Peer Review Policy

Health Nexus: Digital Health and Medical AI is committed to a rigorous, fair, timely, confidential, and independent peer-review process. Peer review is used to assess the originality, methodological quality, ethical integrity, transparency, clinical or public-health relevance, technical validity, and scholarly contribution of submitted manuscripts.

The journal applies a double-anonymous peer-review model as its standard review procedure. The identities of authors and reviewers are concealed from one another throughout the review process. Authors are therefore required to submit a separate title page and a fully anonymised manuscript.

Peer review supports editorial decision-making but does not transfer editorial responsibility to reviewers. The final decision on every manuscript rests with the Editor-in-Chief or an authorised handling editor acting under the journal’s editorial policies.

1. Scope of the Policy

This policy applies to original research articles, review articles, systematic reviews and meta-analyses, methodological articles, technical and software articles, implementation and evaluation studies, protocols, case studies, perspectives, commentaries, and other scholarly submissions considered by the journal.

Some invited content, including editorials, introductions, obituaries, announcements, and certain commissioned commentaries, may be assessed through editorial review rather than full external peer review. The review route used for such content will be determined according to its scholarly claims, evidentiary content, and potential effect on clinical, scientific, or public understanding.

Commissioned or invited status does not guarantee publication.

2. Double-Anonymous Review

Under the journal’s double-anonymous model:

  • Reviewers are not informed of the authors’ identities.
  • Authors are not informed of the reviewers’ identities.
  • The anonymous manuscript must not contain author names, affiliations, email addresses, acknowledgements, institutional logos, grant-holder details, or other identifying information.
  • Authors must remove identifying information from file names, document properties, tracked changes, comments, headers, and footers.
  • Self-citations should be written neutrally and should not disclose authorship.
  • Identifying declarations and acknowledgements should be supplied on the separate title page.

The editorial office will make reasonable efforts to preserve anonymity. However, complete anonymity cannot be guaranteed where authorship may be inferred from the subject matter, dataset, research setting, preprint, conference presentation, cited work, or other publicly available information.

Reviewers must not attempt to identify the authors. If a reviewer becomes aware of an author’s identity, the reviewer must inform the handling editor and disclose whether this knowledge creates an actual or perceived conflict of interest.

3. Initial Editorial Screening

All submissions undergo an initial editorial and technical assessment before external peer review. This assessment may consider:

  • Relevance to the journal’s aims and scope
  • Originality and potential scholarly contribution
  • Compliance with the selected article type
  • Completeness of the submission files and declarations
  • Quality and clarity of academic English
  • Adequacy of the research question and study design
  • Compliance with applicable reporting guidelines
  • Ethics approval, informed consent, and trial registration
  • Data, code, model, and materials availability
  • Authorship, funding, and conflict-of-interest disclosures
  • Disclosure of generative AI or AI-assisted technologies
  • Similarity, duplication, citation integrity, and potential publication misconduct
  • Compliance with the PSG Author–Date Citation Format

A manuscript may be returned for technical correction, transferred to a more appropriate article type, or declined without external review when it:

  • Falls outside the journal’s scope
  • Does not meet minimum scholarly or methodological standards
  • Lacks sufficient originality or relevance
  • Contains serious ethical, legal, or research-integrity concerns
  • Is insufficiently prepared for meaningful peer review
  • Does not provide adequate information to evaluate an AI, digital-health, clinical, or computational system
  • Makes clinical, safety, or performance claims unsupported by the study design

A decision not to send a manuscript for external review is an editorial decision and does not necessarily indicate research misconduct or a definitive judgement on the broader value of the work.

4. Assignment to a Handling Editor

Manuscripts that pass initial screening are assigned to an Editor-in-Chief, Deputy Editor, Associate Editor, Section Editor, or another suitably qualified academic editor.

The handling editor is responsible for:

  • Assessing whether external review is appropriate
  • Selecting independent and qualified reviewers
  • Evaluating reviewer reports
  • Requesting additional methodological, statistical, clinical, technical, ethical, or regulatory review where necessary
  • Recommending or issuing an editorial decision within the authority delegated by the journal
  • Managing conflicts of interest and maintaining confidentiality

An editor must decline or transfer responsibility for a manuscript where an actual, potential, or perceived conflict of interest could affect editorial independence.

5. Selection of Reviewers

Reviewers are selected on the basis of subject expertise, methodological competence, relevant publication experience, independence, availability, and ability to provide a constructive and timely assessment.

For research articles, review articles, systematic reviews, methodological articles, technical articles, protocols, and substantial clinical or policy studies, the journal normally seeks reports from at least two independent reviewers.

Additional reviewers may be invited when a manuscript requires expertise in more than one area, including:

  • Clinical medicine or specialist healthcare practice
  • Digital health and health informatics
  • Artificial intelligence, machine learning, or data science
  • Biostatistics and epidemiology
  • Qualitative and mixed-methods research
  • Software engineering or cybersecurity
  • Health economics or implementation science
  • Bioethics, law, regulation, or health policy
  • Patient safety, human factors, or health equity

The journal may proceed with one sufficiently detailed external report for a limited category of short, invited, highly specialised, or non-empirical submissions, provided that the handling editor considers the available assessment adequate. The editor may also conduct an additional substantive review.

6. Author-Suggested and Excluded Reviewers

Authors may suggest qualified reviewers when submitting a manuscript. Suggested reviewers should:

  • Have demonstrable expertise relevant to the manuscript
  • Be independent of the authors and their institutions
  • Have no recent collaborative, supervisory, financial, personal, or professional relationship with the authors
  • Not have been involved in the design, conduct, analysis, or preparation of the work
  • Use a verifiable institutional or professional email address where possible

Authors may also identify individuals whom they prefer not to review the manuscript and should provide a brief reason. Such requests will be considered but are not binding.

The editorial office retains sole responsibility for reviewer selection and is not required to invite author-suggested reviewers.

Authors must not provide fabricated reviewer identities, false contact details, or reviewer suggestions intended to compromise the independence of peer review. Evidence of peer-review manipulation may result in rejection and further action under the journal’s publication-ethics procedures.

7. Reviewer Invitations and Acceptance

Reviewer invitations provide sufficient information to allow the invited reviewer to evaluate:

  • Whether the manuscript falls within the reviewer’s expertise
  • Whether the reviewer can complete the review within the requested period
  • Whether any competing interest or prior involvement exists
  • Whether the reviewer can comply with confidentiality and ethical requirements

An invited reviewer should decline the invitation when:

  • The manuscript lies outside the reviewer’s competence
  • The reviewer cannot meet the requested deadline
  • A conflict of interest could affect or appear to affect the review
  • The reviewer has previously assessed the same manuscript for another journal and cannot provide an independent assessment
  • The reviewer has participated in the work or has confidential prior knowledge of it

Declining an invitation does not disadvantage a reviewer. Where appropriate, the invited reviewer may suggest alternative independent experts.

8. Reviewer Conflicts of Interest

Reviewers must disclose any relationship, activity, or interest that could influence—or reasonably be perceived as influencing—their assessment.

Potential conflicts may include:

  • Current or recent collaboration with an author
  • Employment at the same institution or within the same organisational unit
  • A recent supervisory, mentoring, student, or examiner relationship
  • Personal, familial, or close professional relationships
  • Direct academic rivalry or a serious professional dispute
  • Financial interests in a product, company, patent, licence, or technology discussed in the manuscript
  • Participation in a competing study or commercial development
  • Prior access to the manuscript or its underlying data
  • Strongly held intellectual, ideological, political, or institutional interests that may prevent objective assessment

The existence of a relationship does not automatically disqualify a reviewer. The reviewer must disclose it, and the editor will determine whether the review can proceed.

If a conflict becomes apparent after review has begun, the reviewer must stop the review and contact the editorial office immediately.

9. Confidentiality

Submitted manuscripts are confidential scholarly communications. Reviewers and editors must protect the manuscript, associated files, reviewer reports, author responses, data, code, images, and all information obtained through the review process.

Reviewers must not:

  • Share the manuscript or review materials with another person without prior editorial permission
  • Discuss the manuscript publicly or privately outside the authorised review process
  • Use unpublished information, ideas, methods, data, code, images, or results for personal, academic, institutional, or commercial advantage
  • Contact the authors directly concerning the manuscript
  • Retain manuscript files after the review process has concluded, except where retention is authorised by the journal
  • Upload confidential manuscript material to an external service that does not provide adequate confidentiality and data-protection safeguards

Reviewers who wish to involve a trainee, colleague, or co-reviewer must obtain prior permission from the handling editor. Any approved contributor must comply with the same confidentiality, conflict-of-interest, and ethical obligations, and their contribution must be disclosed to the editor.

10. Use of Artificial Intelligence by Reviewers and Editors

Reviewers and editors remain personally responsible for all assessments, recommendations, and decisions made during peer review. Artificial-intelligence systems cannot act as reviewers, editors, or decision-makers.

Reviewers and editors must not upload a submitted manuscript, figure, table, dataset, source code, reviewer report, author response, or other confidential material to a public or third-party generative AI system where confidentiality, data security, intellectual-property protection, and deletion cannot be assured.

Any proposed use of an AI-assisted tool in the review process requires prior written authorisation from the editorial office. Where use is authorised, the reviewer or editor must:

  • Identify the tool and version used
  • Explain the specific purpose for which it was used
  • Confirm that no confidential or identifiable data were exposed improperly
  • Verify independently the accuracy, completeness, and fairness of the output
  • Disclose the use of the tool to the journal
  • Accept full responsibility for the final review or decision

AI tools must not be used to replace expert judgement, fabricate reviewer comments, generate unsupported criticism, infer author identities, assess confidential patient information without authorisation, or make final recommendations.

11. Standards for Reviewer Reports

Reviewer reports should be independent, evidence-based, specific, constructive, respectful, and proportionate to the manuscript’s claims.

Reviewers should assess, where applicable:

  • Originality and significance of the research question
  • Relevance to the journal’s aims and scope
  • Appropriateness of the study design and methodology
  • Clarity of inclusion, exclusion, sampling, and data-collection procedures
  • Adequacy of statistical or qualitative analysis
  • Transparency of digital-health and AI methods
  • Separation of training, validation, and test datasets
  • Risk of data leakage, overfitting, spectrum bias, or selective reporting
  • Appropriateness of comparator systems and performance measures
  • Internal and external validation
  • Calibration, discrimination, clinical utility, and error analysis
  • Subgroup performance, fairness, and potential algorithmic bias
  • Reproducibility and availability of data, code, models, prompts, and materials
  • Clinical relevance, patient safety, and proportionality of claims
  • Ethical approval, informed consent, privacy, and data governance
  • Compliance with applicable reporting guidelines
  • Accuracy and completeness of citations and references
  • Whether the conclusions are supported by the results
  • Whether limitations and uncertainty are adequately acknowledged

Reviewers should distinguish between:

  • Essential revisions required for validity, ethics, transparency, or interpretation
  • Recommended revisions that would improve clarity or scholarly value
  • Optional suggestions reflecting personal preference

Reviewers should not require authors to cite the reviewer’s own publications unless those works are directly relevant and necessary. Requests for excessive, coercive, or irrelevant citation are prohibited.

Discriminatory, insulting, hostile, defamatory, or personally directed comments will not be transmitted to authors and may result in the reviewer being removed from the review process.

12. Confidential Comments to the Editor

Reviewers may provide confidential comments to the handling editor when necessary. Such comments may address:

  • Suspected plagiarism, duplication, data fabrication, image manipulation, or peer-review manipulation
  • Undisclosed conflicts of interest
  • Serious ethical, legal, privacy, or patient-safety concerns
  • Doubts about the authenticity of data, authorship, or institutional approval
  • Concerns that should not be disclosed immediately to the authors while an investigation is considered

The substantive scholarly reasons supporting a recommendation should normally appear in the comments intended for the authors. Reviewers should not provide a favourable report to the authors while privately recommending rejection for undisclosed reasons unrelated to a legitimate confidential concern.

13. Specialist, Statistical, and Technical Review

The journal may obtain additional specialist review at any stage of evaluation.

Examples include:

  • Statistical review of sample-size calculations, modelling, inference, missing-data procedures, or multiplicity
  • Technical review of software, source code, model architecture, cybersecurity, interoperability, or system performance
  • Clinical review of patient safety, diagnostic claims, treatment recommendations, or clinical workflow integration
  • Ethics or legal review of consent, privacy, data use, discrimination, liability, or regulatory compliance
  • Data or image-integrity review
  • Language or accessibility review where presentation prevents reliable assessment

Specialist review may supplement rather than replace the principal peer-review reports.

14. Editorial Decisions

Following assessment of the manuscript and available reviewer reports, the editor may issue one of the following decisions:

  • Reject without external review
  • Reject after peer review
  • Major revision
  • Minor revision
  • Accept subject to technical or editorial corrections
  • Accept

Reviewer recommendations are advisory. The editor evaluates the quality of the reports, the manuscript’s compliance with journal policies, the authors’ responses, and the overall evidentiary record.

The editor is not required to follow a numerical majority of reviewer recommendations. Where reports conflict, the editor may:

  • Evaluate the competing arguments directly
  • Request clarification from a reviewer
  • Invite an additional reviewer
  • Obtain specialist or statistical review
  • Issue a reasoned editorial decision based on the available evidence

Acceptance is not final until all substantive, ethical, technical, authorship, data, licensing, and production requirements have been satisfied.

15. Revision and Re-Review

Authors invited to revise a manuscript must submit:

  • A revised anonymous manuscript
  • A clean version and, where requested, a version showing changes
  • A detailed point-by-point response to each reviewer and editor comment
  • Revised supplementary files and reporting checklists where applicable
  • Updated declarations, data statements, figures, tables, code, or model documentation where necessary

Each comment should be reproduced and followed by the authors’ response. Where an author does not accept a requested change, the response should provide a clear, evidence-based explanation.

A revision invitation does not guarantee eventual acceptance.

Major revisions are normally returned to one or more original reviewers. Minor revisions may be assessed by the handling editor without further external review. The editor may invite new reviewers where the revised manuscript introduces substantial new methods, data, analyses, claims, or ethical considerations.

The journal may permit more than one revision round when further revision is likely to resolve clearly defined concerns. Repeated revision will not be used to prolong consideration of a manuscript that cannot meet the journal’s standards.

16. Review and Revision Timeframes

The journal aims to manage peer review efficiently while preserving the quality and independence of scholarly assessment.

Normal service targets are:

  • Initial editorial screening: approximately 5–10 working days
  • External reviewer report: approximately 21–28 days after acceptance of the invitation
  • First editorial decision after external review: normally within 4–6 weeks, subject to reviewer availability and manuscript complexity
  • Minor revision: normally 14 calendar days
  • Major revision: normally 30 calendar days

These are operational targets rather than guarantees. Highly specialised, interdisciplinary, technically complex, ethically sensitive, or substantially revised manuscripts may require additional time.

Authors and reviewers should contact the editorial office promptly when an extension is required. A manuscript may be closed or treated as withdrawn when a revision remains overdue and the authors do not respond to editorial communication.

17. Submissions by Editors and Editorial Board Members

Editors, editorial board members, reviewers, publisher employees, and individuals closely connected with the journal may submit manuscripts. Such submissions receive no preferential treatment.

Where an editor or board member is an author or has a relevant conflict:

  • The individual will have no access to reviewer identities or confidential editorial discussion beyond what is available to an ordinary author.
  • The manuscript will be assigned to an independent editor with no relevant conflict.
  • Reviewer selection and decision-making will be conducted independently.
  • The submitting editor or board member will not participate in the editorial decision.
  • The relationship will be disclosed in the published article where appropriate.

A guest editor may recommend a decision on a special-issue manuscript but must not exercise unchecked authority over final acceptance. The journal retains independent editorial oversight.

18. Special Issues and Thematic Collections

Manuscripts submitted to special issues, thematic collections, supplements, or conference-related collections are subject to the same standards of peer review, ethics, authorship, transparency, and editorial independence as regular submissions.

Guest editors must:

  • Declare relevant interests
  • Maintain confidentiality
  • Use independent and qualified reviewers
  • Recuse themselves from manuscripts involving collaborators, colleagues, students, supervisors, competitors, or other conflicts
  • Apply the journal’s policies consistently

The Editor-in-Chief or a designated independent journal editor retains authority to review, modify, or overturn a guest editor’s recommendation when required to protect research integrity and editorial independence.

19. Suspected Misconduct During Peer Review

Reviewers should alert the editor when they identify a reasonable concern involving:

  • Plagiarism or duplicate publication
  • Fabricated, falsified, or selectively reported data
  • Manipulated images, figures, or clinical records
  • Undisclosed use of data, code, or intellectual property
  • Inadequate ethics approval or consent
  • Fabricated references or citation manipulation
  • Authorship irregularities
  • Peer-review manipulation
  • Undisclosed financial or institutional interests
  • Unsafe or materially misleading clinical claims

Reviewers should report the concern confidentially and provide the basis for it. They should not conduct an independent investigation, contact the authors, notify the authors’ institution, or make public allegations.

The editorial office may pause peer review while a concern is assessed and may request original data, ethics documentation, authorship confirmation, image files, code, model records, or other supporting materials.

20. Reviewer Misconduct

Reviewer misconduct may include:

  • Breach of confidentiality
  • Undisclosed conflicts of interest
  • Misappropriation of unpublished ideas, data, code, or methods
  • Impersonation or delegation without permission
  • Fabricated review reports
  • Coercive citation requests
  • Discriminatory or abusive comments
  • Uploading confidential material to unauthorised AI systems
  • Deliberate obstruction or unreasonable delay
  • Collusion with authors or other reviewers

Where reviewer misconduct is substantiated, the journal may disregard the report, remove the reviewer from the database, notify relevant editors or institutions where justified, correct affected editorial records, or take other proportionate action.

21. Reviewer Identities and Review Reports

The journal does not routinely disclose reviewer identities to authors or publish reviewer identities with accepted articles.

Reviewer reports, author responses, and editorial correspondence are treated as confidential editorial records and are not ordinarily published.

The journal may use anonymised and aggregated information about peer-review performance for quality assurance, reviewer recognition, editorial training, or statistical reporting, provided that confidential manuscript information is protected.

22. Editorial Independence

Editorial decisions are based on the manuscript’s scholarly merit, methodological quality, ethical acceptability, relevance, transparency, and contribution to the journal’s field.

Commercial considerations, advertising relationships, institutional interests, author nationality, personal characteristics, political pressure, or the views of the journal owner must not determine acceptance or rejection.

The Editor-in-Chief has authority over editorial content and is responsible for protecting the independence and integrity of the journal’s decision-making process.

23. Appeals

Authors may appeal an editorial decision when they believe that a material error occurred in the review or decision-making process.

An appeal must:

  • Be submitted by the corresponding author
  • Be received within 30 calendar days of the decision
  • Identify the manuscript title and submission number
  • State the specific procedural, factual, methodological, or ethical basis of the appeal
  • Address the decision and reviewer comments professionally and point by point
  • Provide supporting evidence where applicable

General disagreement with the reviewers, dissatisfaction with rejection, or submission of a substantially rewritten manuscript does not by itself constitute a valid appeal.

Appeals are normally considered by an editor who was not primarily responsible for the original decision. The journal may obtain additional independent advice. One formal appeal is normally permitted for each manuscript, and the decision following appeal is final within the journal’s internal process.

24. Quality Assurance and Policy Review

The editorial office may evaluate reviewer timeliness, report quality, conflict-of-interest compliance, confidentiality, professionalism, and the consistency of editorial decisions.

Reviewers who repeatedly provide inadequate, late, conflicted, or unethical reports may no longer be invited.

This policy may be revised to reflect developments in publication ethics, medical publishing, artificial intelligence, data governance, peer-review practice, and applicable legal or regulatory requirements.