Electronic Health Information System Research Articles

Outcomes of nephrostomy and double J stent in malignant ureteral obstruction in the Palestinian practice

BackgroundMalignant ureteral obstruction (MUO) is a serious health condition in which a malignant tumor compresses the ureter. The optimal decompressive intervention in MUO remains unclear. This study was conducted to assess and compare renal function, the occurrence of ureterohydronephrosis (UHN), intraoperative, and postoperative complications among patients with MUO who underwent double J stenting (DJS) and percutaneous nephrostomy (PCN) in the Palestinian practice.MethodsThis study was conducted in retrospective design in one of the main tertiary care hospitals in the West Bank of Palestine. The data were collected from the electronic health information system of the hospital for the patients with MUO who received either DJS or PCN as a decompressive intervention from January 2018 to January 2024.ResultsIn this retrospective analysis, 62 patients who had stage 2 to stage 4 cancer and suffered MUO were included. The mean age of the patients was 60.8 ± 13.6 years. Of the patients, 40 (64.5%) were male and 22 (35.5%) were female. Of the patients, 26 (41.9%) had urinary bladder cancer. Of the patients, 23 (37.1%) had flank pain and 16 (25.8%) had lower urinary tract symptoms. Of the patients, 34 (54.8%) experienced bilateral UHN and 28 (45.2%) experienced unilateral UHN. In this study, 43 patients (69.4%) received PCN, and 19 (30.6%) received DJS as a decompressive intervention. Of the patients, 36 (58.1%) suffered postoperative complications. Stent migration/slip, UTIs, and urosepsis were the most commonly reported postoperative complications. There were no statistically significant differences in the occurrence of intraoperative complications, postoperative complications, time elapsed from receiving the decompression intervention to the diagnosis of complications, ICU admission, prognosis of UHN, serum creatinine, and serum BUN between both decompressive interventions.ConclusionDespite improvements in renal functions, creatinine and BUN levels remained abnormal even after receiving a decompressive intervention. Postoperative complications were frequently reported among patients who received DJS or PCN as decompressive interventions. Larger prospective studies are still needed to determine the optimal interventions to improve outcomes, quality of life, and survival rates of patients with DJS or PCN.

Digital communication between mothers and community health workers to support neonatal health (CHV-NEO): study protocol for a randomized controlled trial

BackgroundProvision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver such interventions. We developed an interactive short message service (SMS) intervention for neonatal health in Kenya, named CHV-NEO. CHV-NEO sends automated, theory-based, actionable, messages throughout the peripartum period that guide mothers to evaluate maternal and neonatal danger signs and facilitate real-time dialogue with a CHW via SMS. We integrated this intervention into Kenya’s national electronic community health information system (eCHIS), which is currently used at scale to support CHW workflow.MethodsThe effect of CHV-NEO on clinical and implementation outcomes will be evaluated through a non-blinded cluster randomized controlled trial. Twenty sites across Kisumu County in Western Kenya were randomized 1:1 to provide either the national eCHIS with integrated CHV-NEO messaging (intervention) or standard of care using eCHIS without CHV-NEO (control). We will compare neonatal mortality between arms based on abstracted eCHIS data from 7200 pregnant women. Secondary outcomes include self-reported provision of essential newborn care (appropriate cord care, thermal care, and timely initiation of breastfeeding), knowledge of neonatal danger signs, and care-seeking for neonatal illness, compared between arms based on questionnaires with a subgroup of 2000 women attending study visits at enrollment in pregnancy and 6 weeks postpartum. We will also determine CHV-NEO’s effect on CHW workflows and evaluate determinants of intervention acceptability, adoption, and fidelity of use through questionnaires, individual interviews, and messaging data.DiscussionWe hypothesize that the CHV-NEO direct-to-client communication strategy can be successfully integrated within existing CHW workflows and infrastructure, improve the provision of at-home essential newborn care, increase timely referral of neonatal illness to facilities, and reduce neonatal mortality. The intervention’s integration into the national eCHIS tool will facilitate rapid scale-up if it is clinically effective and successfully implemented.Trial registrationClinicalTrials.gov, NCT05187897. The CHV-NEO study was registered on January 12, 2022.

Abstract C175: Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago

Abstract Background: Women constitute 50% of people living with HIV, and cervical cancer (CCA) is among the top cancers for incidence and mortality, in the Caribbean. Women living with HIV (WLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in WLWH. Objective: A preliminary quality improvement evaluation of pilot CCA screening (Pap smear) targeting WLWH in Trinidad and Tobago from July 2020 to September 2021. Methodology: The electronic health information system from a large clinic was used to abstract Pap testing data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 242 WLWH attended the women's clinic (WHC) from July 2020 to September 2021. The average age was 41.2 (age range: 20-72). Most (78.9%) reported sexual activity initiation between 15-29 years old, and 2 in 3 (66.1%) had sexual activity in the last 12 months. Among our participants, 67.8% were Afro-Caribbean, 20.7% were Mixed, and 5.8% were East Indian. The majority of WLWH completed at least secondary education (69.8%). Almost half were single (49.6%), and 59.5% were employed/self-employed. Additionally, 11.6% of patients reported a family history of CCA. The WHC provided Pap test to 91.7% of WLWH, 69.3% had normal Pap test results, 9.2% had abnormal Pap test results, and 0.4% were diagnosed with CCA in situ. Additionally, 8.6% found infections including Candida Albicans, Actinomyces, and Trichomoniasis. For those with abnormal Pap tests, timely follow-up care was provided to prevent further illnesses and cervical dysplasia. WLWH with cervical cancer in situ were scheduled/referred to treatments to prevent CCA progression. Discussion: A women’s clinic approach to CCA screening was successful in providing Pap tests and promoting timely diagnostic and therapeutic care to prevent CCA. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining and disseminating clinic-based CCA screening and HPV-related cancer prevention to reduce cancer-related morbidity and mortality among WLWH. Citation Format: Jonathan Edwards, Gaole Song, Selena Todd, Tessa Galindo, Sharon Soyer, Gregory Boyce, Kamilah Thomas-Purcell, Jarrett Sharlene, Diadrey-Ann Sealy, Kathy-Ann Pate-Robinson, Kimlin Ashing, Jeffrey Edwards, Nyla Lyons. Implementing cervical cancer screening services in women living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C175.

Abstract C178: Uptake of prostate cancer screening services in men living with HIV in Trinidad and Tobago

Abstract Background: Compared to other groups, Black men have a higher incidence and mortality of prostate cancer (PCa). Worldwide, the Caribbean region has one of the highest age-standardized PCa incidences with 76 cases per 100,000 population per year. PCa incidence in predominantly Afro-Caribbean countries ranges from 160 in Barbados to 304 men diagnosed per 100,000 in Jamaica. In Tobago, 10% of adult men over 40yrs were found to be diagnosed with PCa. Additionally, men living with HIV (MLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. Thus, in the Caribbean, there is a pressing need for clinic-based PCa screening in MLWH. Objective: A preliminary quality improvement evaluation of a prostate cancer screening (PSA test) program targeting MLWH in Trinidad and Tobago from January 2019 to May 2024. Methodology: The electronic health information system from a large clinic was used to abstract prostate cancer screening (PSA) delivery. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. According to NCCN guidelines, since most of our patients were Afro-Caribbean or Mixed, this study treated all MLWH aged < 75yrs as men with high risk and used 3 ng/mL as the threshold; the threshold was 4 ng/mL for MLWH >75yrs. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: Between January 2019 and May 2024, a total of 2,442 MLWH were eligible to participate in the PSA screening clinic. The average age was 54.0 (age range: 40- 90). 62.9% were Afro-Caribbean, 17.6% were Mixed, 7.4% were East Indian/Indian, and 0.6% were Caucasian. 45.6% of MLWH completed at least secondary education. 26.2% reported having steady partners and 82.5% reported their sexual orientation was heterosexual. Among all MLWH who attended the clinic, 2,127 (87.1%) were referred for PSA tests and 1,640 (77%) MLWH received their PSA tests. For PSA results collected from participants aged 40-75, 86.6% were ≤ 3 ng/mL and 13.4% were > 3 ng/mL. Additionally, among PSA results of participants aged over 75, 51.9% were < 4 ng/mL and 48.1% were ≥ 4 ng/mL. Discussion: To the best of our knowledge, this study is the first of its kind in the Caribbean region. Among MLWH, PSA screening rate was relatively high at 77%. Not too surprising, the PSA results showed 13% of men under 75 and almost 50% of men over 75 had elevated PSAs requiring confirmatory screening and follow-up. Hence, we conclude that a whole-person care approach that includes cancer prevention with prostate cancer screening can be effective. We thus recommend an implementation and dissemination science approach to create strategies for adopting, implementing, sustaining, and disseminating clinic-based prostate cancer-related prevention to reduce related morbidity and mortality among MLWH within the Caribbean and the Americas. Citation Format: Jonathan Edwards, Gaole Song, Gregory Boyce, Selena Todd, Sharon Soyer, Tessa Galindo, Kimlin Ashing, Jeffrey Edwards. Uptake of prostate cancer screening services in men living with HIV in Trinidad and Tobago [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C178.

Abstract C174: Examining cervical cancer screening rates among women living with HIV in Kajiado County, Kenya

Abstract Background: Kenyan women are disproportionately affected by HIV than their male counterparts, with a prevalence 5.5% compared to men whose prevalence is 2.9%. Women living with HIV (WLHIV) are more susceptible to cancer, in particular HPV-related cancers due to their immune-compromised status. In response, Kenyan Health Ministry recommends that women living with HIV (WLWH) be screened for cervical cancer annually by either visual inspection with acetic acid (VIA) or visual inspection with Lugol’s iodine (VILI), cytology and testing for HPV once every two years. Objective: Examining the rate of cervical cancer screening among women living with HIV (WLWH) in Kajiado County in 2022. Methodology: The electronic health information system was used to abstract data for WLWH in Kajiado county with 57 antiretroviral (ART) facilities. However, our analysis accessed data from 38 facilities whose data is captured in the health information system. Authorized health care workers from the County were requested to abstract redacted data from the health information system. No personal identifiers were collected from the system as away of protecting the privacy of individuals and abiding with the Kenya’s data protection law. Authorization to access the county was obtained from the county’s department of health while ethical approval was obtained from Mount Kenya University’s Institutional Scientific and Ethics Review Committee. Results: In 2022, a total of 16,827 people living with HIV were enrolled for care at the 38 ART selected sites. 11,785 (70%) were women with an age range of 15 to 49 years. A total of 3342 WLWH, representing 28.36% of the target population, were screened by using VIA. Of those screened, 3240 (97%) tested negative, 78 (2.3%) had positive results while 24 (0.7%) had suspicious lesions. Conclusion: Our analysis shows low reach of cervical cancer screening with only 28.36% of the targeted women being screened in 2022. The only available testing method (VIA) is less robust as compared to cytology and HPV testing. Thus, cervical cancer screening is underutilized, and importantly the available screening suffers fromWe also found a gap in reporting of HPV testing in the county. We thus recommend implementation science with community engagement examining the barriers to cervical cancer screening and HPV testing as well as timely reporting from multistakeholder e.g., system, provider, patient, family and advocate perspectives. This multisectoral health system-services approach will better inform research, practice and policy for effective HPV-related cancer prevention and control to reduce cancer-related morbidity and mortality among WLWH,. Citation Format: Caren Kamau, MS, Alice Njoroge,MS, Francis Makokha,PhD, Kimlin Ashing,PhD. Examining cervical cancer screening rates among women living with HIV in Kajiado County, Kenya [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C174.

Abstract C176: Implementing HPV vaccination services in people living with HIV in Trinidad and Tobago: COVID-19 vaccination may have boosted HPV vaccination

Abstract Background: Globally, Caribbean countries are among the most heavily burdened by both HIV and cervical cancer (CCA). People living with HIV (PLWH) are more susceptible and vulnerable to cancer due to their immune-compromised status. There is a pressing need for clinic-based CCA prevention in PLWH. Objective: A preliminary quality improvement evaluation of the vaccination program targeting PLWH in Trinidad and Tobago from October 2018 to May 2024. Methodology: The electronic health information system from a large clinic was used to abstract HPV vaccination data. No personal identifiers were collected from the system to protect the privacy of individuals and abide by Trinidad and Tobago’s data protection law. Evaluation of quality improvement of interventions approach was applied. Descriptive analyses were conducted using SPSS. Results: A total of 5,615 PLWH were eligible to participate in the HPV Vaccination clinic from October 2018 to May 2024. The average age was 39.6 (age range: 18- 51); 51.4% were women and 48.6% were men. Most (81.7%) PLWH reported their sexual orientation was heterosexual. Among our participants, 62.4% were Afro-Caribbean, 18.6% were Mixed, and 7.4% were East Indian/Indian. The majority of PLWH completed at least secondary education (69.8%). Half were single (50.5%), and 42.1% were employed/self-employed. Among these HPV vaccine-eligible persons, 1,157 patients (20.6%) received HPV vaccines. For those who had received vaccines, 254 patients (22.0%) were vaccinated with at least 1dose of the HPV vaccine, 301 (26.0%) were vaccinated up to dose 2 HPV vaccine, and 602 (52.0%) were vaccinated up to dose 3 HPV vaccine. Importantly, of those who received the HPV vaccine, the rate of uptake varied for each year. The uptake of HPV vaccine from January to May 2024 was 10.5% and in 2023 it was 18.5%. The highest uptake was in 2021 which was 22.4% followed by that in 2022 which was 20.3%. Between 2018 and 2020, the uptakes were 13.7% for 2020, 12.1% for 2019, and 5.3% for 2018. Discussion: Overall, the HPV vaccination rate for PLWH was relatively low; only 1 in 5 was vaccinated. Still, we saw an interesting trend with the highest vaccination uptake during the peak years of COVID-19 vaccinations. Hence, our data suggest that the COVID-19 vaccination program may have boosted HPV vaccination. Given our lessons learned, our goal is to seek funding for an implementation and dissemination science approach for adopting, implementing, and sustaining clinic-based HPV-related cancer prevention by bundling services such as Pap-Testing, PSA testing and/or co-vaccination (e.g., flu, shingles) to improve reach and uptake towards reducing cancer-related morbidity and mortality among PLWH. Citation Format: Tessa Galindo, Jonathan Edwards, Gaole Song, Sharon Soyer, Selena Todd, Gregory Boyce, Kimlin Ashing, Jeffrey Edwards. Implementing HPV vaccination services in people living with HIV in Trinidad and Tobago: COVID-19 vaccination may have boosted HPV vaccination [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C176.

Mapping the way: functional modelling for community-based integrated care for older people

BackgroundHealthcare system sustainability is challenged by several critical issues; one of the most pressing is the ageing population. Traditional, episodic care delivery models are not designed for older people who are medically complex and frail. These individuals would benefit from health and social care that is more comprehensive, coordinated, person-centred and accessible in the communities in which they live. Delivering this is a challenging endeavour. Community-based health and social care professionals are siloed, dispersed across various locations and sectors, each with their own mental models, electronic health information systems, and means of communication. To move away from fragmented care delivery models and towards a more integrated approach to care, an analysis of the process of community-based comprehensive geriatric assessment was conducted in an urban location in Atlantic Canada. The purpose of the study was to identify where in the community-based comprehensive geriatric assessment process challenges and opportunities existed for moving towards a more integrated model of care delivery.MethodThe functional resonance analysis method (FRAM) and dynamic FRAM (DynaFRAM) modelling were used to model the community-based health and social care system and create a hypothetical patient journey scenario. Data collected to inform modelling consisted of document review, focus groups, and semi-structured interviews with health and social care professionals providing care and service to older people in the community setting.Findings.Challenges and opportunities for implementing integrated care in the local context were identified. Findings from the FRAM and DynaFRAM analysis informed the co-design of multi-level process improvement recommendations that aim to move the local community-based comprehensive geriatric assessment process towards a more integrated model of care.ConclusionsA transformative redesign of community-based health and social care in the local context is necessary but cannot be accomplished without an understanding of how health and social care professionals conduct their work and how older people may receive care under the dynamic conditions. The FRAM and DynaFRAM modelling provided an enhanced understanding of system operations and functionality and demonstrated a critical step that should not be overlooked for decision-makers in their efforts to implement a more integrated model of care.

Strategies to promote patient-centeredness within the healthcare industry: A grey-based multicriteria decision making methods.

The international policy agenda has recently advocated for the development of patient-centeredness in healthcare service delivery. Consequently, various stakeholders in the healthcare systems have expressed a vital need for identifying strategies and tools that can enhance patient-centeredness. The objective of this paper was to prioritise and benchmark the strategies that can improve patient-centeredness in healthcare service delivery. We employed a multi-stage research scenario that consisted of two phases: a phase including of a scoping review to identify the current strategies to improve patient-centeredness (PC); And, a phase including of a multicriteria best-worst method to assign weights to PC principles, and a questionnaire administered to a sample of experts for benchmarking the strategies derived from the literature using the Grey Multi-Attributive Border Approximation Area Comparison (MABAC-G) method. The most important principle of patient-centeredness was deemed to be access to care, while telehealth tools and Electronic Health Information Systems were respectively suggested as the most efficacious platforms for promoting patient-centeredness. We recommend that administrators and policy makers in the healthcare industry prioritise the implementation and research of strategies such as telehealth tools and electronic health information systems to enhance access and patient-centeredness in the healthcare systems.

Cervical cancer prevention and care in HIV clinics across sub-Saharan Africa: results of a facility-based survey.

To eliminate cervical cancer (CC), access to and quality of prevention and care services must be monitored, particularly for women living with HIV (WLHIV). We assessed implementation practices in HIV clinics across sub-Saharan Africa (SSA) to identify gaps in the care cascade and used aggregated patient data to populate cascades for WLHIV attending HIV clinics. Our facility-based survey was administered between November 2020 and July 2021 in 30 HIV clinics across SSA that participate in the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We performed a qualitative site-level assessment of CC prevention and care services and analysed data from routine care of WLHIV in SSA. Human papillomavirus (HPV) vaccination was offered in 33% of sites. Referral for CC diagnosis (42%) and treatment (70%) was common, but not free at about 50% of sites. Most sites had electronic health information systems (90%), but data to inform indicators to monitor global targets for CC elimination in WLHIV were not routinely collected in these sites. Data were collected routinely in only 36% of sites that offered HPV vaccination, 33% of sites that offered cervical screening and 20% of sites that offered pre-cancer and CC treatment. Though CC prevention and care services have long been available in some HIV clinics across SSA, patient and programme monitoring need to be improved. Countries should consider leveraging their existing health information systems and use monitoring tools provided by the World Health Organization to improve CC prevention programmes and access, and to track their progress towards the goal of eliminating CC.

IT-Related Barriers and Facilitators to the Implementation of a New European eHealth Solution, the Digital Survivorship Passport (SurPass Version 2.0): Semistructured Digital Survey.

To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care centers representing 6 European countries and 3 distinct health system scenarios: (1) national electronic health information systems (EHISs) in Austria and Lithuania, (2) regional or local EHISs in Italy and Spain, and (3) cancer registries or hospital-based EHISs in Belgium and Germany. We aimed to identify and describe barriers and facilitators for SurPass (version 2.0) implementation concerning semiautomation of data input, interoperability, data protection, privacy, and cybersecurity. IT specialists from the 6 LTFU care centers participated in a semistructured digital survey focusing on IT-related barriers and facilitators to SurPass (version 2.0) implementation. We used the fit-viability model to assess the compatibility and feasibility of integrating SurPass into existing EHISs. In total, 13/20 (65%) invited IT specialists participated. The main barriers and facilitators in all 3 health system scenarios related to semiautomated data input and interoperability included unaligned EHIS infrastructure and the use of interoperability frameworks and international coding systems. The main barriers and facilitators related to data protection or privacy and cybersecurity included pseudonymization of personal health data and data retention. According to the fit-viability model, the first health system scenario provides the best fit for SurPass implementation, followed by the second and third scenarios. This study provides essential insights into the information and IT-related influencing factors that need to be considered when implementing the SurPass (version 2.0) in clinical practice. We recommend the adoption of Health Level Seven Fast Healthcare Interoperability Resources and data security measures such as encryption, pseudonymization, and multifactor authentication to protect personal health data where applicable. In sum, this study offers practical insights into integrating digital health solutions into existing EHISs.

A Study of Cerebral Venous Sinus Thrombosis with Special Reference to Newer Risk Predictors.

Cerebral venous thrombosis (CVT) is an uncommon and frequently unrecognized type of stroke that affects approximately five people per million annually, accounts for 0.5 to 1% of all strokes, and is more commonly seen in young individuals. The exact incidence of CVT in India remains unknown. The risk factors for venous thrombosis in general are linked classically to the Virchow's triad of stasis of the blood, changes in the vessel wall, and changes in the composition of the blood. There have been numerous studies evaluating long-term as well as short-term outcomes in the presence of these inflammatory mediators. They have been reported to be beneficial in predicting outcome and, hence, potentially in guiding management. Evaluation of prevailing risk factors associated with cerebral venous sinus thrombosis (CVST). Description of the distribution of newer inflammatory markers among the study population and their association with functional and neurologic outcome at 30 days following the occurrence of cerebral VST. Approval from the Institutional Review Board was obtained. Written informed consent was given by willing patients, explained in vernacular. Relevant details were obtained via a clinical history and laboratory values and imaging data obtained from the hospital's electronic health information system, which were then recorded in the proforma. No personal identifying data was collected. The sample size for this study was lower than originally planned, owing to the coronavirus disease 2019 (COVID-19) pandemic. The patients were called for follow-up after 1 month of the detection of VST, and their neurologic status was recorded on the Glasgow Coma Scale (GCS) and functional status on the modified Rankin Scale (mRS). Descriptive analysis of baseline characteristics was done. Mann-Whitney U and Kruskal-Wallis H tests of significant difference between means for nonparametric data were used. Linear regression was carried out on the variables found to differ significantly among subpopulations having good and poor neurologic outcomes. Receiver operating characteristic (ROC) curves were then derived for both outcome categories. The study enrolled 30 patients, with ages from 18 to 70 years, of which 19 (63.3%) were male and 11 (36.67%) were female. No risk factor was identified in 23.3% of cases. The most common risk factor was the presence of substance abuse. Among presenting features, headaches were the most common, followed by seizures and focal neurologic deficits (83.3, 30, and 23.3, respectively). Coexisting intraparenchymal hemorrhage was seen in 46.67% of patients, with the transverse sinuses most commonly involved (28.77%). The median neutrophil-to-lymphocyte ratio (NLR) was 3.415 [interquartile range (IQR) 2.634-5.637], with median platelet-to-lymphocyte ratio (PLR) 160.728 (IQR 107.728-227.776) and median systemic immune-inflammation index (SII) 1067.883 (IQR 509.694-1522.837). The NLR, PLR, and SII values were found to differ significantly among subgroups having good and poor neurologic outcome on the mRS. PLR and SII significantly differed among subgroups with venous involvement and among subgroups with good and poor neurologic status on GCS, on admission as well as 30-day follow-up. NLR, PLR, and SII values on admission showed a positive association with poor neurologic outcomes. Here, a significant correlation is seen between the values of complete blood count (CBC)-derived inflammatory markers on admission. Higher-powered studies are needed to assess the potential benefits of incorporating these markers in existing risk stratification models to improve their predictive accuracy.

The Red Cross Red Crescent Health Information System (RCHIS): an electronic medical records and health information management system for the red cross red crescent emergency response units

BackgroundThe Red Cross and Red Crescent Movement (RCRC) utilizes specialized Emergency Response Units (ERUs) for international disaster response. However, data collection and reporting within ERUs have been time-consuming and paper-based. The Red Cross Red Crescent Health Information System (RCHIS) was developed to improve clinical documentation and reporting, ensuring accuracy and ease of use while increasing compliance with reporting standards.Case presentationRCHIS is an Electronic Medical Record (EMR) and Health Information System (HIS) designed for RCRC ERUs. It can be accessed on Android tablets or Windows laptops, both online and offline. The system securely stores data on Microsoft Azure cloud, with synchronization facilitated through a local ERU server. The functional architecture covers all clinical functions of ERU clinics and hospitals, incorporating user-friendly features. A pilot study was conducted with the Portuguese Red Cross (PRC) during a large-scale event. Thirteen super users were trained and subsequently trained the staff. During the four-day pilot, 77 user accounts were created, and 243 patient files were documented. Feedback indicated that RCHIS was easy to use, requiring minimal training time, and had sufficient training for full utilization. Real-time reporting facilitated coordination with the civil defense authority.ConclusionsThe development and pilot use of RCHIS demonstrated its feasibility and efficacy within RCRC ERUs. The system addressed the need for an EMR and HIS solution, enabling comprehensive clinical documentation and supporting administrative reporting functions. The pilot study validated the training of trainers’ approach and paved the way for further domestic use of RCHIS. RCHIS has the potential to improve patient safety, quality of care, and reporting efficiency within ERUs. Automated reporting reduces the burden on ERU leadership, while electronic compilation enhances record completeness and correctness. Ongoing feedback collection and feature development continue to enhance RCHIS’s functionality. Further trainings took place in 2023 and preparations for international deployments are under way. RCHIS represents a significant step toward improved emergency medical care and coordination within the RCRC and has implications for similar systems in other Emergency Medical Teams.

Abstract 821: Uptake of cervical cancer screening services by women living with HIV in Kajiado County Kenya

Abstract Background: This project is an African Caribbean Cancer Consortium (AC3) facilitated study: Women living with HIV (WLHIV) are more susceptible to cancer due to their immune-compromised status. The Kenya Ministry of Health recommends that women diagnosed with HIV should be screened for cervical cancer annually by either visual inspection with acetic acid (VIA) or visual inspection with Lugol’s iodine (VILI), cytology and testing for HPV once every two years. Objective: We determined the uptake of cervical cancer screening and HPV testing by women living with HIV (WLHIV) in Kajiado County in 2022. Methodology: The electronic health information system was used to abstract data for WLHIV in Kajiado county. Kajiado county has 57 antiretroviral (ART) facilities. However, our analysis accessed data from 38 facilities whose data is captured in the health information system. Authorized health care workers from the county were requested to abstract redacted data from the health information system. No personal identifiers were collected from the system as a means of protecting the privacy of individuals and abiding with the Kenya’s data protection law. Authorization to access the county was obtained from the county’s department of health while ethical approval was obtained from Mount Kenya University’s Institutional Scientific and Ethics Review Committee. Results: A total of 16,827 people living with HIV were enrolled for care at the 38 ART selected sites in 2022. Out on the total population that was enrolled for care, 11,785 (70%) were women with an age range of 15 to 49 years. A total of 3342 WLHIV, representing 28.36% of the target population, were screened by using visual inspection with acetic acid (VIA). Data for other methods of screening and HPV testing was not available in the health information systems. Of those screened, 3240 (97%) tested negative, 78 (2.3%) had positive results while 24 (0.7%) had suspicious lesions. Conclusion: Our analysis shows low uptake of cervical cancer screening services with only 28.36% of the targeted women being screened in 2022. The only available testing method (VIA) is less robust as compared to cytology and HPV testing. We also found a gap in reporting of HPV testing in the county. We thus recommend implementation science research examining the systemic barriers to HPV testing and reporting to better inform best practice HPV-related cancer prevention and control policy and practice to reduce cancer-related morbidity and mortality among WLHIV. Citation Format: Caren Kamau, Alice Njoroge, Francis Makokha, Kimlin T. Ashing. Uptake of cervical cancer screening services by women living with HIV in Kajiado County Kenya [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 821.

Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model.

IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. This study aimed to assess HEWs' intentions to use the eCHIS for health data management and service provision. A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs' intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (β=0.256; P=.007), self-expectancy (β=0.096; P=.04), social influence (β=0.203; P=.02), and hedonic motivation (β=0.217; P=.03) were significantly associated with HEWs' intention to use the eCHIS. HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.

Effects of Health Records Management on Health Service Delivery: A case study of the Prestea Government Hospital. (PGH)

Background: The most crucial instrument when discussing patient healthcare are medical records. Both their management and their utilization are crucial for patient care management. Ghana has used many medical records management systems to aid in healthcare development. Retrospective and epidemiological investigations are slowed down by poor data quality, which inhibits research. As expectations have grown, more initiatives to capture and save patient records electronically are planned. Aim: The purpose of the study is to investigate the perception of health worker about the EHRs use and impact on service delivery. Materials and methods: The study's focus is on the health workers at Prestea Government Hospital (PGH), which include nurses, physicians, biotechnologists, Health Information Manager, pharmacists, midwives, etc. A sample size of 100 people from the intended audience was used. Standardized questionnaires were self-completed by respondent. The Completed questionnaires were given numbers to protect participants anonymity. Participants received sufficient information regarding their right to decline study participation and to withdraw at any time without repercussions. Data was entered into Excel and exported to SPSS for analysis. Descriptive and inferential analysis was performed and the outcomes were shown as tables, graphs, and figures. Results: In all, out of 100 respondents, 35% of them were males and 65% were women. There were a lot of female replies since many of the respondents were nurses. Medical laboratory technicians comprised the smallest proportion of the workforce (5%) of all occupational groups. Prestea Government Hospital survey respondents overwhelmingly concur that electronic health records (EHRs) aid in the delivery of treatment. According to a survey, medical practitioners think the facility's EHR has all of the forms that are utilized there. The idea that the facility's EHRs help with data collection is accepted by few people. Medical professionals believe that the use of EHRs makes it simple to obtain historical patient data. This is so that all information may be easily accessed while undergoing medical treatment and kept securely saved. The system features alarms that play when erroneous data is entered. Although the system features pre-programmed commands that allow for uninterrupted navigation, there are frequently disruptions due to power fluctuations. Conclusion: Access to patients' medical records via an electronic health information system platform is crucial for making medical decisions that will result in effective care delivery in healthcare facilities, lower the risk of treatment errors, decrease patient waiting times, and lower the number of medical errors, a study has found.

On the Innovative World of Care: Unveiling the Lived Experiences of Nurses in Using an Electronic Health Information System

As healthcare systems worldwide continue to undergo digital transformation, the integration of health informatics has become pivotal in enhancing patient care, communication, and overall healthcare efficiency. The purpose of this descriptive phenomenological study was to explore and understand the experiences of staff nurses using an electronic health information system. A purposive sample of 14 senior nurses were interviewed. Using Collaizzi (1978) phenomenological method, rigor was established through application of verification, validation, and validity. From 205 significant statements, 15 cluster themes emerged. The experiences of staff nurses in employing the electronic information system included struggles during the initial encounter with the new electronic health information system, working with IT support, workflow disruption, issues regarding limited devices and internet connection, need for training, and having staff pay for errors committed. Their means of coping with the challenges of their experiences focused on recognizing workflow efficiency as perceived benefit, changes in the protocol for improvement, support from superiors and hospital management, as well as collaboration and coordination with others. The insights that staff nurses wanted to share with their peers and the nursing practice in general were personal alignment and resilience, upgrading the system, enhancing staff competency, and meeting workforce demands. Nurses adapting to a new electronic health information system echo wider healthcare's digital hurdles. Let's learn from their struggles and resilience to prioritize user-friendly designs, accessible technology, and robust training. This empowers and supports our essential nurses, paving the way for successful health informatics.

Users involvement in the electronic health information systems development process in Uganda: what is missing in relation to requirements gathering and analysis

Abstract User involvement in the electronic health information systems (eHIS) development process is crucial for gathering and analysing requirements that accurately reflect user needs. This is because their involvement is linked to the gathering and analysis of requirements that align with user needs. However, several studies reveal that there is still limited user involvement during these crucial phases, leading to the development of ineffective and inefficient systems that do not reflect user needs. Thus, this study explored how users were involved in the requirements gathering and analysis phases during eHIS development, with an aim of identifying the missing elements that hindered the design of more effective and effective eHIS. A cross-sectional survey, encompassing secondary and primary users, explored their involvement in the requirements gathering, analysis and design phases, using both open-ended and close ended questionnaires. Respondents (n = 140) were purposively selected from 20 organizations in northern and central Uganda. Data were cleaned and analysed using Microsoft Excel. The findings revealed a dominant use of a top-down approach, favouring the capture of high-level requirements at the Ministry of Health level, and among implementing partners. However, less attention was given to gathering and analysing requirements from facility-level users. Even when collected, primary users reported that their opinions and recommendations were often ignored/disregarded, resulting in eHIS designs with usability-related challenges. This study underscores the critical need for active user involvement in the early stages of eHIS development to ensure alignment with user needs and work practices.

Acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia: a retrospective cross-sectional observational study

BackgroundThe electronic community health information system has been increasingly developed and deployed to quantify and support quality health service delivery by community health workers in Ethiopia. However, the success and failure of the electronic community health information system depend on the acceptability and use by its users. This study assessed the acceptability and use of the electronic community health information system and its determinants among health extension workers in Ethiopia.MethodsA retrospective cross-sectional observational study was conducted among 587 randomly selected health extension workers from six regions of Ethiopia. The Revised Technology Acceptance Model was used as a theoretical framework for the study. Descriptive statistics, structural equation modeling, and principal component analysis techniques were used to analyze the data. For all significance tests, multiple comparison adjustments were made using the Bonferroni Correction Method.ResultsThere was near universal acceptance of the electronic community health information system, ranging from 94.4 to 97.4% among health extension workers. However, actual use of the system was considerably lower, at 50%. Perceived usefulness of the electronic community health information system had a direct and positive effect on acceptability (β3 = 0.415, p < 0.001). Perceived ease of use had both direct and indirect positive effects on electronic community health information system acceptability (β2 = 0.340, p < 0.001 and β1*β3 = 0.289, p < 0.001, respectively), while acceptability had a direct and positive effect on the use of the electronic community health information system (β3 = 0.297, p < 0.001).ConclusionsDespite the very high acceptability of the electronic community health information system among health extension workers, actual use of the system is considerably lower. Hence, an integrated and coordinated approach is required to close the acceptance-use gap.

The Adoption of Information System Technology in Piloting the Current State of Health Institution in Tier Three Nations

This article is a pragmatic approach on the evaluation and implementation of the health information system as directed in assisting medical institutions to store patients’ health record in an electronic based method. In order to manage lots of information, the health information system comes in handy to sort data, processes and people. The system which consists of a set of interrelated components gathers, stores, and disseminates health or organizational related information of individuals working in the same health sector. All around the world the applications of digital health technology have become vital tools of modern information technology which has aided in the smooth and efficient delivery of quality healthcare. Studies have shown that the success of the electronic health information system implementation in developing countries is still low, and various reasons have however been identified as the cause of this poor outcome. This article is a pragmatic approach on the evaluation of information system technology adoption in the Nigerian health sector. The work focuses on factors that will determine the successful implementation of the health information system in health institutions in Nigeria, and how these factors can be enhanced using the Information System Quality Dimensions (Service Quality, System Quality, and Information Quality) as findings from this study show that attention should be on updating and upgrading the Information System quality dimensions (service Quality, Information Quality, and System Quality) since it reveals that there is a high dependence on these dimensions to bridge the research gap; as results show that there is an overall correlation between the analyzed variables.

National routine data for low birthweight and preterm births: Systematic data quality assessment for United Nations member states (2000-2020).

Low birthweight (<2500 g) and preterm birth (<37 weeks) are markers of newborn vulnerability. To facilitate informed decisions about investments in prevention and care, it is imperative to enhance data quality and use. Hence, the objective of this study is to systematically assess the quality of data concerning low birthweight and preterm births within routine administrative data sources. Systematic data quality assessment by adopting the WHO Data Quality Framework. National routine data system from UN member states. Livebirths. National routine administrative data on low birthweight and preterm births for 195 countries from 2000 to 2020 were systematically collated, totalling >700 million live births. The WHO data quality framework was adapted to undertake standardised data quality assessments. Availability, reporting quality, internal and external consistency of low birthweight and preterm data. Most United States Member States (64%: 124/195) had national data on low birthweight and (40%: 82/195) had data on preterm birth. Routine data system reporting was highest in North America, Australasia and Europe, where more than 95% live births had data on low birthweight and over 75% had data preterm births. In contrast,data reporting was lowest in sub-Saharan Africa (13% for low birthweight, 8% for preterm births) and Southern Asia (16% for low birthweight, 5% for preterm births). Most countries collect individual-level data; but, aggregate data reporting from hospital-based systems remain common in sub-Saharan Africa and Southern Asia. While data quality was generally high in North America, Australasia and Europe, gaps remain in the availability of gestational age metadata. Consistency between low birthweight and preterm rates were poor in Southern Asia and sub-Saharan Africa regions across time. There was high external consistency between low birthweight rates obtained from routine administrative data compared with low birthweight rates obtained from survey data for countries with highdata quality. Sub-Saharan Africa and South Asia countries have data gaps but also opportunities for rapid progress. Most births occure in facilities, electronic health information systems already include low birthweight, and adding accurate gestational age including with ultrasound assessment is becoming increasingly attainable. Moving toward the collection of individual level data would enable monitoring of quality of care and longer-term outcomes. This is crucial for every child and family and essential for measuring progress towards relevant sustainable development goals. The assessment will inform countries' actions for data quality improvement at national level and use of data for impact.