Use of information and communication technologies to support effective work practice innovation in the health sector: a multi-site study

ICT Application and Use in Health Sciences Research at the Global Level: A Scientometric Study

The growing use of information and communication technology has now expanded to health professionals in practice. This study aimed to highlight the current status of Information and Communication Technology (ICT) use in health sciences as reported in journal papers between 2002 and 2021. This paper presents the annual trends, top institutes and countries, citations, h-index, keywords distribution, and top authors in this research domain. The data were extracted from the Web of Science database, and R studio and Bibexcel tools were used for analysis. The study analyzed a total of 140 documents published over a span of two decades. Health Care Sciences Services (34) and Computer Science published the most health science articles (29). The USA (19) was the most productive country, followed by England (16) and the Netherlands (15). Berg M was the most productive author, with 36 articles. The results show that institutions such as Erasmus University and Duke University have published numerous articles on the topic, encouraged by specific R&D funding schemes, and made a significant contribution to the development of health sciences research. The findings of this study offer valuable information about international initiatives and projects relevant to the advancement of ICT in health science research, which may be utilized to pinpoint potential future study topics such as artificial intelligence development.

[Feasibility of using artificial intelligence for screening COVID-19 patients in ParaguayViabilidade do uso de inteligência artificial na triagem de pacientes com COVID-19 no Paraguai]

Objetivo.

Estudiar la factibilidad de utilización de la inteligencia artificial como método sensible y específico para el cribado de COVID-19 en pacientes con afecciones respiratorias empleando imágenes de tórax obtenidas con tomógrafo y una plataforma de telemedicina.

Métodos.

Entre marzo del 2020 y junio del 2021 se realizó un estudio observacional descriptivo multicéntrico de factibilidad basada en inteligencia artificial (IA) para el cribado de COVID-19 en imágenes de tórax de pacientes con afecciones respiratorias que acudieron a hospitales públicos. El diagnóstico de las imágenes tomográficas de tórax se realizó a través de la plataforma de IA; luego, se comparó con el diagnóstico molecular (RT-PCR) para determinar la concordancia entre ambos y analizar su factibilidad para el cribado de pacientes con sospecha de COVID-19. Las imágenes y los resultados diagnóstico se enviaron a través de una plataforma de telemedicina.

Resultados.

Se realizó el cribado de 3 514 pacientes con sospecha diagnóstica de COVID-19, en 14 hospitales a nivel nacional. La mayoría de los pacientes tenían entre 27 y 59 años, seguidos por los mayores de 60 años. La edad promedio fue de 48,6 años; el 52,8% eran de sexo masculino. Los hallazgos más frecuentes fueron neumonía grave, neumonía bilateral con derrame pleural, enfisema pulmonar bilateral y opacidad difusa en vidrio esmerilado, entre otros. Se determinó un promedio de 93% de concordancia y 7% de discordancia entre las imágenes analizadas mediante IA y la RT-PCR. La sensibilidad y especificidad del sistema de IA, obtenidas comparando el resultado del cribado obtenido por IA con la RT-PCR, fueron de 93% y 80% respectivamente.

Conclusiones.

Es viable la utilización de IA sensible y específica para la detección rápida estratificada de COVID-19 en pacientes con afecciones respiratorias utilizando imágenes obtenidas mediante tomografía de tórax y una plataforma de telemedicina en los hospitales públicos de Paraguay.

Experience Delivering Tele-practice Services among Upcoming and Working Professionals of Speech Language Pathology

Introduction Since the outbreak of the COVID-19 epidemic, tele-practice has become the new normal in the field of Speech-Language Pathology. Students and professionals throughout the country are embracing this new normal. Both groups confront problems; documentation of the problems may provide insight into how to improve tele-practice services.

Aim The purpose of this study was to compare the problems that undergraduate students, postgraduate students, and working professionals in the field of Speech-Language Pathology experience in daily practice.

Methods A descriptive cross-sectional survey study using a web-based questionnaire was conducted to examine the obstacles experienced by students and working professionals in the field of speech-language pathology, as well as their perspectives about tele-practice. There was a total of 20 questions. Divided into four sections, closed questions and Likert scale questions were used for demographic details, practice aspects, experience during telerehabilitation, and evaluation and treatment.

Results The study had 118 participants (47% postgraduate students, 29% undergraduate students, and 24% professionals). Only 16% of clinicians were properly trained to provide services via tele-mode. All participants reported providing service to the pediatric population to be challenging, with autism spectrum disorder, fluency disorders, and hearing impairment to be difficult to handle cases. In tele-mode, undergraduate students reported a decrease in the number of cases and difficulties selecting therapy materials when compared with the other two groups. All three groups reported a lack of evidence-based teletherapy resources available. There was no difference in perceived difficulty between the three groups while conducting assessment and achieving treatment goals via tele-mode.

Conclusion Tele-practice is generally recognized and employed, according to data availability. In terms of resource selection, evaluation, and treatment sessions, the difficulties faced by students and experts are disturbing. In the realm of speech-language pathology, strategies to address these issues could pave the way for tele-practice. As a result, better policies are strongly advised to address these difficulties to improve future tele-mode service quality.

Rapid screening for COVID-19 by applying artificial intelligence to chest computed tomography images: A feasibility study

Aim

The aim of the study was to present the results and impact of the application of artificial intelligence (AI) in the rapid diagnosis of COVID-19 by telemedicine in public health in Paraguay.

Methods

This is a descriptive, multi-centered, observational design feasibility study based on an AI tool for the rapid detection of COVID-19 in chest computed tomography (CT) images of patients with respiratory difficulties attending the country's public hospitals. The patients' digital CT images were transmitted to the AI diagnostic platform, and after a few minutes, radiologists and pneumologists specialized in COVID-19 downloaded the images for evaluation, confirmation of diagnosis, and comparison with the genetic diagnosis (reverse transcription polymerase chain reaction (RT-PCR)). It was also determined the percentage of agreement between two similar AI systems applied in parallel to study the viability of using it as an alternative method of screening patients with COVID-19 through telemedicine.

Results

Between March and August 2020, 911 rapid diagnostic tests were carried out on patients with respiratory disorders to rule out COVID-19 in 14 hospitals nationwide. The average age of patients was 50.7 years, 62.6% were male and 37.4% female. Most of the diagnosed respiratory conditions corresponded to the age group of 27-59 years (252 studies), the second most frequent corresponded to the group over 60 years, and the third to the group of 19-26 years. The most frequent findings of the radiologists/pneumologists were severe pneumonia, bilateral pneumonia with pleural effusion, bilateral pulmonary emphysema, diffuse ground glass opacity, hemidiaphragmatic paresis, calcified granuloma in the lower right lobe, bilateral pleural effusion, sequelae of tuberculosis, bilateral emphysema, and fibrotic changes, among others. Overall, an average of 86% agreement and 14% diagnostic discordance was determined between the two AI systems. The sensitivity of the AI system was 93% and the specificity 80% compared with RT-PCR.

Conclusion

Paraguay has an AI-based telemedicine screening system for the rapid stratified detection of COVID-19 from chest CT images of patients with respiratory conditions. This application strengthens the integrated network of health services, rationalizing the use of specialized human resources, equipment, and inputs for laboratory diagnosis.

Bibliometric Study of Technology and Occupational Health in Healthcare Sector: A Worldwide Trend to the Future

Since the eighties, technological tools have modified how people interact in their environment. At the same time, occupational safety and health measures have been widely applied. The European Agency for Safety and Health at Work considers that information and communication technologies are the main methods to achieve the goals proposed to improve working life and the dissemination of good practices. The principal objective was to determine the trends of publications focused on these technologies and occupational safety in the healthcare sector during the last 30 years. A bibliometric study was carried out. The 1021 documents showed an increased trend per country, especially for the United States (p < 0.001) and year (p < 0.001). The citations per year showed significant differences between citations of articles published before 2007 (p < 0.001). The year was also linked to the increase or decrease of articles (72.2%) and reviews (14.9%) (p < 0.001). The analysis of journal co-citations also showed that the main journals (such as Infection Control and Hospital Epidemiology) were linked to other important journals and had a major part in the clusters formed. All these findings were discussed in the manuscript and conclusions were drawn.

Sicily Network for Liver Cancer: A Multidisciplinary Network Model for the Management of Primary Liver Tumors

Background: The management of primary liver tumors requires the involvement of multiple specialist skills and the best possible treatment in terms of cost, risk, and benefit that could be provided by hepatobiliary or transplant surgeon, interventional radiologist, hepatologist, radiotherapist, or oncologist is needed to be chosen for each patient. This is particularly relevant for hepatocellular carcinoma (HCC), that is the most common primary liver tumor, and it occurs in more than 90% of cases in the setting of cirrhosis. Methods: To address the increasing complexity of cancer care, multidisciplinary tumor boards (MDTBs) have evolved to offer patients appropriate and tailored cancer treatments. In Sicily (Italy), MDTBs have been organized in a Regional Network, the Sicily Network for Liver Cancer, that answers to the need for an equal and fair access to cancer care, to improve the diagnostic and therapeutic appropriateness, to ease patients care, to improve the efficacy of cancer treatments, and finally to optimize the risk-cost-benefit ratio of therapies and follow-up. Results: It has been shown that multidisciplinary management is associated with significantly improved survival in patients with liver cancer. In this study, we present the aims, the organization, and the current and future activities of the Sicily Network for Liver Cancer, an integrated health care multidisciplinary network for the management of patients with primary liver tumors in Sicily. Conclusions: The coexistence of two diseases (HCC and cirrhosis) requires the expertise of many physicians to provide optimal care to patients with HCC. Treatment decisions should be discussed in multidisciplinary meetings, as no single treatment strategy can be applied to all patients, and treatment must be individualized to improve overall survival of patients with liver tumors.

National electrocardiographic mapping by telemedicine for diagnosis and prevention of cardiological pathologies in Paraguay

Introduction:

Telemedicine tools offer multiple advantages to achieve an epidemiological screening of communities in rural settings countrywide. However, evidence on the cardiological pathology surveillance in these communities is limited. The feasibility of telemedicine as an electrocardiographic (EKG) mapping tool for the diagnosis and prevention of cardiological pathologies in Paraguay was investigated.

Methods:

A descriptive study was conducted in 60 telediagnostic centers countrywide in Paraguay to evaluate the feasibility of telemedicine as an EKG mapping tool for the diagnosis and prevention of cardiological pathologies over a period of 5 years from 2014 to 2018. The adherence rate was determined comparing yearly scheduled visits versus fulfilled visits at the telemedicine platform.

Results:

During the study, 246,217 remote EKG diagnoses were performed in 60 hospitals using telemedicine. The patients were 19.4% children/adolescents and 80.6% adults. The results of EKG tests in the children/adolescent group were 79.4% normal and 20.6% abnormal. The most frequent abnormal heart rhythms observed were sinusal bradicardia (10.6%), sinusal tachycardia (3.2%), and unspecified arrhythmia (2.8%). In the adult group, the results were 66.3% normal and 33.7% abnormal. The most frequent abnormal heart rhythms in this group were sinusal bradicardia (11.2%), blockade of the right branch (4.8%), and left ventricular hypertrophy (4.7%). The most frequent cardiovascular risk factors observed were the association of hypertension and obesity (40%), hypertension and diabetes (20%), and hypertension and dyslipidemia (19%). During the test period (2014–2018), the average rate of patient adherence to the prevention program was 2.26 for each 1000 diagnosis.

Conclusion:

These results demonstrate the feasibility of telemedicine as an EKG mapping tool for the diagnosis and prevention of cardiological pathologies in low-resource countries, thus enhancing cardiovascular disease surveillance and optimizing human and financial resources.

Delivering safe and effective test-result communication, management and follow-up: a mixed-methods study protocol

INTRODUCTION

The failure to follow-up pathology and medical imaging test results poses patient-safety risks which threaten the effectiveness, quality and safety of patient care. The objective of this project is to: (1) improve the effectiveness and safety of test-result management through the establishment of clear governance processes of communication, responsibility and accountability; (2) harness health information technology (IT) to inform and monitor test-result management; (3) enhance the contribution of consumers to the establishment of safe and effective test-result management systems.

METHODS AND ANALYSIS

This convergent mixed-methods project triangulates three multistage studies at seven adult hospitals and one paediatric hospital in Australia.Study 1 adopts qualitative research approaches including semistructured interviews, focus groups and ethnographic observations to gain a better understanding of test-result communication and management practices in hospitals, and to identify patient-safety risks which require quality-improvement interventions.Study 2 analyses linked sets of routinely collected healthcare data to examine critical test-result thresholds and test-result notification processes. A controlled before-and-after study across three emergency departments will measure the impact of interventions (including the use of IT) developed to improve the safety and quality of test-result communication and management processes.Study 3 adopts a consumer-driven approach, including semistructured interviews, and the convening of consumer-reference groups and community forums. The qualitative data will identify mechanisms to enhance the role of consumers in test-management governance processes, and inform the direction of the research and the interpretation of findings.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the South Eastern Sydney Local Health District Human Research Ethics Committee and Macquarie University. Findings will be disseminated in academic, industry and consumer journals, newsletters and conferences.

Perceptions of Risk Stratification Workflows in Primary Care

Risk stratification (RS) in primary care is frequently used by policy-makers, payers, and health systems; the process requires risk assessment for adverse health outcomes across a population to assign patients into risk tiers and allow care management (CM) resources to be targeted effectively. Our objective was to understand the approach to and perception of RS in primary care practices. An online survey was developed, tested, and administered to 148 representatives of 37 primary care practices engaged in RS varying in size, location and ownership. The survey assessed practices’ approach to, perception of, and confidence in RS, and its effect on subsequent CM activities. We examined psychometric properties of the survey to determine validity and conducted chi-square analyses to determine the association between practice characteristics and confidence and agreement with risk scores. The survey yielded a 68% response rate (100 respondents). Overall, participants felt moderately confident in their risk scores (range 41–53.8%), and moderately to highly confident in their subsequent CM workflows (range 46–68%). Respondents from small and independent practices were more likely to have higher confidence and agreement with their RS approaches and scores (p < 0.01). Confidence levels were highest, however, when practices incorporated human review into their RS processes (p < 0.05). This trend was not affected by respondents’ professional roles. Additional work from a broad mixed-methods effort will add to our understanding of RS implementation processes and outcomes.

[Public health impact of a remote diagnosis system implemented in regional and district hospitals in Paraguay]

Objetivo.

Determinar la viabilidad y puesta en marcha de un sistema de telediagnóstico para dar asistencia sanitaria a poblaciones remotas y dispersas del Paraguay.

Métodos.

El estudio fue realizado en todos los hospitales regionales, generales y principales hospitales distritales de las 18 regiones sanitarias del Paraguay. En el sistema se registraron los datos clínicos y las imágenes tomográficas, ecográficas y trazados electrocardiográficos del paciente que precisaba de un diagnóstico por parte de un médico especialista. Esta información se transmitió a los especialistas en imagenología y en cardiología para su diagnóstico remoto y posterior envío del informe a los hospitales conectados al sistema. Se analizó el costo-beneficio e impacto de la herramienta de telediagnóstico desde la perspectiva del Sistema Nacional de Salud.

Resultados.

Entre enero de 2014 y mayo de 2015 se realizaron 34 096 telediagnósticos distribuidos en 25 hospitales a través del Sistema de Telemedicina del Ministerio de Salud. El costo unitario promedio del diagnóstico remoto fue de USD 2,6 (dólares estadounidenses) para electrocardiograma (ECG), tomografía y ecografía, mientras que el costo unitario para el diagnóstico “cara a cara” fue de UDS 11,8 para ECG; USD 68,6 para tomografía y USD 21,5 para ecografía. La reducción del costo mediante el diagnóstico remoto fue de 4,5 veces para ECG; 26,4 veces para tomografía y de 8,3 veces para ecografía. En términos monetarios, la implementación del sistema de telediagnóstico, durante los 16 meses del estudio, significó un ahorro promedio de USD 2 420 037.

Conclusión.

Paraguay cuenta con un sistema de telediagnóstico para electrocardiografía, tomografía y ecografía aplicando las tecnologías de la información y comunicación (TIC) de bajo costo, basadas en software libre y escalable a otros tipos de estudios diagnósticos a distancia; de interés para la salud pública. Con una aplicación práctica del telediagnóstico, se contribuyó al fortalecimiento de la red integrada de servicios y programas de salud, lo que permitió maximizar el tiempo del profesional y su productividad, mejorar la calidad, aumentar el acceso y la equidad, y disminuir los costos.

Waste in health information systems: a systematic review

Purpose

The purpose of this paper is to discuss a systematic review on waste identification related to health information systems (HIS) in Lean transformation.

Design/methodology/approach

A systematic review was conducted on 19 studies to evaluate Lean transformation and tools used to remove waste related to HIS in clinical settings.

Findings

Ten waste categories were identified, along with their relationships and applications of Lean tool types related to HIS. Different Lean tools were used at the early and final stages of Lean transformation; the tool selection depended on the waste characteristic. Nine studies reported a positive impact from Lean transformation in improving daily work processes. The selection of Lean tools should be made based on the timing, purpose and characteristics of waste to be removed.

Research limitations/implications

Overview of waste and its category within HIS and its analysis from socio-technical perspectives enabled the identification of its root cause in a holistic and rigorous manner.

Practical implications

Understanding waste types, their root cause and review of Lean tools could subsequently lead to the identification of mitigation approach to prevent future error occurrence.

Originality/value

Specific waste models for HIS settings are yet to be developed. Hence, the identification of the waste categories could guide future implementation of Lean transformations in HIS settings.

Technology meets tradition: The perceived impact of the introduction of information and communication technology on ward rounds in the intensive care unit

BACKGROUND

Public policy in many health systems is currently dominated by the quest to find ways to 'do more with less'-to achieve better outcomes at a reduced cost. The success or failure of initiatives in support of this quest are often understood in terms of an adversarial dynamic or struggle between the professional logics of medicine and of management. Here, we use the case of the introduction of information and communication technology (ICT) to a well-established ritual of medical autonomy (the medical ward round) to articulate a more nuanced explanation of how and why new ways of working with technology are accepted and adopted (or not).

METHODS

The study was conducted across four intensive care units (ICUs) in major teaching hospitals in Sydney, Australia. Using interviews, we examined 48 doctors' perceptions of the impact of ICT on ward round practice. We applied the concept of institutional logics to frame our analysis. Interview transcripts were analysed using a hybrid of deductive and inductive thematic analysis.

RESULTS

The doctors displayed a complex engagement with the technology that belies simplistic characterisations of medical rejection of managerial encroachment. In fact, they selectively welcomed into the ward round aspects of the technology which reinforced the doctor's place in the healthcare hierarchy and which augmented their role as scientists. At the same time, they guarded against allowing managerial logic embedded in ICT to de-emphasise their embodied subjectivity in relation to the patient as a person rather than as a collection of parameters.

CONCLUSION

ICT can force the disruption of some aspects of existing routines, even where these are long-established rituals. Resistance arose when the new technology did not fit with the 'logic of care'. Incorporation of the logic of care into the design and customisation of clinical information systems is a challenge and potentially counterproductive, because it could attempt to apply a technological fix to what is essentially a social problem. However, there are significant opportunities to ensure that new technologies do not obstruct doctors' roles as carers nor disrupt the embodied relationship they need to have with patients.

Social challenges when implementing information systems in everyday work in a nursing context

Implementation of information systems in healthcare has become a lengthy process where healthcare staff (eg, nurses) are expected to put information into systems without getting the overall picture of the potential usefulness for their own work. The aim of this study was to explore social challenges when implementing information systems in everyday work in a nursing context. Moreover, this study aimed at putting perceived social challenges in a theoretical framework to address them more constructively when implementing information systems in healthcare. Influenced by institutional ethnography, the findings are based on interviews, observations, and written reflections. Power (changing the existing hierarchy, alienation), professional identity (calling on hold, expert becomes novice, changed routines), and encounter (ignorant introductions, preconceived notions) were categories (subcategories) presented in the findings. Social Cognitive Theory, Diffusion of Innovations, organizational culture, and dramaturgical analysis are proposed to set up a theoretical framework. If social challenges are not considered and addressed in the implementation process, it will be affected by nurses' solidarity to existing power structures and their own professional identity. Thus, implementation of information systems affects more aspects in the organization than might have been intended. These aspects need to be taken in to account in the implementation process.

Epilepsy services in Ireland: 'A survey of people with epilepsy in relation to satisfaction, preferences and information provision'

BACKGROUND

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland.

METHOD

A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre.

RESULTS

Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted.

CONCLUSION

This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision.

Organizational framework for health information technology

PURPOSE

We do not yet know how best to design, implement, and use health information technology (IT). A comprehensive framework that captures knowledge on the implementation, use, and optimization of health IT will help guide more effective approaches in the future.

METHODS

The authors conducted a targeted review of existing literature on health IT implementation and use, including health IT-related theories and models. By crosswalking elements of current theories and models, the authors identified five major facets of an organizational framework that provides a structure to organize and capture information on the implementation and use of health IT.

RESULTS

The authors propose a novel organizational framework for health IT implementation and use with five major facets: technology, use, environment, outcomes, and temporality. Each major facet is described in detail along with associated categories and measures.

CONCLUSION

The proposed framework is an essential first step toward ensuring a more consistent and comprehensive understanding of health IT implementation and use and a more rigorous approach to data collection, measurement development, and theory building.

Does the implementation of an electronic prescribing system create unintended medication errors? A study of the sociotechnical context through the analysis of reported medication incidents

Background

Even though electronic prescribing systems are widely advocated as one of the most effective means of improving patient safety, they may also introduce new risks that are not immediately obvious. Through the study of specific incidents related to the processes involved in the administration of medication, we sought to find out if the prescribing system had unintended consequences in creating new errors. The focus of this study was a large acute hospital in the Midlands in the United Kingdom, which implemented a Prescribing, Information and Communication System (PICS).

Methods

This exploratory study was based on a survey of routinely collected medication incidents over five months. Data were independently reviewed by two of the investigators with a clinical pharmacology and nursing background respectively, and grouped into broad types: sociotechnical incidents (related to human interactions with the system) and non-sociotechnical incidents. Sociotechnical incidents were distinguished from the others because they occurred at the point where the system and the professional intersected and would not have occurred in the absence of the system. The day of the week and time of day that an incident occurred were tested using univariable and multivariable analyses. We acknowledge the limitations of conducting analyses of data extracted from incident reports as it is widely recognised that most medication errors are not reported and may contain inaccurate data. Interpretation of results must therefore be tentative.

Results

Out of a total of 485 incidents, a modest 15% (n = 73) were distinguished as sociotechnical issues and thus may be unique to hospitals that have such systems in place. These incidents were further analysed and subdivided into categories in order to identify aspects of the context which gave rise to adverse situations and possible risks to patient safety. The analysis of sociotechnical incidents by time of day and day of week indicated a trend for increased proportions of these types of incidents occurring on Sundays.

Conclusion

Introducing an electronic prescribing system has the potential to give rise to new types of risks to patient safety. Being aware of these types of errors is important to the clinical and technical implementers of such systems in order to, where possible, design out unintended problems, highlight training requirements, and revise clinical practice protocols.

The health care journeys experienced by people with epilepsy in Ireland: what are the implications for future service reform and development?

Opportunities exist to significantly improve the quality and efficiency of epilepsy care in Ireland. Historically, epilepsy research has focused on quantitative methodologies that often fail to capture the invaluable insight of patient experiences as they negotiate their health care needs. Using a phenomenological approach, we conducted one-to-one interviews with people with epilepsy, reporting on their understanding of their health care journey from onset of symptoms through to their first interaction with specialist epilepsy services. Following analysis of the data, five major themes emerged: delayed access to specialist epilepsy review; uncertainty regarding the competency and function of primary care services; significant unmet needs for female patients with epilepsy; disorganization of existing epilepsy services; and unmet patient information needs. The findings reveal important insights into the challenges experienced by people with epilepsy in Ireland and identify the opportunities for future service reorganization to improve the quality and efficiency of care provided.