Evolution of health information management and information technology in emergency medicine

Management of information within emergencies departments in developing countries: analysis at the National Emergency Department in Benin

Introduction

The management of health information is a key pillar in both emergencies reception and handling facilities, given the strategic position and the potential of these facilities within hospitals, and in the monitoring of public health and epidemiology. With the technological revolution, computerization made the information systems evolve in emergency departments, especially in developed countries, with improved performance in terms of care quality, productivity and patient satisfaction. This study analyses the situation of Benin in this field, through the case of the Academic Clinic of Emergency Department of the National University Teaching Hospital of Cotonou, the national reference hospital.

Methods

The study is cross-sectional and evaluative. Collection techniques are literature review and structured interviews. The components rated are resources, indicators, data sources, data management and the use-dissemination of the information through a model adapted from Health Metrics Network framework. We used quantitative and qualitative analysis.

Results

The absence of a regulatory framework restricts the operation of the system in all components and accounts for the lack and inadequacy of the dedicated resources.

Conclusion

Dedication of more resources for this system for crucial needs such as computerization requires sensitization and greater awareness of the administrative authorities about the fact that an effective health information management system is of prime importance in this type of facility.

A two phase study to revise the Australian Practice Standards for Specialist Critical Care Nurses

BACKGROUND

Observational work to develop the ACCCN Competency Standards was undertaken more than 20 years ago. Since then the landscape of critical care nursing as a specialty has changed and it is not known if the Competency Standards reflected contemporary practice.

OBJECTIVES

To revise the ACCCN Competency Standards for Specialist Critical Care Nurses to ensure they continue to meet the needs of critical care nurses and reflect current practice.

METHODS

A two-phased project was undertaken. In Phase I focus groups were held in all states. Thematic analysis was conducted using two techniques. The standards were revised based on the main themes. Phase II consisted of an eDelphi technique. A national panel of critical care nurses responded to three survey rounds using a 7 point likert-type scale to indicate their level of agreement with the revised standards. A 70% agreement level for each statement was determined a priori.

RESULTS

Phase I: 12 focus groups (79 participants) were conducted. Phase II: A panel of specialist critical care nurses (research, management, clinical practice and education) responded to round 1 (n=64), round 2 (n=56), and round 3 (n=40). Fifteen practice standards with elements and performance criteria were grouped into four domains (professional practice, provision and coordination of care, critical thinking and analysis, collaboration and leadership). The revised Practice Standards for Specialist Critical Care Nurses build upon and are additional to the Nursing & Midwifery Board of Australia National Competency Standards for Registered Nurses. The standards reflect contemporary critical care nurse practices using an expanded range of technologies to care for complex critically ill patients across the lifespan in diverse settings.

CONCLUSION

The national study has resulted in the 3rd edition of the Practice Standards for Specialist Critical Care Nurses. There was input from stakeholders and agreement that the revised standards capture contemporary Australian critical care nursing practice.

Assessing and comparing information security in swiss hospitals

BACKGROUND

Availability of information in hospitals is an important prerequisite for good service. Significant resources have been invested to improve the availability of information, but it is also vital that the security of this information can be guaranteed.

OBJECTIVE

The goal of this study was to assess information security in hospitals through a questionnaire based on the International Organization for Standardization (ISO) and the International Electrotechnical Commission (IEC) standard ISO/IEC 27002, evaluating Information technology - Security techniques - Code of practice for information-security management, with a special focus on the effect of the hospitals' size and type.

METHODS

The survey, set up as a cross-sectional study, was conducted in January 2011. The chief information officers (CIOs) of 112 hospitals in German-speaking Switzerland were invited to participate. The online questionnaire was designed to be fast and easy to complete to maximize participation. To group the analyzed controls of the ISO/IEC standard 27002 in a meaningful way, a factor analysis was performed. A linear score from 0 (not implemented) to 3 (fully implemented) was introduced. The scores of the hospitals were then analyzed for significant differences in any of the factors with respect to size and type of hospital. The participating hospitals were offered a benchmark report about their status.

RESULTS

The 51 participating hospitals had an average score of 51.1% (range 30.6% - 81.9%) out of a possible 100% where all items in the questionnaire were fully implemented. Room for improvement could be identified, especially for the factors covering "process and quality management" (average score 1.3 ± 0.8 out of a maximum of 3) and "organization and risk management" (average score 1.3 ± 0.7 out of a maximum of 3). Private hospitals scored significantly higher than university hospitals in the implementation of "security zones" and "backup" (P = .008).

CONCLUSIONS

Half (50.00%, 8588/17,177) of all assessed hospital beds in German-speaking Switzerland are in hospitals that have a score of 49% or less of the maximum possible score in information security. Patient data need to be better protected because of the data protection laws and because sensitive, personal data should be guaranteed confidentiality, integrity, and availability.

First medical contact and physicians' opinion after the implementation of an electronic record system

Hospitals implement electronic medical record systems (EMRSs) that are intended to support medical and nursing staff in their daily work. Evolution toward more computerization seems inescapable. Nevertheless, this evolution introduced new problems of organization. This before-and-after observational study evaluated the door-to-first-medical-contact (FMC) times before and after the introduction of EMRS. A satisfaction questionnaire, administered after the "after" period, measured clinicians' satisfaction concerning computerization in routine clinical use. The following 5 questions were asked: Do you spare time in your note taking with EMRS? Do you spare time in the medical care that you provide to the patients with EMRS? Does EMRS improve the quality of medical care for your patients? Are you satisfied with the EMRS implementation? Would you prefer a return to handwritten records? Results showed an increase in door-to-FMC time induced by EMRS and a lower triage capacity. In the satisfaction questionnaire, clinicians reported minimal satisfaction but refused to return to handwritten records. The increase in door-to-FMC time may be explained by the improved quantity/quality of data and by the many interruptions due to the software. Medical reorganization was requested after the installation of the EMRS.

Electronic interface for emergency department management of asthma: a randomized control trial of clinician performance

OBJECTIVES

To evaluate the effectiveness of an integrated and dynamic electronic decision support system for management of acute asthma in the ED.

METHODS

A randomized trial was conducted comparing clinician performance using this electronic interface compared with paper documentation in a simulation scenario. The outcomes were documentation of asthma-related information and consultation times.

RESULTS

Use of this electronic interface was associated with significantly higher rates of documentation in 7 out of 10 variables, including provision of written short-term asthma management plans. After adjustment for participant seniority, there was no significant difference in consultation times.

CONCLUSION

In a simulation trial, use of this electronic interface was associated with improvements in clinical and discharge documentation. Further studies are required to test this prototype in clinical practice.