Background:Virtual reality (VR) has the potential to enhance telemental health care (TMH) by enabling accessible, engaging, and personalized treatment from home. Although VR is well-supported for in-person treatment, evidence for telehealth-based VR is limited. Moreover, no prior research has demonstrated the feasibility of therapists and clients conducting therapy sessions remotely within a shared (ie, multiuser) VR experience. Objective:The primary objective of this study was to evaluate the feasibility of conducting a randomized controlled efficacy trial (RCT) comparing exposure therapy delivered via Doxy.me VR (Doxy.me Inc)-a multiuser, telehealth-based VR app-to standard TMH in adults with clinically elevated fear of dogs, snakes, or spiders. A secondary objective was to preliminarily examine clinical (ie, specific phobia symptom severity) and treatment-related outcomes (ie, therapeutic alliance, client satisfaction, system usability, presence, cybersickness, and treatment fidelity). Methods:This study used a single-site, fully remote, parallel, feasibility RCT design. Participants were randomly assigned using a 1:1 ratio to receive 12 weekly exposure therapy sessions over 3 months, delivered via either standard TMH or Doxy.me VR. Assessments were conducted at baseline, each session, midtreatment, and posttreatment. All therapy sessions were audio recorded, 20% of which were randomly selected and rated for treatment fidelity. Feasibility benchmarks during the 12-month trial included: (1) enrolling 30 participants during Months 1-9 of the trial; (2) collecting 70% of midtreatment self-report data; (3) collecting 70% of posttreatment self-report data; (4) collecting 70% of weekly self-report data; and (5) achieving treatment fidelity ≥80%. Between-group differences in clinical treatment-related outcomes also were examined preliminarily. Results:A total of 54 participants were enrolled between October 25, 2023 and July 26, 2024, and randomly assigned to the Doxy.me VR (n=29) and TMH (n=25) conditions, exceeding our recruitment target by 180%. Among the 30 participants targeted for completion, data were obtained from 29 (96.7%) at midtreatment and 28 (93.3%) at posttreatment. Participants completed 86.5% (180/208) of weekly self-report assessments. Treatment fidelity was 90% based on ratings of 41 session recordings. There were no significant between-group differences in clinical outcomes (all P>.05) or most treatment-related outcomes. However, client satisfaction improved significantly more for the Doxy.me VR condition compared to TMH (P=.04). Power analyses indicated that a sample of 160 participants would ensure adequate power for a fully powered trial. Conclusions:Telehealth-based, multiuser, synchronous VRET is feasible and shows preliminary evidence of efficacy. These findings are promising, and opportunities to improve procedures identified in this feasibility trial will directly inform the protocol for a fully powered RCT evaluating telehealth-based VR and its potential to improve treatment of mental health disorders.

The US COVID-19 Public Health Emergency ended on May 11, 2023. Lawmakers and regulators extended some flexibilities while they deliberate effective long-term telemedicine policy. Here, we discuss critical challenges in telemedicine compliance and regulation grounded in scholarly literature and current events. We specifically consider obstacles and progress toward solutions in telemedicine law and regulation regarding privacy and security issues, care across state borders, and prescribing over telemedicine in the United States. We conclude that simplified policies are needed to keep telemedicine accessible to providers and patients and that current privacy and security measures need refinement to protect patients appropriately.

Objective:Our objective was to determine how social vulnerabilities, broadband access, and rurality relate to telemedicine use across the United States through large-scale analysis of real-world telemedicine data. Materials and Methods:We conducted a retrospective, observational study of dyadic U.S. telemedicine sessions that occurred January 1, 2022 to December 31, 2022, linked to the 2020 Centers for Disease Control and Prevention Social Vulnerability Index (SVI) and the National Center for Health Statistics Urban-Rural Classification Scheme for Counties. We examined county-level telemedicine use rates (sessions per 1000 population) in relation to SVI indexes, broadband internet access, and rurality classifications using polynomial regression and data visualization. Results:We found a negative, nonlinear association between overall social and socioeconomic status vulnerabilities and telemedicine use. Telemedicine rates in urban counties exceeded that of rural counties. There was more variability in telemedicine use for the urban counties according to social vulnerability and broadband access. Discussion:Rurality and broadband access demonstrated a greater effect on telemedicine use than social vulnerability, and the relationship between social vulnerability, broadband access, and telemedicine use differed for rural versus urban areas. Conclusion:This observational study of nearly 8 million U.S. telemedicine sessions showed that rurality and broadband access are key drivers of telemedicine use and may be more important than many social vulnerabilities in determining community-level telemedicine use. We also found nuanced differences in the relationship between social vulnerability and telemedicine use between rural and urban counties, and at different levels of broadband access.

BackgroundVirtual reality (VR) has strong potential to enhance the effectiveness of telemental health care (TMH) by providing accessible, personalized treatment from home. While there is ample research supporting VR for in-person treatment, there is only preliminary data on the efficacy of telemedicine-based VR. Furthermore, the majority of VR apps used in therapy are not designed for mental health care. VR has the potential to enhance TMH through innovative technology solutions designed specifically for the enhancement of remotely delivered evidence-based practices. This feasibility randomized controlled efficacy trial aims to fill both of these gaps by piloting a novel telemedicine-based VR app (Doxy.me VR) equipped with animal phobia exposure stimuli. ObjectiveThis is a feasibility randomized controlled efficacy trial comparing exposure therapy via a telemedicine-based VR clinic versus standard TMH with adults with an intense fear of dogs, snakes, or spiders. The primary objective is to assess the feasibility of a fully powered trial. The secondary objective is to conduct a preliminary examination of clinical outcomes (eg, specific phobia symptoms). MethodsThis single-site trial will enroll a minimum of 30 and a maximum of 60 adults with self-reported fear of dogs, snakes, or spiders. Potential participants will be recruited through clinical trial and research recruitment websites and posting flyers. All self-report assessments and homework will be partially automated using REDCap (Research Electronic Data Capture; Vanderbilt University) forms and surveys, but the baseline assessment of phobia symptoms and exposure intervention will be administered by the study therapist. ResultsThe feasibility of the proposed trial methodology will be assessed using enrollment, retention, assessment completion, and treatment protocol fidelity benchmarks. Between-group differences in specific phobia, anxiety, and depression symptoms while covarying for pretreatment scores, will be conducted using repeated measures ANOVA along with differences in therapeutic alliance and presence. Data obtained from these analyses will inform power analyses for a fully powered efficacy trial. In total, 54 participants were randomized between October 25, 2023, and July 26, 2024 (Doxy.me VR n=28 and TMH n=26). Data analysis will be completed and submitted by the end of the second quarter of 2025. ConclusionsThis feasibility randomized controlled trial comparing Doxy.me VR versus TMH aims to enhance the delivery of evidence-based treatments via telemedicine and reduce barriers to remotely delivered exposure therapy. This feasibility trial will be followed by a fully powered efficacy trial on telemedicine-based VR for animal phobias. Trial RegistrationClinicalTrials.gov NCT06302868; https://clinicaltrials.gov/study/NCT06302868 International Registered Report Identifier (IRRID)DERR1-10.2196/65770

Cognitive training is a promising intervention for psychological distress; however, its effectiveness has yielded inconsistent outcomes across studies. This research is a pre-registered individual-level meta-analysis to identify factors contributing to cognitive training efficacy for anxiety and depression symptoms. Machine learning methods, alongside traditional statistical approaches, were employed to analyze 22 datasets with 1544 participants who underwent working memory training, attention bias modification, interpretation bias modification, or inhibitory control training. Baseline depression and anxiety symptoms were found to be the most influential factor, with individuals with more severe symptoms showing the greatest improvement. The number of training sessions was also important, with more sessions yielding greater benefits. Cognitive trainings were associated with higher predicted improvement than control conditions, with attention and interpretation bias modification showing the most promise. Despite the limitations of heterogeneous datasets, this investigation highlights the value of large-scale comprehensive analyses in guiding the development of personalized training interventions.

OBJECTIVE:There is tremendous public health interest in cost-efficient, scalable interventions to improve post-disaster mental health. The authors examined the efficacy of Bounce Back Now (BBN), a mobile application, versus an enhanced usual care app (EUC). METHODS:A population-based trial was conducted with a diverse sample of 1,357 adults affected by Hurricane Harvey, Irma, Maria, Florence, or Michael in 2017 and 2018. Participants were eligible if they were ≥18 years of age, had access to an Internet-accessible device, were English speaking, and lived in a hurricane-affected area. BBN is designed to address symptoms of posttraumatic stress, depression, and sleep disturbance using evidence-based techniques grounded in behavioral and cognitive principles. Depressive, posttraumatic stress, and sleep symptoms were measured. RESULTS:Participants' accessing of the BBN and EUC apps was similar. Active engagement was significantly greater among BBN users than EUC users (d=0.31), but BBN users engaged more actively in coping skills activities than in more time-intensive elements designed to promote behavior change. Moderate symptom reduction was observed in both conditions; Cohen's d values for the 3-month postbaseline assessment ranged from 0.49 to 0.60 in the BBN condition and from 0.36 to 0.41 in the EUC condition. Latent change models revealed that BBN users had significantly greater reductions in depression, sleep difficulty, and PTSD symptoms than EUC users, and these differences were maintained at the 6-month and 12-month postbaseline assessments. CONCLUSIONS:Population impact is driven by reach and effectiveness. The potential reach of BBN is high, which heightens opportunity for population-level impact, but per-user symptom reduction was modest. Per-user impact may be improved by embedding digital health resources in the context of a broader health care strategy.

There is growing need for better mental health care. It is now possible to combine convenient telehealth with engaging virtual reality towards new opportunities for personalized mental health. The goal of this study was to understand mental health clients’ perspectives on telehealth-based virtual reality therapy. We qualitatively analyzed 17, individual semi-structured interviews of mental health clients about experiences and reactions to exposure therapy over conventional telehealth, virtual reality in general, and telehealth-based virtual reality for mental healthcare. Clients were generally younger adults (M = 29.7 years), female (52.9%, 9/17), non-Hispanic White (88.2%, 15/17), and with varied income (M = $35,671; SD = $30,074; unemployed to $100,000). Clients enjoyed how telehealth made exposure therapy more accessible and comfortable, but could feel unmotivated due to lack of in-person accountability and presence. While none used VR for therapy, most tried VR with positive perceptions of it. All but one client believed telehealth-based VR exposure therapy would be useful, easy, and comfortable. However, many clients were unsure VR would feel realistic. Clients proposed tele-VR for art therapy, avatar-based therapy, and immersive games to build rapport with their therapist. Clients felt tele-VR should address specific needs, and their primary concerns were costs and insurance coverage of VR services. Overall, clients expressed excitement that VR can enhance engagement and personalization of telehealth, if costs are minimized and VR is simple to use. These results provide insights into client needs and suggest key directions to explore immersive telehealth solutions.

Background In the postpandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. Objective Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. Methods We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test. Results A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of health care providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8% (17/115) to 19.1% (30/115) of health care providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. Conclusions These health care providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy making in the United States.

BACKGROUND:Deep learning approaches have tremendous potential to improve the predictive power of traditional suicide prediction models to detect and predict intentional self-harm (ISH). Existing research is limited by a general lack of consistent performance and replicability across sites. We aimed to validate a deep learning approach used in previous research to detect and predict ISH using clinical note text and evaluate its generalizability to other academic medical centers. METHODS:We extracted clinical notes from electronic health records (EHRs) of 1,538 patients with International Classification of Diseases codes for ISH and 3,012 matched controls without ISH codes. We evaluated the performance of two traditional bag-of-words models (i.e., Naïve Bayes, Random Forest) and two convolutional neural network (CNN) models including randomly initialized (CNNr) and pre-trained Word2Vec initialized (CNNw) weights to detect ISH within 24 hours of and predict ISH from clinical notes 1-6 months before the first ISH event. RESULTS:In detecting concurrent ISH, both CNN models outperformed bag-of-words models with AUCs of.99 and F1 scores of 0.94. In predicting future ISH, the CNN models outperformed Naïve Bayes models with AUCs of 0.81-0.82 and F1 scores of 0.61-.64. CONCLUSIONS:We demonstrated that leveraging EHRs with a well-defined set of ISH ICD codes to train deep learning models to detect and predict ISH using clinical note text is feasible and replicable at more than one institution. Future work will examine this approach across multiple sites under less controlled settings using both structured and unstructured EHR data.

Background In response to the COVID-19 pandemic, the United States extended regulatory flexibilities to make telemedicine more accessible to providers and patients. Some of these flexibilities allowed providers to intake patients over telemedicine and prescribe certain scheduled medications without an in-person visit. Objective We aim to understand providers’ parameters for their comfort in prescribing over telemedicine and report on solutions providers have adopted in response to potential barriers and challenges in prescribing via telemedicine. Methods As part of a larger mixed methods study between February and April 2024, we conducted 16 semistructured interviews with mental health providers who prescribe via telemedicine within the United States. We used the results of a web-based, cross-sectional survey to develop a codebook and support recruitment. We analyzed a subsection of the 16 interviews using content analysis to capture comfort, barriers, and workarounds in telemedicine prescribing. We reported codes by frequency and by provider. Results Participants were typically male (11/16, 69%), provided care mostly or completely over telemedicine (11/16, 69%), and were psychiatrists (8/16, 50%) or other physician (3/16, 19%). Providers’ primary states (10/16, 62%) of practice included Oregon, Texas, New York, and California. The content analysis yielded a total of 234 codes, with three main codes—comfort (98/234, 41.9%), barriers or challenges (85/234, 36.3%), and workarounds or solutions (27/234, 11.5%)—and two subcodes—uncomfortable prescribing (30/98, 31%) and comfortable prescribing (68/98, 69%) over telemedicine. Participants reported being comfortable prescribing over telemedicine as long as they could meet their main parameters of working within their expertise, having access to needed patient health information, and being compliant with rules and regulations. Participants reported frustrations with e-prescription workflows and miscommunications with pharmacies. Solutions to ease frustrations and alleviate discomforts in prescribing over telemedicine included developing workflows to help patients complete laboratory tests and physical examinations and directly communicating with pharmacies. Conclusions By applying content analysis to the semistructured provider interviews, we found that physicians are comfortable prescribing via telemedicine when they feel they are practicing within their personal parameters for safety. While many providers experience frustrations such as miscommunication with pharmacies, these barriers appear to not prevent them from telemedicine prescribing. With expected changes in 2024 and 2025 to the US laws and regulations for telemedicine prescribing, we may see changes in provider comfort in prescribing.

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INTRODUCTION:This study investigated how mental health providers' use of telemedicine has changed since the coronavirus disease (COVID) 2019 pandemic and their expectations for continuing to use it once the pandemic ends. METHODS:A 15-min online survey was completed by 175 practicing and licensed telemental health providers who use telemedicine. In addition to personal and professional demographic items, the survey included items about the frequency of telemedicine use, proportion of caseload served by telemedicine, comfort using telemedicine before and during the COVID-19 pandemic, and expectations to use telemedicine after the pandemic ends. A series of χ2 analyses, an independent samples t-test, and analyses of variance were conducted. RESULTS:The pandemic resulted in a greater proportion of telemental health providers using telemedicine on a daily basis (17% before and 40% during the pandemic; p < 0.01) and serving more than half of their caseload remotely (9.1% before and 57.7% during the pandemic; p < 0.05). Also, there was a statistically significant increase in their comfort using telemedicine before and during the pandemic (p < 0.001). Providers reported expecting to use telemedicine more often after the pandemic ends (M = 3.35; SD = 0.99). Expectations to provide telemental health services after the pandemic were greater for mental health counselors, providers who practiced in rural regions, and providers who served patients through out-of-pocket payments. DISCUSSION:Telemental health providers use telemedicine daily as a result of the COVID-19 pandemic, with expectations of continuing to use telemedicine in practice after the pandemic. This expectation is more prominent in certain segments of providers and warrants further investigation.

Background During the COVID-19 pandemic, federal and state health policies allowed temporary flexibilities for Medicare and Medicaid beneficiaries, leading to a sharp increase in telemedicine use. However, many of the flexibilities that enabled innovation and growth in telemedicine continue temporarily since the federal emergency declaration ended in May 2023, and the United States has not made permanent decisions about telemedicine policy. Analysts have raised concerns about increased spending, program integrity, safety, and equity, and recommend strengthening oversight. Methods Here, we argue that we must continue the flexibilities to better understand telemedicine’s quality, safety, and outcomes, and until the United States can develop an evidence-based digital health strategy. A premature regression to pre-pandemic telemedicine policies risks unintended consequences. Conclusion We must continue the current policy flexibilities, safeguard against fraud and abuse, and immediately prioritize research and evaluation of telemedicine’s quality, safety, and outcomes, to avoid unintended consequences and support more permanent policy decision-making.

Mental health care providers have widely adopted telemedicine since the beginning of the COVID-19 pandemic. Some providers have reported difficulties implementing telemedicine and are still determining its sustainability. Recommendations, best practices, and guidelines have been published for telemedicine-based mental health care (i.e., telemental care or TMH) but have yet to be synthesized. Through our scoping review of practice guidelines, we aimed to identify themes of TMH guidelines and clinical recommendations published during the first two years of the COVID-19 pandemic, the importance of those topics based on the frequency of mentions per resulting article, and the types of guidelines published for providers during that time. Authors searched Pubmed/MEDLINE and ScienceDirect for articles using the PRISMA-ScR on TMH practice published from January 2020 to March 2022. We included articles during screening if they were available in English and provided recommendations, best practices, or guidelines for TMH. We excluded duplicates, articles unrelated to telehealth, brief editorial introductions, and those not fully available. We applied the Healthcare Provider Taxonomy of the National Uniform Claim Committee to article titles and abstracts to identify records relevant to mental health. The authors used content and thematic analysis to identify critical themes. Of the 818 articles yielded, we excluded 218 during our title and abstract screening. From the remaining 600 articles, we excluded 104 duplicates and were left with 64 after the application of the taxonomy. We excluded eight of these articles due to the inability to find the full papers or irrelevance to the topic. Content and thematic analysis provided three main themes–along with subthemes and topics–of facilitators, concerns, and changes advised. The majority of articles called for further research (41/56) and for telemental education and innovation in some form (35/56) regarding changes advised. Sixteen articles included specific types of guidelines, recommendations, or checklists for providers. Results of the scoping review highlight the need for further research at larger scales to develop effective guidelines and protocols for successful therapy plans. Additionally, a consideration of health inequities within populations during telemental care implementation and research would ensure ethical implementation of telemental care. The subthemes of changes advised appear to be interconnected and draw on themes, subthemes, and topics found in concerns and facilitators.

Background Self-administered web-based questionnaires are widely used to collect health data from patients and clinical research participants. REDCap (Research Electronic Data Capture; Vanderbilt University) is a global, secure web application for building and managing electronic data capture. Unfortunately, stakeholder needs and preferences of electronic data collection via REDCap have rarely been studied. Objective This study aims to survey REDCap researchers and administrators to assess their experience with REDCap, especially their perspectives on the advantages, challenges, and suggestions for the enhancement of REDCap as a data collection tool. Methods We conducted a web-based survey with representatives of REDCap member organizations in the United States. The survey captured information on respondent demographics, quality of patient-reported data collected via REDCap, patient experience of data collection with REDCap, and open-ended questions focusing on the advantages, challenges, and suggestions to enhance REDCap’s data collection experience. Descriptive and inferential analysis measures were used to analyze quantitative data. Thematic analysis was used to analyze open-ended responses focusing on the advantages, disadvantages, and enhancements in data collection experience. Results A total of 207 respondents completed the survey. Respondents strongly agreed or agreed that the data collected via REDCap are accurate (188/207, 90.8%), reliable (182/207, 87.9%), and complete (166/207, 80.2%). More than half of respondents strongly agreed or agreed that patients find REDCap easy to use (165/207, 79.7%), could successfully complete tasks without help (151/207, 72.9%), and could do so in a timely manner (163/207, 78.7%). Thematic analysis of open-ended responses yielded 8 major themes: survey development, user experience, survey distribution, survey results, training and support, technology, security, and platform features. The user experience category included more than half of the advantage codes (307/594, 51.7% of codes); meanwhile, respondents reported higher challenges in survey development (169/516, 32.8% of codes), also suggesting the highest enhancement suggestions for the category (162/439, 36.9% of codes). Conclusions Respondents indicated that REDCap is a valued, low-cost, secure resource for clinical research data collection. REDCap’s data collection experience was generally positive among clinical research and care staff members and patients. However, with the advancements in data collection technologies and the availability of modern, intuitive, and mobile-friendly data collection interfaces, there is a critical opportunity to enhance the REDCap experience to meet the needs of researchers and patients.

Virtual reality (VR) can enhance mental health care. In particular, the effectiveness of VR-based exposure therapy (VRET) has been well-demonstrated for treatment of anxiety disorders. However, most applications of VRET remain localized to clinic spaces. We aimed to explore mental health therapists’ perceptions of telehealth-based VRET (tele-VRET) by conducting semi-structured, qualitative interviews with 18 telemental health therapists between October and December 2022. Interview topics included telehealth experiences, exposure therapy over telehealth, previous experiences with VR, and perspectives on tele-VRET. Therapists described how telehealth reduced barriers (88.9%, 16/18), enhanced therapy (61.1%, 11/18), and improved access to clients (38.9%, 7/18), but entailed problems with technology (61.1%, 11/18), uncontrolled settings (55.6%, 10/18), and communication difficulties (50%, 9/18). Therapists adapted exposure therapy to telehealth by using online resources (66.7%, 12/18), preparing client expectations (55.6%, 10/18), and adjusting workflows (27.8%, 5/18). Most therapists had used VR before (72.2%, 13/18) and had positive impressions of VR (55.6%, 10/18), but none had used VR clinically. In response to tele-VRET, therapists requested interactive session activities (77.8%, 14/18) and customizable interventions components (55.6%, 10/18). Concerns about tele-VRET included risks with certain clients (77.8%, 14/18), costs (50%, 9/18), side effects and privacy (22.2%, 4/18), and inappropriateness for specific forms of exposure therapy (16.7%, 3/18). These results reveal how combining telehealth and VRET may expand therapeutic options for mental healthcare providers and can help inform collaborative development of immersive health technologies.

Objective: Family health history (FHx) is an important tool in assessing one’s risk towards specific health conditions. However, user experience of FHx collection tools is rarely studied. ItRunsInMyFamily.com (ItRuns) was developed to assess FHx and hereditary cancer risk. This study reports a quantitative user experience analysis of ItRuns. Methods: We conducted a public health campaign in November 2019 to promote FHx collection using ItRuns. We used software telemetry to quantify abandonment and time spent on ItRuns to identify user behaviors and potential areas of improvement. Results: Of 11,065 users who started the ItRuns assessment, 4305 (38.91%) reached the final step to receive recommendations about hereditary cancer risk. Highest abandonment rates were during Introduction (32.82%), Invite Friends (29.03%), and Family Cancer History (12.03%) subflows. Median time to complete the assessment was 636 s. Users spent the highest median time on Proband Cancer History (124.00 s) and Family Cancer History (119.00 s) subflows. Search list questions took the longest to complete (median 19.50 s), followed by free text email input (15.00 s). Conclusion: Knowledge of objective user behaviors at a large scale and factors impacting optimal user experience will help enhance the ItRuns workflow and improve future FHx collection.

BackgroundDigital health and telemedicine are potentially important strategies to decrease health care’s environmental impact and contribution to climate change by reducing transportation-related air pollution and greenhouse gas emissions. However, we currently lack robust national estimates of emissions savings attributable to telemedicine. ObjectiveThis study aimed to (1) determine the travel distance between participants in US telemedicine sessions and (2) estimate the net reduction in carbon dioxide (CO2) emissions attributable to telemedicine in the United States, based on national observational data describing the geographical characteristics of telemedicine session participants. MethodsWe conducted a retrospective observational study of telemedicine sessions in the United States between January 1, 2022, and February 21, 2023, on the doxy.me platform. Using Google Distance Matrix, we determined the median travel distance between participating providers and patients for a proportional sample of sessions. Further, based on the best available public data, we estimated the total annual emissions costs and savings attributable to telemedicine in the United States. ResultsThe median round trip travel distance between patients and providers was 49 (IQR 21-145) miles. The median CO2 emissions savings per telemedicine session was 20 (IQR 8-59) kg CO2). Accounting for the energy costs of telemedicine and US transportation patterns, among other factors, we estimate that the use of telemedicine in the United States during the years 2021-2022 resulted in approximate annual CO2 emissions savings of 1,443,800 metric tons. ConclusionsThese estimates of travel distance and telemedicine-associated CO2 emissions costs and savings, based on national data, indicate that telemedicine may be an important strategy in reducing the health care sector’s carbon footprint.

Telemedicine enables critical human communication and interaction between researchers and participants in decentralized research studies. There is a need to better understand the overall scope of telemedicine applications in clinical research as the basis for further research. This narrative, nonsystematic review of the literature sought to review and discuss applications of telemedicine, in the form of synchronous videoconferencing, in clinical research. We searched PubMed to identify relevant literature published between January 1, 2013, and June 30, 2023. Two independent screeners assessed titles and abstracts for inclusion, followed by single-reviewer full-text screening, and we organized the literature into core themes through consensus discussion. We screened 1044 publications for inclusion. Forty-eight publications met our inclusion and exclusion criteria. We identified six core themes to serve as the structure for the narrative review: infrastructure and training, recruitment, informed consent, assessment, monitoring, and engagement. Telemedicine applications span all stages of clinical research from initial planning and recruitment to informed consent and data collection. While the evidence base for using telemedicine in clinical research is not well-developed, existing evidence suggests that telemedicine is a potentially powerful tool in clinical research.