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Medical Epidemiology

Laboratory of Medical Informatics

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The laboratory conducts research on how new technologies and new media (specifically social media, apps for smartphone and tablets, digital health andweb 2.0 tools) impact on health professionals’ education and updating and which implications they have on the disease prevention and care of patients. The laboratory is also involved in studies on the use of social media as a tool to communicate and promote health, specifically by hospitals, medical centres, and health organizations. Moreover, research activity includes highly specialized lectures, seminars and courses for health professionals’ and health communicators’ education and updates on the use of digital health, digital therapeutics, social media, and web 2.0 tools.


Survey on the Use of Health Apps and Wearables Among Patients

The Laboratory of Medical Informatics, together with the Laboratory of Medical Research and Consumer Involvement, collaborated with the Digital Health Innovation Observatory of the Milan Polytechnic Institute. The laboratory coordinated and conducted the survey "Digital Innovation of Health and Care: Insights from the Italian Associations for Patient Advocacy". The survey collected and analyzed the point of view of patient association representatives on the impact, use and obstacles of new digital technologies for health, with particular reference to health apps and wearables (such as wristbands and smartwatches). The main results, published in 2018, illustrate that these tools offer new opportunities to involve patients in the various processes concerning the management and knowledge of their state of health. Health apps providing information and services, and those facilitating drug compliance are the most used. Their use, however, especially for medical purposes, is limited, as patients - and patients' associations - are waiting for more evidence showing their real efficacy as well as interventions that make their use easier. Use of Social Media by Italian Local Authorities as a Means to Communicate and Promote Health The use of social media by the Italian local health authorities for health communication is still limited to experiences of little importance, as shown by some research groups. In a project conducted by the Laboratory of Medical Informatics (in collaboration with the Univiersity of Cagliari), the aim was to investigate how much and in what manner the Italian local health authorities use social media for health communication and promotion. Results have shown that Facebook, YouTube, Twitter, Instagram, and LinkedIn are currently used respectively by 47%, 38%, 33%, 9%, ad 6% of the 101 Italian local health authorities. Most of the communicated information is related to the launch of articles published on the official website. In only a few cases social media are used for health promotion purposes. On average, they use 2 social media accounts opened on different social media sites (11% of them at least 3).

Survey on the of social media tools and health apps for smartphones and tablets among Italians

The laboratory is involved in surveys whose aim is to describe how physicians and health professionals are using social media tools (with particular interest in Facebook, Twitter, and YouTube) and medical applications for smartphones and tablets. Similar types of surveys have been conducted in collaboration with the ANMCO (Italian Society of Cardiologists) and SIU (Italian Society of Urologists) to discover how these tools are used by Italian cardiologists and urologists. A recent survey of 965 Italian physicians (26% general practitioners or paediatricians, and 74% other healthcare professionals) shows that Facebook, Twitter, LinkedIn, YouTube, and Instagram are used respectively by 52%, 16%, 37%, 77%, and 21% of respondents, but only one of three (respectively 15%, 6%, 25%, 26%, and 2%) use them for their work. On average, the physicians declared using 2 social media accounts on different social media sites. To communicate with their patients, 84% reported using e-mail systems, 64% WhatsApp, and 60% SMS.

Survey On The Of Social Media Tools Among Italian Physical Therapists

A new survey on the use of social media tools was conducted in 2018 among 477 Italian physical therapists who are members of the National Italian Society of Physical Medicine and Rehabilitation (SIMFER). Preliminary results show that Facebook, Twitter, LinkedIn, and YouTube are used, respectively by 67%, 21%, 45%, and 87% of respondents, but only a minority of them use these tools for their work. Instagram (30%), Pinterest (12%), and Telegram (13%) are other social media sites used by the responders. To communicate with their patients, 87% reported using e-mail systems, 64% WhatsApp, and 50% SMS.

Training activities

The laboratory is involved in training activities on issues related to the use of digital health, digital therapeutics, health apps, social media, and web 2.0 technologies in medicine. The training activity is addressed to health professionals and health communicators. The members of the laboratory staff held (or attended as invited teachers) a number of training courses, workshops, and master courses. Onsite CME courses for Italian physicians are also delivered using the training/educational facilities and equipment available at the Mario Negri Institute.

Introduction to digital therapeutics in Italy

Digital therapeutics are software tools that are based on changes in behaviors or lifestyles and on the application of cognitive-behavioral therapies through the implementation of clinical guidelines and programs. Unlike other digital medicine tools that focus on diagnosis and support for disease management, and unlike digital health tools that focus on several aspects of health and well-being, the aim of digital therapeutics is to treat diseases. The effectiveness and efficacy of digital therapies is studied by using the methodology of randomized clinical trials, in analogy to what happens for the study of traditional drugs. Similarly, digital therapeutics are approved and regulated by regulatory agencies (such as Food and Drug Administration - FDA - and European Medicines Agency - EMA), prescribed by doctors and reimbursed by the National Health Systems or by insurance companies. Several dozen digital therapeutics have already been approved worldwide. In Italy, they are struggling to take off due to a cultural backwardness on this topic as well as on digital transformation, and due to the lack of rules capable of governing the phenomenon. Over the last year, the Laboratory of Medical Informatics has contributed, together with over 40 leading professionals from the academic, regulatory, clinical, scientific, and economic field, to developing a white paper titled “Digital Therapeutics: an opportunity for Italy” (available as of today only in Italian with the title “Terapie digitali: un'opportunità per l'Italia”)to introduce digital therapeutics in Italy from several points of view, including the research, the regulation, the prescription and the possible reimbursement.

Systematic review and Meta-analysis on the efficacy of digital health tools in the management of HIV

The Laboratory of Medical Informatics, together with the Laboratory of Lifestyles Epidemiology, conducted a systematic review of the scientific literature and several meta-analyses on randomized clinical trials aimed at measuring the efficacy of digital health tools in improving outcomes in patients with HIV or those at risk of become HIV patients. Out of 145 studies identified, 73 concerned the use of communication tools such as SMS, 43 the use of web-based platforms/systems, 14 the use of social media platforms, 10 the use of videos and 5 the use of smartphone apps. Of the 145 studies identified, 44 had as the main outcome the adherence to treatment with antiretroviral therapy (ART), 30 the use of condoms, 28 the execution of HIV tests, 20 the improved knowledge on issues related to HIV and AIDS, 15 the retention in care and 8 the quality of life. The meta-analyzes conducted on these trials demonstrated the greater efficacy of digital health tools in favoring the compliance to ART treatment (RR = 1.14, 95% CI 1.05-1.24). Among the tools used, the most effective were those based on communication tools such as SMS (RR = 1.14, 95% CI 1.04-1.25). The digital health tools have also proved effective in favoring the execution of HIV tests among people at risk (RR = 1.92, 95% CI 1.43-2.58) and partially effective in improving knowledge on issues related to HIV and AIDS (SMD = 3.28, 95% CI -0.12-6.67).

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