Electronic Information Systems Research Articles

German Patient Blood Management Network: effectiveness and safety analysis in 1.2 million patients

BackgroundPatient Blood Management (PBM) is a patient-centred, systematic, evidence-based approach to improve patient outcomes by managing and preserving a patient's own blood whilst promoting patient safety and empowerment. The effectiveness and safety of PBM over a longer period have not yet been investigated. MethodsWe performed a prospectively designed, multicentre follow-up study with non-inferiority design. Data were retrospectively extracted case-based from electronic hospital information systems. All in-hospital patients (≥18 yr) undergoing surgery and discharged between January 1, 2010 and December 31, 2019 were included in the analysis. The PBM programme focused on three domains: preoperative optimisation of haemoglobin concentrations, blood-sparing techniques, and guideline adherence/standardisation of allogeneic blood product transfusions. The outcomes were utilisation of blood products, composite endpoint of in-hospital mortality and postoperative complications (myocardial infarction/ischaemic stroke/acute renal failure with renal replacement therapy/sepsis/pneumonia), anaemia rate at admission and discharge, and hospital length of stay. ResultsA total of 1 201 817 (pre-PBM: n=441 082 vs PBM: n=760 735) patients from 14 (five university/nine non-university) hospitals were analysed. Implementation of PBM resulted in a substantial reduction of red blood cell utilisation. The mean number of red blood cell units transfused per 1000 patients was 547 in the PBM cohort vs 635 in the pre-PBM cohort (relative reduction of 13.9%). The red blood cell transfusion rate was significantly lower (P<0.001) with odds ratio 0.86 (0.85–0.87). The composite endpoint was 5.8% in the PBM vs 5.6% in the pre-PBM cohort. The non-inferiority aim (safety of PBM) was achieved (P<0.001). ConclusionsAnalysis of >1 million surgical patients showed that the non-inferiority condition (safety of Patient Blood Management) was fulfilled, and PBM was superior with respect to red blood cell transfusion. Clinical trial registrationNCT02147795.

Accuracy of GNSS Position Stored in Fishing Boat Location Transmitters in Comparison with That of DGPS Position

Fishing boat laws in Korea require fishing boats to be equipped with a location transmitter. Approximately 91% of registered fishing boats have V-pass terminals, whereas those with a gross tonnage of 10 t or more have either V-pass or automatic identification system (AIS) terminals (or use both). Most navigators, including the fishing boat location transmitter, rely on the satellite signals provided by the global navigation satellite system (GNSS) without considering the accuracy of the navigation instruments that indicate ship location. Many scholars are conducting research to analyze the accuracy of GNSS locations through continuous experiments; however, few of them focus on fishing boat location transmitters. Particularly, the location accuracy of V-pass equipment is unknown. Notably, the V-pass and AIS terminals used in fishing boats are mainly designed to locate fishing boats in need of assistance following a marine accident rather than to provide information on approaching ships and preventing collisions. Therefore, this study aimed to compare GNSS location storage data extracted from the location transmitter (V-pass and AIS terminal) of the accident fishing boat with the DGPS location information from the Electronic Chart Display and Information System to check the position error and use it for accident analysis and investigation.

Adherence to evidence-based guidelines for the management of pneumonia in a tertiary teaching hospital in Riyadh

BackgroundAdherence to therapeutic guidelines is crucial when treating pneumonia, as it reduces mortality rate, length of hospital stay and duration of antibiotic therapy. However, the high non-adherence rate to treatment guidelines, in general, and to the Infectious Disease Society of America (IDSA) guidelines, are still reported globally. According to our knowledge, no existing data is available regarding the rate of physicians' adherence to the IDSA guidelines for managing pneumonia in Saudi Arabia. Therefore, we aim to assess the adherence rate and the clinical outcomes among patients treated according to the IDSA guidelines, in a tertiary care center in Riyadh. MethodsA single-centered, retrospective, cross-sectional, observational study was conducted at King Khalid University Hospital, Riyadh, Saudi Arabia. All data were extracted from the hospital's electronic information system, known as Esihi. Adult patients (≥18 years old) diagnosed and treated in the hospital for community-acquired pneumonia, hospital-acquired pneumonia, or ventilator-associated pneumonia from Nov 2019 to Nov 2021 were included. ResultsA total of 148 patients were included in this study, and the management of 50% of them (74 patients) adhered to the guidelines' recommendations. Even though the patients who received guidelines-adhered management were older (70 ± 16 vs 59 ± 22; p = 0.001), and had a higher CURB-65 score for pneumonia severity (1.86 ± 1.03 vs 1.39 ± 1.26; p = 0.026) and an average calculated Charlson comorbidity index (4.62 ± 2.19 vs 3.28 ± 2.80; p = 0.001) than patients who were treated irrespectively of the guidelines, yet they had a better cure rate (95% vs 84%; adjusted OR, 3.9; 95% CI, 0.82–18.58), lower mortality (5% vs 14%; adjusted OR, 0.38; 95% CI, 0.04–4.05) and shorter length of hospital stay (LOS) (6.5 vs 8 days; p = 0.082); compared to patients who were treated irrespectively of the guidelines. ConclusionsComparable to previous literature, non-adherence to evidence-based guidelines has been observed in 50% of patients treated for pneumonia. Despite being nonsignificant, higher clinical cure rates, shorter LOS, and lower mortality rates have been observed in patients who were treated based on evidence-based guidelines. Further measures to improve guidelines compliance in pneumonia treatment are needed.

Cyber Resilience Implications for the Financial System

In August of 2008, cyber-attacks began to affect the Georgian public and private sectors. The cyber-attacks coincided with the Russian Invasion of Georgia, which is also known as the “FiveDay War”. While most of the initial cyber-attacks that were directed against Georgia affected the public sector and media, including various government websites and Georgian news portals, a significant portion of the cyber-attacks affected the Georgian financial system. The cyber-attacks that were directed at the financial system had the effect of bringing down online banking services. In addition, the National Bank of Georgia, which serves as the central bank of Georgia, had its website hacked. As a result of the hack, the official, reference exchange rate of the Georgian Lari to the U.S. Dollar was modified. Luckily, most consumers and other stakeholders were unable to see the unauthorized modification of the exchange rate due to the fact that most of the Georgian internet space was under a distributed denial-of-service attack at the time. If the exchange rate modification on the central bank’s webpage would have been seen by a larger audience, when Internet services are generally readily available to the public, the implications and the impact to the financial system would likely have been much greater. The events of August, 2008 and several other large-scale cyber risk-related incidents have shown that cyber resilience has become an increasingly vital part of financial stability. In addition, the growing use and adoption of electronic information systems in the face of digital transformation of the financial system has clearly brough cyber risk to the forefront of attention. According to the U.S. National Institute of Standards and Technology (NIST), cyber resilience is defined as the ability to anticipate, withstand, recover from, and adapt to adverse conditions, stresses, attacks, or compromises on systems that use or are enabled by cyber resources. Financial institutions that make up the financial system, especially those institutions that are deemed as being systemically important to the safe and sound functioning of the economy, need to have relevant governance, management and control processes in order to ensure cyber resilience. Furthermore, cyber resilience also needs to include an aspect of stress testing in the wake of adverse or unexpected events. Without a robust stress testing framework, it will be difficult to gain assurance that an organization such as a commercial bank or a credit union will be able to cope with various cyber risk scenarios. It is therefore important to have a holistic approach towards cyber resilience and cyber risk, in general. This is especially true for the financial system, since it forms the backbone of most national economies. The following paper presents the various aspects of cyber resilience, which need to be considered when analyzing cyber risk within the context of the financial system.

Individual and contextual level enablers and barriers determining electronic community health information system implementation in northwest Ethiopia

BackgroundThe government of Ethiopia has envisioned digitalizing primary healthcare units through the electronic community health information system (eCHIS) program as a re-engineering strategy aiming to improve healthcare data quality, use, and service provision. The eCHIS is intended as a community-wide initiative to integrate lower health structure with higher administrative health and service delivery unit with the ultimate goal of improving community health. However, the success or failure of the program depends on the level of identifying enablers and barriers of the implementation. Therefore, this study aimed to explore individual and contextual-level enablers and barriers determining eCHIS implementation.MethodWe conducted an exploratory study to determine the enablers and barriers to successfully implementing eCHIS in rural Wogera district, northwest Ethiopia. In-depth interviews and key informant interviews were applied at participants from multiple sites. A thematic content analysis was conducted based on the key themes reported. We applied the five components of consolidated framework for implementation research to interpret the findings.ResultsFirst, based on the intervention's characteristics, implementers valued the eCHIS program. However, its implementation was impacted by the heavy workload, limited or absent network and electricity. Outer-setting challenges were staff turnover, presence of competing projects, and lack of incentive mechanisms. In terms of the inner setting, lack of institutionalization and ownership were mentioned as barriers to the implementation. Resource allocation, community mobilization, leaders’ engagement, and availability of help desk need emphasis for a better achievement. With regard to characteristics of the individuals, limited digital literacy, older age, lack of peer-to-peer support, and limited self-expectancy posed challenges to the implementation. Finally, the importance of mentoring and engaging community and religious leaders, volunteers, having defined plan and regular meetings were identified elements of the implementation process and need emphasis.ConclusionThe findings underlined the potential enablers and barriers of eCHIS program for quality health data generation, use, and service provision and highlighted areas that require emphasis for further scale-up. The success and sustainability of the eCHIS require ongoing government commitment, sufficient resource allocation, institutionalization, capacity building, communication, planning, monitoring, and evaluation.

Analysis of Electronic Chart and Information Display, Ship Identification Systems and Radar in Order to Increase the Energy Efficiency of a Maritime Vessel

This paper puts into discussion the navigation integrated deck and its components. The role of AIS (Automatic Identification System) is presented. The radar with its characteristics is analyzed and starting from the block diagram, a characterization of its role within the integrated deck is carried out. An IT model for navigation radar and ECDIS (Electronic Chart Display and Information System) was developed.

Barriers, facilitators and motivators of electronic community health information system use among health workers in Ethiopia.

The electronic community health information system (eCHIS) has been implemented in Ethiopia to support health services delivered by community health workers. Despite the many benefits of digitizing community health information systems, the implementation of the eCHIS is challenged by many barriers resulting in low uptake. This study assessed the barriers, facilitators, and motivators of eCHIS use among health workers with focus on health extension workers (HEWs) in Ethiopia. Phenomenological approach was used to assess the barriers, facilitators and motivators of eCHIS use in Amhara, Harari, Oromia, Sidama, South West Ethiopia and Southern Nation Nationalities and People's regions of Ethiopia. Data were collected from 15-29 May 2022. A total of 54 face-to-face in-depth interviews were conducted among HEWs, HEW supervisors, health information technicians and managers. The interviews were audiotaped using Open Data Kit, transcribed verbatim and translated into English. OpenCode 4.03 software was used for coding and categorizing the data. Thematic analysis was used to analyze the data. The HEWs and other eCHIS users reported lack of infrastructure and resources; poor quality of training, follow-up, and supervision; parallel recording using the manual and electronic system; and HEWs' workload as barriers hindering eCHIS use. Data quality, retrievability, and traceability; tablet portability; encouragement from supervisors; and positive image in the community resulting from HEWs using tablets in their routine activities were the main facilitators of eCHIS use. The study identified various barriers that adversely affect the use of eCHIS. An integrated and coordinated approach to eCHIS implementation that encompasses removing the barriers, and reinforcing facilitators is required.

Driving Model of Electronic Information System Based on Agent Modeling and Simulation

Abstract It is an effective method to use Agent for modeling and simulation in a complex environment. The Repast Simphony development platform lays the foundation for Agent modeling and simulation. In this paper, a simulation model of the Repast Simphony system is developed. Then this paper constructs a new electronic information system based on the principle of a composite adaptive system. The system uses different levels of adaptive agents as the base unit. Then, the behavior and relation of agents at the same level are explained in detail, and the information transmission and mechanism of action between agents at different levels are studied. The experimental results show that the agent-based evaluation method can comprehensively consider the advantages and disadvantages of each factor, and it can evaluate other targets. At the same time, this method has higher accuracy and better adaptability.

Прогнозирование результатов сдачи сессии на основе анализа текущей успеваемости студентов с использованием данных информационной управляющей системы «Электронный университет»

One of the actual tasks of the Dean’s office is regular monitoring and analysis of academic performance during the semester in order to predict the results of the session and identify lagging students, work with whom should be given priority. A large contingent of students on the course, which can be several hundred people, requires both direct communication with participants of the educational process and the use of special electronic information systems to organize effective monitoring of academic performance. The article provides brief information about the display of current academic performance in the information management system “Electronic University” (IMS “EU”) of Bauman Moscow State Technical University. The main methods of determining the level of a student’s current academic performance using the data of the IMS “EU” are presented. Comparison and analysis of the data of the IMS “EU” on the current academic performance of students of the “Special Mechanical Engineering” Faculty of Bauman Moscow State Technical University in November 2022 was carried out in comparison with the results of the winter session of the 2022–2023 academic year for the same students. Based on the analysis, a criterion for identifying lagging students is proposed based on the results of the analysis of current academic performance using the IMS “EU” and recommendations are given on ways to improve the effectiveness of such an analysis.

From Paper Files to Web-Based Application for Data-Driven Monitoring of HIV Programs: Nigeria's Journey to a National Data Repository for Decision-Making and Patient Care.

Timely and reliable data are crucial for clinical, epidemiologic, and program management decision making. Electronic health information systems provide platforms for managing large longitudinal patient records. Nigeria implemented the National Data Repository (NDR) to create a central data warehouse of all people living with human immunodeficiency virus (PLHIV) while providing useful functionalities to aid decision making at different levels of program implementation. We describe the Nigeria NDR and its development process, including its use for surveillance, research, and national HIV program monitoring toward achieving HIV epidemic control. Stakeholder engagement meetings were held in 2013 to gather information on data elements and vocabulary standards for reporting patient-level information, technical infrastructure, human capacity requirements, and information flow. Findings from these meetings guided the development of the NDR. An implementation guide provided common terminologies and data reporting structures for data exchange between the NDR and the electronic medical record (EMR) systems. Data from the EMR were encoded in extensible markup language and sent to the NDR over secure hypertext transfer protocol after going through a series of validation processes. By June 30, 2021, the NDR had up-to-date records of 1,477,064 (94.4%) patients receiving HIV treatment across 1,985 health facilities, of which 1,266,512 (85.7%) patient records had fingerprint template data to support unique patient identification and record linkage to prevent registration of the same patient under different identities. Data from the NDR was used to support HIV program monitoring, case-based surveillance and production of products like the monthly lists of patients who have treatment interruptions and dashboards for monitoring HIV test and start. The NDR enabled the availability of reliable and timely data for surveillance, research, and HIV program monitoring to guide program improvements to accelerate progress toward epidemic control.

Surgical site infection surveillance in German hospitals: a national survey to determine the status quo of digitalization

BackgroundSurveillance of surgical site infections (SSI) relies on access to data from various sources. Insights into the practices of German hospitals conducting SSI surveillance and their information technology (IT) infrastructures are scarce. The aim of this study was to evaluate current SSI surveillance practices in German hospitals with a focus on employed IT infrastructures.MethodsGerman surgical departments actively participating in the national SSI surveillance module “OP-KISS” were invited in August 2020 to participate in a questionnaire-based online survey. Depending on whether departments entered all data manually or used an existing feature to import denominator data into the national surveillance database, departments were separated into different groups. Selected survey questions differed between groups.ResultsOf 1,346 invited departments, 821 participated in the survey (response rate: 61%). Local IT deficits (n = 236), incompatibility of import specifications and hospital information system (n = 153) and lack of technical expertise (n = 145) were cited as the most frequent reasons for not using the denominator data import feature. Conversely, reduction of workload (n = 160) was named as the main motivation to import data. Questions on data availability and accessibility in the electronic hospital information system (HIS) and options to export data from the HIS for the purpose of surveillance, yielded diverse results. Departments utilizing the import feature tended to be from larger hospitals with a higher level of care.ConclusionsThe degree to which digital solutions were employed for SSI surveillance differed considerably between surgical departments in Germany. Improving availability and accessibility of information in HIS and meeting interoperability standards will be prerequisites for increasing the amount of data exported directly from HIS to national databases and laying the foundation for automated SSI surveillance on a broad scale.

Assessing secular trends in HIV rapid diagnostic test uptake and positivity in Northeast Iran, a country in MENA region; ingredients for target-specific prevention policies

BackgroundIran is amongst the first three countries in Middle East and North Africa (MENA) region where two-thirds of region’s new HIV infections are reported. HIV testing at the population level is key to interrupting the HIV transmission chain. The current study aimed to evaluate the history of HIV rapid diagnostic testing (HIV-RDT) and its correlates in northeast Iran.MethodsIn this cross-sectional study, de-identified records of HIV-RDTs were extracted by the census method from the electronic health information system of 122 testing facilities between 2017 and 2021. Descriptive, bivariate, and multiple logistic regression analyses were performed to identify the factors associated with HIV-RDT uptake and risks and drivers of HIV-RDT positivity, separately among men and women.ResultsConducting 66,548 HIV-RDTs among clients with a mean age of 30.31 years, 63% female, 75.2% married, and 78.5% with high school education or below, yielded 312 (0.47%) positive results. Test uptake was comparatively low among men and the unmarried sub-population. Prenatal care and high-risk heterosexual intercourse were the most frequent reasons for taking HIV-RDT among women and men, respectively (76% and 61.2%). High-risk heterosexual contact, tattooing, mother-to-child transmission (MTCT), having a partner at risk of HIV infection, and injecting drugs were test seekers’ most reported transmission routes. One-third of the newly-infected female clients were identified through prenatal testing. Multivariate analysis revealed older age at the time of testing (Adjusted Odd Ratio (AOR) = 1.03), divorce (AOR = 2.10), widowhood (AOR = 4.33), education level of secondary school (AOR = 4.67), and unemployment (AOR = 3.20) as significant demographic predictors of positive HIV-RDT (P-value < 0.05). However, clients’ nationality, testing history, duration of HIV exposure, and reported reasons for taking HIV-RDT were not associated with the test result (P-value > 0.05).ConclusionInnovative strategies are required to scale up test uptake and positive yields among the key population in the region. The current evidence strongly suggests implementing gender-targeted strategies, according to the differences in demographic and behavioral risk between men and women.

CMS Finalizes New Medicare Advantage Prior Authorization Rule

CMS Finalizes New Medicare Advantage Prior Authorization Rule

Understanding the implication of direct health facility financing on health commodities availability in Tanzania.

The Government of Tanzania (GoT) has in the last decade made progress in strengthening the health system financing with progress towards Universal Health Coverage (UHC). The major reforms includes development of the health financing strategy, reforming the Community Health Fund (CHF) and introduction of the Direct Health Facility Financing (DHFF). DHFF was introduced in all district councils in the 2017/18 financial year. One of the anticipated goals of DHFF is to improve availability of health commodities. The objective of this study is to assess the effect of DHFF in improving the availability of health commodities in primary health care facilities. This study employed cross sectional study design, using quantitative techniques to analyze data related to expenditures and availability of health commodities at the primary health care facilities in Tanzania mainland. Secondary data was extracted from Electronic Logistics Management Information System (eLMIS) and Facility Financial Accounting and Reporting System (FFARS). Descriptive analysis was used to summarize the data using Microsoft Excel (2021) and inferential analysis was done using Stata SE 16.1. There has been an increase in allocation of funds for health commodities over the past three years. The Health Basket Funds (HBFs) accounted for an average of 50% of all health commodities expenditures. The complimentary funds (user fees and insurance) contributed about 20%, which is less than the 50% required by the cost sharing guideline. There is potentiality in DHFF improving visibility and tracking of health commodities funding. Implementation of DHFF has increased the amount of funding for health commodities at health facilities. The visibility and tracking of health commodity funding has improved. There is a scope of increasing health commodity funds at health facilities since the expenditures on health commodities is lower than what is indicated in the cost sharing collection and use guideline.

Deploying the Red Cross Red Crescent Health Information System (RCHIS) into a Type-One Fixed EMT: How the Use of a Custom Built Application for Electronic Medical Records and Data Reporting Improves Patient Care and Mandatory Reporting.

Introduction:RCHIS is an Electronic Medical Record (EMR) and Health Information System (HIS) that has been purpose-built for use by Red Cross Red Crescent (RCRC) Emergency Response Units (ERUs), which are the equivalent of Type 1 (fixed and mobile) and Type 2 facilities in the Emergency Medical Teams (EMT) classification.Method:A three day in-person super user training was held with 13 participants: 9 first aid volunteers, 2 nurses and 2 medical doctors. Seven of the delegates had experience using an EMR. These super users served as trainers for staff at the pilot.The pilot occurred with the Portuguese Red Cross (PRC) for the Peregrinação de Fátima, where 200,000 people were in attendance. The PRC was part of a wider coordination cell with the civil defense authority, who required live reporting from the three Type 1 fixed clinics PRC had set up.Results:In total there were 77 user accounts, of which, 243 patients were consulted with and either discharged or referred throughout the four day pilot.The delegates shared feedback directly and through a survey. 88% stated that RCHIS was ‘very easy’ to use with the majority of delegates requiring less than 20 minutes of training to be using the application and inputting patient data related to their user role. Additionally, after their training 95% of delegates stated they had sufficient training to use RCHIS to its full extent. Informal feedback from delegates was hugely positive, indicating that it was improving patient care and also continuity of care when a patient returned the next day.The civil defense authorities were able to utilize the real-time reporting to assist in their operational response. The application was well received by the wider civil defense authority.Conclusion:The first RCHIS pilot was very successful from both a technical and organizational perspective.

From Two hours to Two Seconds: Using the Red Cross Red Crescent Health Information System (RCHIS) to Complete the WHO Emergency Medical Teams - Minimum Data Set Reporting

Introduction:Standardization of data collection and reporting within EMT’s is challenging. In past deployments, the Red Cross Red Crescent Type one and two facilities (Emergency Response Units- ERU’s) have collected data by hand using paper-based form and Excel spreadsheets. This process can be laborious, time consuming and often inaccurate.Method:RCHIS is both an electronic medical record (EMR) and health information system (HIS). RCHIS has been designed to produce pre-made reports including the MDS in seconds extracting data from the patient records. Through significant testing and pilot deployments in a domestic type one fixed clinic, the rapid production of reports such as the MDS has increased compliance and accuracy with reporting.Results:The utilization of an EMR and integrated HIS system for increasing compliance and accuracy with the MDS has been hugely successful. An in-depth analysis of the export data was done to confirm the 100% accuracy within the MDS report.Furthermore, feedback from users and managers within the ERU’s expressed the excitement for the ease of reporting not only to the EMTCC, but also to IFRC and back-donors. Moving forwards, this data collection will also be used to collect essential data to audit and improve the quality of care provided within the RCRC ERU’s.Conclusion:In conclusion, the utilization of RCHIS within a domestic ERU (equivalent to an EMT type one or two) has been hugely successful. The next steps will involve the deployment of RCHIS within an international deployment.

Pregnancy and delivery characteristics and outcomes in Northwestern Syria: A prospective cohort study.

Detail a picture of the current pregnancy and delivery characteristics and outcomes in Northwestern Syria. This is a prospective observational study, using an electronic health information system, from four healthcare centers in two provinces in Northwestern Syria. We classified the population into two groups: Displaced people are those who live inside refugee camps; and residents are housed outside the camps. We analyzed data from 21 294 pregnant women. Among them 69.6% were displaced. Less than 1% of all care met the standard WHO's antenatal guidelines, and 3.9% met the focused WHO guidelines. Displaced women were more likely to have no antenatal visits (35.8% vs. 25.4%). We found a high rate of anemia (45.8%), prevalence of adolescent pregnancy (20.7%), cesarean-section (25.2%), preterm birth (4.2%), low birth weight (8.3%), and newborn mortality rate within 24 hours of birth (1.2%). Preterm births were more likely to occur in women who had no record of antenatal visits (4.2%) and the prevalence decreased with the increasing number of antenatal visits. We found huge deficiency in perinatal care among all women in this region. We found high cesarean-section rate, anemia, premature birth, newborn mortality within 24 h of birth, and high adolescent pregnancy.

Service availability and readiness of malaria surveillance information systems implementation at primary health centers in Indonesia.

One of the most important indicators in malaria eradication is the malaria surveillance information system (SISMAL) for recording and reporting medical cases. This paper aims to describe the availability and readiness of SISMALs at primary health centers (PHCs) in Indonesia. A cross-sectional survey was implemented in seven provinces for this study. The data was analyzed using bivariate, multivariate, and linear regression. The availability of the information system was measured by assessing the presence of the electronic malaria surveillance information system (E-SISMAL) at the studied PHCs. The readiness was measured by averaging each component of the assessment. From 400 PHC samples, only 58.5% had available SISMALs, and their level of readiness was only 50.2%. Three components had very low levels of readiness: (1) the availability of personnel (40.9%), (2) SISMAL integration and storage (50.2%), and (3) the availability of data sources and indicators (56.8%). Remote and border (DTPK) areas had a 4% better readiness score than non-DTPK areas. Endemic areas were 1.4% better than elimination areas, while regions with low financial capacity were 3.78% better than regions with high financial capacity, with moderate capacity (2.91%). The availability rate of the SISMAL at PHCs is only 58.5%. Many PHCs still do not have SISMALs. The readiness of the SISMAL at these PHCs is significantly related to DTPK/remote area, high endemicity status, and low financial capacity. This study found that the implementation of SISMAL is more accessible to malaria surveillance for the remote area and regions with low financial capacity. Therefore, this effort will well-fit to address barrier to malaria surveillance in developing countries.

Analysis of Barriers to the Use of Health Information Systems for Tuberculosis Patients at the Parongpong Community Health Center, West Bandung Regency, Indonesia

Based on the rules from the government contained in the Regulation of the Minister of Health of the Republic of Indonesia Number 31 of 2019, the Public Health Center information system can be implemented electronically so that the data obtained can be stored safely. An electronic health center information system must have an application, an internet, and a local network (LAN). This can also support Health Promotion activities through electronic media and online reporting to the Minister of Health of the Republic of Indonesia. This research aims to apply innovative health education to the problem of low Tuberculosis patient visits. This is done by analyzing a fishbone diagram and determining priority solutions to problems that have resulted in no real follow-up plans (RTL) so that targets have not been met and there has been no evaluation action at the Parongpong Health Center. This activity is carried out in several stages, namely 1) problem analysis with fishbone, 2) USG (urgency, seriousness, growth), and 3) SWOT analysis. Furthermore, counseling was carried out to all people in the Parongpong sub-district. The results obtained from calculating the score using the SWOT analysis are to make regulations on procedures and standard operating procedures (SOP) for the use of the Tuberculosis Information System (SITB) to optimize health information management at the Parongpong Health Center, West Bandung Regency, Indonesia.

Uptake of reproductive, maternal and child health services during the first year of the COVID-19 pandemic in Uganda: A mixed methods study.

Use of reproductive health (RH), maternal, newborn and child health (MNCH) services in Uganda is suboptimal. Reasons for this are complex; however, service-delivery factors such as availability, quality, staffing, and supplies, contribute substantially to low uptake. The COVID-19 pandemic threatened to exacerbate existing challenges to delivery and use of high-quality RH and MNCH services. We conducted a mixed methods study, combining secondary analysis of routine electronic health management information system (eHMIS) data with exploratory key informant interviews (KII) to examine changes in health service uptake over the course of the pandemic and to understand service delivery adaptations implemented in response. We analyzed eHMIS data for four services (family planning, facility-based deliveries, antenatal visits, and immunization for children by one year), comparing them across four time periods: pre-COVID-19, partial lockdown, total lockdown and post lockdown. Additionally, KIIs were used to document adaptations made for continuity of health services. Use of services declined substantially during total lockdown; however, rebounded quickly to earlier observed levels, during the post lockdown for all four services, especially for immunization for children by one year. KIIs identified several health services delivery adaptations. At the community level, these included: community outreaches, training some mothers as community liaisons to encourage others to seek health services, and support from local leaders to create call centers to facilitate clients transport during travel restrictions. Health facilities creatively used space to accommodate social distancing and shifted providers' roles. District leadership reassigned health workers to facilities closest to their homes, provided vehicle passes to staff, and ambulances to transport pregnant women in critical need. WhatsApp groups facilitated communication at district level and enabled redistribution of supplies. Ministry of Health produced critical guidelines for continuity of health services. Implementing partners provided and redistributed commodities and personal protective equipment, and provided technical support, training and transport.