Patient-centered Healthcare System Research Articles

Advancements in health information technology and their role in enhancing cancer care: Innovations in early detection, treatment, and data privacy

The rapid advancement of Health Information Technology (HIT) has revolutionized cancer care, introducing new capabilities in early detection, individualized treatment, and data security. This paper reviews the key HIT innovations that have reshaped oncology, including the widespread adoption of Electronic Health Records (EHRs), the use of artificial intelligence (AI) in diagnostic processes, and the application of telemedicine and predictive analytics to improve treatment planning. These technologies have enabled earlier and more accurate diagnoses, expanded access to care, and facilitated data-driven, personalized treatment strategies. In parallel, this review addresses the importance of safeguarding sensitive patient data, focusing on encryption, anonymization techniques, and the regulatory frameworks like HIPAA and GDPR that ensure data privacy. Finally, the paper discusses future directions for HIT, particularly the potential of AI-driven decision support systems, real-time data analytics, and privacy-enhancing algorithms to further advance cancer care, creating a more secure, efficient, and patient-centered healthcare system.

Health service quality and patients’ satisfaction among hospitals: the cohesive care of human beings and accomplishment of human rights

Purpose In this study, the researchers explored the influence of service quality-related constructs on patients’ satisfaction with Egyptian health-care centers. Design/methodology/approach In this study, the researchers used a quantitative approach and concluded the study based on 316 valid cases collected from patients of Egyptian health-care centers. Findings Using path analysis with analysis of moment structures (AMOS), this study's results demonstrate that reliability and responsiveness, empathy, nursing care and medical care positively affect patients' satisfaction. On the other hand, the tangibles have a negative effect on patient satisfaction. Practical implications This study’s findings benefit policymakers by shaping evidence-based policies. Health-care managers can implement strategies that prioritize the identified factors and can foster a more patient-centric and effective health-care system. Also, this study’s findings guide health-care institutes to maintain human rights by serving poor and needy patients. More generally, this study's outcomes enrich the depth of the domain literature. Originality/value This study’s findings add to the existing knowledge and fill contextual gaps by confirming patients’ satisfaction with the service quality of Egyptian health-care centers.

Racial Disparities in Plastic Surgery Outcomes: A Systematic Literature Review and Meta-Analysis.

Racial disparities in surgical outcomes have been shown to lead to subpar results in various patients. Variability and contradictions in the current literature highlight the need for a crucial evaluation of the matter in studies focusing on plastic and reconstructive surgery. Investigating the matter is a pivotal step toward effective guidelines that mitigate factors contributing to racial disparities in outcomes and improve our perception of a patient-centered health-care system. The study aimed to identify whether racial disparities exist in plastic and reconstructive surgery procedures. Systematic review of the literature as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed to find relevant articles assessing the impact of race on surgical outcomes. PubMed, Embase, MEDLINE, and Cochrane library were screened by both authors, and relevant articles were identified. Prevalence of complications were extracted from included studies, and odds ratio (OR) with 95% confidence interval (CI) was calculated and grouped for a statistical analysis. Meta-analysis of 13 studies, with a mean of 8059 patients per study, demonstrated a pooled OR of 1.21 (95% CI: 1.00-1.46), indicating an insignificant association between non-White race and postoperative complications. Subanalysis comparing African American patients to White patients (10 studies) showed an OR of 1.36 (95% CI: 1.06-1.74), signifying a statistically significant risk for African Americans. No publication bias was observed, but substantial heterogeneity (73% and 79%) suggested varied study factors influencing outcomes. Racial disparities exist in plastic and reconstructive outcomes. Physicians and medical staff should focus on patients' sociodemographic background, accessibility to care, support cycles, and language proficiency, while determining the surgical plan and postoperative care.

Healthcare can't stop evolving: innovation as the catalyst for unleashing the managerial potential of value-based healthcare by stimulating intangible assets and enhancing organizational resilience.

With increasing healthcare service utilization and the introduction of costly therapies, healthcare organizations are pressured to deliver cost-effective services within constrained budgets. Rising costs and the need for efficient healthcare delivery are major concerns for governments, insurers, and health plans. It aims to understand the impact of these intangible assets on creating value and organizational resilience in healthcare, informing better practices and strategies for VBHC implementation. An applied research approach using the Work Breakdown Structure (WBS) methodology was adopted. The research was divided into seven interconnected Work Packages (WPs), each designed to investigate different aspects of the integration between VBHC and intangible assets, with a focus on enhancing organizational resilience through innovative health processes. Key methodologies included literature reviews and qualitative analyses, employing Open Innovation and Design Thinking. The study revealed a dynamic interplay between VBHC, organizational resilience, and intangible assets. It showed that managerial effectiveness is influenced by direct patient outcomes and elements like intellectual capital and organizational reputation. Data integration from various Work Packages provided new insights into how intangible assets underpin VBHC strategies, proposing novel management approaches. Findings highlight the essential role of intangible assets in enhancing service delivery and fostering sustainable healthcare practices. The study highlights a significant oversight in the integration of intangible assets within healthcare organizations, despite their crucial role in optimizing VBHC. It supports literature emphasizing the importance of intellectual capital and organizational culture in enhancing healthcare management efficiency and resilience. A paradigm shift in VBHC to include these assets is needed for building a more adaptable and sustainable healthcare system. This integration can lead to better clinical outcomes, patient satisfaction, and overall healthcare efficiency, aligning more closely with VBHC goals. Recognizing and effectively managing intangible assets are paramount for the successful implementation of VBHC and enhanced organizational resilience. Strategic integration of these assets into healthcare management practices can significantly improve patient outcomes and create a more sustainable, patient-centered, and resilient healthcare system. Future studies should develop methodologies for robust measurement and integration of these assets to fully realize the potential of VBHC.

Implementation of Telemedicine in Medical Practice: Opportunities and Barriers

The integration of telemedicine into medical practice represents a transformative shift in healthcare delivery, offering both unprecedented opportunities and encountering significant barriers. This journal article explores the implementation of telemedicine, examining the multifaceted landscape of benefits and challenges associated with its adoption in medical settings. The opportunities presented by telemedicine include enhanced accessibility to healthcare services, especially in remote or underserved areas, improved patient outcomes through timely interventions, and increased efficiency in healthcare delivery. Telemedicine also facilitates remote patient monitoring, teleconsultations, and the exchange of medical information, contributing to a more patient-centric and adaptable healthcare system. However, the implementation of telemedicine faces several barriers, including regulatory complexities, concerns about data security and privacy, technological infrastructure limitations, and the need for healthcare professionals to adapt to new modes of communication. Cultural and organizational resistance further complicates the seamless integration of telemedicine into established medical practices. The article critically analyzes case studies and global implementations of telemedicine, highlighting successful models and lessons learned. It emphasizes the importance of policy frameworks, standardization, and ongoing training for healthcare providers to optimize the benefits of telemedicine while mitigating potential risks.

Machine Learning for Evaluating Hospital Mobility: An Italian Case Study

This study delves into hospital mobility within the Italian regions of Apulia and Emilia-Romagna, interpreting it as an indicator of perceived service quality. Utilizing logistic regression alongside other machine learning techniques, we analyze the impact of structural, operational, and clinical variables on patient perceptions of quality, thus influencing their healthcare choices. The analysis of mobility trends has uncovered significant regional differences, emphasizing how the regional context shapes perceived service quality. To further enhance the analysis, SHAP (SHapley Additive exPlanations) values have been integrated into the logistic regression model. These values quantify the specific contributions of each variable to the perceived quality of service, significantly improving the interpretability and fairness of evaluations. A methodological innovation of this study is the use of these SHAP impact scores as weights in the data envelopment analysis (DEA), facilitating a comparative efficiency analysis of healthcare facilities that is both weighted and normative. The combination of logistic regression and SHAP-weighted DEA provides a deeper understanding of perceived quality dynamics and offers essential insights for optimizing the distribution of healthcare resources. This approach underscores the importance of data-driven strategies to develop more equitable, efficient, and patient-centered healthcare systems. This research significantly contributes to the understanding of perceived quality dynamics within the healthcare context and promotes further investigations to enhance service accessibility and quality, leveraging machine learning as a tool to increase the efficiency of healthcare services across diverse regional settings. These findings are pivotal for policymakers and healthcare system managers aiming to reduce regional disparities and promote a more responsive and personalized healthcare service.

Strategies for Healthcare Disaster Management in the Context of Technology Innovation: the Case of Bulgaria

In Bulgaria, integrating technology and innovation is crucial for advancing sustainable healthcare disaster management, enhancing disaster response and recovery, and minimizing long-term environmental and social impacts. The purpose of the study is to assess the impact of modern technological innovations on the effectiveness of disaster management in health care in Bulgaria with a focus on Health Information Systems (HIS), Telemedicine, Telehealth, e-Health, Electronic Health Records, Artificial Intelligence (AI), Public Communication Platforms, and Data Security and Privacy. These innovations, when integrated effectively, can significantly strengthen Bulgaria's preparedness and response capabilities, improving efficiency and reducing the environmental footprint of disaster interventions. Collaboration with technology experts, research institutions, and international organizations is essential for successful implementation. The research aims to assess how these technologies can enhance disaster management efficacy, adopting a methodical approach using Systematic Literature Reviews (SLRs). Systematic Literature Reviews (SLRs) utilize precise criteria for research selection and evaluation to reduce bias, systematically compiling and analyzing data from various studies to offer evidence-based insights. They are crucial for uncovering research gaps, indicating areas needing further exploration. Findings highlight the transformative potential of technology integration in streamlining communication, data management, and operational efficiency. The study underscores the urgent need for an integrated approach and a culture of innovation within the healthcare sector, emphasizing ongoing assessment and adaptation of technology-based strategies. While acknowledging limitations and calling for further research, the study provides valuable insights into Bulgaria's healthcare disaster management strategies and sets the stage for future investigations to refine and expand upon these strategies. It advocates for a strategic framework guiding the efficient integration of technology into disaster management, aiming for resilient and patient-centric healthcare systems.

Editorial from Editor-in-Chief

In the realm of public health, the integration of academic research with practical application is crucial for driving meaningful change and improving health outcomes. In the field of health management, this synergy is especially vital when it comes to enhancing the quality of service, ensuring patient safety, and optimizing the utilization of resources. By bridging the gap between theory and practice, we can pave the way for more effective strategies that address the multifaceted challenges facing our healthcare system today. The integration of academic research with practical application is essential for driving positive changes in health management and improving health outcomes. By bridging the gap between theory and practice, we can create a more sustainable, efficient, and patient-centered healthcare system. It is imperative that researchers, practitioners, policymakers, and stakeholders work together to ensure that evidence-based practices are translated into real-world solutions that benefit individuals, communities, and society as a whole. Only through collaboration and innovation can we truly transform the landscape of public health and pave the way for a healthier future for all.

Exploring healthcare workers’ experience and barriers in disclosing patient safety-related incidents: A qualitative study in Indonesian hospitals

ABSTRACT Background Open disclosure of patient safety incidents is a strategy to enhance patient safety by preventing future occurrences. This study aimed to identify factors that facilitate or hinder the implementation of open disclosure in Indonesian hospitals. Methods Using a qualitative descriptive research method, 12 healthcare professionals with at least one year of experience and prior incident disclosure experience participated in online interviews. Thematic analysis revealed that open disclosure practices are uncommon in Indonesian hospitals. Results The findings suggest that open disclosure practices are not common practice in Indonesian hospitals. Key issues include unclear responsibility for disclosure, determining which incidents should be disclosed, understanding patient and family responses, implementing follow-up procedures and addressing barriers such as cultural factors, fear of disclosure, lack of protection and insufficient awareness and training among healthcare professionals. Conclusion Promoting open disclosure can improve patient-provider relationships and patient safety. Therefore, healthcare organizations, policymakers and educational institutions should collaborate to foster open disclosure, safeguard patients and educate healthcare professionals, leading to a more secure, transparent and patient-centric healthcare system.

The pivotal role of data harmonization in revolutionizing global healthcare: a framework and a case study

Aim: Data harmonization standardizes healthcare information, enhancing accessibility and interoperability, which is crucial for improving patient outcomes and driving medical research and innovation. It enables precise diagnoses and personalized treatments, and boosts AI model efficiency. However, significant challenges such as ethical concerns, technical barriers in the data lifecycle, AI biases, and varied regional regulations impede progress, underscoring the need for solutions like adopting universal standards such as HL7 FHIR, where the lack of generalized harmonization efforts is significant. Methods: We propose an advanced, holistic framework that utilizes FAIR-compliant reference ontologies (based on the FAIRplus and FAIR CookBook criteria) to make data findable, accessible, interoperable, and reusable enriched with terminologies from OHDSI (Observational Health Data Sciences and Informatics) vocabularies and word embeddings to identify lexical and conceptual overlaps across heterogeneous data models. Results: The proposed approach was applied to autoimmune diseases, cardiovascular diseases, and mental disorders using unstructured data from EU cohorts involving 7,551 patients with primary Sjogren’s Syndrome, 25,000 patients with cardiovascular diseases, and 3,500 patients with depression and anxiety. Metadata from these datasets were structured into dictionaries and linked with three newly developed reference ontologies (ROPSS, ROCVD, and ROMD), which are accessible on GitHub. These ontologies facilitated data interoperability across different systems and helped identify common terminologies with high precision within each domain. Conclusion: Through the proposed framework, we aim to urge the adoption of data harmonization as a priority, emphasizing the need for global cooperation, investment in technology and infrastructure, and adherence to ethical data usage practices toward a more efficient and patient-centered global healthcare system.

'Two heads are better than one'-exploring the experiences of Ghanaian communities on the role of patient and public participation in health system improvement.

Patient and Public Participation (PPP) is key to improving health systems. Yet, studies have shown that PPP implementations across many countries have been largely tokenistic. Particularly, in Ghana, whilst PPP is prioritized in national health policies and legislation, there appears to be little research focused on understanding PPP's role in health system improvement. The aim of this study, therefore, is to examine how PPP is working across the Ghanaian health system levels, as well as to understand the perspectives and experiences of participants on how PPP contributes to health system improvement. The qualitative study was undertaken in six communities in three districts in the Ashanti region of Ghana. Data were collected from semi-structured individual interviews. The selection of participants was purposive, based on their PPP-related roles. As a result, findings of this study may not reflect the experiences of others who are not directly involved in PPP initiatives. Thirty-five participants, mainly health service users and health professionals, were interviewed. Data were transcribed and analysed descriptively using Braun and Clarke's (2006) thematic analysis approach. Overall, participants noted PPP implementation was largely limited at higher health system levels (i.e. national, regional and district levels), but was functioning at the community level. PPP also improved access to health services, responsiveness to patient needs, community-health worker relationships, health-seeking behaviours, empowered healthcare users and improved health outcomes. The study, therefore, recommended the need to undertake PPP across all levels of the health system to maximize PPP's role in health system improvement. Finally, the study suggested prioritizing PPP, especially for resource-poor countries, to complement government's efforts in improving accessibility of healthcare services to many communities and also provide a more patient-centred healthcare system responsive to patients' and public needs.

A review of emerging trends in telemedicine: Healthcare delivery transformations

Telemedicine, characterized by the remote delivery of healthcare services using technology, has undergone remarkable transformations in recent years. This review explores the emerging trends in telemedicine and their profound impact on healthcare delivery. The paper begins by providing a background on telemedicine, tracing its evolution, and emphasizing its growing significance in the healthcare landscape. The primary objective is to shed light on the current state of telemedicine, identify key trends, and analyze their transformative effects on healthcare delivery. The technological landscape of telemedicine is examined, focusing on innovations in video conferencing, virtual consultations, and the integration of electronic health records. Furthermore, the role of artificial intelligence (AI) is explored, encompassing diagnostic assistance through medical imaging algorithms and the integration of chatbots and virtual health assistants. Specialized areas of telemedicine, such as mental health services and chronic disease management, are discussed in detail to highlight specific transformations in these domains. The critical aspect of patient and healthcare provider adoption is scrutinized, emphasizing patient engagement, overcoming technological barriers, and addressing the challenges faced by healthcare professionals in virtual settings. Anticipating the future of telemedicine, the review outlines upcoming innovations such as virtual reality applications and the impact of 5G technology. Simultaneously, it addresses persisting challenges, including health inequalities, ensuring quality of care, and ethical considerations. This review synthesizes the current state of telemedicine, identifies transformative trends, and provides insights into the future of healthcare delivery. It calls for continued research, policy development, and strategic implementation to maximize the potential of telemedicine in creating a more accessible, efficient, and patient-centric healthcare system.

Navigating the Ethical Landscape: Implementing Machine Learning in Smart Healthcare Informatics

The integration of Machine Learning (ML) into healthcare informatics holds immense promise, revolutionizing patient care and treatment strategies. However, as this technology advances, it brings forth ethical challenges crucial for careful navigation. ML offers unprecedented abilities to analyze vast healthcare data, leading to personalized medicine and improved outcomes. Yet, ethical concerns emerge, notably in privacy protection, algorithm bias, transparency, informed consent, and data quality. Transparency, explainability, and patient autonomy in decision-making processes are crucial to foster trust and accountability. Striking a balance between innovation and compliance, ensuring data quality, and promoting human-AI collaboration are essential. Addressing these challenges demands adherence to ethical frameworks, continuous monitoring, multidisciplinary governance, education, and regulatory compliance. To fully harness ML's potential in healthcare while upholding ethical standards, collaboration among stakeholders is imperative, ensuring patient welfare remains central amid technological advancements. Ethical considerations must be embedded at every stage of ML implementation to maintain an ethical, equitable, and patient-centered healthcare system.

Readiness for Inter-Professional Learning among Undergraduate Allied Health Science Students in Hayatabad Peshawar

Background: Inter-professional learning (IPL) is increasingly recognized as a vital component of healthcare education, fostering collaboration, enhancing teamwork skills, and preparing students for a patient-centered healthcare system. Despite its growing importance, the readiness and attitudes towards IPL among healthcare students vary across disciplines and regions, necessitating detailed exploration. Objective: This study aimed to assess the attitudes towards and readiness for IPL among undergraduate allied health science students at Khyber Medical University, Peshawar, and to explore the implications of these attitudes for healthcare education and practice. Methods: A cross-sectional survey was conducted over six months, utilizing convenience sampling to recruit 376 undergraduate students from the departments of Physical Therapy, Occupational Therapy, Speech and Language Pathology, and Nursing. The Readiness for Inter-professional Learning Scale (RIPLS) questionnaire was distributed through WhatsApp, Twitter, and email, covering aspects such as teamwork and collaboration, professional identity, and roles and responsibilities. Data were analyzed using SPSS version 25 to calculate means, standard deviations, and to conduct Independent t-tests. Results: The study found that a significant majority of students (72.1%) expressed strong agreement with the importance of IPL in their curriculum. The mean scores for the RIPLS sub-scales were: Teamwork and Collaboration (13.76 ± 2.609), Negative Professional Identity (10.57 ± 1.972), Positive Professional Identity (6.40 ± 1.359), and Role and Responsibility (7.50 ± 1.267). Independent t-tests revealed significant gender differences in attitudes towards teamwork and collaboration (Male: 13.42 ± 2.017, Female: 14.07 ± 3.034, p=0.015) and roles and responsibility (Male: 7.3187 ± 1.16940, Female: 7.6701 ± 1.33290, p=0.007), but not in professional identities. Conclusion: The study underscores a generally positive attitude towards IPL among healthcare students, with notable readiness for teamwork and understanding of roles and responsibilities. These findings highlight the necessity of integrating IPL into healthcare education curricula to enhance collaborative skills and prepare students for the complexities of modern healthcare delivery.

Challenges and strategies for conducting research in primary health care practice: an integrative review

BackgroundProviding accessible and high-quality patient-centered healthcare remains a challenge in many countries, despite global efforts to strengthen primary health care (PHC). Research and knowledge management are integral to enhancing PHC, facilitating the implementation of successful strategies, and promoting the use of evidence-based practices. Practice-based research in primary care (PC-PBR) has emerged as a valuable approach, with its external validity to diverse PHC settings, making it an effective means of translating research findings into professional practice.ObjectiveTo identify challenges and strategies for conducting practice-based research in primary health care services.MethodAn integrative literature review was conducted by searching the PubMed, Embase, Scopus, Web of Science, and Lilacs databases. The research question, guided by the PICo framework, directed the execution of study selection and data extraction. Data analysis followed the RAdAR method's three phases: pre-analysis, data analysis, and interpretation of results.ResultsOut of 440 initially identified articles, 26 met the inclusion criteria. Most studies were conducted in high-income countries, primarily the United States. The challenges and strategies for PC-PBR were categorized into six themes: research planning, infrastructure, engagement of healthcare professionals, knowledge translation, the relationship between universities and health services, and international collaboration. Notable challenges included research planning complexities, lack of infrastructure, difficulties in engaging healthcare professionals, and barriers to knowledge translation. Strategies underscore the importance of adapting research agendas to local contexts, providing research training, fostering stakeholder engagement, and establishing practice-based research networks.ConclusionThe challenges encountered in PC-PBR are consistent across various contexts, highlighting the need for systematic, long-term actions involving health managers, decision-makers, academics, diverse healthcare professionals, and patients. This approach is essential to transform primary care, especially in low- and middle-income countries, into an innovative, comprehensive, patient-centered, and accessible healthcare system. By addressing these challenges and implementing the strategies, PC-PBR can play a pivotal role in bridging the gap between research and practice, ultimately improving patient care and population health.

A STUDY ON MACHINE LEARNING IN ENHANCING CLINICAL DECISION SUPPORT SYSTEMS

Abstract—In recent years, the integration of machine learning into clinical decision support systems has revolutionized healthcare. This groundbreaking technology has empowered healthcare professionals by enhancing their ability to make more accurate, timely, and personalized decisions for patients. Through the power of machine learning, healthcare providers can now tap into vast amounts of patient data to improve diagnoses, treatment recommendations, and overall patient care. This transformation not only saves lives but also contributes to a more efficient and patient-centered healthcare system. Keywords—Clinical decision support systems, Healthcare, Patient data, Evidence-based recommendations, Patient-centered healthcare system

Editor’s Welcome

Tēnā koutou katoa and welcome to Issue 36 of Te Hautaka o ngā Akongā Rongoā, the New Zealand Medical Student Journal (NZMSJ). The theme of this issue is “Advocacy in Health,” which is crucial in the betterment of the healthcare system for both patients and health professionals. It is our privilege to share with our readers a wide range of insightful and high-quality articles by health care professional students, clinicians, and academics from Aotearoa. Advocacy plays a core role in the realm of healthcare, serving as a powerful catalyst for positive change and improved outcomes on both individual and systemic levels. Healthcare advocacy for the individual involves standing up for the rights, needs, and well-being of patients, ensuring that their voices are heard and their concerns addressed. On a broader scale, advocacy in healthcare contributes to the refinement of healthcare policies, regulations, and services. As providers working on the front lines, health professionals often better identify areas of necessary improvement than policy-makers. Advocacy campaigns and initiatives can shed light on systemic issues, drive policy changes, and influence healthcare regulations that ultimately shape the healthcare experience for everyone. We believe that by holding stakeholders accountable and pushing for transparency, advocacy serves as a counterbalance to potential shortcomings in the healthcare sector. Overall, the significance of ad- vocacy in healthcare extends beyond individual cases, contributing to a more inclusive, patient-centric, and effective healthcare system for entire communities and populations.

Data-Driven Healthcare: Evaluating the Effectiveness of the Patient Record Management System at RHU-Del Carmen

This paper delves into the transformative potential of data-driven approaches in healthcare and evaluates the implementation and impact of the Patient Record Management System (PRMS) at RHU-Del Carmen. The study aims to streamline healthcare operations, enhance data accessibility, and promote evidence-based decision-making. Through a comprehensive evaluation with an overall score of 4.4 out of 5, the study highlights the system's effectiveness in improving patient care, optimizing care coordination, and providing valuable clinical insights. The findings affirm the significance of data-driven healthcare practices and emphasize the importance of leveraging patient data for enhanced healthcare outcomes, ultimately driving towards a patient-centric and data-enabled healthcare system

Toward Patient-Centric Healthcare Systems: Key Requirements and Framework for Personal Health Records Based on Blockchain Technology

Healthcare data are considered sensitive and confidential, and storing these sensitive data in traditional (i.e., centralized) databases may expose risks, such as penetration or data leaks. Furthermore, patients may have incomplete health records since they visit various healthcare centers and leave their data scattered in different places. One solution to resolve these problems and permit patients to own their records is a decentralized personal health record (PHR); this can be achieved through decentralization and distribution systems, which are fundamental attributes of blockchain technology. Additionally, the requirements for this solution should be identified to provide practical solutions for stakeholders. This study aims to identify the key requirements for PHRs. A design science methodology was utilized to meet the study objectives, and thirteen healthcare experts were interviewed to elicit the requirements and the previous studies. Thirty-three requirements are defined, and based on these, high- and low-level architectures are developed and explained. The result illustrates that the developed solution-based Hyperledger Fabric framework is a promising method for the achievement of PHRs that guarantee security aspects, such as integrity, confidentiality, privacy, traceability, and access control.

Preferences for labor and childbirth, expressed orally or as a written birth plan: Prevalence and determinants from a nationwide population-based study.

Shared decision-making is an important component of a patient-centered healthcare system. We assessed the prevalence of parturients with preferences for their labor and childbirth, expressed verbally in the birthing room or as a written birth plan, and studied maternal, obstetric, and organizational factors associated with their expression. Data came from the 2016 National Perinatal Survey, a cross-sectional nationwide population-based survey conducted in France. Preferences for labor and childbirth were studied in three categories: expressed verbally, in writing (birth plan), or unexpressed or nonexistent. Analyses used multinomial multilevel logistic regression. The analysis included 11,633 parturients: 3.7% had written a birth plan, 17.3% expressed their preferences verbally, and 79.0% either did not have or did not express any preferences. Compared with the latter group, written or verbal preferences were both significantly associated with prenatal care by independent midwives (respectively, adjusted odds ratio (aOR) 2.19; 95% confidence interval (CI), [1.59-3.03], and aOR 1.43; 95% CI [1.19-1.71]) and with attendance at childbirth education classes (respectively, aOR 4.99; 95% CI [3.49-7.15], and aOR 2.27; 95% CI [1.98-2.62]). As years in traditional schooling increased, so did its association with preferences. Conversely, parturients from African countries were significantly less likely than French mothers to express preferences. A written birth plan was also associated with characteristics of maternity unit organization. Only one in five parturients reported having expressed preferences for labor and childbirth to healthcare professionals in the birthing room. This expression of preferences was associated with maternal characteristics and the organization of care.