Implementation Of Health Information Systems Research Articles

Emergency department 72-hour revisits among children with chronic diseases: a Saudi Arabian study

BackgroundEmergency Department (ED) revisits have often been used as an indicator of medical care quality. This study aimed to quantify the frequency of ED revisits within 72 h of discharge and identify its factors among children with chronic diseases.MethodsWe designed a retrospective cohort study of children with at least one chronic disease who were also under 18 years of age and had attended and were discharged from the ED at King Abdullah Specialist Children’s Hospital (KASCH-RD), Riyadh, Saudi Arabia between April 19, 2015 and July 29, 2017. The outcome measure was the frequency of ED revisits during a period of 72 h after discharge.ResultsThe study included 11,057 ED discharges of children with at least one chronic disease. Their revisit rate was 1211 (11%), with 83 (6.9%) having had a second ED revisit within 72 h of ED discharge. According to ICD-10 codes, the most common causes of ED revisits were respiratory, digestive, genitourinary, symptoms, and external causes. Factors of frequent ED revisits within 72 h were young age, institutional health insurance coverage, year of new health information system (2015), external causes, and genitourinary.ConclusionThe rate of 72-h ED revisits after discharge of children with chronic diseases treated at KASCH-RD was relatively high, and was associated with young age, institutional health insurance coverage, year of a new health information system implementation, and external causes of ED visit. These study findings amplify the need for intervention to reduce the rate of early ED revisits among children with chronic diseases.

스마트 헬스케어 존을 활용한 개인 건강 정보 시스템의 설계 및 구현

최근 인구 고령화와 기대수명의 증가, 생활습관 악화 등으로 인해 만성질환 유병률과 여러 개의 만성질환을 보유한 복합 만성질환 유병률이 급증하고 있다. 이러한 분위기 속에 지속적인 건강 상태를 모니터링하고 병의원, 지역 보건 기관들과 연계를 통해 보다 효율적으로 건강 상태를 모니터링하고 관리하기 위한 연구는 미흡한 실정이다. 이에 본 논문에서는 스마트 헬스케어존을 활용한 개인건강정보 시스템을 설계, 구현한다. 제안한 시스템은 사용자 웹, 모바일 앱, 스마트 헬스케어 존, 내부 업무 시스템 등으로 구성되며, 이를 기반으로 개인의 건강 정보 모니터링 및 지속적인 관리 체계를 수립한다. 제안한 시스템은 향후 적극적인 건강관리 및 모니터링 도구로써 혁신적인 역할을 할 것으로 기대한다.

Pre-Implementation evaluation of a nationwide information system for university hospitals: lessons learned from a study in Brazil

ABSTRACTInitiatives to implement nationwide health information systems (HIS) have been developed in different countries. Despite the potential of these initiatives of improving the quality of healthcare, the evidence of failures are numerous. We analysed the perceptions of a nationwide hospital information system by a group of 36 managers and healthcare professionals of a university hospital, prior to its adoption (pre-implementation evaluation), with the purpose of identifying issues which were likely to affect its implementation and use. This research takes a qualitative approach. Interviews, questionnaires and documentary research were used to collect data. Analysis was based on coding and categorisation. The results point out to seven areas of concern of the participants of the research those emerged from the analysis: hardware and software; government management, politics and trade unions; workplace practices; education, training and support; implementation management; staff skills; and communication. We identified that these issues are similar to problems resulting from HIS evaluations performed after their adoption. This discovery reveals that problems that usually arise from the implementation and use of nationwide HIS can be anticipated and dealt with beforehand when pre-implementation qualitative evaluations are performed. These evaluations contribute to improve intra-organisational and inter-stakeholders’ communication in comprehensive nationwide HIS adoption programmes.

Nurses satisfaction with the use of Health Information System (HIS) in a Saudi tertiary care medical center

The use of health information system is increasing and there is substantial evidence suggesting that the successful implementation of HIS in hospitals is significantly related to nurse's satisfaction and attitudes. In Saudi Arabia, no such studies -according to the author's knowledge- have addressed this topic.

Health Management Information System (HMIS) in Medicare –Patients’ Experience at ESIC main Hospital and Dispensaries in Tirunelveli sub- Region

The rapid growth in Information and Communication Technology (ICT), and the power of internet has strongly impacted the business and service delivery models of today‘s global environment. E-Hospital Management Systems provide the benefits of streamlined operations, enhanced administration and control, superior patient care, strict cost control and improved profitability. The concept of patient care can be defined as the creation of more value for patients through the removal of all non-value-added steps or actions. An important precondition of optimal patient care is that patient information is completely and accurately recorded and accessible. In this paper, we examine the implementation of an electronic health information system called the Health Management Information System (HMIS) and its effects on patient care in the ESIC main hospital and dispensaries in Tirunelveli sub-region. Two models -the Technology Acceptance Model (TAM) and TAM2 -were used to examine the transition from a paper to electronic environment and to assess processes and outcomes at the patient levels. Empirically, this paper discusses a qualitative research undertaken in the ESIC main hospital and dispensaries in Tirunelveli sub-region, with the participation of ESIC patients in the HMIS adoption process. A deductive reasoning approach was applied to collect data from patients in the sample. Deductive reasoning usually commences with generalizations, and seeks to see if these generalizations apply to specific instances. From this case study, the success factors and challenges faced in successful HMIS adoption among patients are highlighted. Some of the other mandatory factors are also discussed in detail for clarity on health information system implementation and adoption.

Open Source Adoption in Health Sector: Understanding the Stakeholder Relationships in a Resource Constrained Setting

AbstractFree and Open Source Software (FOSS) is increasingly being the choice to strengthen health information systems (HIS) in Low and Middle Income Country (LMIC) contexts. FOSS is becoming a commercially viable option in today's software industry. In LMIC context, bridging the gap between generic open source design and specific local contexts calls for the participation of multi‐sector stakeholders to realise FOSS implementations. This multi‐sector stakeholder network, together with the FOSS platform can be theorised to form a software ecosystem (SE) around FOSS implementations in a resource constrained setting.In this new paradigm, governing the open source acquisition and implementation process becomes a central challenge, which is distinct from the governance of open source developer communities. This paper attempts to identify the essential stakeholder categories involved in FOSS HIS implementations in a LMIC context and; to understand the stakeholder interactions in this SE at different stages. The analysis is based on a longitudinal case study of two open source HIS implementations and an attempt to establish a FOSS governance body in the State health sector of Sri Lanka during the period 2011–2014. The paper contributes by suggesting a model to understand the essential stakeholder categories and their interactions in FOSS implementation SE in resource constrained settings.

Editor's Comments: Health Information Systems – Opportunities and Challenges in a Global Health Ecosystem

Health Information Systems (HIS) and Health Information Technology (HIT) have experienced significant growth in use and improved functionality in recent years. The global HIS/HIT market is estimated to grow exponentially in value by 2020. This growth in market size is largely attributable to three key factors: 1) the need for disruptive solutions to challenge the spiraling cost of healthcare, 2) the increased penetration into new markets of healthcare related systems, and 3) the increasing demand for personalized medicine driven by the availability of novel, real-time data streams not previously experienced in the healthcare domain. This short article explores these three aspects of HIS/HIT. In order to achieve meaningful advances in people's health through the provision of new technologies, a more integrated and holistic approach is needed in the design and implementation of HIS. The increasing costs of healthcare coupled with the heightened expectations of stakeholders continues to place increasing pressure on those tasked with delivering new health technologies that are ‘fit for purpose’ in respective healthcare settings. More attention needs to be given to understanding the cost of healthcare and how HIS/HIT may create value in healthcare services.

Trends, Findings, and Opportunities: An Archival Review of Health Information Systems Research in Nigeria

Low and middle income countries continue to struggle with limited availability of healthcare capability and resources. Recently, a variety of health information systems (HIS) projects have been piloted in an attempt to overcome these challenges by improving the quality of data to support the delivery of healthcare services from the community to hospital settings. Indeed, existing literature considers a breath of pilot HIS studies that have been undertaken in African countries. This study focuses on HIS interventions in the West African country of Nigeria. This paper conducts an archival analysis of existing literature on HIS in Nigeria published in premier Information Systems (IS) and Health Informatics outlets. This analysis provides a comprehensive picture of existing literature by identifying trends, discussing findings, and proposing new research opportunities. The 18 articles meeting the inclusion criteria are reviewed. Using a framework developed by Leon, Schneider, and Daviaud (2012), we consider current trends to elucidate the factors influencing health IS implementation in developing countries. Several challenges face IS implementation in Nigeria such as the lack of policy guidance, resistance among end users, and cultural barriers. Existing studies are limited in scope, theory, and level of analysis applied. The paper contributes to the literature by providing practical recommendations to better navigate future HIS implementations in developing countries, while also identifying avenues through which IS researchers can advance the HIS literature in an empirical, theoretical, and practical sense.

Cervical cancer data and data systems in limited-resource settings: Challenges and opportunities.

Appropriate collection and use of health information is critical to the planning, scaling up, and improvement of cervical cancer programs. The health information systems implementation landscape is unique to each country; however, systems serving cervical cancer programs in low-resource settings share characteristics that present common challenges. In response, many programs have taken innovative approaches to generating the quality information needed for decision making. Recent advances in health information technology also provide feasible solutions to challenges. This article draws from the experiences of the authors and from current literature to describe outstanding challenges and promising practices in the implementation of cervical cancer data systems, and to make recommendations for next steps. Recommendations include engaging all stakeholders-including providers, program managers, implementing partners, and donors-in promoting national, district, and community information systems; building on existing systems and processes, as well as introducing new technologies; and evolving data collection and data systems as programs advance.

Implementation of Health Information System-A Case Study of Magrabi Hospitals, KSA

Today's healthcare market has created its niche by adopting emerging technologies and ensuring minimal rate of failures. Embracing integrated Health Information System (HIS) is one such venture that not only helps the organization to excel in the market but also caters to the needs of the public. The present research paper is a case study of HIS implementation of Magrabi hospitals and centres, in Saudi Arabia. Though implementing HIS is a herculean task, with respect to the efforts as well as investment, Magrabi could achieve this task with at most care. The system could promote service efficacy across all the centres and hospitals of Magrabi. The paper analyses the procedures and strategies followed in order to prepare the entity ready for transformation. That is, the method of actualizing the health system implementation is also detailed in this study. Overall, the case research tried to know the extent of improvement took place in all the streams of operations in Magrabi group after automation. To gather this information, data is collected from all the in-charges of respective departments as well as users, who are in managerial cadre. This data is tabulated against various cycles (revenue and payroll). From the opinion of the stakeholders it can be easily understood that HIS has brought a sea change in the service flows of Magrabi group. Apart from the benefits of HIS implementation, the lacunae of the study along with the future research prospects in these lines are suggested for the possible improvements.

Countering the “dam effect”: the case for architecture and governance in developing country health information systems

ABSTRACTThis paper presents a case for enterprise architecture (EA) and IT governance for driving techno-organizational change and coordination of health information systems (HISs) in developing countries. We support our claim with analyses of a large-scale electronic HIS in Ethiopia by tracing the logic of actors’ decisions and conduct within and beyond the organizational boundaries of the Ethiopian Federal Ministry of Health to understand how the information system innovation process is designed, legitimized and imposed by internal and external organizational forces. In the absence of formalized institutional arrangements throughout the HIS development and implementation, an international development agency fills a key gap forming an obligatory passage point which we conceptualize as “the dam effect.” Drawing on actor-network theory, we identify three important implications of EA and IT governance: (1) to help achieve an alignment of interests within the enterprise; (2) to serve as a tool for protecting the interests of the enterprise in external negotiations; and (3) to serve as a pragmatic approach to carrying out techno-organizational change.

The Technology Factors as Barriers for Sustainable Health Information Systems (HIS) – A Review

Information system is widely adopted in many fields including healthcare. Healthcare organizations now consider increased efficiency, improved patient care, quality of services, and safety. Hence Health Information System (HIS) is basically introduced to transform the traditional way of data collection and organization in hospitals, to a modern way of systematic collection, maintaining and dissemination of data. Its implementation is to support medical practitioners and administrative staff in securing patients’ health information in a digital-based record, to efficiently and effectively improve performance in the health system or any of its component parts. However, despite its numerous benefits, some of barriers still hinder its successful implementation and adoption, which needs to be addressed. This study discussed these barriers related to technology using the IS Success Model. This review paper becomes necessary in order to highlight the barriers that led to technical difficulties facing HIS implementation in hospitals, so as to suggest possible solutions that will improve services rendered in health industry based on findings.

Organizational Capacity Building for Sustainable Health Information Systems: A Case Study from Ghana

Abstract Background and Purpose: Implementing ICT innovations especially in low resourced countries has been documented in the information systems (IS) literature as a very challenging feat because of the existence of weak organizational structures leading to manifestations of silos of fragmented country ICT projects lacking the basic organizational structures to scale and become sustainable over time [31, 11, 33]. In 2010 Ghana adopted the DHIS2 software as a replacement of the existing and challenged health information system (HIS) to enable it track progress on the health related millennium development goals (MDG). The outcome has been a successful nation-wide implementation of HIS in all public health facilities. This paper looked at the factors that enabled the successful implementation and sustenance of the adopted software in Ghana. Methods: Concepts from information infrastructure theory and the notion of the installed base were used as lenses to collect and analyse the empirical data. Data collection and analysis was qualitative using participant observation, focused group discussions, semi-structured interviews and document analysis. Results: This has been possible because of realignment of selected elements of the installed base necessary for achieving set objectives. For Ghana the elements identified were manpower development, resource mobilization, strengthening of institutions and networking with stakeholders to leverage on available resources and technology. Conclusions: Sustainability of HIS in resource constrained contexts requires selection of elements of the installed base necessary for effective organizational capacity building. And these elements must be interdependent otherwise the objective of sustainability might not be accomplished. Effective capacity building efforts of an organization therefore involves combining strategies synergistically to ensure long-term sustainability. Key words: Organizational Capacity Building, Installed Base, DHIS2

Assessing Skills and Capacity for Informatics: Activities Most Commonly Performed by or for Local Health Departments.

To describe the informatics activities performed by and for local health departments. Analysis of data from the 2015 Informatics Capacity and Needs Assessment Survey of local health departments conducted by the Jiann-Ping Hsu College of Public Health at Georgia Southern University in collaboration with the National Association of County & City Health Officials. 324 local health departments. Informatics activities performed at or for local health departments in use and analysis of data, system design, and routine use of information systems. A majority of local health departments extract data from information systems (69.5%) and use and interpret quantitative (66.4%) and qualitative (55.1%) data. Almost half use geographic information systems (45.0%) or statistical or other analytical software (39.7%). Local health departments were less likely to perform project management (35.8%), business process analysis and redesign (24.0%), and developing requirements for informatics system development (19.7%). Local health departments were most likely to maintain or modify content of a Web site (72.1%). A third of local health departments (35.8%) reported acting as "super users" for their information systems. A significantly higher proportion of local health departments serving larger jurisdictions (500 000+) and those with shared governance reported conducting informatics activities. Most local health department informatics activities are completed by local health department staff within each department or a central department, but many state health departments also contribute to informatics at the local level. Larger local health departments and those with shared governance were more likely to perform informatics activities. Local health departments need effective leadership, a skilled workforce, strong partnerships, and policies that foster implementation of health information systems to successfully engage in informatics. Local health departments also face important training needs, including data analytics, project management, and geographical information systems, so they can adapt to the increasing availability of electronic data and changes in technology.

Indicators of Organizational Support in Implementing Maternal and Child Health Information System

<p style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial;">Nowadays, the implementation of health informtion system in Indonesia still encounters a number of obstacles e.g. redundant data, activities duplication, data quality, data not in harmony with the necessities, report not submitted on time, unoptimized feedback, low information utilization, and inefficient resources. This research aimed to analyze the indicators of organizational support which were suspected as one of the obstacles of the implementation of Maternal and Child Health Information System in Health Office of Ngawi Regency. The population of this cross sectional research was all village midwives administratively in duty in the areas of Ngawi Regency in 2015. Data was taken from all member of populaton through questionnaire filling, which was then analyzed by using confirmatory factor analysis (CFA). The result of data analysis suggested that the coefficient value that has been standardized from each indicators were as follows: supervisor support = 0.82, work condition = 0.80, and reard = 0.90. Indicators of organizational support<br />in implementing Maternal and Child Health Information System at Ngawi Regency Health Office, respectively from the most important are: reward, supervisor support, and work condition.</p>

Indicators of Organizational Support in Implementing Maternal and Child Health Information System

<p style="color: #000000; font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 10px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-style: initial; text-decoration-color: initial;">Nowadays, the implementation of health informtion system in Indonesia still encounters a number of obstacles e.g. redundant data, activities duplication, data quality, data not in harmony with the necessities, report not submitted on time, unoptimized feedback, low information utilization, and inefficient resources. This research aimed to analyze the indicators of organizational support which were suspected as one of the obstacles of the implementation of Maternal and Child Health Information System in Health Office of Ngawi Regency. The population of this cross sectional research was all village midwives administratively in duty in the areas of Ngawi Regency in 2015. Data was taken from all member of populaton through questionnaire filling, which was then analyzed by using confirmatory factor analysis (CFA). The result of data analysis suggested that the coefficient value that has been standardized from each indicators were as follows: supervisor support = 0.82, work condition = 0.80, and reard = 0.90. Indicators of organizational supportin implementing Maternal and Child Health Information System at Ngawi Regency Health Office, respectively from the most important are: reward, supervisor support, and work condition.</p>

Comparing Training Methods for a New Interactive Whiteboard

The successful implementation of health information systems can be affected by various barriers ranging from technological, human, and organizational. Training is one of the most cited factors for successful implementation. The goal of this study was to evaluate the effectiveness of various training methods. The first two levels Kirkpatrick’s Four-Level Training Evaluation model were utilized to evaluate the training approaches for four groups: No training (control), training through an instructional booklet, training through a video tutorial and super-user training. Following training, participants answered a questionnaire about their impressions of the training and were asked to complete an exercise with an interactive whiteboard. The questionnaire suggested that users preferred super-user training. Based on the results of the exercise, there was a statistically significant difference between training methods in terms of the number of correctly answer questions. Super-user and video training were significantly better compared to the control group. There were no statistically significant differences in the amount of time it took to complete the exercise. Based on these results, super-user training is recommended.

The Impact of Management Factors on the Success and Failure of Health Information Systems

There are several factors that can influence the success and failure of health information systems including functional, technical, cultural, and economic factors, however one of the most important factors is the impact of management factors. This research aimed to evaluate the impact of management factors on the success and failure of health information systems in the current evidences and also provide a framework in this field. This applied study was conducted by the qualitative method. It also includes two different stages of reviewing the evidences and the implementation of the Delphi technique in order to validate the proposed model. The presented model in this study consists of 16 management factors affecting the success and the failure of health information systems. The sub-factors including user involvement, having strategy, accessibility, allocation and prioritization of the competitive resources were introduced as the most important management factors with 86.7 of totally agree comments due to the opinions of experts. In general the results indicated that the relationship between the management structure of health information systems and the successes and failures of these systems has been considered during the recent years. An open and multi-factorial viewpoint should be developed for the implementation of health information systems and also all factors affecting the success and failure of these systems should be considered.

Key influences in the design and implementation of mental health information systems in Ghana and South Africa.

Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa. We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach. Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana. Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions. Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influences.

Clinical Audits in Outpatient Clinics for Chronic Obstructive Pulmonary Disease: Methodological Considerations and Workflow.

ObjectivesPrevious clinical audits for chronic obstructive pulmonary disease (COPD) have provided valuable information on the clinical care delivered to patients admitted to medical wards because of COPD exacerbations. However, clinical audits of COPD in an outpatient setting are scarce and no methodological guidelines are currently available. Based on our previous experience, herein we describe a clinical audit for COPD patients in specialized outpatient clinics with the overall goal of establishing a potential methodological workflow.MethodsA pilot clinical audit of COPD patients referred to respiratory outpatient clinics in the region of Andalusia, Spain (over 8 million inhabitants), was performed. The audit took place between October 2013 and September 2014, and 10 centers (20% of all public hospitals) were invited to participate. Cases with an established diagnosis of COPD based on risk factors, clinical symptoms, and a post-bronchodilator FEV1/FVC ratio of less than 0.70 were deemed eligible. The usefulness of formally scheduled regular follow-up visits was assessed. Two different databases (resources and clinical database) were constructed. Assessments were planned over a year divided by 4 three-month periods, with the goal of determining seasonal-related changes. Exacerbations and survival served as the main endpoints.ConclusionsThis paper describes a methodological framework for conducting a clinical audit of COPD patients in an outpatient setting. Results from such audits can guide health information systems development and implementation in real-world settings.