Real world performance of the 21st Century Cures Act population-level application programming interface

OBJECTIVE

To evaluate the real-world performance of the SMART/HL7 Bulk Fast Health Interoperability Resources (FHIR) Access Application Programming Interface (API), developed to enable push button access to electronic health record data on large populations, and required under the 21st Century Cures Act Rule.

MATERIALS AND METHODS

We used an open-source Bulk FHIR Testing Suite at 5 healthcare sites from April to September 2023, including 4 hospitals using electronic health records (EHRs) certified for interoperability, and 1 Health Information Exchange (HIE) using a custom, standards-compliant API build. We measured export speeds, data sizes, and completeness across 6 types of FHIR.

RESULTS

Among the certified platforms, Oracle Cerner led in speed, managing 5-16 million resources at over 8000 resources/min. Three Epic sites exported a FHIR data subset, achieving 1-12 million resources at 1555-2500 resources/min. Notably, the HIE's custom API outperformed, generating over 141 million resources at 12 000 resources/min.

DISCUSSION

The HIE's custom API showcased superior performance, endorsing the effectiveness of SMART/HL7 Bulk FHIR in enabling large-scale data exchange while underlining the need for optimization in existing EHR platforms. Agility and scalability are essential for diverse health, research, and public health use cases.

CONCLUSION

To fully realize the interoperability goals of the 21st Century Cures Act, addressing the performance limitations of Bulk FHIR API is critical. It would be beneficial to include performance metrics in both certification and reporting processes.

Trends in caesarean section rates in Europe from 2015 to 2019 using Robson's Ten Group Classification System: A Euro-Peristat study

OBJECTIVE

To assess changes in caesarean section (CS) rates in Europe from 2015 to 2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends.

DESIGN

Observational study utilising routine birth registry data.

SETTING

A total of 28 European countries.

POPULATION

Births at ≥22 weeks of gestation in 2015 and 2019.

METHODS

Using a federated model, individual-level data from routine sources in each country were formatted to a common data model and transformed into anonymised, aggregated data.

MAIN OUTCOME MEASURES

By country: overall CS rate. For TGCS groups (by country): CS rate, relative size, relative and absolute contribution to overall CS rate.

RESULTS

Among the 28 European countries, both the CS rates (2015, 16.0%-55.9%; 2019, 16.0%-52.2%) and the trends varied (from -3.7% to +4.7%, with decreased rates in nine countries, maintained rates in seven countries (≤ ± 0.2) and with increasing rates in 12 countries). Using the TGCS (for 17 countries), in most countries labour induction increased (groups 2a and 4a), whereas multiple pregnancies (group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease across all TGCS groups, whereas in countries with increasing rates, CS tended to increase in most groups. In countries with the greatest increase in CS rates (>1%), the absolute contributions of groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a (induction of labour), 2b and 4b (prelabour CS) and 10 (preterm cephalic singletons) to the overall CS rate tended to increase.

CONCLUSIONS

The TGCS shows varying CS trends and rates among countries of Europe. Comparisons between European countries, particularly those with differing trends, could provide insight into strategies to reduce CS without clinical indication.

Identifying and validating the components for the development of an information system for health grey literature in Iran: A mixed method approach

BACKGROUND

Considering the importance and necessity of establishing a nationwide information system for health grey literature in Iran, this study aimed to identify the main dimensions and components needed for developing a health grey literature information system in Iran and validate them according to experts' opinions.

MATERIALS AND METHODS

A mixed-method approach with an exploratory sequential design was used in this study. The research was done in following main steps: (1) conducting a systematic literature review to identify the potential components of the health grey literature information system suggested in the literature, (2) Interviewing 19 experts to explore further components required for designing the health grey literature system for Iran and doing a thematic analysis for analyzing the interviews, and (3) validating the identified components by a Delphi panel in two rounds for finalizing the initially-approved dimensions and components. Descriptive statistical analysis was also used for analyzing the Delphi panel's data.

RESULTS

Eight dimensions were identified as necessary for developing Iran's health grey literature information system (including 31 components and 111 elements). The main dimensions included goals, data sources, minimum data set, data collection techniques, data content management procedures, quality control approaches, stakeholders, and management and policy-making.

CONCLUSION

Using the identified and validated functional components in this study can be helpful In designing a health grey literature system that is of value for health policymakers and medical researchers as well as health information users.

Trend of incompleteness of the Robson Classification variables in the Live Birth Information (SINASC) in the state of Paraná, Brazil, 2014-2020

OBJECTIVE

To assess the incompleteness of the Robson Classification variables in the Live Birth Information System (Sistema de Informação sobre Nascidos Vivos - SINASC), in the state of Paraná, and its trend, 2014-2020.

METHODS

This was a time-series study that analyzed six variables, according to health macro-regions. Incompleteness was classified (percentage of "ignored" and "blank fields") as follows: excellent (< 1.0%); good (1.0-2.9%); regular (3.0-6.9%); poor (≥ 7.0%). Prais-Winsten regression was used to estimate trends.

RESULTS

A total of 1,089,116 births were evaluated. The variable "cesarean section before the onset of labor" was classified as poor in 2014 (39.4%) and 2015 (44.3%) in the state and in all macro-regions, but with a decreasing trend in incompleteness. The variables "gestational age" in the North and Northwest macro-regions, and "parity" and "number of fetuses" in the Northwest macro-region showed an increasing trend.

CONCLUSION

Most of the variables evaluated showed low percentages of incompleteness with a decreasing trend, but there is a need to improve the completion of some variables.

Patients' Use of Telemedicine Mobile Application During COVID-19 Restrictions

Telemedicine is being used in an increasing number of countries as an alternative to face-to-face traditional healthcare, to reduce the chances of spreading COVID-19. Although the use and benefits of telemedicine have been increasingly demonstrated for a long time, we do not know much about its adoption and use during the COVID-19 pandemic, when the community is confined by the social distancing restrictions. The main aim of this research is to study the factors affecting the adoption and use of telemedicine in patients during the period of COVID-19 restrictions. We also want to investigate the benefits of telemedicine for patients. We used a qualitative approach in this study. We interviewed six patients who used telemedicine during the COVID-19 restrictions. We find that telemedicine applications offered an overall positive experience for patients as a viable alternative way of medical care when physical attendance was restricted.

Characterization of cases and epidemiological and operational indicators of leprosy: analysis of time series and spatial distribution, Piauí state, Brazil, 2007-2021

OBJECTIVE

To analyze epidemiological characteristics, temporal trends and spatial distribution of leprosy cases and indicators in the state of Piauí, 2007-2021.

METHODS

This was an ecological time-series study using data from the Notifiable Health Conditions Information System, describing the spatial distribution and the temporal trend of leprosy using Prais-Winsten regression.

RESULTS

A total of 17,075 new cases of leprosy were reported. There was a falling trend in the overall detection rate [annual percentage change (APC) = -6.3; 95%CI -8.1;-4.5)], detection in children under 15 years of age (APC = -8,6; 95%CI -12,7;-4,3) and detection of cases with grade 2 physical disability (APC = -4,4; 95%CI -7,0;-1,8). There was a rising trend in the proportion of multibacillary cases. Spatial distribution of the average detection rate identified hyperendemic areas in the Carnaubais, Entre Rios, Vale dos Rios Piauí e Itaueiras regions.

CONCLUSION

High leprosy detection rates were found, despite the falling trend of indicators, except the proportion of multibacillary cases.

MAIN RESULTS

Between 2007 and 2021, Piauí showed an improving trend in all indicators analyzed, except the proportion of new multibacillary cases. Spatial distribution identified hyperendemic areas in different regions of the state.

IMPLICATIONS FOR SERVICES

This study provides health services with a broad overview of the epidemiological situation of leprosy in Piauí, with evidence of the populations and locations most affected by the disease, whereby public authorities need to reinforce the promotion of health actions.

PERSPECTIVES

It is expected that actions to prevent and control the disease will be adopted, such as offering early diagnosis, ensuring correct treatment and implementing measures to prevent physical disabilities.

[Evaluation of the impact of the implementation of the new primary health care information system on records of patient care and home visits in Brazil]

The replacement of the Primary Care Information System (SIAB, 1998-2015), as of January 2016, by the new Health Information System for Primary Care (SISAB) determined new forms of collecting, processing, and using information, with a possible impact on the records of activities carried out in primary health care in Brazil. This study aimed to evaluate the implementation impact of the new information system on records of physicians' and nurses' patient care and home visits of community health workers (CHW) in Brazil from 2007 to 2019. To this end, a Bayesian structural time-series model approach was used, based on a diffuse state-space regression. From 2016 to 2019, 463.47 million physician care, 210.61 million nursing care, and 1.28 billion CHW visits were recorded. Following the trend recorded before the implementation, 598.86 million, 430.46 million, and 1.5 billion physician and nursing appointments and CHW visits would be expected, respectively. In relative terms, there was a decrease of 25% in physician care, 51% in nursing care, and 15% in CHW visits when compared to the value expected by the Bayesian method. The negative impact on the records of patient care and home visits identified in this study, whether due to difficulties in adapting to the new system or a reduction in improper records, must be investigated so that the challenge of improving the primary care information system can be understood and overcome in a planned way.

[Evaluation of the effectiveness of the intervention to improve the Brazilian Mortality Information System in Pernambuco, Brazil: a quasi-experimental study]

This study evaluated the influence of the variation in the implementation of the Brazilian Mortality Information System (SIM) on the results, before and after the intervention to improve the system in Pernambuco, Brazil. The SIM logical model and matrix of indicators and assessment were described, primary data were collected from the 184 municipalities and secondary data were collected from the system database. The degree of implementation (DI) was obtained from the indicators of structure and process, and then related to result indicators, based on the model. The intervention was directed at the shortcomings identified, and developed using strategic stages. The percentage of annual variation of the DI and the results before and after the intervention were calculated. The SIM was classified as partially implemented in the pre- (70.6%) and post-intervention (73.1%) evaluations, with increments in all components. The Health Regions followed the same classification of the state level, except for XII (80.3%), regarding implemented score after the intervention. The coverage of the system; deaths with a defined underlying cause; monthly transfer; and timely submission of data were above 90% in both evaluations. There was an improvement in the completeness of infant Death Certificates and in the timely recording of notifiable events. Strengthening the management and operationalization of the SIM with interventions applied to data registration can improve the system's results.

Designing a comprehensive minimum dataset for patients with COVID-19 in Iranian hospital information systems

BACKGROUND

The Minimum Data Set (MDS) plays a vital role in data exchange, collection and quality improvement. In the context of the COVID-19 pandemic, there is a need for a tailored MDS that aligns with the specific information needs of the Iranian community and integrates seamlessly into the country's Hospital Information Systems (HIS).

OBJECTIVE

The study aimed to develop a comprehensive MDS for COVID-19 patients in Iran, with objectives to identify essential data elements and integrate the MDS into HIS, enhancing data exchange and supporting decision-making.

METHOD

This study employed a comparative-descriptive approach to design COVID-19 patient data elements based on World Health Organisation and Centers for Disease Control and Prevention guidelines. The Delphi technique involved 35 experts in two rounds for checklist refinement. The finalised MDS consisted of 9 main terms and 80 sub-terms, analysed using descriptive statistics and IBM SPSS software.

RESULTS

Of 35 experts involved with the study, 69% were male and 31% female, and Health Information Management experts were the majority (34%). The refined MDS for COVID-19 in Iran comprises 50 data elements, while 30 elements were excluded. The MDS includes 8 main terms and 80 sub-terms, with unanimous approval for identity, underlying disease, and treatment sections.

CONCLUSION

The customised MDS for COVID-19 patients in Iran addresses data collection challenges and supports effective disease prevention and management. By providing comprehensive and reliable information, the MDS enhances healthcare quality, facilitates timely access to medical records, and fosters integrated health services.

Challenges and successes in implementing an integrated electronic patient record (HIVE) at the Manchester University National Health Service Foundation Trust, England: 1000+ legacy systems, 10 hospitals, one electronic patient record

BACKGROUND

The Manchester University National Health Service (NHS) Foundation Trust (MFT) is one of the largest NHS Trusts in England. Historically, the Trust has had very mixed clinical record keeping, including over 1000 individual information systems. None of these health information technology systems had the full functionality of an integrated electronic patient record (EPR). MFT evolved to its current size and complexity with a vision to improve patient care in Greater Manchester by adopting a Trust-wide EPR. The EPR "Go Live" occurred in September 2022.

AIM

To describe the process of EPR integration as it reflected and impacted upon MFT's health information management (HIM) teams.

METHOD

MFT worked through a 2-year readiness program of work. This included technical readiness, software development and migration planning. Migration of data from the approximately 1000 systems was a major undertaking, during which access to the clinical history and ongoing operational reporting needed to be maintained. Pre-implementation requirements were outlined, a change management program was implemented, and the overall implementation was managed to tight timelines.

DISCUSSION

"Go Live" was achieved for the EPIC EPR product (HIVE) within MFT. Legacy systems are still in the process of being decommissioned and staff are transacting within HIVE. Significant changes in processes and reporting continue to be made, despite some challenges.

CONCLUSION

The Trust delivered the single largest EPIC European "Go live." Lessons learnt continue to be identified. The impact of what the EPR means for the HIM function is described.

A Call to Reconsider a Nationwide Electronic Health Record System: Correcting the Failures of the National Program for IT

The National Programme for IT (NPfIT) was launched in 2005 to implement 7 nationwide IT services across the National Health Service (NHS). Despite the success of many of these designated “deliverables,” the establishment of a single nationwide electronic health record (EHR) system never fully materialized. As a result, NHS medical records are now stored using a diverse array of alternate EHR systems, which frequently restricts health care practitioners from accessing extensive portions of their patients’ notes. This not only limits their ability to make well-informed clinical decisions but also impacts the quality of care they are able to provide. This article assesses the medical, economic, and bureaucratic implications of an NHS-wide EHR system. Additionally, it explores how the shortcomings of the NPfIT should be addressed when attempting to introduce such a system in the future.

Anthropometric indicators in traditional peoples and communities in Brazil: analysis of individual records from the Food and Nutrition Surveillance System, 2019

OBJECTIVE

To describe the prevalence of underweight and obesity indicators among individuals registered as traditional peoples and communities in the Food and Nutrition Surveillance System, across Brazil, in 2019.

METHODS

This was a descriptive study using individual secondary data from participants receiving care in the Primary Health Care within the Brazilian National Health System.

RESULTS

In the study population (N = 13,944), there was a higher prevalence of short stature among male children and adolescents (14.2%), when compared to their female counterparts (11.8%); in the adult female population, there was a higher prevalence of obesity (23.0%), when compared to the male population (11.3%); the prevalence of low height-for-age in riverine communities (18.5%) and obesity in the adult faxinalense population (75.1%) stood out.

CONCLUSION

Anthropometric disparities between different communities require tailored responses, emphasizing targeted primary health care and programs to ensure food and nutrition security.

MAIN RESULTS

It was possible to identify a higher prevalence of low weight and height-for-age in the child population of riverine communities, while faxinalense communities showed a higher prevalence of obesity in adults.

IMPLICATIONS FOR SERVICES

Continuous improvement in the implementation of SISVAN protocols is recommended, as well as strengthening the assistance provided to communities with the worst indicators.

PERSPECTIVES

Studies assessing the potential impact of interventions to mitigate the effects of malnutrition in communities, through in-depth qualitative research or probabilistic quantitative studies using primary data.

Requirements specification, design, and evaluation of dental image exchange and management system with user-centered approach: A case study in Iran

Background and Aims

Systems existing in hospital or clinic settings offer services within the physical environment. Examples of such systems include picture archiving and communication systems, which provide remote services for patients. To develop a successful system, methods like software development life cycles (SDLCs) and design techniques, such as prototyping, are needed. This study aimed to specify requirements, design, and evaluation of dental image exchange and management system using a user-centered approach.

Methods

This cross-sectional study was conducted in four phases, each corresponding to different stages of SDLCs. User-needs data were used to gathered by interviews and observations. A prototype was developed using object-oriented programming and presented to users for feedback. Finally, focus group was used to finalized the prototype into the desired system.

Results

User needs were identified and prioritized from the outset, with ease of use, security, and mobile apps being their most essential requirements. The prototype underwent several iterations of design and evaluation in focus group sessions until users were satisfied, and their feedback was incorporated. Eventually, the prototype was refined into the final system with users' consent.

Conclusion

The study revealed that instant access to information, voluntary participation, user interface (UI) design, and usefulness were critical variables for users and should be integral to any system. Successful implementation of such a system requires careful consideration of end-users' needs and their application to the system. Moreover, integrating the system with electronic health records can further enhance the treatment process and the efficiency of medical staff. The voluntary perspective of users played a significant role in achieving an exemplary UI and overall satisfaction with the system. Developers and policymakers should consider these aspects in similar system development projects.

[Digital transformation as a strategy to strengthen essential public health functions in the AmericasTransformação digital como estratégia de fortalecimento das funções essenciais de saúde pública nas Américas]

This article systematizes the main actions taken to address the essential public health functions (EPHF) in the context of the digital transformation of health systems. A narrative review was conducted, in which the conceptual framework of the renewed EPHF was linked to the eight guiding principles of the digital transformation of the health sector.In the selected publications, the main actions in digital transformation included electronic health records, telemedicine, digital health legislation, digital literacy, patient portals, open-source technologies, and data governance. These actions make it possible to increase the quality and efficiency of health systems, promote accessibility, and improve health outcomes.

Descriptive study of reported cases of sexual violence and specialized care services in the state of Minas Gerais, Brazil, 2019

OBJECTIVE

to describe the sociodemographic profile of reported cases of sexual violence (SV) and the distribution of care services for this health condition in the state of Minas Gerais, Brazil, 2019.

METHODS

this was a descriptive study of the cases of sexual violence reported on the Notifiable Health Conditions Information System and care services registered in the National Health Establishment Registry.

RESULTS

a total of 4,418 notifications of SV were identified during the study period, representing more than 12 notifications per day; the majority of notifications were among females (87.0%) and among children and adolescents (72.0%); the distribution of care services showed care gaps in four of the 14 health macro-regions of the state of Minas Gerais; the maximum distances traveled to access referral services ranged from 93 to 327 km.

CONCLUSION

the scarcity of care services for people subjected to sexual violence in the micro-regions and macro-regions of Minas Gerais highlights the need for planning public policies aimed at increasing access to these services.

MAIN RESULTS

Over 12 notifications of sexual violence were reported per day in the state of Minas Gerais in 2019, with a higher prevalence in females, children and adolescents, mixed-race/Black people. Care gaps were identified in four macro-regions of the state.

IMPLICATIONS FOR SERVICES

There was a need for victims to travel long distances to receive care in municipalities with referral services for comprehensive care for sexual violence, which may hinder access and timely care.

PERSPECTIVES

It is expected that the results can contribute to improving public policies, considering the need to strategically plan the location of specialized services for people subjected to sexual violence.

Quality of child anthropometric data from SISVAN, Brazil, 2008-2017

OBJECTIVE

To evaluate the quality of anthropometric data of children recorded in the Food and Nutrition Surveillance System (SISVAN) from 2008 to 2017.

METHOD

Descriptive study on the quality of anthropometric data of children under five years of age admitted in primary care services of the Unified Health System, from the individual databases of SISVAN. Data quality was annually assessed using the indicators: coverage, completeness, sex ratio, age distribution, weight and height digit preference, implausible z-score values, standard deviation, and normality of z-scores.

RESULTS

In total, 73,745,023 records and 29,852,480 children were identified. Coverage increased from 17.7% in 2008 to 45.4% in 2017. Completeness of birth date, weight, and height corresponded to almost 100% in all years. The sex ratio was balanced and approximately similar to the expected ratio, ranging from 0.8 to 1. The age distribution revealed higher percentages of registrations from the ages of two to four years until mid-2015. A preference for terminal digits "zero" and "five" was identified among weight and height records. The percentages of implausible z-scores exceeded 1% for all anthropometric indices, with values decreasing from 2014 onwards. A high dispersion of z-scores, including standard deviations between 1.2 and 1.6, was identified mainly in the indices including height and in the records of children under two years of age and residents in the North, Northeast, and Midwest regions. The distribution of z-scores was symmetric for all indices and platykurtic for height/age and weight/age.

CONCLUSIONS

The quality of SISVAN anthropometric data for children under five years of age has improved substantially between 2008 and 2017. Some indicators require attention, particularly for height measurements, whose quality was lower especially among groups more vulnerable to nutritional problems.

A documentary analysis of Victorian Government health information assets' websites to identify availability of documentation for data sharing and reuse in Australia

BACKGROUND

Health data sharing is important for monitoring diseases, policy and practice, and planning health services. If health data are used for secondary purposes, information needs to be provided to assist in reuse.

OBJECTIVES

To review government health information asset websites to ascertain the extent of readily available, explanatory documentation for researcher sharing and reuse of these data.

METHOD

Documentary analysis was undertaken on selected Victorian Government health information assets' websites in Australia. Data were obtained on nine information-categories: data custodian; data context; data dictionary; quality controls; data quality; limitations; access process; privacy/confidentiality/security and research requests/outputs. Information-categories were compared by dataset type (administrative or population-health) and by curating organisation (government or other agency). Descriptive statistics were used.

RESULTS

The majority of the 25 websites examined provided information on data custodian (96%) and data context (92%). Two-thirds reported access process (68%) and privacy/confidentiality/security information (64%). Compared with population-health websites, administrative dataset websites were more likely to provide access to a data dictionary (67% vs 50%) and information on quality controls (56% vs 44%), but less likely to provide information on the access process (56% vs 75%) and on research requests/outputs (0% vs 56%, p = 0.024). Compared with government-curated websites, other agency websites were more likely to provide information on research requests/outputs (80% vs 7%, p < 0.001).

CONCLUSION

There is inconsistent explanatory documentation available for researchers for reuse of Victorian Government health datasets. Importantly, there is insufficient information on data quality or dataset limitations. Research-curated dataset websites are significantly more transparent in displaying research requests or outputs.

The translation into Portuguese of the 11th International Statistical Classification of Diseases and Related Health Problems (ICD-11)

The 11th International Statistical Classification of Diseases and Related Health Problems (ICD-11) represents an advance in the focus on knowledge and new disease approaches. The ICD is used for different practical purposes, enabling assessment of progress in the global health agenda, resource allocation, patient safety, health care qualification, and health insurance reimbursement. It is entirely digital, with technological resources that allow periodic updating. In early 2022, ICD-11 entered into official force, having been made available in several official ICD languages such as Arabic, Chinese, Spanish, French, and English. The translation process into Brazilian Portuguese, coordinated by the Federal University of Minas Gerais (UFMG), with support from the Brazilian Ministry of Health (MS) and PAHO/WHO, is presented here. The work was carried out in three stages between August 2021 and December 2022 by translators with different backgrounds: medical specialists (49), physiotherapists (1), pharmacologists (1), and dentists (1). This methodological article aims to broaden the discussion of perspectives on implementing the ICD-11 in Brazil and build an opportunity for its adaptation and use by other Portuguese-speaking countries.

[Spatial analysis of maternal morbidity and mortality in users of the Brazilian Unified National Health System in the city of Rio de Janeiro, Brazil, 2014-2016]

The objective of this study is to analyze the maternal morbidity and mortality of women treated in hospitals of the Brazilian Unified National Health System (SUS) in the city of Rio de Janeiro in the period 2014-2016. An ecological study was conducted using data from the Brazilian Information System on Live Birth (SINASC), the Brazilian Mortality Information System (SIM), and the Brazilian Hospital Information System (SIH/SUS). For the analysis of the maternal mortality ratio (MMR), data from the SIM were used. For the analysis of maternal morbidity, World Health Organization criteria were used to estimate the ratios of maternal near miss and potentially life-threatening conditions. SINASC was used to retrieve data on the number of live births, for demographic characterization, social aspects, and access to prenatal care. To evaluate the spatial association between the indicators MMR, ratios of maternal near miss, and potentially life-threatening conditions and the demographic, social, obstetric, and access indicators, obtained from SINASC, the bivariate Moran Index was estimated with a significance level of 0.05, using the GeoDa program. In the period analyzed, the MMR in the Rio de Janeiro was 94.16/100,000 live births, the ratio of maternal near miss was 28.21/1,000 live births, and the potentially life-threatening conditions was 34.31/1,000 live births. Cases of potentially life-threatening conditions were used for the first time in this study and presented diagnoses and procedures during hospitalization more consistent with the maternal mortality profile in the city of Rio de Janeiro. There was a significant association between MMR and percentage of live births in SUS, potentially life-threatening conditions and percentage of live births in SUS, and potentially life-threatening conditions and being single.

Automated coding and selection of causes of death in Peru: a descriptive study, 2016-2019

MAIN RESULTS

It could be seen good performance of the software for the automatic selection of the underlying cause of death, increasing from 69.6% in 2016 to 78.8% in 2019. There was a correlation between this result and the use of online death certificates by physicians.

IMPLICATIONS FOR SERVICES

Automatic coding and selection of causes of death improve productivity and timeliness of information, contributing to the quality of the country's information system.

PERSPECTIVES

It is necessary to analyze the agreement between the medical terms in the software dictionaries used in South American countries in order to improve standardization and comparability of information on causes of death.

OBJECTIVE

to describe software performance in the automatic selection of the underlying cause of death in Peru, between 2016 and 2019.

METHODS

this was a descriptive study on the software performance in the automated selection of the underlying cause of death over the years (chi-square test for trend) and the correlation between the type of death certificate and software performance (correlation coefficient and coefficient of determination).

RESULTS

a total of 446,217 death certificates were analyzed; the proportion of death certificates with the underlying cause of death increased from 69.6% in 2016 to 78.8% in 2019 (p-value < 0.001); it could be seen a direct linear correlation between electronic death certificates and software performance (correlation coefficient = 0.95; R2 = 0.89).

CONCLUSION

the software showed good performance in the automatic selection of the underlying cause of death, with a significant increase between 2016 and 2019.

Towards a Recommendation for Good Health Data Modeling (GHDM) - Results of Expert Interviews

Appropriate data models are essential for the systematic collection, aggregation, and integration of health data and for subsequent analysis. However, recommendations for modeling health data are often not publicly available within specific projects. Therefore, the project Zukunftslabor Gesundheit investigates recommendations for modeling. Expert interviews with five experts were conducted and analyzed using qualitative content analysis. Based on the condensed categories "governance", "modeling" and "standards", the project team generated eight hypotheses for recommendations on health data modeling. In addition, relevant framework conditions such as different roles, international cooperation, education/training and political influence were identified. Although emerging from interviewing a small convenience sample of experts, the results help to plan more extensive data collections and to create recommendations for health data modeling.

The suitability of government health information assets for secondary use in research: A fit-for-purpose analysis

BACKGROUND

Governments have responsibility for ensuring the quality and fitness-for-purpose of personal health data provided to them. While these health information assets are used widely for research, this secondary usage has received minimal research attention.

OBJECTIVE

This study aimed to investigate the secondary uses, in research, of population health and administrative datasets (information assets) of the Department of Health (DoH), Victoria, Australia. The objectives were to (i) identify research based on these datasets published between 2008 and 2020; (ii) describe the data quality studies published between 2008 and 2020 for each dataset and (iii) evaluate "fitness-for-purpose" of the published research.

METHOD

Using a modified scoping review, research publications from 2008 to 2020 based on information assets related to health service provision and containing person-level data were reviewed. Publications were summarised by data quality and purpose-categories based on a taxonomy of data use. Fitness-for-purpose was evaluated by comparing the publicly stated purpose(s) for which each information asset was collected, with the purpose(s) assigned to the published research.

RESULTS

Of the >1000 information assets, 28 were utilised in 756 publications: 54% were utilised for general research purposes, 14% for patient safety, 10% for quality of care and 39% included data quality-related publications. Almost 85% of publications used information assets that were fit-for-purpose.

CONCLUSION

The DoH information assets were used widely for secondary purposes, with the majority identified as fit-for-purpose. We recommend that data custodians, including governments, provide information on data quality and transparency on data use of their health information assets.

Attaining consensus on a core dataset for upper limb lymphoedema using the Delphi method: A foundational step in creating a clinical support system

Background: Lymphoedema is a condition of localised swelling caused by a compromised lymphatic system. The protein-rich fluid accumulating in the interstitial tissue can create inflammation and irreversible changes to the skin and underlying tissue. An array of methods has been used to assess and report these changes. Heterogeneity is evident in the clinic and in the literature for the domains assessed, outcomes and outcome measures selected, measurement protocols followed, methods of analysis, and descriptors used to report change. Objective: This study seeks consensus on the required items for inclusion in a core data set for upper limb lymphoedema to digitise the monitoring and reporting of upper limb lymphoedema. Methods: The breadth of outcomes and descriptors in common use were captured in prior studies by this research group. This list was refined by frequency and proposed to experts in the field (n = 70) through a two-round online modified Delphi study. These participants rated the importance of each item for inclusion in the dataset and identified outcomes or descriptors they felt were missing in Round 1. In Round 2, participants rated any new outcomes or descriptors proposed and preference for how numeric data is displayed. Results: The core dataset was confirmed on completion of Round 2. Interlimb difference as a percentage, and limb volume were preferred for graphed display over time; and descriptors for observed and palpated change narrowed from 42 to 20. Conclusion: This dataset provides the foundation to create a clinical support system for upper limb lymphoedema.

Determining the relationship between dengue and vulnerability in a Brazilian city: a spatial modeling analysis

Dengue is a viral infection transmitted by the Aedes aegypti mosquito. This study aimed to assess the distribution of cases and deaths from dengue and severe dengue, and its relationship with social vulnerability in Belo Horizonte, State of Minas Gerais, Brazil, from 2010 to 2018. The incidence and lethality rates of dengue and their relationship with sex, age, education, skin color, and social vulnerability were studied using chi-square tests, Ordinary Least Squares (OLS), and Geographically Weighted Regression (GWR) analyses. The number of cases of dengue in Belo Horizonte during the study period was 324,044 dengue cases, with 1,334 cases of severe dengue and 88 deaths. During the past few decades, the incidence rate of both dengue and severe cases varied, with an average incidence rate of respectively 1515.5 and 6.2/100,000 inhabitants. The increase in dengue cases was directly related to areas with higher social vulnerability areas and more working-age people. Also, the disease is more severe in people self-declared as black, elderly, and male. The findings of this study might provide relevant information for health services in the organization of control and prevention policies for this problem, emphasizing the most vulnerable urban areas and categories.

Sisvan food intake markers: structure and measurement invariance in Brazil

OBJECTIVE

To characterize the internal structure of the Food and Nutrition Surveillance System (Sisvan) form of food intake markers for individuals over 2 years of age and to investigate measurement invariance between Brazilian macro-regions, life stages and over the years.

METHODS

A parallel analysis with factor estimation was carried out, complemented with exploratory factor analysis using all Sisvan records with valid responses in the country in 2015 (n = 298,253). Only the first record per individual was considered. Next, multigroup confirmatory factor analysis was used to investigate configural, metric and scalar invariance between the five macro-regions (Midwest, Northeast, North, Southeast, South) and life stages (children, adolescents, adults, elderly) in the same reference year. Invariance was evaluated longitudinally using valid individual records from 2015 to 2019 (n = 4,578,960). The adequacy of fit indices was observed at each step.

RESULTS

Acceptable fit indices and adequate factor loadings were found for a two-dimensional model, which grouped ultra-processed foods (factor 1) and unprocessed or minimally processed foods (factor 2). The two-dimensional structure, with the respective items in each factor underlying the set of markers, was equivalent across macro-regions, life stages and longitudinally, confirming the configural invariance. The weights of each item and its scale were homogeneous for all groups of interest, confirming metric and scalar invariances.

CONCLUSIONS

The internal structure of the Sisvan form of food intake markers adequately reflected its conceptual foundation, with stability of factors related to healthy and unhealthy eating in configuration, weights and scale in the investigated categories. These findings qualify food and nutritional surveillance actions, enhancing the use of Sisvan food intake markers in research, monitoring, individual guidance, and care production in the Brazilian Unified Health System.

"A living lab within a lab": approaches and challenges for scaling digital public health in resource-constrained settings

A living lab is an emerging concept, particularly in Europe, as a vehicle to develop digital innovations through a process of co-produced design and development, which takes place, physically and socially, in real-life use contexts. However, there is limited research relating to guiding our understanding of the process by which such labs are established, and digital innovations are co-created and scaled to other settings requiring similar solutions. Furthermore, beyond Europe, the concept of a living lab has not found widespread application in low- and middle-income countries (LMICs), particularly in their public health contexts. Public health systems offer the unique scaling challenge of "all or nothing", implying that data are required from the whole population rather than isolated pilot settings. The living lab approach promises the rich potential to strengthen public systems but comes with twin interconnected challenges. First, for building appropriate digital solutions to address local public health challenges, and second, in scaling them to other public health facilities. This article investigates these twin challenges through ongoing empirical work in India and identifies three key domains of analysis, which are as follows: the first concerns the process of establishing an enabling structure of a "living lab within a lab"; the second concerns leveraging the capabilities offered by free and open-source digital technologies; and the third concerns the driving impetus to scaling through agile and co-constructed technical support.

A completeness indicator of gestational and congenital syphilis information in Brazil

OBJECTIVE

To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018.

METHODS

Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA).

RESULTS

Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90).

CONCLUSION

The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.

Telehealth interventions during COVID-19 pandemic: a scoping review of applications, challenges, privacy and security issues

BACKGROUND

The COVID-19, caused by the SARS-CoV-2 virus, proliferated worldwide, leading to a pandemic. Many governmental and non-governmental organisations and research institutes are contributing to the COVID-19 fight to control the pandemic.

MOTIVATION

Numerous telehealth applications have been proposed and adopted during the pandemic to combat the spread of the disease. To this end, powerful tools such as artificial intelligence (AI)/robotic technologies, tracking, monitoring, consultation apps and other telehealth interventions have been extensively used. However, there are several issues and challenges that are currently facing this technology.

OBJECTIVE

The purpose of this scoping review is to analyse the primary goal of these techniques; document their contribution to tackling COVID-19; identify and categorise their main challenges and future direction in fighting against the COVID-19 or future pandemic outbreaks.

METHODS

Four digital libraries (ACM, IEEE, Scopus and Google Scholar) were searched to identify relevant sources. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was used as a guideline procedure to develop a comprehensive scoping review. General telehealth features were extracted from the studies reviewed and analysed in the context of the intervention type, technology used, contributions, challenges, issues and limitations.

RESULTS

A collection of 27 studies were analysed. The reported telehealth interventions were classified into two main categories: AI-based and non-AI-based interventions; their main contributions to tackling COVID-19 are in the aspects of disease detection and diagnosis, pathogenesis and virology, vaccine and drug development, transmission and epidemic predictions, online patient consultation, tracing, and observation; 28 telehealth intervention challenges/issues have been reported and categorised into technical (14), non-technical (10), and privacy, and policy issues (4). The most critical technical challenges are: network issues, system reliability issues, performance, accuracy and compatibility issues. Moreover, the most critical non-technical issues are: the skills required, hardware/software cost, inability to entirely replace physical treatment and people's uncertainty about using the technology. Stringent laws/regulations, ethical issues are some of the policy and privacy issues affecting the development of the telehealth interventions reported in the literature.

CONCLUSION

This study provides medical and scientific scholars with a comprehensive overview of telehealth technologies' current and future applications in the fight against COVID-19 to motivate researchers to continue to maximise the benefits of these techniques in the fight against pandemics. Lastly, we recommend that the identified challenges, privacy, and security issues and solutions be considered when designing and developing future telehealth applications.

Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study

BACKGROUND

Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes.

OBJECTIVE

We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity.

METHODS

A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience.

RESULTS

DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites.

CONCLUSIONS

This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.

Notifications of sexual violence against children and adolescents in Rio Grande do Sul, Brazil: a descriptive study, 2014-2018

OBJECTIVE

to describe characteristics of notifications of sexual violence against children and adolescents according to race/skin color and their distribution in the state of Rio Grande do Sul, Brazil, between 2014 and 2018.

METHODS

this was a descriptive study of data retrieved from the Notifiable Health Conditions Information System (SINAN). Frequency distributions, prevalence and statistical differences were analyzed using Pearson's chi-square test.

RESULTS

of the 8,716 notifications, most occurred in the state capital (48.2%) and related to female victims (82.2%) aged between 10 and 14 years (38.1%). There was a higher prevalence (370/100,000) and relative frequency of rape (84.5%), sexual exploitation (5.8%) and neglect/abandonment (4.6%) among victims of Black race/skin color (p-value < 0.05). Only 4.6% of notifications occurred in primary health care services.

CONCLUSION

notifications were more frequent among female pre-adolescents and prevalence was higher among Black people, who should be a priority target for protective measures. Surveillance of this form of violence needs to be strengthened in primary care.

Assessing the Immunization Information System and electronic health record interface accuracy for COVID-19 vaccinations

Objective

Our objective is to assess the accuracy of the COVID-19 vaccination status within the electronic health record (EHR) for a panel of patients in a primary care practice when manual queries of the state immunization databases are required to access outside immunization records.

Materials and Methods

This study evaluated COVID-19 vaccination status of adult primary care patients within a university-based health system EHR by manually querying the Kansas and Missouri Immunization Information Systems.

Results

A manual query of the local Immunization Information Systems for 4114 adult patients with "unknown" vaccination status showed 44% of the patients were previously vaccinated. Attempts to assess the comprehensiveness of the Immunization Information Systems were hampered by incomplete documentation in the chart and poor response to patient outreach.

Conclusions

When the interface between the patient chart and the local Immunization Information System depends on a manual query for the transfer of data, the COVID-19 vaccination status for a panel of patients is often inaccurate.

Factors associated with multibacillary leprosy in a region of northeastern Brazil

INTRODUCTION

The analysis of factors associated with multibacillary leprosy is important for the development of strategies to mitigate the disease, which persists as a public health problem in Brazil and the world. The objective of this study was to verify the associations between sociodemographic and clinical-epidemiological variables and multibacillary leprosy in the state of northeastern Brazil.

METHODOLOGY

This is a cross-sectional, analytical, and retrospective study, with a quantitative approach, carried out in 16 municipalities in the southwest of Maranhão State, northeastern Brazil. All cases of leprosy reported between January 2008 and December 2017 were considered. Sociodemographic and clinical-epidemiological variables were analyzed using descriptive statistics. The identification of the risk factors associated with multibacillary leprosy was conducted using Poisson regression models. The prevalence ratios and respective 95% confidence intervals were estimated using regression coefficients at a 5% significance level.

RESULTS

A total of 3,903 leprosy cases were analyzed. Individuals older than 15 years, males, with less than 8 years of education, with level I, II, or "not evaluated" disability, and with type 1 or 2 or both reactional states were more likely to have multibacillary leprosy. Therefore, these characteristics may be considered risk factors. No protective factors were identified.

CONCLUSIONS

The investigation revealed important associations between risk factors and multibacillary leprosy. The findings can be considered during the creation of strategies to control and combat the disease.

Provenance Data Management in Health Information Systems: A Systematic Literature Review

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.

[Evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System, from 2005 to 2020]

This study aimed to evaluate the evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System (SINASC). It is a time-series study on the completeness of the variable "occurrence of congenital anomaly" and the consistency of gastroschisis diagnosis in SINASC, in biennia from 2005 to 2020, for federative units, region, and Brazil. The consistency was estimated by the ratio between deaths from gastroschisis registered in the Brazilian Mortality Information System (SIM) and the total number of cases recorded in SINASC. Temporal trend was analyzed by joinpoint regression. In the period, 46,574,995 live births and 10,024 cases of gastroschisis were recorded. A total of 5,632 infant deaths due to gastroschisis were identified. The percentage of incompleteness decreased from 6.52% to 1.87%, with an annual percentage variation (APV) of -14.5%, and completeness reached excellence (≤ 5% of incompleteness), except in the Central-West Region. Case/death ratios above 1 were found in the North and Northeast regions and in some federative units in the Central-West, but there was a decrease, approaching the mortality found in studies in the South and Southeast regions. Its reduction was more pronounced until 2009-2010 (APV = -10.7%) and smaller later (APV = -4.4%). The quality of the gastroschisis registry reflects regional differences in the overall quality of SINASC, constituting as a marker for malformations that require complex neonatal care.

Personal data governance and privacy in digital reproductive, maternal, newborn, and child health initiatives in Palestine and Jordan: a mapping exercise

Introduction

There is a rapid increase in using digital technology for strengthening delivery of reproductive, maternal, newborn, and child health (RMNCH) services. Although digital health has potentially many benefits, utilizing it without taking into consideration the possible risks related to the security and privacy of patients' data, and consequently their rights, would yield negative consequences for potential beneficiaries. Mitigating these risks requires effective governance, especially in humanitarian and low-resourced settings. The issue of governing digital personal data in RMNCH services has to date been inadequately considered in the context of low-and-middle-income countries (LMICs). This paper aimed to understand the ecosystem of digital technology for RMNCH services in Palestine and Jordan, the levels of maturity of them, and the implementation challenges experienced, particularly concerning data governance and human rights.

Methods

A mapping exercise was conducted to identify digital RMNCH initiatives in Palestine and Jordan and mapping relevant information from identified initiatives. Information was collected from several resources, including relevant available documents and personal communications with stakeholders.

Results

A total of 11 digital health initiatives in Palestine and 9 in Jordan were identified, including: 6 health information systems, 4 registries, 4 health surveillance systems, 3 websites, and 3 mobile-based applications. Most of these initiatives were fully developed and implemented. The initiatives collect patients' personal data, which are managed and controlled by the main owner of the initiative. Privacy policy was not available for many of the initiatives.

Discussion

Digital health is becoming a part of the health system in Palestine and Jordan, and there is an increasing use of digital technology in the field of RMNCH services in both countries, particularly expanding in recent years. This increase, however, is not accompanied by clear regulatory policies especially when it comes to privacy and security of personal data, and how this data is governed. Digital RMNCH initiatives have the potential to promote effective and equitable access to services, but stronger regulatory mechanisms are required to ensure the effective realization of this potential in practice.

[Data processing of the Brazilian National System of Controlled Product Management for drug utilization research with antimicrobials]

The Brazilian National System of Controlled Product Management (SNGPC) stores data on the dispensing of manufactured and compounded drugs and pharmaceutical inputs, whether controlled and antimicrobial, based on the records of private pharmacies and drugstores. This study assessed the quality of SNGPC data from the dispensing records of manufactured antibiotics, aiming to propose their use in drug utilization researchs (DURs), with a descriptive and retrospective design, analyzing the raw dataset of the SNGPC from January 2014 to December 2020. A total of 475,805,207 drug-dispensing records were collected. On average, antibiotics corresponded to 54.5% of the total records. The quality dimension "unreported" was systematically identified in the variables "active ingredient", "sex", "age" and "ICD-10". The amount of vials/bottles and packages ranged from one to 536 units and the amount of pharmaceutical inputs dispensed, from one to 7,500 units. Results show that 25% of the records exceed an individual therapy and the SNGPC has no critical mechanism to avoid dispensations outside the therapeutic standard for the class. Despite vulnerabilities due to data quality, which can be overcome, the SNGPC allows for the construction of different analytical plans, involving time and other aggregations, in the analysis of community use of antimicrobials and controlled drugs, which makes it a powerful source of data for DUR.

Clinical decision support systems to improve drug prescription and therapy optimisation in clinical practice: a scoping review

OBJECTIVE

Clinical decision support systems (CDSSs) can reduce medical errors increasing drug prescription appropriateness. Deepening knowledge of existing CDSSs could increase their use by healthcare professionals in different settings (ie, hospitals, pharmacies, health research centres) of clinical practice. This review aims to identify the characteristics common to effective studies conducted with CDSSs.

MATERIALS AND METHODS

The article sources were Scopus, PubMed, Ovid MEDLINE and Web of Science, queried between January 2017 and January 2022. Inclusion criteria were prospective and retrospective studies that reported original research on CDSSs for clinical practice support; studies should describe a measurable comparison of the intervention or observation conducted with and without the CDSS; article language Italian or English. Reviews and studies with CDSSs used exclusively by patients were excluded. A Microsoft Excel spreadsheet was prepared to extract and summarise data from the included articles.

RESULTS

The search resulted in the identification of 2424 articles. After title and abstract screening, 136 studies remained, 42 of which were included for final evaluation. Most of the studies included rule-based CDSSs that are integrated into existing databases with the main purpose of managing disease-related problems. The majority of the selected studies (25 studies; 59.5%) were successful in supporting clinical practice, with most being pre-post intervention studies and involving the presence of a pharmacist.

DISCUSSION AND CONCLUSION

A number of characteristics have been identified that may help the design of studies feasible to demonstrate the effectiveness of CDSSs. Further studies are needed to encourage CDSS use.

Spatiotemporal risk assessment and COVID-19 trend estimation in a federative unit in northeastern Brazil

BACKGROUND

Coronavirus disease 2019 (COVID-19) has spread worldwide, causing a high burden of morbidity and mortality, and has affected the various health service systems in the world, demanding disease monitoring and control strategies. The objective of this study was to identify risk areas using spatiotemporal models and determine the COVID-19 time trend in a federative unit of northeastern Brazil.

METHODS

An ecological study using spatial analysis techniques and time series was carried out in the state of Maranhão, Brazil. All new cases of COVID-19 registered in the state from March 2020 to August 2021 were included. Incidence rates were calculated and spatially distributed by area, while the spatiotemporal risk territories were identified using scan statistics. The COVID-19 time trend was determined using Prais-Winsten regressions.

RESULTS

Four spatiotemporal clusters with high relative risks for the disease were identified in seven health regions located in the southwest/northwest, north and east of Maranhão. The COVID-19 time trend was stable during the analysed period, with higher rates in the regions of Santa Inês in the first and second waves and Balsas in the second wave.

CONCLUSIONS

The heterogeneously distributed spatiotemporal risk areas and the stable COVID-19 time trend can assist in the management of health systems and services, facilitating the planning and implementation of actions toward the mitigation, surveillance and control of the disease.

Completeness and quality of information about death from COVID-19 in a Brazilian state: A descriptive population-based register study

Health information is particularly essential in times of pandemics in which rapid response is crucial for political and stakeholder decision-making processes, and therefore the availability of data as well as its quality analysis are necessary. This study aimed to describe the completeness and quality of the e-Sistema Único de Saúde (SUS) Health Surveillance database (SUS Vigilância em Saúde) of the state of Espírito Santo, Brazil, from the notification of deaths from corana virus disease 2019 (COVID-19) from January 2020 to June 2021. A descriptive population-based register study was conducted from the analysis of the completeness of secondary data from the record of deaths from COVID-19, retrieved from the e-SUS Vigilância em Saúde (Health Surveillance) (VS) database of the state of Espírito Santo, Brazil, from January 2020 to June 2021. A total of 11,359 death records from COVID-19 via e-SUS VS in the state of Espírito Santo, Brazil, were evaluated. The score used to assess incompleteness was the 1 proposed by Romero and Cunha which classifies as excellent (when < 5%), good (between 5% and 10%), regular (between 10% and 20%), poor (between 20% and 50%), and very poor (when > 50%), according to the percentage of the absence of information. Descriptive statistical analyses were conducted in the Stata program, version 15.1. "Case identification" variables, and "condition" variables were classified as excellent completeness. Among the evolution variables, only "hospitalization" was classified as regular. Among the laboratory variables, only the polymerase chain reaction presented excellent completeness, while the "rapid test" and "serologies for immunoglobulin G, and immunoglobulin M" variables were classified as good completeness. It is concluded that most of the variables available in e-SUS VS of the state of Espírito Santo, Brazil, of notification of deaths from COVID-19 in 2020 presented excellent completeness, confirming the excellent quality of the state database.

Are Health Information Systems Ready for the Digital Transformation in Portugal? Challenges and Future Perspectives

PURPOSE

This study aimed to reflect on the challenges of Health Information Systems in Portugal at a time when technologies enable the creation of new approaches and models for care provision, as well as to identify scenarios that may characterize this practice in the future.

DESIGN/METHODOLOGY/APPROACH

A guiding research model was created based on an empirical study that was conducted using a qualitative method that integrated content analysis of strategic documents and semi-structured interviews with a sample of fourteen key actors in the health sector.

FINDINGS

Results pointed to the existence of emerging technologies that may promote the development of Health Information Systems oriented to "health and well-being" in a preventive model logic and reinforce the social and management implications.

ORIGINALITY/VALUE

The originality of this work resided in the empirical study carried out, which allowed us to analyze how the various actors look at the present and the future of Health Information Systems. There is also a lack of studies addressing this subject.

RESEARCH LIMITATIONS/IMPLICATIONS

The main limitations resulted from a low, although representative, number of interviews and the fact that the interviews took place before the pandemic, so the digital transformation that was promoted was not reflected. Managerial implications and social implications: The study highlighted the need for greater commitment from decision makers, managers, healthcare providers, and citizens toward achieving improved digital literacy and health. Decision makers and managers must also agree on strategies to accelerate existing strategic plans and avoid their implementation at different paces.

For-profit versus non-profit cybersecurity posture: breach types and locations in healthcare organisations

BACKGROUND

The implementation of emerging technologies has resulted in an increase of data breaches in healthcare organisations, especially during the COVID-19 pandemic. Health information and cybersecurity managers need to understand if, and to what extent, breach types and locations are associated with their organisation's business type.

OBJECTIVE

To investigate if breach type and breach location are associated with business type, and if so, investigate how these factors affect information systems and protected health information in for-profit versus non-profit organisations.

METHOD

The quantitative study was performed using chi-square tests for association and post-hoc comparison of column proportions analysis on an archival data set of reported healthcare data breaches from 2020 to 2022. Data from the Department of Health and Human Services website was retrieved and each organisation classified as for-profit or non-profit.

RESULTS

For-profit organisations experienced a significantly higher number of breaches due to theft, and non-profit organisations experienced a significantly higher number of breaches due to unauthorised access. Furthermore, the number of breaches that occurred on laptops and paper/films was significantly higher in for-profit organisations.

CONCLUSION

While the threat level of hacking techniques is the same in for-profit and non-profit organisations, certain breach types are more likely to occur within specific breach locations based on the organisation's business type. To protect the privacy and security of medical information, health information and cybersecurity managers need to align with industry-leading frameworks and controls to prevent specific breach types that occur in specific locations within their environments.

Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised provider order entry system

OBJECTIVES

Computerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this goal, especially in paediatric settings. The objectives of this study were to (1) analyse the impact of a paediatric CPOE system on medication safety and (2) suggest potential error prevention strategies.

METHODS

A pre-post observational study was conducted at the pilot ward (n=60 beds) of a paediatric academic health centre through mixed methods. The implementation project and medication management workflows were described through active participation to the project management team, observation, discussions and analysis of related documents. Furthermore, using incident reports, the nature of each error and error rate was compared between the preperiod and postperiod.

RESULTS

The global error rate was lower, but non-statistically significant, in the post implementation phase, which was mostly driven by a significant reduction in errors during order acknowledgement, transmission and transcription. Few errors occurred at the prescription step, and most errors occurred during medication administration. Furthermore, some errors could have been prevented using a CPOE in the pre-implementation period, and the CPOE led to few technology-related errors.

DISCUSSION AND CONCLUSION

This study identified both intended and unintended effects of CPOE adoption through the entire medication management workflow. This study revealed the importance of simplifying the acknowledgement, transmission and transcribing steps through the implementation of a CPOE to reduce medication errors. Improving the usability of the electronic medication administration record could help further improve medication safety.

Effect of a hospital command centre on patient safety: an interrupted time series study

BACKGROUND

Command centres have been piloted in some hospitals across the developed world in the last few years. Their impact on patient safety, however, has not been systematically studied. Hence, we aimed to investigate this.

METHODS

This is a retrospective population-based cohort study. Participants were patients who visited Bradford Royal Infirmary Hospital and Calderdale & Huddersfield hospitals between 1 January 2018 and 31 August 2021. A five-phase, interrupted time series, linear regression analysis was used.

RESULTS

After introduction of a Command Centre, while mortality and readmissions marginally improved, there was no statistically significant impact on postoperative sepsis. In the intervention hospital, when compared with the preintervention period, mortality decreased by 1.4% (95% CI 0.8% to 1.9%), 1.5% (95% CI 0.9% to 2.1%), 1.3% (95% CI 0.7% to 1.8%) and 2.5% (95% CI 1.7% to 3.4%) during successive phases of the command centre programme, including roll-in and activation of the technology and preparatory quality improvement work. However, in the control site, compared with the baseline, the weekly mortality also decreased by 2.0% (95% CI 0.9 to 3.1), 2.3% (95% CI 1.1 to 3.5), 1.3% (95% CI 0.2 to 2.4), 3.1% (95% CI 1.4 to 4.8) for the respective intervention phases. No impact on any of the indicators was observed when only the software technology part of the Command Centre was considered.

CONCLUSION

Implementation of a hospital Command Centre may have a marginal positive impact on patient safety when implemented as part of a broader hospital-wide improvement programme including colocation of operations and clinical leads in a central location. However, improvement in patient safety indicators was also observed for a comparable period in the control site. Further evaluative research into the impact of hospital command centres on a broader range of patient safety and other outcomes is warranted.

Involving multiple stakeholders in assessing and reviewing a novel data visualisation tool for a national neonatal data asset

OBJECTIVES

We involved public and professional stakeholders to assess a novel data interrogation tool, the Neonatal Health Intelligence Tool, for a National Data Asset, the National Neonatal Research Database.

METHODS

We recruited parents, preterm adults, data managers, clinicians, network managers and researchers (trialists and epidemiologists) for consultations demonstrating a prototype tool and semi-structured discussion. A thematic analysis of consultations is reported by stakeholder group.

RESULTS

We held nine on-line consultations (March-December 2021), with 24 stakeholders: parents (n=8), preterm adults (n=2), data managers (n=3), clinicians (n=3), network managers (n=2), triallists (n=3) and epidemiologists (n=3). We identified four themes from parents/preterm adults: struggling to consume information, Dads and data, bring data to life and yearning for predictions; five themes from data managers/clinicians/network managers: benchmarking, clinical outcomes, transfers and activity, the impact of socioeconomic background and ethnicity, and timeliness of updates and widening availability; and one theme from researchers: interrogating the data.

DISCUSSION

Other patient and public involvement (PPI) studies have reported that data tools generate concerns; our stakeholders had none. They were unanimously supportive and enthusiastic, citing visualisation as the tool's greatest strength. Stakeholders had no criticisms; instead, they recognised the tool's potential and wanted more features. Parents saw the tool as an opportunity to inform themselves without burdening clinicians, while clinicians welcomed an aid to explaining potential outcomes to parents.

CONCLUSION

All stakeholder groups recognised the need for the tool, praising its content and format. PPI consultations with all key groups, and their synthesis, illustrated desire for additional uses from it.

Characteristics of intimate partner violence in Mato Grosso do Sul state, Brazil, 2009-2018

OBJECTIVE

to analyze intimate partner violence (IPV) in Mato Grosso do Sul state, Brazil, with emphasis on physical violence.

METHODS

this was a cross-sectional study applying multiple correspondence analysis (MCA) to records retrieved from the Notifiable Health Conditions Information System covering the period from 2009 to 2018.

RESULTS

of the 9,950 notifications registered, 91.8% were notifications of physical violence; higher rates were found in young females (189.2/100,000), who had up to incomplete high school education (139.6/100,000), had a partner (202.7/100,000), were Indigenous (488.8/100,000), and were living on the border with other countries (223,1/100,000); the aggressors were mostly current partners (76.9%) and male (95.5%); MCA revealed that physical violence was predominant at weekends, at night, with use of physical force and when the aggressor was under the influence of alcohol; most IPV did not occur at home, but was committed by current partners and was not a repeated event.

CONCLUSION

IPV stood out among young victims, those who had a partner, low education, Indigenous women and occurred notably in the border region.

Completeness of notifications of accidents involving venomous animals in the Information System for Notifiable Diseases: a descriptive study, Brazil, 2007-2019

OBJECTIVE

to describe the completeness of notifications of accidents involving venomous animals held on the Notifiable Health Conditions Information System (SINAN), in Brazil and its macro-regions, from 2007 to 2019.

METHODS

we analyzed essential and non-mandatory fields for snakebite, spider bite and scorpion sting notifications, considering the following completeness categories: Excellent (≤5.0% incompleteness), Good (5.0% to 10.0%), Regular (10.0% to 20.0%), Poor (20.0% to ≤50.0%) and Very Poor (>50.0%). Proportional change in completeness between 2007 and 2019 was estimated.

RESULTS

1,871,462 notifications were investigated. The "localized manifestations", "systemic manifestations", "case classification", "case progression" and "zone of occurrence" fields had excellent or good completeness. Completeness was regular or poor for the "schooling" and "race/color" fields. The "occupation" field was predominantly poorly or very poorly filled in. There was a proportional worsening in completeness (PC<0) in most regions for the "zone of occurrence", "case progression" and "schooling" fields.

CONCLUSION

completeness of most fields improved, although socioeconomic and occupational fields require more attention.

Temporal trend of congenital syphilis in the most populous municipality of metropolitan region II of Rio de Janeiro state

OBJECTIVE

This study aimed to explore the temporal trend in congenital syphilis, according to sociodemographic and prenatal care in the city of São Gonçalo - Rio de Janeiro, from 2007 to 2018.

METHODS

Ecological time series study, with data from SINAN (Information System for Notifiable Diseases) and SINASC (Information System on Live Births databases). We calculated annual incidence (per 1,000 live births) according to sociodemographic and prenatal variables. For the same variables, we calculated trends by logarithmic regression (Joinpoint Regression), estimating the annual percentage change.

RESULTS

A total of 2,420 cases were reported from 2007 to 2018, with an increasing trend: 64.9% per year (2010-2013) and 24.9% (2013-2018). In 2018, the highest rates were in adolescents (90.6/1,000 live births), black women (87.6/1,000 live births), low-educated women (122.8/1,000 live births), and those without prenatal care (677.4/1,000 live births). The annual percentage change of these categories was, respectively, 37.3% (2010-2018), 33.5% (2012-2018), 39.9% (2014-2018), and 85.0% (2011-2015), but all categories showed a crescent trend.

CONCLUSIONS

We identified high congenital syphilis incidences and crescent trends, especially in more vulnerable groups, pointing to social and healthcare inequalities. Prenatal care needs to be more comprehensive and qualified, primarily for young, low-educated, and black women.

Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response

Since 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported implementation and maintenance of health information systems for HIV/AIDS and related diseases, such as tuberculosis, in numerous countries. As the COVID-19 pandemic emerged, several countries conducted rapid assessments and enhanced existing PEPFAR-funded HIV and national health information systems to support COVID-19 surveillance data collection, analysis, visualization, and reporting needs. We describe efforts at the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, USA, and CDC country offices that enhanced existing health information systems in support COVID-19 pandemic response. We describe CDC activities in Haiti as an illustration of efforts in PEPFAR countries. We also describe how investments used to establish and maintain standards-based health information systems in resource-constrained settings can have positive effects on health systems beyond their original scope.

Sexual Violence against Adolescents in the State of Espírito Santo, Brazil: An Analysis of Reported Cases

OBJECTIVE

We describe the prevalence of the reported cases of sexual violence against adolescents and analyze their associated factors.

METHODS

A cross-sectional analytical study (n = 561) was conducted with reported data on sexual violence against adolescents in the state of Espírito Santo registered in SINAN between 2011 and 2018 to understand the prevalence and predictors of sexual violence against adolescent victims, as well as to describe the perpetrators and the nature of the aggression. Variables to characterize the victim, aggression, and perpetrator were used. Bivariate analyses were performed using chi-square (χ²) and Fisher's exact tests, and multivariate analyses were conducted using log-binomial models; the results were presented with prevalence ratios. All analyses were stratified by sex.

RESULTS

The prevalence of sexual violence was 32.6%, and 93% of the victims were female. In both males and females, the reported sexual violence was associated with a younger age (10-12 years old), living at home, being related to the perpetrator, and a history of sexual violence. In females, the reported sexual violence was also associated with the number of perpetrators, and in males, with the perpetrator's age.

CONCLUSIONS

Our findings show the high frequency of reporting of sexual violence and the characteristics of the victim, the aggression, and the aggressor as factors associated with its occurrence in both sexes. The importance of health information systems for disseminating data and the need for measures to prevent and treat the violence among adolescents is urgent.