Healthcare Information Systems Research Articles

Long COVID outcomes in an asthmatic cohort and its implications for asthma control

Long COVID outcomes in an asthmatic cohort and its implications for asthma control

3LGM2IHE: Requirements for Data-Protection-Compliant Research Infrastructures-A Systematic Comparison of Theory and Practice-Oriented Implementation.

The TMF (Technology, Methods, and Infrastructure for Networked Medical Research) Data Protection Guide (TMF-DP) makes path-breaking recommendations on the subject of data protection in research projects. It includes comprehensive requirements for applications such as patient lists, pseudonymization services, and consent management services. Nevertheless, it lacks a structured, categorized list of requirements for simplified application in research projects and systematic evaluation. The 3LGM2IHE ("Three-layer Graphbased meta model - Integrating the Healthcare Enterprise [IHE] " ) project is funded by the German Research Foundation (DFG). 3LGM2IHE aims to define modeling paradigms and implement modeling tools for planning health care information systems. In addition, one of the goals is to create and publish 3LGM2 information system architecture design patterns (short "design patterns") for the community as design models in terms of a framework. A structured list of data protection-related requirements based on the TMF-DP is a precondition to integrate functions (3LGM2 Domain Layer) and building blocks (3LGM2 Logical Tool Layer) in 3LGM2 design patterns. In order to structure the continuous text of the TMF-DP, requirement types were defined in a first step. In a second step, dependencies and delineations of the definitions were identified. In a third step, the requirements from the TMF-DP were systematically extracted. Based on the identified lists of requirements, a fourth step included the comparison of the identified requirements with exemplary open source tools as provided by the "Independent Trusted Third Party of the University Medicine Greifswald" (TTP tools). As a result, four lists of requirements were created, which contain requirements for the "patient list", the "pseudonymization service", and the "consent management", as well as cross-component requirements from the TMF-DP chapter 6 in a structured form. Further to requirements (1), possible variants (2) of implementations (to fulfill a single requirement) and recommendations (3) were identified. A comparison of the requirements lists with the functional scopes of the open source tools E-PIX (record linkage), gPAS (pseudonym management), and gICS (consent management) has shown that these fulfill more than 80% of the requirements. A structured set of data protection-related requirements facilitates a systematic evaluation of implementations with respect to the fulfillment of the TMF-DP guidelines. These re-usable lists provide a decision aid for the selection of suitable tools for new research projects. As a result, these lists form the basis for the development of data protection-related 3LGM2 design patterns as part of the 3LGM2IHE project.

Technology acceptance model of Tuberculosis Integrated Information System in Indonesian primary healthcare

: This article investigates the acceptance model of the technology of tuberculosis integrated information system (TIIS) adopted and its effects on the actual use in the Indonesian healthcare facility. Some factors such as the perceived usefulness and ease of use are investigated to understand their relationship with the system’s actual use. Quantitative research has been done in this study using a structural equation model (SEM) and partial least square. This study shows that respondents’ perceived usefulness and the ease of use of TIIS positively affect the adopted system’s actual use. The evaluation of the influence of perceived usefulness and perceived ease of use and external variables such as subjective, image, job relevance, and facilitating condition on the intention to use using TIIS to support the implementation of the program of prevention of infectious diseases in a developing country such as Indonesia would help the government to treat the tuberculosis disease better.

Comparative Analysis of HQS, JCI and HIMSS-EMRAM Quality Assessment Models Widely Used in Turkey

The standards developed for measuring quality ensure the management of the dynamic structure of health services, the reduction of uncertainties, and the prevention of errors since quality relies on measurement, evaluation, and continuous improvement. Additionally, the models used in measuring health service quality are divided into two: case-based and indicator-based. Using the document analysis method, this study compared the Joint Commission International (JCI), Healthcare Quality Standards (HQS) and Healthcare Information and Management Systems Society (HIMSS) – Electronic Medical Record Adoption Model (EMRAM) models, which are included in the indicator-based health quality measurement models, in terms of the concepts, processes, and standards featured in them. Within the scope of the study, a total of 1,141 standards from all three models were examined. Ethical approval was taken from local ethics committee on 10/08/2020. Upon the comparison, it was understood that the HQS and JCI models were more similar in "presence rates" than the HIMSS-EMRAM model in terms of concept (83%), process (66%), and standard (64%). It was concluded that HIMSS EMRAM standards can be used as a very useful tool for making improvements and identifying deficiencies in HQS and JCI processes.

Drug closed-loop management system using mobile technology

BackgroundDrug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system.MethodsUsing mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods.ResultsAfter the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year.ConclusionsMobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used.

Implementation of Health Information Systems to Improve Patient Identification.

Wellbeing can be ensured in society through quality healthcare, a minimum of medical errors, and the improved performance of healthcare professionals. To this end, health information systems have been implemented in hospitals, with this implementation representing progress in medicine and information technologies. As a result, life expectancy has significantly increased, standards in healthcare have been raised, and public health has improved. This progress is influenced by the process of managing healthcare organizations and information systems. While hospitals tend to adapt health information systems to reduce errors related to patient misidentification, the rise in the occurrence and recording of medical errors in Lebanon resulting from failures to correctly identify patients reveals that such measures remain insufficient due to unknown factors. This research aimed to investigate the effect of health information systems (HISs) and other factors related to work-related conditions on reductions in patient misidentification and related consequences. The empirical data were collected from 109 employees in Neioumazloum Hospital in Lebanon. The results revealed a correlation between HISs and components and the effects of other factors on patient identification. These other factors included workload, nurse fatigue, a culture of patient safety, and lack of implementation of patient identification policies. This paper provides evidence from a Lebanese hospital and paves the way for further studies aiming to explore the role of information technologies in adopting HISs for work performance and patient satisfaction. Improved care for patients can help achieve health equality, enhance healthcare delivery performance and patient safety, and decrease the numbers of medical errors.

Kevin Clauson, Tennessee pharmacist and technology expert, dies at 51.

Kevin Alan Clauson, professor of pharmacy practice at the Lipscomb University College of Pharmacy and Health Sciences in Nashville, TN, died September 15 at age 51 years. Clauson was a leader in the field of digital health. He served as a technology advisor for many organizations, including the Food and Drug Administration, the World Health Organization, and the Healthcare Information and Management Systems Society. He was a featured speaker and writer on the use of blockchain in healthcare, consumer health informatics, social media in healthcare, and mobile health. “Kevin had a tremendous gift for describing cutting-edge technology in ways that made complex topics understandable to a wide audience,” said ASHP Chief Executive Officer Paul W. Abramowitz. “He was passionate about pharmacy, and his work with students and residents gave many up-and-coming pharmacists the skills they needed to successfully launch their own careers. Kevin’s untimely death is a sad loss to the profession, his family, and the many friends and colleagues whose lives he influenced.”

ETL Processes for Integrating Healthcare Data - Tools and Architecture Patterns.

Improving the interoperability of healthcare information systems is a crucial clinical care issue involving disparate but coexisting information systems. However, healthcare organizations are also facing the dilemma of choosing the right ETL tool and architecture pattern as data warehouse enterprises. This article gives an overview of current ETL tools for healthcare data integration. In addition, we demonstrate three ETL processes for clinical data integration using different ETL tools and architecture patterns, which map data from various data sources (e.g. MEONA and ORBIS) to diverse standards (e.g. FHIR and openEHR). Depending on the project's technical requirements, we choose our ETL tool and software architecture pattern to boost team efficiency.

클라우드 기반 의료정보시스템 도입에 대한 지각된 위험 및 혜택이 수용저항에 미치는 영향: 가치기반수용모형을 기반으로

In the 4th industrial revolution era, cloud computing has been spreading in various industries. In the healthcare industry as well, calls for advancing the healthcare information system (HIS) through cloud-based digital transformation are gaining momentum so that healthcare services can be received ‘anytime and anywhere’ from a patient perspective, not from a hospital one. Most of the previous studies on cloud computing in the field of HIS have been conducted from the perspective of hospitals that establish and operate HIS; there is a clear limitation that it has not been conducted from the perspective of patients who need healthcare services. Therefore, based on the value-based adoption model (VAM), this study derives perceived risk (i.e., privacy risk, performance risk, institutional risk) and perceived benefit (i.e., usefulness, shared benefit, economic benefit) factors, and investigates their impact on perceived value and acceptance resistance in the context of cloud-based HIS. A structural equation model analysis was conducted using 118 samples obtained through an online survey targeting potential HIS users at general hospitals in Korea. As a result of hypotheses testing, it was found that privacy risk, shared benefit, and economic benefit significantly impact perceived value, which in turn negatively influences acceptance resistance. This study is the first to apply the VAM to the context of cloud-based HIS. Research findings would help managers considering the introduction of cloud-based HIS in the future prepare practical guidelines to reduce user acceptance resistance effectively.

Development of a Standardized Curriculum for Nursing Informatics in Korea.

This study explored the current status of nursing informatics education in South Korea and developed a standardized curriculum for it. Data were collected in two stages: first, an online survey conducted from December 2020 to February 2021 among 60 nursing schools to analyze the current status of nursing informatics education; and second, a two-round Delphi survey with 15 experts from March to April 2021 to determine the mean and standard deviation of the demand for each learning objective in nursing informatics education. A standardized curriculum proposal was developed based on the results of the two-round Delphi survey. Nursing informatics was most commonly taught in the fourth year (34%), with two credits. The proportion of elective major subjects was high in undergraduate and graduate programs (77.4% and 78.6%, respectively), while the proportion of nursing informatics majors was low (21.4%). The curriculum developed included topics such as nursing information system-related concepts, definitions and components of healthcare information systems, electronic medical records, clinical decision support systems, mobile technology and health management, medical information standards, personal information protection and ethics, understanding of big data, use of information technology in evidence-based practice, use of information in community nursing, genome information usage, artificial intelligence clinical information systems, administrative management systems, and information technology nursing education. Nursing informatics professors should receive ongoing training to obtain recent medical information. Further review and modification of the nursing informatics curriculum should be performed to ensure that it remains up-to-date with recent developments.

Gestational and congenital syphilis across the international border in Brazil.

Brazil lacks data from syphilis in its border areas. We aimed to describe the spatial and temporal distribution of acquired syphilis (AS), in pregnancy (SP) and congenital syphilis (CS) in Brazilian municipalities in the arches border contexts. An ecological, cross-sectional study was conducted from 2010 to 2020. The study was based on the cases of syphilis available in the Notifiable Diseases Information System (SINAN), and on the Primary Health Care Information System. The detection rates of AS and SP, and the incidence of CS were estimated, and the time series was analyzed. Data between the border arches were compared. In 2020, data showed 7,603 cases of AS (detection rate 64.8/100,000 inhabitants), 3,960 cases of SP (detection rate of 21.6/1,000 live births) and 836 cases of CS (incidence of 4.6/1,000 live births) in the border region. Between 2010 and 2020, the mean annual increase of detection rate of SP was 53.4% in Brazil, 48.0% in the border region, 59.6% in the North Arch, 28.8% in the Central and 67.2% in the South. Annual variation on the incidence of CS for the same period was 31.0% in Brazil 38.4% at the border, in the North and South Arcs 18.3% and 65.7% respectively. The Central Arch showed an increase only between 2010 and 2018 (62.7%). A total of 427 (72.6%) municipalities has primary health care coverage ≥ 95% of the population. In 2019, 538 (91.8%) municipalities reported using rapid tests for syphilis, which decreased to 492 (84%) in 2020. In 2019, 441 (75.3%) municipalities reported administering penicillin, and 422 (72%) in 2020. Our data show syphilis reman problem at the Brazilian border, rates in pregnant are high. It was observed a reduction in the detection rates, SP and the incidence of CS between 2018 and 2020. Syphilis should be included on the agenda of all management levels, aiming at expanding access and quality care.

Compressed gastric image generation based on soft-label dataset distillation for medical data sharing

Background and objective: Sharing of medical data is required to enable the cross-agency flow of healthcare information and construct high-accuracy computer-aided diagnosis systems. However, the large sizes of medical datasets, the massive amount of memory of saved deep convolutional neural network (DCNN) models, and patients′ privacy protection are problems that can lead to inefficient medical data sharing. Therefore, this study proposes a novel soft-label dataset distillation method for medical data sharing.Methods:The proposed method distills valid information of medical image data and generates several compressed images with different data distributions for anonymous medical data sharing. Furthermore, our method can extract essential weights of DCNN models to reduce the memory required to save trained models for efficient medical data sharing.Results: The proposed method can compress tens of thousands of images into several soft-label images and reduce the size of a trained model to a few hundredths of its original size. The compressed images obtained after distillation have been visually anonymized; therefore, they do not contain the private information of the patients. Furthermore, we can realize high-detection performance with a small number of compressed images.Conclusions: The experimental results show that the proposed method can improve the efficiency and security of medical data sharing.

SWOT Analysis and Expert Assessment of the Effectiveness of the Introduction of Healthcare Information Systems in Polyclinics in Aktobe, Kazakhstan.

The purpose of this study was to assess the organizational effectiveness of the introduction of a healthcare information system (electronic medical records and databases) in healthcare in Kazakhstan. The authors used a combination of 2. expert assessment and strengths, weaknesses, opportunities, and threats (SWOT) analysis. SWOT analysis is a necessary element of research, constituting a mandatory preliminary stage both when drawing up strategic plans and for taking corrective measures in the future. The expert survey was conducted using 2 questionnaires. The study involved 40 experts drawn from specialists in primary healthcare in Aktobe: 15 representatives of administrative and managerial personnel (chief doctors and their deputies, heads of medical statistics offices, organizational and methodological offices, and internal audit services) and 25 general practitioners. The following functional indicators of the medical and organizational effectiveness of the introduction of information systems in polyclinics were highlighted: first, improvement of administrative control, followed in descending order by registration and movement of medical documentation, statistical reporting and process results, and the cost of employees' working time. There has been no reduction in financial costs, namely in terms of the costs of copying, delivery of information in paper form, technical equipment, and paper.

Securing healthcare information system through fuzzy based decision-making methodology.

The purpose of the healthcare Information System (HIS) is to replace the conventional method of data gathering and organization in hospitals into a modern method of systematic data collection, maintenance and dissemination. There has been an unprecedented rise in the malware and cyber-attacks on HIS recently. Cyber-attacks have become a major crisis for the healthcare industry. To address this scenario, the present paper conducts a study on the security factors integral to the healthcare information system and conducts the performance analysis of these factors. For this intent, the study has employed the Fuzzy Analytic Hierarchy Process (F.AHP) integrated with Technique Order Preference by Similarity to Ideal Solution (TOPSIS) integrated framework for evaluating the performance of each factor. Thereafter, the factors that play a vital role in healthcare data security breaches have been prioritized as per their security weights. Furthermore, the validity of the results obtained by the stated methodology has been established by conducting the sensitivity analysis and comparison of results with the other methods by using the same data set. Based on results thus obtained, the access control and software security have been identified as the most promising security factors.

Enhancing EHR Implementation with Process Mining

Hospitals have increased the adoption of Hospital Information Systems to optimize processes for the efficient and effective delivery of services to customers (i.e., patients). However, there are still challenges in adopting information systems in healthcare, despite technological advancements and the enormous business benefits. These challenges have led to resistance of some healthcare providers to use these systems. Moreover, investigative and diagnostic measures are not exhaustively carried out to improve the processes of healthcare centers and the implemented information systems used in executing the processes. Fortunately, process mining techniques help optimize business processes, but they are primarily utilized post-implementation/post-go-live. This paper demonstrates the role process mining can play in adopting an EMR/EHR by improving the existing EHR Implementation Lifecycle by proposing an Enhanced Model. We suggest using process mining at suitable phases of the EHR Implementation lifecycle, not post-implementation/post-go-live only. Therefore, we propose an Enhanced EHR Implementation Lifecycle that supports process mining as part of a testing protocol adopted for EMRs/EHRs usability in conformance to the organization’s workflow in other implementation phases. An experiment is performed with event logs from an open-source EHR for the feasibility of the proposed Enhanced EHR/EMR implementation model.

Assessment of Data Quality in a Fragmented Health Information System: A Case Study in Two Health Regions in Gabon

Background: Quality data is a key element for every organization including the organization of the healthcare system. In fact, quality data allows any healthcare system to follow and evaluate the defined objectives in order to meet the needs of their customers. Therefore, it is necessary that the processes of producing these data are well structured and efficient. Unfortunately, in so many sub-Saharan African countries those processes have limits causing a qualitative issue in the collected data in the healthcare sector (for example, the low levels completeness, low levels of accuracy, low levels of promptitude) this is more and more frequent and it undermines the rightness of the intervention choices in the management of any healthcare system. Objective: To assess the level of performance of Gabon's health information system, we undertook to carry out an evaluation study of the processes used to collect quality data. Methods: This qualitative study was implemented using a five-step approach (identification of indicators in the data collection process, specification of data allowing the calculation of indicators, design of the data collection questionnaire, collection of data and health information system performance evaluation). For this assessment, we have chosen to rely on the characteristics (criteria) of three determinants that help ensure data quality (data recording and storage, verification of data accuracy and data processing and analysis). Results: It appears that 58% of the structures do not meet all the criteria that favor the recording and storage of data, 53% do not meet all the criteria that favor the verification of the accuracy of the data and 56% do not meet all the criteria that promote good data processing and analysis. Discussion: Although the dimensions used to assess the quality of the data in our study are not exhaustive, they nevertheless have the merit of describing and giving an idea of the level of performance of the healthcare information system in Gabon. Conclusion: We note from this study that Gabon's healthcare information system has limitations that do not allow it to produce reliable data to support strategic decisions and the results of this study may serve as material for reflection on the improvement of the current health information system.

Evaluating Digital Health Capability at Scale Using the Digital Health Indicator.

Background Health service providers must understand their digital health capability if they are to drive digital transformation in a strategic and informed manner. Little is known about the assessment and benchmarking of digital maturity or capability at scale across an entire jurisdiction. The public health care system across the state of Queensland, Australia has an ambitious 10-year digital transformation strategy. Objective The aim of this research was to evaluate the digital health capability in Queensland to inform digital health strategy and investment. Methods The Healthcare Information and Management Systems Society Digital Health Indicator (DHI) was used via a cross-sectional survey design to assess four core dimensions of digital health transformation: governance and workforce; interoperability; person-enabled health; and predictive analytics across an entire jurisdiction simultaneously. The DHI questionnaire was completed by each health care system ( n = 16) within Queensland in February to July 2021. DHI is scored 0 to 400 and dimension score is 0 to 100. Results The results reveal a variation in DHI scores reflecting the diverse stages of health care digitization across the state. The average DHI score across sites was 143 (range 78–193; SD35.3) which is similar to other systems in the Oceania region and global public systems but below the global private average. Governance and workforce was on average the highest scoring dimension (x̅= 54), followed by interoperability (x̅ = 46), person-enabled health (x̅ = 36), and predictive analytics (x̅ = 30). Conclusion The findings were incorporated into the new digital health strategy for the jurisdiction. As one of the largest single simultaneous assessments of digital health capability globally, the findings and lessons learnt offer insights for policy makers and organizational managers.

Standardization of information in laboratory diagnostics. Proposal of the Polish Society of Laboratory Diagnostics

In modern laboratory diagnostics, the flow of information in electronic form is common, more and more extensive, and complicated. For the flow of this information to be efficient and complete, it should include medical diagnostic laboratories and their complete environment, including nationwide healthcare information systems. Optimizing the electronic flow of information requires standardization of terminology and coding of laboratory procedures and the creation of IT infrastructure, which, with institutional support, will ensure adequate access to laboratory diagnostic data in the healthcare system. In this article, we present a system proposal prepared by the Section for Standardization of Information in Laboratory Medicine of the PSLD in cooperation with experts from other bodies, the purpose of which would be to systematize, improve the quality and certainty of processing information on laboratory diagnostics. The proposed System of Standardization of Information in Laboratory Diagnostics (SSILD) should ultimately allow for the unambiguity of the names and codes of procedures using the LOINC® terminology, certainty as to the key features of the procedures, certainty as to the reference intervals/decision values, access to information necessary for the interpretation of the result and clarity as to whether the procedures are covered by the regulation of the guaranteed benefits basket.

ECG Standards and Formats for Interoperability between mHealth and Healthcare Information Systems: A Scoping Review.

Interoperability is defined as the ability of a system or device to communicate between different technologies and software applications. This allows the exchange and use of data in an efficient, precise, and robust way. The present article gives researchers and healthcare information systems developers a qualitative and quantitative synthesis of the state of knowledge related to data formats and data standards proposed for mHealth devices interoperability in healthcare information systems that retrieve and store ECG data. We carry out a scoping review to answer to following questions: (1) What digital data formats or data standards have been proposed for the interoperability of electrocardiograph data between traditional healthcare information systems and mobile healthcare information systems? (2) What are the advantages and disadvantages of these data formats or data standards? The scoping review was conducted in four databases in accordance with the JBI methodology for scoping reviews, and in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A total of 4018 studies were identified of which 30 studies met the inclusion criteria. Based on our findings, we identify four standards and nine formats for capturing and storing streaming ECG data in mobile health applications. The standards used were HL7, SCP-ECG, x73-PHD, and PDF/A. Formats include CSV, PDF-ECG, and seven XML-based formats. These are ECG-XML, HL7-XML, mPCG-XML, mECGML, JSON, SaECG, and CDA R2.

Integrated care with digital health innovation: pressing challenges

PurposeDigital health care has emerged as one of the most important means to deliver integrated care by care providers in recent years. As the use of digital health increases, there are some pressing issues such as interoperability of data across different healthcare information systems, regulatory environment and security and privacy of patient’s information which need to be discussed and addressed in order to reduce information silos and to ensure efficient and seamless use of digital health technologies. The purpose of this paper is to address these issues.Design/methodology/approachIn this paper the authors outline the key concepts of interoperability, key challenges pertaining in achieving interoperability and concepts of security and privacy in context of digital health models of integrated care.FindingsThe study suggests that standardization of digital health information systems and connecting existing systems to health network, addressing privacy and security related issues through a comprehensive but supportive regulatory environment and educating citizens and healthcare providers are some of the ways to achieve effective use of digital health in models of integrated care.Originality/valueAlthough the concepts of privacy and interoperability are not new, however, as per best of the authors’ knowledge, this is the first attempt to discuss the challenges and possible actions to meet the objective of achieving integrated care through digital innovation.