Advancing health information technology roadmaps in long term care

Assessing Associations Between Health Information Technology Maturity and Nursing Home Survey Deficiencies

One in three nursing home (NH) residents experience adverse events. One strategy for safer NH care is health information technology (HIT). Two national NH surveys measuring HIT maturity were administered in 2020 (N = 719) and 2021 (N = 312). Quarterly NH survey deficiencies from the same years were linked to HIT maturity surveys. Descriptive statistics and logistic regression were used in analysis. NHs were of similar size and location, with more for-profit facilities. Most (67.5% and 61.9%, respectively) NH administrators reported having capabilities to share data internally within their facility, and not externally. Mean HIT maturity scores increased from Year 1 to Year 2. Over 2 years, 5,406 deficiencies were reported, mostly (31.3%) for nutrition and dietary deficiencies. There were negative associations between HIT maturity and deficiency scope. With a 1-unit increase in HIT maturity, relative risk of widespread scope decreased by 14%. Among covariates, bed size, staffing, and year were significant factors associated with deficiency scope. [Journal of Gerontological Nursing, 50(1), 8-14.].

Information security and privacy in hospitals: a literature mapping and review of research gaps

Information security and privacy are matters of concern in every industry. The healthcare sector has lagged in terms of implementing cybersecurity measures. Therefore, hospitals are more exposed to cyber events due to the criticality of patient data. Currently, little is known about state-of-the-art research on information security and privacy in hospitals. The purpose of this study is to report the outcome of a systematic literature review on research about the application of information security and privacy in hospitals. A systematic literature review following the PRISMA methodology was conducted. To reference our sample according to cybersecurity domains, we benchmarked each article against two cybersecurity frameworks: ISO 27001 Annex A and the NIST framework core. Limited articles in our papers referred to the policies and compliance sections of ISO 27001. In addition, most of our sample is classified by the NIST function "Protect," meaning activities related to identity management, access control and data security. Furthermore, we have identified key domains where research in security and privacy are critical, such as big data, IOT, cloud computing, standards and regulations. The results indicate that although cybersecurity is a growing concern in hospitals, research is still weak in some areas. Considering the recrudescence of cyber-attacks in the healthcare sector, we call for more research in hospitals in managerial and non-technical domains of information security and privacy that are uncovered by our analysis.

Understanding health information exchange processes within Canadian long-term care: A scoping review

BACKGROUND

Providing supportive care to long-term care residents with complex medical conditions generates substantial amounts of health information. This information must be documented, shared and acted upon by the various care providers within the circle of care.

OBJECTIVES

The purpose of this scoping review is to describe the current digital health information exchange (HIE) processes used within Canadian long-term care facilities (LTCFs).

METHODS

The scoping review followed Arksey and O'Malley's approach to the methodology. Electronic databases (e.g. CINAHL, MEDLINE and SCOPUS) were searched between 2010 and 2020 using terms including 'health information exchange', 'communication' and 'health information technology'. Articles were included if they were Canadian-based and relevant to our definition of health information exchange.

RESULTS

The search yielded 2091 citations for title and abstract screening; 78 citations were selected for independent full-text review, 42 of those met study criteria. The findings revealed gaps between the expectations of HIE for quality health care and the realities of HIE processes that impact the provision of care in long-term care.

CONCLUSIONS

We conclude that increased provider engagement and effective use of HIE processes is recommended to improve the safety and quality of health care in the long-term care sector.

IMPLICATIONS FOR PRACTICE

HIE implementation should be preceded a review of various aspects of workflow to identify information gaps and inefficiencies that can be addressed by digitization.

Calling all nurses-Now is the time to take action on improving the quality of care in nursing homes

For a number of decades, nurses have raised concerns about nursing-related issues in nursing homes (NH) such as inadequate registered nurse (RN) staffing, insufficient RN and advanced practice registered nurse (APRN) gerontological expertise, and lack of RN leadership competencies. The NASEM Committee on the Quality of Care in Nursing Homes illuminated the long-standing issues and concerns affecting the quality of care in nursing homes and proposed seven goals and associated recommendations intended to achieve the Committee's vision: Nursing home residents receive care in a safe environment that honors their values and preferences, addresses goals of care, promotes equity, and assesses the benefits and risks of care and treatments. This paper outlines concrete and specific actions nurses and nursing organizations can take to ensure the recommendations are implemented.

Design and process optimization of combined medical and elderly care services: An integrated service blueprint-TRIZ model

China's increasingly aging population is resulting in an imbalance between supply and demand for elderly care resources. The theory of "combined medical and elderly care" (CMEC) has introduced a new perspective in the conception of China's elderly care problems. This study employed the service blueprint, fuzzy failure mode and effects analysis (Fuzzy-FMEA), and the theory of inventive problem solving (TIPS or the Russian acronym TRIZ) for the process optimization of CMEC services in three phases. In the first phase (service process analysis), potential service failure points in the service process were analyzed using the service blueprint technique. In the second phase (service failure diagnosis), Fuzzy-FMEA was applied to diagnose the service failure modes and explore the possible causes and effects. The service failure modes were then prioritized based on fuzzy numbers and the cumulative fuzzy risk priority number (Fuzzy-RPN). Finally, in the third phase (generation of service optimization solutions), the TRIZ parameters, inventive principles, and contradiction matrix were first employed to select TRIZ inventive principles. The selected TRIZ inventive principles were then used to inspire inventive solutions for new service processes. Finally, a case study was conducted on the service processes of elderly care institutions to demonstrate the applicability of the optimization solutions.

Nursing Home-Sensitive Hospitalizations and the Relevance of Telemedicine: A Scoping Review

The aging of society is increasing the number of hospitalizations of nursing home residents. Telemedicine might help reduce the frequency of these potentially risk-associated hospitalizations. This scoping review looked for evidence of a change in the rate of hospitalization and, if mentioned, any cost savings and/or staff acceptance of the use of telemedicine in a nursing home setting. To identify available evidence, the electronic databases PubMed, Livivo, EBSCO and JSTOR were searched (without time or regional constraints) for comparative primary research studies on this topic in peer-reviewed journals. A total of 1127 articles were retrieved and 923 titles and abstracts were screened, with 16 studies published between 2001 and 2022 being included. Telemedicine consultation reduced the hospitalization of nursing home residents in 14/16 and care costs in 8/11 articles. Staff satisfaction was mentioned positively in five studies. Most studies used telemedicine involving medical diagnostic technologies (10), (electronic) health records (9), specialists (9) and specialized nursing staff (11). Few studies had a higher level of evidence: only one randomized clinical trial was included. There is the need for high credibility studies, using guidelines on protocol and reporting, to better understand the hindering and facilitating factors of telemedicine provision in the healthcare of nursing home residents.

Development and Pilot Analysis of the Nursing Home Health Information Technology Maturity Survey and Staging Model

The current research includes a psychometric test of a nursing home (NH) health information technology (HIT) maturity survey and staging model. NHs were assembled based on HIT survey scores from a prior study representing NHs with low (20%), medium (60%), and high (20%) HIT scores. Inclusion criteria were NHs that completed at least two annual surveys over 4 years. NH administrators were excluded who participated in the Delphi panel responsible for instrument recommendations. Recruitment occurred from January to May 2019. Administrators from 121 of 429 facilities completed surveys. NHs were characteristically for-profit, medium bed size, and metropolitan. A covariance matrix demonstrated that all dimensions and domains were significantly correlated, except HIT capabilities and integration in administrative activities. Cronbach's alpha was very good (0.86). Principal component analysis revealed all items loaded intuitively onto four components, explaining 80% variance. The HIT maturity survey and staging model can be used to assess nine dimensions and domains, total HIT maturity, and stage, leading to reliable assumptions about NH HIT. [Research in Gerontological Nursing, 15(2), 93-99.].

Technology‐driven 5G enabled e‐healthcare system during COVID‐19 pandemic

Technology‐driven control measures could be an important tool to control the COVID‐19 pandemic crisis. This study evaluates the potentiality of emerging technologies such as 5G and 6G communication, Deep Learning (DL), big data, Internet of Things (IoT) etc. for controlling the COVID‐19 transmission and ensuring health safety. The healthcare sector is able to provide a unified, rapid, and incessant service to people by applying modern wireless connectivity tools like 5G or 6G during the COVID‐19 pandemic. This study has identified eight key areas of applications for the COVID‐19 management like infection detection; travel history analysis; identification of infection symptoms; early detection; transmission identification; access to information in lockdown; movement of people; and development of medical treatments and vaccines. Data have been collected from the respondents living in Sakaka city, KSA during pandemic. This study reveals that most people receive information from social networking sites, health professionals, and television without facing any challenges. The analysis shows that, during the COVID‐19 pandemic, about 42% of respondents felt tense always or most of the time in a day. Only 28.6% of respondents felt tense sometimes, whereas the remainder (about 30%) did not feel tense in relation to the COVID‐19 crisis. Satisfaction with COVID‐19‐related information is also positively correlated with COVID‐19‐related information literacy (r = 0.53, p < 0.01) that is also positively correlated with depression or emotion, anxiety, and stress (r = ‐0.15, p < 0.05). The long‐term pandemic is creating several psychological symptoms including anxiety, stress, and depression, irrespective of age.

Stakeholders’ Views on Priorities Essential for Establishing a Supportive Environment for Clinical Trials in Nursing Homes

BACKGROUND

The U.S. clinical research enterprise in nursing homes was unprepared to mount clinical trials in nursing homes to address urgent questions relevant to prevention and treatment during the COVID-19 pandemic. We identify priorities essential for establishing a supportive environment for future clinical trials in nursing homes.

METHODS

Two cross-sectional online questionnaires were administered between January and February 2021. One was administered to nursing home providers, researchers, and policymakers; respondents rated the importance of attributes of researchers, facilities, leaders and staff for conducting clinical trials in nursing homes. Because importance may depend on trial type, respondents rated each attribute for efficacy trials (testing an intervention in ideal circumstances) and effectiveness trials (testing an intervention in "real world" circumstances). We calculated the attribute rating means and standard deviations, and used content analysis to characterize open-ended responses. The second questionnaire for resident family members and advocates included open-ended questions about nursing home research, and factors influencing willingness to participate.

RESULTS

The attributes rated as most essential for conducting efficacy and effectiveness trials in nursing homes are research team attributes, that is, that researchers recognize regulatory constraints; understand and adapt to nursing home workflow; and work collaboratively with nursing home leaders to identify priorities. Resident and facility diversity emerged as essential for effectiveness trials; important dimensions included resident race, ethnicity and income, as well as nursing home urban/rural location, quality ratings, geography, staffing ratios, size, and profit status. Caregivers and resident advocates stressed the importance of communication among participants, researchers, and nursing home leadership and staff at all stages of a trial.

CONCLUSION

Developing a robust U.S. clinical research enterprise capable of efficiently mounting future clinical trials in nursing homes will require a reimagining of the relationships that exist between researchers, facilities, nursing home leaders, and residents, with a research infrastructure specifically focused on supporting and fostering these connections.

Routine Health Information Systems in the European Context: A Systematic Review of Systematic Reviews

(1) Background: The aim of this study is to provide a better understanding of the requirements to improve routine health information systems (RHISs) for the management of health systems, including the identification of best practices, opportunities, and challenges in the 53 countries and territories of the WHO European region. (2) Methods: We conducted an overview of systematics reviews and searched the literature in the databases MEDLINE/PubMed, Cochrane, EMBASE, and Web of Science electronic databases. After a meticulous screening, we identified 20 that met the inclusion criteria, and RHIS evaluation results were presented according to the Performance of Routine Information System Management (PRISM) framework. (3) Results: The reviews were published between 2007 and 2020, focusing on the use of different systems or technologies and aimed to analyze interventions on professionals, centers, or patients' outcomes. All reviews examined showed variability in results in accordance with the variability of interventions and target populations. We have found different areas for improvement for RHISs according to the three determinants of the PRISM framework that influence the configuration of RHISs: technical, organizational, or behavioral elements. (4) Conclusions: RHIS interventions in the European region are promising. However, new global and international strategies and the development of tools and mechanisms should be promoted to highly integrate platforms among European countries.