Designing an Emergency Medical Information System for the Early Stages of Disasters in Developing Countries: The Human Interface Advantage, Simplicity and Efficiency

Barriers in Health Information Systems and Technologies to Support Maternal and Neonatal Referrals at Primary Health Centers

Objectives

This study explored health workers’ perceptions and experiences regarding the maternal and neonatal referral system, focusing on barriers of health information systems and technologies (IS/IT) at primary health centers (PHCs) in South Tangerang, Indonesia.

Methods

This qualitative study was conducted using semi-structured interviews, which were conducted at the South Tangerang District Health Office and three PHCs. Interviews were conducted with nine participants responsible for maternal and neonatal referrals in their organizations. The data were analyzed using qualitative content analysis.

Results

In South Tangerang, the Primary Health Care Information System (SIMPUS) is used to register patients and record data on medical treatment. To facilitate referrals, the PHCs currently use the Integrated Referral Information System (SISRUTE), P-Care, and the Integrated Emergency Management System (SPGDT). The following four IS/IT barriers to support maternal and neonatal referrals were found: technology, human resources, organizational support, and the referral process and implementation.

Conclusions

The barriers in technology, human resources, and organizational support cause problems in the maternal and neonatal referral process and in the implementation of referrals. Barriers to referrals can influence patients’ ability to receive appropriate care in a timely fashion and lead to inefficiency in maternal and neonatal referrals. This study contributes knowledge about IS/IT implementation in maternal and neonatal referral systems and provides recommendations to health regulators and application developers for the implementation of IS/IT in Indonesia.

Utilisation of Electronic Health Records for Public Health in Asia: A Review of Success Factors and Potential Challenges

INTRODUCTION

Electronic health records offer a valuable resource to improve health surveillance and evaluation as well as informing clinical decision making. They have been introduced in many different settings, including low- and middle-income countries, yet little is known of the progress and effectiveness of similar information systems within Asia. This study examines the implementation of EHR systems for use at a population health level in Asia and to identify their current role within public health, key success factors, and potential barriers in implementation.

MATERIAL AND METHODS

A systematic search process was implemented. Five databases were searched with MeSH key terms and Boolean phrases. Articles selected for this review were based on hospital provider electronic records with a component of implementation, utilisation, or evaluation for health systems or at least beyond direct patient care. A proposed analytic framework considered three interactive components: the content, the process, and the context.

RESULTS

Thirty-two articles were included in the review. Evidence suggests that benefits are significant but identifying and addressing potential challenges are critical for success. A comprehensive preparation process is necessary to implement an effective and flexible system.

DISCUSSION

Electronic health records implemented for public health can allow the identification of disease patterns, seasonality, and global trends as well as risks to vulnerable populations. Addressing implementation challenges will facilitate the development and efficacy of public health initiatives in Asia to identify current health needs and mitigate future risks.

Mobile phone-based mHealth approaches for public health surveillance in sub-Saharan Africa: a systematic review

Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region.

Preparing routine health information systems for immediate health responses to disasters

During disaster times, we need specific information to rapidly plan a disaster response, especially in sudden-onset disasters. Due to the inadequate capacity of Routine Health Information Systems (RHIS), many developing countries face a lack of quality pre-disaster health-related data and efficient post-disaster data processes in the immediate aftermath of a disaster. Considering the significance of local capacity during the early stages of disaster response, RHIS at local, provincial/state and national levels need to be strengthened so that they provide relief personnel up-to-date information to plan, organize and monitor immediate relief activities. RHIS professionals should be aware of specific information needs in disaster response (according to the Sphere Project's Humanitarian Minimum Standards) and requirements in data processes to fulfil those information needs. Preparing RHIS for disasters can be guided by key RHIS-strengthening frameworks; and disaster preparedness must be incorporated into countries' RHIS. Mechanisms must be established in non-disaster times and maintained between RHIS and information systems of non-health sectors for exchanging disaster-related information and sharing technologies and cost.

Development traumatic brain injury computer user interface for disaster area in Indonesia supported by emergency broadband access network

Disasters bring consequences of negative impacts on the environment and human life. One of the common cause of critical condition is traumatic brain injury (TBI), namely, epidural (EDH) and subdural hematoma (SDH), due to downfall hard things during earthquake. We proposed and analyzed the user response, namely neurosurgeon, general doctor/surgeon and nurse when they interacted with TBI computer interface. The communication systems was supported by TBI web based applications using emergency broadband access network with tethered balloon and simulated in the field trial to evaluate the coverage area. The interface consisted of demography data and multi tabs for anamnesis, treatment, follow up and teleconference interfaces. The interface allows neurosurgeon, surgeon/general doctors and nurses to entry the EDH and SDH patient's data during referring them on the emergency simulation and evaluated based on time needs and their understanding. The average time needed was obtained after simulated by Lenovo T500 notebook using mouse; 8-10 min for neurosurgeons, 12-15 min for surgeons/general doctors and 15-19 min for nurses. By using Think Pad X201 Tablet, the time needed for entry data was 5-7 min for neurosurgeon, 7-10 min for surgeons/general doctors and 12-16 min for nurses. We observed that the time difference was depending on the computer type and user literacy qualification as well as their understanding on traumatic brain injury, particularly for the nurses. In conclusion, there are five data classification for simply TBI GUI, namely, 1) demography, 2) specific anamnesis for EDH and SDH, 3) treatment action and medicine of TBI, 4) follow up data display and 5) teleneurosurgery for streaming video consultation. The type of computer, particularly tablet PC was more convenient and faster for entry data, compare to that computer mouse touched pad. Emergency broadband access network using tethered balloon is possible to be employed to cover the communications systems in disaster area.

An emergency medical communications system by low altitude platform at the early stages of a natural disaster in Indonesia

A natural disaster is a consequence of a natural hazard, such as a tsunami, earthquake or volcanic eruption, affecting humans. In order to support emergency medical communication services in natural disaster areas where the telecommunications facility has been seriously damaged, an ad hoc communication network backbone should be build to support emergency medical services. Combinations of requirements need to be considered before deciding on the best option. In the present study we have proposed a Low Altitude Platform consisting of tethered balloons combined with Wireless Fidelity (WiFi) 802.11 technology. To confirm that the suggested network would satisfy the emergency medical service requirements, a communications experiment, including performance service measurement, was carried out.