Interorganizational health information exchange-related patient safety incidents: A descriptive register-based qualitative study

Conditions for and potential solutions associated with continuity of care for patients with complex care needs across Swedish regions with differing population densities

BACKGROUND

This study, conducted across three distinct geographical regions in Sweden, highlights the diverse conditions and challenges in healthcare provision. The study focuses on the sparsely populated northern regions of Sweden, the capital city of Stockholm, and the southeast rural area of Sweden. Each location presents unique obstacles to continuity of care, influenced by factors such as population density and geographical disparities. By examining the experiences of patients with complex care needs, their family carers, and healthcare personnel, this study aims to describe the conditions for and identify potential solutions associated with the delivery of continuity in care in different geographical regions of Sweden, with differing population densities.

METHOD

Secondary analysis was conducted using qualitative content analysis on interview data from two studies, consisting of 53 transcripts from individual, pair, and focus group interviews held between August 2018 and November 2019. The potential solutions identified from participants' experiences were categorized into region-specific and common themes. Three personas-Vera, Bo, and Inga-were developed, each representing a scenario based on the region-specific analyses.

RESULTS

Despite regional differences, universal solutions to common challenges were identified focusing on relational, management, and informational aspects. Common key obstacles to continuity of care included resource shortages, insufficient information transfer, and privacy regulations. Possible solutions for overcoming these challenges include prioritizing relational continuity, streamlining processes, and advocating for a unified communication system. By collaborating, building trust, understanding patient preferences, and ensuring clear communication, healthcare personnel can effectively promote continuity of care.

CONCLUSIONS

Building a stable workforce while prioritizing relational continuity, along with patients' preferences and needs, is essential for ensuring continuity of care from multiple providers. Digital solutions can enhance collaboration across distances, while coordinating responsibilities within smaller geographical areas can strengthen partnerships among healthcare organizations. Direct dialogue, along with ensuring that everyone has access to relevant information through a unified communication system, is vital for management continuity. By integrating these universal and transferable solutions to the obstacles associated with continuity of care, we can create a cohesive care experience for patients, regardless of geographical and demographic conditions.

Technologies for Interoperable Internet of Medical Things Platforms to Manage Medical Emergencies in Home and Prehospital Care: Scoping Review

BACKGROUND

The aging global population and the rising prevalence of chronic disease and multimorbidity have strained health care systems, driving the need for expanded health care resources. Transitioning to home-based care (HBC) may offer a sustainable solution, supported by technological innovations such as Internet of Medical Things (IoMT) platforms. However, the full potential of IoMT platforms to streamline health care delivery is often limited by interoperability challenges that hinder communication and pose risks to patient safety. Gaining more knowledge about addressing higher levels of interoperability issues is essential to unlock the full potential of IoMT platforms.

OBJECTIVE

This scoping review aims to summarize best practices and technologies to overcome interoperability issues in IoMT platform development for prehospital care and HBC.

METHODS

This review adheres to a protocol published in 2022. Our literature search followed a dual search strategy and was conducted up to August 2023 across 6 electronic databases: IEEE Xplore, PubMed, Scopus, ACM Digital Library, Sage Journals, and ScienceDirect. After the title, abstract, and full-text screening performed by 2 reviewers, 158 articles were selected for inclusion. To answer our 2 research questions, we used 2 models defined in the protocol: a 6-level interoperability model and a 5-level IoMT reference model. Data extraction and synthesis were conducted through thematic analysis using Dedoose. The findings, including commonly used technologies and standards, are presented through narrative descriptions and graphical representations.

RESULTS

The primary technologies and standards reported for interoperable IoMT platforms in prehospital care and HBC included cloud computing (19/30, 63%), representational state transfer application programming interfaces (REST APIs; 17/30, 57%), Wi-Fi (17/30, 57%), gateways (15/30, 50%), and JSON (14/30, 47%). Message queuing telemetry transport (MQTT; 7/30, 23%) and WebSocket (7/30, 23%) were commonly used for real-time emergency alerts, while fog and edge computing were often combined with cloud computing for enhanced processing power and reduced latencies. By contrast, technologies associated with higher interoperability levels, such as blockchain (2/30, 7%), Kubernetes (3/30, 10%), and openEHR (2/30, 7%), were less frequently reported, indicating a focus on lower level of interoperability in most of the included studies (17/30, 57%).

CONCLUSIONS

IoMT platforms that support higher levels of interoperability have the potential to deliver personalized patient care, enhance overall patient experience, enable early disease detection, and minimize time delays. However, our findings highlight a prevailing emphasis on lower levels of interoperability within the IoMT research community. While blockchain, microservices, Docker, and openEHR are described as suitable solutions in the literature, these technologies seem to be seldom used in IoMT platforms for prehospital care and HBC. Recognizing the evident benefit of cross-domain interoperability, we advocate a stronger focus on collaborative initiatives and technologies to achieve higher levels of interoperability.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/40243.

Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study

BACKGROUND

Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements.

OBJECTIVE

This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care.

METHODS

This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis.

RESULTS

Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange.

CONCLUSIONS

The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care.

From challenges to opportunities: Digital transformation in hospital-at-home care

BACKGROUND

Digital transformation is an ongoing sosio-technological process that can create opportunities in the health sector. However, the current landscape of digital transformation in hospital-at-home care is unknown.

AIM

To describe healthcare providers' perspectives of digital transformation in hospital-at-home care.

METHODS

A total of 25 semi-structured interviews were conducted in September-October 2023 in all Finnish wellbeing services counties (n = 21), the city of Helsinki (n = 1), and private health care providers (n = 3). Snowball sampling was used (N = 46). The data underwent an inductive content analysis.

RESULT

The analysis revealed four main and 17 generic categories of challenges and opportunities of digital transformation in hospital-at-home care. These challenges and opportunities were related to 1) Health information exchange in and across hospital-at-home care; 2) Management of hospital-at-home care; 3) Logistics in hospital-at-home care planning and delivery; and 4) Digital health interventions in hospital-at-home care delivery.

CONCLUSIONS

The challenges and opportunities of digital transformation in the hospital-at-home care is intricately linked to the efficiency of health information exchange, management, logistics, and digital health interventions. Addressing the key areas of improvement in health information exchange can lead to more streamlined patient care processes and improved communication between healthcare professionals and patients. Digital transformation in management and logistics can improve overall efficiency within healthcare systems. Digital health interventions may promote equitable and universal access to high-quality healthcare. Continued focus on health care information infrastructure, in particular interoperability of electronic health records and optimization of information flow, will be essential to realize the full potential of digitalization.

Challenges and needs in cerebrovascular disease pathway: A qualitative descriptive study from the patients' and healthcare professionals' perspectives

AIM(S)

To understand patients' and healthcare professionals' experiences to improve care in and across different domains of the cerebrovascular disease pathway.

DESIGN

A qualitative descriptive study.

METHODS

Semi-structured in-person interviews were conducted among 22 patients diagnosed with acute cerebrovascular disease and 26 healthcare professionals taking care of them in a single tertiary-level hospital from August 2021 to March 2022. Data were analysed using deductive and inductive content analysis. The consolidated criteria for reporting qualitative research was used to ensure reliable reporting.

RESULTS

Overall, 19 generic and 79 sub-categories describing perceived challenges with 17 generic and 62 sub-categories describing perceived needs were identified related to primary prevention, organization of stroke services, management of acute stroke, secondary prevention, rehabilitation, evaluation of stroke outcome and quality assessment, and life after stroke.

CONCLUSION

Several challenges and needs were identified in and across the different domains of the cerebrovascular disease pathway. There is a requirement for adequate resources, early initiation of treatment, early diagnostics and recanalization, dedicated rehabilitation services, long-term counselling and support, and impact evaluation of services to improve cerebrovascular disease care. Future research on caregivers', and clinical leadership experiences in and across the cerebrovascular disease pathway is needed to explore the provision of services.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The results of this study can be applied by organizations, managers and research for developing and improving services in the cerebrovascular disease pathway.

IMPACT

This study identified several patient-related, organizational and logistical needs and challenges, with suggestions for required actions, that can benefit the provision of effective, high-quality cerebrovascular disease care.

REPORTING METHOD

We have adhered to relevant EQUATOR guidelines with the COREQ reporting method.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public involvement.

An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective

Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.