Health Information Infrastructure Research Articles

Artificial Intelligence in Enhancing the Kosovo Health Information System

The contemporary healthcare landscape faces unprecedented challenges, ranging from data fragmentation within health information systems to the need for timely and accurate diagnostics. This research explores the transformative potential of Artificial Intelligence (AI) in enhancing the Kosovo Health Information System (HIS). By leveraging the capabilities of AI, we aim to address existing limitations in data interoperability, predictive analytics, and personalized healthcare. The study incorporates a comprehensive literature review, methodological data collection, and analysis of the current state of the Kosovo HIS. Drawing inspiration from successful global implementations, we delve into the possibilities of AI applications in diagnosis, treatment personalization, and population health management. The research also examines ongoing initiatives and collaborations aimed at integrating AI into the Kosovo HIS. Through a critical assessment of technical challenges and ethical considerations, the paper provides insights into the opportunities and hurdles associated with the implementation of AI in healthcare. Ultimately, this research contributes to the discourse on the future prospects of healthcare in Kosovo, highlighting the potential long-term impacts of AI integration and offering recommendations for advancing the country's health information infrastructure. Received: 5 February 2024 / Accepted: 23 April 2024 / Published: 5 May 2024

Global Trends and Hotspots in Nursing Research on Decision Support Systems: A Bibliometric Analysis in CiteSpace.

Decision support systems have been widely used in healthcare in recent years; however, there is lack of evidence on global trends and hotspots. This descriptive bibliometric study aimed to analyze bibliometric patterns of decision support systems in nursing. Data were extracted from the Web of Science Core Collection. Published research articles on decision support systems in nursing were identified. Co-occurrence and co-citation analysis was performed using CiteSpace version 6.1.R2. In total, 165 articles were analyzed. A total of 358 authors and 257 institutions from 20 countries contributed to this research field. The most productive authors were Andrew Johnson, Suzanne Bakken, Alessandro Febretti, Eileen S. O'Neill, and Kathryn H. Bowles. The most productive country and institution were the United States and Duke University, respectively. The top 10 keywords were "care," "clinical decision support," "clinical decision support system," "decision support system," "electronic health record," "system," "nursing informatics," "guideline," "decision support," and "outcomes." Common themes on keywords were planning intervention, national health information infrastructure, and methodological challenge. This study will help to find potential partners, countries, and institutions for future researchers, practitioners, and scholars. Additionally, it will contribute to health policy development, evidence-based practice, and further studies for researchers, practitioners, and scholars.

Understanding security behaviour among healthcare professionals by comparing results from technology threat avoidance theory and protection motivation theory

ABSTRACT We investigate security behaviour among healthcare professionals while comparing upon two prevalent theories in information security (IS) research: Protection Motivation Theory (PMT) and Technology Threat Avoidance Theory (TTAT). Although IS research often uses these models, very few studies compare the two models using a diverse sample of 245 healthcare professionals. The data were analysed using partial least squares regression - structural equation modelling (PLS-SEM). Results indicated that both models were similarly robust at predicting security behaviour. Perceived severity and response efficacy positively influenced avoidance motivation (AM) for PMT. All factors of the threat appraisal arm of TTAT and safeguard efficacy played an influencing role on AM in TTAT. Response cost and self-efficacy were not supported in either model, providing us with potentially new insights into this specific population’s security intentions. With the addition of Perceived Threat, TTAT appears to be slightly more robust model with 64% of the variance explained by the given model while PMT explains only 60% of the variance. Given the ever-increasing risk of data breaches in healthcare, practical applications and implications of the study’s findings to health information technology (HIT) policy and infrastructure are also discussed.

COVID-19 Perceptions Among North Carolina Native Americans: Using a Qualitative Approach

Background COVID-19 has amplified the health and economic disparities in Native American communities. However, there are limited data from Native American populations. This study is the first phase of the Building Resilience And Vital Equity (BRAVE) project, the scope of which is to understand Indigenous perceptions, attitudes, and behaviors about COVID-19 and design and implement culturally sensitive interventions to increase testing and vaccinations among Native American communities. Method We recruited 26 Native Americans and conducted open-ended, semi-structured interviews to explore participants’ perceptions of COVID-19 and related themes, such as needed support, informational sources, trust, communication, and protection of elders. Results The results show that wearing a mask, hand sanitizing, and social distancing had very high support while perceptions of testing and vaccination decisions were mixed. Additionally, two themes stand out: the lack of reliable information resources to learn about COVID-19 and the lack of trust in the government. Limitation This study included a small sample size, which makes it difficult to include participants from diverse demographic backgrounds. Lack of familiarity with the online meeting format and the limited internet access in some indigenous communities may have prevented some people from participating. Conclusion The findings confirmed the need to improve existing public health information infrastructure and helped explain the intensified impact of COVID-19 on the Indigenous marginalized community. The findings help identify the key factors that affect Native Americans’ testing and vaccination decisions and provide guidance on the designs of community intervention programs.

The need for and challenges of nutrition and dietetics registry studies: An update on the Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII).

Data linking medical nutrition therapy (MNT) with outcomes is needed to demonstrate the value of nutrition and dietetics professionals. Registry studies are at the intersection of practice and research and the Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII) is the optimal resource to conduct registry studies for data aggregation on practice patterns and related outcomes. The Academy plays a leadership role in developing and maintaining a methodological framework for nutrition registry studies as a means to demonstrate MNT outcomes, improve the Nutrition Care Process (NCP) and Terminology (NCPT), and advance the visibility and impact of the dietetics profession. Thus, there is a high priority to disseminate nutrition care registry study findings. The purpose of this report is to provide a current update on ANDHII with an emphasis on identified strengths, weaknesses and challenges and describe a conceptual framework from which both RDNs in practice and/or research and education can become involved in nutrition registry studies.

Enhancing the nation's public health information infrastructure: a report from the ACMI symposium.

The COVID-19 pandemic exposed multiple weaknesses in the nation's public health system. Therefore, the American College of Medical Informatics selected "Rebuilding the Nation's Public Health Informatics Infrastructure" as the theme for its annual symposium. Experts in biomedical informatics and public health discussed strategies to strengthen the US public health information infrastructure through policy, education, research, and development. This article summarizes policy recommendations for the biomedical informatics community postpandemic. First, the nation must perceive the health data infrastructure to be a matter of national security. The nation must further invest significantly more in its health data infrastructure. Investments should include the education and training of the public health workforce as informaticians in this domain are currently limited. Finally, investments should strengthen and expand health data utilities that increasingly play a critical role in exchanging information across public health and healthcare organizations.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

A Brief History of Public Health Informatics-Lessons for Leaders and a Look Into the Future.

Analyzing the Role of the @sapawarga_jabar Twitter Account in Advancing Digital-Based Public Services towards Smart City Development in West Java Province, Indonesia

This study analyzes the impact of the @sapawarga_jabar Twitter account on digital-based public services for smart city development in West Java, Indonesia. Using a qualitative approach, the study examines the content and effectiveness of the Twitter account in delivering public services. Data analysis is conducted using the @sapawarga_jabar Twitter account and Nvivo 12 Plus software. Findings demonstrate that the account provides services related to car tax payments, employment, health information, and regional infrastructure development. Engagement rates peaked in March 2022, indicating active user participation and information dissemination. The study also identifies both positive and negative impacts, highlighting improved access to services and limitations due to internet access. Overall, the research contributes insights into the role of social media in enhancing digital public services for smart city initiatives in West Java. These findings can guide policymakers in optimizing social media platforms for effective public service delivery and smart city development.

Review of applied health informatics courses in a multidisciplinary biomedical informatics department.

IntroductionApplied health informatics infrastructure is a requirement for learning health systems and it is imperative that we train a workforce that can support this infrastructure. Our department offers courses in several interdisciplinary programs with topics ranging from bioinformatics to population health informatics. Due to changes in the field and our faculty members, we sought to assess our courses relevant to applied health informatics.MethodsIn this paper, we discuss the three‐phase evaluation of our program and include the survey we developed to identify the skills and knowledge base of our faculty.ResultsWe show how this assessment allowed us to identify gaps and develop strategies for program expansion.ConclusionsA focus on workforce development can help to guide and focus curricular review in an interdisciplinary graduate program.

Investigating Health Managers’ Perspectives of Factors Influencing Their Acceptance of eHealth Services in the Kingdom of Saudi Arabia: A Quantitative Study

Background: Kingdom of Saudi Arabia (KSA) is a country with one of the largest land masses and the most difficult geographical terrain in the Middle East. The accessibility of advanced health services, especially for people in rural areas, has been considered one of the main health challenges. To overcome this problem, many initiatives to embrace technology in healthcare were launched by the Ministry of Health (MOH). Despite the growth of utilizing eHealth interventions in the country, more research related to the end-users’ acceptance of eHealth services remains needed. This study aimed to investigate the relative importance of factors that influence health managers’ acceptance of eHealth services in KSA against behavioural intention (BI) and use behaviour (UB). Methods: An online questionnaire was designed based on two sources: first, the thirty-nine factors identified in a related systematic review to be relevant to eHealth acceptance in KSA, and second, the validated questionnaire adopted from the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Participants were asked to rate the relative importance of the factors. The questionnaire was available in both Arabic and English. Professionals in KSA with a health management role from different backgrounds such as health professions, Health Information Technology, and administration were invited to take part. Participation links were distributed across social media platforms. Ethical approval had been gained. Results: 385 responses were received. Findings highlighted the relative importance of the main determinants that health managers in the KSA thought were important to influence their acceptance of eHealth services. The top rated influential factors were (i) availability of operational resources, (ii) privacy and security of health information, (iii) Information and Communication Technology infrastructure and readiness, (iv) availability of qualified human resources, and (v) quality of eHealth systems and applications. Of the UTAUT constructs, performance expectancy (PE) and social influence, which encapsulate factors such as management support, change resistance, and stakeholders’ voice that can play a crucial role in the acceptance of technology as part of daily work, showed significance to the BI, as well as facilitating conditions and PE to the UB. However, some results need further investigation to clarify ambiguity. Conclusion: Findings from this study may help address the current challenges and barriers and prioritize the main areas to improve eHealth acceptance in the KSA. Further research is planned to explore the identified factors across KSA through in-depth interviews.

An Interoperable Electronic Health Record System for Clinical Cardiology

Currently in hospitals, there are several separate information systems that manage, very often autonomously, the patient’s personal, clinical and diagnostic data. An electronic health record system has been specifically developed for a cardiology ward and it has been designed “ab initio” to be fully integrated into the hospital information system and to exchange data with the regional health information infrastructure. All documents have been given as Health Level 7 (HL7) clinical document architecture and messages are sent as HL7-Version 2 (V2) and/or HL7 Fast Healthcare Interoperability Resources (FHIR). Specific decision support sections for specific aspects have also been included. The system has been used for more than three years with a good level of satisfaction by the users. In the future, the system can be the basis for secondary use for clinical studies, further decision support systems and clinical trials.

The InfAct proposal for a sustainable European health information infrastructure on population health: the Distributed Infrastructure on Population Health (DIPoH)

BackgroundIn Europe, data on population health is fragmented, difficult to access, project-based and prone to health information inequalities in terms of availability, accessibility and especially in quality between and within countries. This situation is further exacerbated and exposed by the recent COVID-19 pandemic. The Joint Action on Health Information (InfAct) that builds on previous works of the BRIDGE Health project, carried out collaborative action to set up a sustainable infrastructure for health information in the European Union (EU). The aim of this paper is to present InfAct’s proposal for a sustainable research infrastructure, the Distributed Infrastructure on Population Health (DIPoH), which includes the setup of a Health Information Portal on population health to be maintained beyond InfAct’s time span.MethodsThe strategy for the proposal was based on three components: scientific initiatives and proposals to improve Health Information Systems (HIS), exploration of technical acceptability and feasibility, and finally obtaining high-level political support.. The technical exploration (Technical Dialogues—TD) was assumed by technical experts proposed by the countries, and political guidance was provided by the Assembly of Members (AoM), which gathered representatives from Ministries of Health and Science of EU/EEA countries. The results from the AoM and the TD were integrated in the sustainability plan compiling all the major outputs of InfAct.ResultsThe InfAct sustainability plan was organized in three main sections: a proposal of a new research infrastructure on population health (the DIPoH), new health information tools and innovative proposals for HIS, and a comprehensive capacity building programme. These activities were carried out in InfAct and are being further developed in the Population Health Information Research Infrastructure (PHIRI). PHIRI is a practical rollout of DIPoH facilitating and generating the best available evidence for research on health and wellbeing of populations as impacted by COVID-19.ConclusionsThe sustainability plan received wide support from Member States and was recognized to have an added value at EU level. Nevertheless, there were several aspects which still need to be considered for the near future such as: (i) a commitment of stable financial and political support by Member States (MSs), (ii) the availability of resources at regional, national and European level to deal with innovations, and (iii) a more direct involvement from EU and international institutions such as the European Centre for Disease Prevention and Control (ECDC), the World Health Organization (WHO) and the Organisation for Economic Cooperation and Development OECD for providing support and sustainable contributions.

National, regional, and global causes of mortality in 5–19-year-olds from 2000 to 2019: a systematic analysis

SummaryBackgroundInvestments in the survival of older children and adolescents (aged 5–19 years) bring triple dividends for now, their future, and the next generation. However, 1·5 million deaths occurred in this age group globally in 2019, nearly all from preventable causes. To better focus the attention of the global community on improving survival of children and adolescents and to guide effective policy and programmes, sound and timely cause of death data are crucial, but often scarce.MethodsIn this systematic analysis, we provide updated time-series for 2000–19 of national, regional, and global cause of death estimates for 5–19-year-olds with age-sex disaggregation. We estimated separately for countries with high versus low mortality, by data availability, and for four age-sex groups (5–9-year-olds [both sexes], 10–14-year-olds [both sexes], 15–19-year-old females, and 15–19-year-old males). Only studies reporting at least two causes of death were included in our analysis. We obtained empirical cause of death data through systematic review, known investigator tracing, and acquisition of known national and subnational cause of death studies. We adapted the Bayesian Least Absolute Shrinkage and Selection Operator approach to address data scarcity, enhance covariate selection, produce more robust estimates, offer increased flexibility, allow country random effects, propagate coherent uncertainty, and improve model stability. We harmonised all-cause mortality estimates with the UN Inter-agency Group for Child Mortality Estimation and systematically integrated single cause estimates as needed from WHO and UNAIDS.FindingsIn 2019, the global leading specific causes of death were road traffic injuries (115 843 [95% uncertainty interval 110 672–125 054] deaths; 7·8% [7·5–8·1]); neoplasms (95 401 [90 744–104 812]; 6·4% [6·1–6·8]); malaria (81 516 [72 150–94 477]; 5·5% [4·9–6·2]); drowning (77 460 [72 474–85 952]; 5·2% [4·9–5·5]); and diarrhoea (72 679 [66 599–82 002], 4·9% [4·5–5·3]). The leading causes varied substantially across regions. The contribution of communicable, maternal, perinatal, and nutritional conditions declined with age, whereas the number of deaths associated with injuries increased. The leading causes of death were diarrhoea (51 630 [47 206–56 235] deaths; 10·0% [9·5–10·5]) in 5–9-year-olds; malaria (31 587 [23 940–43 116]; 8·6% [6·6–10·4]) in 10–14-year-olds; self-harm (32 646 [29 530–36 416]; 13·4% [12·6–14·3]) in 15–19-year-old females; and road traffic injuries (48 757 [45 692–52 625]; 13·9% [13·3–14·3]) in 15–19-year-old males. Widespread declines in cause-specific mortality were estimated across age-sex groups and geographies in 2000–19, with few exceptions like collective violence.InterpretationChild and adolescent survival needs focused attention. To translate the vision into actions, more investments in the health information infrastructure for cause of death and in the related life-saving interventions are needed.FundingBill & Melinda Gates Foundation and WHO.

Integrating technical and political views for a sustainable European Distributed Infrastructure on Population Health

BackgroundNon-Communicable diseases (NCD) are the main contributors to mortality and burden of disease. There is no infrastructure in Europe that could provide health information (HI) on Public Health monitoring and Health Systems Performance (HSP) for research and evidence-informed decision-making. Moreover, there was no EU and European Economic Area Member States (EU/EEA MSs) general consensus, on developing this initiative and guarantee its sustainability. The aim of this study is to analyze the integration of technical and political views made by the Joint Action on Health Information (InfAct; Information for Action) and the results obtained from those activities, in terms of advice and national and institutional support to develop an integrated and sustainable European Distributed Infrastructure on Population Health (DIPoH) for research and evidence-informed policy-making.MethodsInfAct established two main boards, the Technical Dialogues (TDs) and the Assembly of Members (AoM), to provide a platform for discussion with EU/EEA MSs to establish a sustainable infrastructure for HI: 1) The TDs were composed by national technical experts (NTE) with the aim to discuss and provide feedback about scientific aspects, feasibility and EU-added value of the infrastructure proposed by InfAct. 2) The AoM gathered country representatives from Ministries of Health and Research at the highest political level, with the aim of providing policy-oriented advice for the future political acceptance, support, implementation, and development of InfAct’s outcomes including DIPoH.The documentation provided for the meetings consisted in Fact-Sheets, where the main results, new methods and proposals were clearly exposed for discussion and assessment; altogether with more extended information of the DIPoH. The documentation was provided to national representatives within one more before each TD and AoM meeting.The Agenda and methodological approaches for each TD and AoM meeting consisted in the presentations of the InfAct outcomes extending the information provided in the Fact-Sheets; followed by a non-structured interaction, exchange of information, discussion and suggestions by the MSs representatives.The outcomes of the non-structured discussions were collected in Minutes of the TD and AoM meetings, and the final version was obtained with the consensus of all participants. Additionally, structured letters of political support were provided to the AoM representatives, for them to consider providing their MS written support for DIPoH.ResultsNTE, within the TDs, considered that DIPoH was useful for technical mutual learning and cooperation among and within countries; although they considered that the technical feasibility to uptake InfAct deliverables at the national and EU level was complex. The AoM focused on political support, resources, and expected MSs returns. The AoM representatives agreed in the interest of setting up an integrated and sustainable HI infrastructure and they considered DIPoH to be well-articulated and defined; although, some of them, expressed some barriers for providing DIPoH political support. The AoM representatives stated that the AoM is the most suitable way to inform EU MSs/ACs about future advances of DIPoH. Both boards provided valuable feedback to develop this infrastructure. Eleven countries and sixteen institutions supported the proposal, either by letters of political support or by signing the Memorandum of Understandings (MoU) and three countries, additionally, provided expression of financial commitment, for DIPoH to be added to the ESFRI 2021 roadmap.ConclusionsTDs and AoM were key forums to develop, advise, advocate and provide support for a sustainable European research infrastructure for Population Health.

Health data collection methods and procedures across EU member states: findings from the InfAct Joint Action on health information

BackgroundHealth-related data are collected from a variety of sources for different purposes, including secondary use for population health monitoring (HM) and health system performance assessment (HSPA). Most of these data sources are not included in databases of international organizations (e.g., WHO, OECD, Eurostat), limiting their use for research activities and policy making. This study aims at identifying and describing collection methods, quality assessment procedures, availability and accessibility of health data across EU Member States (MS) for HM and HSPA.MethodsA structured questionnaire was developed and administered through an online platform to partners of the InfAct consortium form EU MS to investigate data collections applied in HM and HSPA projects, as well as their methods and procedures. A descriptive analysis of the questionnaire results was performed.ResultsInformation on 91 projects from 18 EU MS was collected. In these projects, data were mainly collected through administrative sources, population health interview or health examination surveys and from electronic medical records. Tools and methods used for data collection were mostly mandatory reports, self-administered questionnaires, or record linkage of various data sources. One-third of the projects shared data with EU research networks and less than one-third performed quality assessment of their data collection procedures using international standardized criteria. Macrodata were accessible via open access and reusable in 22 projects. Microdata were accessible upon specific request and reusable in 15 projects based on data usage licenses. Metadata was available for the majority of the projects, but followed reporting standards only in 29 projects. Overall, compliance to FAIR Data principles (Findable, Accessible, Interoperable, and Reusable) was not optimal across the EU projects.ConclusionsData collection and exchange procedures differ across EU MS and research data are not always available, accessible, comparable or reusable for further research and evidence-based policy making. There is a need for an EU-level health information infrastructure and governance to promote and facilitate sharing and dissemination of standardized and comparable health data, following FAIR Data principles, across the EU.

Evaluating the Implementation of Evidence-based Kidney Nutrition Practice Guidelines: The AUGmeNt Study Protocol

Evidence-based nutrition practice guidelines (EBNPGs) inform registered dietitian nutritionist (RDN) care for patients with chronic kidney disease grade 5 treated by dialysis; however, there has been little evaluation of best practices for implementing EBNPGs. In this effectiveness-implementation hybrid study with a quasi-experimental design, United States RDNs in hemodialysis clinics will document initial and follow-up nutrition care for patients with chronic kidney disease grade 5 treated by dialysis using the Academy of Nutrition and Dietetics Health Informatics Infrastructure before and after being randomly assigned to a training model: (1) EBNPG knowledge training or (2) EBNPG knowledge training plus an implementation toolkit. The aims of the study include examining congruence of RDN documentation of nutrition care with the EBNPG; describing common RDN-reported EBNPG acceptability, adoption, and adaptation issues; and determining the feasibility of estimating the impact of RDN care on nutrition-related patient outcomes. The AUGmeNt study can inform effective development and implementation of future EBNPGs. Keywords: Chronic kidney diseases; medical nutrition therapy; implementation science; clinical practice guideline; nutrition care process terminology; dietitian.

World Trade Center Health Program - United States, 2012-2020.

Problem/ConditionAfter the September 11, 2001, terrorist attacks on the United States, approximately 400,000 persons were exposed to toxic contaminants and other factors that increased their risk for certain physical and mental health conditions. Shortly thereafter, both federal and nonfederal funds were provided to support various postdisaster activities, including medical monitoring and treatment. In 2011, as authorized by the James Zadroga 9/11 Health and Compensation Act of 2010, the CDC World Trade Center (WTC) Health Program began providing medical screening, monitoring, and treatment of 9/11-related health conditions for WTC responders (i.e., persons who were involved in rescue, response, recovery, cleanup, and related support activities after the September 11, 2001, terrorist attacks) and affected WTC survivors (i.e., persons who were present in the dust or dust cloud on 9/11 or who worked, lived, or attended school, child care centers, or adult day care centers in the New York City disaster area).Reporting Period Covered2012–2020.Description of SystemThe U.S. Department of Health and Human Services WTC Health Program is administered by the director of CDC’s National Institute for Occupational Safety and Health. The WTC Health Program uses a multilayer administrative claims system to process members’ authorized program health benefits. Administrative claims data are primarily generated by clinical providers in New York and New Jersey at the Clinical Centers of Excellence and outside those states by clinical providers in the Nationwide Provider Network. This report describes WTC Health Program trends for selected indicators during 2012–2020.ResultsIn 2020, a total of 104,223 members were enrolled in the WTC Health Program, of which 73.4% (n = 76,543) were responders and 26.6% (n = 27,680) were survivors. WTC Health Program members are predominantly male (78.5%). The median age of members was 51 years (interquartile range [IQR]: 44−57) in 2012 and 59 years (IQR: 52−66) in 2020. During 2012−2020, enrollment and number of certifications of WTC-related health conditions increased among members, with the greatest changes observed among survivors. Overall, at enrollment, most WTC Health Program members lived in New York (71.7%), New Jersey (9.3%), and Florida (5.7%). In 2020, the total numbers of cancer and noncancer WTC-related certifications among members were 20,612 and 50,611, respectively. Skin cancer, male genital system cancers, and in situ neoplasms (e.g., skin and breast) are the most common WTC-related certified cancer conditions. The most commonly certified noncancer conditions are in the aerodigestive and mental health categories. The average number of WTC-related certified conditions per certified member is 2.7. In 2020, a total of 40,666 WTC Health Program members received annual monitoring and screening examinations (with an annual average per calendar year of 35,245). In 2020, the total number of WTC Health Program members who received treatment was 41,387 (with an annual average per calendar year of 32,458).InterpretationSince 2011, the WTC Health Program has provided health care for a limited number of 9/11-related health conditions both for responders and survivors of the terrorist attacks. Over the study period, program enrollment and WTC certification increased, particularly among survivors. As the members age, increased use of health services and costs within the WTC Health Program are expected; chronic diseases, comorbidities, and other health-related conditions unrelated to WTC exposures are more common in older populations, which might complicate the clinical management of WTC-related health conditions.Public Health ActionAnalysis of administrative claims data in the context of WTC research findings can better clarify the health care use patterns of WTC Health Program members. This information guides programmatic decision-making and might also help guide future disaster preparedness and response health care efforts. Strengthening the WTC Health Program health informatics infrastructure is warranted for timely programmatic and research decision-making.

Managing Pandemics with Health Informatics.

SummaryObjective: To summarize significant research contributions on managing pandemics with health informatics published in 2020. Methods: An extensive search using PubMed and Scopus was conducted to identify peer-reviewed articles published in 2020 that examined health informatics systems used during the global COVID-19 pandemic. The selection process comprised three steps: 1) 15 candidate best papers were first selected by the two section editors; 2) external reviewers from internationally renowned research teams reviewed each candidate best paper; and 3) the final selection of three best papers was conducted by the editorial committee of the International Medical Informatics Association (IMIA) Yearbook. Results: Selected best papers represent the important and diverse ways that health informatics supported clinical and public health responses to the global COVID-19 pandemic. Selected papers represent four groups of papers: 1) Use of analytics to screen, triage, and manage patients; 2) Use of telehealth and remote monitoring to manage patients and populations; 3) Use of EHR systems and administrative systems to manage internal operations of a hospital or health system; and 4) Use of informatics methods and systems by public health authorities to capture, store, manage, and visualize population-level data and information. Conclusion: Health informatics played a critical role in managing patients and populations during the COVID-19 pandemic. Health care and public health organizations both leveraged available information systems and standards to rapidly identify cases, triage infected individuals, and monitor population trends. The selected best papers represent a fraction of the body of knowledge stemming from COVID-19, most of which is focused on pandemic response. Future work will be needed to help the world recover from the pandemic and strengthen the health information infrastructure in preparation for the next pandemic.

Development, Status Quo, and Challenges to China's Health Informatization During COVID-19: Evaluation and Recommendations.

By applying advanced health information technology to the health care field, health informatization helps optimize health resource allocation, improve health care services, and realize universal health coverage. COVID-19 has tested the status quo of China’s health informatization, revealing challenges to the health care system. This viewpoint evaluates the development, status quo, and practice of China’s health informatization, especially during COVID-19, and makes recommendations to address the health informatization challenges. We collected, assessed, and evaluated data on the development of China’s health informatization from five perspectives—health information infrastructure, information technology (IT) applications, financial and intellectual investment, health resource allocation, and standard system—and discussed the status quo of the internet plus health care service pattern during COVID-19. The main data sources included China’s policy documents and national plans on health informatization, commercial and public welfare sources and websites, public reports, institutional reports, and academic papers. In particular, we extracted data from the 2019 National Health Informatization Survey released by the National Health Commission in China. We found that China developed its health information infrastructure and IT applications, made significant financial and intellectual informatization investments, and improved health resource allocations. Tested during COVID-19, China’s current health informatization system, especially the internet plus health care system, has played a crucial role in monitoring and controlling the pandemic and allocating medical resources. However, an uneven distribution of health resources and insufficient financial and intellectual investment continue to challenge China’s health informatization. China’s rapid development of health informatization played a crucial role during COVID-19, providing a reference point for global pandemic prevention and control. To further promote health informatization, China’s health informatization needs to strengthen top-level design, increase investment and training, upgrade the health infrastructure and IT applications, and improve internet plus health care services.

Integrating an Electronic Health Record System into a Regional Health Information System: An HL7 FHIR Architecture.

This paper presents an architecture which has been developed in order to integrate a routinely used cardiologic EHR system into the health information infrastructure system of the region where the EHR is used. A Service Oriented Approach based on HL7 and FHIR was used, achieving interoperability, security and confidentiality at all levels. The system has been used for about a year and has brought about significant improvements in the provision of care.