The role of electronic medical records in improving the quality of health care services: Comparative study

Assessing the integration of refugee health data into national health information systems in Jordan, Lebanon, and Uganda

BACKGROUND

With the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators.

METHODS

The study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria.

RESULTS

Our analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees' well-being and access to healthcare services.

CONCLUSION

The current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

Longitudinal cohort study of discrepancies between prescribed and administered polypharmacy rates: implications for National Aged Care Quality Indicator Programs

BACKGROUND

Polypharmacy is frequently used as a quality indicator for older adults in Residential Aged Care Facilities (RACFs) and is measured using a range of definitions. The impact of data source choice on polypharmacy rates and the implications for monitoring and benchmarking remain unclear. We aimed to determine polypharmacy rates (≥9 concurrent medicines) by using prescribed and administered data under various scenarios, leveraging electronic data from 30 RACFs.

METHOD

A longitudinal cohort study of 5662 residents in New South Wales, Australia. Both prescribed and administered polypharmacy rates were calculated biweekly from January 2019 to September 2022, providing 156 assessment times. 12 different polypharmacy rates were computed separately using prescribing and administration data and incorporating different combinations of items: medicines and non-medicinal products, any medicines and regular medicines across four scenarios: no, 1-week, 2-week and 4-week look-back periods. Generalised estimating equation models were employed to identify predictors of discrepancies between prescribed and administered polypharmacy.

RESULTS

Polypharmacy rates among residents ranged from 33.9% using data on administered regular medicines with no look-back period to 63.5% using prescribed medicines and non-medicinal products with a 4-week look-back period. At each assessment time, the differences between prescribed and administered polypharmacy rates were consistently more than 10.0%, 4.5%, 3.5% and 3.0%, respectively, with no, 1-week, 2-week and 4-week look-back periods. Diabetic residents faced over two times the likelihood of polypharmacy discrepancies compared with counterparts, while dementia residents consistently showed reduced likelihood across all analyses.

CONCLUSION

We found notable discrepancies between polypharmacy rates for prescribed and administered medicines. We recommend a review of the guidance for calculating and interpreting polypharmacy for national quality indicator programmes to ensure consistent measurement and meaningful reporting.

EMR-Based Interventions on HPV Vaccination Initiation, Completion, and Receiving the Next Dose: A Meta-Analytic Review

Despite the acknowledged importance of Human Papillomavirus (HPV) vaccination in reducing HPV-related diseases, the influence of electronic medical records (EMR) on HPV vaccination uptake (HVU) remains underexplored. This study aimed to evaluate the efficacy of EMR-based interventions on HVU. A systematic review and meta-analysis of randomized controlled trials were performed, focusing on studies that primarily used EMR-based interventions to measure initiation rates, completion rates, and receipt of the next required vaccine dose. Subgroup analyses were conducted to assess the differential effects of supplementary strategies, provider feedback, and parental education or reminders on these outcomes. The results of the comprehensive analysis provided robust evidence for the significant role of EMR interventions, demonstrating an average increase of 4.7% in vaccine initiation, 6.6% in vaccine completion, and 7.2% in receipt of the next HPV vaccine dose. Additionally, the subgroup analyses indicated that provider feedback and parental education could further enhance the effectiveness of EMR-based interventions. These findings support the broader adoption of digital health technologies in vaccination programs, offering vital insights for healthcare providers, policymakers, and researchers, and emphasizing the need for continued technological innovation to improve public health outcomes.

Improving quality of care by standardising patient data collection in electronic medical records in an oncology department in Spain

BACKGROUND

Evaluation of quality of care in oncology is key in ensuring patients receive adequate treatment. American Society of Clinical Oncology's (ASCO) Quality Oncology Practice Initiative (QOPI) Certification Program (QCP) is an international initiative that evaluates quality of care in outpatient oncology practices.

METHODS

We retrospectively reviewed free-text electronic medical records from patients with breast cancer (BR), colorectal cancer (CRC) or non-small cell lung cancer (NSCLC). In a baseline measurement, high scores were obtained for the nine disease-specific measures of QCP Track (2021 version had 26 measures); thus, they were not further analysed. We evaluated two sets of measures: the remaining 17 QCP Track measures, as well as these plus other 17 measures selected by us (combined measures). Review of data from 58 patients (26 BR; 18 CRC; 14 NSCLC) seen in June 2021 revealed low overall quality scores (OQS)-below ASCO's 75% threshold-for QCP Track measures (46%) and combined measures (58%). We developed a plan to improve OQS and monitored the impact of the intervention by abstracting data at subsequent time points.

RESULTS

We evaluated potential causes for the low OQS and developed a plan to improve it over time by educating oncologists at our hospital on the importance of improving collection of measures and highlighting the goal of applying for QOPI certification. We conducted seven plan-do-study-act cycles and evaluated the scores at seven subsequent data abstraction time points from November 2021 to December 2022, reviewing 404 patients (199 BR; 114 CRC; 91 NSCLC). All measures were improved. Four months after the intervention, OQS surpassed the quality threshold and was maintained for 10 months until the end of the study (range, 78-87% for QCP Track measures; 78-86% for combined measures).

CONCLUSIONS

We developed an easy-to-implement intervention that achieved a fast improvement in OQS, enabling our Medical Oncology Department to aim for QOPI certification.

Service Quality and Related Factors in Primary Health Care Services: A Cross-Sectional Study

Primary health care services aim to prevent diseases and improve health efficiently and effectively. This study measures perceived service quality in a primary healthcare organization and examines the effect of personality traits on service quality. The cross-sectional study population comprised individuals over the age of 18 who applied to the Bingöl Central Community Health Centre. A total of 460 participants were included in the study between November 2018 and March 2019. The participants completed a face-to-face questionnaire that included socio-demographic characteristics, the SERVQUAL Scale, and an abbreviated form of the revised Eysenck Personality Questionnaire. This study is based on doctoral research in public health. The study found median values for personality trait sub-dimensions as follows: neuroticism: 2, psychoticism: 2.65, extraversion: 4, and lying: 5. The SERVQUAL Score was -0.02. The study revealed that the quality of primary health care services did not meet the participants' expectations. The study findings also indicated that age, educational attainment, and extraverted and psychotic personality traits were significantly associated with the satisfaction of service quality expectations (p < 0.05). It is recommended to provide primary health care services in facilities with good physical characteristics, with sufficient and competent health personnel, and in a timely and accurate manner to improve service quality.

The Reasons for Physicians and Pharmacists' Acceptance of Clinical Support Systems in Saudi Arabia

This research aims to identify the technological and non-technological factors influencing user acceptance of the CDSS in a group of healthcare facilities in Saudi Arabia. The study proposes an integrated model that indicates the factors to be considered when designing and evaluating CDSS. This model is developed by integrating factors from the "Fit between Individuals, Task, and Technology" (FITT) framework into the three domains of the human, organization, and technology-fit (HOT-fit) model. The resulting FITT-HOT-fit integrated model was tested using a quantitative approach to evaluate the currently implemented CDSS as a part of Hospital Information System BESTCare 2.0 in the Saudi Ministry of National Guard Health Affairs. For data collection, a survey questionnaire was conducted at all Ministry of National Guard Health Affairs hospitals. Then, the collected survey data were analyzed using Structural Equation Modeling (SEM). This analysis included measurement instrument reliability, discriminant validity, convergent validity, and hypothesis testing. Moreover, a CDSS usage data sample was extracted from the data warehouse to be analyzed as an additional data source. The results of the hypotheses test show that usability, availability, and medical history accessibility are critical factors influencing user acceptance of CDSS. This study provides prudence about healthcare facilities and their higher management to adopt CDSS.

Assessing primary health care readiness for large-scale electronic health record system implementation: Project team perspective

INTRODUCTION

The introduction of information technology was one of the key priorities for policymakers in healthcare organisations over the last two decades, due to the potential benefits of this technology to improve healthcare services and quality. However, about 50% of those projects failed to achieve their intended aims. This was as a result of several factors and included the level of readiness to the new IT projects.

AIM

The aim of the study was to assess the readiness of Saudi primary health care centres (PHCCs) readiness for the implementation of an electronic health record system (EHRS) from the project team perspective.

METHODS

Explanatory mixed methods design was used with both qualitative and quantitative methods. Thirty-one members of project team at the ministry of health (MOH) participated in the online-based questionnaire, while 13 participants from the same population took part in the semi-structure interviews. Eight different readiness scales were quantitatively examined. These scales include resources, Knowledge, process, management structure and administrative support, end user, technology and values and goals.

RESULT

Although, very high level of readiness has been recorded at the process, management structure and administrative support levels, readiness was average at the end user, technology and values and goals levels. Moreover, the study findings revealed that primary health care centres readiness for an electronic health record system must be considered in the early stages of implementation (pre-implementation phase), particularly readiness at a technical level, such as preparedness of the infrastructure. A positive significant correlation has been recorded between all readiness scales with centralization of management system and financial resources.

CONCLUSION

Overall, the level of primary health care centres readiness recorded to be high, which indicates that primary health care centres are ready for implementation of the electronic health record system, and in this context, management structure, organizational process, financial recourses and administrative support play significant roles to increase the project success rate.

A Crisis in the Health System and Quality of Healthcare in Economically Developed Countries

A health crisis caused by a pandemic tested the effectiveness of national healthcare systems by testing both financing and organizational and technical performance of patient care. At that time, the structural flaws in healthcare systems and inequalities in the level of healthcare in its different dimensions and countries due to resource constraints were highlighted. Therefore, the paper concentrates on investigating how the crisis in the health system affects the quality of healthcare services as a result of changes in the availability of financial, material, and human resources belonging to this system. The quantitative data, in terms of healthcare characterizing the OECD countries and selected non-member economies, treated as an example of economically developed regions, were chosen for the analysis. The study included five areas of resources, i.e., demographic, financial, human, technical, and the delivery of basic services in healthcare. T-test method for dependent samples, supplemented with Hedge's g statistics, was applied to test the differences between the mean values of individual indicators. The results indicate the occurrence of changes in some areas of the healthcare system due to a crisis. Identifying areas that are particularly vulnerable to sudden changes in the healthcare system helps to understand which resource areas need to be strategically managed first, as shifts in levels respond to deteriorating healthcare quality outcomes.

Autoimmune haemolytic anaemia due to immunodeficiency

Autoimmune disorders are common presenting manifestations of immunodeficiency syndromes. We present a case of a woman in her late teens, with a history of frequent sinopulmonary tract infections during her childhood, who presented to our hospital with anaemia, jaundice and fatigue. She also had significant physical growth retardation for her age and sex. With this case report, we intend to present the diagnostic and therapeutic challenges faced by the patient and our healthcare system and propose a few feasible solutions to tackle these challenges.

Support vector machine deep mining of electronic medical records to predict the prognosis of severe acute myocardial infarction

Cardiovascular disease is currently one of the most important diseases causing death in China and the world, and acute myocardial infarction is a major cause of cardiovascular disease. This study provides an analytical technique for predicting the prognosis of patients with severe acute myocardial infarction using a support vector machine (SVM) technique based on information gleaned from electronic medical records in the Medical Information Marketplace for Intensive Care (MIMIC)-III database. The MIMIC-III database provided 4785 electronic medical records data for inclusion in the model development after screening 7070 electronic medical records of patients admitted to the intensive care unit for treatment of acute myocardial infarction. Adopting the APS-III score as the criterion for identifying anticipated risk, the dimensions of data information incorporated into the mathematical model design were found using correlation coefficient matrix heatmaps and ordered logistic analysis. An automated prognostic risk-prediction model was developed using SVM, and the fit was evaluated by 5× cross-validation. We used a grid search method to further optimize the parameters and improve the model fit. The excellent generalization ability of SVM was fully verified by calculating the 95% confidence interval of the area under the receiver operating characteristic curve (AUC) for six algorithms (linear discriminant, tree, Kernel Naive Bayes, RUSBoost, KNN, and SVM). Compared to the remaining five models, its confidence interval was the narrowest with higher fitting accuracy and better performance. The patient prognostic risk prediction model constructed using SVM had a relatively impressive accuracy (92.2%) and AUC value (0.98). In this study, a model was designed for fitting that can maximize the potential information to be gleaned in the electronic medical records data. It was demonstrated that SVM models based on electronic medical records data can offer an effective solution for clinical disease prognostic risk assessment and improved clinical outcomes and have great potential for clinical application in the clinical treatment of myocardial infarction.

Restricted use of copy and paste in electronic health records potentially improves healthcare quality

ABSTRACT

The copy-and-paste feature is commonly used for clinical documentation, and a policy is needed to reduce overdocumentation. We aimed to determine if the restricted use of copy and paste by doctors could improve inpatient healthcare quality.Clinical documentation in an inpatient dataset compiled from 2016 to 2018 was used. Copied-and-pasted text was detected in word templates using natural language programming with a threshold of 70%. The prevalence of copying and pasting after the policy introduction was accessed by segmented regression for trend analysis. The rate of readmission for the same disease within 14 days was assessed to evaluate inpatient healthcare quality, and the completion of discharge summary notes within 3 days was assessed to determine the timeliness of note completion. The relationships between these factors were used cross-correlation to detect lag effect. Poisson regression was performed to identify the relative effect of the copy and paste restriction policy on the 14-day readmission rate or the discharge note completion rate within 3 days.The prevalence of copying and pasting initially decreased, then increased, and then flatly decreased. The cross-correlation results showed a significant correlation between the prevalence of copied-and-pasted text and the 14-day readmission rate (P < .001) and a relative risk of 1.105 (P < .005), with a one-month lag. The discharge note completion rate initially decreased and not affected long term after restriction policy.Appropriate policies to restrict the use of copying and pasting can lead to improvements in inpatient healthcare quality. Prospective research with cost analysis is needed.

Exploring the Gap Between Patients' Expectations and Perceptions of Healthcare Service Quality

PURPOSE

This study aimed to explore the gap between patients' expectations of healthcare service quality in ‎Jordanian hospitals against their perceptions of service received using SERVQUAL model.

METHODS

The study used a cross-sectional design. The study data were collected randomly from 415 patients (participants) ‎who completed the SERVEQUAL questionnaire. The data were analyzed using ‎statistical procedures such as descriptive, t-test, and ANOVA.

RESULTS

The results showed ‎that there is a gap between mean score of patients' expectations of what should be available in the ‎hospital and patients' perceptions of the service received in the hospital. Patients' expectations were higher than their perceptions on all five SERVQUAL domains (Tangibles, Reliability, Responsiveness, Assurance, and Empathy).

CONCLUSION

Hospital managers should take necessary actions to improve healthcare services in their hospitals with respect to all SERVQUAL domains. These actions should be directed to reduce the gap between patients' expectation and their perceptions in order to provide services meet patients' needs.

[Learning from coding data-surgical treatment of benign prostatic syndrome : Big data for BPS]

Benign prostatic syndrome (BPS) is one of the most common urological diseases. Currently, there are numerous surgical methods to treat BPS. The digitalisation of medicine enables new study approaches in healthcare research using digital data from individual treatment pathways. In the present work, BPS-specific longitudinal trend analyses were performed. Treatment-related figures, both with regard to the therapy methods and predefined patient cohorts, could be examined after validating the datasets. This meant that information on relevant characteristics of surgical BPS treatment could be read and calculations made that reflect the overall impact of these processes. In the future, it is expected that increasingly comprehensive, higher-quality digital datasets on different clinical pictures will be available for analytical purposes. Intensification of research projects in this field is desirable. The results thus obtained enable further optimisation steps of certain treatment actions and provide important key figures for the strategy development of a medical facility.

Improving the Quality of Medical Documentation in Orthopedic Surgical Notes Using the Surgical Tool for Auditing Records (STAR) Score

Aims Due to the significant value held by medical records in terms of influencing patient care and medico-legal cases, this study aimed to investigate the quality of surgical notes and their improvement through periodic auditing during a six-year period at a major tertiary hospital. Methodology This study retrospectively evaluated surgical records of patients undergoing elective orthopedic surgeries at Jordan University Hospital from 2016 to 2021 using the Surgical Tool for Auditing Records (STAR) validated questionnaire. This questionnaire is composed of six distinct sections aimed to quantify the quality of medical records and demonstrate their associated deficiencies. Pre- and post-audit STAR scores were analyzed using the two independent sample t-test on Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp. Armonk, NY). Results A total of 454 records were randomly selected and evaluated using the STAR questionnaire. There was an overall significant trend of improvement in the quality of records in all evaluated years compared to the 2016 baseline. The most pronounced improvements were in the records of 2021 as compared to the 2016 baseline (97.4 ± 0.7 vs. 94.3 ± 1.6; p:<0.05), in which the Initial Clerking, Subsequent Entries, and Operative Record domains had the most significant magnitude of change. The Consent and Anesthesia domains plateaued over the study's period in terms of overall quality. The most improved STAR domain was the Discharge Summary domain, in which four subsections (follow-up, diagnosis, complications, and medications on discharge) had significant STAR score increases (all; p:<0.05). Conclusion Our study implies that simple measures, including personnel education and training and periodic auditing, are effective measures in increasing the quality of surgical records. High-quality medical records need to be sustained and continuously improved, as they contribute to better health care, promote research, and contribute to economic gains through cost-effective practices.

A Cross-Cultural Perspective on the Blended Service Quality for Ride-Sharing Continuance

This research aims to elucidate the service quality factors influencing customer satisfaction with ride-sharing services. Particularly, this research compares Chinese and US consumers to identify the influence of national culture on user attitudes. Empirical research was conducted via two online surveys in China and the US. Data were collected and analyzed using partial least squares (PLS) analysis. The results show that while the satisfaction of the Chinese ride-sharing consumers was affected primarily by reliability, followed by platform assurance and empathy, the satisfaction of American consumers was influenced mainly by the conditions of ride-sharing vehicles (tangibles). The PLS-MGA results indicate that satisfaction with ride-sharing services had a significantly stronger impact on American than on Chinese continuance intention. Managerial implications are provided.

The Impact of Information and Communication Technology on Doctors' and Registered Nurses' Working Conditions and Clinical Work - A Cross-Sectional Study in a Norwegian Hospital

Purpose

Previous studies indicate that the introduction of information and communication technology (ICT) in health care organizations impairs health care professional’s working conditions and diminishes job discretion. Most of these studies, however, were designed to explore the influence of ICT exclusively on a single group of health care professionals and thereby did not consider the influence of the same technology on other groups of health care professionals. The aim of this article is to explore the influence of a fully integrated ICT system on both doctors and registered nurses within the same working environment: a high-tech hospital.

Methods

This is a cross-sectional study conducted in a high-tech Norwegian hospital. Data were collected in 2016. In total, 264 registered nurses and 172 doctors responded to a questionnaire on their working conditions and experiences with ICT in clinical work. Descriptive statistics, compare means, cross-tables, Chi-square and bivariate correlation analysis were used to analyze the data. Statistical significance was set at p < 0.05.

Results

The findings revealed differences in doctors' and registered nurses' working conditions. Registered nurses reported a statistically significant higher workload and better job content than doctors. There was no difference in job discretion between doctors and registered nurses. Both occupational groups experienced that the ICT system impairs patient contact and the quality of health services. We found statistically significant correlations between registered nurses’ and doctors’ experiences with ICT in clinical work and working conditions, whereof the strongest correlation was related to job discretion in clinical work.

Conclusion

This study concludes that the impact of ICT on doctors’ and registered nurses’ working conditions in a hospital depends on the experiences of ICT in clinical work. In consequence, it is recommended to involve doctors and registered nurses in the implementation of ICT in hospitals.

Electronic Health Records, Interoperability and Patient Safety in Health Systems of High-income Countries: A Systematic Review Protocol

INTRODUCTION

The availability and routine use of electronic health records (EHRs) have become commonplace in healthcare systems of many high-income countries. While there is an ever-growing body of literature pertaining to their use, evidence surrounding the importance of EHR interoperability and its impact on patient safety remains less clear. There is, therefore, a need and opportunity to evaluate the evidence available regarding this relationship so as to better inform health informatics development and policies in the years to come. This systematic review aims to evaluate the impact of EHR interoperability on patient safety in health systems of high-income countries.

METHODS AND ANALYSIS

A systematic literature review will be conducted via a computerised search through four databases: PubMed, Embase, Health Management Information Consortium and PsycInfo for relevant articles published between 2010 and 2020. Outcomes of interest will include impact on patient safety and the broader effects on health systems. Quality of the randomised quantitative studies will be assessed using Cochrane Risk of Bias Tool. Non-randomised papers will be evaluated with the Risk of Bias In Non-Randomised Studies-of Interventions tool. Drummond's Checklist will be used for publications pertaining to economic evaluation. The National Institute for Health and Care Excellence quality appraisal checklist will be used to assess qualitative studies. A narrative synthesis will be conducted for included studies, and the body of evidence will be summarised in a summary of findings table.

ETHICS AND DISSEMINATION

This review will summarise published studies with non-identifiable data and, thus, does not require ethical approval. Findings will be disseminated through preprints, open access peer-reviewed publications, and conference presentations.

PROSPERO REGISTRATION NUMBER

CRD42020209285.

The role of organizational factors in how efficiency-thoroughness trade-offs potentially affect clinical quality dimensions – a review of the literature

Purpose

The purpose of this paper is to increase knowledge of the role organizational factors have in how health personnel make efficiency-thoroughness trade-offs, and how these trade-offs potentially affect clinical quality dimensions.

Design/methodology/approach

The paper is a thematic synthesis of the literature concerning health personnel working in clinical, somatic healthcare services, organizational factors and clinical quality.

Findings

Identified organizational factors imposing trade-offs were high workload, time limits, inappropriate staffing and limited resources. The trade-offs done by health personnel were often trade-offs weighing thoroughness (e.g. providing extra handovers or working additional hours) in an environment weighing efficiency (e.g. ward routines of having one single handover and work-hour regulations limiting physicians' work hours). In this context, the health personnel functioned as regulators, balancing efficiency and thoroughness and ensuring patient safety and patient centeredness. However, sometimes organizational factors limited health personnel's flexibility in weighing these aspects, leading to breached medication rules, skipped opportunities for safety debriefings and patients being excluded from medication reviews.

Originality/value

Balancing resources and healthcare demands while maintaining healthcare quality is a large part of health personnel's daily work, and organizational factors are suspected to affect this balancing act. Yet, there is limited research on this subject. With the expected aging of the population and the subsequent pressure on healthcare services' resources, the balancing between efficiency and thoroughness will become crucial in handling increased healthcare demands, while maintaining high-quality care.

Retention of patient-held medical records for chronic diseases in Mozambique

Introduction

Non-Communicable Diseases (NCD) are becoming a public health problem in Mozambique and wider sub-Saharan Africa, and are driving changes to guaranty lifelong follow up of patients within the health systems. Patient-Held Medical Records (PHMR) are an option for this follow-up in under-resourced health systems. We designed a study to assess the rate of retention and quality of conservation of the PHMR.

Methods

we conducted a prospective observational study from November 2016 to October 2018 in a peri-urban hospital from in Mozambique. Consecutive newly diagnosed patients with cardiovascular disease were given PHMR. Data was collected after their first consultation and one year after. The retention and quality of conservation were assessed after 12 months.

Results

overall 134 PHMR were given to patients (24;17.9% children and 77;57.5% female), of which 121 (90.3%) retained at 12 months (90.9% in good conservation state). Most patients had on average four visits to health facilities during the study, all registered in the PHMR. Retention could not be confirmed in 13 patients who did not return the PHMR.

Conclusion

PHMR retention rates were high in an urban low-income setting in Africa, with high quality of conservation, thus supporting its use to replace hospital paper-based medical files. Specific research is recommended on acceptability, quality of information registered and patient´s perception.

Health informatics publication trends in Saudi Arabia: a bibliometric analysis over the last twenty-four years

OBJECTIVE

Understanding health informatics (HI) publication trends in Saudi Arabia may serve as a framework for future research efforts and contribute toward meeting national "e-Health" goals. The authors' intention was to understand the state of the HI field in Saudi Arabia by exploring publication trends and their alignment with national goals.

METHODS

A scoping review was performed to identify HI publications from Saudi Arabia in PubMed, Embase, and Web of Science. We analyzed publication trends based on topics, keywords, and how they align with the Ministry of Health's (MOH's) "digital health journey" framework.

RESULTS

The total number of publications included was 242. We found 1 (0.4%) publication in 1995-1999, 11 (4.5%) publications in 2000-2009, and 230 (95.0%) publications in 2010-2019. We categorized publications into 3 main HI fields and 4 subfields: 73.1% (n=177) of publications were in clinical informatics (85.1%, n=151 medical informatics; 5.6%, n=10 pharmacy informatics; 6.8%, n=12 nursing informatics; 2.3%, n=4 dental informatics); 22.3% (n=54) were in consumer health informatics; and 4.5% (n=11) were in public health informatics. The most common keyword was "medical informatics" (21.5%, n=52). MOH framework-based analysis showed that most publications were categorized as "digitally enabled care" and "digital health foundations."

CONCLUSIONS

The years of 2000-2009 may be seen as an infancy stage of the HI field in Saudi Arabia. Exploring how the Saudi Arabian MOH's e-Health initiatives may influence research is valuable for advancing the field. Data exchange and interoperability, artificial intelligence, and intelligent health enterprises might be future research directions in Saudi Arabia.

The role of e-health in improving control and management of COVID 19 outbreak: current perspectives

E-health could play an important role in the global response to Coronavirus disease 2019 (COVID-19). This paper aims to outline the roles of using e-health in the control and management of COVID-19 based on current perspectives. Many databases and health organizations were searched. The results indicated that there are significant roles of e-health in strengthening the efforts to control and manage this COVID-19 pandemic through improving safe coordination and communication, affording an alternative for education and training, analyzing the data, and providing safe care. Further studies are recommended to evaluate the role of e-health in the control and management of COVID-19.

Association between Electronic Medical Records and Healthcare Quality

The implementation of electronic medical records (EMRs) has generally been thought to improve medical efficiency and safety, but consistent evidence of improved healthcare quality due to EMRs in population-based studies is lacking. We assessed the relationship between the degree of EMR adoption and patient outcomes.We performed an observational study using discharge data from Tri-service General Hospital from 2013 to 2018. The levels of EMR utilization were divided into no EMRs, partial EMRs and full EMRs. The primary healthcare quality indicators were inpatient mortality, readmission within 14 days, and 48-hour postoperative mortality. We performed a Cox proportional hazards regression analysis to evaluate the relationship between the EMR utilization level and healthcare quality.In total, 262,569 patients were included in this study. Compared with no EMRs, full EMR implementation led to lower inpatient mortality [adjusted hazard ratio (HR) 0.947, 95% confidence interval (CI): 0.897-0.999, P = ..049] and a lower risk of readmission within 14 days (adjusted HR 0.627, 95% CI: 0.577-0.681, P < .001). Full EMR implementation was associated was a lower risk of 48-hour postoperative mortality (adjusted HR 0.372, 95% CI: 0.208-0.665, P = .001) than no EMRs. Partial EMR implementation was associated with a higher risk of readmission within 14 days than no EMRs (HR 1.387, 95% CI: 1.298-1.485, P < .001).Full EMR adoption improves healthcare quality in medical institutions treating severely ill patients. A prospective study is needed to confirm this finding.

User Acceptance of Electronic Medical Record System: Implementation at Marie Stopes International, Myanmar

Objectives

This study assessed the technical feasibility and aimed to determine the factors influencing intention to use Electronic Medical Records (EMRs) at Marie Stopes International, Myanmar (MSI-M).

Methods

A cross-sectional survey was conducted among 112 participants who were working at the clinics and head office of MSI-M. Demographic information, type of office, technical feasibility, information communication technology knowledge, computer usage, and user acceptance towards the proposed system were obtained from the participants.

Results

The results indicated low health information technology usage and network availability at MSI-M clinics. Positive perception of EMRs was found among the staff members of MSI-M, which was reflected by positive responses regarding perceived usefulness (average score of 4.15), perceived ease of use (average score of 4.03), and intention to use (average score of 4.10) on a 5-point Likert scale. Statistically, staff from the head office expressed less desire to implement an EMR system (odds ratio = 0.07; 95% confidence interval, 0.01–0.97), especially when they do not perceive the usefulness of the system (odds ratio = 5.05; 95% confidence interval, 2.39–10.69).

Conclusions

Since health information technology usage and network availability were low in MSI-M, it is important to strengthen the information and communication technology infrastructure and introduce a policy for capacity building at MSI-M. Adequate training and strong leadership support are recommended for the successful initial implementation and sustainability of an EMR system at MSI-M.