Healthcare Information Systems Research Articles

Development and Testing Requirements for an Integrated Maternal and Child Health Information System in Iran: A Design Thinking Case Study.

Management of child health care can be negatively affected by incomplete recording, low data quality, and lack of data integration of health management information systems to support decision making and public health program needs. Given the importance of identifying key determinants of child health via capturing and integrating accurate and high-quality information, we aim to address this gap through the development and testing requirements for an integrated child health information system. A five-phase design thinking approach including empathizing, defining, ideation, prototyping, and testing was applied. We employed observations and interviews with the health workers at the primary health care network to identify end-users' challenges and needs using tools in human-centered design and focus group discussion. Then, a potential solution to the identified problems was developed as an integrated maternal and child health information system (IMCHIS) prototype and tested using Software Quality Requirements and Evaluation Model (SQuaRE) ISO/IEC 25000. IMCHIS was developed as a web-based system with 74 data elements and seven maternal and child health care requirements. The requirements of "child disease" with weight (0.26), "child nutrition" with weight (0.20), and "prenatal care" with weight (0.16) acquired the maximum weight coefficient. In the testing phase, the highest score with the weight coefficient of 0.48 and 0.73 was attributed to efficiency and functionality characteristics, focusing on software capability to fulfill the tasks that meet users' needs. Implementing a successful child health care system integrates both maternal and child health care information systems to track the effect of maternal conditions on child health and support managing performance and optimizing service delivery. The highest quality score of IMCHIS in efficiency and functionality characteristics confirms that it owns the capability to identify key determinants of child health.

Retraction Note: Designing statistical assessment healthcare information system for diabetics analysis using big data

Retraction Note: Designing statistical assessment healthcare information system for diabetics analysis using big data

Data and care integration for post-acute intensive care program of stroke patients: effectiveness assessment using a disease-matched comparator cohort

PurposeTo assess the effectiveness of an integrated care program for post-acute care of stroke patients, the return home program (RHP program), deployed in Barcelona (North-East Spain) between 2016 and 2017 in a context of health and social care information systems integration.Design/methodology/approachThe RHP program was built around an electronic record that integrated health and social care information (with an agreement for coordinated access by all stakeholders) and an operational re-design of the care pathways, which started upon hospital admission instead of discharge. The health outcomes and resource use of the RHP program participants were compared with a population-based matched control group built from central healthcare records of routine care data.FindingsThe study included 92 stroke patients attended within the RHP program and the patients' matched controls. Patients in the intervention group received domiciliary care service, home rehabilitation, and telecare significantly earlier than the matched controls. Within the first two years after the stroke episode, recipients of the RHP program were less frequently institutionalized in a long-term care facility (5 vs 15%). The use of primary care services, non-emergency transport, and telecare services were more frequent in the RHP group.Originality/valueThe authors' analysis shows that an integrated care program can effectively promote and accelerate delivery of key domiciliary care services, reducing institutionalization of stroke patients in the mid-term. The integration of health and social care information allows not only a better coordination among professionals (thus avoiding redundant assessments) but also to monitor health and resource use outcomes of care delivery.

Optimized Wayfinding Signage Positioning in Hospital Built Environment through Medical Data and Flows Simulations

This study argues that medical data should be better utilized and attention should be paid to the patient’s visual experience during their journey to the emergency department (ED). Wayfinding in medical settings remains a challenge for patients. One reason is that decision makers do not adequately understand what the patients have seen and been through during their journey in the ED built environment, which leads to inaccurate selection and misplacement of signage. This study claims that there is still room to optimize existing wayfinding design methods. This study selected a representative large-scale general hospital in China, collected the annual healthcare information system (HIS) data of ED patients in 2021, and reproduced the clinical process of ED patients in the form of a probability treemap through categorical analysis. Furthermore, Massmotion was used to simulate the patient’s journey and obtain their vision focus area (VFA). With the VFA and field observation record, the research targeted 17 wall surfaces in the ED built environment. On the basis of the comparative analysis, we found the misplacement of the current signage system and the direction of future optimization. This method can provide a reference for designers during their decision-making process to aim for an efficient wayfinding system.

Data governance in healthcare information systems: A systematic literature review

Background: This study aimed to investigate data governance (DG) related to challenges associated with healthcare information systems (HIS), by reviewing guidelines emerging from academic sources as part of a consolidated systematic literature review (SLR). The research contributed theoretically towards the body of knowledge, by reviewing challenges and guidelines related to DG within the healthcare environment. It contributed practically to the body of knowledge through understanding the healthcare information’s systems status. The study also contributed methodologically and significantly to SLR strategies.Objectives: The objective of this study was to understand the features of HIS; acquire information about DG success and understand the influence noted on DG.Method: The study conducted an SLR over the period 2010–2020. Literature collection was not only restricted to South African publications but was extended to international sources. This study adapted a mono method.Results: The study revealed that many organisations have realised that the only method to fix the data problem is the implementation of effective DG. With the increased adoption and rise of cloud computing, DG is gaining interest amongst specialists.Conclusion: The shift from paper-based systems led organisations to seek organisational change through digital transformation. The proper collection and utilisation of electronic healthcare record is the foundation of the digital healthcare. Many organisations value DG as a promising method of maintaining data as a valuable asset.

Experience of Unilateral Cleft Lip Repair using the Anatomical Subunit Technique in an Omani Population over a Five-Year Period.

ObjectivesThis study aimed to report the authors’ experience with the anatomical subunit technique for unilateral cleft lip repair, which has gained popularity worldwide.MethodsFrom July 2015 to April 2020, 114 consecutive cases of cleft lip underwent primary cleft lip repair with closed rhinoplasty by a single surgeon. The demographic data, severity and type of the cleft lip, surgical outcomes, including vermillion notching, were assessed by an independent senior surgeon. The rate of revision surgery was collected from the Al-Shifa® - 3Plus healthcare information system (Ministry of Health, Oman). Parents’ satisfaction regarding scar quality and lip and nose appearance was collected and all data were statistically analysed.ResultsA total of 82 cases satisfied the inclusion criteria. The mean age at surgery for cleft lip was 32 weeks. Among these, 35 cases (43%) were complete cleft lips and 47 cases (57%) were incomplete. Additionally, 43 children (52%) were born of consanguineous marriage. Six patients (7%) needed revision surgery. The digital survey was completed by 40 subjects (response rate: 48.8%) which showed 85% satisfaction rate with the postoperative scar and 77.5% satisfaction with the aesthetic appearance of the nose.ConclusionThe anatomical subunit technique resulted in a predictable outcome indicating a high rate of patient satisfaction with scar quality and nasal and lip symmetry in children with varying severity of cleft lip. The high percentage of consanguinity (52%) in this study highlights the need for more targeted national campaigns involving premarital counselling in the Omani population.

Machine learning-enabled healthcare information systems in view of Industrial Information Integration Engineering

Recent studies on Machine learning (ML) and its industrial applications report that ML-enabled systems may be at a high risk of failure or they can easily fall short of business objectives. Cutting-edge developments in this field have increased complexity and also brought new challenges for enterprise information integration. This situation can even get worse when considering the vital importance of ML-enabled healthcare information systems (HEIS). Therefore, the main argument of this paper is that we need to adopt the principles of Industrial Information Integration Engineering (IIIE) for the design, development, and deployment processes of ML-enabled systems. A mixed research paradigm is adopted, and therefore, this study is conducted by following the guidelines and principles of Action Research, Design Science Research, and IIIE. The contributions of this study are two-fold: (a) to draw researchers’ and practitioners’ attention to the integration problems of ML-enabled systems and discuss them in view of IIIE, and (b) to propose an enterprise integration architecture for ML-enabled HEIS of a university hospital, which is designed and developed by following the guidelines and principles of IIIE.

Design and implementation of the new Italian healthcare digital interoperable registry for implantable medical devices

AbstractNowadays, the role played by registries in monitoring and improving healthcare, including the quality of medical devices, is widely recognized. A well‐designed digital healthcare registry, in particular regarding data collection procedures and tools, can effectively support goals such as monitoring a (large) population subject to a specific condition, describing the natural history of diseases, supporting observational study methods, as well as evaluating the clinical effectiveness or cost effectiveness of healthcare products and services. This article describes the architecture of a new platform implementing a digital interoperable healthcare registry, the Italian Implantable Prostheses Registry (RIPI). One of the main goals of RIPI is to provide reliable and high‐quality data for monitoring surgery outcomes, performing survival analysis, assessing the safety of devices and procedures, and supporting the traceability of patients. The article focuses on the key aspects and choices that guided the design and implementation processes of the new platform. Most of the design choices came from specific requirements to fulfill, in particular concerning data quality, access policy, interoperability, extensibility and modularity. Overall, the article discusses the main challenges and the adopted solutions, proposing a design perspective and describing an experience of interest for computer scientists, engineers and practitioners, in particular in the area of healthcare information systems.

The Usability of IT Systems in Document Management, Using the Example of the ADPIECare Dorothea Documentation and Nurse Support System.

Background: In 2016, an IT system was developed at MUL for the documentation of nursing practice. Preparing nursing students for the implementation of eHealth solutions under simulated conditions is crucially important for achieving the digital competencies necessary for health care systems in the future. Scientific evidence demonstrates that the use of an IT system in clinical practice shortens the time required for the preparation of documentation, increases the safety of clinical decisions and provides data for analysis and for the creation of predictive models for the purposes of HB HTA. Methods: The system was created through the cooperation of an interprofessional team at the Medical University of Łódź. The ADPIECare system was implemented in 2016 at three universities in Poland, and in 2017 a study of its usability was conducted using a questionnaire made available by Healthcare Information and Management Systems Society, “Defining and Testing EMR Usability MASTER V2 Final” on 78 nurses—students of MA in Nursing at Medical University of Łódź. Findings: Over 50% of the surveyed nurses indicated the usability of the system for the “effectiveness of documentation” variable. The same group of respondents had a positive attitude towards patient care planning with the use of the assessed system. In the opinions of the examined parties, positive opinions predominated, such as, e.g., “the system is intuitive”, “the system facilitates work”, “all patient assessments are in one place”, and “the time needed for data entry would be shortened”.

WHERE DOES RESPONSIBILITY LIE? ANALYSING LEGAL AND REGULATORY RESPONSES TO FLAWED CLINICAL DECISION SUPPORT SYSTEMS WHEN PATIENTS SUFFER HARM.

Clinical decision support systems (CDSSs) are digital healthcare information systems that apply algorithms to patient data to generate tailored recommendations. They are designed to support, but neither dictate nor execute, clinical decisions. CDSSs can introduce new risks, both by design features that heighten clinician burden and by outright errors that generate faulty recommendations for care. In the latter instance, if such unintercepted recommendations were to result in harm to the patient, novel legal questions emerge. Does legal responsibility for this harm lie with the clinician, the software developer or both? What is the clearest path to a remedy? Further, how does the Australian regulatory framework provide for oversight and redress? This article analyses the potential forms of legal redress in negligence, contract and under statutory consumer law, for the patient and the clinician. It also examines the Australian regulatory framework, specifically in relation to the Australian Competition and Consumer Commission and the Therapeutic Goods Administration, and reflects on the framework's adequacy to protect patients and clinicians. It finds that the regulatory approach and the contour of legal risk still centre upon the clinician's duty to exercise decisional autonomy and to intercept flawed recommendations generated by algorithmic errors within CDSSs.

Cloud computing and IoT integration for health checking system

With the raise of technologies in the fourth industry revolution, Internet of things appeared as an emerging technology, especially, in the healthcare industry. The cloud computing as a main section of IoT structure can be a great integration to get more benefits to provide healthcare for our society. In this paper, researchers more concentrated on individuals and autonomous extension of solitary strategies, with less emphasis on patient monitoring. While the main aim of technology management of healthcare information systems has been accomplished throughout the proposed combination of Internet of Things and Cloud Computing in the context of medical profession. A low-cost, secure, and trusted healthcare tracking system that offers real-time monitoring dashboard for biological indicator has been proposed. The utilization of this integration to track and control health system was applied, thus, a remotely controlled platform based on the cloud computing design paradigm has been developed in the field of health information, while an efficient algorithms in future hospital cloud service and monitoring system implementations have examine and evaluate this design. A CloudSim simulation results showed that the proposed algorithm revealed better results from analogue anneals algorithm and ant colony optimal design with an improvement of 40% in the system efficiency. Therefore, the integrated proposed algorithm is of an importance to be developed and could be applied to non-coordinate system to improve solutions to the optimization and scattering.

Trải nghiệm của người bệnh điều trị ngoại trú tại Khoa Khám Bệnh Đa Khoa, Viện Y Dược Học Dân Tộc năm 2021 và một số yếu tố ảnh hưởng

Objective: Describe the experience of outpatients at the Department of General Examination, Traditional Medicine Institute, Ho Chi Minh City in 2021 and analyze some factors affecting their experience. Methods: Applying cross-sectional design with quantitative and qualitative methods. Quantitative data were collected on 460 patients using self-completed questionnaires. There were 03 interview and 03 discussion meetings conducted after the preliminary quantitative results were available. Result: The percentage of patients with a positive overall experience is high with 84.79%, in which the rate of positive experiences is sorted from high to low according to the following groups of factors: medical examination and treatment services, health worker communication, utility service provision, hospital fees, waiting times, and procedures. 6 main factors are affecting the experience of outpatients: medical finance, human resources, information systems, pharmacy/drugs and equipment, and system administration. Conclusions: Outpatients have a positive experience at the Department of General Examination. Healthcare finance, human resources, information systems, pharmacy/drugs and equipment, and system administration were identified as factors affecting the experience. Keywords: outpatient, experience, outpatient experience

Research on Sports Health Care Information System Based on Computer Deep Learning Algorithm.

There are various problems in diagnosing and treating tumor diseases in significant hospitals. The content includes misjudgement and over-surgery issues. For example, the judgment of pulmonary nodules mainly relies on artificial experience, and most of the artificial experience is too radical. This paper is mainly based on the extensive medical data of significant hospitals, extracts the diagnosis and treatment data and digital images of similar cases from the extensive database, classifies them through the deep learning of the computer, and then proposes the control mechanism and the solution of the doctor's misjudgement and excessive medical treatment. This method mainly relies on the CT and MRI digital images of various types of tumor diseases accumulated in the history of major hospitals. Based on the preliminary judgment of each diagnosis and treatment and the results of surgical and pathological examinations, the accumulation of various types of digital images from the history is used. The features are analysed and extracted, the model is built, and finally, a predictive analysis system for this type of tumor is obtained, which can predict the benign and malignant cases of currently occurring cases and avoid the limitations and instability of artificial experience greatest extent. It is proved by experiments and combined with Spearman to remove redundancy. The redundancy removal method SVM_RFE is used for dimensionality reduction. The method can timely correct the misjudgement of the doctor's experience and effectively reduce the instability of the manual, which provides a solution for solving the contradiction between doctors and patients and improving the scientific of diagnosis and treatment.

Telemedicine in the Past and Now – Polish Regulatory Framework and the Scope of Civil and Criminal Liability of the Medical Staff

The development of telemedicine prompts us to focus on legal aspects related to the provision of ICT services by physician, as well as criminal liability for causing exposure to immediate risk of loss of life or health, as well as civil liability in the event of damage, excluding issues related to the provision of services by persons performing other medical professions (e.g. nurses, midwives, laboratory diagnosticians, pharmacists). Although telemedicine has become a permanent part of the scenario of providing services, the provisions of law refer to the discussed issue in a fragmentary manner. At the same time, the specificity of services implies a wide risk of the guarantor’s criminal liability for exposing the patient to the immediate risk of loss of life or health. The above is directly related to the omission of personal doctor-patient contact, which increases the probability of making a diagnostic or therapeutic error. Before the entry into force on 12 December 2015 of the Act of 9 October 2015 amending the Act on the information system in health care [...], only individual legal regulations related to the use of ICT to provide health services, as well as documents on the principles of medical ethics and deontology. Currently, there are no doubts that the provision of health services with the use of ICT is permissible and in accordance with the applicable law. The pandemic period contributed to the introduction of provisions regulating the principles of providing health services with the use of ICT in strictly defined areas, including, inter alia, primary health care.

Classification of Challenges and Threats in Healthcare Cybersecurity: A Systematic Review.

The rapid development of electronic health has highlighted the essential position information security holds today in the healthcare industry. Indeed, healthcare organisations have increasingly become targets for cyberattacks. The authors investigated cybersecurity challenges through identifying cases within the academic literature related to cybersecurity threats and vulnerabilities present within healthcare settings. The fast adoption of healthcare information systems has exposed the healthcare industry to numerous kinds of cyberattacks, thereby prompting the international academic community to investigate these threats. There are various cybersecurity challenges and vulnerabilities within healthcare that could later be exploited and lead to cybercrimes. As security systems continue to develop, the interest in cybersecurity as a form of defense and protection is expected to grow.

P954: ESTABLISHING THE NATIONAL INSTITUTE FOR HEALTH RESEARCH (NIHR) HEALTH INFORMATICS COLLABORATIVE (HIC) MULTIPLE MYELOMA (MM) REGISTRY

Background: Real world data provides unique insights into the natural history of MM, resource utilisation, adherence to standards and outcomes of treatments outside clinical trials. However, the quality of such initiatives can be poor due to the need for manual data entry, inability to integrate multiple data sources, lack of harmonisation of data across centres and limited generalisability due to centre bias. Exemplar registries collate and transform multidisciplinary routinely collected data from Electronic Health Records (EHRs) to a common data language allowing integration, analysis and expansion. Aims: To develop a secure national MM registry beginning with a three site pilot. Methods: Potential registry providers were evaluated against the following criteria: previous experience, infrastructure and technical capability, data governance, compliance with legal standards and cost effectiveness. The platform required ethical and data sharing approvals. A common data model was investigated and a myeloma focused multidisciplinary dataset was designed and mapped to source data. Data extraction, transformation and analysis is planned. Results: 8 providers were assessed for suitability. The NIHR HIC was chosen due to its established data sharing network across 30 UK sites and overarching governance framework. This platform permitted the establishment of harmonised data flow, comparable across sites and retaining clinical interpretability. A minimal myeloma dataset of routinely collected information was agreed by clinicians and data scientists to contain the following fields: baseline and disease characteristics including imaging findings eg: extramedullary/paramedullary disease, skeletal/spinal disease, comorbidities, mode of presentation, cytogenetics, treatments including chemotherapy, stem cell transplants/CAR-T cells, spinal interventions, anti-infectives, bisphosphonates and other supportive care. Each variable was mapped to identify the location of raw data in the EHR, its format and suitability for extraction. For unstructured data, eg: cytogenetics and imaging reports, natural language processing is being developed to extract key fields. To enable harmonisation of data from different systems, data is transformed into a common data model. The Observational Medical Outcomes Partnership common data model (OMOP CDM) was chosen as it provided a framework for systematic analysis of data from disparate data sources, typical of those held within health care information systems. This model allows for international benchmarking and collaboration for research. OMOP CDM maps commonly used coding systems and vocabularies, eg ICD-10, SNOMED-CT into standard concepts permitting raw data entering the registry to be standardised into a research ready format that is person-centric, disease agnostic and syntactically and semantically defined. Anonymised data from multiple sites will be electronically transferred to a ISO27001 certified, GDPR compliant UCL data safe haven for analysis. Oversight is provided by the Steering Committee of clinicians, data scientists, myeloma patients and Myeloma UK with patient involvement at every step. Data will be analysed to answer 3 initial themes (Image 1), and extended further to include control data for Health Technology Appraisals. To date we have successfully identified an initial cohort of over 4000 myeloma cases since 2015. Image:Summary/Conclusion: The NIHR HIC Myeloma registry represents a research ready platform to integrate and analyse UK wide real word data. Detailed data analysis and progress in answering the initial 3 themes is ongoing. Funding: Myeloma UK & NIHR

Healthcare information system

The 21st century has seen innovations in information technology and the healthcare sector is not left behind. Patient healthcare record has witnessed a transformation from a paper-based model to an electronic health-based system, more importantly, cloud-based frameworks have been suggested for storing and managing patient health record. However, security and privacy concerns have been an impediment and the relationship between suggested design and adoption is unclear. In this paper, we propose a framework from a public healthcare perspective that expressly captures patient records and stores these records in a secure database and is accessible for retrieval by authorized medical personnel and researchers. The framework aims to capture patient information with a unique security identifier and provides access within the infrastructure flow to the medical personnel on demand for effective diagnosis.

Frameworks for Integrating Learning Analytics With the Electronic Health Record.

The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.

Design and Implementation of Model-Driven Development for Nursing Information System.

Current healthcare industries are more focusing on quality, efficiency, and safety. Nursing information systems are among the key components of healthcare information systems; they can help nurses to use data more effectively while managing their nursing activities, allowing them to improve patient care and develop their knowledge. According to clinical various needs and various hospitals, so as to develop a flexible Nursing Information System, this study based on the MVC, Object-Oriented Programming is used to develop the web interface, and web service is used to exchange data with HIS. This design and implements a flexible Nursing Information System which is applied and summarized clinically on the function of acquiring clinical data from the different clinical requirements and showing the web pages and different kinds of forms from the device browser. Under the software development environment of high variability, high complexity, and high customization in the medical industry, a scalable and maintainable nursing information system is realized through the MVC architecture and the Master-Detail data table design, which can meet the needs of different organizations.

Understanding IoHT and Edge/Fog Computing Solutions for Smart In-Home Remote Healthcare

Healthcare information systems have been dominated by cloud technology and the Internet of Things (IoT) for decades today. In some urgent scenarios, we reveal a prevailing architectural framework that is based on fog/edge optimal computing approaches smart in-home remote healthcare solutions and architectures and recognize the challenges and requirements of IoHT devices for diverse utilization instances. Even with these upsides, conventional centralized access constraint confronts privacy problems and patient health data security. This study likewise constructs a “blockchain-enabled edge that computes” mechanism, through which smart contracts with the consensus protocol produced by Edge Intelligent Server are deployed to secure privacy topics and balance scalability in trustless surroundings. We expect this paper to be a significant guideline for the subsequent elaboration of fog/edge-based systems that compute solutions for smart in-home remote healthcare IoT applications. There will be a change of paradigm from “hospital-based” to “distributed patient in-home healthcare”.