Existing Hospital Information System Research Articles

Health professionals' perceptions of the development needs of incident reporting software: A qualitative systematic review.

To systemically identify and synthesize information on health professionals' and students' perceptions regarding the development needs of incident reporting software. A systematic review of qualitative studies. A database search was conducted using Medline, CINAHL, Scopus, Web of Science and Medic without time or language limits in February 2023. A total of 4359 studies were identified. Qualitative studies concerning the perceptions of health professionals and students regarding the development needs of incident reporting software were included, based on screening and critical appraisal by two independent reviewers. A thematic synthesis was conducted. From 10 included studies, five analytical themes were analysed. Health professionals and students desired the following improvements or changes to incident reporting software: (1) the design of reporting software, (2) the anonymity of reporting, (3) the accessibility of reporting software, (4) the classification of fields and answer options and (5) feedback and tracking of reports. Wanted features included suitable reporting forms for various specialized fields that could be integrated into existing hospital information systems. Rapid, user-friendly reporting software using multiple reporting platforms and with flexible fields and predefined answer options was preferred. While anonymous reporting was favoured, the idea of reporting serious incidents with both patient and reporter names was also suggested. Health professionals and students provided concrete insights into the development needs for reporting software. Considering the underreporting of healthcare cases, the perspectives of healthcare professionals must be considered while developing user-friendly reporting tools. Reporting software that facilitates the reporting process could reduce underreporting. The ENTREQ reporting guideline was used to support the reporting of this systematic review. There was no patient or public contribution. The protocol is registered in the International Prospective Register of Systematic Reviews with register number CRD42023393804.

A novel blockchain-based architectural modal for healthcare data integrity: Covid19 screening laboratory use-case

In this paper, we are proposing a blockchain-based architectural model to ensure the integrity of healthcare-sensitive data in an AI-based medical research context. In our approach, we will use the HL7 FHIR standardized data structure to ensure the interoperability of our approach with the existing hospital information systems (HIS). Indeed, structuring the data coming from several heterogeneous sources would enhance its quality. In addition, a standardised data structure would help establish a more accurate security and data protection model throughout the process of data collection cleansing and processing. Hence, we designed our architecture to be interoperable with all FHIR-based HISs to add a trust layer to the current medical research process. In this paper we are to achieve our goal, we will combine continua healthcare IoT architecture and Hyperledger fabric architecture. Our trust layer model is composed of four components: (1) an architecture that integrates with the HL7 FHIR data exchange framework, which extends an open protocol that supports efficient standards-based healthcare data exchange (2) a blockchain layer to support access control and auditing of FHIR health records that are stored in the data exchange network databases; (3) a distributed architecture consisting of multiple trusted nodes ensure privacy protection for health data; and (4) an application programming interface (API) will be available for use by the network.

An IoT-based interoperable architecture for wireless biomonitoring of patients with sensor patches

The alliance between the Internet of Things (IoT) and healthcare has the potential to improve healthcare assistance at different stages of care through distributed vital sign sensing, paving the way for domiciliary hospitalization. In this work, we propose an innovative design for an IoT-based interoperable healthcare system to wirelessly monitor and classify patient status. To support our research, we identify gaps, and discuss standards, protocols and technologies based on works that use relevant IoT applications in healthcare. The proposed architecture is centered on several low-energy unobtrusive sensors attached to the patients’ bodies, as well as their beds, which encompass data acquisition nodes linked to a smart gateway that aggregates data. The smart gateway is integrated with an existing hospital information system through the exchange of Electronic Health Records (EHR), making relevant patient data easily available to health professionals on systems which are familiar to them. A use case scenario is presented in order to fulfill functional and non-functional requirements and provide a better understanding of connection and communication between the distinct entities of the proposed architecture, which is based on Bluetooth Low Energy (BLE) technology at the data acquisition level, the Message Queuing Telemetry Transport (MQTT) protocol at the internal level, and on the Fast Healthcare Interoperability Resources (FHIR) standard at the higher level.

Analysis and Improvement of Nursing Quality Based on Standardized Information Integration

Information is becoming increasingly important in social development, and the medical industry’s informatization has made significant progress. This paper evaluates the role of nursing informatization in improving nursing quality management by analyzing and comparing changes in nursing quality before and after the implementation of nursing informatization. Using modern computer network technology to evaluate nursing quality, monitor the implementation of nursing management plans, and control nursing quality links in real time has helped to promote and improve nursing quality. The integration mode of the existing hospital information system is sorted out and standardized according to the requirements of refined hospital management. We can optimize the overall architecture of the hospital information system, reduce the tight coupling between business systems, support rapid integration and flexible expansion of business systems, and lay a foundation for the cooperation and data sharing of medical resources in and out of the hospital by establishing a hospital information platform based on standardized specifications.

The Holy grail of healthcare analytics: what it takes to get there?

BackgroundIndian healthcare is rapidly growing and needs efficiency more than ever, which can be achieved by leveraging healthcare analytics. National Digital Health Mission has set the stage for digital health...

Machine Learning Approaches for Predicting Acute Respiratory Failure, Ventilator Dependence, and Mortality in Chronic Obstructive Pulmonary Disease.

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and contributes to high morbidity worldwide. Patients with COPD have a higher risk for acute respiratory failure, ventilator dependence, and mortality after hospitalization compared with the general population. Accurate and early risk detection will provide more information for early management and better decision making. This study aimed to build prediction models using patients’ characteristics, laboratory data, and comorbidities for early detection of acute respiratory failure, ventilator dependence, and mortality in patients with COPD after hospitalization. We retrospectively collected the electronic medical records of 5061 patients with COPD in three hospitals of the Chi Mei Medical Group, Taiwan. After data cleaning, we built three prediction models for acute respiratory failure, ventilator dependence, and mortality using seven machine learning algorithms. Based on the AUC value, the best model for mortality was built by the XGBoost algorithm (AUC = 0.817), the best model for acute respiratory failure was built by random forest algorithm (AUC = 0.804), while the best model for ventilator dependence was built by LightGBM algorithm (AUC = 0.809). A web service application was implemented with the best models and integrated into the existing hospital information system for physician’s trials and evaluations. Our machine learning models exhibit excellent predictive quality and can therefore provide physicians with a useful decision-making reference for the adverse prognosis of COPD patients.

Knowledge, Practice, Attitude, Usability and Satisfaction Related to Existing Hospital Information System among Nurses

Introduction: Nurses represent the largest computer technology user group and using computer to enter patient’s health history, documenting an assessment, physician’s orders and access laboratory results [1]. Methods: A descriptive cross-sectional study was conducted among the Nurses in Wards, ICUs and Emergency Department at ILBS, New Delhi. Total enumerative sampling technique was used to select 204 Nurses. Data was collected using Structured knowledge questionnaire, Practice checklist related to documentation, Likert attitude scale and Questionnaire for user Interface satisfaction to gather information about Knowledge, Practice, Attitude, Usability and Satisfaction related to existing HIS. Descriptive and Inferential statistics were used to analyse the data. Results: Majority of the Nurses (80.3%) had average Knowledge, with Duplication of work (86.2%) in both HIS and paper records were found in Practice area. Total of 60.3 percent nurses had favourable attitude towards using existing HIS. Majority of Nurses reported that HIS was easy to use (>80%), but not satisfied with the system as the computer never informs about its progress, unreliable and slow system speed frequently. Most of the Nurses (67.6%) felt mistakes were difficult to correct in HIS. Conclusion: Nurses had average knowledge with good documentation practice and favourable attitude related to HIS but least satisfied with the system speed. However, there were some duplication in documentation practice and dissatisfaction seen with the system among Nurses. HIS needs to review and update regularly and informed to all stakeholders on a timely basis so that Usability of the system and the Satisfaction among nurses may increase. Keywords: Hospital Information System, EHR, EMR, Nursing Informatics.

Construction and Application of a Medical-Grade Wireless Monitoring System for Physiological Signals at General Wards.

Physiological signals can contain abundant personalized information and indicate health status and disease deterioration. However, in current medical practice, clinicians working in the general wards are usually lack of plentiful means and tools to continuously monitor the physiological signals of the inpatients. To address this problem, we here presented a medical-grade wireless monitoring system based on wearable and artificial intelligence technology. The system consists of a multi-sensor wearable device, database servers and user interfaces. It can monitor physiological signals such as electrocardiography and respiration and transmit data wirelessly. We highly integrated the system with the existing hospital information system and explored a set of processes of physiological signal acquisition, storage, analysis, and combination with electronic health records. Multi-scale information extracted from physiological signals and related to the deterioration or abnormality of patients could be shown on the user interfaces, while a variety of reports could be provided daily based on time-series signal processing technology and machine learning to make more information accessible to clinicians. Apart from an initial attempt to implement the system in a realistic clinical environment, we also conducted a preliminary validation of the core processes in the workflow. The heart rate veracity validation of 22 patient volunteers showed that the system had a great consistency with ECG Holter, and bias for heart rate was 0.04 (95% confidence interval: −7.34 to 7.42) beats per minute. The Bland-Altman analysis showed that 98.52% of the points were located between Mean ± 1.96SD. This system has been deployed in the general wards of the Hyperbaric Oxygen Department and Respiratory Medicine Department and has collected more than 1000 cases from the clinic. The whole system will continue to be updated based on clinical feedback. It has been demonstrated that this system can provide reliable physiological monitoring for patients in general wards and has the potential to generate more personalized pathophysiological information related to disease diagnosis and treatment from the continuously monitored physiological data.

Case-mix adjusted postanaesthesia care unit length of stay and business intelligence dashboards for feedback to anaesthetists

BackgroundDespite advances in business intelligence software and evidence that feedback to doctors can improve outcomes, objective feedback regarding patient outcomes for individual anaesthetists is hampered by lack of useful benchmarks. We aimed to address this issue by producing case-mix and risk-adjusted postanaesthesia care unit (PACU) length of stay (LOS) benchmarks for integration into modern reporting tools. MethodsWe extended existing hospital information systems to calculate predicted PACU LOS using a neural network trained on patient age, surgery duration, sex, operating specialty, urgency, weekday, and insurance status (n=100 511). We then calculated the difference between observed mean and predicted PACU LOS for individual doctors, and compared the results with and without case-mix adjustment. We report practical implications of using visual analytics dashboards displaying the difference between observed and predicted PACU LOS to provide feedback to anaesthetic doctors. ResultsThe neural network accounted for over half of observed variation in individual doctors' mean PACU LOS (mean predicted and mean actual LOS Spearman's r2=0.57). Account for case-mix reduced apparent spread, with 80% of individual doctors falling in a band of 4.3 min after case-mix adjusting, compared with a range of 24 min without adjustment. Case-mix adjusting also identified different individual doctors as outliers (Weighted Cohen's kappa [κ]=0.27). Finally, we demonstrated that we were able to integrate the adjusted metrics into routine reporting tools. ConclusionWith caution, case-mix adjustment of anaesthetic outcome measures such as PACU LOS potentially provides a useful continuous quality improvement tool. Unadjusted outcome measures are imprecise at best and misleading at worst.

Process Control Charts in Falls Prevention: The Experience of the Local Healthcare Authority of Romagna, Italy.

Patient safety is a great concern of healthcare institutions and the correct reporting and management of adverse events is a key element for supporting safety improvement efforts. Patient falls are the most frequent adverse event in hospitals and often cause serious patient outcomes. In this work, we describe the experience of the Local Healthcare Authority of Romagna, Italy that, within the framework of a quality and safety improvement programme, designed, developed and implemented a desktop application for monitoring inpatient falls. A multidisciplinary team created a software tool based on R, an open source software for statistical computing that, appropriately combined with the existing hospital information system, is used to obtain Shewhart u-control charts for monitoring the monthly fall rates. The tool had been implemented in twenty nine hospital units. The results indicate that the proposed application gave a valuable contribution in the safety improvement activities. Its usefulness extended beyond the “safety problem” as it also enabled hospital managers to identify a number of critical issues in data collection. As a result, where necessary, improvement actions had been implemented. Furthermore, the use of open source software led to a considerable cost reduction and facilitated customization of the software tool.

Sistem Informasi Ketersediaan Ruangan Rumah Sakit Terintegrasi Aplicare BPJS Kesehatan

health is a very basic thing in the needs of every human being this is also regulated in the 1945 Constitution. The government in realizing health services mandated by the law has a national health insurance program (JKN) organized by the Health Social Security Organizing Agency (BPJS Health). This JKN program until December 31, 2017 the number of participants who participated had reached 187,982,949 which means 72.9% of the Indonesian population. Aplicares is an application of a health BPJS that functions to find locations and information about the desired health facilities that can be seen on the web of health facilities.bpjs-kesehatan.go.id/aplicares. Hospitals that have collaborated with health BPJS are required to be able to enter the room data they have into the aplicares and be updated continuously even in real time. Poor hospitals IT experts who understand programming languages have difficulty entering data because BPJS Health only provides scripting and examples of programming languages. Existing Hospital Information Systems (SIM-RS) are usually made by Developer Systems outside of Hospital staff, so to add new modules must add additional costs. With the Information System Availability of Integrated Hospital Rooms with BPJS Health Aplicares that are built with Motede Waterfall, it becomes the solution to these problems

The Rise and Need for Mobile Apps for Maternal and Child Health Care in China: Survey Based on App Markets.

BackgroundMobile health services are thriving in the field of maternal and child health in China due to expansions in the field of electronic health and the introduction of the two-child policy. There are numerous maternal and child health apps in computer stores, but the exact number of apps, number of downloads, and features of these apps is not known.ObjectiveThis study aimed to explore the use of maternal and child health apps in Android and iOS app stores and to describe the key functional features of the most popular apps, with the purpose of providing insight into further research and development of maternal and child health mobile health products.MethodsThe researchers conducted a search in the 3 most popular Android app stores (Tencent MyApp, Baidu Mobile Assistant, and 360 Mobile Assistant) and the iTunes App Store in China. All apps regarding family planning (contraception and preparing for pregnancy), pregnancy and perinatal care, neonatal care and health, and development for children under 6 years were included in the initial analysis. Maternal and child health mobile apps with predominant features of product marketing, children’s songs, animation, or games were excluded from the study. The 50 most frequently used apps in each of the Android stores as well as the iTunes store (a total of 78 deduplicated apps) were selected and downloaded for an in-depth analysis.ResultsA total of 5276 Android apps and 877 iOS apps developed for maternal and child health care were identified. Of the 78 most frequently used apps, 43 (55%) apps focused on one stage of MCH care, mainly targeting child care (25 apps) and before pregnancy care (11 apps), whereas 35 (45%) of the apps covered 2 or more stages, most of which (32 apps) included both pregnancy and child care services. The app features that were commonly adopted by the popular apps were health education, communication, health status self-monitoring, a diary, reminders, and counseling. Within the app feature of “health status self-monitoring,” the researchers found 47 specific tools supporting activities such as pregnancy preparation, fetal heart monitoring, blood glucose and blood pressure monitoring, and doctor visits. A few apps were equipped with external devices (n=3) or sensors. No app with intelligent decision-support features to support disease management for conditions such as gestational diabetes and pregnancy-induced hypertension was found. A small number of apps (n=5) had a Web connection with hospital information systems to support appointment making, payments, hospital service guidance, or checking of laboratory results.ConclusionsThere are thousands of maternal and child health apps in the Chinese market. Child care, pregnancy, and before pregnancy were the mostly covered maternal and child health stages, in that order. Various app features and tools were adopted by maternal and child health apps, but the use of internal or external sensors, intelligent decision support, and tethering with existing hospital information systems was rare and these features need more research and development.

Design and Implementation of the Intensive Care Unit Quality Management Registry: Monitoring Quality and Cost of an Adult Intensive Care Unit in a Greek State Hospital.

Intensive care electronic registries have been instrumental in quality measurement, improvement, and assurance of intensive care. In this article, the development and pilot implementation of the Intensive Care Unit Quality Management Registry are described, with a particular focus on monitoring the quality and operational cost in an adult ICU at a northern Greek state hospital. A relational database was developed for a hospital ICU so that qualitative and financial data are recorded for further analysis needed for planning quality care improvement and enhanced efficiency. Key features of this database registry were low development cost, user friendliness, maximum data security, and interoperability in existing hospital information systems. The database included patient demographics, nursing and medical parameters, and quality and performance indicators as established in many national registries worldwide. Cost recording was based on a mixed approach: at patient level ("bottom-up" method) and at department level ("top-down" method). During the pilot phase of the database operation, regular monitoring of quality and cost data revealed several fields of quality excellence, while indicating room for improvement for others. Parallel recording and trending of multiple parameters showed that the database can be utilized for optimum ICU quality and cost management and also for further research purposes by nurses, physicians, and administrators.

The challenges of emerging HISs in bridging the communication gaps among physicians and nurses in China: an interview study

BackgroundTo explore the current situation, existing problems and possible causes of said problems with regards to physician-nurse communication under an environment of increasingly widespread usage of Hospital Information Systems and to seek out new potential strategies in information technology to improve physician-nurse communication.MethodsSemi-structured interviews were conducted with 20 physicians and nurses in five leading tertiary grade A hospitals in Beijing, China (two physicians and two nurses in each hospital). The interviews primarily included three aspects comprising the current situation and problems of clinical physician-nurse communication, the application and problems of Hospital Information Systems, and assessments on the improvement of physician-nurse communication through the usage of information technology. The inductive conventional content analysis approach was employed.Results(1) Physicians and nurses are generally quite satisfied with the current situation of communication. However, the information needs of nurses are prone to being overlooked, and the communication methods are primarily synchronous communication such as face-to-face and phone communication. (2) Hospital Information Systems are gradually being used for physician-nurse communication; in the meantime, physicians and nurses face challenges with regards to the improvement of physician-nurse communication through the usage of information technology. Challenges differ based on the different stages of using the system and the different levels of understanding of physicians and nurses towards information technology. Their dissatisfaction mainly deals with system errors and the level of convenience in using the system. (3) In-depth interviews found that in general, physicians and nurses have a strong interest and trust in improving physician-nurse communication through appropriate information technology, e.g., communication methods such as information reminders for physicians and nurses through mobile devices and instant voice-to-text conversion methods.ConclusionsThere are objective risks in physician-nurse communication in Chinese hospitals, and clinical information systems lack solutions to the relevant problems. Developing a dedicated, mobile, quick and convenient module for physician-nurse communication within existing hospital information system with automatic reminders for important information that segregates between synchronous and asynchronous communication according to the different types of information could help improve physician-nurse communication.

Computerized Clinical Pharmacy Management System Improves Prescribing Quality and Rational Antimicribial Use

To introduce the increased efficiency and improved health care provision brought by incorporating a certified clinical pharmacy management (CPM) system into an existing hospital information system. Evaluate the appropriateness rate of prescriptions or orders, the rational use of antimicrobial use, and the workflow of clinical pharmacist before and after the adoption of the CPM system. The adoption of the CPM system markedly increased the appropriateness rate of prescriptions and orders by 89% in 2011 as compared to that of 2010. The CPMS decrease the antimicrobial use both in outpatients and inpatients by 47.0% and 51.9 respectively in December 2011 as compared to that of January 2011. The CPMS also streamlined the clinical pharmacist’s workflow and help disseminate medication use knowledge and policies within the hospital.

The Study of Hospital Information Systems in the 8th Health Region

The research aims to explore the existing hospital information system (HIS) and their resources in the 8th health region according to the roadmap for the National Health Information Center (NHIC) from Ministry of Public Health (MOPH). In order to determine the functions and flows between each system module for data interconnect and exchange, health provider levels from the primary care unit (first-level hospital) up to the provincial hospital (advance-level hospital) were analyzed. Four major categories, both the front-office and back-office, were evaluated by using questionnaire, survey, and interview. Medical services, inventory for drug and medical supply, monetary and fiscal, human resource, and surveillance process modules are mentioned. Infrastructures and their protocols are included in this investigation.

Design of Integrated Medical Information System Based on The Cloud

Today, the medical information system has evolved in the way of integrated healthcare IT information systems. Therefore, it is trying to build advanced U-Healthcare service. Though the U-Healthcare environments is exchanged the information between systems in many cases, however since the each system is different, the integration and exchange of data is difficult. To overcome this problem, in this paper it proposes that we suggests a possible DBaaS(DataBase as a Service) for the heterogeneous integration of medical information management and data exchange. First, the proposed system builds DBaaS cloud by integrating the meta-DB Schema level and DB Schema for each hospital. And, the mapping the schema data and the existing hospital information system is possible using the International Standard HL7. By applying the proposed method to the hospital system, it comes true the efficient exchange of information between the patients, doctors, staffs through the data mapping of the one to multi-system.

A minimal e-referral for meaningful share of maternal health information in public health scenarios

Primary health centres (PHCs) across India provide antenatal, delivery and postnatal healthcare to expecting mothers. In case the expecting mother suffers from a pregnancy-related medical condition that cannot be treated at the PHC, she is referred to the nearest specialist or secondary hospital. The objective of this paper is to present a minimal, affordable and interoperable extensible markup language (XML)-based electronic referral (e-referral) prototype. The e-referral system transfers patient information from the PHC to a specialist at any hospital, for pregnancy-related medical problems. A subject matter expert (SME) panel was formed to identify the minimal dataset and an optimal format for e-referrals in the maternal use case. The data quality of the proposed e-referral information was measured. The e-referral data structures were proven to be complete. The interoperability level achieved by the e-referral prototype was quantified. The minimal e-referral is human processable or syntactically interoperable. The XML-based e-referral data can be very easily integrated with existing hospital information systems.

Big-Bang introduction of an Clinical Information System

Big Bang introduction of a clinic information system The replacement of existing hospital information systems will be a future must for many hospitals. For this, extensive preparation and proceedings are necessary. Good experience with “Big Bang” has been made by the Uniklinik Balgrist. Starting on day X, the hospital personnel were only allowed to work using the new clinic information system (CIS). From this date on, all stakeholders had to enter their information, prescriptions, and other documentation into the new system. The subsequent monitoring by and support from experienced system users proved crucial for the success of the new CIS. Lessons learned: good preparation, customized IT environment, and close accompaniment at introduction.

Implementing a disease-specific Electronic Medical Record System at Bangkok Medical Center: Lessons Learned

Diabetic Mellitus (DM) is a lifelong chronic disease that has a major impact on health care costs. Taking care of diabetic patients relies heavily on adequate and accurate informatics.  In order for care providers to view a patient history and to be able to project the trend of future treatments, the health information system must be concise and include a function for easy access to patient  records to efficiently locate all the related data. At the Bangkok Medical Center (BMC), the existing Hospital Information System (HIS) is mainly used to manage administrative functions, such as making appointments, registering patients, order entry, results reporting, and billing. The traditional paper clinical record from  providers are still used and scanned as an image into the HIS.  We found that the HIS is too generalized and broad, and does not meet the specific needs for diabetes management. The display of information is sub-optimal, not only because it’s incomplete and  often contains scanned images of illegibly written notes, but also because it presents a cluttered user interface (UI) that includes  myriad windows with laboratory results, radiology reports and medication lists, making viewing of summarized data quite difficult.