Obstacles and features of health information systems: A systematic literature review

The barriers and challenges of using health information technology in medication administration process for pediatrics and neonates: A qualitative study

Background and Aims

Children and neonates are more susceptible to diseases and are a vulnerable group in medication administration (MA). Nurses interact directly with patients, ensuring safety and preventing unintended outcomes. Health Information Technology (HIT) has transformed health care, aiding nurses in decision-making and treatment responses. Despite its benefits, technology presents challenges that must be overcome to facilitate the nursing practice. Therefore, the present study aimed to explore the barriers to HIT use in the process of MA in children and neonates in a developing country.

Methods

Semi-structured face-to-face interviews were conducted with 22 health care professionals across seven pediatric and neonatal settings. Also, observations were made of these settings for 3 weeks. A qualitative analysis was performed using the conventional content analysis method, recommended by Colaizzi's seven-step approach.

Results

The results showed that the most significant barriers to adopting technology in MA process could be classified into two main categories: "inappropriate management approaches" with two sub-categories ("Managers' reluctance to adopt new technology", "lack of adequate budget for hardware resources"), and "resistance to change" with two sub-categories ("A desire to use conventional (traditional) approaches in care", "cultural issues and impracticality of providing some specialized technology services").

Conclusion

The findings revealed MA process complexities, which have been insufficiently examined in the current literature. We have highlighted the need for improved "effectiveness of HIT systems in administering medication processes, budget for hardware resources, and managers" interest in using new technology. The present findings can guide the development of more effective and user-friendly HIT systems in pediatric and neonatal care settings.

Health information management systems and practices in conflict-affected settings: the case of northwest Syria

BACKGROUND

In conflict settings, as it is the case in Syria, it is crucial to enhance health information management to facilitate an effective and sustainable approach to strengthening health systems in such contexts. In this study, we aim to provide a baseline understanding of the present state of health information management in Northwest Syria (NWS) to better plan for strengthening the health information system of the area that is transitioning to an early-recovery stage.

METHODS

A combination of questionnaires and subsequent interviews was used for data collection. Purposive sampling was used to select twenty-one respondents directly involved in managing and directing different domains of health information in the NWS who worked with local NGOs, INGOs, UN-agencies, or part of the Health Working Group. A scoring system for each public health domain was constructed based on the number and quality of the available datasets for these domains, which were established by Checci and others.

RESULTS & CONCLUSIONS

Reliable and aggregate health information in the NWS is limited, despite some improvements made over the past decade. The conflict restricted and challenged efforts to establish a concentrated and harmonized HIS in the NWS, which led to a lack of leadership, poor coordination, and duplication of key activities. Although the UN established the EWARN and HeRAMS as common data collection systems in the NWS, they are directed toward advocacy and managed by external experts with little participation or access from local stakeholders to these datasets.

RECOMMENDATIONS

There is a need for participatory approaches and the empowerment of local actors and local NGOs, cooperation between local and international stakeholders to increase access to data, and a central domain for planning, organization, and harmonizing the process. To enhance the humanitarian health response in Syria and other crisis areas, it is imperative to invest in data collection and utilisation, mHealth and eHealth technologies, capacity building, and robust technical and autonomous leadership.

Adapting national data systems for donor transition: comparative analysis of experience from Georgia and China

Health management information systems (HMISs) are essential in programme planning, budgeting, monitoring and evidence-informed decision-making. This paper focuses on donor transitions in two upper-middle-income countries, China and Georgia, and explores how national HMIS adaptations were made and what facilitated or limited successful and sustainable transitions. This comparative analytical case study uses a policy triangle framework and a mixed-methods approach to explore how and why adaptations in the HMIS occurred under the Gavi Alliance and the Global Fund-supported programmes in China and Georgia. A review of published and grey literature, key informant interviews and administrative data analysis informed the study findings. Contextual factors such as the global and country context, and health system and programme needs drove HMIS developments. Other factors included accountability on a national and international level; improvements in HMIS governance by establishing national regulations for clear mandates of data collection and reporting rules and creating institutional spaces for data use; investing in hardware, software and human resources to ensure regular and reliable data generation; and capacitating national players to use data in evidence-based decision-making for programme and transition planning, budgeting and outcome monitoring. Not all the HMIS initiatives supported by donors were sustained and transitioned. For the successful adaptation and sustainable transition, five interlinked and closely coordinated support areas need to be considered: (1) coupling programme design with a good understanding of the country context while considering domestic and external demands for information, (2) regulating appropriate governance and management arrangements enhancing country ownership, (3) avoiding silo HMIS solutions and taking integrative approach, (4) ensuring the transition of funding onto domestic budget and enforcing fulfilment of the government's financial commitments and finally (5) investing in technologies and skilled human resources for the HMIS throughout all levels of the health system. Neglecting any of these elements risks not delivering sustainable outcomes.

Identifying the data elements and functionalities of clinical decision support systems to administer medication for neonates and pediatrics: a systematic literature review

BACKGROUND

Patient safety is a central healthcare policy worldwide. Adverse drug events (ADE) are among the main threats to patient safety. Children are at a higher risk of ADE in each stage of medication management process. ADE rate is high in the administration stage, as the final stage of preventing medication errors in pediatrics and neonates. The most effective way to reduce ADE rate is using medication administration clinical decision support systems (MACDSSs). The present study reviewed the literature on MACDSS for neonates and pediatrics. It identified and classified the data elements that mapped onto the Fast Healthcare Interoperability Resources (FHIR) standard and the functionalities of these systems to guide future research.

METHODS

PubMed/ MEDLINE, Embase, CINAHL, and ProQuest databases were searched from 1995 to June 31, 2021. Studies that addressed developing or applying medication administration software for neonates and pediatrics were included. Two authors reviewed the titles, abstracts, and full texts. The quality of eligible studies was assessed based on the level of evidence. The extracted data elements were mapped onto the FHIR standard.

RESULTS

In the initial search, 4,856 papers were identified. After removing duplicates, 3,761 titles, and abstracts were screened. Finally, 56 full-text papers remained for evaluation. The full-text review of papers led to the retention of 10 papers which met the eligibility criteria. In addition, two papers from the reference lists were included. A total number of 12 papers were included for analysis. Six papers were categorized as high-level evidence. Only three papers evaluated their systems in a real environment. A variety of data elements and functionalities could be observed. Overall, 84 unique data elements were extracted from the included papers. The analysis of reported functionalities showed that 18 functionalities were implemented in these systems.

CONCLUSION

Identifying the data elements and functionalities as a roadmap by developers can significantly improve MACDSS performance. Though many CDSSs have been developed for different medication processes in neonates and pediatrics, few have actually evaluated MACDSSs in reality. Therefore, further research is needed on the application and evaluation of MACDSSs in the real environment.

PROTOCOL REGISTRATION

(dx.doi.org/10.17504/protocols.io.bwbwpape).

A global blockchain for recording high rates of COVID-19 vaccinations

Blockchain has been recently proposed to securely record vaccinations against COVID-19 and manage their verification. However, existing solutions may not fully meet the requirements of a global vaccination management system. These requirements include the scalability required to support a global vaccination campaign, like one against COVID-19, and the capability to facilitate the interoperation between the independent health administrations of different countries. Moreover, access to global statistics can help to control securing community health and provide continuity of care for individuals during a pandemic. In this paper, we propose GEOS, a blockchain-based vaccination management system designed to address the challenges faced by the global vaccination campaign against COVID-19. GEOS offers interoperability between vaccination information systems at both domestic and international levels, supporting high vaccination rates and extensive coverage for the global population. To provide those features, GEOS uses a two-layer blockchain architecture, a simplified byzantine-tolerant consensus algorithm, and the Boneh-Lynn-Shacham signature scheme. We analyze the scalability of GEOS by examining transaction rate and confirmation times, considering factors such as the number of validators, communication overhead, and block size within the blockchain network. Our findings demonstrate the effectiveness of GEOS in managing COVID-19 vaccination records and statistical data for 236 countries, encompassing crucial information such as daily vaccination rates for highly populous nations and the global vaccination demand, as identified by the World Health Organization.

A Systematic Literature Review of Health Information Systems for Healthcare

Health information system deployment has been driven by the transformation and digitalization currently confronting healthcare. The need and potential of these systems within healthcare have been tremendously driven by the global instability that has affected several interrelated sectors. Accordingly, many research studies have reported on the inadequacies of these systems within the healthcare arena, which have distorted their potential and offerings to revolutionize healthcare. Thus, through a comprehensive review of the extant literature, this study presents a critique of the health information system for healthcare to supplement the gap created as a result of the lack of an in-depth outlook of the current health information system from a holistic slant. From the studies, the health information system was ascertained to be crucial and fundament in the drive of information and knowledge management for healthcare. Additionally, it was asserted to have transformed and shaped healthcare from its conception despite its flaws. Moreover, research has envisioned that the appraisal of the current health information system would influence its adoption and solidify its enactment within the global healthcare space, which is highly demanded.

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.

Functioning of the citizen’s electronic medical records in the prison system

Abstract This paper aimed to describe the implementation and operation of the e-SUS AB strategy in the Prison Primary Care Teams in Paraíba. A qualitative study was conducted through semi-structured interviews with 21 professionals, doctors, and nurses, from 11 primary care teams in prisons in Paraíba and the health management of the Penitentiary Administration Secretariat. A semi-structured roadmap was adopted for the interviews from the script previously established by the Ministry of Health for the implementation of the e-SUS AB system, which resulted in three thematic categories after being transcribed and analyzed per Bardin’s content analysis proposal: the health information system and the prison setting; management actions for the implementation of the e-SUS AB and; skills and competencies of professionals to use the e-SUS AB system. The e-SUS AB was implemented in the prison system with some obstacles concerning the physical and technological structure of the setting, the insufficient professional training, and the lack of skills with information technologies highlighted by the respondents. People feel the need to implement the citizen’s electronic medical records to ensure continuity of care for people deprived of liberty.

Funcionamento do prontuário eletrônico do cidadão no sistema prisional

Resumo O artigo teve como objetivo descrever a implantação e funcionamento da estratégia e-SUS AB nas Equipes de Atenção Primária Prisional na Paraíba. Foi realizado estudo de abordagem qualitativa, por meio de entrevistas semiestruturadas, com 21 profissionais, médicos e enfermeiros, de 11 equipes de atenção básica prisionais da Paraíba, além da gerência de saúde da Secretaria de Administração Penitenciária. Para as entrevistas, adotou-se um roteiro semiestruturado, elaborado a partir do roteiro previamente estabelecido pelo Ministério da Saúde para implantação do sistema e-SUS AB. Após transcritas e analisadas segundo a proposta de análise de conteúdo de Bardin, resultaram em três categorias temáticas: o sistema de informação em saúde e o cenário prisional; ações da gestão para implantação do e-SUS AB; e habilidades e competências dos profissionais para manuseio do sistema e-SUS AB. O e-SUS AB foi implantando no sistema prisional com alguns entraves relacionados à estrutura física e tecnológica do cenário, à insuficiência de capacitações profissionais, além da falta de habilidade com tecnologias da informação destacadas pelos entrevistados. As pessoas sentem a necessidade de implantação do prontuário eletrônico do cidadão para garantir a continuidade do cuidado às pessoas privadas de liberdade.

Primary Health Care System Strengthening Project in Sri Lanka: Status and Challenges with Human Resources, Information Systems, Drugs and Laboratory Services

A Primary Healthcare-System-Strengthening Project (PSSP) is implemented by the Ministry of Health, Sri Lanka, with funding support from the World Bank for providing quality care through primary medical care institutions (PMCIs). We used an explanatory mixed-methods study to assess progress and challenges in human resources, drug availability, laboratory services and the health management information system (HMIS) at PMCIs. We conducted a checklist-based assessment followed by in-depth interviews of healthcare workers in one PMCI each in all nine provinces. All PMCIs had medical/nursing officers, but data entry operators (44%) and laboratory technicians (33%) were mostly not available. Existing staff were assigned additional responsibilities in PSSP, decreasing their motivation and efficiency. While 11/18 (61%) essential drugs were available in all PMCIs, buffer stocks were not maintained in >50% due to poor supply chain management and storage infrastructure. Only 6/14 (43%) essential laboratory investigations were available in >50% of PMCIs, non-availability was due to shortages of reagents/consumables and lack of sample collection−transportation system. The HMIS was installed in PMCIs but its usage was sub-optimal due to perceived lack of utility, few trained operators and poor internet connectivity. The PSSP needs to address these bottlenecks as a priority to ensure sustainability and successful scale-up.