) in Southeastern Virginia (2016–2020), we found Mood Affective Disorders were most prevalent (41.66%), followed by Schizophrenia Spectrum and Other Psychotic Disorders. Females predominantly experienced mood disorders, with patient ages typically ranging from late thirties to mid-forties. Medicare coverage was notably high among schizophrenia patients, while emergency admissions and comorbidities significantly impacted total healthcare charges. Machine learning models, including gradient boosting, random forest, neural networks, logistic regression, and Naive Bayes, were validated through 100 repeated 5-fold cross-validations. …

A Spine-Specific Lexicon For The Sentiment Analysis Of Interviews With Adult Spinal Deformity Patients Correlate With Sf-36, Sf-36, And Odi Scores: A Pilot Study Of 25 Patients, Ross Gore, Michael M. Safaee, Christopher J. Lynch, Christopher P. Ames

VMASC Publications

Classic health-related quality of life (HRQOL) metrics are cumbersome, time-intensive, and subject to biases based on the patient’s native language, educational level, and cultural values. Natural language processing (NLP) converts text into quantitative metrics. Sentiment analysis enables subject matter experts to construct domain-specific lexicons that assign a value of either negative (−1) or positive (1) to certain words. The growth of telehealth provides opportunities to apply sentiment analysis to transcripts of adult spinal deformity patients’ visits to derive a novel and less biased HRQOL metric. In this study, we demonstrate the feasibility of constructing a spine-specific lexicon for sentiment analysis …

Athletic Training Students' Use Of Health Information Technology Professional Behaviors During Clinical Experiences: A Report From The Aate Research Network, Cailee E. Welch Bacon, Julie M. Cavallario, Stacy E. Walker, R. Curtis Bay, Bonnie L. Van Lunen

Rehabilitation Sciences Faculty Publications

Context:

As an essential core competency for high-quality healthcare, health information technology (HIT) leverages the use of technology, such as electronic record systems, to collect and use patient care information to make informed clinical decisions. There is a dearth of information regarding professional athletic training students' (ATSs') use of HIT professional behaviors during clinical experiences.

Objective:

To assess HIT professional behaviors ATSs engage with during clinical experience patient encounters (PEs). DESIGN: Multisite panel design.

Setting:

12 professional athletic training programs.

Participants:

363 ATSs enrolled across the participating professional athletic training programs entered patient encounter information within E*Value during their scheduled …

A Bibliometric Analysis Of Ai-Driven Healthcare Literature Containing Kos Keywords: Trends, Themes, And Gaps, Julaine Clunis, Eric Asare

STEMPS Faculty Publications

As artificial intelligence (AI) becomes increasingly embedded in healthcare applications, concerns have emerged around the trustworthiness, interpretability, and context-awareness of these systems. Knowledge Organization Systems (KOS) hold considerable potential to address these challenges by supporting semantic standardization, explainability, and domain alignment. This study presents a bibliometric analysis of scholarly publications referencing both AI and healthcare concepts to examine how KOS are positioned within this evolving discourse. The findings indicate that while early literature frequently and explicitly referenced KOS—such as ontologies, controlled vocabularies, and classification systems—their visibility has declined relative to newer paradigms such as machine learning and large language models. …

A Governance-Centric Framework For Strengthening Healthcare Cybersecurity: A Systems Perspective, Sujatha Alla, Sai Gireesh Komaragiri, Teresa Duvall, Satluk Karahan, Nagesh Bheesetty, Vijay Kumar Chattu

Engineering Management & Systems Engineering Faculty Publications

Healthcare systems face unprecedented security and privacy challenges due to increasing digitization and interconnectedness. This paper provides a comprehensive analysis of these challenges by examining various cyberattacks, defensive mechanisms, and governance frameworks within modern healthcare infrastructure. The research systematically categorizes prevalent security threats, such as ransomware, insider threats, and data breaches, identifying vulnerabilities specific to healthcare systems. Furthermore, the study evaluates current defensive strategies, including encryption techniques, access control systems, and intrusion detection tools, assessing their effectiveness against complex cyber threats. A key focus is placed on governance structures and their role in cybersecurity resilience. The research explores how regulatory …

A Qualitative Analysis Of College Students' Interest In Mhealth Solutions, Leslie Hoglund, Craig M. Becker, Cara Tonn

Health Behavior, Policy & Management Faculty Publications

This study explores college students' perceptions of an AI-driven mHealth application designed to promote well-being. With rising mental health challenges in academic settings, students increasingly seek digital tools that provide holistic support for physical, mental, and financial health. Through focus groups, this qualitative study examines students' preferences for personalized health tracking, educational content, and flexible reminders within a private, supportive community. Key findings emphasize students' desire for a balanced, all-in-one app that integrates health and wellness tools without overwhelming them with notifications. Students also highlighted the importance of social media integration for outreach, though concerns were raised about potential stress …

The Reliability Gap: How Traditional Search Engines Outperform Artificial Intelligence (Ai) Chatbots In Rosacea Public Health Information Quality, Houston C. Nelson, Morgan T. Beauchamp, April A. Pace

Department of Medicine Faculty Publications

Background: The internet has become a primary source of health information for the public, with important implications for patient decision-making and public health outcomes. However, the quality and readability of this content vary widely. With the rise of generative artificial intelligence (AI) tools such as ChatGPT and Gemini, new challenges and opportunities have emerged in how patients access and interpret medical information.

Objective: To evaluate and compare the quality, credibility, and readability of consumer health information provided by traditional search engines (Google, Bing) and generative AI platforms (ChatGPT, Gemini) using three validated instruments: DISCERN, JAMA Benchmark Criteria, and Flesch-Kincaid Readability …

Personalized Prediction Of Tumor Recurrence With Image-Guided Physics-Informed Computational Model In High-Grade Gliomas, Walia Farzana, Khan M. Iftekharuddin

Electrical & Computer Engineering Faculty Publications

High grade gliomas are infiltrating tumors characterized by their diffusive invasion and proliferative growth. Across and within patients heterogeneity of tumors makes it challenging to determine tumor spatial extent after surgical resection. Traditionally, tumor growth predictions after surgical resections rely on generalized models and population-based observations, which do not account for individual patient differences. To address this gap, we propose a personalized approach with image-guided computational model (digital twin) that incorporates physics-based modeling to predict tumor recurrence. Our digital twin involves an inverse modeling step, followed by a recurrence model that accounts for varying surgical effects. The physics-guided inverse model …

Development Of A Personalized Conversational Health Agent To Enhance Physical Activity For Blind And Low-Vision Individuals, Soyoung Choi, Jooyoung Seo, Ashwath Krishnan, Sanchita Kamath, Justin Haegele

Human Movement Studies & Special Education Faculty Publications

Background: With the advancements in mobile health (mHealth) technologies, sighted individuals can benefit from mobile apps and wearable devices to more easily manage their physical activity (PA) and wellness data through intuitive touch gestures and effective data visualizations. However, for blind and low-vision (BLV) individuals, these conventional interaction methods are often challenging, not only limiting their ability to use these technologies but also potentially diminishing their motivation to adopt them to support health-promoting behaviors. We aimed to develop a health monitoring application called Personalized and Conversational Health Agent (PCHA) that supports BLV individuals with self-monitoring and management of their PA …

Patient Perceptions Of Audio-Only Versus Video Telehealth Visits: A Qualitative Study Among Patients In An Academic Medical Center Setting, Ryan Kruis, Elizabeth A. Brown, Jada Johnson, Kit N. Simpson, James Mcelligott, Jillian Harvey

Community & Environmental Health Faculty Publications

Introduction: Telehealth utilization surged during the COVID-19 pandemic, offering expanded health care access. Audio-only visits emerged as a crucial tool for patients facing technology or connectivity barriers to still use telehealth. This qualitative study aims to better understand patient perceptions of audio-only versus video telehealth visits during the COVID-19 pandemic, and how patients perceive the role of each in their overall health care. Methods: Semi-structured interviews were conducted with 14 adult patients seeking care at an academic medical center located in the Southeast region of the United States. Patients had experienced both an audio-only and video telehealth visit within the …

Data Driven Trade-Off Analysis For Cybersecurity, Goskel Kucukkaya, Murat Ozer, Murat Balci, Emrah Ugurlu

Engineering Management & Systems Engineering Faculty Publications

Trade-off analysis, a specialization of systems engineering, addresses design criteria like security, cost, performance, and compliance. Monte Carlo simulations are commonly employed to generate impact scenarios for trade-off analysis combined with solution alternatives that accommodate industry-specific considerations and uncertainties. In the cyber domain, this paper proposes a methodology for data-driven trade-off analysis in cybersecurity, leveraging industry reports as primary data sources using confidentiality, integrity, and availability as trade-off analysis objectives. Distribution functions are derived to manage and model uncertainties for various industries. The approach given in this study aims to facilitate informed choices and to enhance cybersecurity decision making and …

Political Prioritization For Digital Health And Health Equity Through Global Health Diplomacy, Vijay Kumar Chattu, Sujatha Alla, Bawa Singh

Engineering Management & Systems Engineering Faculty Publications

[Introduction] We have found the article "Digital health and health equity: How digital health can address healthcare disparities and improve access to quality care in Africa" published in the recent issue to be very relevant and interesting.¹ Qoseem et al have highlighted that there is a great need for continuous advocacy for strengthening the health systems through telehealth promotion and increasing access to healthcare services to achieve health equity.

Assessment Of Interest In A Virtual Avatar-Based Nutrition Education Program Among Youth-Serving Community Partners, Basheerah Enahora, Gina L. Tripicchio, Regis Kopper, Omari L. Dyson, Jeffrey Labban, Lenka H. Shriver, Lauren A. Haldeman, Christopher K. Rhea, Jared T. Mcguirt

Rehabilitation Sciences Faculty Publications

Objective

Examine the appeal of a virtual avatar-led nutrition education program among youth-serving community partners in North Carolina.

Methods

We surveyed community partners using the Diffusion of Innovation Theory constructs of relative advantage, compatibility, and complexity. Logistic regression evaluated the appeal and likelihood of the program's future use.

Results

Community partners (n = 100) agreed that the program was an innovative (87%) and convenient (85%) way for youth and parents to learn about nutrition. Partners who perceived the program as a relative advantage to current programs had significantly higher odds of future use intention (P = 0.005). Those who found …

Designing A Blockchain-Empowered Telehealth Artifact For Decentralized Identity Management And Trustworthy Communication: Interdisciplinary Approach, Xueping Liang, Nabid Alam, Tahmina Sultana, Eranga Bandara, Sachin Shetty

VMASC Publications

Background: Telehealth played a critical role during the COVID-19 pandemic and continues to function as an essential component of health care. Existing platforms cannot ensure privacy and prevent cyberattacks.

Objective: The main objectives of this study are to understand existing cybersecurity issues in identity management and trustworthy communication processes in telehealth platforms and to design a software architecture integrated with blockchain to improve security and trustworthiness with acceptable performance.

Methods: We improved personal information security in existing telehealth platforms by adopting an innovative interdisciplinary approach combining design science, social science, and computer science in the health care domain, with prototype …

Diagnostic Certainty During In-Person And Telehealth Autism Evaluations, Natasha N. Ludwig, Calliope Holingue, Ji Su Hong, Luther G. Kalb, Danika Pfeiffer, Rachel Reetzke, Deepa Menon

Speech-Language Pathology Faculty Publications

Background

Many diagnostic evaluations abruptly shifted to telehealth during the COVID-19 pandemic; however, little is known about the impact on diagnosis patterns for children evaluated for autism spectrum disorder (ASD). The purpose of this clinical research study was to examine (1) the frequency of diagnoses evaluated beyond ASD; (2) the frequency of diagnoses made, including ASD; and (3) clinician diagnostic certainty for all diagnoses evaluated for children who received an evaluation due to primary concerns about ASD via telehealth during the pandemic compared to those evaluated in person before the pandemic at an ASD specialty clinic.

Methods

The sample included …

Infusing Machine Learning And Computational Linguistics Into Clinical Notes, Funke V. Alabi, Onyeka Omose, Omotomilola Jegede

Mathematics & Statistics Faculty Publications

Entering free-form text notes into Electronic Health Records (EHR) systems takes a lot of time from clinicians. A large portion of this paper work is viewed as a burden, which cuts into the amount of time doctors spend with patients and increases the risk of burnout. We will see how machine learning and computational linguistics can be infused in the processing of taking clinical notes. We are presenting a new language modeling task that predicts the content of notes conditioned on historical data from a patient's medical record, such as patient demographics, lab results, medications, and previous notes, with the …

Telehealth In Emergency Medicine Residency Training: A Model Curriculum, Laura Oh, Rahul Bhat, Michael J. Carr, Aditi U. Joshi, Bruce M. Lo, Ashley C. Rider, Lulu Wang, Michael C. Wadman, Samuel D. Luber

Department of Emergency Medicine Faculty Publications

Emergency physicians are well-positioned to take a leadership role in telehealth, particularly in emerging categories such as triage, direct acute unscheduled care, and virtual observation. However, the growth of telehealth has outpaced curricular development in emergency medicine (EM) residency programs. This manuscript presents a model longitudinal telehealth curriculum, developed by the consensus of education experts, including representatives from the telehealth interest groups from EM's two primary specialty societies: the American College of Emergency Physicians and the Society for Academic Emergency Medicine. The curriculum describes overarching goals and components that may serve as a foundation for individual institutions seeking to train …

Expanding A Behavioral View On Digital Health Access: Drivers And Strategies To Promote Equity, Maura M. Kepper, Lauren A. Fowler, Isabelle S. Kusters, Jean W. Davis, Manal Baqer, Sarah Sagui-Henson, Yunyu Xiao, Adati Tarfa, Jean C. Yi, Bryan Gibson, Kristin E. Heron, Nicole M. Alberts, Marissa Burgermaster, Veronica Njie-Carr, Lisa M. Klesges

Psychology Faculty Publications

The potential and threat of digital tools to achieve health equity has been highlighted for over a decade, but the success of achieving equitable access to health technologies remains challenging. Our paper addresses renewed concerns regarding equity in digital health access that were deepened during the COVID-19 pandemic. Our viewpoint is that (1) digital health tools have the potential to improve health equity if equitable access is achieved, and (2) improving access and equity in digital health can be strengthened by considering behavioral science-based strategies embedded in all phases of tool development. Using behavioral, equity, and access frameworks allowed for …

Athletic Trainer's Perceptions Of And Experiences With Professional Development Approaches For Enhancing Clinical Documentation, Sarah L. Nottingham, Tricia M. Kasamatsu, Julie M. Cavallario, Cailee E. Welch Bacon

Rehabilitation Sciences Faculty Publications

Context

Little is known about how athletic trainers (ATs) learn clinical documentation, but previous studies have identified that ATs have a need for more educational resources specific to documentation.

Objective

To obtain ATs' perspectives on learning clinical documentation.

Design

Qualitative study.

Setting

Web-based audio interviews.

Patients or Other Participants

Twenty-nine ATs who completed 2 different continuing education (CE) clinical documentation modules. Participants averaged 36.2 ± 9.0 years of age and included 16 women and 13 men representing 21 US states and 8 clinical practice settings.

Data Collection and Analysis

Participants were recruited from a group of ATs who completed 1 …

The Impacts Of Role Overload And Role Conflict On Physicians' Technology Adoption, Eun Hee Park, Ghiyoung P. Im, Jing Zhang, Young Hwan Lee, Kyung Hee Chun, Young Soon Park

Information Technology & Decision Sciences Faculty Publications

Technology adoption is an important solution for physicians to increase work efficiency, and thus deal with role conflict among their multiple job roles. Prior studies have not investigated how multiple job roles and role conflict influence physicians’ technology adoption intentions. Based on role strain theory and role identity theory, we present a model of physicians’ technology adoption intentions to support their primary (clinical care) versus secondary (teaching or research) job roles. We test the model using surveys with 156 physicians at nine medical schools in Korea. The results of our data analysis largely support our hypotheses. Role overload in each …

Counselors' Perceptions Of Their Preparedness For Telemental Health Services: A Phenomenological Examination, Daniel C. Holland, Jeffry L. Moe, Alan M. "Woody" Schwitzer, Shana Pribesh, Jeanel Franklin

Counseling & Human Services Faculty Publications

Background: To examine counselors' perceptions of their formal preparation for engaging in telemental health (TMH) counseling with the intent of gaining an understanding of their lived experiences.

Materials and Methods: Semistructured interviews were conducted with seven seasoned counselors who regularly engage in technology-mediated distance counseling.

Results: The results highlighted themes within two emerging categories: the counselor and training/education. Themes related to motivation and specific counselor attributes emerged from the first category and themes of availability, inadequacy, and modality emerged from the second category.

Discussion: The implications from this study suggest a lack of availability and standardization of effective training on …

Virtual Home Visits During Covid-19 Pandemic: Mothers' And Home Visitors' Perspectives, Abdullah Al-Taiar, Michele A. Kekeh, Stephanie Ewers, Amy L. Prusinski, Kimberly J. Alombro, Nancy Welch

Community & Environmental Health Faculty Publications

Background

The experiences of mothers enrolled in Maternal, Infant and Early Childhood Home Visiting (MIECHV) program with virtual home visiting (VHV) during the pandemic remain mostly unknown. This study aimed to describe in detail the experience of home visitors and mothers with VHV during COVID-19 pandemic. This is a prerequisite for guiding future efforts to optimize MIECHV services that are provided through virtual operation.

Methods

Focus groups discussion were conducted with home visitors (n = 13) and mothers (n = 30) who were enrolled in BabyCare program in Virginia from January 2019 to June 2022. This included mothers who received …

Architectural Design Of A Blockchain-Enabled, Federated Learning Platform For Algorithmic Fairness In Predictive Health Care: Design Science Study, Xueping Liang, Juan Zhao, Yan Chen, Eranga Bandara, Sachin Shetty

VMASC Publications

Background: Developing effective and generalizable predictive models is critical for disease prediction and clinical decision-making, often requiring diverse samples to mitigate population bias and address algorithmic fairness. However, a major challenge is to retrieve learning models across multiple institutions without bringing in local biases and inequity, while preserving individual patients' privacy at each site.

Objective: This study aims to understand the issues of bias and fairness in the machine learning process used in the predictive health care domain. We proposed a software architecture that integrates federated learning and blockchain to improve fairness, while maintaining acceptable prediction accuracy and minimizing overhead …