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Bostan S, Johnson OA, Jaspersen LJ, Randell R. Contextual Barriers to Implementing Open-Source Electronic Health Record Systems for Low- and Lower-Middle-Income Countries: Scoping Review. J Med Internet Res 2024; 26:e45242. [PMID: 39088815 DOI: 10.2196/45242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/29/2023] [Accepted: 02/09/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Low- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. OBJECTIVE This interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research. METHODS We conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach. RESULTS This review included 13 studies that examined open-source EHRs' adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes. CONCLUSIONS While open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers' experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.
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Affiliation(s)
- Sarah Bostan
- Leeds University Business School, University of Leeds, Leeds, United Kingdom
- School of Healthcare, University of Leeds, Leeds, United Kingdom
- School of Computing, University of Leeds, Leeds, United Kingdom
| | - Owen A Johnson
- School of Computing, University of Leeds, Leeds, United Kingdom
| | - Lena J Jaspersen
- Leeds University Business School, University of Leeds, Leeds, United Kingdom
| | - Rebecca Randell
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
- Wolfson Centre for Applied Health Research, Bradford, United Kingdom
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2
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Tsafnat G, Dunscombe R, Gabriel D, Grieve G, Reich C. Converge or Collide? Making Sense of a Plethora of Open Data Standards in Health Care. J Med Internet Res 2024; 26:e55779. [PMID: 38593431 DOI: 10.2196/55779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 03/13/2024] [Indexed: 04/11/2024] Open
Abstract
Practitioners of digital health are familiar with disjointed data environments that often inhibit effective communication among different elements of the ecosystem. This fragmentation leads in turn to issues such as inconsistencies in services versus payments, wastage, and notably, care delivered being less than best-practice. Despite the long-standing recognition of interoperable data as a potential solution, efforts in achieving interoperability have been disjointed and inconsistent, resulting in numerous incompatible standards, despite the widespread agreement that fewer standards would enhance interoperability. This paper introduces a framework for understanding health care data needs, discussing the challenges and opportunities of open data standards in the field. It emphasizes the necessity of acknowledging diverse data standards, each catering to specific viewpoints and needs, while proposing a categorization of health care data into three domains, each with its distinct characteristics and challenges, along with outlining overarching design requirements applicable to all domains and specific requirements unique to each domain.
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Affiliation(s)
- Guy Tsafnat
- Evidentli Pty Ltd, Surry Hills, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie Univeristy, Macquarie Park, Australia
- OHDSI OMOP + FHIR Working Group,
| | - Rachel Dunscombe
- openEHR International, St. Helens, United Kingdom
- Imperial College London, London, United Kingdom
| | - Davera Gabriel
- Evidentli Pty Ltd, Surry Hills, Australia
- OHDSI OMOP + FHIR Working Group,
- School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Grahame Grieve
- Health Level 7 International, Ann Arbor, MI, United States
- Health Intersections Pty Ltd, Melbourne, Australia
| | - Christian Reich
- OHDSI OMOP + FHIR Working Group,
- Odysseus Data Services, Cambridge, MA, United States
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Yogev D, Goldberg T, Arami A, Tejman-Yarden S, Winkler TE, Maoz BM. Current state of the art and future directions for implantable sensors in medical technology: Clinical needs and engineering challenges. APL Bioeng 2023; 7:031506. [PMID: 37781727 PMCID: PMC10539032 DOI: 10.1063/5.0152290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Implantable sensors have revolutionized the way we monitor biophysical and biochemical parameters by enabling real-time closed-loop intervention or therapy. These technologies align with the new era of healthcare known as healthcare 5.0, which encompasses smart disease control and detection, virtual care, intelligent health management, smart monitoring, and decision-making. This review explores the diverse biomedical applications of implantable temperature, mechanical, electrophysiological, optical, and electrochemical sensors. We delve into the engineering principles that serve as the foundation for their development. We also address the challenges faced by researchers and designers in bridging the gap between implantable sensor research and their clinical adoption by emphasizing the importance of careful consideration of clinical requirements and engineering challenges. We highlight the need for future research to explore issues such as long-term performance, biocompatibility, and power sources, as well as the potential for implantable sensors to transform healthcare across multiple disciplines. It is evident that implantable sensors have immense potential in the field of medical technology. However, the gap between research and clinical adoption remains wide, and there are still major obstacles to overcome before they can become a widely adopted part of medical practice.
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Affiliation(s)
| | | | | | | | | | - Ben M. Maoz
- Authors to whom correspondence should be addressed: and
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Louw C. Digital Public Health Solutions in Response to the COVID-19 Pandemic: Comparative Analysis of Contact Tracing Solutions Deployed in Japan and Germany. J Med Internet Res 2023; 25:e44966. [PMID: 37314852 DOI: 10.2196/44966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/06/2023] [Accepted: 05/08/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND In response to the COVID-19 pandemic, numerous countries, including the likes of Japan and Germany, initiated, developed, and deployed digital contact tracing solutions in an effort to detect and interrupt COVID-19 transmission chains. These initiatives indicated the willingness of both the Japanese and German governments to support eHealth solution development for public health; however, end user acceptance, trust, and willingness to make use of the solutions delivered through these initiatives are critical to their success. Through a case-based analysis of contact tracing solutions deployed in Japan and Germany during the COVID-19 pandemic we may gain valuable perspectives on the transnational role of digital technologies in crises, while also projecting possible directions for future pandemic technologies. OBJECTIVE In this study, we investigate (1) which types of digital contact tracing solutions were developed and deployed by the Japanese and German governments in response to the COVID-19 pandemic and (2) how many of these solutions are open-source software (OSS) solutions. Our objective is to establish not only the type of applications that may be needed in response to a pandemic from the perspective of 2 geographically diverse, world-leading economies but also how prevalent OSS pandemic technology development has been in this context. METHODS We analyze the official government websites of Japan and Germany to identify digital solutions that are developed and deployed for contact tracing purposes (for any length of time) during the timeframe January-December 2021, specifically in response to the COVID-19 pandemic. We subsequently perform a case-oriented comparative analysis, also identifying which solutions are published as open-source. RESULTS In Japan, a proximity tracing tool (COVID-19 Contact-Confirming Application [COCOA]) and an outbreak management tool (Health Center Real-time Information-sharing System on COVID-19 [HER-SYS]) with an integrated symptom tracking tool (My HER-SYS) were developed. In Germany, a proximity tracing tool (Corona-Warn-App) and an outbreak management tool (Surveillance Outbreak Response Management and Analysis System [SORMAS]) were developed. From these identified solutions, COCOA, Corona-Warn-App, and SORMAS were published as open-source, indicating support by both the Japanese and German governments for OSS pandemic technology development in the context of public health. CONCLUSIONS Japan and Germany showed support for developing and deploying not only digital contact tracing solutions but also OSS digital contact tracing solutions in response to the COVID-19 pandemic. Despite the open nature of such OSS solutions' source code, software solutions (both OSS and non-OSS) are only as transparent as the live or production environment where their processed data is hosted or stored. Software development and live software hosting are thus 2 sides of the same coin. It is nonetheless arguable that OSS pandemic technology solutions for public health are a step in the right direction for enhanced transparency in the interest of the greater public good.
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Affiliation(s)
- Candice Louw
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
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5
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Peplinski JE, Pearce JM. Economic Efficiency of an Open-Source National Medical Lab Software in Canada. J Med Syst 2023; 47:50. [PMID: 37081312 PMCID: PMC10119013 DOI: 10.1007/s10916-023-01949-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/15/2023] [Indexed: 04/22/2023]
Abstract
Although the Canada federal government has invested over $3.1 billion developing health information technology (HIT), all 10 provinces still have their own separate HIT systems, which are non-interoperable, expensive, and inconsistent. After first reviewing how these systems operate, this paper analyzes the costs and savings of integrating the common billing, lab results, and diagnostic imaging (BLD) functions of these separate systems using free and open-source software and proposes a system for this, HermesAPI. Currently, 8 provincial governments representing over 95% of Canada's population allow private companies to create their own electronic medical records (EMR) system and integrate with provincial BLD systems. This study found the cost to develop and maintain HermesAPI would be between CAD$610,000 to CAD$740,000, but would prevent CAD$120,000 per company per province in development costs for a total savings of $6.4 million. HermesAPI would lower barriers to entry for the HIT industry to increase competition, improve the quality of HIT products, and ultimately patient care. The proposed open-source approach of the HermesAPI is one option towards building a more interoperable, less expensive, and more consistent HIT system for Canada.
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Affiliation(s)
- Jack E. Peplinski
- Department of Electrical and Computer Engineering and Ivey Business School, Western University, London, ON Canada
| | - Joshua M. Pearce
- Department of Electrical and Computer Engineering and Ivey Business School, Western University, London, ON Canada
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Faujdar DS, Prinja S, Singh T, Sahay S, Kumar R. Costing analysis of an information & communications technology-enabled primary healthcare facility in India. Indian J Med Res 2023; 157:231-238. [PMID: 37282386 PMCID: PMC10438417 DOI: 10.4103/ijmr.ijmr_454_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND & OBJECTIVES Information and communications technology (ICT) has often been endorsed as an effective tool to improve primary healthcare. However, evidence on the cost of ICT-enabled primary health centre (PHC) is lacking. The present study aimed at estimating the costs for customization and implementation of an integrated health information system for primary healthcare at a public sector urban primary healthcare facility in Chandigarh. METHODS We undertook economic costing of an ICT-enabled PHC based on health system perspective and bottom-up costing. All the resources used for the provision of ICT-enabled PHC, capital and recurrent, were identified, measured and valued. The capital items were annualized over their estimated life using a discount rate of 3 per cent. A sensitivity analysis was undertaken to assess the effect of parameter uncertainties. Finally, we assessed the cost of scaling up ICT-enabled PHC at the state level. RESULTS The estimated overall annual cost of delivering health services through PHC in the public sector was ₹ 7.88 million. The additional economic cost of ICT was ₹ 1.39 million i.e. 17.7 per cent over and above a non-ICT PHC cost. In a PHC with ICT, the cost per capita increased by ₹ 56. On scaling up to the state level (with 400 PHCs), the economic cost of ICT was estimated to be ₹ 0.47 million per year per PHC, which equates to approximately six per cent expenditure over and above the economic cost of a regular PHC. INTERPRETATION & CONCLUSIONS Implementing a model of information technology-PHC in a state of India would require an augmentation of cost by about six per cent, which seems fiscally sustainable. However, contextual factors related to the availability of infrastructure, human resources and medical supplies for delivering quality PHC services will also need to be considered.
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Affiliation(s)
| | - Shankar Prinja
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Tarundeep Singh
- Department of Community Medicine & School of Public Health, Chandigarh, India
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Rajesh Kumar
- Department of Community Medicine & School of Public Health, Chandigarh, India
- Former Dean (Academic), Postgraduate Institute of Medical Education & Research, Chandigarh, India
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Lario R, Kawamoto K, Sottara D, Eilbeck K, Huff S, Del Fiol G, Soley R, Middleton B. A method for structuring complex clinical knowledge and its representational formalisms to support composite knowledge interoperability in healthcare. J Biomed Inform 2023; 137:104251. [PMID: 36400330 DOI: 10.1016/j.jbi.2022.104251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/08/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The use and interoperability of clinical knowledge starts with the quality of the formalism utilized to express medical expertise. However, a crucial challenge is that existing formalisms are often suboptimal, lacking the fidelity to represent complex knowledge thoroughly and concisely. Often this leads to difficulties when seeking to unambiguously capture, share, and implement the knowledge for care improvement in clinical information systems used by providers and patients. OBJECTIVES To provide a systematic method to address some of the complexities of knowledge composition and interoperability related to standards-based representational formalisms of medical knowledge. METHODS Several cross-industry (Healthcare, Linguistics, System Engineering, Standards Development, and Knowledge Engineering) frameworks were synthesized into a proposed reference knowledge framework. The framework utilizes IEEE 42010, the MetaObject Facility, the Semantic Triangle, an Ontology Framework, and the Domain and Comprehensibility Appropriateness criteria. The steps taken were: 1) identify foundational cross-industry frameworks, 2) select architecture description method, 3) define life cycle viewpoints, 4) define representation and knowledge viewpoints, 5) define relationships between neighboring viewpoints, and 6) establish characteristic definitions of the relationships between components. System engineering principles applied included separation of concerns, cohesion, and loose coupling. RESULTS A "Multilayer Metamodel for Representation and Knowledge" (M*R/K) reference framework was defined. It provides a standard vocabulary for organizing and articulating medical knowledge curation perspectives, concepts, and relationships across the artifacts created during the life cycle of language creation, authoring medical knowledge, and knowledge implementation in clinical information systems such as electronic health records (EHR). CONCLUSION M*R/K provides a systematic means to address some of the complexities of knowledge composition and interoperability related to medical knowledge representations used in diverse standards. The framework may be used to guide the development, assessment, and coordinated use of knowledge representation formalisms. M*R/K could promote the alignment and aggregated use of distinct domain-specific languages in composite knowledge artifacts such as clinical practice guidelines (CPGs).
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Affiliation(s)
- Robert Lario
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | | | - Karen Eilbeck
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Stanley Huff
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States; Graphite Health, Salt Lake City, UT, United States
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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8
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Shen-Gunther J, Cai H, Wang Y. HPV Integration Site Mapping: A Rapid Method of Viral Integration Site (VIS) Analysis and Visualization Using Automated Workflows in CLC Microbial Genomics. Int J Mol Sci 2022; 23:ijms23158132. [PMID: 35897706 PMCID: PMC9331699 DOI: 10.3390/ijms23158132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023] Open
Abstract
Human papillomavirus (HPV) integration within the host genome may contribute to carcinogenesis through various disruptive mechanisms. With next-generation sequencing (NGS), identification of viral and host genomic breakpoints and chimeric sequences are now possible. However, a simple, streamlined bioinformatics workflow has been non-existent until recently. Here, we tested two new, automated workflows in CLC Microbial Genomics, i.e., Viral Hybrid Capture (VHC) Data Analysis and Viral Integration Site (VIS) Identification for software performance and efficiency. The workflows embedded with HPV and human reference genomes were used to analyze a publicly available NGS dataset derived from pre- and cancerous HPV+ cervical cytology of 21 Gabonese women. The VHC and VIS workflow median runtimes were 19 and 7 min per sample, respectively. The VIS dynamic graphical outputs included read mappings, virus-host genomic breakpoints, and virus-host integration circular plots. Key findings, including disrupted and nearby genes, were summarized in an auto-generated report. Overall, the VHC and VIS workflows proved to be a rapid and accurate means of localizing viral-host integration site(s) and identifying disrupted and neighboring human genes. Applying HPV VIS-mapping to pre- or invasive tumors will advance our understanding of viral oncogenesis and facilitate the discovery of prognostic biomarkers and therapeutic targets.
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Affiliation(s)
- Jane Shen-Gunther
- Gynecologic Oncology & Clinical Investigation, Department of Clinical Investigation, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA
- Correspondence: (J.S.-G.); (Y.W.)
| | - Hong Cai
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA;
- South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Yufeng Wang
- Department of Molecular Microbiology and Immunology, University of Texas at San Antonio, San Antonio, TX 78249, USA;
- South Texas Center for Emerging Infectious Diseases, University of Texas at San Antonio, San Antonio, TX 78249, USA
- Correspondence: (J.S.-G.); (Y.W.)
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9
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Ye Y, Barapatre S, Davis MK, Elliston KO, Davatzikos C, Fedorov A, Fillion-Robin JC, Foster I, Gilbertson JR, Lasso A, Miller JV, Morgan M, Pieper S, Raumann BE, Sarachan BD, Savova G, Silverstein JC, Taylor DP, Zelnis JB, Zhang GQ, Cuticchia J, Becich MJ. Open-source Software Sustainability Models: Initial White Paper From the Informatics Technology for Cancer Research Sustainability and Industry Partnership Working Group. J Med Internet Res 2021; 23:e20028. [PMID: 34860667 PMCID: PMC8686402 DOI: 10.2196/20028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 12/14/2020] [Accepted: 09/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background The National Cancer Institute Informatics Technology for Cancer Research (ITCR) program provides a series of funding mechanisms to create an ecosystem of open-source software (OSS) that serves the needs of cancer research. As the ITCR ecosystem substantially grows, it faces the challenge of the long-term sustainability of the software being developed by ITCR grantees. To address this challenge, the ITCR sustainability and industry partnership working group (SIP-WG) was convened in 2019. Objective The charter of the SIP-WG is to investigate options to enhance the long-term sustainability of the OSS being developed by ITCR, in part by developing a collection of business model archetypes that can serve as sustainability plans for ITCR OSS development initiatives. The working group assembled models from the ITCR program, from other studies, and from the engagement of its extensive network of relationships with other organizations (eg, Chan Zuckerberg Initiative, Open Source Initiative, and Software Sustainability Institute) in support of this objective. Methods This paper reviews the existing sustainability models and describes 10 OSS use cases disseminated by the SIP-WG and others, including 3D Slicer, Bioconductor, Cytoscape, Globus, i2b2 (Informatics for Integrating Biology and the Bedside) and tranSMART, Insight Toolkit, Linux, Observational Health Data Sciences and Informatics tools, R, and REDCap (Research Electronic Data Capture), in 10 sustainability aspects: governance, documentation, code quality, support, ecosystem collaboration, security, legal, finance, marketing, and dependency hygiene. Results Information available to the public reveals that all 10 OSS have effective governance, comprehensive documentation, high code quality, reliable dependency hygiene, strong user and developer support, and active marketing. These OSS include a variety of licensing models (eg, general public license version 2, general public license version 3, Berkeley Software Distribution, and Apache 3) and financial models (eg, federal research funding, industry and membership support, and commercial support). However, detailed information on ecosystem collaboration and security is not publicly provided by most OSS. Conclusions We recommend 6 essential attributes for research software: alignment with unmet scientific needs, a dedicated development team, a vibrant user community, a feasible licensing model, a sustainable financial model, and effective product management. We also stress important actions to be considered in future ITCR activities that involve the discussion of the sustainability and licensing models for ITCR OSS, the establishment of a central library, the allocation of consulting resources to code quality control, ecosystem collaboration, security, and dependency hygiene.
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Affiliation(s)
- Ye Ye
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Seemran Barapatre
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Michael K Davis
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Keith O Elliston
- Axiomedix, Inc., Bedford, MA, United States.,PHEMI Systems Corp., Vancouver, BC, Canada.,tranSMART foundation, Wakefield, MA, United States
| | - Christos Davatzikos
- Department of Radiology, School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Andrey Fedorov
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Ian Foster
- Department of Computer Science, University of Chicago, Chicago, IL, United States
| | - John R Gilbertson
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andras Lasso
- The Perk Lab for Percutaneous Surgery, School of Computing, Queen's University, Kingston, ON, Canada
| | | | - Martin Morgan
- Department of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | | | | | | | - Guergana Savova
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jonathan C Silverstein
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Donald P Taylor
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joyce B Zelnis
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Guo-Qiang Zhang
- The University of Texas Health Science Center at Houston, Houston, TX, United States
| | | | - Michael J Becich
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
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Damsin T, Canivet G, Jacquemin P, Seidel L, Gillet P, Giet D, Nikkels AF. Value of Teledermoscopy in Primary Healthcare Centers: Preliminary Results of the TELESPOT Project in Belgium. Dermatol Ther (Heidelb) 2020; 10:1405-1413. [PMID: 32946049 PMCID: PMC7649191 DOI: 10.1007/s13555-020-00445-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Teledermoscopy using smartphone-based applications is becoming more and more important in a setting of increasing frequency of skin cancer and difficult access to specialized care. The TELESPOT project aimed to provide rapid diagnosis and speed up patient flow between primary healthcare centers and a tertiary care center in Belgium. The aim of the present study is to describe the development of an in-house smartphone-based dermoscopy application, evaluate its real-life value in a series of primary healthcare centers, and present preliminary diagnostic data. METHODS Modified Likert scales were used to assess patient and general practitioner (GP) satisfaction rates for the system. Furthermore, a total of 105 photographic and dermoscopic images were acquired in a series of 80 patients at participating centers. RESULTS Overall, patient and GP satisfaction levels were 89% and 94%, respectively. High-priority management was recommended in 7.6% of cases (8/105: 3 basal cell carcinoma, 1 primary cutaneous B-cell lymphoma, 1 Spitz melanocytic nevus, 1 congenital nevus, 1 in situ melanoma, and 1 invasive melanoma, proven by histology). CONCLUSIONS The primary healthcare centers were highly satisfied with the TELESPOT project in terms of user-friendliness, efficacy, and reliability as well as in providing a reinforced image of first-line medicine efforts in combating skin cancer.
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Affiliation(s)
- Thomas Damsin
- Department of Dermatology, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium
| | - Gregory Canivet
- Department of Computer Applications, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium
| | - Pauline Jacquemin
- Department of Methods of Projects, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium
| | - Laurence Seidel
- Department of Biostatistics, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium
| | - Pierre Gillet
- Medical Director, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium
| | - Didier Giet
- Department of General Medicine, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium
| | - Arjen F Nikkels
- Department of Dermatology, University Hospital Centre, CHU du Sart-Tilman, Liege, Belgium.
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11
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Faujdar DS, Sahay S, Singh T, Kaur M, Kumar R. Field testing of a digital health information system for primary health care: A quasi-experimental study from India. Int J Med Inform 2020; 141:104235. [PMID: 32688290 DOI: 10.1016/j.ijmedinf.2020.104235] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Information and Communication Technologies (ICTs) are acknowledged as vital tools to strengthen Primary Health Care (PHC) in low- and middle-income countries (LMICs). However, these technologies have been used only for selected services. Moreover, there is limited evidence on how effective these interventions are in improving comprehensive primary health care in LMICs. Therefore, we developed an integrated digital solution and field-tested its impact on PHC services in an urban community of India. METHODS An integrated health information system for primary health care (IHIS4PHC) was designed on a free and open source digital platform which provided multiple features for registration of population and tracking for promotive, preventive, and curative health services (e.g. Antenatal Care, Immunization, TB, Malaria, and Hypertension Treatment etc.), and for generation of aggregate reports for real-time monitoring. The IHIS4PHC was implemented in an urban health centre of Chandigarh (India) which catered to about 25,000 population. A quasi-experimental study design was chosen for analysing the impact of IHIS4PHC on PHC services. Household sample surveys were conducted at baseline and endline in the intervention and comparison community to estimate the coverage of selected health indicators using standard questionnaires. Difference-in-difference method with adjusted generalised estimating equation was used for the assessment of the net impact of IHIS4PHC. RESULTS In relation to the comparison community, statistically significant (p < 0.05) increase was observed at the IHIS4PHC implementing centre in primary health care adequacy (7.2 %), and in the care-seeking behaviour for chronic illness (16.5 %). Improvements were also noticed in other health indicators such as mean blood pressure, adherence to antihypertensive medication, intake of dietary salt by hypertensives, intention to quit tobacco, and vitamin A supplementation. CONCLUSIONS The digital IHIS4PHC design was found to be effective in improving PHC-based health services. Therefore, IHIS4PHC like digital solutions should be considered for strengthening PHC services in LMICs.
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Affiliation(s)
- Dharamjeet S Faujdar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Norway.
| | - Tarundeep Singh
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Manmeet Kaur
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rajesh Kumar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
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O'Neill B, Ryan C, Roy S, Simes T. Supporting Nursing Faculty With a Digital Repository of Simulation Resources. TEACHING AND LEARNING IN NURSING 2020. [DOI: 10.1016/j.teln.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hazarika HJ, Handique A, S. Ravikumar SR. DICOM-based medical image repository using DSpace. COLLECTION AND CURATION 2020. [DOI: 10.1108/cc-11-2019-0039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to provide image repository to the medical professional in an open source platform, which will increase the visibility of Digital Imaging and Communication in Medicine (DICOM) image in a network mode; further, the proposed system will reduce the storage cost of the images to significant level.
Design/methodology/approach
The authors have developed a new institutional repository model for the medical professionals cum radiologists to preserve, store and retrieve medical images from one database with the help of open source software. The authors used JavaScript programming to integrate and develop the DICOM Standard with DSpace.
Findings
Major outcome of this work is that DICOM images can be accommodated in DSpace without modifying the image properties and keeping intact the various dimensions of image viewing options. Further, it was found that the images are retrieved without any ease because of the robust indexing system.
Research limitations/implications
Major limitation of this study was the size of the data (5000 DICOM image) with which the authors have tested the system. The scalability of the system has to be tested on various fronts, for which separate study has to be done.
Practical implications
Once this system is in place, DICOM user can store, retrieve and access the image from Web platform. This proposed repository will be the storehouse of various DICOM images with reasonable storage costs.
Originality/value
In addition to exploring the opportunities of open source software (OSS) implementation in Medical Fields, this study includes issues related to implementation of open source repository for storing and preserving medical image. This is the first time in Library Science field to create and develop Open Source DICOM Medical Image Library with the help of DSpace. The study will create value for library professionals as well as medical professionals and OSS vendors to understand the medical market in the context of OSS.
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Liang D, Darko AP, Zeng J. Interval-valued pythagorean fuzzy power average-based MULTIMOORA method for multi-criteria decision-making. J EXP THEOR ARTIF IN 2019. [DOI: 10.1080/0952813x.2019.1694589] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Decui Liang
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, China
| | - Adjei Peter Darko
- School of Management and Economics, University of Electronic Science and Technology of China, Chengdu, China
| | - Ju Zeng
- Department of Radiology, The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan, China
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Purkayastha S, Allam R, Maity P, Gichoya JW. Comparison of Open-Source Electronic Health Record Systems Based on Functional and User Performance Criteria. Healthc Inform Res 2019; 25:89-98. [PMID: 31131143 PMCID: PMC6517630 DOI: 10.4258/hir.2019.25.2.89] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives Open-source Electronic Health Record (EHR) systems have gained importance. The main aim of our research is to guide organizational choice by comparing the features, functionality, and user-facing system performance of the five most popular open-source EHR systems. Methods We performed qualitative content analysis with a directed approach on recently published literature (2012–2017) to develop an integrated set of criteria to compare the EHR systems. The functional criteria are an integration of the literature, meaningful use criteria, and the Institute of Medicine's functional requirements of EHR, whereas the user-facing system performance is based on the time required to perform basic tasks within the EHR system. Results Based on the Alexa web ranking and Google Trends, the five most popular EHR systems at the time of our study were OSHERA VistA, GNU Health, the Open Medical Record System (OpenMRS), Open Electronic Medical Record (OpenEMR), and OpenEHR. We also found the trends in popularity of the EHR systems and the locations where they were more popular than others. OpenEMR met all the 32 functional criteria, OSHERA VistA met 28, OpenMRS met 12 fully and 11 partially, OpenEHR-based EHR met 10 fully and 3 partially, and GNU Health met the least with only 10 criteria fully and 2 partially. Conclusions Based on our functional criteria, OpenEMR is the most promising EHR system, closely followed by VistA. With regards to user-facing system performance, OpenMRS has superior performance in comparison to OpenEMR.
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Affiliation(s)
- Saptarshi Purkayastha
- Department of BioHealth Informatics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Roshini Allam
- Department of BioHealth Informatics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Pallavi Maity
- Department of BioHealth Informatics, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
| | - Judy W Gichoya
- Dotter Institute, Oregon Health and Science University, Portland, OR, USA
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Laack TA, Lones EA, Schumacher DR, Todd FM, Cook DA. Sharing simulation-based training courses between institutions: opportunities and challenges. Adv Simul (Lond) 2018; 2:1. [PMID: 29450002 PMCID: PMC5806268 DOI: 10.1186/s41077-016-0034-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/13/2016] [Indexed: 11/30/2022] Open
Abstract
Background Sharing simulation-based training (SBT) courses between institutions could reduce time to develop new content but also presents challenges. We evaluate the process of sharing SBT courses across institutions in a mixed method study estimating the time required and identifying barriers and potential solutions. Methods Two US academic medical institutions explored instructor experiences with the process of sharing four courses (two at each site) using personal interviews and a written survey and estimated the time needed to develop new content vs implement existing SBT courses. Results The project team spent approximately 618 h creating a collaboration infrastructure to support course sharing. Sharing two SBT courses was estimated to save 391 h compared with developing two new courses. In the qualitative analysis, participants noted the primary benefit of course sharing was time savings. Barriers included difficulty finding information and understanding overall course flow. Suggestions for improvement included establishing a standardized template, clearly identifying the target audience, providing a course overview, communicating with someone familiar with the original SBT course, employing an intuitive file-sharing platform, and considering local culture, context, and needs. Conclusions Sharing SBT courses between institutions is feasible but not without challenges. An initial investment in a sharing infrastructure may facilitate downstream time savings compared with developing content de novo.
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Affiliation(s)
- Torrey A Laack
- 1Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota USA.,2Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota USA
| | - Ellen A Lones
- 3Dartmouth-Hitchcock Patient Safety Training Center, Lebanon, NH USA
| | - Donna R Schumacher
- 1Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota USA
| | - Frances M Todd
- 3Dartmouth-Hitchcock Patient Safety Training Center, Lebanon, NH USA
| | - David A Cook
- 1Multidisciplinary Simulation Center, Mayo Clinic, Rochester, Minnesota USA.,4Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota USA
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Syzdykova A, Malta A, Zolfo M, Diro E, Oliveira JL. Open-Source Electronic Health Record Systems for Low-Resource Settings: Systematic Review. JMIR Med Inform 2017; 5:e44. [PMID: 29133283 PMCID: PMC5703976 DOI: 10.2196/medinform.8131] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/14/2017] [Accepted: 09/13/2017] [Indexed: 12/02/2022] Open
Abstract
Background Despite the great impact of information and communication technologies on clinical practice and on the quality of health services, this trend has been almost exclusive to developed countries, whereas countries with poor resources suffer from many economic and social issues that have hindered the real benefits of electronic health (eHealth) tools. As a component of eHealth systems, electronic health records (EHRs) play a fundamental role in patient management and effective medical care services. Thus, the adoption of EHRs in regions with a lack of infrastructure, untrained staff, and ill-equipped health care providers is an important task. However, the main barrier to adopting EHR software in low- and middle-income countries is the cost of its purchase and maintenance, which highlights the open-source approach as a good solution for these underserved areas. Objective The aim of this study was to conduct a systematic review of open-source EHR systems based on the requirements and limitations of low-resource settings. Methods First, we reviewed existing literature on the comparison of available open-source solutions. In close collaboration with the University of Gondar Hospital, Ethiopia, we identified common limitations in poor resource environments and also the main requirements that EHRs should support. Then, we extensively evaluated the current open-source EHR solutions, discussing their strengths and weaknesses, and their appropriateness to fulfill a predefined set of features relevant for low-resource settings. Results The evaluation methodology allowed assessment of several key aspects of available solutions that are as follows: (1) integrated applications, (2) configurable reports, (3) custom reports, (4) custom forms, (5) interoperability, (6) coding systems, (7) authentication methods, (8) patient portal, (9) access control model, (10) cryptographic features, (11) flexible data model, (12) offline support, (13) native client, (14) Web client,(15) other clients, (16) code-based language, (17) development activity, (18) modularity, (19) user interface, (20) community support, and (21) customization. The quality of each feature is discussed for each of the evaluated solutions and a final comparison is presented. Conclusions There is a clear demand for open-source, reliable, and flexible EHR systems in low-resource settings. In this study, we have evaluated and compared five open-source EHR systems following a multidimensional methodology that can provide informed recommendations to other implementers, developers, and health care professionals. We hope that the results of this comparison can guide decision making when needing to adopt, install, and maintain an open-source EHR solution in low-resource settings.
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Affiliation(s)
- Assel Syzdykova
- University of Aveiro, Department of Electronics, Telecommunications and Informatics (DETI) / Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Aveiro, Portugal.,BMD Software, Aveiro, Portugal
| | - André Malta
- University of Aveiro, Department of Electronics, Telecommunications and Informatics (DETI) / Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Aveiro, Portugal
| | - Maria Zolfo
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - José Luis Oliveira
- University of Aveiro, Department of Electronics, Telecommunications and Informatics (DETI) / Institute of Electronics and Informatics Engineering of Aveiro (IEETA), Aveiro, Portugal
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O'Kane AA, Park SY, Mentis H, Blandford A, Chen Y. Turning to Peers: Integrating Understanding of the Self, the Condition, and Others' Experiences in Making Sense of Complex Chronic Conditions. Comput Support Coop Work 2016; 25:477-501. [PMID: 32355411 PMCID: PMC7175643 DOI: 10.1007/s10606-016-9260-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People are increasingly involved in the self-management of their own health, including chronic conditions. With technology advances, the choice of self-management practices, tools, and technologies has never been greater. The studies reported here investigated the information seeking practices of two different chronic health populations in their quest to manage their health conditions. Migraine and diabetes patients and clinicians in the UK and the US were interviewed about their information needs and practices, and representative online communities were explored to inform a qualitative study. We found that people with either chronic condition require personally relevant information and use a broad and varied set of practices and tools to make sense of their specific symptoms, triggers, and treatments. Participants sought out different types of information from varied sources about themselves, their medical condition, and their peers’ experiences of the same chronic condition. People with diabetes and migraine expended great effort to validate their personal experiences of their condition and determine whether these experiences were ‘normal’. Based on these findings, we discuss the need for future personal health technologies that support people in engaging in meaningful and personalised data collection, information seeking, and information sharing with peers in flexible ways that enable them to better understand their own condition.
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Affiliation(s)
| | | | - Helena Mentis
- 3University of Maryland, Baltimore County, Baltimore, MD USA
| | | | - Yunan Chen
- 4University of California, Irvine, Irvine, CA USA
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Clarke MA, Belden JL, Kim MS. How Does Learnability of Primary Care Resident Physicians Increase After Seven Months of Using an Electronic Health Record? A Longitudinal Study. JMIR Hum Factors 2016; 3:e9. [PMID: 27025237 PMCID: PMC4811662 DOI: 10.2196/humanfactors.4601] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 10/14/2015] [Accepted: 11/05/2015] [Indexed: 12/02/2022] Open
Abstract
Background Electronic health records (EHRs) with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error-prone use of EHRs in medical practice by new resident physicians. Objective The study goal was to determine learnability gaps between expert and novice primary care resident physician groups by comparing performance measures when using EHRs. Methods We compared performance measures after two rounds of learnability tests (November 12, 2013 to December 19, 2013; February 12, 2014 to April 22, 2014). In Rounds 1 and 2, 10 novice and 6 expert physicians, and 8 novice and 4 expert physicians participated, respectively. Laboratory-based learnability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed 19 tasks, using a think-aloud strategy, based on an artificial but typical patient visit note. We used quantitative performance measures (percent task success, time-on-task, mouse activities), a system usability scale (SUS), and qualitative narrative feedback during the participant debriefing session. Results There was a 6-percentage-point increase in novice physicians’ task success rate (Round 1: 92%, 95% CI 87-99; Round 2: 98%, 95% CI 95-100) and a 7-percentage-point increase in expert physicians’ task success rate (Round 1: 90%, 95% CI 83-97; Round 2: 97%, 95% CI 93-100); a 10% decrease in novice physicians’ time-on-task (Round 1: 44s, 95% CI 32-62; Round 2: 40s, 95% CI 27-59) and 21% decrease in expert physicians’ time-on-task (Round 1: 39s, 95% CI 29-51; Round 2: 31s, 95% CI 22-42); a 20% decrease in novice physicians mouse clicks (Round 1: 8 clicks, 95% CI 6-13; Round 2: 7 clicks, 95% CI 4-12) and 39% decrease in expert physicians’ mouse clicks (Round 1: 8 clicks, 95% CI 5-11; Round 2: 3 clicks, 95% CI 1-10); a 14% increase in novice mouse movements (Round 1: 9247 pixels, 95% CI 6404-13,353; Round 2: 7991 pixels, 95% CI 5350-11,936) and 14% decrease in expert physicians’ mouse movements (Round 1: 7325 pixels, 95% CI 5237-10,247; Round 2: 6329 pixels, 95% CI 4299-9317). The SUS measure of overall usability demonstrated only minimal change in the novice group (Round 1: 69, high marginal; Round 2: 68, high marginal) and no change in the expert group (74; high marginal for both rounds). Conclusions This study found differences in novice and expert physicians’ performance, demonstrating that physicians’ proficiency increased with EHR experience. Our study may serve as a guideline to improve current EHR training programs. Future directions include identifying usability issues faced by physicians when using EHRs, through a more granular task analysis to recognize subtle usability issues that would otherwise be overlooked.
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Affiliation(s)
- Martina A Clarke
- Department of Internal Medicine, Division of Cardiology, University of Nebraska Medical Center, Omaha, NE, United States
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Abstract
Highly customizable laboratory information systems help to address great variations in laboratory workflows, typical in Pathology. Often, however, built-in customization tools are not sufficient to add all of the desired functionality and improve systems interoperability. Emerging technologies and advances in medicine often create a void in functionality that we call a functionality gap. These gaps have distinct characteristics—a persuasive need to change the way a pathology group operates, the general availability of technology to address the missing functionality, the absence of this technology from your laboratory information system, and inability of built-in customization tools to address it. We emphasize the pervasive nature of these gaps, the role of pathology informatics in closing them, and suggest methods on how to achieve that. We found that a large number of the papers in the Journal of Pathology Informatics are concerned with these functionality gaps, and an even larger proportion of electronic posters and abstracts presented at the Pathology Informatics Summit conference each year deal directly with these unmet needs in pathology practice. A rapid, continuous, and sustainable approach to closing these gaps is critical for Pathology to provide the highest quality of care, adopt new technologies, and meet regulatory and financial challenges. The key element of successfully addressing functionality gaps is gap ownership—the ability to control the entire pathology information infrastructure with access to complementary systems and components. In addition, software developers with detailed domain expertise, equipped with right tools and methodology can effectively address these needs as they emerge.
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Vincent CJ, Niezen G, O'Kane AA, Stawarz K. Can standards and regulations keep up with health technology? JMIR Mhealth Uhealth 2015; 3:e64. [PMID: 26041730 PMCID: PMC4526895 DOI: 10.2196/mhealth.3918] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 03/07/2015] [Accepted: 03/23/2015] [Indexed: 11/13/2022] Open
Abstract
Technology is changing at a rapid rate, opening up new possibilities within the health care domain. Advances such as open source hardware, personal medical devices, and mobile phone apps are creating opportunities for custom-made medical devices and personalized care. However, they also introduce new challenges in balancing the need for regulation (ensuring safety and performance) with the need to innovate flexibly and efficiently. Compared with the emergence of new technologies, health technology design standards and regulations evolve slowly, and therefore, it can be difficult to apply these standards to the latest developments. For example, current regulations may not be suitable for approaches involving open source hardware, an increasingly popular way to create medical devices in the maker community. Medical device standards may not be flexible enough when evaluating the usability of mobile medical devices that can be used in a multitude of different ways, outside of clinical settings. Similarly, while regulatory guidance has been updated to address the proliferation of health-related mobile phone apps, it can be hard to know if and when these regulations apply. In this viewpoint, we present three examples of novel medical technologies to illustrate the types of regulatory issues that arise in the current environment. We also suggest opportunities for support, such as advances in the way we review and monitor medical technologies.
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Tillmann T, Gibson AR, Scott G, Harrison O, Dominiczak A, Hanlon P. Systems Medicine 2.0: potential benefits of combining electronic health care records with systems science models. J Med Internet Res 2015; 17:e64. [PMID: 25831125 PMCID: PMC4387294 DOI: 10.2196/jmir.3082] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 09/05/2014] [Accepted: 09/12/2014] [Indexed: 12/25/2022] Open
Abstract
Background The global burden of disease is increasingly dominated by non-communicable diseases.These diseases are less amenable to curative and preventative interventions than communicable disease. This presents a challenge to medical practice and medical research, both of which are experiencing diminishing returns from increasing investment. Objective Our aim was to (1) review how medical knowledge is generated, and its limitations, (2) assess the potential for emerging technologies and ideas to improve medical research, and (3) suggest solutions and recommendations to increase medical research efficiency on non-communicable diseases. Methods We undertook an unsystematic review of peer-reviewed literature and technology websites. Results Our review generated the following conclusions and recommendations. (1) Medical knowledge continues to be generated in a reductionist paradigm. This oversimplifies our models of disease, rendering them ineffective to sufficiently understand the complex nature of non-communicable diseases. (2) Some of these failings may be overcome by adopting a “Systems Medicine” paradigm, where the human body is modeled as a complex adaptive system. That is, a system with multiple components and levels interacting in complex ways, wherein disease emerges from slow changes to the system set-up. Pursuing systems medicine research will require larger datasets. (3) Increased data sharing between researchers, patients, and clinicians could provide this unmet need for data. The recent emergence of electronic health care records (EHR) could potentially facilitate this in real-time and at a global level. (4) Efforts should continue to aggregate anonymous EHR data into large interoperable data silos and release this to researchers. However, international collaboration, data linkage, and obtaining additional information from patients will remain challenging. (5) Efforts should also continue towards “Medicine 2.0”. Patients should be given access to their personal EHR data. Subsequently, online communities can give researchers the opportunity to ask patients for direct access to the patient’s EHR data and request additional study-specific information. However, selection bias towards patients who use Web 2.0 technology may be difficult to overcome. Conclusions Systems medicine, when combined with large-scale data sharing, has the potential to raise our understanding of non-communicable diseases, foster personalized medicine, and make substantial progress towards halting, curing, and preventing non-communicable diseases. Large-scale data amalgamation remains a core challenge and needs to be supported. A synthesis of “Medicine 2.0” and “Systems Science” concepts into “Systems Medicine 2.0” could take decades to materialize but holds much promise.
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Affiliation(s)
- Taavi Tillmann
- Department of Epidemiology & Public Health, University College London, London, United Kingdom.
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Safadi H, Chan D, Dawes M, Roper M, Faraj S. Open-source health information technology: A case study of electronic medical records. HEALTH POLICY AND TECHNOLOGY 2015. [DOI: 10.1016/j.hlpt.2014.10.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Kiah MLM, Haiqi A, Zaidan BB, Zaidan AA. Open source EMR software: profiling, insights and hands-on analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2014; 117:360-82. [PMID: 25070757 DOI: 10.1016/j.cmpb.2014.07.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 07/06/2014] [Accepted: 07/09/2014] [Indexed: 05/05/2023]
Abstract
BACKGROUND The use of open source software in health informatics is increasingly advocated by authors in the literature. Although there is no clear evidence of the superiority of the current open source applications in the healthcare field, the number of available open source applications online is growing and they are gaining greater prominence. This repertoire of open source options is of a great value for any future-planner interested in adopting an electronic medical/health record system, whether selecting an existent application or building a new one. The following questions arise. How do the available open source options compare to each other with respect to functionality, usability and security? Can an implementer of an open source application find sufficient support both as a user and as a developer, and to what extent? Does the available literature provide adequate answers to such questions? This review attempts to shed some light on these aspects. OBJECTIVE The objective of this study is to provide more comprehensive guidance from an implementer perspective toward the available alternatives of open source healthcare software, particularly in the field of electronic medical/health records. METHODS The design of this study is twofold. In the first part, we profile the published literature on a sample of existent and active open source software in the healthcare area. The purpose of this part is to provide a summary of the available guides and studies relative to the sampled systems, and to identify any gaps in the published literature with respect to our research questions. In the second part, we investigate those alternative systems relative to a set of metrics, by actually installing the software and reporting a hands-on experience of the installation process, usability, as well as other factors. RESULTS The literature covers many aspects of open source software implementation and utilization in healthcare practice. Roughly, those aspects could be distilled into a basic taxonomy, making the literature landscape more perceivable. Nevertheless, the surveyed articles fall short of fulfilling the targeted objective of providing clear reference to potential implementers. The hands-on study contributed a more detailed comparative guide relative to our set of assessment measures. Overall, no system seems to satisfy an industry-standard measure, particularly in security and interoperability. The systems, as software applications, feel similar from a usability perspective and share a common set of functionality, though they vary considerably in community support and activity. CONCLUSION More detailed analysis of popular open source software can benefit the potential implementers of electronic health/medical records systems. The number of examined systems and the measures by which to compare them vary across studies, but still rewarding insights start to emerge. Our work is one step toward that goal. Our overall conclusion is that open source options in the medical field are still far behind the highly acknowledged open source products in other domains, e.g. operating systems market share.
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Affiliation(s)
- M L M Kiah
- Department of Computer System & Technology, Faculty of Computer Science & IT, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - Ahmed Haiqi
- Faculty of Engineering, Universiti Kebangsaan Malaysia, 43600 Bangi, Malaysia
| | - B B Zaidan
- Department of Computer System & Technology, Faculty of Computer Science & IT, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia
| | - A A Zaidan
- Department of Computing, Faculty of Arts, Computing and Creative Industry, Universiti Pendidikan Sultan Idris, Tanjong Malim, Perak, Malaysia.
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Karopka T, Schmuhl H, Demski H. Free/Libre open source software in health care: a review. Healthc Inform Res 2014; 20:11-22. [PMID: 24627814 PMCID: PMC3950260 DOI: 10.4258/hir.2014.20.1.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 01/16/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives To assess the current state of the art and the contribution of Free/Libre Open Source Software in health care (FLOSS-HC). Methods The review is based on a narrative review of the scientific literature as well as sources in the context of FLOSS-HC available through the Internet. All relevant available sources have been integrated into the MedFLOSS database and are freely available to the community. Results The literature review reveals that publications about FLOSS-HC are scarce. The largest part of information about FLOSS-HC is available on dedicated websites and not in the academic literature. There are currently FLOSS alternatives available for nearly every specialty in health care. Maturity and quality varies considerably and there is little information available on the percentage of systems that are actually used in health care delivery. Conclusions The global impact of FLOSS-HC is still very limited and no figures on the penetration and usage of FLOSS-HC are available. However, there has been a considerable growth in the last 5 to 10 years. While there where only few systems available a decade ago, in the meantime many systems got available (e.g., more than 300 in the MedFLOSS database). While FLOSS concepts play an important role in most IT related sectors (e.g., telecommunications, embedded devices) the healthcare industry is lagging behind this trend.
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Affiliation(s)
- Thomas Karopka
- BioCon Valley GmbH, Greifswald, Germany. ; International Medical Informatics Association Open Source Health Informatics Working Group, Geneva, Switzerland. ; European Federation Medical Informatics Libre/Free and Open Source Software in Health Informatics Working Group, Copenhagen, Denmark
| | - Holger Schmuhl
- International Medical Informatics Association Open Source Health Informatics Working Group, Geneva, Switzerland. ; European Federation Medical Informatics Libre/Free and Open Source Software in Health Informatics Working Group, Copenhagen, Denmark. ; Laboratory for Medical Information Systems, Institute for Biological and Medical Imaging of the Helmholtz Zentrum Munchen, Neuherberg, Germany
| | - Hans Demski
- European Federation Medical Informatics Libre/Free and Open Source Software in Health Informatics Working Group, Copenhagen, Denmark. ; Laboratory for Medical Information Systems, Institute for Biological and Medical Imaging of the Helmholtz Zentrum Munchen, Neuherberg, Germany
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Aminpour F, Sadoughi F, Ahamdi M. Utilization of open source electronic health record around the world: A systematic review. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2014; 19:57-64. [PMID: 24672566 PMCID: PMC3963324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 05/30/2013] [Accepted: 06/05/2013] [Indexed: 11/05/2022]
Abstract
Many projects on developing Electronic Health Record (EHR) systems have been carried out in many countries. The current study was conducted to review the published data on the utilization of open source EHR systems in different countries all over the world. Using free text and keyword search techniques, six bibliographic databases were searched for related articles. The identified papers were screened and reviewed during a string of stages for the irrelevancy and validity. The findings showed that open source EHRs have been wildly used by source limited regions in all continents, especially in Sub-Saharan Africa and South America. It would create opportunities to improve national healthcare level especially in developing countries with minimal financial resources. Open source technology is a solution to overcome the problems of high-costs and inflexibility associated with the proprietary health information systems.
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Affiliation(s)
- Farzaneh Aminpour
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Farahnaz Sadoughi, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. E-mail:
| | - Maryam Ahamdi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Masum H, Lackman R, Bartleson K. Developing global health technology standards: what can other industries teach us? Global Health 2013; 9:49. [PMID: 24134866 PMCID: PMC3853011 DOI: 10.1186/1744-8603-9-49] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 09/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a lack of effective and affordable technologies to address health needs in the developing world. One way to address problems of innovation and affordability is to design global health technologies to follow agreed-upon standards. This Debate article argues that we can better develop standards for global health technologies if we learn lessons from other industries. DISCUSSION The article's Background section begins by explaining why standards are needed in global health. For example, if global health technologies can be modularized into independent interfacing parts, these parts can then interact via well-defined standards in a "plug and play" fashion. This can avoid development of mutually incompatible solutions by different organizations, speed the pace of innovation, unlock health systems from single providers and approaches, and lower barriers to entry. The Background then gives a brief primer on standards and discusses incentives for health standards. The article's Discussion section begins with brief relevant cases of standards development from other industries, including electricity, container shipping, CD standards, Universal Serial Bus (USB), and the Internet. It then explores lessons from these and other industries that suggest how to develop standards for global health technologies. The remainder of the Discussion considers intellectual property and regulatory issues and standards-based global health business models, and ends with a checklist of considerations for health standards development leaders. (The associated Additional file discusses observations from standards development for cell phones and semiconductors, as well as challenges in the standards development process itself.) Throughout the article, point-of-care diagnostics are used as an illustrative example. An initiative is already underway to explore standardized diagnostics platforms. SUMMARY This Debate article aims to convince the reader that standards can benefit global health technologies if we learn lessons from other industries. The article draws from historical examples and the authors' experiences to suggest principles, challenges, and opportunities in developing these standards. If implemented well, standardized platforms can lower barriers to entry, improve affordability, and create a vibrant ecosystem of innovative new global health technologies.
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Affiliation(s)
- Hassan Masum
- Sandra Rotman Centre, University Health Network and University of Toronto, 101 College Street Suite 406, Toronto, ON M5G 1L7, Canada
| | - Rebecca Lackman
- Grand Challenges Canada, 101 College Street Suite 406, Toronto, ON M5G 1L7, Canada
| | - Karen Bartleson
- Synopsys, Inc, 700 East Middlefield Road, Mountain View, CA 94043, USA
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Abstract
The recent NHS 'hack days' have showcased the enthusiasm and talent of the junior doctor body as well as the potential of open source, open governance and small-medium enterprise. There still remains much scope for developing better value digital health services within the NHS. This article sets out the current state of NHS information technology (IT), how it fails to meet the needs of patients and professionals alike and suggests how better value digital health can be achieved.
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van Velsen L, Beaujean DJMA, van Gemert-Pijnen JEWC. Why mobile health app overload drives us crazy, and how to restore the sanity. BMC Med Inform Decis Mak 2013; 13:23. [PMID: 23399513 PMCID: PMC3621678 DOI: 10.1186/1472-6947-13-23] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 01/29/2013] [Indexed: 11/25/2022] Open
Abstract
Background Smartphones and tablet computers have become an integral part of our lives. One of their key features is the possibility of installing third-party apps. These apps can be very helpful for improving health and healthcare. However, medical professionals and citizens are currently being overloaded with health apps. Consequently, they will have difficulty with finding the right app, and information and features are fragmented over too many apps, thereby limiting their usefulness. Discussion In order to combat health app overload, suppliers of apps need to do three things. One, join the open source movement, so that a few apps can work as gateway to medical information by incorporating information from different sources. Two, standardize content, so that the information provided via apps is readable. And third, in order to prevent information overload from occurring within an app, content should be personalized towards an individual’s characteristics and context. Summary Suppliers of medical information and features need to join the open source movement and must make use of standardized medical information formats, in order to allow third parties to create valuable, mobile gateway apps. This can prevent the occurrence of health app overload. By going along in these trends, we can make health apps achieve the impact on healthcare quality and citizens’ health many of us envision.
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Affiliation(s)
- Lex van Velsen
- National Institute for Public Health and the Environment, P,O, box 1, Bilthoven 3720 BA, The Netherlands.
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