Twenty-five years of national health IT: exploring strategy, structure, and systems in the English NHS

The digital divide between primary and secondary care: An analysis using SARS-CoV-2 hospital admissions

Using data from two ED. departments of 773 patients admitted with SARS-CoV-2, ICD-10 codes derived from the General Practitioner - Summary Care Record (GP-SCR) and Emergency Department (ED.) records were analysed for code discrepancies and whether this related to increased mortality. The average number of ICD-10 codes in both GP-SCR and ED. records was higher for patients who died than patients who survived (all p < .0001). Pre-existing GP digital data provides a better prediction of mortality than data collected manually during admission clerking in the ED. Up to 78.47% of GP-SCR codes were missed in the ED. records and up to 45.49% of the ED. record codes were not in the GP-SCR. A subset of missed ICD-10 codes were identified as being able to predict outcome; a trend towards increasing death rate as the proportion of missed codes increases. Initiatives to make the GP-SCR available to the wider healthcare community should improve patient care and reduce bias during development of machine learning based algorithms.

Researching big IT in the UK National Health Service: A systematic review of theory-based studies

OBJECTIVE

To identify and discuss theory-based studies of large-scale health information technology programs in the UK National Health Service.

MATERIALS AND METHODS

Using the PRISMA systematic review framework, we searched Scopus, PubMed and CINAHL databases from inception to March 2022 for theory-based studies of large-scale health IT implementations. We undertook detailed full-text analyses of papers meeting our inclusion criteria.

RESULTS

Forty-six studies were included after assessment for eligibility, of which twenty-five applied theories from the information systems arena (socio-technical approaches, normalization process theory, user acceptance theories, diffusion of innovation), twelve from sociology (structuration theory, actor-network theory, institutional theory), while nine adopted other theories. Most investigated England's National Program for IT (2002-2011), exploring various technologies among which electronic records predominated. Research themes were categorized into user factors, program factors, process outcomes, clinical impact, technology, and organizational factors. Most research was qualitative, often using a case study strategy with a longitudinal or cross-sectional approach. Data were typically collected through interviews, observation, and document analysis; sampling was generally purposive; and most studies used thematic or related analyses. Theories were generally applied in a superficial or fragmentary manner; and articles frequently lacked detail on how theoretical constructs and relationships aided organization, analysis, and interpretation of data.

CONCLUSION

Theory-based studies of large NHS IT programs are relatively uncommon. As large healthcare programs evolve over a long timeframe in complex and dynamic environments, wider adoption of theory-based methods could strengthen the explanatory and predictive utility of research findings across multiple evaluation studies. Our review has confirmed earlier suggestions for theory selection, and we suggest there is scope for more explicit use of such theoretical constructs to strengthen the conceptual foundations of health informatics research. Additionally, the challenges of large national health informatics programs afford wide-ranging opportunities to test, refine, and adapt sociological and information systems theories.

The Large-Scale Implementation of a Health Information System in Brazilian University Hospitals: Process and Outcomes

Governments around the globe are paving the way for healthcare services that can have a profound impact on the overall well-being and development of their nations. However, government programs to implement health information technologies on a large-scale are challenging, especially in developing countries. In this article, the process and outcomes of the large-scale implementation of a hospital information system for the management of Brazilian university hospitals are analyzed. Based on a qualitative approach, this research involved 21 hospitals and comprised a documentary search, interviews with 24 hospital managers and two system user focus groups, and a questionnaire of 736 respondents. Generally, we observed that aspects relating to the wider context of system implementation (macro level), the managerial structure, cultural nuances, and political dynamics within each hospital (meso level), as well as the technology, work activities, and individuals themselves (micro level) acted as facilitators and/or obstacles to the implementation process. The dynamics and complex interactions established between these aspects had repercussions on the process, including the extended time necessary to implement the national program and the somewhat mixed outcomes obtained by hospitals in the national network. Mostly positive, these outcomes were linked to the eight emerging dimensions of practices and work processes; planning, control, and decision making; transparency and accountability; optimization in the use of resources; productivity of professionals; patient information security; safety and quality of care; and improvement in teaching and research. We argued here that to maximize the potential of information technology in healthcare on a large-scale, an integrative and cooperative vision is required, along with a high capacity for change management, considering the different regional, local, and institutional contexts.

Health Information Exchange: Understanding the Policy Landscape and Future of Data Interoperability

OBJECTIVES

To review recent literature on health information exchange (HIE), focusing on the policy approach of five case study nations: the United States of America, the United Kingdom, Germany, Israel, and Portugal, as well as synthesize lessons learned across countries and provide recommendations for future research.

METHODS

A narrative review of each nation's HIE policy frameworks, current state, and future HIE strategy.

RESULTS

Key themes that emerged include the importance of both central decision-making as well as local innovation, the multiple and complex challenges of broad HIE adoption, and the varying role of HIE across different national health system structures.

CONCLUSION

HIE is an increasingly important capability and policy priority as electronic health record (EHR) adoption becomes more common and care delivery is increasingly digitized. While all five case study nations have adopted some level of HIE, there are significant differences across their level of data sharing infrastructure and maturity, and each nation took a different policy approach. While identifying generalizable strategies across disparate international systems is challenging, there are several common themes across successful HIE policy frameworks, such as the importance of central government prioritization of data sharing. Finally, we make several recommendations for future research to expand the breadth and depth of the literature on HIE and guide future decision-making by policymakers and practitioners.

Health Information System and Health Care Applications Performance in the Healthcare Arena: A Bibliometric Analysis

There have been several studies centred on health information systems with many insights provided to enhance health care applications globally. These studies have provided theoretical schemes for fortifying the enactment and utilisation of the Health Information System (HIS). In addition, these research studies contribute greatly to the development of HIS in alignment with major stakeholders such as health practitioners and recipients of health care. Conversely, there has been trepidation about HIS' sustainability and resilience for healthcare applications in the era of digitalization and globalization. Hence, this paper investigates research on HIS with a primary focus on health care applications to ascertain its sustainability and resilience amidst the transformation of the global healthcare space. Therefore, using a bibliometric approach, this paper measures the performance of health information systems and healthcare for health care applications using bibliometric data from the web of science database. The findings reveal solid evidence of the constructive transformation of health information systems and health care applications in the healthcare arena, providing ample evidence of the adaptation of HIS and health care applications within the healthcare arena to the fourth industrial revolution and, additionally, revealing the resilient alignment of health care applications and health information systems.

Digital Health Policy and Programs for Hospital Care in Vietnam: Scoping Review

Background

There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence–based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government’s requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability.

Objective

This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals.

Methods

We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Thư Viện Pháp Luật, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step.

Results

In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians’ performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system’s capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks.

Conclusions

Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting.

Identifying strategies to overcome roadblocks to utilising near real-time healthcare and administrative data to create a Scotland-wide learning health system

Creating a learning health system could help reduce variations in quality of care. Success is dependent on timely access to health data. To explore the barriers and facilitators to timely access to patients' data, we conducted in-depth semi-structured interviews with 37 purposively sampled participants from government, the NHS and academia across Scotland. Interviews were analysed using the framework approach. Participants were of the view that Scotland could play a leading role in the exploitation of routine data to drive forward service improvements, but highlighted major impediments: (i) persistence of paper-based records and a variety of information systems; (ii) the need for a proportionate approach to managing information governance; and (iii) the need for support structures to facilitate accrual, processing, linking, analysis and timely use and reuse of data for patient benefit. There is a pressing need to digitise and integrate existing health information infrastructures, guided by a nationwide proportionate information governance approach and the need to enhance technological and human capabilities to support these efforts.

Electronic health records for better health in the lower- and middle-income countries

Purpose

Electronic health records (EHR) can enable collection and use of data for achieving better health both at the patient and population health levels. The World Health Organization's (WHO) draft 2019 four-year global digital health strategy aims to “improve health for everyone, everywhere by accelerating the adoption of appropriate digital health” and EHRs are key to achieving better health goals. Despite the fact that EHRs can help to achieve better health, there is lack of evidence explaining national and sub-national EHR development in the limited resource settings.

Design/methodology/approach

We conducted a landscape study to describe the EHR development and use in the low- and middle-income countries for achieving better health. We reviewed literature from four scientific databases and analyzed gray literature identified in consultation with 17 international experts.

Findings

The findings of this literature review are presented in three subsections. The first two subsections describe key stakeholders for development of national and sub-national EHR and health information architecture which includes status of ehealth foundations, EHR, and sub-systems in the country. The third subsection presents and discusses key challenges related to sustainability of national and sub-national EHRs. The findings in these three subsections are further explored through examples of health information flow in Uganda, and electronic medical record/EHR implementation in Sierra Leone and Malawi. These examples briefly describe stakeholders, information architecture, and sustainability challenges.

Originality/value

This paper fills an important research gap and clearly explains the urgent research need to build context-specific EHR development models to enable use of data for better health.