National Health Information Infrastructure Research Articles

Global Trends and Hotspots in Nursing Research on Decision Support Systems: A Bibliometric Analysis in CiteSpace.

Decision support systems have been widely used in healthcare in recent years; however, there is lack of evidence on global trends and hotspots. This descriptive bibliometric study aimed to analyze bibliometric patterns of decision support systems in nursing. Data were extracted from the Web of Science Core Collection. Published research articles on decision support systems in nursing were identified. Co-occurrence and co-citation analysis was performed using CiteSpace version 6.1.R2. In total, 165 articles were analyzed. A total of 358 authors and 257 institutions from 20 countries contributed to this research field. The most productive authors were Andrew Johnson, Suzanne Bakken, Alessandro Febretti, Eileen S. O'Neill, and Kathryn H. Bowles. The most productive country and institution were the United States and Duke University, respectively. The top 10 keywords were "care," "clinical decision support," "clinical decision support system," "decision support system," "electronic health record," "system," "nursing informatics," "guideline," "decision support," and "outcomes." Common themes on keywords were planning intervention, national health information infrastructure, and methodological challenge. This study will help to find potential partners, countries, and institutions for future researchers, practitioners, and scholars. Additionally, it will contribute to health policy development, evidence-based practice, and further studies for researchers, practitioners, and scholars.

Review of National-Level Personal Health Records in Advanced Countries.

ObjectivesThis review article examines international examples of personal health records (PHRs) in advanced countries and discusses the implications of these examples for the establishment and utilization of PHRs in South Korea.MethodsThis article synthesized PHR case reports of Organization for Economic Co-operation and Development (OECD) member countries, the Global Digital Health Partnership website on PHRs, and patient portals of individual countries to review the status of PHR services. The concept and significance of PHRs were also discussed with respect to PHR utilization status in European Union and OECD countries.ResultsA review of international PHR services showed that the countries shared common points regarding the establishment of Electronic Health Records and national health information infrastructure. In addition, the countries provided services centered on primary healthcare institutions and public hospitals. However, promoting more positive participation and increasing the PHR acceptance rate requires workflow integration, including Electronic Medical Records, the provision of incentives, and the preparation of a supportive legal framework.ConclusionsSouth Korea is also conducting a national-level PHR project. Since the scope of PHRs is extensive and a wide range of PHR services must be connected, an extensive trial-and-error process will be necessary. A long-term strategy should be prepared, and necessary resources should be secured to establish national-level PHRs.

Assembling A National Health Information Infrastructure: The Case of Vietnam

AbstractDigital infrastructure development and evolution is a topic that has gained increasing interests from researchers, practitioners, and policy makers. Conceptualized as a large scale system transcending boundary of single organisation and involving multiple stakeholders, the evolutionary trajectory of information infrastructure is contingent, unpredictable, and in many cases end up in the so called drifting status quo. Some researchers believe such systems could not be designed but instead should be “cultivated”, a term referring to the process of incremental build and upon something rather than at once and from scratch. This paper explored the four dimensional concept of “architectural knowledge” proposed by Andersson et al. (2008) with the aim to identify additional approaches to cultivation. Using empirical data from a longitudinal and action research project that lasted three years from 2012 to 2014 in building the health information infrastructure in Vietnam, we found out that architectural knowledge could be a powerful lens in understanding generative mechanisms of information infrastructure.

Vision and eye health in children 36 to

This article provides a rationale for developing an integrated data system for recording vision screening and eye care follow-up outcomes in preschool-aged children. The recommendations were developed by the National Expert Panel to the National Center for Children's Vision and Eye Health at Prevent Blindness and funded by the Maternal and Child Health Bureau of the Health Resources and Services Administration, US Department of Health and Human Services. Guidance is provided regarding specific elements to be included, as well as the characteristics and architecture of such a data system. Vision screening for preschool-aged children is endorsed by many organizations concerned with children's health issues. Currently, there is a lack of data on the proportion of children screened and no effective system to ensure that children who fail screenings access appropriate comprehensive eye examinations and follow-up care. The expansion of currently existing, or developing integrated health information systems, which would include child-level vision screening data, as well as referral records and follow-up diagnosis and treatment, is consistent with the proposed national approach to an integrated health information system (National Health Information Infrastructure). Development of an integrated vision data system will enhance eye health for young children at three different levels: (1) the child level, (2) the health care provider level, and (3) an epidemiological level. It is critical that the end users, the professionals who screen children and the professionals who provide eye care, be involved in the development and implementation of the proposed integrated data systems. As essential stakeholders invested in ensuring quality eye care for children, this community of professionals should find increasing need and opportunities at local, state, and national levels to contribute to cooperative guidance for data system development.

Development of a master health facility list in Nigeria.

IntroductionRoutine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome.MethodsThe MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state.ResultsThe national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria.DiscussionUnique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS.ConclusionDevelopment and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.

Going abroad of korean health information systems.

Seoul National University Hospital has recently announced the signing of a Memorandum of Understanding (MOU) to export its hospital information systems to Saudi Arabia and the United Arab Emirates [1]. The Korea Health and Welfare Information Service (KHWIS) has agreed to export its cloud computing based Public Healthcare Information System (PHIS) to the Philippines Ministry of Health. The Mongolian Ministry of Health is also interested in adopting the PHIS because a majority of its health institutes are public and they are widely spread out across a large territory. Both the Philippines and Mongolian government believe that the PHIS can reduce maintenance costs and easily implement the system without the use of highly skilled IT personnel. The BIT, a Korean IT Company, is developing the National Health Information System for Iraq and it recently exported a hospital information system to the International Medical Center in Mongolia. The Korea Digital Hospital Export Agency (KDHEA) has also signed an MOU to export information systems to military hospitals in Columbia. Healthcare institutions in Korea have become increasingly digitized in the past ten years. Almost all hospitals have adopted the computerized provider order entry (CPOE) system, patient management systems, and insurance claim systems using electronic data interchange (EDI). Over 80% of tertiary hospitals have adopted Electronic Medical Records (EMRs) and picture archive and communication systems (PACSs) [2]. Over 3,500 public health institutes are implementing the Web-based PHIS using the cloud computing approach [3]. The high adoption rate of information systems in Korea is one of the highest in the world. Healthcare Informatics Research (HIR), the official journal of the Korean Society of Medical Informatics, has introduced the development and use of information systems for selected Korean hospitals since 2010 to enable them to share their experiences in developing and implementing systems. All nine hospitals that have appeared in HIR were implementing CPOE, EMR, PACS, and a clinical data repository or data warehouse. And three hospitals were implementing enterprise resource planning (ERP) systems: Severance Hospital, Asan Medical Center, and Gil Hospital. On the other hand, each hospital has unique features. For example, Yonsei University Severance Hospital has used medical record items to create clinical documents for EMRs, which allowed for easy data entry and improved the reusability of medical information [4]. Distinctive features of Asan Medical Information Systems (AMIS) were the high alert-medication recognition system, the integrated patient monitoring system, and the clinical indicator management system [5]. Samsung Medical Center extensively used smartphones to provide mobile access of patient information [6]. Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care [7]. The closed-loop medication administration (CLMA) system automatically delivers containers of medication with radio-frequency identification (RFID) tags from pharmacy to wards. At a ward, nurses use a PDA to scan a patient's wristband RFID tag before administering a medication. The PHIS developed by KHWIS covers 3,501 public institutes including 254 public health centers, 1,346 health sub-centers, and 1,901 health posts throughout the country with one server based on cloud computing architecture [3]. A high-speed broadband network allows for implementation of CPOE on a real-time basis. The PHIS supports 47 public health services including tuberculosis and vaccination in addition to clinical services, such as CPOE and EMR. Moreover, the PHIS supports a real-time information exchange with eight government agencies, including the Health Insurance Review Agency (HIRA) and Korea Center for Disease Control. The PHIS was patented by the Korean Intellectual Property Office and Patent Cooperation Treaty, and was accredited as ISO 9001. As the Korean government strongly promotes the export of such health information systems, several leading hospitals and government agencies, such as KHWIS and HIRA, are actively exploring the possibility of exporting their systems. While Korean health information systems have high technical excellence with a wide variety of functions, there are several weaknesses to overcome before they can become a leading product in a competitive international market. First, most Korean health information systems are based on EMR for the treatment of patients, rather than Electronic Health Records (EHRs) for life-time healthcare of individuals. Therefore, they lack EHR functionalities and interoperability. However, most countries emphasize the importance of a sharable EHR (life-time collection of summarized individual health and clinical information) for their national health information infrastructure in order to share patient information among public health institutes. Second, many Korean health information systems have not followed international health informatics standards, such as ISO/TC 215 or Health Level 7. Since standards are essential to ensure interoperability of EHRs, the successful deployment of Korean health information systems to health institutes abroad largely depends on how well Korean health institutes overcome these weaknesses.

Design of a public health informatics curriculum

Public Health Informatics has been identified as one of the four domains of the National Health Information Infrastructure by the U.S. Department of Health and Human Services. Proposed is the design of a professional curriculum in Public Health Informatics leading to the professionally accredited Master of Public Health (M.P.H.) degree. The relevant literature is reviewed and discussed. The educational goals and objectives for the proposed Public Health Informatics curriculum are specified. The course of study is then outlined, with each of the educational goals and objectives tied to specific coursework. Directions for future efforts to implement advanced education and training opportunities in the proposed Public Health Informatics curriculum are presented.

National Health Information Infrastructure Model: A Milestone for Health Information Management Education Realignment

Challenges and drawbacks of the health information management (HIM) curriculum at the Master's degree were examined, including lack of well-established computing sciences and inadequacy to give rise to specific competencies. Information management was condensed to the hospital setting to intensify the indispensability of a well-organized educational campaign. The healthcare information dimensions of a national health information infrastructure (NHII) model present novel requirements for HIM education. Articles related to challenges and barriers to adoption of the personal health record (PHR), the core component of personal health dimension of an NHII, were searched through sources including Science Direct, ProQuest, and PubMed. Through a literature review, concerns about the PHR that are associated with HIM functions and responsibilities were extracted. In the community/public health dimension of the NHII the main components have been specified, and the targeted information was gathered through literature review, e-mail, and navigation of international and national organizations. Again, topics related to HIM were evoked. Using an information system (decision support system, artificial neural network, etc.) to support PHR media and content, patient education, patient-HIM communication skills, consumer health information, conducting a surveillance system in other areas of healthcare such as a risk factor surveillance system, occupational health, using an information system to analyze aggregated data including a geographic information system, data mining, online analytical processing, public health vocabulary and classification system, and emerging automated coding systems pose major knowledge gaps in HIM education. Combining all required skills and expertise to handle personal and public dimensions of healthcare information in a single curriculum is simply impractical. Role expansion and role extension for HIM professionals should be defined based on the essence of HIM roles and responsibilities. Forming a curriculum development team consisting of various professional profiles brings divergent views regarding the HIM curriculum and paves the way for HIM to branch out at the Master's and Ph.D. levels based on advanced information technology.

Design principles in the development of (public) health information infrastructures.

In this article the author outlines the key issues in the development of a regional health information infrastructure suitable for public health data collections. A set of 10 basic design and development principles as used and validated in the development of the successful New Zealand National Health Information Infrastructure in 1993 are put forward as a basis for future developments. The article emphasises the importance of securing clinical input into any health data that is collected, and suggests strategies whereby this may be achieved, including creating an information economy alongside the care economy.It is suggested that the role of government in such developments is to demonstrate leadership, to work with the sector to develop data, messaging and security standards, to establish key online indexes, to develop data warehouses and to create financial incentives for adoption of the infrastructure and the services it delivers to users. However experience suggests that government should refrain from getting involved in local care services data infrastructure, technology and management issues.

Can Psychiatry Cross the Quality Chasm? Improving the Quality of Health Care For Mental and Substance Use Conditions

In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care. (Reprinted with permission from American Journal of Psychiatry 2007; 164:712–719)

Electronic health records, platforms, libraries, and evidence: report on the Association of Academic Health Sciences Libraries symposium's keynote presentation by Kenneth Mandl

The keynote speaker for the Association of Academic Health Sciences Libraries symposium on electronic health records (EHRs) and knowledge-based information was Kenneth Mandl. Mandl is associate professor at Harvard Medical School and director of the Intelligent Health Laboratory at the Children's Hospital Informatics Program, Harvard University–Massachusetts Institute of Technology Division of Health Sciences Technology. He is a pioneer in both consumer informatics and population health monitoring, and he has innovated and published extensively in the areas of personally controlled health records (PCHRs), disease outbreak detection, public health surveillance, and national health information infrastructure. Mandl has reviewed and approved the following account of his keynote address, “Electronic Health Records: Platforms, Libraries, and Evidence.”

A media analysis approach to evaluating national health information infrastructure development

PurposeThe purpose of this paper is to evaluate electronic health record (EHR) initiatives at the national/external level. Governments are investing large amounts of money in national EHR systems. These systems are socially and politically complex and a variety of stakeholders (e.g. at the individual, organisational or national level) have an interest in evaluating such systems from technical, economic or patient outcome perspectives. In cognisance of academic research in the area, this paper presents an approach which uses the perspective of one particular type of professional critic, the media, to identify issues and evaluate their impact at a national level.Design/methodology/approachThe work is conducted using an established evaluation framework and formal content analysis of selected relevant articles from the quality press of three selected countries.FindingsDifferent issues take prominence in centralised vs decentralised EHR approaches. In countries with a decentralised approach issues of standards and interoperability take the fore. Where there is a more centralised approach the media focus is more on project management, budgetary and financial aspects. In all coverage political and economic aspects are emphasised over technical or patient outcome issues.Originality/valueThe paper represents the application of the content‐context‐process framework. It contributes to the information systems evaluation literature at the national/external level.

Reproducing Social Inequality and Unequal Treatment in the National Health Information Infrastructure

This research analyzes how discourse constituting the currently proposed National Health Information Infrastructure (NHII) may reproduce existing social inequality in healthcare. Textually oriented critical discourse analysis and corpus linguistics methods compare 3 executive summaries from the Institute of Medicine reports: the Quality Chasm and Insuring Health series, and the stand-alone report Unequal Treatment. These methods proved effective in studying the social action of language used in those summaries and will be useful in studying a larger corpus of discourse constituting the NHII. Further research will provide information to prevent or mitigate the reproduction of social inequality in healthcare through the proposed NHII.

Electronic dental record information model

Electronic dental records (EDRs) vary widely with regard to the content and structure of the information they contain. At a time when electronic patient records are becoming increasingly essential in delivering high-quality patient care, the 'Tower of Babel' that today's EDRs represent is an increasingly significant drawback. This situation prevents the computational approaches for supporting patient and will also significantly hamper the exchange of patient information within the emerging National Health Information Infrastructure. Incomplete and fragmented EDRs force many practitioners to maintain both paper- and computer-based patient records, potentially contributing to the very limited adoption of completely electronic patient records by general dentists. This paper proposes an electronic dental record information model (EDRIM) design as a reference standard for the content and structure of EDRs.

Focus on Alcohol & Drug Abuse: Improving Service Delivery for Individuals With Co-occurring Disorders: New Perspectives on the Quadrant Model

Focus on Alcohol & Drug Abuse: Improving Service Delivery for Individuals With Co-occurring Disorders: New Perspectives on the Quadrant Model

Building a data warehouse for infection control

Recently, the convergence of several themes in health care has stimulated interest in exploiting data collected during clinical encounters to monitor and improve the quality of health care. Infection control departments can be supported by assembling previously collected electronic data into a data warehouse to monitor infections, report communicable diseases, and detect clusters of organisms. I present the rationale for constructing a data warehouse and describe the steps and challenges of developing a data warehouse to support infection control activities.

Why There Can Be No Sustainable National Healthcare IT Program Without a Translational Health Information Science

Health information technology research has historically suffered from the persistence of paper-based systems as a barrier to research and refinement of information models. While the field of (non-medical) information science offers a potentially rich source of data, there exist relatively few theoretical links between medical and non-medical information models. This paper argues that the establishment of an integrated translational research pathway is not only useful, but is a critical and necessary step in the realization of a national health information infrastructure in the USA.

Can Psychiatry Cross the Quality Chasm? Improving the Quality of Health Care For Mental and Substance Use Conditions

In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century , put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions , examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine’s analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care.

Can Psychiatry Cross the Quality Chasm? Improving the Quality of Health Care For Mental and Substance Use Conditions

In 2001, a seminal Institute of Medicine report, Crossing the Quality Chasm: A New Health System for the 21st Century, put forth a comprehensive strategy for improving the quality of U.S. health care. This strategy attained considerable traction within the overall U.S. health care system and subsequent attention in the mental health community as well. A new Institute of Medicine report, Improving the Quality of Health Care for Mental and Substance Use Conditions, examines the quality chasm strategy in light of the distinctive features of mental and substance use health care, including concerns about patient decision-making abilities and coercion into care, a less developed quality measurement and improvement infrastructure, lagging use of information technology and participation in the development of the National Health Information Infrastructure, greater separations in care delivery accompanied by more restrictions on sharing clinical information, a larger number of provider types licensed to diagnose and treat, more solo practice, and a differently structured marketplace. This article summarizes the Institute of Medicine's analysis of these issues and recommendations for improving mental and substance use health care and discusses the implications for psychiatric practice and related advocacy efforts of psychiatrists, psychiatric organizations, and other leaders in mental and substance use health care.

Achievable Steps Toward Building a National Health Information Infrastructure in the United States

Consensus is growing that a health care information and communication infrastructure is one key to fixing the crisis in the United States in health care quality, cost, and access. The National Health Information Infrastructure (NHII) is an initiative of the Department of Health and Human Services receiving bipartisan support. There are many possible courses toward its objective. Decision makers need to reflect carefully on which approaches are likely to work on a large enough scale to have the intended beneficial national impacts and which are better left to smaller projects within the boundaries of health care organizations. This report provides a primer for use by informatics professionals as they explain aspects of that dividing line to policy makers and to health care leaders and front-line providers. It then identifies short-term, intermediate, and long-term steps that might be taken by the NHII initiative.