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Xu J. The Current Status and Promotional Strategies for Cloud Migration of Hospital Information Systems in China: Strengths, Weaknesses, Opportunities, and Threats Analysis. JMIR Med Inform 2024; 12:e52080. [PMID: 38315519 PMCID: PMC10877487 DOI: 10.2196/52080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND In the 21st century, Chinese hospitals have witnessed innovative medical business models, such as online diagnosis and treatment, cross-regional multidepartment consultation, and real-time sharing of medical test results, that surpass traditional hospital information systems (HISs). The introduction of cloud computing provides an excellent opportunity for hospitals to address these challenges. However, there is currently no comprehensive research assessing the cloud migration of HISs in China. This lack may hinder the widespread adoption and secure implementation of cloud computing in hospitals. OBJECTIVE The objective of this study is to comprehensively assess external and internal factors influencing the cloud migration of HISs in China and propose promotional strategies. METHODS Academic articles from January 1, 2007, to February 21, 2023, on the topic were searched in PubMed and HuiyiMd databases, and relevant documents such as national policy documents, white papers, and survey reports were collected from authoritative sources for analysis. A systematic assessment of factors influencing cloud migration of HISs in China was conducted by combining a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis and literature review methods. Then, various promotional strategies based on different combinations of external and internal factors were proposed. RESULTS After conducting a thorough search and review, this study included 94 academic articles and 37 relevant documents. The analysis of these documents reveals the increasing application of and research on cloud computing in Chinese hospitals, and that it has expanded to 22 disciplinary domains. However, more than half (n=49, 52%) of the documents primarily focused on task-specific cloud-based systems in hospitals, while only 22% (n=21 articles) discussed integrated cloud platforms shared across the entire hospital, medical alliance, or region. The SWOT analysis showed that cloud computing adoption in Chinese hospitals benefits from policy support, capital investment, and social demand for new technology. However, it also faces threats like loss of digital sovereignty, supplier competition, cyber risks, and insufficient supervision. Factors driving cloud migration for HISs include medical big data analytics and use, interdisciplinary collaboration, health-centered medical service provision, and successful cases. Barriers include system complexity, security threats, lack of strategic planning and resource allocation, relevant personnel shortages, and inadequate investment. This study proposes 4 promotional strategies: encouraging more hospitals to migrate, enhancing hospitals' capabilities for migration, establishing a provincial-level unified medical hybrid multi-cloud platform, strengthening legal frameworks, and providing robust technical support. CONCLUSIONS Cloud computing is an innovative technology that has gained significant attention from both the Chinese government and the global community. In order to effectively support the rapid growth of a novel, health-centered medical industry, it is imperative for Chinese health authorities and hospitals to seize this opportunity by implementing comprehensive strategies aimed at encouraging hospitals to migrate their HISs to the cloud.
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Affiliation(s)
- Jian Xu
- Department of Health Policy, Beijing Municipal Health Big Data and Policy Research Center, Beijing, China
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Cai D, Wang X, Yu H, Bai C, Mao Y, Liang M, Xia X, Liu S, Wang M, Lu X, Du J, Shen X, Guan W. Infiltrating characteristics and prognostic value of tertiary lymphoid structures in resected gastric neuroendocrine neoplasm patients. Clin Transl Immunology 2024; 13:e1489. [PMID: 38322490 PMCID: PMC10844765 DOI: 10.1002/cti2.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 12/13/2023] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
Objectives Tertiary lymphoid structures (TLSs) are lymphocyte aggregates that play an anti-tumor role in most solid tumors. However, the functions of TLS in gastric neuroendocrine neoplasms (GNENs) remain unknown. This study aimed to determine the characteristics and prognostic values of TLS in resected GNEN patients. Methods Haematoxylin-eosin, immunohistochemistry (IHC) and multiple fluorescent IHC staining were used to assess TLS to investigate the correlation between TLSs and clinicopathological characteristics and its prognostic value. Results Tertiary lymphoid structures were identified in 84.3% of patients with GNEN. They were located in the stromal area or outside the tumor tissue and mainly composed of B and T cells. A high density of TLSs promoted an anti-tumor immune response in GNEN. CD15+ TANs and FOXP3+ Tregs in TLSs inhibited the formation of TLSs. High TLS density was significantly associated with prolonged recurrence-free survival (RFS) and overall survival (OS) of GNENs. Univariate and multivariate Cox regression analyses revealed that TLS density, tumor size, tumor-node-metastasis (TNM) stage and World Health Organisation (WHO) classification were independent prognostic factors for OS, whereas TLS density, tumor size and TNM stage were independent prognostic factors for RFS. Finally, OS and RFS nomograms were developed and validated, which were superior to the WHO classification and the TNM stage. Conclusion Tertiary lymphoid structures were mainly located in the stromal area or outside the tumor area, and high TLS density was significantly associated with the good prognosis of patients with GNEN. Incorporating TLS density into a nomogram may improve survival prediction in patients with resected GNEN.
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Affiliation(s)
- Daming Cai
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xingzhou Wang
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Heng Yu
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Chunhua Bai
- Dermatology and Interventional Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Yonghuan Mao
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Mengjie Liang
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xuefeng Xia
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Song Liu
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Meng Wang
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Xiaofeng Lu
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
| | - Junfeng Du
- Department of General Surgery, The 7th Medical CenterChinese PLA General HospitalBeijingChina
| | - Xiaofei Shen
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
- Department of General SurgeryDrum Tower Clinical Medical College of Nanjing Medical UniversityNanjingChina
| | - Wenxian Guan
- Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical SchoolNanjing UniversityNanjingChina
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He X, Cui F, Lyu M, Sun D, Zhang X, Shi J, Zhang Y, Jiang S, Zhao J. Key Factors Influencing the Operationalization and Effectiveness of Telemedicine Services in Henan Province, China: Cross-Sectional Analysis. J Med Internet Res 2024; 26:e45020. [PMID: 38180795 PMCID: PMC10799288 DOI: 10.2196/45020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/26/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Telemedicine has demonstrated its potential in alleviating the unbalanced distribution of medical resources across different regions. Henan, a province in China with a population of approximately 100 million, is especially affected by a health care divide. The province has taken a proactive step by establishing a regional collaborative platform for telemedicine services provided by top-tier provincial hospitals. OBJECTIVE We aim to identify the key factors that influence the current operationalization and effectiveness of telemedicine services in Henan province. The insights gained from this study will serve as valuable references for enhancing the efficient operation of telemedicine platforms in low- and middle-income regions. METHODS We analyzed service reports from the performance management system of telemedicine services in Henan province throughout 2020. Using descriptive statistics and graphical methods, we examined key influencing factors, such as management competency; device configuration; and hospital capability, capacity, and service efficacy, across hospitals at 2 different tiers. In addition, we used generalized linear models and multiple linear regression models to identify key operational factors that significantly affect the service volume and efficacy of 2 major telemedicine services, namely teleconsultation and tele-education. RESULTS Among the 89 tier 3 hospitals and 97 tier 2 hospitals connected to the collaborative telemedicine platform, 65 (73%) and 55 (57%), respectively, have established standardized management procedures for telemedicine services. As the primary delivery method for telemedicine services, 90% (80/89) of the tier 3 hospitals and 94% (91/97) of the tier 2 hospitals host videoconferencing consultations through professional hardware terminals rather than generic computers. Teleconsultation is the dominant service type, with an average annual service volume per institution of 173 (IQR 37-372) and 60 (IQR 14-271) teleconsultations for tier 3 and tier 2 hospitals, respectively. Key factors influencing the service volume at each hospital include available funding, management competency, the number of connected upper tiers, and the number of professional staff. After receiving teleconsultations from tier 3 (65/89, 73%) and tier 2 (61/97, 63%) hospitals, patients reported significant improvements in their medical conditions. In addition, we observed that service efficacy is positively influenced by management competency, financial incentives, the number of connected upper or lower tiers, and the involvement of participating medical professionals. CONCLUSIONS Telemedicine has become increasingly popular in Henan province, with a notable focus on teleconsultation and tele-education services. Despite its popularity, many medical institutions, especially tier 2 hospitals, face challenges related to management competency. In addition to enhancing the effectiveness of existing telemedicine services, health care decision-makers in Henan province and other low- and middle-income regions should consider expanding the service categories, such as including remote emergency care and telesurgery, which have promise in addressing crucial health care needs in these regions.
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Affiliation(s)
- Xianying He
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Cui
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Minzhao Lyu
- School of Electrical Engineering and Telecommunications, University of New South Wales, Sydney, Australia
| | - Dongxu Sun
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xu Zhang
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jinming Shi
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yinglan Zhang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shuai Jiang
- Finance Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jie Zhao
- National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Cabello MKE, De Guzman JE. Utilization of accessible resources in the fabrication of an affordable, portable, high-resolution, 3D printed, digital microscope for Philippine diagnostic applications. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002070. [PMID: 37988332 PMCID: PMC10662710 DOI: 10.1371/journal.pgph.0002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/22/2023] [Indexed: 11/23/2023]
Abstract
Philippine clinical laboratory licensing requirements mandate that diagnostic microscopy for Tuberculosis (TB) sputum microscopy, urinalysis, pap smears, wet smears, an option for complete blood count, stool exams, and malaria thick and thin smears should be accessible and available in health facilities including primary care centers. However, access to these essential diagnostics is hampered by the lack of trained personnel, relatively high costs for supplies and equipment especially in rural and underserved areas. This served as motivation for our team to utilize accessible resources in the form of affordable 3D printers, available CAD software, and components to build our low-cost Openflexure microscope (OFM) prototype. We successfully fabricated our prototype for a total of 310$ with a weight of 525g. We used pathology teaching slides from the Ateneo School of Medicine and Public Health and examined the OFM prototype imaging capabilities. The calculated image resolution was 13% higher compared to an LED light microscope sample captured by a mobile phone at 40x and 15% for 100x. The sampled slide images had adequate clarity with some identifiable cellular features for Rheumatic Heart Disease (RHD), Tuberculosis in soft tissue, and Ascariasis. We were able to correct the color aberrations of the OFM we built and was able to scan images up to 1000x magnification without using oil. Given the features and cost, the OFM prototype can be an attractive and affordable option as an alternative or augmentation to diagnostic microscopy in Philippine primary care. Moreover, it may enable telepathology to support diagnostic microscopy in frontline care.
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Affiliation(s)
- Mark Kristan Espejo Cabello
- Research Faculty, Ateneo de Manila University School of Medicine and Public Health, Center for Research and Innovation, Pasig City, National Capital Region, Philippines
| | - Jeremie E. De Guzman
- Research Faculty, Ateneo de Manila University School of Medicine and Public Health, Center for Research and Innovation, Pasig City, National Capital Region, Philippines
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Kothari K, Damoi JO, Zeizafoun N, Asiimwe P, Glerum K, Bakaleke M, Giibwa A, Umphlett M, Marin M, Zhang LP. Increasing access to pathology services in low- and middle-income countries through innovative use of telepathology. Surg Endosc 2023; 37:7206-7211. [PMID: 37365395 DOI: 10.1007/s00464-023-10220-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), surgical care can be limited by access to pathology services. In Uganda, the pathologist-to-population ratio is less than 1 to 1 million people. The Kyabirwa Surgical Center in Jinja, Uganda, created a telepathology service in collaboration with an academic institution in New York City. This study demonstrated the feasibility and considerations of implementing a telepathology model to supplement the critical pathology needs of a low-income country. METHODS This was a retrospective, single-center study of an ambulatory surgery center with pathology capability using virtual microscopy. The remote pathologist (also known as a telepathologist) controlled the microscope and reviewed histology images transmitted across the network in real time. In addition, this study collected demographics, clinical histories, the surgeon's preliminary diagnoses, and the pathology reports from the center's electronic medical record. RESULTS Nikon's NIS Element Software was used as a dynamic, robotic microscopy model with a video conferencing platform for communication. An underground fiber optic cable established Internet connectivity. After a two-hour tutorial session, the lab technician and pathologist were able to proficiently use the software. The remote pathologist read (1) pathology slides with inconclusive reports from external pathology labs, and (2) tissues labeled by the surgeon as suspicious for malignancy, which belonged to patients who lacked financial means for pathology services. Between April 2021 and July 2022, tissue samples of 110 patients were examined by a telepathologist. The most common malignancies on histology were squamous cell carcinoma of the esophagus, ductal carcinoma of the breast, and colorectal adenocarcinoma. CONCLUSION With the increasing availability of video conference platforms and network connections, telepathology is an emerging field that can be used by surgeons in LMICs to improve access to pathology services, confirming histological diagnosis of malignancies to ensure appropriate treatment.
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Affiliation(s)
- Krsna Kothari
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA.
| | | | - Nebras Zeizafoun
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | | | - Katie Glerum
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | | | | | - Melissa Umphlett
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Michael Marin
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
| | - Linda P Zhang
- Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, USA
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Peshkova M, Yumasheva V, Rudenko E, Kretova N, Timashev P, Demura T. Digital twin concept: Healthcare, education, research. J Pathol Inform 2023; 14:100313. [PMID: 37168801 PMCID: PMC10165159 DOI: 10.1016/j.jpi.2023.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/13/2023] Open
Abstract
Introducing the concept of digital twins in healthcare, medical education, and research is a complex multistage challenge requiring participation of multidisciplinary teams. In pursuing this goal, we have created a validated database of scans of colorectal tumor slides associated with relevant clinical and histological information. This database is also linked to the blood bank, which opens a wide range of opportunities for further research. Herein, we present our experience within the scope of the digital twins initiative.
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Affiliation(s)
- Maria Peshkova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, 119991 Moscow, Russia
- Institute for Regenerative Medicine, Sechenov University, 119991 Moscow, Russia
- Corresponding author.
| | | | - Ekaterina Rudenko
- Institute for Clinical Morphology and Digital Pathology, Sechenov University, 119991 Moscow, Russia
| | - Natalia Kretova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, 119991 Moscow, Russia
- Institute for Clinical Morphology and Digital Pathology, Sechenov University, 119991 Moscow, Russia
| | - Peter Timashev
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov University, 119991 Moscow, Russia
- Institute for Regenerative Medicine, Sechenov University, 119991 Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, 119991 Moscow, Russia
| | - Tatiana Demura
- Institute for Clinical Morphology and Digital Pathology, Sechenov University, 119991 Moscow, Russia
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Kantasiripitak C, Laohawetwanit T, Apornvirat S, Niemnapa K. Validation of whole slide imaging for frozen section diagnosis of lymph node metastasis: A retrospective study from a tertiary care hospital in Thailand. Ann Diagn Pathol 2022; 60:151987. [PMID: 35700561 DOI: 10.1016/j.anndiagpath.2022.151987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The use of whole slide imaging (WSI) for frozen section (FS) diagnosis is helpful, particularly in the context of pathologist shortages. However, there is minimal data on such usage in resource-limited settings. This study aims to validate the use of WSI for FS diagnosis of lymph node metastasis using a low-cost virtual microscope scanner with consumer-grade laptops at a tertiary care hospital in Thailand. METHODS FS slides were retrieved for which the clinical query was to evaluate lymph node metastasis. They were digitized by a virtual microscope scanner (MoticEasyScan, Hong Kong) using up to 40× optical magnification. Three observers with different pathology experience levels diagnosed each slide, reviewing glass slides (GS) followed by digital slides (DS) after two weeks of a wash out period. WSI and GS diagnoses were compared. The time used for scanning and diagnosis of each slide was recorded. RESULTS 295 FS slides were retrieved and digitized. The first-time successful scanning rate was 93.6 %. The mean scanning time was 2 min per slide. Both intraobserver agreement and interobserver agreement of WSI and GS diagnoses were high (Cohen's K; kappa value >0.84). The time used for DS diagnosis decreased as the observer's experience with WSI increased. CONCLUSIONS Despite varying pathological experiences, observers using WSI provided accurate FS diagnoses of lymph node metastasis. The time required for DS diagnoses decreased with additional observer's experience with WSI. Therefore, a WSI system containing low-cost scanners and consumer-grade laptops could be used for FS services in hospital laboratories lacking pathologists.
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Affiliation(s)
| | - Thiyaphat Laohawetwanit
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Sompon Apornvirat
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Kongkot Niemnapa
- Advanced Digital Simulation Center, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
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