Local Health Information System Research Articles

The equivalent value (EV)-based workload assessment of primary healthcare workers in Beijing, China

BackgroundQuantitative methods for estimating the workload of primary healthcare (PHC) workers are essential for improving the performance of PHC institutions. However, measuring the workload of PHC workers is challenging due to the diverse and complex range of services covered by PHC. This study aims to use an equivalent value (EV)-based approach to assess the workload of PHC workers and inform policymakers about the current workload burden in Beijing, China.MethodsThe EV-based workload assessment system was designed by three main steps: identifying the list of essential PHC service items provided by PHC workers, quantifying the EV of each service item, and calculating the corresponding workload for PHC workers and community health centers (CHCs). The study included 18 CHCs, which were divided into three groups based on population density and topography: Group I (eight urban CHCs), Group II (six CHCs in semi-mountainous areas), and Group III (four CHCs in mountainous areas). Data were collected from local health information system, which automatically collected real-time service volume data for 500 PHC service items at 18 CHCs in the sample district in Beijing from 2017 to 2021.ResultsThis study identified 503 essential PHC service items and defined their EVs. The theoretical full-capacity workload per PHC worker was 6024 EVs, serving as the base workload. The actual annual workload per PHC worker was 7240.0 EVs during 2017–2021. The base workload per budgeted position for the three types of CHCs was 6468.6 EVs for Group I, 5268.5 EVs for Group II, and 5038.7 EVs for Group III. Compared with the actual workload of 7702.3 EVs, 6568.3 EVs, and 5979.0 EVs in each group, respectively, all PHC workers in the sample district were overburdened during the study period.ConclusionsThe EV-based method provides a feasible solution for comprehensively assessing the workload of publicly funded PHC institutions in other regions. This study offers valuable insights to help local policymakers understand the workload burden of PHC workers, objectively evaluate their performance, and guide future health workforce planning.

Strengthening China’s National Essential Public Health Services Package for hypertension and diabetes care: protocol for an interrupted time series study with mixed-methods process evaluation and health economic evaluation

BackgroundDespite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. “EMERALD” is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions.MethodsThe EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions.DiscussionThis study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector’s contribution to addressing the growing burden of non-communicable diseases in China.Trial registrationThe study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024).

The mental health of children and adolescents at Matosinhos: characteristics and obstacles to care

Abstract Background Mental health disorders are a public health issue. Most mental disorders begin during childhood and adolescence. Epidemiological studies regarding the diagnosis, prevalence, and access to treatment by children and adolescents are scarce, especially in Portugal. This research protocol aims to characterize the referral process and waiting times for these consultations at a Portuguese Local Health Unit between 2017 and 2022 (covering about 180,000 people); and to identify barriers to adequate health care for children and adolescents from the perspective of healthcare professionals from the hospital and primary care units. Methods We used a mixed methods study. Qualitative data allowed interpretation and reflection of quantitative data, with validation and integration of results. We conducted a descriptive analysis of the variables obtained through the local Health Information System and semi-structured interviews with a sample of healthcare professionals involved in mental health care for children and adolescents at the hospital and primary care unit levels. Results Preliminary results show a break in the number of consultations in 2018, due to the lack of professionals, and a yearly increase after COVID-19. Follow-up appointments and evaluation processes have long waiting times since there is a focus on ensuring shorter waiting times for the first consultation, and there is a shortage of professionals in mental health teams. The staff identified the need to integrate schools into care - referral and evaluation - and to promote community-based programs that train skills in children, adolescents, and caregivers. Conclusions Health indicators allow the assessment of epidemiological data and access to care, yet it is fundamental to listen to the professionals in the field to identify barriers, needs, and possible actions that more effectively promote mental health in this population. Key messages • Mental health disorders in children and adolescents are a significant public health issue in Portugal, yet there are scarce epidemiological studies on diagnosis, prevalence, and access to treatment. • There is a need to address the shortage of mental health professionals and integrate schools and community-based programs into mental health care to improve access and promote mental health.

Adherence to DASH Dietary Pattern and Its Association with Incident Hyperuricemia Risk: A Prospective Study in Chinese Community Residents.

Hyperuricemia represents a great burden on global public health, and it is important to provide effective guidance at the level of dietary patterns. We evaluated the association between the Dietary Approaches to Stop Hypertension (DASH) diet and the risk of hyperuricemia in a large-scale, community-based cohort in East China. In total, 45,853 participants that did not have either hyperuricemia nor gout were included and assigned a DASH dietary score based on their baseline dietary intake. They were then divided into five quintiles (Q1-Q5) according to their score, followed by cross-linkages with local health information systems and in-person surveys. Cox proportional hazards models were adopted to calculate hazard ratio (HR) and 95% confidence intervals (CIs). During a median follow-up of 4.54 years, 2079 newly diagnosed hyperuricemia cases were documented. Compared to the DASH Q1 group, the risk of incident hyperuricemia for the Q5 group was significantly reduced by 16% (HR: 0.84; 95% CIs: 0.72-0.97) in the adjusted model. The associations of DASH diet with hyperuricemia appeared stronger (P for interaction <0.001) among participants with 3-4 cardiometabolic diseases at baseline, compared with their counterparts. Our results suggest that the DASH diet could be taken into account in the recognition of risk population and the prevention of hyperuricemia.

Metal Constituents of Fine Particulate Matter Mass and Incident Depression: A Community-based Cohort Study in China

BACKGROUND AND AIM: Little is known about the effects of chemical constituents of fine particulate matter (particles with aerodynamic diameter ≤ 2.5 μm, PM2.5). This study aims to estimate the associations between constituents of PM2.5 and incident depression. METHODS: This large cohort study recruited the local adults in Ningbo, a southeastern coastal city in China. Depression cases were ascertained from local Health Information System. Daily PM2.5 samples were collected at seven monitoring sites for the 10th-16th seven consecutive days and further measured for ten PM2.5-bound metals. Land-use regression models were conducted to predict the residential PM2.5-bound metals exposure. We conducted three cox proportional hazards models which respectively employed single constituent, constituent adjusting for PM2.5 and constituent residual calculated by PM2.5 as exposures to estimate the effect of constituents on incident depression. Environmental Risk Score (ERS) and Weighted Quintile Score (WQS) were utilized to estimate the overall effect of all metals. RESULTS: In fully adjusted constituent models, the higher concentrations of ambient Lead(Pb), Nickel(Ni), Mercury(Hg), Chromium(Cd) and Beryllium(Be) were significantly associated with higher risk of incident depression. In ERS analyses, one main effect (Tl), three squared terms (Hg, Cd and Al) and twelve pairwise interactions (Tl & Pb, Tl & Be, et al) were selected by adaptive elastic-net (AENET) for construction of ERS of incident depression-related ambient metal mixtures. The ERS index was positively and significantly associated with depression incidence. And similar results were found for WQS index which suggesting that Al, Sb, Hg, Tl, Mn and Be contributed the most to the association. CONCLUISIONS: These findings highlighted the associations of exposure to PM2.5-bound metals with incident depression. Further studies are needed to confirm the findings and examine the underlying mechanisms. KEYWORDS: PM2.5-bound Metal, depression, Cox Proportional Hazardous Regression, ERS, WQS.

Toward National One Health Data: Reconfiguring Local Health Information Systems through Enterprise Architecture

Indonesian government is currently on the course of nationwide digital transformation, manifested through its ‘One-Data Policy’ recently introduced by top-level government. The initiative also includes the country’s health information systems (HIS) for which various technological choices are under consideration to be implemented. However, such a sound and ambitious initiative often overlook the configurational outlook of local systems where the data is created and aggregated to the national system. This study addresses this issue by exploring the issues pertaining to local HIS and developing its enterprise architecture to reconfigure the existing arrangement of the systems. Using a case study of Palangka Raya municipal health government, this study contributes to this current important agenda by delineating the complexity that occurs at local HIS and proposing a set of enterprise architecture artifacts required toward Indonesian one health data.

Association of residential greenness and incident depression: Investigating the mediation and interaction effects of particulate matter

BackgroundGrowing evidence has linked residential greenness to depression, the results from prospective cohort study are still limited. And it remains unclear whether particulate matter (PM) modify, mediate, or interact the greenness-depression relationship. MethodsWe collected data from Yinzhou Cohort(N = 47,516) which was recruited between June 2015 and December 2017. Depression cases before April 2020 were ascertained from local Health Information System covered all residents' health care records. Residential greenness (the Normalized Difference Vegetation Index, NDVI, and the Enhanced Vegetation Index, EVI) and PM (particulate matters with diameters≤2.5 μm, PM2.5 and particulate matters with diameters≤10 μm, PM10) were estimated based on participants' residential coordinates. We conducted Cox models employing age as timescale to estimate the association between residential greenness within different buffers and incident depression. Furthermore, we explored the potential confounding, mediation and interaction relationship between greenness and PM. ResultsDuring the 99,556 person-years of follow-up, 1043 incident depression cases occurred. In single exposure models, residential greenness was inversely associated with depression incidence (e.g. Hazard Ratio (HR) = 0.86, 95% confidence interval (CI): 0.79, 0.94 for per interquartile range (IQR) increase NDVI 250 m). The protective association between greenness was attenuated after introducing PM2.5 and PM10 into the models. We identified multiplicative interactions between greenness and PM exposure for depression (e.g. HR interaction = 0.91, 95%CI: 0.85, 0.98 for per IQR decrease NDVI 250 m and per IQR increase PM2.5). Besides, we found the protective association of greenness was partly mediated by PM (e.g. mediation proportion = 52.9% between NDVI 250 m and PM2.5). ConclusionsIn this longitudinal cohort study, residents living in greener neighborhoods had a lower risk of depression incidence and the benefits were interacted and partly mediated by PM. Improvement in residential greenness could be an actionable and planning intervention to prevent depression.

Can We Use Routine Data for Strategic Decision Making? A Time Trend Comparison Between Survey and Routine Data in Mali

Countries with scarce resources need timely and high-quality data on coverage of health interventions to make strategic decisions about where to allocate investments in health. Household survey data are generally regarded as "gold standard," high-quality data. This study assessed the comparability of intervention coverage time trends from routine and survey data at national and subnational levels in Mali. We compared 3 coverage indicators: contraceptive prevalence rate, institutional delivery, and 3 doses of diphtheria, pertussis, and tetanus (DPT3) vaccine, using 3 Mali Demographic and Health Surveys (DHS 2001, 2006, and 2012-2013) and routine health system data covering 2001-2012. For routine data, we used local health information system (HIS) annual reports and an HIS database. To compare time trends between the data sources, we calculated the percentage point change and 95% confidence interval from 2001-2006 and 2006-2012. We then computed the absolute and relative differences between the 2 data sources for each indicator over time at national and regional levels and assessed their level of significance. The direction and magnitude of the time trends of contraceptive prevalence rate, institutional delivery, and DPT3 vaccine from 2001 to 2012 were similar at the national level between data sources. At the regional level, there were significant differences in the magnitude and direction of time trends for institutional delivery and the DPT3 vaccine; contraceptive prevalence trends were more consistent. Routine data tended to overestimate DPT3 coverage, and underestimate institutional delivery and contraceptive prevalence relative to survey data. Routine data in Mali-particularly at the national level-appear to be appropriate for use to inform program planning and prioritization, but routine time trends should be interpreted with caution at the subnational level. For program evaluations, routine data may not be appropriate to draw accurate inferences about program impact.

The associations of greenness and incident depression with co-exposed of particulate matter

BACKGROUND AND AIM: Surrounding green as a part of resilience environment is reported to benefit mental health by direct protection and the mitigation of hazardous environmental exposure. In this study, we aimed to evaluate the association of surrounding green with incident depression and explore whether and how the association is affected by co-exposure to PM. METHODS: Data were derived from a large-prospective cohort of community-dwelling adults in China. Depression cases were ascertained from local Health Information System linking participants to the health records of hospitals. We estimated the exposure to surrounding green (the average Normalized Difference Vegetation Index, NDVI) and particulate matter (PM, predicted by land-use regression models) at the participants’ residential addresses. We conducted Cox proportional hazards models upon adjusting a series of potential confounders including sociodemographic characteristics, lifestyle factors and health status, such as self-perceived stress and morbidity. Furthermore, we explored the confounding, interaction and mediation relationship between greenness and particulate matter on the incident depression and estimated the cumulative risk indexes (CRIs). RESULTS:In single exposure models, NDVI was inversely associated with depression incidence. The estimates were attenuated slightly when further adjusted for PM2.5 and PM10. The joint hazard ratio (JHR) of per IQR decrease of NDVI and per IQR increase of PM10 was higher than both in single exposures. Besides, we found the protective effect of greenness was not mediated by PM but was interacted with PM10. CONCLUSIONS:In this large prospective cohort study, residents living in the greener neighborhoods had a lower risk of incident depression. The protective effect was found to be confounded by the PM, since the mediation analysis showed no significance. KEYWORDS: Green space, Particulate matter, Mental health outcomes, Incidence.

Fast prototyping of a local fuzzy search system for decision support and retraining of hospital staff during pandemic

PurposeThe COVID-19 pandemic showed an urgent need for decision support systems to help doctors at a time of stress and uncertainty. However, significant differences in hospital conditions, as well as skepticism of doctors about machine learning algorithms, limit their introduction into clinical practice. Our goal was to test and apply the principle of ”patient-like-mine” decision support in rapidly changing conditions of a pandemic.MethodsIn the developed system we implemented a fuzzy search that allows a doctor to compare their medical case with similar cases recorded in their medical center since the beginning of the pandemic. Various distance metrics were tried for obtaining clinically relevant search results. With the use of R programming language, we designed the first version of the system in approximately a week. A set of features for the comparison of the cases was selected with the use of random forest algorithm implemented in Caret. Shiny package was chosen for the design of GUI.ResultsThe deployed tool allowed doctors to quickly estimate the current conditions of their patients by means of studying the most similar previous cases stored in the local health information system. The extensive testing of the system during the first wave of COVID-19 showed that this approach helps not only to draw a conclusion about the optimal treatment tactics and to train medical staff in real-time but also to optimize patients’ individual testing plans.ConclusionsThis project points to the possibility of rapid prototyping and effective usage of ”patient-like-mine” search systems at the time of a pandemic caused by a poorly known pathogen.

Caries experience in children under 5 years old in the Xingu indigenous park in Brazil

Aim: The present study sought to investigate dental caries experience and its association with sociodemographic, postnatal and breastfeeding variables in children in the agerange from 6 to 71 months of age, in the Xingu Indigenous Park, Mato Grosso, Brazil. Methods: This was an analytical cross-sectional study that used secondary data pertaining to 402 indigenous children of the Low, Middle and Eastern Xingu regions, who participated in the Oral Health Epidemiological Survey in 2013. The dependent variable was dental caries, dichotomized by the median (dmf-t≤1 and dmf-t>1). The data of independent variables were obtained by means of instruments of the Local Health Information System of the Xingu Indigenous Special Sanitary District (DSEI). Raw analyses were performed to test the association of the independent variables with the dependent variable. The variables were tested in the multiple logistic regression model. Results: The mean value of the dmf-t index was 2.60 and the prevalence of affected children was 51%. In the multiple analysis, only children older than 36 months (OR: 6.64; CI95%: 4.11 to 10.73) and those that were breastfed for a longer period of time (OR: 1.88; CI95%: 1.16 to 3.02) showed significant association with the dmf-t>1 index. Conclusion: Childhood dental caries among indigenous children was associated with age and breastfeeding prolonged for over 26 months, therefore, pointing out the need to offer dental follow-up care at earlier ages.

Cohort profile: protocol and baseline survey for the Shanghai Suburban Adult Cohort and Biobank (SSACB) study

PurposeThe Shanghai Suburban Adult Cohort and Biobank (SSACB) was established to identify environmental, lifestyle and genetic risk factors for non-communicable chronic diseases (NCDs) in adults (20–74 years old) living in...

Organization and systematization of data of people with disabilities: support for networked care

The integral care of people with disabilities is weakened by the non-organization and systematization of information. The objective of this study was to organize and systematize data of people with disabilities accompanied in municipal health services in the context of primary and mild complexity care, in Sao Paulo capital, concerning socio-demographic profile, access to professional care and aiding equipment and service accessibility. It also aimed to establish an association between sociodemographic aspects and types of disability. Qualitative, retrospective, exploratory, descriptive and documentary research were based on analyses of users’ medical records and data from local health information systems. Information was collected on 166 people, 89 men (53.6%) and 83 (50%) adults between 19 and 59 years old; 44 (43.1%) users completed or did not complete elementary school. Of the 102 people who reported employment status, 38 (37.3%) were not working and among those who worked, 22 (41.5%) were men. Multiple disabilities (33.4%), physical disabilities (24.5%) and intellectual disabilities (21.6%) were recorded more often. A statistical association (p=0.005) was identified between age and type of disability, where physical disability was the most frequent among those between 6 and 14 years, and multiple disability was associated among the elderly. In primary care, users predominantly accessed doctors and nurses, and in mild complexity care, they contacted occupational therapists, physiotherapists and psychologists. Among the equipment, the use of wheelchairs prevailed. Architectural barriers were observed in services of mild complexity and there was a low offer of public transportation. There is a need to improve recording information, however it was possible to organize data on the part of people with disabilities, a fundamental action for networked care.

Integrated Detection and Prediction of Influenza Activity for Real-Time Surveillance: Algorithm Design.

BackgroundInfluenza is a viral respiratory disease capable of causing epidemics that represent a threat to communities worldwide. The rapidly growing availability of electronic “big data” from diagnostic and prediagnostic sources in health care and public health settings permits advance of a new generation of methods for local detection and prediction of winter influenza seasons and influenza pandemics.ObjectiveThe aim of this study was to present a method for integrated detection and prediction of influenza virus activity in local settings using electronically available surveillance data and to evaluate its performance by retrospective application on authentic data from a Swedish county.MethodsAn integrated detection and prediction method was formally defined based on a design rationale for influenza detection and prediction methods adapted for local surveillance. The novel method was retrospectively applied on data from the winter influenza season 2008-09 in a Swedish county (population 445,000). Outcome data represented individuals who met a clinical case definition for influenza (based on International Classification of Diseases version 10 [ICD-10] codes) from an electronic health data repository. Information from calls to a telenursing service in the county was used as syndromic data source.ResultsThe novel integrated detection and prediction method is based on nonmechanistic statistical models and is designed for integration in local health information systems. The method is divided into separate modules for detection and prediction of local influenza virus activity. The function of the detection module is to alert for an upcoming period of increased load of influenza cases on local health care (using influenza-diagnosis data), whereas the function of the prediction module is to predict the timing of the activity peak (using syndromic data) and its intensity (using influenza-diagnosis data). For detection modeling, exponential regression was used based on the assumption that the beginning of a winter influenza season has an exponential growth of infected individuals. For prediction modeling, linear regression was applied on 7-day periods at the time in order to find the peak timing, whereas a derivate of a normal distribution density function was used to find the peak intensity. We found that the integrated detection and prediction method detected the 2008-09 winter influenza season on its starting day (optimal timeliness 0 days), whereas the predicted peak was estimated to occur 7 days ahead of the factual peak and the predicted peak intensity was estimated to be 26% lower than the factual intensity (6.3 compared with 8.5 influenza-diagnosis cases/100,000).ConclusionsOur detection and prediction method is one of the first integrated methods specifically designed for local application on influenza data electronically available for surveillance. The performance of the method in a retrospective study indicates that further prospective evaluations of the methods are justified.

National Health Information Network: Lessons Learned From the USA and the UK

National Health Information Network (NHIN) is a network in which all health care organizations, government agencies and other health-related organizations are connected to each other to exchange information about health. Due to the necessity of a framework for NHIN development, in this paper, according to the literature review, a definition for NHIN framework was provided, and then the NHIN related projects were reviewed in the United States of America (USA) and the United Kingdom (UK), NHIN and National Programme for Information Technology in the NHS (NPfIT), respectively. The Review of NHIN framework in the countries studied show some similarities and differences in each dimension that are discussed in this framework. NHIN guiding principles in the NHS NPfIT were not regarded or were considered incomplete, compared to the US. NHIN architecture in the US is decentralized while it is centralized in the UK. Based on the review of NHIN framework, these two countries represent important points that can be used in many other countries. However, it can be said that the development of NHIN does not only mean the implementation of national system or systems, or the binding of local health information systems, but It also needs to build on a framework in which many of the issues related to the formation of NHIN would be considered; including the cooperation between government, private sector and stakeholders with regard to local, national and international needs.

On Teaching International Courses on Health Information Systems. Lessons Learned during 16 Years of Frank - van Swieten Lectures on Strategic Information Management in Health Information Systems.

SummaryBackgroundHealth information systems (HIS) are one of the most important areas for biomedical and health informatics. In order to professionally deal with HIS well-educated informaticians are needed. Because of these reasons, in 2001 an international course has been established: The Frank – van Swieten Lectures on Strategic Information Management of Health Information Systems.ObjectivesReporting about the Frank – van Swieten Lectures and about our students‘ feedback on this course during the last 16 years. Summarizing our lessons learned and making recommendations for such international courses on HIS.MethodsThe basic concept of the Frank – van Swieten lectures is to teach the theoretical background in local lectures, to organize practical exercises on modelling sub-information systems of the respective local HIS and finally to conduct Joint Three Days as an international meeting were the resulting models are introduced and compared.ResultsDuring the last 16 years, the Universities of Amsterdam, Braunschweig, Heidelberg/Heilbronn, Leipzig as well as UMIT were involved in running this course. Overall, 517 students from these universities participated. Our students‘ feedback was clearly positive. The Joint Three Days of the Frank – van Swieten Lectures, where at the end of the course all students can meet, turned out to be an important component of this course. Based on the last 16 years, we recommend common teaching materials, agreement on equivalent clinical areas for the exercises, support of group building of international student groups, motivation of using a collaboration platform, ensuring quality management of the course, addressing different levels of knowledge of the students, and ensuring sufficient funding for joint activities.ConclusionsAlthough associated with considerable additional efforts, we can clearly recommend establishing such international courses on HIS, such as the Frank – van Swieten Lectures.

O acesso público da informação em saúde para as doenças negligenciadas no Brasil

To weigh the data on neglected diseases publicised by the Brazilian government, the categories adopted by SINAN Net (System of Information on Notifiable Diseases/Sistema de Informacao de Agravos de Notificacao) between 2006 and 2008 were surveyed. In the cases of diseases where local HIS (Health Information Systems) were used, the available data were compiled from scientific publications and governmental websites. An analysis of the data available at SINAN Net showed a lack of standardisation of the included categories. Although SINAN Net is the publicised version of SINAN, it does not make information such as the date of updating/insertion of data available in real time, which represents a major limitation to the use of such data. For the information afforded by SINAN Net to be effectively used for monitoring the public health actions and assessing their impact on the control of notifiable diseases, an analysis of the database quality must be performed on a consistent basis to identify and solve the problems of the lack and inconsistency of data and the duplicity of records for the public access to information to be reliable and to place local conditions into a nationwide, situational context.

Telematic integration of health data: a practicable contribution

The patients’ clinical and healthcare data should virtually be available everywhere, both to provide a more efficient and effective medical approach to their pathologies, as well as to make public healthcare decision makers able to verify the efficacy and efficiency of the adopted healthcare processes. Unfortunately, customised solutions adopted by many local Health Information Systems in Italy make it difficult to share the stored data outside their own environment. In the last years, worldwide initiatives have aimed to overcome such sharing limitation. An important issue during the passage towards standardised, integrated information systems is the possible loss of previously collected data. The herein presented project realises a suitable architecture able to guarantee reliable, automatic, user-transparent storing and retrieval of information from both modern and legacy systems. The technical and management solutions provided by the project avoid data loss and overlapping, and allow data integration and organisation suitable for data-mining and data-warehousing analysis.

Web-based infectious disease reporting using XML forms

Objective Exploring solutions for infectious disease information sharing among hospital and public health information systems is imperative to the improvement of disease surveillance and emergent response. This paper aimed at developing a method to directly transmit real-time data of notifiable infectious diseases from hospital information systems to public health information systems on the Internet by using a standard eXtensible Markup Language (XML) format. Methods The mechanism and work flow by which notifiable infectious disease data are created, reported and used at health agencies in China was evaluated. The capacity of all participating providers to use electronic data interchange to submit transactions of data required for the notifiable infectious disease reporting was assessed. The minimum data set at national level that is required for reporting for national notifiable infectious disease surveillance was determined. The standards and techniques available worldwide for electronic health data interchange, such as XML, HL7 messaging, CDA and ATSM CCR, etc. were reviewed and compared, and an XML implementation format needed for this purpose was defined for hospitals that are able to access the Internet to provide a complete infectious disease reporting. Results There are 18,703 county or city hospitals in China. All of them have access to basic information infrastructures including computers, e-mail and the Internet. Nearly 10,000 hospitals possess hospital information systems used for electronically recording, retrieving and manipulating patients’ information. These systems collect 23 data items required in the minimum data set for national notifiable infectious disease reporting. In order to transmit these data items to the disease surveillance system and local health information systems instantly and without duplication of data input, an XML schema and a set of standard data elements were developed to define the content, structure and semantics of the data set. These standards make it possible to view and analyse the data accurately outside the hospital information systems in many different document formats. The paper also identified other issues involved in notifiable disease reporting in the future, such as the adoption of approved vocabulary standards and implementation problems such as the route, secure transfer, parsing, and objective identifying of the XML message. Conclusions XML is an increasingly important standard for exchange and transmission of data between disparate applications and systems. As in its early stages of developing an interoperable health information system in China, the XML document structures could be a way to exchange the notifiable case information among interest parties on the web at present.

Sistemas de Información en Salud: de sistemas cerrados a la ciudadanía social. Un desafío en la reducción de desigualdades en la gestión local

The traditional concept of health information systems (HIS) poses numerous problems when attempting to support local management orientated to the reduction of health inequalities. How does one design a local HIS, and what would its characteristics be? We view HIS as open and complex systems of which we ourselves are a part. The hypothesis is that a HIS that provides support to local management must be conceived as a set of processes including data, information, knowledge, communication, and action (DIKCA). Data constitute a complex structure with five components. Information is a set of processed data; meanwhile knowledge output involves a subject's understanding and grasp of the phenomenon. Communication links the previous concepts to action. Strategic and communicative actions should be priorities in local management. This proposal aims at management support by the HIS to eliminate health inequalities and build an inclusive society.