Health Information Technology Systems Research Articles

Primary Care Physicians’ Satisfaction With Interoperable Health Information Technology

Enabling widespread interoperability-the ability of health information technology systems to exchange information and to use that information without special effort-is a primary focus of public policy on health information technology. More information on clinicians' experience using that technology can serve as one measure of the impact of that policy. To assess primary care physician perspectives on the state of interoperability. A cross-sectional survey of family medicine physicians in the US was conducted from December 12, 2021, to October 12, 2022. A sample of family medicine physicians who completed the Continuous Certification Questionnaire (CCQ), a required part of the American Board of Family Medicine certification process, which has a 100% response rate, were invited to participate. Eighteen items on the CCQ assessed experience accessing and using various information from outside organizations, including medications, immunizations, and allergies. A total of 2088 physicians (1053 women [50%]; age reported categorically as either ≥50 years or <50 years) completed the CCQ interoperability questions in 2022. Of these respondents, 35% practiced in hospital or health system-owned practices, while 27% practiced in independently owned practices. Eleven percent were very satisfied with their ability to electronically access all 10 types of information from outside organizations included on the questionnaire, and a mean of 70% were at least somewhat satisfied. A total of 23% of family medicine physicians reported information from outside organizations was very easy to use, and an additional 65% reported that information was somewhat easy to use. Only 8% reported that information from different electronic health record (EHR) developers' products was very easy to use compared with 38% who reported information from the same EHR developer's product was very easy to use. This survey study of family medicine physicians found modest and uneven improvement in physicians' experience with interoperability. These findings suggest that substantial heterogeneity in satisfaction by information type, source of information, EHR, practice type, ownership, and patient population necessitates diverse policy and strategies to improve interoperability.

Operational disruption in healthcare associated with software functionality issue due to software security patching: a case report.

Despite many benefits, the extensive deployment of Health Information Technology (HIT) systems by healthcare organizations has encountered many challenges, particularly in the field of telemetry concerning patient monitoring and its operational workflow. These challenges can add more layers of complexity when an unplanned software security patching is performed, affecting patient monitoring and causing disruption in daily clinical operations. This study is a reflection on what happened associated with software security patching and why it happened through the lens of an incident report to develop potential preventive and corrective strategies using qualitative analyses-inductive and deductive approaches. There is a need for such analyses to identify the underlying mechanism behind such issues since very limited research has been conducted on the study of software patching. The incident was classified as a "software functionality" issue, and the consequence was an "incident with a noticeable consequence but no patient harm", and the contributing factor was a software update, i.e., software security patching. This report describes how insufficient planning of software patching, lack of training for healthcare professionals, contingency planning on unplanned system disruption, and HIT system configuration can compromise healthcare quality and cause risks to patient safety. We propose 15 preventive and corrective strategies grouped under four key areas based on the system approach and social-technical aspects of the patching process. The key areas are (i) preparing, developing, and deploying patches; (ii) training the frontline operators; (iii) ensuring contingency planning; and (iv) establishing configuration and communication between systems. These strategies are expected to minimize the risk of HIT-related incidents, enhance software security patch management in healthcare organizations, and improve patient safety. However, further discussion should be continued about general HIT problems connected to software security patching.

Health Information Technology 기반 국내외 의료용 마약류 모니터링 시스템 비교 분석

This study was conducted to propose ways to improve the domestic system based on a comparative analysis of domestic and foreign Health Information Technology (HIT) system using cases to prevent misuse and abuse of controlled substances. Korea, the United States, and Australia were selected as the countries to be investigated as representative examples of nationwide use of HIT. Literature data was collected from the official website of the system operating organization and major literature databases and search engines such as Pubmed and Google Scholar using the name of each country's HIT system as a keyword. We focused on analyzing the purpose of system operation, target drugs, information collection method, system operation method, and compensation to system users. Korea’s Narcotics Information Management System (NIMS) is the only system that can track the serial numbers of controlled substances in connection with prescription and dispensing records, and is designed and operated with a focus on regulatory purposes to improve legal compliance. NIMS had a relatively long reporting cycle, so there were limitations in checking the latest controlled substances prescription and dispensing records. It was also the only system in which pharmacists did not have the authority and role to check and monitor prescription records. In order to effectively prevent misuse and abuse of controlled substances, the reporting cycle must be shortened by switching to a real-time monitoring system including nonreimbursement medications. In addition, there is a need to guarantee pharmacists the authority to request prescription records before dispensing and the roles that accompany this.

Integrating clinical pharmacists into transitions of care: A qualitative study of barriers and facilitators among federally qualified health centers

AbstractBackgroundComprehensive medication management (CMM) is a service provided by clinical pharmacists. CMM aims to optimize pharmacotherapy outcomes by ensuring patients' medications are indicated, effective, safe, and patients are able to adhere to the prescribed medication regimen and take the medications as intended. The goal of CMM is to optimize patients' medications to ensure they are meeting their medication and health‐related goals.ObjectiveThe objective of this project is to evaluate facilitators and barriers to integrating CMM during transitions of care (ToC) at Federally Qualified Health Centers (FQHCs).DesignSemistructured qualitative interviews were conducted with 22 key informants identified through purposive sampling at three FQHCs. Interviews were coded and analyzed deductively using a modified Consolidated Framework for Implementation Research (CFIR) adapted for ToC.Key ResultsThirty‐nine codes were identified across all CFIR constructs, including the addition of a new construct, “Patient characteristics.” Major facilitators included the perceived advantage and feasibility of the intervention, standardization of ToC processes, and organizational buy‐in. Major barriers included health information technology system limitations, communication barriers with discharge facilities, technical and staffing challenges in applying criteria to identify patients for CMM, and low patient throughput.ConclusionsIdentifying early‐stage barriers and facilitators are key to maximize facilitators and address barriers to support successful implementation. The findings of this work are being used to guide project adaptations to better integrate CMM into the ToC processes.

Characterizing patient details-related challenges from health information technology-related incident reports from Swedish healthcare.

Despite many benefits offered by Health Information Technology (HIT) systems, new technology brings new and unforeseen risks to healthcare quality and patient safety if they're not properly planned, designed, implemented, and managed. This study examined health information technology-related (HIT) incidents to identify patient details-related issues, their association with contributing factors, and outcomes. Sources of information comprised retrospectively collected incident reports (n = 95) using two sampling methods, i.e., purposive and snowball sampling. The incident reports were analyzed using both the inductive method (thematic analysis) and the deductive approach using an existing framework, i.e., the International Classification for Patient Safety. The studies identified 90 incidents with 120 patient details-related issues-categorized as either information-related (48%) or documentation-related (52%) problems; around two-thirds of the 120 issues were characterized by human factors. Of the total sample, 87 contributing factors were identified, of which "medical device/system" (45%) and "documentation" (20%) were the most common contributing factors. Of 90 incidents, more than half (59%) comprised patient-related outcomes-patient inconvenience (47%) and patient harm (12%) and the remaining 41% (n = 37) included staff or organization-related outcomes. More than half of the incidents resulted in patient-related outcomes, namely patient inconvenience and patient harm, including disease risks, severe health deterioration, injury, and even patient death. Incidents associated with patient details can cause deleterious effects; therefore, characterizing them should be a routine part of clinical practice to improve the constantly changing healthcare system.

A Nationwide Chronic Disease Management Solution via Clinical Decision Support Services: Software Development and Real-Life Implementation Report.

The increasing population of older adults has led to a rise in the demand for health care services, with chronic diseases being a major burden. Person-centered integrated care is required to address these challenges; hence, the Turkish Ministry of Health has initiated strategies to implement an integrated health care model for chronic disease management. We aim to present the design, development, nationwide implementation, and initial performance results of the national Disease Management Platform (DMP). This paper's objective is to present the design decisions taken and technical solutions provided to ensure successful nationwide implementation by addressing several challenges, including interoperability with existing IT systems, integration with clinical workflow, enabling transition of care, ease of use by health care professionals, scalability, high performance, and adaptability. The DMP is implemented as an integrated care solution that heavily uses clinical decision support services to coordinate effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines and, hence, to increase the quality of health care delivery. The DMP is designed and implemented to be easily integrated with the existing regional and national health IT systems via conformance to international health IT standards, such as Health Level Seven Fast Healthcare Interoperability Resources. A repeatable cocreation strategy has been used to design and develop new disease modules to ensure extensibility while ensuring ease of use and seamless integration into the regular clinical workflow during patient encounters. The DMP is horizontally scalable in case of high load to ensure high performance. As of September 2023, the DMP has been used by 25,568 health professionals to perform 73,715,269 encounters for 16,058,904 unique citizens. It has been used to screen and monitor chronic diseases such as obesity, cardiovascular risk, diabetes, and hypertension, resulting in the diagnosis of 3,545,573 patients with obesity, 534,423 patients with high cardiovascular risk, 490,346 patients with diabetes, and 144,768 patients with hypertension. It has been demonstrated that the platform can scale horizontally and efficiently provides services to thousands of family medicine practitioners without performance problems. The system seamlessly interoperates with existing health IT solutions and runs as a part of the clinical workflow of physicians at the point of care. By automatically accessing and processing patient data from various sources to provide personalized care plan guidance, it maximizes the effect of evidence-based decision support services by seamless integration with point-of-care electronic health record systems. As the system is built on international code systems and standards, adaptation and deployment to additional regional and national settings become easily possible. The nationwide DMP as an integrated care solution has been operational since January 2020, coordinating effective screening and management of chronic diseases in adherence to evidence-based clinical guidelines.

Dentists' Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study.

The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists' information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. This study aims to determine Indiana dentists' information needs regarding patients' medical information and their opinions about accessing it via an HIE. We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents' characteristics and responses. Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients' medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient's information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Patients' medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs.

Association of health information technology-driven multidisciplinary approaches with low-density lipoprotein cholesterol target achievement in patients with an acute coronary syndrome

ObjectiveControlling of low-density lipoprotein cholesterol (LDL-C) in patients with acute coronary syndrome (ACS) remains a challenge. Health information technology (HIT) is increasingly being applied to close quality gaps in chronic illness care. The aim of this study was to perform a qualitative review of the association of implementing HIT on lipid management processes of care and LDL-C goal attainment in patients with ACS. MethodEligible patients with a discharge diagnosis of ACS from January 2018 to December 2021 at a tertiary medical center were retrospectively reviewed. An HIT system with a multidisciplinary approach including initiating high-intensity statin therapy, periodic laboratory follow-up, titration of lipid-lowering agents, patient education, patient-level and system-level interventions involving database monitoring and outreach by centralized care teams was introduced in October 2018. Electronical medical records including data on medications and laboratory findings at discharge and within 1 year were compared before and after implementing the HIT system. ResultsA total of 2001 ACS patients (average age 63 ± 12.7 years, 79.66 % men) were analyzed. The LDL-C < 70 mg/dL goal attainment rates (36.52 %, 53.57 %, 59.22 %, 62.18 % in 2018–2021) and medium serum LDL-C levels (80.5 mg/dL, 68 mg/dL, 65 mg/dL, 64 mg/dL in 2018–2021) significantly improved within 6 months (2018 as the reference, all p<0.001). The LDL-C attainment rate at 12 months also steadily increased (53.80 %, 61.82 %, 64.21 % in 2019–2021, p = 0.019). Most of the patients switched to a high-intensity statins regimen at discharge (0.57 %, 63.67 %, 72.41 %, 84.44 %, in 2018–2021, p<0.001 with 2018 as the reference), with low adverse event rates. The maintenance rates of high-intensity statin regimens at 12 months continued to improve (41.36 %, 49.04 %, 61.39 % in 2019–2021, p<0.001). ConclusionsEfforts to control LDL-C should be increased in ACS patients by initiating and intensifying statin treatment earlier. Our results confirmed that a team-based strategy with HIT improved LDL-C target achievement for most patients with ACS.

Impact of team-based health information technology to improve low-density lipoprotein cholesterol goal attainment after acute coronary syndrome hospital discharge: a single-center experience

Abstract Objectives The reduction in circulating low-density lipoprotein cholesterol (LDL-C) is the primary aim of lipid-lowering therapies as a method of atherosclerotic cardiovascular disease risk reduction. Although guidelines recommended strictly control of low-density lipoprotein cholesterol (LDL-C) below 70 mg/dL by high-intensity statin therapy in patients with acute coronary syndrome (ACS), the LDL-C target goal is not often attained. Health information technology (HIT) with information integration, decision making algorithm, is being applied on chronic illness care. Purpose We aimed to perform a qualitative review of the impact of HIT interventions on lipid management and LDL-C goal attainment in patients after ACS hospital discharge. Method Consecutive ACS patients with dyslipidemia (LDL-C &amp;gt;100 mg/dL) at discharge between January 2018 and December 2021 in a tertiary medical center were retrospectively reviewed. The LDL-C &amp;lt;70 mg/dL is defined as target. The team-based approach quality improvement program that consisted of patient education and high-intensity statin initiation before discharge, outpatient clinics with periodic laboratory follow-up, titration of lipid-lowering agents, and system-level interventions that involve database monitoring and outreach by centralized care teams, was introduced in October 2018. Electronical medical records including the medications, laboratory data at discharge and within 1 year were compared, before and after initiation of HIT system. Result A total 2248 ACS patients were included. The LDL-C &amp;lt;70 mg/dL attainment rate (36.52%, 53.57%, 59.22%, 62.18% in 2018, 2019, 2020, and 2021) and medium serum LDL-C level (80.5 mg/dL, 68 mg/dL, 65 mg/dL, 64 mg/dL in 2018, 2019, 2020, and 2021) significantly improved within 6 months after initiation of the team-based integrated intervention with assisted by HIT (2018 as the reference, all p&amp;lt;0.001). The LDL-C goal attainment rate at 12-month kept increasing gradually (53.80%, 61.82%, 64.21%, in 2019, 2020, 2021, p= 0.019). Most of the population initiated with moderate-intensity statin in 2018 (76.24%, 20.92%, 10.95%, 6.41% in 2018, 2019, 2020, and 2021), then switched to a high-intensity statin after initiation of the program (0.57%, 63.67%, 72.41%, 84.44% in 2018, 2019, 2020, and 2021) (2018 as the reference, all p&amp;lt;0.001), while the adverse event rates including hepatotoxicity and rhabdomyolysis remained similarly low. Conclusion Our results confirmed that multifaceted intervention with HIT assisted multidisciplinary approach could substantially improve LDL-C goal attainment in post-ACS patients. There was a direct relationship between high-intensity statins and LDL-C goal attainment, without significant increase of adverse events.LDL-C goal attainment rate and levelLower lipid treatment and adverse event

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review.

A frequently used feature of electronic patient portals is the viewing of test results. Research on patient portals is abundant and offers evidence to help portal implementers make policy and practice decisions. In contrast, no comparable comprehensive summary of research addresses the direct release of and patient access to test results. This scoping review aims to analyze and synthesize published research focused on patient and health care provider perspectives on the direct release of laboratory, imaging, and radiology results to patients via web portals. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Searches were conducted in CINAHL, MEDLINE, and other databases. Citations were screened in Covidence using the inclusion and exclusion criteria. Primary studies that focused on patient and health care provider perspectives on patient access to laboratory and imaging results via web portals were included. An updated search was conducted up to August 2023. Our review included 27 articles-20 examining patient views, 3 examining provider views, and 4 examining both patient and provider views. Data extraction and inductive data analysis were informed by sensitizing concepts from sociomaterial perspectives, and 15 themes were generated. Patient perspectives (24 papers) were synthesized using nine themes: (1) patterns of use and patient characteristics; (2) emotional response when viewing the results and uncertainty about their implications; (3) understanding test results; (4) preferences for mode and timing of result release; (5). information seeking and patients' actions motivated by viewing results via a portal; (6) contemplating changes in behavior and managing own health; (7) benefits of accessing test results via a portal; (8) limitations of accessing test results via a portal; and (9) suggestions for portal improvement. Health care provider perspectives (7 papers) were synthetized into six themes: (1) providers' view of benefits of patient access to results via the portal; (2) effects on health care provider workload; (3) concerns about patient anxiety; (4) timing of result release into the patient portal; (5) the method of result release into the patient portal: manual versus automatic release; and (6) the effects of hospital health information technology system on patient quality outcomes. The timing of the release of test results emerged as a particularly important topic. In some countries, the policy context may motivate immediate release of most tests directly into patient portals. However, our findings aim to make policy makers, health administrators, and other stakeholders aware of factors to consider when making decisions about the timing of result release. This review is sensitive to the characteristics of patient populations and portal technology and can inform result release framework policies. The findings are timely, as patient portals have become more common internationally.

Challenges and successes in implementing an integrated electronic patient record (HIVE) at the Manchester University National Health Service Foundation Trust, England: 1000+ legacy systems, 10 hospitals, one electronic patient record.

The Manchester University National Health Service (NHS) Foundation Trust (MFT) is one of the largest NHS Trusts in England. Historically, the Trust has had very mixed clinical record keeping, including over 1000 individual information systems. None of these health information technology systems had the full functionality of an integrated electronic patient record (EPR). MFT evolved to its current size and complexity with a vision to improve patient care in Greater Manchester by adopting a Trust-wide EPR. The EPR "Go Live" occurred in September 2022. To describe the process of EPR integration as it reflected and impacted upon MFT's health information management (HIM) teams. MFT worked through a 2-year readiness program of work. This included technical readiness, software development and migration planning. Migration of data from the approximately 1000 systems was a major undertaking, during which access to the clinical history and ongoing operational reporting needed to be maintained. Pre-implementation requirements were outlined, a change management program was implemented, and the overall implementation was managed to tight timelines. "Go Live" was achieved for the EPIC EPR product (HIVE) within MFT. Legacy systems are still in the process of being decommissioned and staff are transacting within HIVE. Significant changes in processes and reporting continue to be made, despite some challenges. The Trust delivered the single largest EPIC European "Go live." Lessons learnt continue to be identified. The impact of what the EPR means for the HIM function is described.

A Survey of Technology Abandonment in US Nursing Homes

ObjectiveAdoption of health information technology (HIT) in nursing homes (NHs) improves quality of care. Although there is a robust body of research on HIT adoption, the closely related process of technology abandonment is not well understood. As NHs grow more reliant on HIT, problems of technology abandonment, defined as failure to scale up, spread, and sustain HIT need to be studied. Our objective is to describe HIT abandonment and its associations with organizational characteristics among a national sample of US NHs. DesignLongitudinal, retrospective analysis of data from 2 sources: HIT Maturity Survey and Staging model and public data from the Care Compare database. Setting and ParticipantsRandom sample of NHs (n = 299) representing each US state that completed the HIT maturity survey in 2 consecutive years: year 1 (Y1) was June 2019–August 2020 and year 2 (Y2) was June 2020–August 2021. MethodsThe primary dependent variable was technology abandonment, operationalized by using total HIT maturity score, HIT maturity stage, and subscale scores within each dimension/domain. Independent variables were NH organizational characteristics including bed size, type of ownership, urbanicity, Centers for Medicare & Medicaid Services Five-Star Overall Rating and Staffing Rating. ResultsOver the 2-year period, HIT abandonment occurred in 28% (n = 85) of NHs compared with 44% (n = 133) that experienced growth in HIT systems. HIT capabilities in resident care were abandoned most frequently. Using multivariable multinomial logistic regression, we found that large NHs (bed size greater than 120) were more likely to experience technology abandonment in administrative activities. Conclusions and ImplicationsTechnology abandonment can increase strain on scarce resources and may impact administrators’ ability to oversee clinical operations, especially in large NHs. This study contributes to the limited understanding of technology abandonment and can serve as a building block for others working to ensure limited resources are used effectively to improve care for NH residents.

Digital Technology in Hospital Administration: A Strategic Choice.

Digital technology has encompassed all aspects of healthcare. There are many international and national organizations, guidelines, and formats available in health information systems (HIS), but many are presently still not being used in India. The aim is to give a flawless, secure, and user-friendly health information technology (IT) system for Indian healthcare. We discuss the timeline of digital technology in hospital administration, administrative applications, and the importance of clinical quality in health. Clinical perspectives of clinical information systems (CIS), both in acute as well as chronic clinical care models. Cross-integration of healthcare in IT (HIT) in electronic health records (EHR) or electronic medical records (EMRs), in chronic disease management (CDM) systems, and in clinical decision support systems (CDSS) are elaborated. Also, practical strategic application methods are discussed. The limitations of the current HIS software in India are mostly used for transaction reporting, prescription, and administrative tools. They lack CIS and strategic business applications as compared to mature multinational company (MNC) HIS software. Along with this, various features and levels of HIS Software, challenges of HIT adoption, Indian health IT standards, and the future framework of IT in health in India are systematically analyzed. We aim at all physicians in India and at all levels of practice, from individuals, group practices, health institutes, or corporate hospitals, and to encourage them to make strategic use of CIS and strategic IT applications in their individual practice and hospital management. This will improve clinical outcomes, patient safety, practitioner performance, adherence to treatment guidelines, and reduction in medical errors, along with efficiency improvements and cost reductions. How to cite this article: Taneja D, Kulkarni SV, Sinha S, et al. Digital Technology in Hospital Administration: A Strategic Choice. J Assoc Physicians India 2023;71(10):83-88.

Evaluation of the Design and Development of the HeLe Newborn Hearing Screening Tele-Audiology Systems for the Philippines

Introduction. There is increasing interest in innovation development and management in the Philippines, especially in the last decade. In the advocacy for universal hearing health, the HeLe, “Hearing for Life’’ Research Program was implemented. HeLe developed novel telehealth technologies and field tested a proof-of-concept service delivery model to improve provision of newborn hearing screening and intervention services in the Philippines.Objective. As the HeLe research period concludes, this appraisal was organized to document and assess the health information technology systems of the HeLe.Methods. The evaluation follows the elements of the Centers for Disease Control and Prevention (CDC) guidelines for evaluation of public health surveillance systems. It centers on the status of the eHealth-based components of the HeLe NHS interventions: HeLe NHS module in the Community Health Information Tracking System (CHITS) electronic medical records system, the Tele-Audiology module in National Telehealth System (NTS), and the HeLe NHS registry. The evaluation is based on interviews of key HeLe research staff and documentation review.Results. The HeLe system has a stable, SQL-Server-based architecture. It is a secure, web-based system with clean separation of back-end database and front-end Web, using Secure Socket Layer (SSL) technology. Standardization of data via mapping ensures reliable, comparable measures. HeLe demonstrates that NHS data collected by the HeLe NHS device can be sent to, stored in, and extracted from the CHITS electronic medical record system and exchanged across platforms. Where actual patient and NHS data were available, this HeLe system is validated to be efficacious to capture and seamlessly exchange data across various eHealth platforms. These eHealth technologies are described to be at Technology Readiness Level 5, “technologies are validated in a relevant environment”. The HeLe program, however, needs to address completeness in documentation as a standard practice, if only to ensure better management of risks introduced by novel eHealth systems in patient care. The CDC public healthsurveillance checklist used for this assessment is useful in identifying gaps in research management for the HeLe inventors. It is recommended to be incorporated to be standard and implemented early in the next iteration of the HeLe research.Conclusions. Overall, the HeLe technologies, in this initial stage of research, have achieved the purpose for which they were developed. As a novel technologybased NHS system, HeLe is a potentially powerfultool to assist in monitoring newborn hearing disease caseloads by community-based primary care clinics,NHS facilities, and hospitals that provide definitive medical services. As other health systems strengthening reforms take root in the Philippines, secure exchange of data electronically across the country would depend on sound technologies, including those used in hearing health. This paper can be instructive to the emerging research community in the eHealth and biomedical development space especially in resource-challenged settings. Likewise, lessons can reinforce institutional support from research agencies, clinicians, and state/county or subnational health departments for policy andresource mobilization to better manage those identified with congenital hearing loss.&#x0D;

How to Make Outpatient Healthcare Data in Germany Available for Research in the Dynamic Course of Digital Transformation.

There is increasing interest on re-use of outpatient healthcare data for research, as most medical diagnosis and treatment is provided in the ambulatory sector. One of the early projects to bring primary data from German ambulatory care into clinical research technically, organizationally and in compliance with legal demands has been the RADAR project, that is based on a broad consent and has used the then available practice information system's interfaces to extract and transfer data to a research repository. In course of the digital transformation of the German healthcare system, former standards are abandoned and new interoperability standards, interfaces and regulations on secondary use of patient data are defined, however with slow adoption by Health-IT systems. Therefore, it is of importance for all initiatives that aim at using ambulatory healthcare data for research, how to access this data in an efficient and effective way. Currently defined healthcare standards are compared regarding coverage of data relevant for research as defined by the RADAR project. We compare four architectural options to access ambulatory health data through different components of healthcare and health research data infrastructures along the technical, organizational and regulatory conditions, the timetable of dissemination and the researcher's perspective. A high-level comparison showed a high degree of semantic overlap in the information models used. Electronic patient records and practice information systems are alternative data sources for ambulatory health data - but differ strongly in data richness and accessibility. Considering the compared dimensions of architectural routes to access health data for secondary research use we conclude that data extraction from practice information systems is currently the most promising way due to data availability on a mid-term perspective. Integration of routine data into the national research data infrastructures might be enforced by convergence of to date different information models.

Re-Engineering the Hospital Discharge to Improve the Transition From Hospital to Home

The hospital discharge is non-standardized and frequently marked with poor quality and is an important driver of healthcare costs. There is now ample evidence that improving communication at hospital discharge can prevent problems after hospital discharge including rehospitalization. The ReEngineered Discharge (RED) successfully delivers high quality transitions in care, improves patient satisfaction, achieves patient-centered outcomes, and reduces rehospitalization by over 20% while lowering healthcare costs. However, implementing these evidence-based processes into US hospitals requires smooth integration into customary hospital workflows, while not increasing health professional time needed to carry out these duties. Now, rapidly evolving health-information technology systems using conversational agents such as the MayaRED have great potential to deliver the benefits of RED, with the added benefits of saving nurses' and other health professionals' time, delivering post-discharge reinforcement of the care plan and connecting chronic care patients to remote patient monitoring platforms.

In support of interoperability: A laboratory perspective.

Healthcare in the United States has become increasingly digital since the passage of the HITECH Act in 2009. As a result, there is a growing need to optimize healthcare IT to allow for the interoperable exchange of data. As a result, the Office of the National Coordinator for Health IT has implemented their Final Rule for the 21st Century Cures Act. This requires certified health IT systems to use modernized messaging standards for the safe and secure exchange of data within health information networks and also requires the use of terminology standards including LOINC, SNOMED CT, and UCUM for coding clinical and laboratory data. Given the critical importance of laboratory results in the delivery of healthcare, laboratorians must become familiar with these principles of interoperability. Their clinical laboratory expertise is needed to appropriately structure and code test results to safeguard against improper aggregation or misinterpretation by downstream users and systems.

The NASEM Report: Are the Solutions Part of the Problem?

The NASEM Report: Are the Solutions Part of the Problem?

Economic Efficiency of an Open-Source National Medical Lab Software in Canada.

Although the Canada federal government has invested over $3.1billion developing health information technology (HIT), all 10 provinces still have their own separate HIT systems, which are non-interoperable, expensive, and inconsistent. After first reviewing how these systems operate, this paper analyzes the costs and savings of integrating the common billing, lab results, and diagnostic imaging (BLD) functions of these separate systems using free and open-source software and proposes a system for this, HermesAPI. Currently, 8 provincial governments representing over 95% of Canada's population allow private companies to create their own electronic medical records (EMR) system and integrate with provincial BLD systems. This study found the cost to develop and maintain HermesAPI would be between CAD$610,000 to CAD$740,000, but would prevent CAD$120,000 per company per province in development costs for a total savings of $6.4million. HermesAPI would lower barriers to entry for the HIT industry to increase competition, improve the quality of HIT products, and ultimately patient care. The proposed open-source approach of the HermesAPI is one option towards building a more interoperable, less expensive, and more consistent HIT system for Canada.

Implementing Health Information System in King Hamad University Hospital Benefits and Challenges

As a university hospital, it prides itself on using the latest techniques, medical and diagnostic curriculum, as well as up-to-the-minute medical equipment and fully equipped facilities. It has over 1700 employees and accommodates more than 311 beds and 9 operating theatres, a number of internal wards plus an intensive care unit with 12 beds. Healthcare organizations now believe in improved efficiency, reduced costs, improved patient care and quality of services, and safety when they are preparing to apply new information and communication technology (ICT) based applications. Health IT systems allow the gathering of data for use for quality management, outcome reporting, and public health disease surveillance and reporting. However, development is needed with all health IT, particularly concerning design, implementation, and integration between platforms within the surroundings of work.