Patient-facing tech

Chen Wang, Jie Hao +4

How have large language models been used and evaluated for translating pathology reports into patient-facing language? This scoping review followed JBI methodology and PRISMA-ScR, searching six databases for empirical studies of LLM-generated interpretation, rewriting, question answering, or summarization of pathology reports (January 2018 to August 2026). Nineteen studies were included; GPT-family models appeared in 17, and report-level transformation was the most common task (12/19, 63.2%). Fidelity was assessed in all 19 studies, safety in 10 (52.6%), readability in 9 (47.4%), and comprehension and usability in 6 each (31.6%). Only five involved patients or other non-clinicians, and none evaluated performance by health-literacy level, across languages, or prospectively within clinical workflows.

Maria Marecka, Anna Nowicka +2

Does conversational LLM triage capture different information or shift care-seeking intent compared with a structured questionnaire? This retrospective observational study compared 116,890 virtual triage encounters over 28 weeks (January–August 2025), where users self-selected traditional triage (TT; 100,533, 86%) or an LLM-enabled conversational interface (CT; 16,357, 14%) sharing the same Bayesian reasoning engine, with poststratification weighting by age and sex. CT sessions ran longer (median 8 min 21 s vs 4 min 25 s), elicited more clinical findings (median 36 vs 32; P<.001), and had higher self-reported intended adherence to recommended care (34.3% vs 29.2%; P<.001), including self-care (85.4% vs 61.9%). Users self-selected groups.

Yael Redelman-Sidi, Charlie White +6

Who uses the inpatient portal during cancer hospitalizations? This retrospective analysis of 28,386 patients at a high-volume cancer hospital in 2022–2023 used multivariable logistic and Poisson regression to model any portal login and login rates during admissions, including ICU stays. Median age was 65, median length of stay 4 days; 65% (18,588) logged in at least once. Black patients were 32% less likely to log in than White patients (OR 0.68, 95% CI 0.62–0.74), as were single (OR 0.80) and Medicaid-insured patients (OR 0.79). Among 1,782 ICU patients, 55% logged in, with Black patients 41% less likely (OR 0.59).

Milan F Satcher, Elizabeth C Saunders +4

How do adults with opioid use disorder leaving incarceration perceive digital health tools during reentry? This qualitative study conducted semistructured interviews with a purposive sample of 39 adults recently released from New Hampshire prisons and jails, recruited from the EXIT-CJS randomized trial of extended-release buprenorphine, naltrexone, and enhanced treatment as usual, with deductive-inductive content analysis and COREQ reporting. Most participants preferred digital over in-person care for its convenience and its ability to bypass transportation shortages, limited provider availability, and work scheduling conflicts, while still valuing in-person therapeutic connection. Use depended on devices, affordable connectivity, and digital literacy; the abstract reports no effect sizes.

Arif Ahmed, Gondy Leroy +5

Does habitual reliance on generative AI blunt users' ability to calibrate trust in AI-generated health information? Two randomized 2×2 between-participants experiments (338 college students; 563 Mechanical Turk workers) manipulated information accuracy and text-based visual cues (highlighting), measuring trust and self-reported learned dependency with regression models. Accuracy raised trust (experiment 1 B=2.107, 95% CI 1.337-2.878; experiment 2 B=0.203, 95% CI 0.115-0.290), as did learned dependency (B=0.277 and B=0.822). The accuracy-by-dependency interaction was negative in both (B=-0.399; B=-0.459), indicating reduced sensitivity to inaccuracy. Text highlighting had no significant effect and did not moderate dependency.

Samantha M R Kling, Jonathan G Shaw +6

What are the telehealth and broadband barriers facing patients in an urban safety-net clinic, and how aware are they of federal internet subsidies? Roots Community Health, operating as a community-anchored learning health system with a Telehealth Patient Advisory Council, screened 109 adult patients for Affordable Connectivity Program (ACP) eligibility and administered a 66-item cross-sectional survey to 99. Two-thirds (65/99) had used telehealth and 53% (52/99) wanted future telehealth visits. Barriers included slow internet (46/98), no internet access (40/99), and mobile data plan problems (31/98). Most (65/109) had not heard of ACP, though 60/109 were interested in applying.

Paul R Shafer, Alex K Gertner, Monica S Aswani

How has outpatient psychotherapy for commercially insured children been used, delivered, and paid for? This JAMA Network Open study examines use, modality (including in-person versus telehealth delivery), and reimbursement patterns for pediatric outpatient psychotherapy in a commercially insured population. No abstract was available at the time of this digest, so the study's design details, sample size, years covered, and findings are not summarized here; readers should consult the full article for effect sizes and payment estimates.

Celia Jewell, Heidi O'Connor +5

Can telehealth compensate for rural gaps in primary and emergency care where broadband is inadequate? This population-based cross-sectional study mapped broadband, ambulance, and health care deserts across 41 states (249.1 million people), combining FCC 2024 Broadband Data Collection data, ambulance and health care desert data from September 2021 to February 2022, and the 2020 Census. An estimated 11.9 million people (4.8%) lived in broadband deserts, 88.1% of them rural; 649 225 rural residents lived where all three deserts overlapped. Rural broadband subscription was 88.5% versus 92.6% urban; Western states had 31.9% of rural residents in broadband deserts.

Said Dababneh, Nicole Hébert +4

Can AI improve patient comprehension and decision-making during informed consent? This PRISMA-guided systematic review searched PubMed, Embase, and the Cochrane Library, including 33 studies published 2020-2025 across three domains: AI-generated patient education (n=18, 54.5%), consent documentation (n=10, 30.3%), and AI-assisted consent acquisition (n=5, 15.2%). Large language models were accurate but readability stayed above an eighth-grade level (best model Copilot: Flesch-Kincaid 10.59, SD 1.22). AI-generated documents raised Flesch Reading Ease by 44%-122% and lowered required grade levels 10%-47%. In trials, AI-assisted consent shortened consultations (7.7 vs 10.6 minutes; P=.05) and lowered post-consent anxiety in knee arthroplasty (10.48 vs 12.75; P=.04).

Zhengcan Xie, Yuheng Shi +3

How mature are patient-facing technologies built on REDCap? This integrative review followed PRISMA guidelines, searching PubMed, Web of Science, and Embase, and synthesized 14 studies (2016-2026) using aggregate and thematic synthesis, then combined literature evidence with pilot case insights to build a four-tier maturity model spanning Data Collection, System Integration, Personalized Insights, and a conceptual Intelligence Hub. Publications clustered after 2021 (n=12, 86%), most were US-based (n=11, 79%), and 10 implementations (71%) remained at Tiers 1-2, with only 4 (29%) reaching Personalized Insights. The authors call for longitudinal evaluation and deeper integration.

Marek Atter, Alistair Bullen +2

Are electronic patient-reported outcome measure (ePROM) programs in cancer care cost-effective? This systematic review searched Ovid (MEDLINE, Embase), Scopus, and the INAHTA database for English-language papers through March 2025, including 34 publications from 27 studies covering 26 ePROM-integrated interventions for adult cancer populations, alongside parameter extraction for economic modeling. Most interventions (23/26) included alert handling or automated decision support. Only 5 publications reported full cost-effectiveness analyses; 3 were highly uncertain, while 2 showed cost-effectiveness driven by quality-of-life gains and fewer hospitalizations. Five reported partial results (4 favoring ePROMs). Twelve studies had qualitative components, but only 2 addressed economic themes.

Jacqueline Toscano, King Yan Kwok, Meg Simione

Can an EHR template semi-automatically translate clinical documentation into caregivers' preferred language? This pilot development study applied human-centered design and a Discover, Design/Build, Test framework at a pediatric setting, with an interprofessional team of a speech-language pathologist and a certified translation specialist building an English-to-Spanish template in the electronic health record, then surveying speech-language pathologists and caregivers on acceptability and feasibility. The Discover phase documented barriers to providing written documentation in patients' primary language; clinicians endorsed the template's importance but raised feasibility and usability concerns, while caregivers valued receiving information in their primary language. The abstract reports no sample sizes or effect sizes.

Emre Umucu, Beatrice Lee +4

How well do digital health technologies, including AI, include persons with disabilities? This scoping review followed PRISMA-ScR guidance, searching MEDLINE and Web of Science plus gray literature for English-language sources on digital health, disability, and health equity published 2019 to 2025 (searches last run December 2024). Of 925 records identified and 836 screened, 137 underwent full-text review, yielding 40 peer-reviewed articles plus 40 gray literature sources (80 documents). Findings were organized into five themes spanning access enablers, stakeholders, government initiatives, contextual factors, and emerging innovations; participatory codesign and accessible design recurred as enablers. The abstract reports no effect sizes.

Terrence T Liu, John Thomas Menchaca +7

Does telehealth for type 2 diabetes accompany different medication fill patterns and care processes than in-person care alone? This observational cross-sectional study used the nationally representative 2021-2023 Medical Expenditure Panel Survey, comparing unadjusted descriptive measures among 4348 adults with at least one type 2 diabetes visit. Telehealth use was uncommon: 90.7% had only in-person visits and 9.3% had at least one telehealth visit. Insulin prescriptions were more frequent among telehealth users (47.5%, 95% CI 41.0%-54.1%) than nonusers (34.4%, 95% CI 32.1%-36.7%). The authors interpret this as possible greater clinical complexity; comparisons were unadjusted, with no adjusted effect sizes reported.

Jenna M Norton, Karen L Fortuna +5

Can standards-based, interoperable electronic care planning tools support shared care for people with multiple chronic conditions? Using participatory and agile design, the team built data standards plus clinician-facing (eCarePlanner) and patient/caregiver-facing (MyCarePlanner) apps, then evaluated them with mixed methods informed by CFIR Process Redesign and SEIPS across formative, iterative, and summative stages. The apps connected to 4 electronic health records at 17 institutions; 57 patients/caregivers and 15 clinicians participated, predominantly aged 65+, White, and well educated. Most were comfortable using the app (97%) and found loading timely (90%), but only 63% felt it would support complex care coordination, 48% that it improved care team communication, and 37% cited cross-section inconsistencies. Interviews highlighted barriers to moving information across settings.

Lena Lee, Elisa Son +4

How did US family caregivers' digital health engagement change around the COVID-19 pandemic? This cross-sectional trend analysis pooled Health Information National Trends Survey data (HINTS 5 Cycles 3 and 4, HINTS 6) from 2019 to 2022, covering 1676 family caregivers, with weighted multivariable logistic regression. Access to caregivers' own online medical records rose from 48.7% to 72.6% (P<.001) and access to care recipients' records from 30.8% to 44.5% (P<.001); sharing health information on social media grew from 22.5% to 39.1%. High-speed internet was strongly associated with engagement (sharing health information: OR 3.98, 95% CI 2.15-7.35).

Lilach Alon, Inbar Levkovich

What helps or hinders consumers using generative AI tools to seek health information? This scoping review followed JBI guidance and PRISMA-ScR/PRISMA-S, searching 10 databases for English-language empirical studies published from 2022 through a final search on January 8, 2026, and included 27 studies covering symptom appraisal, condition understanding, treatment options, and care navigation. Facilitators centered on comprehensibility and presentation quality (11 studies, 40.7%) and efficiency and access (8, 29.6%); barriers were dominated by credibility and trust concerns (13, 48.1%), especially absent or unclear citations, followed by perceived unsuitability for complex or urgent situations and privacy concerns (4, 14.8%).

Huey Yu Ng, Shamala Ramasamy +5

What multidisciplinary factors shape adoption of digital health technologies such as patient portals, mobile apps and EHRs? This PROSPERO-registered systematic review (CRD420251056883) followed PRISMA 2020, searching multidisciplinary databases via EBSCO Discovery Service for English-language primary studies published between 2015 and June 2025, retaining 82 studies published from 2020 to 2025. Two reviewers screened and extracted using the SPIDER framework mapped to PICOS, appraised quality with the MMAT, and synthesised findings thematically in ATLAS.ti. Five themes emerged: access, equity and affordability; usability, engagement and empowerment; trust, privacy and governance; integration, workforce and sustainability; and clinical effectiveness and quality of care. The abstract reports no effect sizes.

Samantha L Connolly, Rebecca A Raciborski +8

Does the modality of outpatient mental health care — video, phone, or in-person — affect clinical outcomes? This retrospective comparative effectiveness study used VA administrative data for 813,699 patients completing at least 3 outpatient mental health visits from July 2021 to October 2022, with one-year follow-up and inverse probability-weighted regression adjustment. Mental health hospitalization occurred in 0.9% of the video group, 1.6% of the phone group, and 2.1% of the in-person group; average treatment effects favored video by 0.005 points versus both comparators. Appointment completion was 4.1 percentage points higher than phone and 3.6 higher than in-person. Authors note small effect magnitudes and possible residual confounding.

Oliver T Nguyen, Majid Afshar +19

What makes patients willing to accept ambient AI scribes during ambulatory visits, and does baseline trust in AI shape that acceptance? This secondary, convergent mixed-methods analysis re-analyzed survey and interview data from 20 patients seen after ambient AI scribe implementation, summarizing trust items descriptively and coding interviews deductively against the Theoretical Framework of Acceptability plus inductively. Trust ranged from low to high, with 60% reporting moderate trust. Acceptability tracked with minimal ethicality concerns, supportive affective attitudes, low patient burden, perceived benefits, and strong intervention coherence; themes differed minimally by trust level. Patients urged patient education and advance notice. The abstract reports no effect sizes.

Alberto Zambudio Munuera, Miguel Ángel Arrabal Polo +2

Does high usability in a clinician-built, AI-assisted application establish clinical and technical assurance? This single-case retrospective development-and-assurance report examined STUIapp, a browser-based ePROM tool integrating six validated lower urinary tract symptom instruments, using code audit, independent clinical review of a frozen 78-case scoring matrix, WCAG 2.1 measurement, a 23-canary persistent-storage study, and usability testing with 14 clinicians, 26 patients and 12 older adults. Mean SUS was 92.3 (SD 8.8) among clinicians and 92.0 (SD 10.8) among patients, yet all 78 passing automated cases included 17 expected results requiring correction. Other findings: instrument mislabelling, a failed installability manifest, a third-party analytics tag contradicting local-only privacy claims, 10-px text and 2.56:1 contrast, and storage permission denied in 10/10 browser-tab canaries versus granted in 13/13 installed canaries.

Amanda Dahlstrand

Can digital health platforms improve patient-physician matching once geography no longer binds? Using nationwide Swedish online care with time-conditional random assignment of patients to physicians, the author estimates reallocation gains from aligning provider heterogeneity with patient needs. Matching high-risk patients to doctors effective at averting emergency room use lowers ER visits by 4.4 percent (SE 1.3), and reallocation reduces counter-guideline antibiotic prescribing by 3.1 percent (SE 1.4). Trade-offs across outcomes were limited, as horizontal differentiation among doctors and varied patient needs permitted simultaneous improvement; efficiency-enhancing reallocations also carried equity consequences.

Ankeet S Bhatt, Vincent X Liu +24

Can adaptive digital outreach improve statin refills among patients with recent nonadherence? This pragmatic, health system–embedded sequential multiple assignment randomized trial (SMART, PROBE design) at Kaiser Permanente Northern California randomized 20,604 adults (mean age 54.8 years; 40.9% female; 15.3% with established ASCVD) with ASCVD or high risk to portal messaging, SMS, nonsecure email, or usual communication, with second-stage randomization of 14-day nonresponders. Initial outreach raised 14-day refill from 12.0% to 14.4% (adjusted risk difference, 2.3 percentage points; risk ratio, 1.20). A second outreach added gains among nonresponders (13.0% vs 10.4%), while switching modality did not (risk ratio, 1.06).

Cancan Zhang, Audrey D Zhang +5

Has post-pandemic telehealth use declined, and have sociodemographic gaps in access closed? This repeated cross-sectional analysis used the nationally representative 2022 and 2024 Health Information National Trends Survey (11,386 US adults; mean age 48.6 years, 51.1% female), with logistic regression adjusting for sociodemographic, clinical, and access variables and year interactions. Unadjusted telehealth use fell from 39.0% (95% CI 36.9–41.3%) to 34.9% (32.1–37.9%), while the video share of visits held at 71.1% (68.8–73.4%). Use tracked age, internet use, income, and large-metro residence; gender and insurance differences narrowed. About 20% reported technical problems, and over 75% rated telehealth comparable to in-person care.

Tongxin Zhou, Yingfei Wang +2

Why do users of eHealth behavioral interventions taper off over time? The authors extend Expectation-Confirmation Theory by treating engagement as a dynamic learning process, estimating a hierarchical Bayesian structural learning model of how users update perceptions of intervention effectiveness from ongoing experience and how those beliefs drive continued participation. Learning performance was lower for interventions with ambiguous instructions and those targeting short-term health outcomes, which generate noisier feedback and less accurate effectiveness perceptions, associated with reduced sustained engagement. Several denoising design strategies are evaluated in counterfactual simulations. The abstract reports no effect sizes, sample size, or study period.

Wain, K. F., Carroll, N. M. +4

Can a short informational video sent before a clinical visit raise lung cancer screening uptake? In a randomized feasibility trial at Kaiser Permanente Colorado (March–October 2025), 1,093 screening-eligible patients with upcoming primary care or pulmonology appointments were assigned by birth month to a text-delivered video nudge (with or without a rooming QR code; n=549) or usual care (n=544). Intervention patients more often received a screening order within one day (22.6% vs 16.4%; p=.010) and during follow-up (32.6% vs 24.1%; p=.002). Baseline LDCT completion was 8.6% vs 5.7% (p=.078). Seventeen percent viewed the video, watching 79% on average.

Edward Lee Major Iii, Vivek P Shah +4

Do AI scribe–generated patient visit summaries meet patient literacy standards? This retrospective analysis scored 982 consecutive summaries from a commercial AI scribe platform at an academic orthopedic surgery outpatient clinic (December 2023–May 2024, 25 incomplete summaries excluded) using five validated readability indices. Mean Flesch-Kincaid Grade Level was 9.3 (SD 1.2) and mean Flesch Reading Ease was 57.6 ("fairly difficult"); only 0.4% (4/982) met the sixth-grade benchmark and 14.2% (139/982) the eighth-grade threshold. Word count was uncorrelated with grade level (ρ=0.012, P=.70), and indices agreed strongly (W=0.882). No comparison group was included.

Mitchell Tang, Lisa S Rotenstein +3

Why do portal messages from historically marginalized patients get fewer responses? This cross-sectional study applied natural language processing to extract message content and writing style features from 3,619,390 medical advice request threads sent by 511,020 adults to non-trainee primary care clinicians between 2021 and 2023, then used regression to decompose response gaps. Black patients had a 3.7-percentage-point lower response rate from the intended target clinician than White patients (95% CI, -4.1 to -3.3), an 11.6% relative reduction. Message content did not explain the gap, but writing style accounted for 48.0% of it for Black patients, 34.9% for Hispanic patients, 60.5% for patients with only a high school education, and 42.8% for Medicaid beneficiaries.

Anna Gwóźdź-Broczkowska

How should health systems evaluate generative AI that turns clinical information into patient-facing instructions such as discharge summaries, medication explanations and portal messages? This narrative and interpretative review maps empirical studies of AI-generated discharge communication alongside health-literacy, medication-safety, patient-safety and AI-governance literature. The author reports a recurring trade-off: large language models improve readability and understandability, while physician and pharmacist review identifies omissions, inaccuracies, newly introduced actions, medication-related problems and potentially harmful content, especially in complex discharges. A proposed seven-domain framework covers factual accuracy, clinical completeness, actionability, medication clarity, escalation and safety-netting, health-literacy alignment, and accountability with auditability. The abstract reports no effect sizes.

Margolis, S. J., Maddipatla, N. V. S. K. +4

Do patient-facing AI products differ in how they triage and refer simulated patients? Researchers tested nine products against 60 physician-developed standardized clinical cases across 540 multi-turn simulated patient encounters. Overall triage accuracy showed no statistically significant difference across product categories, but referral behavior diverged: branded health AI products over-triaged low-acuity cases far more often (28% vs 3% vs 2%) and more frequently recommended affiliated, fee-requiring clinical services. The authors argue evaluations of patient-facing medical AI should assess referral behavior alongside triage accuracy. The abstract reports no confidence intervals or other effect sizes.

Tiffany C Veinot, Alicia K Stone +7

Do complex telehealth tasks themselves contribute to uptake inequities among socioeconomically marginalized patients? Researchers combined a complexity walkthrough inspection by eight researcher-evaluators of six telehealth tasks required at a Federally-Qualified Health Center with remote user testing of 24 FQHC patients, paired with complexity-focused interviews and surveys and mixed-methods analysis. Patients completed only 33.9% of required subtasks without issues, and took twice as long as walkthrough evaluators. Ambiguity (unclear inputs, unfamiliar concepts and words) and relationship dimensions (context switching, deep navigational hierarchies) most affected perceived difficulty; cognitive load was high for two tasks, and many patients abandoned tasks early.

Mallory Herzog, Linda S Park, Andrew Quanbeck

What drives health systems and payers to adopt — or drop — patient-facing digital health tools? This qualitative study used semistructured interviews conducted August through December 2025 with nine senior leaders from a large Midwestern academic health system and affiliated payers, including a provider-owned health plan and a state Medicaid program, using an evidence-based mobile intervention for alcohol use disorder as the use case. Thematic analysis with inductive and deductive coding identified four decision-making mechanisms: prioritization under organizational constraint, risk mitigation, operational fit, and value determination. The authors argue these processes are largely invisible to patients, clinicians, and developers. No effect sizes are reported.

Laura B Monico, Elizabeth A Bambury +3

How well do patients stay in buprenorphine treatment when care is delivered entirely by telehealth? This retrospective cohort study followed 22,064 adults initiating opioid use disorder treatment in a multistate, telehealth-only addiction program between May 2019 and April 2025 (mean age 41.2 years, 48.6% female, 33.8% rural, 78.5% Medicaid), using chi-square tests and absolute risk differences. Retention fell from 86.8% at month 1 to 71.0% at month 6, then declined gradually through 24 months. At month 6, retention was 70.4% among patients with prior buprenorphine exposure versus 52.0% without (risk difference 18.5 percentage points, 95% CI 15.5-21.5).

Elizabeth C Stade, Zoe M Tait +3

How many U.S. adults turn to general-purpose large language models for their mental health? A cross-sectional survey of 1,871 U.S. adults fielded August–October 2024 used stratified sampling across age, sex, and race/ethnicity to approximate national demographics. Twenty-four percent reported using LLMs for mental health; users skewed young, male, and Black, and reported poorer mental health and difficulty accessing traditional treatment, citing that LLMs are free, convenient, and always available. Reported uses included emotional support, learning therapy skills, and supplementing existing therapy. Combining with Pew estimates of overall LLM use, the authors project 14–18 million U.S. adults.</summary>}</summary>

Jemar R Bather, José A Pagán +5

How do patients view and understand test results released immediately to them under information-blocking rules? This JAMA Network Open study examines patient access to and comprehension of immediately released test results. No abstract was available, so the study's design, population, and findings — including any magnitudes — cannot be summarized here.

Rahael Borchers, Francesco Sergi +4

Did 2025 federal immigration policy changes shift outpatient and telehealth use among likely undocumented patients? This cross-sectional study of electronic health record data from a public safety-net system compared 184 541 visits from January–June 2024 with 182 573 from the same months in 2025, proxying documentation status by non-English primary language without a Social Security number. Likely undocumented patients had 15% higher in-person visit completion overall (IRR, 1.15; 95% CI, 1.13-1.16), but month-specific declines of 5% to 12% in 2025, significant in March (IRR, 0.88) and June (IRR, 0.93). Their telehealth share rose 12% (IRR, 1.12) while falling 5% among patients likely with legal status; total visits were unchanged.

Smith, M., Konieczny, K. A. +7

Can automated post-discharge check-ins surface adverse events in adults with multiple chronic conditions? This mixed-methods, user-centered design study used semi-structured interviews with 37 patients and 23 clinicians to set requirements, then field-tested a prototype in 20 patients for up to 7 days after discharge, drawing on interoperable EHR data to deliver symptom and patient-reported outcome questionnaires with risk-stratified advice and real-time clinician escalation. Patients completed 60% of questionnaires; 7 received Level 2 or 3 advice, 3 triggered Level 3 escalation emails, and 4 of the 7 had chart-confirmed emergency department visits within a week. Clinicians found PRO trends hard to interpret.

Steitz, B. D., Ogunsan, O. O. +11

Can a large language model reliably categorize the content of patient portal messages at scale? Researchers built a zero-shot GPT-4o-mini pipeline applied to all medical advice request messages sent to ambulatory clinicians at an academic medical center in 2024-2025, using an 11-category taxonomy derived by expert panel via modified Delphi; two annotators labeled 750 messages (Cohen kappa 0.80), with 500 held out for evaluation. Micro- and macro-averaged F1 were 0.89 and 0.86, and labels were identical across runs for 93.6% of messages. Across 2.4 million messages, Problems & Management and Medications & Prescriptions appeared in 67.9%, the top four topics in 93.9%, and 51.7% spanned multiple topics.

Karen J Wernli, Melissa L Anderson +13

Can patient-centered outreach improve adherence to annual lung cancer screening? A pragmatic 2×2 factorial randomized trial at Kaiser Permanente Washington enrolled 1837 patients with normal low-dose CT findings (November 2022–April 2024; follow-up through July 2025), assigning usual care, health communication (print/video messaging), stepped reminders (pended LDCT orders for primary care physicians plus patient scheduling outreach), or both. Stepped reminders raised 9-to-15-month rescreening 27.7 percentage points (75.5% vs 47.4%; RR 1.59, 95% CI 1.47-1.72), with larger gains among current tobacco users (risk difference 32.3 vs 24.1 points). Health communication was 4.7 points lower (59.2% vs 63.3%; RR 0.93).

Mehakpreet Kaur, Tamanna Jannat Promi +5

What do virtual hospital services (VHS) for working-age adults actually look like in the published literature? This scoping review followed JBI methodology and PRISMA-ScR, searching four databases for articles published March 2021 to July 2025 on VHS and hybrid hospital-in-the-home models for adults aged 18-65. Of 1624 records, 28 studies met eligibility: 16 described fully virtual models and 12 hybrid HITH. Most combined synchronous and asynchronous communication; mobile apps and wearables were uncommon. Respiratory conditions predominated (17/28), heart failure exacerbation was the most common specific condition (6/28), and patient satisfaction or experience was the most reported outcome (17/28). The authors note heterogeneous terminology, inconsistent reporting, and dominance of pilot and single-site studies.

Sven Richter, Clara Helene Buszello +7

Do LLM-based chatbots improve physician-patient communication? This PRISMA-guided systematic review and random-effects meta-analysis searched PubMed/MEDLINE, Embase, Scopus, and Web of Science for 2020-2025 studies of LLM or chatbot applications in clinical communication, including 10 quantitative, mostly cross-sectional studies from 312 records. In 5 of 6 direct comparisons, LLM responses were rated more empathetic than physician responses; one study found chatbot replies judged empathetic in 45.1% of cases versus 4.6% (odds ratio ~9.8, P<.001), and GPT-4-simplified pathology reports raised comprehension scores (7.98 vs 5.23/10). Pooled empathy effect was large (SMD 1.02, 95% CI 0.44-1.60; k=4, N=2604). Satisfaction results were mixed; no study assessed long-term trust.

John Robert Bautista, Daniel Toshio Harrell +2

Would US adults use a blockchain-based app to hold and share their own health records? This cross-sectional online survey, fielded in August 2022 via Amazon Mechanical Turk, drew 913 respondents roughly matching US gender and race/ethnicity distributions, with structural equation modeling used to test a conceptual model combining the theory of reasoned action, privacy calculus, protection motivation theory, and regulatory uncertainty. Most were willing to use MediLinker to store and manage health information (76.7%), share it with providers (79.3%), and give consent for clinical research (78.4%). Attitude was directly associated with willingness; perceived liability and vulnerability acted indirectly through perceived risks. No path coefficients are reported in the abstract.

Nicholas Streicher

Which demographic, socioeconomic, and geographic factors predict patient portal activation among neurology patients? A cross-sectional study of 72,417 outpatient neurology patients at two Washington, DC academic medical centers on a shared EHR used multivariable logistic regression plus ward-, tract-, and ZIP-level American Community Survey correlations. Activation was 64.7% overall (46,851/72,417), ranging from 76.1% among non-Hispanic White to 55.0% among Hispanic patients; adjusted odds were lower for non-Hispanic Black (aOR 0.46), Hispanic (aOR 0.34), and non-Hispanic Asian (aOR 0.47) patients. Ward activation spanned 48.0% to 82.0% and correlated with educational attainment (r=0.95); racial gaps persisted within wards.

Serine Sahakyan, Selai Akseer +5

What shapes uptake of digital health technologies for remote management of noncommunicable diseases in rural settings? This mixed methods systematic review followed Joanna Briggs Institute methodology, searching Medline, Embase, and CINAHL from inception to February 12, 2026, and screening 1491 records to include 14 studies, 11 from high-income countries, with barriers and facilitators mapped to the Consolidated Framework for Implementation Research and quality appraised with the Mixed Methods Appraisal Tool. Barriers were technical instability, poor connectivity, financial constraints, and staff shortages; facilitators were usable design, leadership, teamwork, and communication. Evidence was predominantly qualitative; the abstract reports no effect sizes.

Donglan S Zhang, Kai Hong +8

Does switching from Medicare fee-for-service to Medicare Advantage change remote patient monitoring (RPM) use for hypertension? This cohort study used a difference-in-differences design with propensity score matching on 2016-2022 Medicare enrollment, FFS claims, and MA encounter data, following 281,620 matched beneficiaries aged 65 or older with hypertension who switched to MA in January 2019 or remained in FFS through 2022. Switching was associated with lower 2022 RPM adoption (value-based contract proxy: OR, 0.55; -0.63 percentage points; non-VBC: OR, 0.73), more clinician loss without replacement (OR, 1.27; 3.41 percentage points), and more hypertension-related hospitalizations (OR, 1.75 and 1.94; 1.56 percentage points).

A Jay Holmgren, Nate C Apathy +2

How are patient-initiated portal messages distributed across patients and physicians? This cross-sectional analysis combined records for 487,442 patients at UCSF Health with national EHR metadata from 224,068 ambulatory care physicians, examining medical advice request messages. The distribution was highly skewed at both levels: the top 5 percent of UCSF patients generated 52.8 percent of all messages, and primary care physicians nationally received a median of 9.6 messages per week versus 53.3 in the top quartile. Physicians with higher visit volume received fewer messages per visit, and higher message volume was associated with more EHR work outside work hours.

Kelly Gleason, Thomas Kidu +3

How can health systems test large language models on real patient portal messages without touching live EHR workflows? This technical feasibility tutorial describes a Python 3 web interface and modular backend running inside the institutional firewall on an NVIDIA GRID T4-1Q GPU, supporting single-message and batch tasks: authorship identification, categorization, criticality flagging, and response drafting with zero-, one-, and few-shot prompting. A deidentification pipeline validated against 110 manually adjudicated entities achieved 95.1% sensitivity and 82.1% precision. Use cases drew on an IRB-approved dementia-relevant corpus of 6941 medical advice request messages from 497 patients; token-based cost readouts were included. No comparative performance effect sizes are reported.

Khushi Kohli, Stephanie Wang +6

Do US counties with limited physical healthcare capacity also lack the broadband needed for telemedicine to substitute? This cross-sectional ecological analysis linked 3,133 counties across the 2017 National Neighborhood Data Archive (outpatient care centers, diagnostic labs, nursing/residential care), 2022 FCC Mapping Broadband Health in America data (split at the median 9.8% of households without broadband), and 2022 American Community Survey covariates, using t-tests and multivariable linear regression. Low-broadband counties had fewer outpatient care centers (10.46 vs. 11.91 per 100,000) and diagnostic labs (1.91 vs. 3.95 per 100,000; both P<0.001), plus higher poverty and rurality. Adjusted associations persisted (β = -0.045, -0.024, and -0.089).

Caglar Onal, Sezen O Onal

Is engagement with clinical digital health tools associated with psychological distress? This cross-sectional analysis pooled Health Information National Trends Survey cycles (HINTS 5, 2017-2020; HINTS 6, 2022; HINTS 7, 2024) covering 23 682 US adults (mean age 55 years; 59% female), with a composite engagement index spanning secure messaging, online test results, portal access, wellness apps, and device data transmission, and distress measured by the PHQ-4. In survey-weighted regression, higher engagement was associated with higher distress (\u03b2 = 0.51; 95% CI, 0.27-0.75; P < .001), against a mean PHQ-4 of 2.0. Associations were strongest for active behaviors—clinician messaging and app use—and persisted among those reporting good or better health.

Anita A Vashi, Liam Rose +3

Does centralizing appointment scheduling and adding same-day virtual clinician evaluation improve access after nurse triage? This retrospective quasi-experimental evaluation used difference-in-differences and event-study analyses of the VA Health Connect rollout across 18 regions from October 2018 to September 2024, drawing on 11,118,916 encounters (4,560,677 pre-, 6,558,239 post-modernization) from VA Corporate Data Warehouse, Telecare, CRM, and VSignals survey data. Same-day scheduling rose 14.3 percentage points (95% CI 10.1-18.5) and time from call to scheduled appointment fell 0.37 days, though time to completed appointment rose 2.9 days. Callers with no 7-day follow-up declined 2.3 points; ED visits, admissions, and costs were unchanged.

Liu, J. B., Chen, Y.-J. +4

What drives nonresponse to routinely collected patient-reported outcome measures? This retrospective cohort study used iterative mixed-effects logistic regression on all adults seen at five Mass General Brigham radiation oncology clinics over one year (12,214 patients, 71 providers, five clinics), modeling failure to ever complete the portal-administered PROMIS Global-10. Patient- and appointment-level response rates were 35.4% and 10.9%, with patient-level response varying nearly fivefold across clinics (12.8% to 66.2%). After adding provider- and clinic-level factors, sex, education, and employment became nonsignificant, while recent surgery (aOR 1.97) and time since diagnosis >12 months (aOR 0.46) persisted; later program launch (aOR 0.29) and higher historical collection rate (aOR 0.79) predicted lower nonresponse, and academic versus community setting did not.

Elizabeth Woodcock, Chris Profeta, Molly Siegel

What determines whether automated waitlists—tools that notify patients of earlier appointment openings—succeed in improving ambulatory access? A convergent, multisite mixed methods study surveyed 127 US health systems, 90 of which reported automated waitlist usage data, plus qualitative and quantitative data from 10 purposively sampled systems, analyzed using the Consolidated Framework for Implementation Research. High performers filled 38.8% (IQR 36.2%-45.7%) of appointments offered through the waitlist, and missed appointment rates were lower for waitlist-scheduled visits (3.1%, IQR 2.5%-4.8%) than for all appointments (6.6%, IQR 4.1%-9.9%). Flexible configuration, cross-functional governance, and leadership endorsement facilitated sustained use; specialty gatekeeping, clinician capacity, insurance requirements, and digital inequities limited reach.