Bio


Dr. Ashley Griffin is a medical informatics postdoctoral research fellow at the Center for Primary Care and Outcomes Research at Stanford and the VA Palo Alto Health Care System Center for Innovation to Implementation. Her research focuses on the use of digital health technologies and patient-generated health data to support patients with multimorbidities. Dr. Griffin's research seeks to develop methods and tools that can empower patients to take an active role in their health and inform decision-making for the care team.

All Publications


  • Health information technology to support cancer survivorship care planning: A systematic review. Journal of the American Medical Informatics Association : JAMIA Mikles, S. P., Griffin, A. C., Chung, A. E. 2021

    Abstract

    The study sought to conduct a systematic review to explore the functions utilized by electronic cancer survivorship care planning interventions and assess their effects on patient and provider outcomes.Based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines, studies published from January 2000 to January 2020 were identified in PubMed, CINAHL, EMBASE, PsychINFO, Scopus, Web of Science, and the ACM Digital Library. The search combined terms for cancer, survivorship, care planning, and health information technology (HIT). Eligible studies evaluated the effects of a HIT intervention on usability, knowledge, process, or health-related outcomes. A total of 578 abstracts were reviewed, resulting in 60 manuscripts describing 40 studies. Thematic analyses were used to define meta-themes of system functions, and Fisher's exact tests were used to examine associations between functions and outcomes.Patients were the target end users for 18 interventions, while 12 targeted providers and 10 targeted both groups. Interventions used patient-reported outcomes collection (60%), automated content generation (58%), electronic sharing (40%), persistent engagement (28%), and communication features (20%). Overall, interventions decreased the time to create survivorship care plans (SCPs) and supported care planning knowledge and abilities, but results were mixed for effects on healthcare utilization, SCP sharing, and provoking anxiety. Persistent engagement features were associated with improvements in health or quality-of-life outcomes (17 studies, Pā€‰=ā€‰.003).Features that engaged users persistently over time were associated with better health and quality-of-life outcomes. Most systems have not capitalized on the potential of HIT to share SCPs across a care team and support care coordination.

    View details for DOI 10.1093/jamia/ocab134

    View details for PubMedID 34333588

  • Gender representation in U.S. biomedical informatics leadership and recognition. Journal of the American Medical Informatics Association : JAMIA Griffin, A. C., Leung, T. I., Tenenbaum, J. D., Chung, A. E. 2021; 28 (6): 1270-1274

    Abstract

    This study sought to describe gender representation in leadership and recognition within the U.S. biomedical informatics community.Data were collected from public websites or provided by American Medical Informatics Association (AMIA) personnel from 2017 to 2019, including gender of membership, directors of academic informatics programs, clinical informatics subspecialty fellowships, AMIA leadership (2014-2019), and AMIA awardees (1993-2019). Differences in gender proportions were calculated using chi-square tests.Men were more often in leadership positions and award recipients (Pā€‰<ā€‰.01). Men led 74.7% (n = 71 of 95) of academic informatics programs and 83.3% (n = 35 of 42) of clinical informatics fellowships. Within AMIA, men held 56.8% (n = 1086 of 1913) of leadership roles and received 64.1% (n = 59 of 92) of awards.As in other STEM fields, leadership and recognition in biomedical informatics is lower for women.Quantifying gender inequity should inform data-driven strategies to foster diversity and inclusion. Standardized collection and surveillance of demographic data within biomedical informatics is necessary.

    View details for DOI 10.1093/jamia/ocaa344

    View details for PubMedID 33555005

    View details for PubMedCentralID PMC8200259

  • Information needs and perceptions of chatbots for hypertension medication self-management: a mixed methods study. JAMIA open Griffin, A. C., Xing, Z., Mikles, S. P., Bailey, S., Khairat, S., Arguello, J., Wang, Y., Chung, A. E. 2021; 4 (2): ooab021

    Abstract

    Chatbots have potential to deliver interactive self-management interventions but have rarely been studied in the context of hypertension or medication adherence. The objective of this study was to better understand patient information needs and perceptions of chatbots to support hypertension medication self-management.Mixed methods were used to assess self-management needs and preferences for using chatbots. We purposively sampled adults with hypertension who were prescribed at least one medication. Participants completed questionnaires on sociodemographics, health literacy, self-efficacy, and technology use. Semi-structured interviews were conducted, audio-recorded, and transcribed verbatim. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using applied thematic analysis.Thematic saturation was met after interviewing 15 participants. Analysis revealed curiosity toward chatbots, and most perceived them as humanlike. The majority were interested in using a chatbot to help manage medications, refills, communicate with care teams, and for accountability toward self-care tasks. Despite general enthusiasm, there were concerns with chatbots providing too much information, making demands for lifestyle changes, invading privacy, and usability issues with deployment on smartphones. Those with overall positive perceptions toward chatbots were younger and taking fewer medications.Chatbot-related informational needs were consistent with existing self-management research, and many felt chatbots would be valuable if customizable and compatible with patient portals, pharmacies, or health apps.Although most were not familiar with chatbots, patients were interested in interacting with them, but this varied. This research informs future design and functionalities of conversational interfaces to support hypertension self-management.

    View details for DOI 10.1093/jamiaopen/ooab021

    View details for PubMedID 33898936

    View details for PubMedCentralID PMC8054030

  • Conversational Agents for Chronic Disease Self-Management: A Systematic Review. AMIA ... Annual Symposium proceedings. AMIA Symposium Griffin, A. C., Xing, Z., Khairat, S., Wang, Y., Bailey, S., Arguello, J., Chung, A. E. 2020; 2020: 504-513

    Abstract

    We conducted a systematic literature review to assess how conversational agents have been used to facilitate chronic disease self-management. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used. Literature was searched across five databases, and we included full-text articles that contained primary research findings for text-based conversational agents focused on self-management for chronic diseases in adults. 1,606 studies were identified, and 12 met inclusion criteria. Outcomes were largely focused on usability of conversational agents, and participants mostly reported positive attitudes with some concerns related to privacy and shallow content. In several studies, there were improvements on the Patient Health Questionnaire (p<0.05), Generalized Anxiety Disorder Scale (p=0.004), Perceived Stress Scale (p=0.048), Flourishing Scale (p=0.032), and Overall Anxiety Severity and Impairment Scale (p<0.05). There is early evidence that suggests conversational agents are acceptable, usable, and may be effective in supporting self-management, particularly for mental health.

    View details for PubMedID 33936424

    View details for PubMedCentralID PMC8075433

  • From Patient Engagement to Precision Oncology: Leveraging Informatics to Advance Cancer Care. Yearbook of medical informatics Griffin, A. C., Topaloglu, U., Davis, S., Chung, A. E. 2020; 29 (1): 235-242

    Abstract

    Conduct a survey of the literature for advancements in cancer informatics over the last three years in three specific areas where there has been unprecedented growth: 1) digital health; 2) machine learning; and 3) precision oncology. We also highlight the ethical implications and future opportunities within each area.A search was conducted over a three-year period in two electronic databases (PubMed, Google Scholar) to identify peer-reviewed articles and conference proceedings. Search terms included variations of the following: neoplasms[MeSH], informatics[MeSH], cancer, oncology, clinical cancer informatics, medical cancer informatics. The search returned too many articles for practical review (23,994 from PubMed and 23,100 from Google Scholar). Thus, we conducted searches of key PubMed-indexed informatics journals and proceedings. We further limited our search to manuscripts that demonstrated a clear focus on clinical or translational cancer informatics. Manuscripts were then selected based on their methodological rigor, scientific impact, innovation, and contribution towards cancer informatics as a field or on their impact on cancer care and research.Key developments and opportunities in cancer informatics research in the areas of digital health, machine learning, and precision oncology were summarized.While there are numerous innovations in the field of cancer informatics to advance prevention and clinical care, considerable challenges remain related to data sharing and privacy, digital accessibility, and algorithm biases and interpretation. The implementation and application of these findings in cancer care necessitates further consideration and research.

    View details for DOI 10.1055/s-0040-1701983

    View details for PubMedID 32823322

    View details for PubMedCentralID PMC7442514

  • Health Tracking and Information Sharing in the Patient-Centered Era: A Health Information National Trends Survey (HINTS) Study. AMIA ... Annual Symposium proceedings. AMIA Symposium Griffin, A. C., Chung, A. E. 2019; 2019: 1041-1050

    Abstract

    We examined the current state of digital health tracking and information sharing with health professionals among patients with chronic conditions using data from the National Cancer Institute's 2018 Health Information National Trends Survey (HINTS). Descriptive statistics were used to examine the characteristics of health tracking and information sharing, Chi-squared tests were used to compare across groups, and multivariate logistic regression models were used to control for covariates. Between 17.4-37.6% of respondents reported sharing information with a health professional through either e-mail, monitoring device, text message, or online medical record message. There were sociodemographic differences across health tracking and information sharing modalities, and patients with chronic conditions disproportionately lacked Internet access, a basic cell phone, smartphone, or tablet compared to those without chronic conditions (p<0.05). This suggests there are sociodemographic and technology-based disparities for health tracking and information sharing for patients with chronic conditions.

    View details for PubMedID 32308901

    View details for PubMedCentralID PMC7153080

  • Patient free text reporting of symptomatic adverse events in cancer clinical research using the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Journal of the American Medical Informatics Association : JAMIA Chung, A. E., Shoenbill, K., Mitchell, S. A., Dueck, A. C., Schrag, D., Bruner, D. W., Minasian, L. M., St Germain, D., O'Mara, A. M., Baumgartner, P., Rogak, L. J., Abernethy, A. P., Griffin, A. C., Basch, E. M. 2019; 26 (4): 276-285

    Abstract

    The study sought to describe patient-entered supplemental information on symptomatic adverse events (AEs) in cancer clinical research reported via a National Cancer Institute software system and examine the feasibility of mapping these entries to established terminologies.Patients in 3 multicenter trials electronically completed surveys during cancer treatment. Each survey included a prespecified subset of items from the National Cancer Institute's Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE). Upon completion of the survey items, patients could add supplemental symptomatic AE information in a free text box. As patients typed into the box, structured dropdown terms could be selected from the PRO-CTCAE item library or Medical Dictionary for Regulatory Activities (MedDRA), or patients could type unstructured free text for submission.Data were pooled from 1760 participants (48% women; 78% White) who completed 8892 surveys, of which 2387 (26.8%) included supplemental symptomatic AE information. Overall, 1024 (58%) patients entered supplemental information at least once, with an average of 2.3 per patient per study. This encompassed 1474 of 8892 (16.6%) dropdowns and 913 of 8892 (10.3%) unstructured free text entries. One-third of the unstructured free text entries (32%) could be mapped post hoc to a PRO-CTCAE term and 68% to a MedDRA term.Participants frequently added supplemental information beyond study-specific survey items. Almost half selected a structured dropdown term, although many opted to submit unstructured free text entries. Most free text entries could be mapped post hoc to PRO-CTCAE or MedDRA terms, suggesting opportunities to enhance the system to perform real-time mapping for AE reporting.Patient reporting of symptomatic AEs using a text box functionality with mapping to existing terminologies is both feasible and informative.

    View details for DOI 10.1093/jamia/ocy169

    View details for PubMedID 30840079

    View details for PubMedCentralID PMC6402312

  • Health and Fitness Apps for Hands-Free Voice-Activated Assistants: Content Analysis. JMIR mHealth and uHealth Chung, A. E., Griffin, A. C., Selezneva, D., Gotz, D. 2018; 6 (9): e174

    Abstract

    Hands-free voice-activated assistants and their associated devices have recently gained popularity with the release of commercial products, including Amazon Alexa and Google Assistant. Voice-activated assistants have many potential use cases in healthcare including education, health tracking and monitoring, and assistance with locating health providers. However, little is known about the types of health and fitness apps available for voice-activated assistants as it is an emerging market.This review aimed to examine the characteristics of health and fitness apps for commercially available, hands-free voice-activated assistants, including Amazon Alexa and Google Assistant.Amazon Alexa Skills Store and Google Assistant app were searched to find voice-activated assistant apps designated by vendors as health and fitness apps. Information was extracted for each app including name, description, vendor, vendor rating, user reviews and ratings, cost, developer and security policies, and the ability to pair with a smartphone app and website and device. Using a codebook, two reviewers independently coded each app using the vendor's descriptions and the app name into one or more health and fitness, intended age group, and target audience categories. A third reviewer adjudicated coding disagreements until consensus was reached. Descriptive statistics were used to summarize app characteristics.Overall, 309 apps were reviewed; health education apps (87) were the most commonly occurring, followed by fitness and training (72), nutrition (33), brain training and games (31), and health monitoring (25). Diet and calorie tracking apps were infrequent. Apps were mostly targeted towards adults and general audiences with few specifically geared towards patients, caregivers, or medical professionals. Most apps were free to enable or use and 18.1% (56/309) could be paired with a smartphone app and website and device; 30.7% (95/309) of vendors provided privacy policies; and 22.3% (69/309) provided terms of use. The majority (36/42, 85.7%) of Amazon Alexa apps were rated by the vendor as mature or guidance suggested, which were geared towards adults only. When there was a user rating available, apps had a wide range of ratings from 1 to 5 stars with a mean of 2.97. Google Assistant apps did not have user reviews available, whereas most of Amazon Alexa apps had at least 1-9 reviews available.The emerging market of health and fitness apps for voice-activated assistants is still nascent and mainly focused on health education and fitness. Voice-activated assistant apps had a wide range of content areas but many published in the health and fitness categories did not actually have a clear health or fitness focus. This may, in part, be due to Amazon and Google policies, which place restrictions on the delivery of care or direct recording of health data. As in the mobile app market, the content and functionalities may evolve to meet growing demands for self-monitoring and disease management.

    View details for DOI 10.2196/mhealth.9705

    View details for PubMedID 30249581

    View details for PubMedCentralID PMC6231786

  • Patient Portals: Who uses them? What features do they use? And do they reduce hospital readmissions? Applied clinical informatics Griffin, A., Skinner, A., Thornhill, J., Weinberger, M. 2016; 7 (2): 489-501

    Abstract

    Patient portals have demonstrated numerous benefits including improved patient-provider communication, patient satisfaction with care, and patient engagement. Recent literature has begun to illustrate how patients use selected portal features and an association between portal usage and improved clinical outcomes.This study sought to: (1) identify patient characteristics associated with the use of a patient portal; (2) determine the frequency with which common patient portal features are used; and (3) examine whether the level of patient portal use (non-users, light users, active users) is associated with 30-day hospital readmission.My UNC Chart is the patient portal for the UNC Health Care System. We identified adults discharged from three UNC Health Care hospitals with acute myocardial infarction, congestive heart failure, or pneumonia and classified them as active, light, or non-users of My UNC Chart. Multivariable analyses were conducted to compare across user groups; logistic regression was used to predict whether patient portal use was associated with 30-day readmission.Of 2,975 eligible patients, 83.4% were non-users; 8.6% were light users; and 8.0% were active users of My UNC Chart. The messaging feature was used most often. For patients who were active users, the odds of being readmitted within 30 days was 66% greater than patients who were non-users (p<0.05). There was no difference in 30-day readmission between non-users and light users.The vast majority of patients who were given an access code for My UNC Chart did not use it within 30 days of discharge. Of those who used the portal, active users had a higher odds of being readmitted within 30 days. Health care systems should consider strategies to: (1) increase overall use of patient portals and (2) target patients with the highest comorbidity scores to reduce hospital readmissions.

    View details for DOI 10.4338/ACI-2016-01-RA-0003

    View details for PubMedID 27437056

    View details for PubMedCentralID PMC4941855