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The objective of this paper is to assess the impact of the diploma "Statistical foundations applied to health information systems". A quasi–experimental study was conducted using a pre and post–test design between January 2021 and April 2022 at the University of Medical Sciences of Santiago de Cuba. Of the empirical methods, a survey applied to graduates and employers and documentary analysis were used. It is concluded that the assessment of the impact of the diploma "Statistical foundations applied to health information systems" is satisfactory, having recognized through the evaluations of the professional performance of its graduates, the improvement of the statistical training of said graduates through the program improvement, which could be confirmed with the satisfaction that graduates and employers have in this regard, it is also confirmed that updating statistical knowledge must become a constant process, which must be evaluated through the professional performance of the graduate for improvement of his work., O objectivo deste trabalho é avaliar o impacto do diploma “Fundamentos estatísticos aplicados aos sistemas de informação em saúde”. Foi realizado um estudo quase experimental, onde foi utilizado um desenho de pré-teste e pós-teste no período entre janeiro de 2021 e abril de 2022 na Universidade de Ciências Médicas de Santiago de Cuba. Dos métodos empíricos, utilizou-se uma pesquisa aplicada a graduados e empregadores e análise documental. Conclui-se que a avaliação do impacto do referido diploma é satisfatória, tendo aumentado o nível de conhecimentos, aptidões e competências dos diplomados do curso, na utilização de técnicas estatísticas para a análise destes sistemas, o que pôde ser confirmado com a satisfação que os licenciados e empregadores têm a este respeito, confirma-se também que a atualização do conhecimento estatístico deve tornar-se um processo constante, que deve ser avaliado através do desempenho profissional do graduado para melhorar o seu trabalho., El presente trabajo tiene como objetivo valorar el impacto del diplomado “Fundamentos estadísticos aplicados a los sistemas de información en salud”. Se realizó un estudio de tipo cuasiexperimental, donde se utilizó un diseño de pretest y postest en el período comprendido entre enero de 2021 y abril del 2022 en la Universidad de Ciencias Médicas de Santiago de Cuba. De los métodos empíricos fueron empleados una encuesta aplicada a egresados y empleadores y el análisis documental. Se concluye que la valoración del impacto del referido diplomado es satisfactoria, al haber potenciado el nivel de conocimientos, habilidades y competencias de graduados de la carrera, en el uso de técnicas estadísticas para el análisis de estos sistemas, lo que se pudo confirmar con la satisfacción que tienen los graduados y empleadores al respecto además se ratifica que la actualización de conocimientos estadísticos debe convertirse en un proceso constante, los cuales deben ser evaluados mediante el desempeño profesional del egresado para el perfeccionamiento de su labor.

Background: The goal of this study is to showed the relationship between the use of health information systems and community satisfaction with health services in primary health care. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. Several different online reference sources, like Pubmed and SagePub, were used to do this. Result: In the PubMed database, the results of our search brought up561 articles, whereas the results of our search on SagePub brought up 447 articles. The results of the search conducted for the last year of 2013 yielded a total 139 articles for PubMed and 67 articles for SagePub. In the end, we compiled a total of 12 papers, 8 of which came from PubMed and 4 of which came from SagePub. We included three research that met the criteria. Conclusion: Implementing a health information system in PHC is beneficial for patients, according to research. This naturally adds value to the service, which contributes to the high level of customer satisfaction.

Aims: This article aims to perform a Systematic Literature Review (SLR) to better understand the structures of different methods, techniques, models, methodologies, and technologies related to provenance data management in health information systems (HISs). The SLR developed here seeks to answer the questions that contribute to describing the results. Method: An SLR was performed on six databases using a search string. The backward and forward snowballing technique was also used. Eligible studies were all articles in English that presented on the use of different methods, techniques, models, methodologies, and technologies related to provenance data management in HISs. The quality of the included articles was assessed to obtain a better connection to the topic studied. Results: Of the 239 studies retrieved, 14 met the inclusion criteria described in this SLR. In order to complement the retrieved studies, 3 studies were included using the backward and forward snowballing technique, totaling 17 studies dedicated to the construction of this research. Most of the selected studies were published as conference papers, which is common when involving computer science in HISs. There was a more frequent use of data provenance models from the PROV family in different HISs combined with different technologies, among which blockchain and middleware stand out. Despite the advantages found, the lack of technological structure, data interoperability problems, and the technical unpreparedness of working professionals are still challenges encountered in the management of provenance data in HISs. Conclusion: It was possible to conclude the existence of different methods, techniques, models, and combined technologies, which are presented in the proposal of a taxonomy that provides researchers with a new understanding about the management of provenance data in HISs., Ministerio de Ciencia e Innovación (España), Depto. de Sistemas Informáticos y Computación, Fac. de Informática, TRUE, pub, Descuento UCM

OBJECTIVES: This study explores the potential of the HeLe Service Delivery Model, a community-based newborn hearing screening (NHS) program supported by a web-based referral system, in improving provision of hearing care services. METHODS: This prospective observational study evaluated the HeLe Service Delivery Model based on records review and user perspectives. We collected system usage logs from July to October 2018 and data on patient outcomes. Semi-structured interviews and review of field reports were conducted to identify implementation challenges and facilitating factors. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. RESULTS: Six hundred ninety-two (692) babies were screened: 110 in the RHUs and 582 in the Category A NHS hospital. Mean age at screening was 1.4±1.05 months for those screened in the RHU and 0.46±0.74 month for those in the Category A site. 47.3% of babies screened at the RHU were ≤1 month old in contrast to 86.6% in the Category A hospital. A total of 10 babies (1.4%) received a positive NHS result. Eight of these ten patients were referred via the NHS Appointment and Referral System; seven were confirmed to have bilateral profound hearing loss, while one patient missed his confirmatory testing appointment. The average wait time between screening and confirmatory testing was 17.1±14.5 days. Facilitating factors for NHS implementation include the presence of champions, early technology adopters, legislations, and capacity-building programs. Challenges identified include perceived inconvenience in using information systems, cost concerns for the patients, costly hearing screening equipment, and unstable internet connectivity. The lack of nearby facilities providing NHS diagnostic and intervention services remains a major block in ensuring early diagnosis and management of hearing loss in the community. CONCLUSION: The eHealth-enabled HeLe Service Delivery Model for NHS is promis

Within the framework of a broader investigation, this paper reports qualitative results whose objective was to analyze the effects that the Information Registration System (IRS) has had on the forms of management and organization of the work of the intersectoral childhood programme Chile Crece Contigo (ChCC), in the pandemic context by COVID19. Taking as reference the actor-network theory and the theory of power proposed by Michel Foucault, 20 semi-structured interviews with regional and communal ChCC actors in a region of southern Chile were analyzed. The results show that there is still resistance on the part of health professionals to use the ChCC platform, due to the multiplicity of records they have to feed, where the IRS is relegated. From an understanding of technologies as actors, the IRS has not managed to articulate the actions of the health sector, which contradicts the supposed role of articulation between different sectors attributed to the territorial coordinators of the ChCC. If we accept that the sociotechnical frameworks are not isolated from the logics of government, we can conclude that the insistence on adopting theChCC’s own IRS may reflect a logic of government, according to which each actor seeks the achievement its objectives through the extraction of resources and data from the action of other sectors, rather than through the articulation with others., En el marco de una investigación más amplia, el presente trabajo da cuenta de resultados cualitativos cuyo objetivo fue analizar los efectos que el Sistema de Registro de la Información (SRI) ha tenido sobre las formas de gestión y organización del trabajo del programa de infancia intersectorial Chile Crece Contigo (ChCC), en el contexto de pandemia por COVID19. Tomando como marcos de referencia, la teoría de actor red y la teoría del poder propuesta por Michel Foucault, se analizan 20 entrevistas semiestructuradas efectuadas a actores regionales y comunales del ChCC de una región del sur austral de Chile. Los resultados dan cuenta que, persiste una resistencia por parte de los profesionales de salud respecto al uso de la plataforma del ChCC, esto debido a la multiplicidad de registros que deben alimentar, donde el SRI queda relegado. Desde una comprensión de las tecnologías como actores, el SRI no ha logrado articular las acciones del sector salud, lo cual se contradice con el supuesto rol de articulación entre distintos sectores que se atribuyen los coordinadores territoriales del ChCC. Si aceptamos que los entramados sociotécnicos no son algo aislado de las lógicas de gobierno, podemos concluir que la insistencia porque se adopten los SRI propios del ChCC, puede ser un reflejo de una lógica de gobierno, según la cual, cada actor busca el logro de sus objetivos, más que por medio de la articulación con otros, por medio de la extracción de recursos y datos que se desprenden de las acciones de otros sectores.

The use of Food and Nutritional Vigilance System allows healthcare providers to plan and monitor actions focused on nutritional conditions in general population. This way, this research aims to verify the nutritional status and the food intake in the elderly population of Mato Grosso do Sul. The study was ecological and retrospective, and used data from the Food and Nutritional Vigilance System, where elderly records, men and women, were verified and measured by the Body Mass Index from 2017 to 2021. Looking at the results, the number of overweight elderly population increased significantly from 2017 to 2021, with predominance within women; men, on the other hand, showed higher percentage in cases of low weight. There was an expressive percentage decrease in the elderly who have three daily meals over the years and the food habit most frequently observed was the intake of ultra-processed food and sweetened beverages. In this way, there are significant correlation between nutritional status and food intake in the elderly population assessed. Eutrophic elderly people, who have low weight, showed healthy food habits in the intake of three daily meals while elderly people, who have unhealthy food intake with high ingestion of candies, were overweight., O uso do Sistema de Vigilância Alimentar e Nutricional no Brasil instrumentaliza os profissionais de saúde para o planejamento e monitoramento de ações voltadas às condições nutricionais da população em geral. Desta forma, o objetivo deste estudo foi verificar o estado nutricional e o consumo alimentar dos idosos residentes no Estado do Mato Grosso do Sul. Do tipo ecológico e retrospectivo, contou com os dados do Sistema de Vigilância Alimentar e Nutricional, onde foram verificados os registros dos idosos do sexo feminino e masculino, avaliados pelo Índice de Massa Corporal de 2017 a 2021. Utilizou-se do Formulário de Cadastro e Acompanhamento Nutricional e dos Formulários de marcadores do consumo alimentar entre 2015 e 2020. Nos resultados, o número de idosos com sobrepeso aumentou de forma significativa de 2017 a 2021, com prevalência de sobrepeso para o sexo feminino, que foi significativamente superior em relação ao sexo masculino e estes apresentaram maior percentual de ocorrência de casos de baixo peso. Houve uma expressiva diminuição do percentual de idosos que fazem as três refeições diárias de forma correta ao longo dos anos e o hábito alimentar mais frequente observado foi o hábito de ingerir alimentos ultraprocessados e bebidas adoçadas. Assim, existem correlações significativas em relação ao estado nutricional e o consumo alimentar dos idosos avaliados. Idosos com eutrofia e baixo peso mostraram-se com hábitos alimentares saudáveis realizando as três refeições ao dia e os idosos com hábitos alimentares não saudáveis com elevada ingestão de guloseimas, principalmente, mostraram-se em condições de sobrepeso.

Health Information Systems are built to support work processes in healthcare organisations. In advance, it is difficult to plan how those processes will run in practice. Nurses, doctors, and other healthcare professionals, run into obstacles when using these systems in their daily work. In an attempt to circumvent these obstacles, they use so-called workarounds: intentional deviations from the prescribed work process. These workarounds are common in healthcare organisations and can have both beneficial and detrimental effects on healthcare processes. This PhD thesis sets out from the conviction that workarounds – beneficial or not – can serve to indicate misalignments between information systems and the work processes they are supposed to support. Using a wide range of methods and techniques, we offer a number of solutions for detecting and analysing workarounds in healthcare organisations, all with the aim of improving work processes in healthcare. We contribute to the scientific literature and healthcare practice in the form of (1) providing insights into the factors that are important in the emergence of workarounds, (2) offering insights into the correct way of addressing different types of workarounds, (3) providing methodological support for detecting and analysing workarounds, and (4) providing methodological support for translating knowledge about workarounds into actionable ideas for process improvements.

Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community, or hospital system. Nordic countries have been developing their health portals including national HIE services systematically. In Finland HIE begun with various regional health information exchange (RHIE) pilots in since 1998. The Kanta patient data repository component in the national HIE has been adopted in routine use since 2012. The current role of non-Kanta RHIE in relation to Kanta services is somewhat unclear. Our research questions are following: 1) Has the availability of RHIE services changed during 2017–2020? 2) What functional types of RHIE are there in Finland in 2020? 3) From the point of view of healthcare provider organizations, at what level is the availability to combine regional information seamlessly into the same view of local patient record systems? Data used in this study were collected using web-based questionnaires in 2017 and 2020 as part of the surveys for monitoring and assessment of social welfare and health care information system services in Finland. This study reported in this article covers all 21 public hospital districts and nearly all public primary health care centers. The quantitative data provided by the organizations were analyzed using SPSS software (version 25). The availability of a particular service or function was calculated as a percentage of all respondents in each sector. The results of this study show that the overall availability of RHIE services has not markedly changed 2017–2020. Functional types of RHIE meaning the role, use and types of RHIE in hospital districts in Finland varies greatly in 2020. We recognized three different types of non-Kanta RHIE in the non-combination organizations (one-way, symmetrical, full symmetrical). Seamless integration of at least some Kanta data into the same view as the main patient health record system data was more common than

The Swedish government and the Swedish Association of Local Authorities and Regions, cametogether on a vision that Sweden will be the most advanced country in offering opportunities fordigitalization and e-health by the year of 2025. Self-monitoring is one aspect that can digitizeworkflow in healthcare. This master thesis sought to investigate the opportunities and restrictions when implementingself-monitoring for heart failure patients in Swedish healthcare. Starting from the holisticperspective as an analysis of the clinician’s interest and the need for self-monitoring systemsby conducting a mixed method approach. Surveys were sent out to different county councilsin Sweden working with heart failure patients, and interviews were conducted withrepresentatives from primary care, specialist care, and advanced home health care. Secondly,interviews were conducted with stakeholders from the field of implementation in order togather qualitative results on the organizational, legal, and technical influencing factors,challenges, and requirements in Swedish healthcare. The qualitative data were processedthrough thematic analysis and the quantitative data was processed through descriptive analysis. The results gathered from clinicians consisted of three areas regarding functionality demandsin self-monitoring systems. The results gathered in the aspect of implementation consisted ofthree main organizational influencing aspects, three solution models from a legal perspective,as well as three aspects related in the field of technology and IT., Sveriges regering och SKR gick samman om en vision om att Sverige ska vara det land somhar kommit längst med att erbjuda möjligheter till digitalisering av vård till år 2025. Egenmon-itorering är en aspekt som kan digitalisera arbetsflöden i vården. Detta masterarbete ämnade att undersöka möjligheter och begränsningar vid implementeringav egenmonitorering för hjärtsviktspatienter i svensk sjukvård. En mixad metodinriktninggenomfördes, som delades upp i två huvudsakliga delar. Första delen ämnade sig till kliniker,där enkäter skickades ut till olika landsting i Sverige som arbetar med hjärtsviktspatienter,samt intervjuer som genomfördes med representanter från primärvård, specialistvård ochavancerad hemsjukvård. Den första delen ämnade till att undersöka klinikers intresse ochbehov av egenmonitorering. Den andra delen bestod av intervjuer med ämnesexperter inomimplementation och digitalisera system för svensk sjukvård. Intervjuerna medimplementationsexperterna genererade kvalitativa resultat utifrån ett organisatoriskt, juridisktoch tekniskt perspektiv. Den kvalitativa datan bearbetades genom en tematisk analys och den kvantitativa datanbearbetades genom en deskriptiv analys. Resultaten som samlats in från kliniker bestod av treområden avseende funktionalitetskrav i egenmonitoreringssystem. Resultaten som samladesin gällande implementationen i svensk sjukvård bestod av tre huvudsakliga organisatoriskapåverkande aspekter, tre lösningsmodeller ur ett juridiskt perspektiv, samt tre aspekterrelaterade till teknik och IT.

Globally the health space is being revolutionised by rapid digital transformation to support care activities, promote healthier lifestyles and ensure informed decision making to improve service delivery. However, many health systems in sub-Saharan Africa are yet to realise the full potential of health information systems (HIS) as a digital transformation initiative. The objective of this article is to establish how the sociotechnical challenges in Africa’s health systems can be addressed by recommending a fitting approach to implement HIS relevant to the context of the continent. The Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) technique was applied to search, identify and filter articles over a 10-year period by applying inclusion and exclusion criteria accordingly. Only 42 articles satisfied the objective of this article. The emergent themes include contextual factors, coordination and collaboration, data complexity, organisation structure, accountability and stakeholders’ perspectives. The results indicated that less attention has been given to how the implementation approach could impact the output of health systems. In conclusion, the authors argue that a decentralised approach to the implementation of HIS is more appropriate for Africa’s health systems. The premise of the authors’ argument is informed by the tiered structure of health systems, varying levels of infrastructural development and use of large volumes of health-related data for resources allocation at the national level. Future studies should investigate the processes for formulation and evaluation of health policies to actively redress the administrative issues associated with the current functional HIS in each African country. Transdisciplinarity Contribution: The paper contributes to the practical implications of implementing HIS in sub-Saharan African health systems by highlighting the contextual realities and data governance complexities that support a decentral

This research work highlights the need for AI-powered applications and their usages for the optimization of information flow processes in the medical sector, from the perspective of how AI-agents can impact human-machine interaction (HCI) for acquiring relevant and necessary information in emergency department (ED). This study investigates how AI-agents can be applied to manage situations of patient related unexpected experiences, such as long waiting times, overcrowding issues, and high number of patients leaving without being diagnosed. For knowledge acquisition, we incorporated modelling workshop techniques for gathering domain information from the domain experts in the context of emergency department in Karolinska Hospital, Solna, Stockholm, Sweden, and for designing the AI-agent utilizing NLP techniques. We discuss how the proposed solution can be used as an assistant to healthcare practitioners and workers to improve medical assistance in various medical procedures to increase flow and to reduce workloads and anxiety levels. The implementation part of this work is based on the natural language processing (NLP) techniques that help to develop the intelligent behavior for information acquisition and its retrieval in a natural way to support patients/relatives’ communication with the healthcare organization efficiently and in a natural way.

Background In Europe, data on population health is fragmented, difficult to access, project-based and prone to health information inequalities in terms of availability, accessibility and especially in quality between and within countries. This situation is further exacerbated and exposed by the recent COVID-19 pandemic. The Joint Action on Health Information (InfAct) that builds on previous works of the BRIDGE Health project, carried out collaborative action to set up a sustainable infrastructure for health information in the European Union (EU). The aim of this paper is to present InfAct's proposal for a sustainable research infrastructure, the Distributed Infrastructure on Population Health (DIPoH), which includes the setup of a Health Information Portal on population health to be maintained beyond InfAct's time span. Methods The strategy for the proposal was based on three components: scientific initiatives and proposals to improve Health Information Systems (HIS), exploration of technical acceptability and feasibility, and finally obtaining high-level political support.. The technical exploration (Technical Dialogues-TD) was assumed by technical experts proposed by the countries, and political guidance was provided by the Assembly of Members (AoM), which gathered representatives from Ministries of Health and Science of EU/EEA countries. The results from the AoM and the TD were integrated in the sustainability plan compiling all the major outputs of InfAct. Results The InfAct sustainability plan was organized in three main sections: a proposal of a new research infrastructure on population health (the DIPoH), new health information tools and innovative proposals for HIS, and a comprehensive capacity building programme. These activities were carried out in InfAct and are being further developed in the Population Health Information Research Infrastructure (PHIRI). PHIRI is a practical rollout of DIPoH facilitating and generatin

O presente estudo teve como objetivo avaliar a correlação da esquistossomose mansônica com o acesso ao saneamento básico na Bahia entre 2015 a 2019. Foi realizado um estudo ecológico com o número de casos positivos de esquistossomose do banco de dados da Vigilância Epidemiológica da Secretaria de Saúde e os dados de saneamento básico (abastecimento de água, coleta de lixo e rede de esgoto) do Painel do Saneamento Básico, referentes ao estado da Bahia no período definido. Posteriormente, as variáveis foram correlacionadas utilizando-se o coeficiente de Spearman e p < 0,05 como nível de significância. Os resultados evidenciaram cobertura de saneamento básico no estado da Bahia inferiores aos níveis nacionais em 2019, com 19%, 47% e 16% da população sem acesso à água, coleta de esgoto e coleta de lixo, respectivamente. Enquanto isso, o período de 2015 a 2019, somou 9.703 casos positivos de esquistossomose na Bahia, com diminuição geral do número de casos no ano de 2019. A relação entre a prevalência da esquistossomose na Bahia e os fatores do saneamento básico selecionados não mostrou correlação significativa, em contraste com a relação evidenciada na literatura. Apesar disso, foi demonstrado alto número de casos de esquistossomose, baixa cobertura do saneamento básico e divergência entre os sistemas de informação em saúde no estado da Bahia, pontos passíveis de melhorias para a condição de saúde e acesso à informação da população., This study aimed to evaluate the correlation of schistosomiasis mansoni with access to basic sanitation in Bahia between 2015 and 2019. An ecological study was carried out with the number of positive cases of schistosomiasis from the Epidemiological Surveillance database of the Department of Health and basic sanitation data (water supply, garbage collection and sewage network) from the Basic Sanitation Panel, referring to the state of Bahia in the defined period. Subsequently, the  variables were correlated using Spearman's coefficient and p <0.05 as the significance level. The results showed basic sanitation coverage in the state of Bahia below national levels in 2019, with 19%, 47% and 16% of the population without access to water, sewage collection and garbage collection, respectively. Meanwhile, the period from 2015 to 2019, totaled 9,703 positive cases of schistosomiasis in Bahia, with a general decrease in the number of cases in the year 2019. The relationship between the prevalence of schistosomiasis in Bahia and selected basic sanitation factors is approximately unrelated, in contrast to the relationship shown in the literature. Despite this, a high number of schistosomiasis cases, low coverage of basic sanitation and divergence between health information systems in the state of Bahia were added, points that could be improved for a health condition and access to information for the population.

Background A Health Information System (HIS) assessment is an evaluation of the functioning of the main elements that compose a national HIS. Assessors from nine countries performed peer assessments of each other’s national HIS in the Joint Action on Health Information (InfAct). The aim of this study is to evaluate the advantages and disadvantages of the InfAct peer assessment methodology as well as the different steps involved in this assessment process. Methods Each peer assessment included a preparatory desk report, a country visit with semi-structured interviews with local stakeholders, a final report and a follow-up stakeholder meeting. A qualitative content analysis of the peer HIS assessment was performed based on 12 semi-structured interviews. Results The main advantage of the assessments is its informal atmosphere, high degree of objectiveness and its networking opportunities. Disadvantages are its informal request format and setting for recommendation uptake. The peer assessment helped the assessors to broaden their understanding of the assessed and their own HISs, to gain knowledge on how to carry out an HIS assessment and to practice their organization, communication, reporting and negotiation skills. All steps of the HIS assessment are essential and each contributes to the enriching experience of the participants. Conclusion The InfAct peer HIS assessment methodology strengthened capacity in national HISs by building up the knowledge and expertise in participating countries and as such addressed health information inequalities. This study confirms the value and relatively easy to implement methodology, and therefore recommends its wide and more systematic application across Europe.

BACKGROUND: This study examines mental, neurological, and substance use (MNS) service usage within refugee camp primary health care facilities in low- and middle-income countries (LMICs) by analyzing surveillance data from the United Nations High Commissioner for Refugees Health Information System (HIS). Such information is crucial for efforts to strengthen MNS services in primary health care settings for refugees in LMICs.METHODS: Data on 744,036 MNS visits were collected from 175 refugee camps across 24 countries between 2009 and 2018. The HIS documented primary health care visits for seven MNS categories: epilepsy/seizures, alcohol/substance use disorders, mental retardation/intellectual disability, psychotic disorders, severe emotional disorders, medically unexplained somatic complaints, and other psychological complaints. Combined data were stratified by 2-year period, country, sex, and age group. These data were then integrated with camp population data to generate MNS service utilization rates, calculated as MNS visits per 1000 persons per month.RESULTS: MNS service utilization rates remained broadly consistent throughout the 10-year period, with rates across all camps hovering around 2-3 visits per 1000 persons per month. The largest proportion of MNS visits were attributable to epilepsy/seizures (44.4%) and psychotic disorders (21.8%). There were wide variations in MNS service utilization rates and few consistent patterns over time at the country level. Across the 10 years, females had higher MNS service utilization rates than males, and rates were lower among children under five compared to those five and older.CONCLUSIONS: Despite increased efforts to integrate MNS services into refugee primary health care settings over the past 10 years, there does not appear to be an increase in overall service utilization rates for MNS disorders within these settings. Healthcare service utilization rates are particularly low for common mental di

Despite the consensus on the importance of evidence based health information for decision28 making andhealth policy formulation, quality information is not always available. This situation led the WHO in 2009to recommend the establishment of an African Health Observatory and National Health Observatories. TheWHO recommended 4 phases approach for the establishment of National Health Observatories was used inCameroon: the preliminary phase, start‐up, strengthening and full operation. Despite a non‐optimal institutionalpositioning, the Cameroon’s Health Observatory is in the strengthening phase and contributes toevidence‐based decision making in the health system. A strong political commitment is fundamental fromthe beginning of the project. The establishment of National Health Observatories calls for genuine nationalownership, both of the process as a whole and of the tool itself. WHO should regularly assess the progress madein the establishment of National Health Observatories in different countries and provide feedback to them. Astep‐by‐step approach, jointly validated by national stakeholders in a roll‐out plan, would be more appropriatefor the sustainability of the work of National Health Observatories., info:eu-repo/semantics/published

Background: Lack of evidence to inform Human Resources for Health (HRH) decisions contributes to inequitable HRH planning and distribution globally, affecting countries’ progress towards universal health coverage and sustainable development. Adoption of HRH models and information systems to address this has been slow in developing countries with partially decentralized health systems. Malawi also plans to roll out integrated Human Resources Information System (iHRIS) at district level to enhance availability of HRH information, as evidence for equitable HRH decisions, improved HRH density and Universal Health Coverage (UHC). This review discussed the applicability of iHRIS adoption in Malawi; and how and whether its use can address the inequitable HRH planning and distribution in Malawi context. Methods: A total of 363 international and local literatures from 2010 to 2022 were identified using a broad range of engines including Thammasat online library and Academic ultimate search. 53 were finally included in this systematic review, through a defined selection criterion. Findings: Districts have limited influence over data use and HRH decisions in partially decentralized health systems such as Malawi. Inequitable HRH planning and distribution is contributed by not only lack of evidence but also lack of corresponding models for responsive HRH projections. additionally, varying data management support and capacity across public and non-public health institutions; more focus on data entry than use; and inefficient data coordination at sub-national levels would limit quality and interoperability of iHRIS data and would defeat the whole purpose for iHRIS. Conclusion: Inequitable HRH planning and distribution of HRH is as a result of factors beyond just the unavailability of HRH information. Comprehensive HRH data should be considered as one of the means and not the single needed solution for inequitable HRH distribution. To achieve equitable HRH for UHC, other strategies

BackgroundHealth information systems (HIS) are fundamental tools for the surveillance of health services, estimation of disease burden and prioritization of health resources. Several gaps in the availability of HIS for kidney disease were highlighted by the first iteration of the Global Kidney Health Atlas.MethodsAs part of its second iteration, the International Society of Nephrology conducted a cross-sectional global survey between July and October 2018 to explore the coverage and scope of HIS for kidney disease, with a focus on kidney replacement therapy (KRT).ResultsOut of a total of 182 invited countries, 154 countries responded to questions on HIS (85% response rate). KRT registries were available in almost all high-income countries, but few low-income countries, while registries for non-dialysis chronic kidney disease (CKD) or acute kidney injury (AKI) were rare. Registries in high-income countries tended to be national, in contrast to registries in low-income countries, which often operated at local or regional levels. Although cause of end-stage kidney disease, modality of KRT and source of kidney transplant donors were frequently reported, few countries collected data on patient-reported outcome measures and only half of low-income countries recorded process-based measures. Almost no countries had programs to detect AKI and practices to identify CKD-targeted individuals with diabetes, hypertension and cardiovascular disease, rather than members of high-risk ethnic groups.ConclusionsThese findings confirm significant heterogeneity in the global availability of HIS for kidney disease and highlight important gaps in their coverage and scope, especially in low-income countries and across the domains of AKI, non-dialysis CKD, patient-reported outcomes, process-based measures and quality indicators for KRT service delivery.

IntroductionThe COVID-19 pandemic has disrupted health systems around the world. The objectives of this study are to estimate the overall effect of the pandemic on essential health service use and outcomes in Mexico, describe observed and predicted trends in services over 24 months, and to estimate the number of visits lost through December 2020.MethodsWe used health information system data for January 2019 to December 2020 from the Mexican Institute of Social Security (IMSS), which provides health services for more than half of Mexico's population-65 million people. Our analysis includes nine indicators of service use and three outcome indicators for reproductive, maternal and child health and non-communicable disease services. We used an interrupted time series design and linear generalised estimating equation models to estimate the change in service use and outcomes from April to December 2020. Estimates were expressed using average marginal effects on the risk ratio scale.ResultsThe study found that across nine health services, an estimated 8.74 million patient visits were lost in Mexico. This included a decline of over two thirds for breast and cervical cancer screenings (79% and 68%, respectively), over half for sick child visits and female contraceptive services, approximately one-third for childhood vaccinations, diabetes, hypertension and antenatal care consultations, and a decline of 10% for deliveries performed at IMSS. In terms of patient outcomes, the proportion of patients with diabetes and hypertension with controlled conditions declined by 22% and 17%, respectively. Caesarean section rate did not change.ConclusionSignificant disruptions in health services show that the pandemic has strained the resilience of the Mexican health system and calls for urgent efforts to resume essential services and plan for catching up on missed preventive care even as the COVID-19 crisis continues in Mexico.

In March 2020, the World Health Organization declared the 2019 coronavirus disease (COVID-19) outbreak a pandemic, with the coronavirus disease spreading worryingly fast. In this context, information systems, digital health (electronic health, mobile health), the Internet of things, play a key role, since they can contribute to fight against COVID-19 by introducing smarter solutions to achieve a rapid control in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the disease. However, these technologies need a solid regulatory framework that contributes to their implementation and integration in health systems, and to improve the national response in public health. In this context, coordination between administrations and the standardization and interoperability of information are necessary. Now is the time to establish the legal and knowledge bases so that everything that has been learned and advanced is integrated into health systems, promoting safe and evidence-based use., En marzo de 2020, la Organización Mundial de la Salud declaró el brote de la enfermedad por coronavirus 2019 (COVID-19) como una pandemia, con una propagación preocupantemente rápida. En este contexto, los sistemas de información, la salud digital (salud electrónica, salud móvil) y/o el Internet de las cosas toman un papel relevante, ya que pueden contribuir a luchar contra la COVID-19, introduciendo soluciones más inteligentes para lograr un control rápido del síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2), el virus que causa la enfermedad. Pero estas tecnologías necesitan de un marco regulatorio sólido que contribuya a su implantación e integración en los sistemas de salud y mejorar la respuesta nacional en materia de Salud Pública. En este contexto, es necesaria una coordinación entre administraciones, así como la estandarización e interoperabilidad de la información. Ahora es tiempo de sentar las bases, tanto legales como de conocimiento, para que todo lo que se ha aprendido y avanzado se integre en los sistemas sanitarios, promoviendo un uso seguro y basado en la evidencia.

Introduction: distance education is a teaching – learning system, with partial or total characteristics, which is developed through information and communication technologies, using a bidirectional method between teachers and students. This system substitutes the traditional method used (personal interaction in the classroom), for a tutoring one in which the students are responsible for their own training process. Objective: to design a system of actions to implement the distance education in the career of Health Information System. Method: to perform this work, an applied and descriptive research with a dialectical materialist approach was carried out in the career - Health Information Systems at the Facultad de Ciencias Médicas “Dr. Ernesto Che Guevara de la Serna”, Pinar del Rio. The historical-logical method was used as theoretical level techniques and also as empirical level methods, documentary review and participatory observation were used too. Results: the outcomes achieved through a critical analysis of teaching - learning process and the distance education, allowed to design a system of actions to be implemented in the career - Health Information Systems. Conclusions: many difficulties found have reveled lack of theoretical, pedagogical and methodological preparation on teachers and tutors, as well as lack of cognitive preparation of students concerning this process., Introdução: a educação a distancia é um sistema de enseñanza-aprendizaje que se desarrolla parcial ou totalmente a través de las Tecnologías de la Información y la Comunicación, bajo un esquema bidireccional entre profesor y alumnos. Este sistema sustenta o modelo de interação pessoal na aula por um de tutoria que responsabiliza o estudiante de sua formação. Objetivo: distribuir um sistema de acionamento para a implementação da educação à distância na carrera Sistemas de Informação e Saúde.Método: para a realização de este trabalho se llevó um cabo de uma investigação aplicada, descritiva, com um enfoque dialéctico materialista na carrera Sistemas de Informação em Saúde da Facultad de Ciencias Médicas “Dr. Ernesto Che Guevara de la Serna” de Pinar del Río; como métodos de nivel teórico se utilizó el histórico-lógico; del nivel empírico la revisión documental y la observación participativa. Resultados: se reflejaron los resultados a través de uma análise crítica del processo de enseñanza y aprendizaje a través de la educación a distancia de la carrera Sistemas de Informação em Salud permitiendo o projeto de um sistema de acciones. Conclusiones: se constata la existencia de dificultades en la preparación teórica, pedagógica y metodológica por parte de los profesores y tutores, así como cognitiva de los estudiantes, en relación con dicho proceso., Introducción: la educación a distancia es un sistema de enseñanza-aprendizaje que se desarrolla parcial o totalmente a través de las Tecnologías de la Información y la Comunicación, bajo un esquema bidireccional entre profesor y alumnos. Este sistema sustituye el modelo de interacción personal en el aula por uno de tutoría que responsabiliza al estudiante de su propia formación.Objetivo: diseñar un sistema de acciones para la implementación de la educación a distancia en la carrera Sistemas de Información en Salud. Método: para la realización de este trabajo se llevó a cabo una investigación aplicada, descriptiva, con un enfoque dialéctico materialista en la carrera Sistemas de Información en Salud de la Facultad de Ciencias Médicas “Dr. Ernesto Che Guevara de la Serna” de Pinar del Río; como métodos de nivel teórico se utilizó el histórico-lógico; del nivel empírico la revisión documental y la observación participativa.Resultados: se reflejaron los resultados a través de un análisis crítico del proceso de enseñanza y aprendizaje a través de la educación a distancia de la carrera Sistemas de Información en Salud permitiendo el diseño de un sistema de acciones.Conclusiones: se constata la existencia de dificultades en la preparación teórica, pedagógica y metodológica por parte de los profesores y tutores, así como cognitiva de los estudiantes, en relación con dicho proceso.

Factors influencing the reporting of patient safety incidents that result from health information technology (HIT) failure are poorly understood. We examined whether organizational justice is associated with the non-reporting of HIT system-related safety incidents among registered nurses. Cross-sectional survey data were collected from nurses (N = 1399) who reported encountering a HIT system-related patient safety incident within the past 12 months. Selecting one or more reasons for not filing an incident report from a predefined list of potential reasons was used as an indicator for non-reporting. Logistic regression models were fit to predict the reason-specific likelihood of non-reporting with organizational justice. High organizational justice was associated with a reduced likelihood of non-reporting if non-reporting occurred because reporting was too hard or took too much time (OR = 0.81, 95% CI 0.67 to 0.96), because the reporting had no impact on the organization’s processes (OR = 0.63, 95% CI 0.53 to 0.76), because the respondent was worried about the consequences (OR = 0.61, 95% CI 0.43 to 0.87), or because the respondent was not required to file a report (OR = 0.67, 95% CI 0.51 to 0.89). Justice was not associated with non-reporting if it occurred due to the lack of access to a reporting system, because no actual harm was caused to the patient, or some other, non-specified reason. The associations were robust to adjustment for several nurse and work characteristics. The results suggest that non-reporting of HIT system-related safety incidents is less common in a high-justice work environment. Fair treatment of nurses may encourage their reporting of safety incidents.

Background: Healthcare relies on health information systems (HISs) to support the care and receive reimbursement for the care provided. Healthcare providers experience many problems with their HISs due to improper architecture design. To support the design of a proper HIS architecture, a reference architecture (RA) can be used that meets the various stakeholder concerns of HISs. Therefore, the objective of this study is to develop and analyze an RA following well-established architecture design methods. Methods: Domain analysis was performed to scope and model the domain of HISs. For the architecture design, we applied the views and beyond approach and designed the RA’s views based on the stakeholders and features from the domain analysis. We evaluated the RA with a case study. Results: We derived the following four architecture views for HISs: The context diagram, decomposition view, layered view, and deployment view. Each view shows the architecture of the HIS from a different angle, suitable for various stakeholders. Based on a Japanese hospital information system study, we applied the RA and derived the application architecture. Conclusion: We demonstrated that the methods of the software architecture design community could be used in the healthcare domain effectively and showed the applicability of the RA

ObjectivePhysician champions are "boots on the ground" physician leaders who facilitate the implementation of, and transition to, new health information technology (HIT) systems within an organization. They are commonly cited as key personnel in HIT implementations, yet little research has focused on their practices and perspectives.Materials and methodsWe addressed this research gap through a qualitative study of physician champions that aimed to capture their challenges and strategies during a large-scale HIT implementation. Email interviews were conducted with 45 physician champions from diverse clinical areas 5 months after a new electronic health record (EHR) system went live in a large academic medical center. We adopted a grounded theory approach to analyze the data.ResultsOur physician champion participants reported multiple challenges, including insufficient training, limited at-the-elbow support, unreliable communication with leadership and the EHR vendor, as well as flawed system design. To overcome these challenges, physician champions developed their own personalized training programs in a simulated context or in the live environment, sought and obtained more at-the-elbow support both internally and externally, and adapted their departmental sociotechnical context to make the system work better.Discussion and conclusionsThis study identified the challenges physician champions faced and the strategies they developed to overcome these challenges. Our findings suggest factors that are crucial to the successful involvement of physician champions in HIT implementations, including the availability of instrumental (eg, reward for efforts), emotional (eg, mechanisms for expressing frustrations), and peer support; ongoing engagement with the champions; and appropriate training and customization planning.

With the vision of a seamless, state-wide approach to patient management, the Department of Health within the Queensland State Government of Australia embarked on a digital transformation journey. This involved the configuration and rollout of an integrated electronic medical record system (ieMR) with computerized provider order entry, ePrescribing, decision support, analytics, and research functionalities, together with new devices and work practices, to create a multi-hospital, whole-of-state digital health ecosystem. From the perspective of the CIO, this teaching case describes the digital transformation of the lead site, Princess Alexandra Hospital, and their experience in becoming Australia’s first large digital hospital. This case has been informed by a multi-year qualitative study involving the collection of primary (observations and interviews) and secondary data (publicly-available project records) before and after the implementation. This case is relevant to undergraduate and postgraduate students in business information systems, executive management, and clinical/health informatics.

In this paper we analyze the role of power relations in the emergence of workarounds in Health Information Systems (HISs). Using an explorative multi-case study of five healthcare organizations in the Netherlands, we identify 51 workarounds as well as the underlying power relations that underlie them. We distinguish two main types of power that are important for the emergence of workarounds: (1) hierarchical differences between actors and (2) system restrictions. Our study unpacks the link between power and HISs, illustrating how actors respond to hierarchical differences and system restrictions to exert their 'power to work around'.

Objective: This study aims to assist hospitals contemplating digital transformation by assessing the reported qualitative effects of rapidly implementing an integrated eHealth system in a large Australian hospital and determining whether existing literature offers a reliable framework to assess the effects of digitisation. Methods: A qualitative, single-site case study was performed using semistructured interviews supplemented by focus groups, observations and documentation. In all, 92 individuals across medical, nursing, allied health, administrative and executive roles provided insights into the eHealth system, which consisted of an electronic medical record, computerised decision support, computerised physician order entry, ePrescribing systems and wireless device integration. These results were compared against a known framework of the effects of hospital digitisation. Results: Diverse, mostly positive, effects were reported, largely consistent with existing literature. Several new effects not reported in literature were reported, namely: (1) improvements in accountability for care, individual career development and time management (2) mixed findings for the availability of real-time data and (3) positive findings for the secondary use of data. Conclusions: The overall positive perceptions of the effects of digitisation should give confidence to health services contemplating rapid digital transformation. Although existing literature provides a reliable framework for impact assessment, new effects are still emerging, and research and practice need to shift towards understanding how clinicians and hospitals can maximise the benefits of digital transformation. What is known about the topic?: Hospitals outside the US are increasingly becoming engaged in eHealth transformations. Yet, the reported effects of these technologies are diverse and mixed with qualitative effects rarely rep

The thesis presents ways of automatically detecting healthcare policy violations in Health Information Systems (HISs), as one part of an overall Information Accountability Framework, intended to hold system users answerable for their information use. The significance of this research is the demonstration of an auditing approach that includes healthcare log enrichment and methods of modelling healthcare policies and standards that can be used for checking policy compliance in the healthcare industry. It also paves the way for how process analytics can be used to hold people accountable for their information use in HISs.

The study aimed at determining the influence of institutional capacity on utilization of Sub-County Health Information System in health facilities in Homabay sub-county. Utilization of Health Information System was raising concerns both locally and globally. This is in view of the role of health managers to take up proactive leadership in demand for and use of data for decision making. The system also helps decision makers to detect and control emerging and endemic health problems, monitor progress towards health goals and promote equity if well utilized.  Low utilization of health information system by healthcare workers in health facilities was identified as a challenge in many developing countries including Kenya. This problem was identified in Homabay Sub-County where the health care workers did not fully utilize information from Sub-county Health Information System despite enormous resources that are provided to help in its implementation. The specific objectives were, firstly to determine how employee capacity influence utilization of district health information system in health facilities in Homabay sub-county. Secondly to establish how availability of funds influence utilization of district health information system in health facilities in Homabay sub-county. Thirdly to assess the extent to which size of healthcare facility influence utilization of district health information system in health facilities in Homabay sub-county. The study was conducted in Homabay sub-county, between July and September 2019. It adopted descriptive research design where both quantitative and qualitative data was collected using questionnaires from a total of 20 District Health Information System managers and 124 users in public health facilities in Homabay Sub County. The researcher adopted stratified random sampling to select the respondents since the population was heterogeneous consisting of different cadres of healthcare workers. Quantitative data was analyzed using both

To monitor the progress of the COVID-19 outbreak, ensure equitable access to testing and treatment, and provide up-to-date information to Indigenous decision-makers engaged in setting up measures to protect their communities, the Manitoba Inuit Association (MIA) mobilized to work with the First Nation Heath and Social Secretariat of Manitoba, Ongomiizwin Research, and the Manitoba Government to identify Inuit in COVID-19 diagnostic tests, including Inuit who reside in Manitoba or those who come from Nunavut to the province to access health services. Provincial work was already underway to add Indigenous identifiers into provincial clinical health information systems; however, it was apparent early in April 2020 that reporting to Indigenous organizations on identified COVID-19 cases for First Nation, Metis, and Inuit People would be also be required in order for remedial measures to occur. This article describes the governance considerations needed to establish an information-sharing agreement with the Government of Manitoba and the role of the MIA in overseeing this process. Further background information is provided in addition to an extended discussion around the context in which Inuit are identified and receive healthcare services in Manitoba.

BackgroundAccurate measures of malaria incidence are essential to track progress and target high-risk populations. While health management information system (HMIS) data provide counts of malaria cases, quantifying the denominator for incidence using these data is challenging because catchment areas and care-seeking behaviours are not well defined. This study's aim was to estimate malaria incidence using HMIS data by adjusting the population denominator accounting for travel time to the health facility.MethodsOutpatient data from two public health facilities in Uganda (Kihihi and Nagongera) over a 3-year period (2011-2014) were used to model the relationship between travel time from patient village of residence (available for each individual) to the facility and the relative probability of attendance using Poisson generalized additive models. Outputs from the model were used to generate a weighted population denominator for each health facility and estimate malaria incidence. Among children aged 6 months to 11 years, monthly HMIS-derived incidence estimates, with and without population denominators weighted by probability of attendance, were compared with gold standard measures of malaria incidence measured in prospective cohorts.ResultsA total of 48,898 outpatient visits were recorded across the two sites over the study period. HMIS incidence correlated with cohort incidence over time at both study sites (correlation in Kihihi = 0.64, p < 0.001; correlation in Nagongera = 0.34, p = 0.045). HMIS incidence measures with denominators unweighted by probability of attendance underestimated cohort incidence aggregated over the 3 years in Kihihi (0.5 cases per person-year (PPY) vs 1.7 cases PPY) and Nagongera (0.3 cases PPY vs 3.0 cases PPY). HMIS incidence measures with denominators weighted by probability of attendance were closer to cohort incidence, but remained underestimates (1.1 cases PPY in Kihihi and 1.4 cases PPY in Nagongera).ConclusionsAlthou

ObjectiveTo assess the association between clinical integration and financial integration, quality-focused care delivery processes, and beneficiary utilization and outcomes.Data sourcesMultiphysician practices in the 2017-2018 National Survey of Healthcare Organizations and Systems (response rate 47%) and 2017 Medicare claims data.Study designCross-sectional study of Medicare beneficiaries attributed to physician practices, focusing on two domains of integration: clinical (coordination of patient services, use of protocols, individual clinician measures, access to information) and financial (financial management and planning across operating units). We examined the association between integration domains, the adoption of quality-focused care delivery processes, beneficiary utilization and health-related outcomes, and price-adjusted spending using linear regression adjusting for practice and beneficiary characteristics, weighting to account for sampling and nonresponse.Data collection/extraction methods1 604 580 fee-for-service Medicare beneficiaries aged 66 or older attributed to 2113 practices. Of these, 414 209 beneficiaries were considered clinically complex (frailty or 2 + chronic conditions).Principal findingsFinancial integration and clinical integration were weakly correlated (correlation coefficient = 0.19). Clinical integration was associated with significantly greater adoption of quality-focused care delivery processes, while financial integration was associated with lower adoption of these processes. Integration was not generally associated with reduced utilization or better beneficiary-level health-related outcomes, but both clinical integration and financial integration were associated with lower spending in both the complex and noncomplex cohorts: (clinical complex cohort: -$2518, [95% CI: -3324, -1712]; clinical noncomplex cohort: -$255 [95% CI: -413, -97]; financial complex cohort: -$997 [95% CI: -$1320, -$679]; and

Objective: to know the epidemiological configuration of cancer care in a health macro-region in the Brazilian state of Minas Gerais between 2008 and 2017. Materials and methods: quantitative, exploratory, cross-sectional and descriptive study, conducted with secondary data from five municipalities of the state of Minas Gerais. Results: there were 54,206 visits to cancer patients, predominantly male (53.38%), aged 60 to 79 years (49.95%), white (79.08%), with incomplete elementary school education (48.36 %), and married (57.34 %). Skin neoplasms represent the most frequent primary location (22.35%). Stage I of the tumor was the most observed (20.98 %). The most prevalent reasons for not treating after the “not applicable” option were advanced disease and lack of clinical conditions or other conditions (6.97 %), whereas stable disease (31.59%) prevailed at the end of the first treatment received. Conclusion: the results provide support to identify the priorities of cancer care and outline the configuration for cancer treatment in patients, which directs the planning of interventions to provide high quality care., Objetivo: conhecer a configuração epidemiológica dos atendimentos oncológicos em uma macrorregião de saúde brasileira, localizada no estado de Minas Gerais, entre 2008 e 2017. Materiais e métodos: estudo quantitativo, exploratório, transversal e descritivo, realizado com dados secundários de cinco municípios localizados no estado de Minas Gerais. Resultados: houve 54.206 atendimentos a indivíduos com câncer, com predominância do sexo masculino (53,38 %), faixa etária de 60 a 79 anos (49,95 %), cor branca (79,08 %), ensino fundamental incompleto (48,36 %) e estado conjugal casado (57,34 %). As neoplasias de pele representam a mais frequente localização primária (22,35 %). O estadiamento I do tumor foi o mais observado (20,98 %). As razões mais predominantes para não tratar, depois da opção “não se aplica”, foram doença avançada, falta de condições clínicas ou outras (6,97 %), ao passo que se verificou predomínio de doença estável (31,59 %) no final do primeiro tratamento recebido. Conclusão: os resultados apresentados oferecem subsídios para identificar as prioridades da atenção oncológica e traçam a configuração dos atendimentos a pacientes com câncer, o que direciona o planejamento de intervenções para proporcionar um atendimento de qualidade., Objetivo: conocer la configuración epidemiológica de la atención del cáncer en una macrorregión de salud, ubicada en el estado de Minas Gerais, Brasil, entre 2008 y 2017. Materiales y métodos: estudio cuantitativo, exploratorio, transversal y descriptivo, realizado con datos secundarios de cinco municipios ubicados en el estado de Minas Gerais. Resultados: se atendieron a 54.206 pacientes con cáncer, predominantemente hombres (53,38 %), en un rango etario de 60 a 79 años (49,95 %), blancos (79,08 %), con educación básica primaria incompleta (48,36 %) y casados (57,34 %). Las neoplasias de piel representan la localización primaria más frecuente (22,35 %). La etapa I del tumor fue la más observada (20,98 %). Las razones más frecuentes para no tratar, después de la opción “no se aplica”, fueron enfermedad avanzada, falta de condiciones clínicas u otras (6,97 %), mientras que se verificó el predominio de la enfermedad estable (31,59 %) al final del primer tratamiento recibido. Conclusión: los resultados presentados brindan apoyo para identificar las prioridades de la atención oncológica y establecen la configuración de la atención para pacientes con cáncer, lo que dirige la planificación de las intervenciones para proporcionar atención de calidad.

We report the large-scale deployment, implementation and adoption of the nationwide centralized integrated and shared Kanta health information services by using the Clinical Adoption Framework (CAF). The meso and macro level dimensions of the CAF were incorporated early into our e-health evaluation framework to assess Health Information System (HIS) implementation at the national level. We found strong support for the CAF macro level model concepts in Finland. Typically, development programs were followed by government policy commitments, appropriate legislation and state budget funding before the CAF meso level implementation activities. Our quantitative data point to the fact that implementing large-scale health information technology (HIT) systems in practice is a rather long process. For HIT systems success in particular citizens’ and professionals’ acceptance are essential. When implementation of the national health information systems was evaluated against Clinical Adoption Meta-Model (CAMM), the results show that Finland has already passed many milestones in CAMM archetypes. According to our study results, Finland seems to be a good laboratory entity to study practical execution of HIT systems, CAF and CAMM theoretical constructs can be used for national level HIS implementation evaluation.

[EN]: The digital era, that we are living nowadays, is transforming health, health care models and services, and the role of society in this new reality. We currently have a large amount of stored health data, including clinical, biometric, and scientific research data. Nonetheless, its potential is not being fully exploited. It is essential to foster the sharing and reuse of this data not only in research but also towards the development of health technologies in order to improve health care efficiency, as well as products, services or digital health apps, to promote preventive and individualized medicine and to empower citizens in health literacy and self-management. In this sense, the FAIR concept has emerged, which implies that health data is findable, accessible, shared and reusable, facilitating interoperability between systems, ensuring the protection of personal and sensitive data. In this paper we review the FAIR concept, ‘FAIRification’ process, FAIR data versus open access data, ethical issues and the general data protection regulation, and digital health and citizen science., [PT]: Vivemos uma nova era digital que está a transformar a saúde, os modelos de cuidados e serviços de saúde, e o próprio papel da sociedade nesta realidade. Atualmente dispomos de uma grande quantidade de dados de saúde armazenados, incluindo dados clínicos, biométricos e de investigação científica, cuja potencialidade não está a ser devidamente explorada. É essencial favorecer a partilha e reutilização destes dados não só na investigação, como também para o desenvolvimento de tecnologias para melhorar a eficiência dos cuidados de saúde, de produtos ou serviços de saúde digitais, promover uma medicina preventiva e individualizada, mas também o empoderamento da população em literacia em saúde e na gestão da doença. Recentemente, surgiu o conceito FAIR que implica que os dados de saúde sejam facilmente localizáveis, acessíveis, partilhados e reutilizáveis, facilitando desta forma a interoperacionalidade entre sistemas e assegurando a proteção de dados pessoais e sensíveis. Neste artigo é feita uma revisão do conceito FAIR, processo de ‘FAIRificação’, dados FAIR versus dados de acesso livre, questões de éticas e o regulamento geral de proteção de dados, e saúde digital e ciência cidadã.

OBJECTIVES: Skills to employ nursing informatics to promote the health of individuals is of such importance that it is considered a core competence. Although investments are made to increase the use of e-health, there is no full understanding of the usability of e-health for healthcare. This paper presents a current picture of how e-health and m-health are defined and used as well as the effects their usage may have on the intended target group. METHODS: Peer-reviewed open-access papers and grey literature that define e-health and m-health from PubMed, SpringerLink, and Google.com were randomized. A mixed method design with an inductive approach was employed. Open-source software were used for analysis. RESULTS: The overview includes 30 definitions of e-health and m-health, respectively. The definitions were thematised into 14 narrative themes. The results of the study, and primarily a three-level model, provide an understanding of how different types of e-health and m-health can be put into practice, and the effects or consequences of using them, which may be either positive or negative. CONCLUSIONS: Mobility and flexibility is important for both m-health and e-health. Five keywords that characterize the definitions of e-health and m-health are "health", "mobile", "use", "information", and "technology". E-health or m-health cannot replace human actors because e-health and m-health consist of social and material interactions. Using e-health and m-health is, thus, about developing healthcare without compromising native relics.

Health information systems are our technological response to the growing demand for health care. However, their success in their mission can be challenging due to the complexity of evaluating technological interventions in health care. In the series of studies compiled in this dissertation, we looked at the evaluation of these systems. We focused on the evaluation of factors that lead to success, where success is indicated by user satisfaction and can be induced by both intervention-specific and individual-specific factors. Study 1 developed a method, called UVON, to elicit and organise the user-demanded qualities in the outcomes of the health information system intervention. Through the application of the UVON method in the FI-STAR project, an EU project which developed and deployed seven e-health applications in seven member countries, ten categories of quality and their subcategories were identified. These qualities formed two questionnaires, specific to the patient and health professional users. Through the questionnaires, the patients and health-professionals users evaluated and graded both the occurrence of those demanded qualities in the project outcomes and their general satisfaction. Study 2 analysed the survey results to find out which of those ten qualities have the highest impact on satisfaction or can predict it better. Two partial least squares structural equation modelling (PLS-SEM) models were constructed, for the patient and health professionals, based on the Unified eValuation using ONtology (UVON) and survey outputs. The models showed that effectiveness is an important quality in creating satisfaction for both user groups. Besides, affordability for the health professionals and efficiency plus safety for the patients were the most influential. A satisfaction index is also introduced for simple and fast inferring of the changes in the outcome qualities. Study 5 recruited outputs and learnings from studies 1 and 2 to design a system that partially a

ObjectiveDecentralized privacy-preserving predictive modeling enables multiple institutions to learn a more generalizable model on healthcare or genomic data by sharing the partially trained models instead of patient-level data, while avoiding risks such as single point of control. State-of-the-art blockchain-based methods remove the "server" role but can be less accurate than models that rely on a server. Therefore, we aim at developing a general model sharing framework to preserve predictive correctness, mitigate the risks of a centralized architecture, and compute the models in a fair way.Materials and methodsWe propose a framework that includes both server and "client" roles to preserve correctness. We adopt a blockchain network to obtain the benefits of decentralization, by alternating the roles for each site to ensure computational fairness. Also, we developed GloreChain (Grid Binary LOgistic REgression on Permissioned BlockChain) as a concrete example, and compared it to a centralized algorithm on 3 healthcare or genomic datasets to evaluate predictive correctness, number of learning iterations and execution time.ResultsGloreChain performs exactly the same as the centralized method in terms of correctness and number of iterations. It inherits the advantages of blockchain, at the cost of increased time to reach a consensus model.DiscussionOur framework is general or flexible and can also address intrinsic challenges of blockchain networks. Further investigations will focus on higher-dimensional datasets, additional use cases, privacy-preserving quality concerns, and ethical, legal, and social implications.ConclusionsOur framework provides a promising potential for institutions to learn a predictive model based on healthcare or genomic data in a privacy-preserving and decentralized way.

Problem: Despite acknowledged benefits, the impact of advance care planning on usual care is inconsistent. Design: Quality improvement study. Setting: A Western Australian regional hospital. Key measures for improvement: This project aimed to create a system for storing, accessing and incorporating advance care planning documents in clinical care. Strategies for change: Interventions over 18 months addressed four areas: medical records processes for receiving and processing advance care planning documents; information technology solutions for electronic storage and alerts; clerical staff duties in regards advance care planning documents; and clinician education. Effects of change: There was a 12-fold increase in advance care planning documents stored electronically and 100% of audited notes had correct filing of advance care planning documents with an alert in place at follow-up audit. Clinician recognition of the presence of an advance care planning document improved. Detailed examples of interventions are described. Lessons learnt: Repeated exposure to different forms of advance care planning education, in conjunction with simple but effective system changes can make a difference in changing established hospital practice. Final impact of these changes on end-of-life care requires further audit.

The global health sector is undergoing rapid digital transformation. Because such transformations often fail to meet expectations, researchers have begun studying the full chain from implementation to outcomes to learn what improvements are needed. Recent studies suggest that it is especially important to learn what 'effective use' of new systems involve, because effective use is the lynchpin between a system and its benefits. A key challenge, however, is operationalizing effective use. In this paper, we compare two approaches: theory-driven, operationalizing effective use using the 'theory of effective use', and context-driven, operationalizing it in terms of the workarounds users devise to achieve their goals. We compare these approaches using survey data from a multi-hospital digital transformation. The results support the theory-driven approach, while offering useful insights on workarounds.

[ES] El Perú, actualmente se encuentra en desarrollo e implementación de la historia clínica electrónica (HCE) y el intercambio de datos clínicos de los ciudadanos en el Sector Salud, proceso al cual viene acoplándose sobre la marcha a los cambios y mejoras propuestas, entre ellos la necesidad de modernización de los estados y la transformación de los sistemas de información en salud, permitiendo la incorporación gradual de las Tecnologías de la Información y Comunicaciones (TIC). Hoy en día, los sistemas de información en salud desempeñan un rol clave porque permiten que la información en salud sea de calidad y completa, pero lo más importante que se encuentre disponible y de manera oportuna para la toma de decisiones operativas y estratégicas que permitan salvar vidas, mejorar la salud y calidad de vida de la población. El presente trabajo, muestra una revisión y análisis en la evolución de la Historia Clínica (HC), los aspectos vinculados a la Ley N° 30024, Ley que Crea el Registro Nacional de Historias Clínicas Electrónicas (RENHICE) y todo lo que antecede al proceso de cambio en las instituciones prestadoras de salud (IPRESS) dentro del Perú. Así como también presentar los componentes principales del marco conceptual que busca fortalecer los sistemas de información en salud, y describir las principales acciones y estrategias del Ministerio de Salud (MINSA) en el Perú, con la finalidad de orientar las políticas para una adecuada toma de decisiones en salud pública. En consecuencia, exponer los pro y contra de las políticas implementadas sobre el manejo actual del proceso, ocasionando que los sistemas de información en salud no logren su fortalecimiento, y retrasen el objetivo de interoperabilidad para el Sector Salud peruano., [EN] Peru is currently in the development and implementation of the electronic medical record (EHR) and the exchange of clinical data of citizens in the Health Sector, a process to which the proposed changes and improvements are progressing, including the need for modernization of the states and the transformation of health information systems, allowing the gradual incorporation of Information and Communication Technologies (TIC). Nowadays, health information systems perfoman a key role because they allow the access to qualified and complete health Information. But the most important thing is that it should be available and in a timely manner for operational and strategic decision making that guarantees saving lives, improve the health and quality life of the population. The present work shows a review and analysis of the evolution of the Clinical History (HC), the aspects related to Law N° 30024: Law that Creates the National Registry of Electronic Medical Records (EHR) and everything that precedes the process of change in the health provider institutes (IPRESS) within Peru. Also as presenting the main components of the conceptual framework that seeks to strengthen health information systems, and describe the main actions and strategies of the Ministry of Health (MINSA) in Peru, with the proposal to guide policies for an adequate take Public health decision making. Consequently, this study focuses on the pros and cons of the policies implemented on the current management of the process, causing the health information systems not to be strengthened, and delay the interoperability objective for the Peruvian Health sector.

Problem: Despite acknowledged benefits, the impact of advance care planning on usual care is inconsistent. Design: Quality improvement study. Setting: A Western Australian regional hospital. Key measures for improvement: This project aimed to create a system for storing, accessing and incorporating advance care planning documents in clinical care. Strategies for change: Interventions over 18 months addressed four areas: medical records processes for receiving and processing advance care planning documents; information technology solutions for electronic storage and alerts; clerical staff duties in regards advance care planning documents; and clinician education. Effects of change: There was a 12-fold increase in advance care planning documents stored electronically and 100% of audited notes had correct filing of advance care planning documents with an alert in place at follow-up audit. Clinician recognition of the presence of an advance care planning document improved. Detailed examples of interventions are described. Lessons learnt: Repeated exposure to different forms of advance care planning education, in conjunction with simple but effective system changes can make a difference in changing established hospital practice. Final impact of these changes on end-of-life care requires further audit. © 2019 National Rural Health Alliance Ltd.

The Vision for eHealth infers that Sweden should be best in the world to utilize the opportunities of the digitization by 2025. One of three particularly important areas of action to realize the vision is standardization of e.g. exchange of information. HL7 FHIR is a modern standard for interoperability within e-health. HL7 FHIR enables the exchange of information between different healthcare information systems in an easy way. The basic building blocks in HL7 FHIR are called resources. These represent healthcare entities of some kind, e.g. Patient, Medication, Care plan, and Device. A base set of resources should either together, or by themselves, be able to satisfy the most common use cases in healthcare. A set of rules about a resource's content is called a profile, which is used for defining extensions and constraints on a resource. Profiles can be used to customize the standard to everything from a small local use-case to characteristics common for a whole country, so-called national profiles. This master thesis project sought to investigate the opportunities and restrictions with HL7 FHIR profiling by mapping the outlook of e-health stakeholders in Sweden. The project conducted a mixed method approach. Surveys were sent out to regions, county councils and private caregivers and interviews were held with national stakeholders, industry suppliers, HL7 Sweden and subject experts. The qualitative data was processed through a thematic analysis and the quantitative data was processed through a descriptive analysis. The results showed that there were positive views on governing and maintaining HL7 FHIR and FHIR profiling on a national level and to the establishment of national FHIR profiles. However, questions remain on how it shold be done. Among caregivers there were in general positive attitudes towards HL7 FHIR as a standard for interoperability and towards a possible implementation. However, the implementation level was low and specific knowledge of HL7 FHIR pro, Vision e-Hälsa 2025 innebär att Sverige ska vara bäst i världen på att utnyttja möjligheterna med digitaliseringen år 2025. Ett av tre särskilt viktiga handlingsområden för att förverkliga visionen är standardisering, t.ex. av utbyte av information. HL7 FHIR är en modern standard för interoperabilitet inom e-hälsa och möjliggör utbyte av information mellan olika hälsoinformationssystem på ett enkelt sätt. De grundläggande byggstenarna i HL7 FHIR kallas resurser. Dessa representerar hälso- och sjukvårdsentiteter av något slag, t.ex. Patient, Medicin, Vårdplan och Apparat. En basuppsättning av resurser ska antingen tillsammans eller i sig själva kunna tillgodose de vanligaste användningsfallen inom hälso- och sjukvård. En uppsättning regler om en resurs innehåll kallas för profil och används för att definiera tillägg och begränsningar på en resurs. Profiler kan användas för att anpassa standarden till allt från ett litet lokalt användningsfall till egenskaper som är gemensamma för ett helt land, så kallade nationella profiler. Detta masterexamensarbete ämnade undersöka möjligheter och begränsningar med HL7 FHIR-profilering genom att kartlägga utsikterna för ehälso-aktörer i Sverige. I projektet genomfördes en mixad metodinriktning, i vilken enkäter skickades ut till regioner, landsting och privata vårdgivare och intervjuer hölls med nationella intressenter, leverantörer, HL7 Sverige och ämnesexperter. Kvalitativ data genomgick en tematisk analys och kvantitativ data genomgick en deskriptiv analys. Resultatet visade på en generellt positiv attityd gentemot ett framtagande och förvaltande av HL7 FHIR och FHIR-profiler på nationell nivå och införande av nationella FHIR-profiler. Däremot kvarstår frågor om hur det ska realiseras. Bland vårdgivare var det generellt positiva attityder gentemot HL7 FHIR som en standard för interoperabilitet och en eventuell implementation. Däremot var den generella implementationsnivån låg och ytterligare kunskap om HL7 FHIR-profiler behövs.