Health Informatics in Developing Countries: Going beyond Pilot Practices to Sustainable Implementations: A Review of the Current Challenges

Exploring Health Informatics in the Battle against Drug Addiction: Digital Solutions for the Rising Concern

Drug addiction is a rising concern globally that has deeply attracted the attention of the healthcare sector. The United States is not an exception, and the drug addiction crisis there is even more serious, with 10% of adults having faced substance use disorder, while around 75% of this number has been reported as not having received any treatment. Surprisingly, there are annually over 70,000 deaths reported as being due to drug overdose. Researchers are continually searching for solutions, as the current strategies have been ineffective. Health informatics platforms like electronic health records, telemedicine, and the clinical decision support system have great potential in tracking the healthcare data of patients on an individual basis and provide precise medical support in a private space. Such technologies have been found to be useful in identifying the risk factors of drug addiction among people and mitigating them. Moreover, the platforms can be used to check prescriptions of addictive drugs such as opioids and caution healthcare providers. Programs such as the Prescription Drug Monitoring Program (PDMP) and the Drug and Alcohol Services Information Systems (DASIS) are already in action in the US, but the situation demands more in-depth studies in order to mitigate substance use disorders. Artificial intelligence (AI), when combined with health informatics, can aid in the analysis of large amounts of patient data and aid in classifying nature of addiction to assist in the provision of personalized care.

A perspective on digital health platform design and its implementation at national level

Accessible and affordable health services and products including medicines, vaccines, and public health are an important health agenda of all countries. It is well understood that without digital health technologies, countries will face difficulties in tackling the needs and demands of their population. Global agencies including the World Health Organization (WHO), United Nations (UN), International Telecommunication Union (ITU), etc. have been instrumental in providing various tools, and guidance through digital health strategies in improving health and digital health maturity of the countries. The Digital Health Platform Handbook (DHPH) is a toolkit published by WHO and ITU to help countries create and implement a digital health platform (DHP) to serve as the underlying infrastructure for an interoperable and integrated national digital health system. We apply the foundational principles of DHPH and provide a perspective of DHP components in a layered, enterprise architecture of a digital health infrastructure. India has rolled out the blueprint of its National Digital Health Mission (NDHM) to address the emerging needs for digitization of healthcare in the country. In this paper, we also illustrate the design and implementation of WHO-ITU DHP components at the national level by exploring India's digital health mission implementation utilizing various digital public goods to build a digital health ecosystem in the country.

Empowering Healthcare through Comprehensive Informatics Education: The Status and Future of Biomedical and Health Informatics Education

OBJECTIVES

Education in biomedical and health informatics is essential for managing complex healthcare systems, bridging the gap between healthcare and information technology, and adapting to the digital requirements of the healthcare industry. This review presents the current status of biomedical and health informatics education domestically and internationally and proposes recommendations for future development.

METHODS

We analyzed evidence from reports and papers to explore global trends and international and domestic examples of education. The challenges and future strategies in Korea were also discussed based on the experts' opinions.

RESULTS

This review presents international recommendations for establishing education in biomedical and health informatics, as well as global examples at the undergraduate and graduate levels in medical and nursing education. It provides a thorough examination of the best practices, strategies, and competencies in informatics education. The review also assesses the current state of medical informatics and nursing informatics education in Korea. We highlight the challenges faced by academic institutions and conclude with a call to action for educators to enhance the preparation of professionals to effectively utilize technology in any healthcare setting.

CONCLUSIONS

To adapt to the digitalization of healthcare, systematic and continuous workforce development is essential. Future education should prioritize curriculum innovations and the establishment of integrated education programs, focusing not only on students but also on educators and all healthcare personnel in the field. Addressing these challenges requires collaboration among educational institutions, academic societies, government agencies, and international bodies dedicated to systematic and continuous workforce development.

Medical education in Bangladesh from Student and Teacher's Perspective: Impact and challenges of the COVID-19 pandemic

Background

In low- and middle-income countries like Bangladesh, where medical education faces a range of challenges-such as lack of infrastructure, well-trained educators, and advanced technologies, abrupt changes in methodologies without adequate preparation are more challenging than in higher-income countries. This was worsened during the COVID-19 pandemic and these challenges have resulted in a change in medical education methodology. This study assesses the medical education procedure, impacts and adaptation strategies and challenges of the COVID-19 pandemic in the medical education system of Bangladesh from learners' as well as educators' perspectives.

Methods

The study collected data from 22 Medical Colleges/Universities across 18 districts of eight divisions using quantitative and qualitative methods. A total of 408 samples were collected consisting of 316 from students and 92 from medical teachers. Descriptive analysis and probit model were performed for obtaining results.

Results

The efficacy of online learning was questionable, but results showed that it was more effective for theory classes (92.4%) followed by clinical classes (75.63%) and the efficacy rate was low for practical classes (54.11%). All types of classes (theory, practical and clinical) are currently using mixed methods to some extent in medical education in Bangladesh. Regarding impacts and adaptation strategy, approximately 75.3% of the students surveyed expressed their acceptance of online education. Over 80% of the participants acknowledged the advantages of online learning, highlighting the freedom to learn from home, cost and time savings, and avoiding physical closeness with other students as major benefits.

Conclusions

To address future challenges like the COVID-19 pandemic in medical education in Bangladesh, a comprehensive policy approach such as strengthening technological infrastructure, promoting blended learning approaches, enhancing faculty training and support, integrating telemedicine into the curriculum, and continuously evaluating and improving policies and interventions can enhance the resilience of its medical education system, and prepare for future challenges.

National ICU Registries as Enablers of Clinical Research and Quality Improvement

OBJECTIVES

Clinical quality registries (CQRs) have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. This narrative review describes the challenges, proposed solutions, and evidence generated by National ICU registries as facilitators for research and quality improvement.

DATA SOURCES

English language articles were identified in PubMed using phrases related to ICU registries, CQRs, outcomes, and case-mix.

STUDY SELECTION

Original research, review articles, letters, and commentaries, were considered.

DATA EXTRACTION

Data from relevant literature were identified, reviewed, and integrated into a concise narrative review.

DATA SYNTHESIS

CQRs have been implemented worldwide by several medical specialties aiming to generate a better characterization of epidemiology, treatments, and outcomes of patients. National ICU registries were created almost 3 decades ago to improve the understanding of case-mix, resource use, and outcomes of critically ill patients. The initial experience in European countries and in Oceania ensured that through locally generated data, ICUs could assess their performances by using risk-adjusted measures and compare their results through fair and validated benchmarking metrics with other ICUs contributing to the CQR. The accomplishment of these initiatives, coupled with the increasing adoption of information technology, resulted in a broad geographic expansion of CQRs as well as their use in quality improvement studies, clinical trials as well as international comparisons, and benchmarking for ICUs.

CONCLUSIONS

ICU registries have provided increased knowledge of case-mix and outcomes of ICU patients based on real-world data and contributed to improve care delivery through quality improvement initiatives and trials. Recent increases in adoption of new technologies (i.e., cloud-based structures, artificial intelligence, machine learning) will ensure a broader and better use of data for epidemiology, healthcare policies, quality improvement, and clinical trials.

Challenges and Strategies for Enhancing eHealth Capacity Building Programs in African Nations

eHealth applications play a crucial role in achieving Universal Health Coverage. (1) Background: To ensure successful integration and use, particularly in developing and low/middle-income countries (LMIC), it is vital to have skilled healthcare personnel. The purpose of this study was to describe challenges that hinder capacity-building initiatives among healthcare personnel in developing and LMIC and suggest interventions to mitigate them. (2) Methods: Adopted a descriptive research design and gathered empirical data through an online survey from 37 organizations. (3) Results: The study found that in developing and LMIC, policymakers and eHealth specialists face numerous obstacles integrating and using eHealth including limited training opportunities. These obstacles include insufficient funds, inadequate infrastructure, poor leadership, and governance, which are specific to each context. The study suggests implementing continuous in-service training, computer-based systems, and academic modules to address these challenges. Additionally, the importance of having solid and appropriate eHealth policies and committed leaders were emphasized. (4) Conclusions: These findings are consistent with previous research and highlight the need for practical interventions to enhance eHealth capacity-building in LMICs. However, it should be noted that the data was collected only from BETTEReHEALTH partners. Therefore, the results only represent their respective organizations and cannot be generalized to the larger population.

Electronic health records post-implementation challenges in selected hospitals: A qualitative study in the Central Region of southern Ghana

BACKGROUND

Electronic health records (EHRs) are useful tools in healthcare settings but implementation in low and middle-income countries (LMIC) face challenges.

OBJECTIVE

To explore post-implementation challenges affecting the deployment of EHRs and their use in selected health facilities in Ghana.

METHOD

Using a qualitative research approach, 21 in-depth interviews were conducted with health workers in two hospitals in the study area in Ghana, in February and June 2020. Purposive sampling was used to select participants. All interviews were audio recorded, transcribed, and coded into themes using QSR Nvivo12 software to aid thematic analyses.

RESULTS

Post-implementation challenges were grouped into lack of technological, logistical and managerial support, and inadequate training. Inadequate equipment was the most reported post-implementation challenge that affected EHR use. Unreliable Internet and network connectivity was a source of frustration, which caused staff to develop negative attitudes towards use of the system. Lack of funding stalled implementation of the system and limited its use to critical care units only. It was also the reason replacement of equipment delayed.

CONCLUSION

While EHR post-implementation challenges facing health facilities are surmountable, managerial support, backed with the requisite logistical and technical support is needed. It is not enough to rely on funding; health institutions should prioritise emerging EHR post-implementation challenges in their operating budgets.

IMPLICATIONS

A national framework is needed to guide effective and sustainable EHR implementation across the country.

Perceived Knowledge, Attitudes, and Barriers Toward the Adoption of Telemedicine Services in the Kingdom of Saudi Arabia: Cross-Sectional Study

BACKGROUND

The adoption of telemedicine has facilitated the opportunity to offer the best health care services. Nevertheless, there is a mismatch between the presence of telemedicine programs in the Kingdom of Saudi Arabia and poor acceptance by the end-user patients.

OBJECTIVE

This study aimed to gain a holistic understanding of the knowledge, attitudes, and barriers of the end-user patients (ie, research participants) toward the utility of telemedicine services in the Kingdom of Saudi Arabia.

METHODS

A cross-sectional, survey-based study was conducted from June 1 to July 31, 2022, in the Kingdom of Saudi Arabia. The questionnaire was developed based on a literature review and was examined for validity and reliability. Knowledge questions used a yes-or-no format, whereas attitude and barrier questions used a 5-point Likert-scale format. Data were reported descriptively and analyzed using SPSS (IBM Corp) software. To evaluate the differences in mean scores and identify sociodemographic factors associated with knowledge and attitudes toward the adoption of telemedicine, the data were analyzed using univariate and multivariable regression analyses, respectively.

RESULTS

Overall, 1024 participants participated in the survey. The percentages of participants who attended a telemedicine service before, during, and after COVID-19 were 49.61% (508/1024), 61.91% (634/1024), and 50.1% (513/1024), respectively. The mean score for knowledge was 3.52 (SD 1.486; range 0-5), reflecting a high level of knowledge. The mean score for attitudes was 37.08 (SD 8.526; range 11-55), reflecting optimistic (positive) attitudes. Regarding barriers, the participants voiced some concerns regarding patient and physician resistance and attributed some cultural and technology-related limitations as potential hindrances to the full adoption of telemedicine services. The place of residence (rural vs nonrural) had a significant impact on the scores of knowledge, attitudes, and barriers, whereas gender had no significant impact. The multivariable regression analysis showed that several sociodemographic factors significantly correlated with knowledge and attitudes toward the adoption of telemedicine services.

CONCLUSIONS

The participants showed good knowledge and positive attitudes toward telemedicine services. The perceived barriers were in line with the published literature. This research calls for the need to strengthen the positive attitudes and rectify the barriers, so that the utility of telemedicine services can be maximized in the community.

Critical risk and success factors for sustainability of an electronic health data capture, processing and dissemination platform for Uganda

Several studies have investigated challenges that have marred success or even caused the failure of eHealth implementations in Uganda; however, none has focused on the risks and success factors of their sustainability. This study explored critical risk and success factors for the sustainability of an electronic health data capture, processing and dissemination platform for Uganda. A mixed-method research design was followed involving collecting empirical data from all four regions of Uganda. A purposive sampling strategy was used to select the study districts per region, health facilities per district, and respondents/participants per facility or district. Findings revealed several risks and success factors for sustainability, including; bad leadership, corruption, lack of sustainable maintenance programs, lack of suitable sustainability plans, lack of ICT infrastructure investment, poor management systems, funds, stakeholder buy-ins, data sharing and access rights. The success factors included reinvestments as a partial sustainability plan for ICT infrastructure. These factors can be leveraged to ensure the continued operation of eHealth implementations in Uganda. Every electronic health project aiming at success should always make due consideration/sustainability plan at the onset of project conceptualisation; as lack of such a plan has often resulted in failed projects after the initial funds have been withdrawn.

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

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

SolarSPELL health and education: global solutions with local impacts

Background

People in remote regions of developing nations have poor health outcomes with lower life expectancy and quality of life compared to higher-resourced areas. Remote communities typically lack stable access to high-quality health services. International humanitarian and development organizations including the United States Peace Corps have a longstanding history of delivering critical services. However, limited infrastructure including access to reliable electricity or internet restricts development workers’ ability to provide effective health services to rural communities. Technology that enhances health education and service delivery in remote communities may improve health outcomes by impacting health knowledge and behavior.

Methods

We partnered with U.S. Peace Corps to provide portable, solar-powered educational learning libraries (SolarSPELL; www.solarspell.org) to remote communities in Pacific Island nations beginning in 2015 with Peace Corps Vanuatu educational volunteers and expanded in 2017 to include health volunteers (SolarSPELL Health). We conducted ethnographic observation and interviews with Vanuatu Peace Corps volunteers, Ministry of Health officials, and local residents of rural communities. We then conducted a comprehensive evidence review to identify current best practices for assessing and treating the most common conditions. We designed simple 2-page documents with assessment and treatment guidelines, reflecting evidence-based best practices, local culture, and resource availability. Each document was accompanied by a whiteboard video featuring simple drawings and narration designed for Peace Corps volunteers and local community members.

Results

We report on findings from a pilot study focused on education for treating low back pain. Preliminary findings indicate significantly increased knowledge for Peace Corps volunteers (p<.01), along with non-significantly increased self-efficacy scores (p=.169). Interview data indicate high levels of satisfaction with the SolarSPELL technology, and widespread community utilization among Peace Corps volunteers and community residents.

Conclusions

Tailored health content on the SolarSPELL platform increases knowledge about critical health topics among Peace Corps volunteers in under-resourced rural communities. The platform and education may have a positive impact on self-efficacy. However, high baseline levels of self-efficacy noted among Peace Corps volunteers may explain the failure to reach statistically significant increases in self-efficacy scores. This finding merits further study. Future work includes measuring individual and community health outcomes, quality of life, and cost benefit resulting from reductions in lost work and transfers for advanced health services. We plan continued implementation and content expansion of SolarSPELL Health in Vanuatu and additional global sites.

An mHealth-Based Health Management Information System Among Health Workers in Volta and Eastern Regions of Ghana: Pre-Post Comparison Analysis

BACKGROUND

Despite the increasing attention to electronic health management information systems (HMISs) in global health, most African countries still depend on inefficient paper-based systems. Good Neighbors International and Evaluate 4 Health have recently supported the Ghana Health Service on the rollout of a mobile health-based HMIS called the e-Tracker system in 2 regions in Ghana. The e-Tracker is an Android-based tracker capture app that electronically manages maternal and child health (MCH) data. The Ghana Health Service has implemented this new system in Community Health Planning and Services in the 2 regions (Volta and Eastern).

OBJECTIVE

This study aims to evaluate changes in health workers' capacity and behavior after using the e-Tracker to deliver MCH services. Specifically, the study assesses the changes in knowledge, attitude, and practice (KAP) of the health workers toward the e-Tracker system by comparing the pre- and postsurvey results.

METHODS

The KAP of frontline health workers was measured through self-administered surveys before and after using the e-Tracker system to assess their capacity and behavioral change toward the system. A total of 1124 health workers from the Volta and Eastern regions responded to the pre-post surveys. This study conducted the McNemar chi-square test and Wilcoxon signed-rank test for a pre-post comparison analysis. In addition, random-effects ordered logistic regression analysis and random-effects panel analysis were conducted to identify factors associated with KAP level.

RESULTS

The pre-post comparison analysis showed significant improvement in health workers' capacity, with higher knowledge and practice levels after using the e-Tracker system. As for knowledge, there was a 9.9%-point increase (from 559/1109, 50.41% to 669/1109, 60.32%) in the proportion of the respondents who were able to generate basic statistics on the number of children born in a random month within 30 minutes. In the practice section, the percentage of respondents who had scheduled clientencounters increased from 91.41% (968/1059) to 97.83% (1036/1059). By contrast, responses to the attitude (acceptability) became less favorable after experiencing the actual system. For instance, 48.53% (544/1121) initially expressed their preferences for an electronic system; however, the proportion decreased to 33.45% (375/1121) after the intervention. Random-effects ordered logistic regression showed that days of overwork were significantly associated with health workers' attitudes toward the e-Tracker system.

CONCLUSIONS

This study provides empirical evidence that the e-Tracker system is conducive to enhancing capacity in MCH data management for providing necessary MCH services. However, the change in attitude implies that the users appear to feel less comfortable using the new system. As Ghana plans to scale up the electronic HMIS system using the e-Tracker to the national level, strategies to enhance health workers' attitudes are necessary to sustain this new system.

Mobile-Social Learning for Continuing Professional Development in Low- and Middle-Income Countries: Integrative Review

BACKGROUND

Access to continuing professional development (CPD) for health care workers in low- and middle-income countries (LMICs) is severely limited. Digital technology serves as a promising platform for supporting CPD for health care workers by providing educational content virtually and enabling virtual peer-to-peer and mentor interaction for enhanced learning. Digital strategies for CPD that foster virtual interaction can increase workforce retention and bolster the health workforce in LMICs.

OBJECTIVE

The objective of this integrative review was to evaluate the evidence on which digital platforms were used to provide CPD to health care workers and clinical students in LMICs, which was complemented with virtual peer-to-peer or mentor interaction. We phrased this intersection of virtual learning and virtual interaction as mobile-social learning.

METHODS

A comprehensive database and gray literature search was conducted to identify qualitative, quantitative, and mixed methods studies, along with empirical evidence, that used digital technology to provide CPD and virtual interaction with peers or mentors. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Eligible articles were written in English, conducted in an LMIC, and used a mobile device to provide CPD and facilitate virtual peer-to-peer or mentor interaction. Titles, abstracts, and full texts were screened, followed by an assessment of the quality of evidence and an appraisal of the articles. A content analysis was then used to deductively code the data into emerging themes.

RESULTS

A total of 750 articles were identified, and 31 (4.1%) were included in the review. SMS text messaging and mobile instant messaging were the most common methods used to provide continuing education and virtual interaction between peers and mentors (25/31, 81%). Across the included articles, participants had high acceptability for using digital platforms for learning and interaction. Virtual peer interaction and mentorship were found to contribute to positive learning outcomes in most studies (27/31, 87%) through increased knowledge sharing, knowledge gains, improved clinical skills, and improved service delivery. Peer-to-peer and mentor interaction were found to improve social support and reduce feelings of isolation (9/31, 29%). There were several challenges in the implementation and use of digital technology for mobile-social learning, including limited access to resources (eg, internet coverage and stable electricity), flexibility in scheduling to participate in CPD, and sociobehavioral challenges among students.

CONCLUSIONS

The summary suggests that mobile-social learning is a useful modality for curriculum dissemination and skill training and that the interface of mobile and social learning serves as a catalyst for improved learning outcomes coupled with increased social capital.

Cancer as a death sentence: developing an initial program theory for an IVR intervention

To address current trends in poor health-seeking behaviour and late cancer diagnosis in many low- and middle-income countries, like Uganda, it is important to explore innovative awareness building interventions. One possible intervention is a common digital format, an interactive voice response (IVR) system, which is suitable for individuals with low technological and reading literacy. It is increasingly acknowledged that developing digital interventions requires co-creation with relevant stakeholders and explication of program developers’ assumptions, to make them effective, sustainable, and scalable. To this end, we sought to develop an initial program theory for a co-created IVR system for cancer awareness in Uganda. Utilising principles of the realist approach, a qualitative exploratory study was conducted through seven focus group discussions (FGDs) with people living with cancer (PLWC), health workers, and policy makers. Thematic analysis of the transcripts resulted in the emergence of four major themes. Through all themes the most consistent finding was that myths, misconceptions, and misinformation about cancer were related to every aspect of the cancer journey and influenced the experiences and lives of PLWC and their caregivers. Participants were positive about the potential of an IVR system but also had reservations about the design and reach of the system. The resulting initial program theory proposes that a context-specific IVR system has the potential to improve awareness on cancer, provided attention is given to aspects such as language, message framing, and accuracy.

Assessing E-Health adoption readiness using diffusion of innovation theory and the role mediated by each adopter's category in a Mauritian context

BACKGROUND

The preparedness of healthcare institutes for the foreseen changes expected to arise through the implementation of E-Health is a significant turning point in determining its success. This should be evaluated through the awareness and readiness of healthcare workers to adopt E-Health technology to reduce health information technology failures.

METHODS

This study investigated the relationship between the perceived attributes of innovation and E-Health adoption decisions of healthcare workers as part of a preimplementation process. Using a cross-sectional quantitative approach, the dimensions of the diffusion of innovation (DOI) theory were used to assess the E-Health readiness of 110 healthcare workers in a Mauritian specialized hospital.

RESULTS

A strong inclination towards E-Health adoption was observed, where the prime stimulators were perceived as modernization of healthcare management (84.1%, ẋ=4.19), increased work efficiency through reduction of duplication (77.6%, ẋ=4.10) and faster generation of results (71.1%, ẋ=4.07). The findings of this study also validated the use of five DOI dimensions (i.e. relative advantage, compatibility, complexity, trialability and observability) in a predictability model (F(5, 101)=17.067, p<0.001) towards E-Health adoption. A significant association between 'adopter category' and 'willingness to recommend E-Health adoption' (χ2(8)=74.89, p<0.001) endorsed the fact that physicians and nursing managers have central roles within a social ecosystem to facilitate the diffusion of technology and influence the adoption of innovation.

CONCLUSION

This is the first study of its kind in Mauritius to successfully characterize each adopter's profile and demonstrate the applicability of the DOI framework to predict the diffusion rate of E-Health platforms, while also highlighting the importance of identifying key opinion leaders who can be primed by innovators regarding the benefits of E-Health platforms, thus ensuring non-disruptive evolutionary innovation in the Mauritian healthcare sector.

Barriers and facilitators of personal health record adoption in Indonesia: Health facilities' perspectives

BACKGROUND

Personal health record (PHR) has been extensively used in developed countries; however, it has been limitedly adopted in developing countries. This study was conducted in Indonesia: a developing country with the largest population in Southeast Asia. PHR that is integrated with health providers is needed to achieve a transformation from a health provider-centered to a patient-centered healthcare system.

OBJECTIVE

To qualitatively analyze barriers and facilitators of PHR adoption by health facilities in Indonesia from the technological, organizational, environmental, and individual factors.

METHODS

In this qualitative study, we used semi-structured interviews with three health facility directors, 17 IT heads, eight physicians, and three nurses from 10 primary healthcare facilities, nine government hospitals, and six private hospitals in Indonesia. Interview data were analyzed using thematic analysis in NVivo 12. The analysis stages involved familiarizing data, generating initial codes, searching themes, evaluating themes, defining and naming themes, and writing reports.

RESULTS

Regarding technological factors, the barriers to PHR adoption include security and privacy, interoperability, and infrastructure. Organizational support can facilitate PHR adoption in terms of organizational factors, while a lack of human resources is a barrier to PHR adoption. Regarding environmental factors, the lack of government regulations is the barrier to PHR adoption, while competition between health facilities and vendor support could facilitate PHR adoption. Finally, regarding individual factors, perceived usefulness and ease of use can be facilitators of PHR adoption, while user attitudes and e-health literacy can be barriers to PHR adoption.

CONCLUSIONS

This study is expected to comprehensively understand PHR adoption in Indonesia and could be applied to other developing countries with similar technological, legal, or cultural characteristics as Indonesia. This study also provides information that can guide health regulators, health facilities, or PHR vendors in planning the implementation of integrated PHR.

Recent Applications of Artificial Intelligence in Radiotherapy: Where We Are and Beyond

In recent decades, artificial intelligence (AI) tools have been applied in many medical fields, opening the possibility of finding novel solutions for managing very complex and multifactorial problems, such as those commonly encountered in radiotherapy (RT). We conducted a PubMed and Scopus search to identify the AI application field in RT limited to the last four years. In total, 1824 original papers were identified, and 921 were analyzed by considering the phase of the RT workflow according to the applied AI approaches. AI permits the processing of large quantities of information, data, and images stored in RT oncology information systems, a process that is not manageable for individuals or groups. AI allows the iterative application of complex tasks in large datasets (e.g., delineating normal tissues or finding optimal planning solutions) and might support the entire community working in the various sectors of RT, as summarized in this overview. AI-based tools are now on the roadmap for RT and have been applied to the entire workflow, mainly for segmentation, the generation of synthetic images, and outcome prediction. Several concerns were raised, including the need for harmonization while overcoming ethical, legal, and skill barriers.

Digital health in oncology in Africa: A scoping review and cross-sectional survey

BACKGROUND

Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied.

AIMS

To describe the current landscape of digital health interventions in oncology in Africa.

METHODS

We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer.

RESULTS

The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship. Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows.

CONCLUSION

Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of life.

Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers

Background

There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill.

Objective

This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia.

Methods

A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis.

Results

A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program.

Conclusions

We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers.

Assessing Health Data Security Risks in Global Health Partnerships: Development of a Conceptual Framework

Background

Health care databases contain a wealth of information that can be used to develop programs and mature health care systems. There is concern that the sensitive nature of health data (eg, ethnicity, reproductive health, sexually transmitted infections, and lifestyle information) can have significant impact on individuals if misused, particularly among vulnerable and marginalized populations. As academic institutions, nongovernmental organizations, and international agencies begin to collaborate with low- and middle-income countries to develop and deploy health information technology (HIT), it is important to understand the technical and practical security implications of these initiatives.

Objective

Our aim is to develop a conceptual framework for risk stratification of global health data partnerships and HIT projects. In addition to identifying key conceptual domains, we map each domain to a variety of publicly available indices that could be used to inform a quantitative model.

Methods

We conducted an overview of the literature to identify relevant publications, position statements, white papers, and reports. The research team reviewed all sources and used the framework method and conceptual framework analysis to name and categorize key concepts, integrate them into domains, and synthesize them into an overarching conceptual framework. Once key domains were identified, public international data sources were searched for relevant structured indices to generate quantitative counterparts.

Results

We identified 5 key domains to inform our conceptual framework: State of HIT, Economics of Health Care, Demographics and Equity, Societal Freedom and Safety, and Partnership and Trust. Each of these domains was mapped to a number of structured indices.

Conclusions

There is a complex relationship among the legal, economic, and social domains of health care, which affects the state of HIT in low- and middle-income countries and associated data security risks. The strength of partnership and trust among collaborating organizations is an important moderating factor. Additional work is needed to formalize the assessment of partnership and trust and to develop a quantitative model of the conceptual framework that can help support organizational decision-making.

Implementation challenges and perception of care providers on Electronic Medical Records at St. Paul's and Ayder Hospitals, Ethiopia

Background

In resources constrained settings, effectively implemented Electronic Medical Record systems have numerous benefits over paper-based record keeping. This system was implemented in the 2009 Gregorian Calendar in the two Ethiopian territory hospitals, Ayder and St. Paul’s. The pilot implementation and similar re-deployment efforts done in 2014 and 2017 Gregorian Calendar failed at St. Paul's. This study aimed to assess the current status, identify challenges, success factors and perception of health care providers to the system to inform on future roll-outs and scale-up plans.

Methods

A cross sectional study design with quantitative and qualitative methods was employed. A survey was administered October to December 2019 using a structured questionnaire. A total of 240 health care providers participated in the study based on a stratified random sampling technique. An interview was conducted with a total of 10 persons that include IT experts and higher managements of the hospital. Descriptive statistics were employed to summarize the survey data using SPSS V.21. Qualitative data were thematically presented.

Results

St. Paul’s hospital predominantly practiced the manual medical recording system. The majority of respondents (30.6%) declared that a lack of training and follow up, lack of management commitment, poor network infrastructure and hardware/software-related issues were challenges and contributed to EMR system failure at St. Paul’s. Results from the qualitative data attested to the above results. The system is found well-functioning at Ayder, and the majority of respondents (38%) noted that lack of training and follow-up was the most piercing challenge. As per the qualitative findings, ICT infrastructure, availability of equipment, incentive mechanisms, and management commitment are mentioned as supportive for successful implementation. At both hospitals, 70 to 95% of participants hold favorable perceptions and are willing to use the system.

Conclusion

Assessing the readiness of the hospital, selecting and acquiring standard and certified EMR systems, provision of adequate logistic requirements including equipment and supplies, and upgrading the hospital ICT infrastructure will allow sustainable deployment of an EMR system.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12911-021-01670-z.

The Brief Review on Telemedicine: New Dream in Developing Countries

: In the new modern world, technology has a remarkable role in human life and affects all aspects of it. Indeed, the need for rapid counteractions, especially in medical requirements, can lead to interesting innovations. Telemedicine was disregarded for being an unwieldy, unreliable, and unaffordable technology. Rapidly evolving telecommunications and information technologies have provided a solid foundation for telemedicine as a feasible, dependable, and useful technology. Telemedicine has been conceived as an integrated system of healthcare delivery that employs telecommunications and computer technology as a substitute for face-to-face contact between provider and client. It has the potential for ameliorating seemingly intractable problems in healthcare such as limited access to care among segments in the population, especially the geographically disadvantaged, uneven quality of care, and cost of inflation. Its true merit has yet to be determined by systematic empirical studies. In another survey, the authors defined telemedicine as a branch of e-health, which works by communication networks and delivers healthcare and medical educations from remote locations. The main aim of telemedicine is to overcome the improper distribution of human and fundamental resources. Telemedicine could be considered from the viewpoint of two basic conditions: (1) as an alternative way for emergency services in remote locations and (2) it is a better option rather than conventional health services; for example, teleradiology for rural hospitals. It can result in appropriate availability of health services and acceptable efficiency. However, this aspect of medicine was considered in the late 1990, and then, developing countries have a long way for research about it.

Research gaps in transforming tuberculosis data to action for better health outcomes: A systematic literature review

Background

In their work to end the tuberculosis (TB) epidemic in lower- and middle-income countries, national TB programs need a tool to measure, monitor, and strengthen relevant capabilities to create a continuous transformation of data into action (D2A) to improve TB program results. However, there is a lack of scientific evidence to determine specific measurement dimensions of a D2A continuum that enables TB programs to identify the barriers and enablers of D2A and to guide the selection of interventions appropriate for the context and decision-making capabilities of various TB program actors.

Methods

A systematic review of peer-reviewed and grey literature was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 48 peer-reviewed publications were selected for data extraction and analysis.

Results

The findings show that selected publications discussed the health system level, stakeholders involved in decision making, decision type, data system, data sources, data use enablers and barriers, decision-making framework and steps, decision outcome/impact, and how that outcome was measured. The findings highlight barriers and enablers to data use and explain the relationship among data sources, decision type, and stakeholders. Seventeen D2A measurement dimensions were identified.

Conclusions

Transforming data to action is a continuous process that recognizes that data use indicators vary by type of decisions, decision makers, and the health system level at which decisions are made. As a logical next step, the project team plans to develop and validate a D2A continuum toolkit that will include a measurement scale, implementation guide, and data collection and analysis Microsoft Excel workbook.

Interoperability opportunities and challenges in linking mhealth applications and eRecord systems: Botswana as an exemplar

Background

Significant investments have been made towards the implementation of mHealth applications and eRecord systems globally. However, fragmentation of these technologies remains a big challenge, often unresolved in developing countries. In particular, evidence shows little consideration for linking mHealth applications and eRecord systems. Botswana is a typical developing country in sub-Saharan Africa that has explored mHealth applications, but the solutions are not interoperable with existing eRecord systems. This paper describes Botswana’s eRecord systems interoperability landscape and provides guidance for linking mHealth applications to eRecord systems, both for Botswana and for developing countries using Botswana as an exemplar.

Methods

A survey and interviews of health ICT workers and a review of the Botswana National eHealth Strategy were completed. Perceived interoperability benefits, opportunities and challenges were charted and analysed, and future guidance derived.

Results

Survey and interview responses showed the need for interoperable mHealth applications and eRecord systems within the health sector of Botswana and within the context of the National eHealth Strategy. However, the current Strategy does not address linking mHealth applications to eRecord systems. Across Botswana’s health sectors, global interoperability standards and Application Programming Interfaces are widely used, with some level of interoperability within, but not between, public and private facilities. Further, a mix of open source and commercial eRecord systems utilising relational database systems and similar data formats are supported. Challenges for linking mHealth applications and eRecord systems in Botswana were identified and categorised into themes which led to development of guidance to enhance the National eHealth Strategy.

Conclusion

Interoperability between mHealth applications and eRecord systems is needed and is feasible. Opportunities and challenges for linking mHealth applications to eRecord systems were identified, and future guidance stemming from this insight presented. Findings will aid Botswana, and other developing countries, in resolving the pervasive disconnect between mHealth applications and eRecord systems.

eHealth Implementation Issues in Low-Resource Countries: Model, Survey, and Analysis of User Experience

BACKGROUND

The implementation of eHealth in low-resource countries (LRCs) is challenged by limited resources and infrastructure, lack of focus on eHealth agendas, ethical and legal considerations, lack of common system interoperability standards, unreliable power, and shortage of trained workers.

OBJECTIVE

The aim of this study is to describe and study the current situation of eHealth implementation in a small number of LRCs from the perspectives of their professional eHealth users.

METHODS

We developed a structural equation model that reflects the opinions of professional eHealth users who work on LRC health care front lines. We recruited country coordinators from 4 LRCs to help recruit survey participants: India, Egypt, Nigeria, and Kenya. Through a web-based survey that focused on barriers to eHealth implementation, we surveyed 114 participants. We analyzed the information using a structural equation model to determine the relationships among the constructs in the model, including the dependent variable, eHealth utilization.

RESULTS

Although all the model constructs were important to participants, some constructs, such as user characteristics, perceived privacy, and perceived security, did not play a significant role in eHealth utilization. However, the constructs related to technology infrastructure tended to reduce the impact of concerns and uncertainties (path coefficient=-0.32; P=.001), which had a negative impact on eHealth utilization (path coefficient=-0.24; P=.01). Constructs that were positively related to eHealth utilization were implementation effectiveness (path coefficient=0.45; P<.001), the countries where participants worked (path coefficient=0.29; P=.004), and whether they worked for privately or publicly funded institutions (path coefficient=0.18; P<.001). As exploratory research, the model had a moderately good fit for eHealth utilization (adjusted R2=0.42).

CONCLUSIONS

eHealth success factors can be categorized into 5 groups; our study focused on frontline eHealth workers' opinions concerning 2 of these groups: technology and its support infrastructure and user acceptance. We found significant disparities among the responses from different participant groups. Privately funded organizations tended to be further ahead with eHealth utilization than those that were publicly funded. Moreover, participant comments identified the need for more use of telemedicine in remote and rural regions in these countries. An understanding of these differences can help regions or countries that are lagging in the implementation and use of eHealth technologies. Our approach could also be applied to detailed studies of the other 3 categories of success factors: short- and long-term funding, organizational factors, and political or legislative aspects.

Caring for Computers: The Hidden Work of Clinical Nurses during the Introduction of Health Information Systems in a Teaching Hospital in Taiwan

Implementing health information systems for enhancing patient care and management occurs worldwide. Discovering how nurses, as important system end-users, experience technology-reliant clinical practice involved focus groups (n = 25) and in-depth individual interviews with nurses (n = 4) and informatics staff (n = 3) in a major Taiwanese medical center. This qualitative study explores the unintended effects of these systems on nurses’ role and clinical practice. First, nurses’ additional role caring for computer devices supporting patient care involves highly-demanding invisible effort, especially when tackling system malfunctions affecting patients with urgent conditions. Second, nurses are resourceful in developing solutions to protect patients during unexpected technical malfunctions. Third, troubleshooting using telephone technical support as the first resort is problematic. It is argued that computerization requires nurses to care for co-clients: patients and computers. Managing technical malfunctions is an unintended consequence for nurses, reflecting the hidden work required by new technology.

Willingness to use telemedicine during COVID-19 among health professionals in a low income country

INTRODUCTION

The coronavirus disease 2019 pandemic has prompted rapid restructuring of the health-care system in an effort to stop the spread of the pandemic. Thus, telemedicine is more preferable in order to prevent the COVID-19 pandemic when face to face meeting is forbidden, allowing provision of health service over a distance. This study aimed to assess willingness to use telemedicine and factors that will determine their extent of willingness during COIVID-19 among healthcare providers working in south west of Ethiopia.

METHODS

Institutional based cross-sectional study design was applied to assess willingness to use telemedicine among healthcare providers working at public health hospitals in south west of Ethiopia. Self-administered questionnaires were used. We have used Epi-info for data entry and Analysis of Moment Structure (AMOS) for analysis. A structural equation modeling was performed to identify factors associated with willingness to use telemedicine at 95% confidence interval (CI).

RESULT

In this study, less than half of respondents had high willingness to use telemedicine. Ease of use (β = 0.79, 95% CI: [0.72, 0.86], p < 0.01), attitude (β = 0.91, 95% CI: [0.87, 0.95], p < 0.01) and patient-physician relationships (β = 0.67, 95% CI: [0.54, 0.70], p < 0.01) were variables associated with willingness to use telemedicine. Anxiety towards technology (β = 0.74, 95% CI: [0.69, 0.79], p < 0.01) and patient-physician relationships (β = 0.87, 95% CI: [0.81, 0.92], p < 0.01) were determinant factors of attitude to use telemedicine.

CONCLUSIONS

The overall willingness to use telemedicine during COVID-19 in this setting is 46.5%. Addressing the problem related with ease of use, attitude and patient-physician relationships will help to increase the overall willingness to use telemedicine during COVID-19. An attempt to improving patient-physician relationship, provision of technical training for ease of use and working on healthcare providers' attitude will help to improve the willingness to use telemedicine.

Tianxia120: A Multimodal Medical Data Collection Bioinformatic System for Proactive Health Management in Internet of Medical Things

A digital medical health system named Tianxia120 that can provide patients and hospitals with “one-step service” is proposed in this paper. Evolving from the techniques of Internet of Medical Things (IoMT), medical dig data, and medical Artificial Intelligence, the system can systematically promote the change of service status between doctors and patients from “passive mode” to “proactive mode” and realize online service that is similar to offline medical treatment scenarios. The system consists of a patient terminal and a doctor terminal. They can perform online inquiry (through graphic, voice, telephone, video, etc.), electronic prescription, multiparameter self-diagnosis, cold chain logistics, medicine distribution, etc. The system can provide rich medical health information, medical tools browsing, and health care big data aggregation processing functions. Compared with the traditional medical system, this system has the characteristics of full function, rich data, and high security. It is expected to be applied to hospital applications and medical research to promote the construction and innovation of clinical medical disciplines.

A Case Study of a Point-of-Care Electronic Medical Record [SABER] in Totonicapán, Guatemala: Benefits, Challenges, and Future Directions

Background:

The adoption of electronic medical records (EMRs) in lower-income nations has progressed slowly due to the lack of adequate infrastructure, funding, and training. However, EMRs have been successfully implemented previously in resource-limited health systems in South Africa, Haiti, Cameroon, Kenya, and Peru. Detailed, organized, and easily accessible medical records are particularly important in emergency departments due to the volume and acuity of the patient population.

Methods:

In order to further study the plausibility of an EMR in a resource-limited emergency department, a web-based, Spanish-language EMR known as SABER was developed for use in Hospital Nacional José Felipe Flores in Totonicapán, Guatemala. The software collects patient data including demographics, triage, initial evaluation, review of systems, physical exam, and evaluation and plan. It then generates a .pdf file consistent with information requirements of the Guatemalan Ministry of Health. Local physicians, medical students, and nurses were trained in the use of the software, which debuted in July 2016. To assess the effectiveness of SABER as an EMR, focus groups and Likert scale surveys were conducted with six physicians and 31 medical students working in the Hospital Nacional emergency department.

Results:

Thirty of 32 medical students and six of six doctors would recommend SABER to another provider. Positive aspects identified by staff include ease of use, quick data entry, and the potential for large data set research.

Discussion:

Remaining challenges include incorporating electronic nursing orders and lab results, troubleshooting technology problems including printer difficulties, a lack of electronic signature capability, and lack of integration with the rest of the hospital. Our study is consistent with other studies that show use of an EMR may help to reduce health disparities through improved patient records, medical data collection, and organization.

Building Consensus on the Priority-Setting for National Policies in Health Information Technology: A Delphi Survey

Objectives

With growing attention on the healthcare industry as a potential market for big data and artificial intelligence in the Fourth Industrial Revolution, countries around the world are introducing and developing various policies and projects related to health information technology (HIT). To assist prioritizing HIT topics in policy making, this study adopts the Delphi technique to garner expert opinions from various fields of health informatics.

Methods

Data were collected from November 2019 to February 2020 using the Delphi technique through two rounds of surveys administered via email. The Delphi panel consisted of 16 experts with a high level of experience in health informatics. They were from the Health Information Policy Advisory Committee of the Ministry of Health and Welfare of Korea, and the board of directors of the Korean Society of Medical Informatics. The experts were asked to assess the importance, urgency, and difficulty of HIT topics in three domains: technology, application, and infrastructure.

Results

Of the 40 topic items, a 100% agreement was reached for the importance of 6 items, including 2 items in technology, 1 item in application, and 3 items in infrastructure domains. Especially, Quadrant I of a 2×2 matrix showing high importance and high urgency included 7 items in the technology domain, 2 items in the application domain, and 13 items in the infrastructure domain.

Conclusions

Most items with high importance and urgency belonged to the infrastructure domain. The findings indicated that fostering an infrastructural environment should be polices with top priorities of HIT.

Telemedicine in Middle Eastern countries: Progress, barriers, and policy recommendations

BACKGROUND

Despite attempts to reform the healthcare delivery system in the Middle East, expectations for its progress have been-and for some still are-somewhat slow.

OBJECTIVE

This study reviewed progress in the use and adoption of telemedicine in Middle Eastern countries. The key dimensions affecting the progress of telemedicine in these countries were identified.

METHOD

A systematic review of the literature was conducted on 43 peer reviewed articles from 2010 to 2020. The review followed the scientific process of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of identification, selection, assessment, synthesis, and interpretation of findings.

RESULTS

The results showed that progress made in the utilization of telemedicine was insufficient and varies across Middle Eastern countries. Certain cultural, financial, organizational, individual, technological, legal, and regulatory challenges were found to prevent telemedicine from being fully used to the point where the full range of medical services can be provided. For example, doctor and patient resistance, poor infrastructure, lack of funding, poor system quality, and lack of information technology training were associated with the low adoption of telemedicine in the region.

CONCLUSION

This review provides a number of recommendations that will help policymakers to move toward the integration of innovative technologies in order to facilitate access to health information, health services, and training. It also recommends that health initiatives should focus on health education and health promotion in order to increase public awareness of the benefits of telemedicine services in the region.

Development and validation of an instrument for measuring competencies on public health informatics of primary health care worker (PHIC4PHC) in Indonesia

Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers' competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson's product-moment correlation for the validity check and Cronbach's alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker's level of education, the higher the PHIC level; the longer the worker's work experience, the lower the PHIC score; and the greater the worker's age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.

Registered nurses' experiences of communication with patients when practising person-centred care over the phone: a qualitative interview study

BACKGROUND

To explore registered nurses' (RNs') experiences of practising person-centred care (PCC) by telephone with people diagnosed with chronic obstructive pulmonary disease and/or chronic heart failure.

METHODS

Qualitative interview study. Four RNs were individually interviewed before, during, and after participating in an intervention practising PCC by telephone. The interviews were analysed using qualitative content analysis.

RESULTS

The results reflect three categories of their experience: realize the complexity of practising PCC by distance, gain insight into what PCC communication meant to RNs and their approach, and develop the professional role by practising PCC theory and ethics.

CONCLUSIONS

PCC over the telephone facilitate healthcare and support patients. Through careful listening, the RNs (1) created space for the individual patients to express their thoughts and feelings and (2) emphasized each patient's capabilities and resources. The RNs also gained an understanding of PCC and what it means to patients and to themselves as practitioners. Potential implications are that it is important for RNs practising PCC by telephone to remould their role, to listen carefully, and to communicate as equals in conversations that respect both parties' knowledge and expertise. Health professionals need supervision and support to fully understand the person-centred approach and provide communications that support it.

Electronic Health Information Systems to Improve Disease Diagnosis and Management at Point-of-Care in Low and Middle Income Countries: A Narrative Review

The purpose of an electronic health information system (EHIS) is to support health care workers in providing health care services to an individual client and to enable data exchange among service providers. The demand to explore the use of EHIS for diagnosis and management of communicable and non-communicable diseases has increased dramatically due to the volume of patient data and the need to retain patients in care. In addition, the advent of Coronavirus disease 2019 (COVID-19) pandemic in high disease burdened low and middle income countries (LMICs) has increased the need for robust EHIS to enable efficient surveillance of the pandemic. EHIS has potential to enable efficient delivery of disease diagnostics services at point-of-care (POC) and reduce medical errors. This review provides an overview of literature on EHIS's with a focus on describing the key components of EHIS and presenting evidence on enablers and barriers to implementation of EHISs in LMICs. With guidance from the presented evidence, we proposed EHIS key stakeholders' roles and responsibilities to ensure efficient utility of EHIS for disease diagnosis and management at POC in LMICs.

Effect of Integrated Pictorial Handbook Education and Counseling on Improving Anemia Status, Knowledge, Food Intake, and Iron Tablet Compliance Among Anemic Pregnant Women in Indonesia: A Quasi-Experimental Study

Purpose

To determine the effect of individual education through a pictorial handbook on anemia in conjunction with counseling on improving hemoglobin and hematocrit level, birth weight, knowledge, iron-rich food and iron-folic acid (IFA) intake.

Patients and Methods

The study developed a pictorial handbook that was conceptualized based on the Health Belief Model and adjusted to some cultural and local contexts. A quasi-experimental pre-test–post-test control group design was used, purposefully conducted between two homogenous municipalities, each having a rate of anemic pregnancy that was 40% or greater. The sample consists of 140 anemic pregnant women randomly allocated via lottery into two groups; the intervention group (n=70), which received two home visits—one for education and another for a counseling session, and control group (n=70), which received routine antenatal care. A chi-square test and a Mann–Whitney U-test were conducted to compare the baseline socio-demographics. An analysis of covariance (ANCOVA), controlling some possible confounders, was performed to analyze the effect of intervention.

Results

The post-test means of hemoglobin F (1, 132) = 122, p-value <0.001, and hematocrit levels F (1, 132) = 373, p-value <0.001, were significantly different and higher in the intervention group compared to the control group. Similar results were found in knowledge, food frequency score, number of IFA intake (with p-value <0.001), birth weight and daily iron intake from food (with p-value <0.05). The intervention had a particularly large effect on food frequency score and number of IFA intake, and medium effect on hemoglobin and hematocrit levels.

Conclusion

Individual education through a pictorial handbook on anemia in conjunction with the counseling intervention program had a positive impact on hemoglobin and hematocrit levels for anemic pregnant women in their third trimester of pregnancy.

Workforce Readiness and Digital Health Integration

The benefits that digital health may offer include clinical, administrative, research, and educational. Research shows that if used in the right circumstances, digital health may increase access to healthcare services, improve clinical outcomes, safety, and quality of care. Digital health also has the potential to improve organisational efficiencies by reducing duplication and unnecessary diagnostic testing. From a healthcare consumer perspective, there is an expectation that healthcare services need to be provided in a more flexible and cost-effective way as in other spheres such as banking, commerce, and media. This is another important driver for consideration to integrate digital health in healthcare services. As digital health continues to be used in routine healthcare services, practitioners may require new knowledge, skills, and competencies to make the best use of this innovative method. Education and training relating to digital health have been recognised as a priority for developing the future healthcare workforce.

Elicitation and prioritization of requirements for electronic health records for oncology in low resource settings: A concept mapping study

BACKGROUND

Understanding functional and non-functional requirements is essential to successfully implement electronic medical record (EMR) systems. Actual requirements will be different for different contexts.

OBJECTIVE

To elicit and prioritize requirements for implementing EMRs in oncology in low and middle income countries (LMICs), and to relate these to requirements from high-income countries.

PARTICIPANTS AND SETTING

Cancer care stakeholders including oncologists, general doctors, nurses, biostatisticians, information technologists, from different LMICs, were involved.

METHODS

Concept mapping was used. Statements of requirements were obtained during focus group discussions (FGDs) and interviews. Using surveys, the requirements were clustered and ranked on importance and feasibility. Data were analyzed in SPSS using agglomerative hierarchical clustering and multidimensional scaling, to create cluster maps and go-zone maps reflecting the relationships between the requirements and their prioritization.

RESULTS

Four FGD sessions, with twenty participants, were conducted. In addition, six participants were interviewed. Twenty-two participants clustered the requirements and sixty-three participants ranked them on importance and feasibility. One hundred and sixty requirement statements were generated which were reduced to sixty-four after de-duplication and merging. Nine clusters were obtained encompassing the following domains, in order of importance: Security, Conducive organization, Management/Governance, General EMR functionalities, Computer infrastructure, Data management, Usability, Oncology decision support, and Ancillary requirements. On ranking, the requirements scored between 3.74 and 4.80 on importance, and between 3.55 and 4.46 on feasibility, on a 5-point Likert scale. We generated concept maps for use when communicating with stakeholders.

CONCLUSION

For oncology EMRs in LMICs, requirements overlap those from high-income countries, but generic EMR functionalities, Infrastructural and organizational requirements are still considered priority in LMICs compared to oncology-specific requirements or advanced EMR features e.g. computerized decision support or interoperability. Concept mapping is a fast and cost-effective method for eliciting and prioritizing EMR requirements in a user-centered manner.

Building Capacity and Training for Digital Health: Challenges and Opportunities in Latin America

Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non–governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America.

Health Status and Health Service Utilization among Vietnamese Farmers in a Mountainous Province

Problems of poor health status and low health service use among farmers in mountainous areas have not been fully investigated. A cross-sectional study was conducted in Son La, a mountainous province in Vietnam, to assess the self-rated health and health care service utilization among farmers. Visual analogue scale (VAS) was used to measure the self-rated health. Multivariate Tobit, Poisson, and logistic regression were employed to identify related factors. Among 197 farmers, the mean VAS score was 67.8 (SD = 15.5). Approximately 40% of participants reported health problems, and the most popular morbidity was hypertension—56.4%. There were 28.9% and 50.3% of farmers using inpatient and outpatient treatments in the last 12 months, respectively. Age, educational level, family income, marital status, alcohol use, and source of information have been identified as associated factors with self-rated health status and morbidities, while age, gender, education, and morbidities were related to health service utilization. Data indicated a high proportion of health issues and a high rate of health care service use among farmers in a mountainous area of Vietnam. Adaptable health policies and prevention programs or preventive health services should be implemented regularly in mountainous regions to protect farmers from the onset of morbidities and to enhance their health.

Integrating capacity development during digital health research: a case study from global health

Background: The Bloomberg Data for Health Initiative Research and Development Arm at Johns Hopkins University Bloomberg School of Public Health, has thus far collected NCD risk factor data from more than 13,000 citizens of three LMICs (Bangladesh, Tanzania and Uganda), and has actively worked to improve capacity with partners worldwide.

Objective: This paper focuses on how a research project, can also act as a capacity building activity through its research into collecting non-communicable disease risk factor data using different mobile phone modalities.

Methods: This paper evaluates the activities undertaken by the project using the ESSENCE Planning Monitoring and Evaluation Framework for Research Capacity Strengthening.

Results: The project was able to successfully integrate meaningful capacity development activities across all partners. Training, networking, sharing resources, joint data collection, and analysis across individual, organizational and project levels were some of the strategies used. The ESSENCE framework allowed a good assessment strategy for this type of work.

Conclusions: This paper highlights the value of making capacity development a high priority for digital health research activities, while also considering the need to monitor and evaluate those activities in order for them to be meaningful and sustainable. It also considers how to utilize the ESSENCE Framework to evaluate capacity development activities through research, and how best to adapt the Framework to different programs.

Artificial intelligence in oncology, its scope and future prospects with specific reference to radiation oncology

OBJECTIVE

Artificial intelligence (AI) seems to be bridging the gap between the acquisition of data and its meaningful interpretation. These approaches, have shown outstanding capabilities, outperforming most classification and regression methods to date and the ability to automatically learn the most suitable data representation for the task at hand and present it for better correlation. This article tries to sensitize the practising radiation oncologists to understand where the potential role of AI lies and what further can be achieved with it.

METHODS AND MATERIALS

Contemporary literature was searched and the available literature was sorted and an attempt at writing a comprehensive non-systematic review was made.

RESULTS

The article addresses various areas in oncology, especially in the field of radiation oncology, where the work based on AI has been done. Whether it's the screening modalities, or diagnosis or the prognostic assays, AI has come with more accurately defining results and survival of patients. Various steps and protocols in radiation oncology are now using AI-based methods, like in the steps of planning, segmentation and delivery of radiation. Benefit of AI across all the platforms of health sector may lead to a more refined and personalized medicine in near future.

CONCLUSION

AI with the use of machine learning and artificial neural networks has come up with faster and more accurate solutions for the problems faced by oncologist. The uses of AI,are likely to get increased exponentially . However, concerns regarding demographic discrepancies in relation to patients, disease and their natural history and reports of manipulation of AI, the ultimate responsibility will rest on the treating physicians.

People Welcomed This Innovation with Two Hands: A Qualitative Report of an mHealth Intervention for Community Case Management in Malawi

INTRODUCTION

Community Case Management (CCM) aims to improve health outcomes among children under five with malaria, diarrhea, and pneumonia, but its effectiveness in Malawi is limited by inconsistent standards of delivery characteristic of paper-based interventions. This may lead to negative impacts on child health outcomes and inefficient use of health system resources. This study evaluated the acceptability and impact of the Supporting LIFE Community Case Management App (SL eCCM App) by Health Surveillance Assistants (HSAs) and caregivers in two districts of Northern Malawi.

METHODS

Data were collected through semi-structured interviews with HSAs and caregivers as part of a nested study within a larger trial. We used deductive and inductive approaches during data analysis. Relevant constructs were identified from the Consolidated Framework for Implementation Research and combined with emerging concepts from the data. The Framework Method was used to chart and explore data, leading to the development of themes.

RESULTS

Seventeen HSAs and 28 caregivers were interviewed. Participants were generally enthusiastic about the SL eCCM App. Nearly all HSAs expressed a preference for the App over routine paper-based CCM. Most HSAs claimed the App was more reliable and less error prone, facilitated more accurate diagnoses and treatment recommendations, and enhanced professional confidence and respect in the community. Some HSAs believed additional features would improve usability of the App, others identified mobile network or electricity shortages as barriers. Not all caregivers understood the purpose of the App, but most welcomed it as a health and technological advancement.

CONCLUSION

The SL eCCM App is acceptable to both HSAs and caregivers, and in most cases, preferred, as it was believed to foster improvements in CCM delivery. Our findings suggest that mobile health interventions for CCM, such as the SL eCCM App, may have potential to improve the effectiveness and efficiency of care to children under five.

Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation

BACKGROUND

Periodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes.

OBJECTIVE

This study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia.

METHODS

A randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit-based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles.

RESULTS

From the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics.

CONCLUSIONS

EDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site.

Information Technology-Assisted Treatment Planning and Performance Assessment for Severe Thalassemia Care in Low- and Middle-Income Countries: Observational Study

Background

Successful models of information and communication technology (ICT) applied to cost-effective delivery of quality care in low- and middle-income countries (LMIC) are an increasing necessity. Severe thalassemia is one of the most common life-threatening noncommunicable diseases of children globally.

Objective

The aim was to study the impact of ICT on quality of care for severe thalassemia patients in LMIC.

Methods

A total of 1110 patients with severe thalassemia from five centers in India were followed over a 1-year period. The impact of consistent use of a Web-based platform designed to assist comprehensive management of severe thalassemia (ThalCare) on key indicators of quality of care such as minimum (pretransfusion) hemoglobin, serum ferritin, liver size, and spleen size were assessed.

Results

Overall improvements in initial hemoglobin, ferritin, and liver and spleen size were significant (P<.001 for each). For four centers, the improvement in mean pretransfusion hemoglobin level was statistically significant (P<.001). Four of five centers achieved reduction in mean ferritin levels, with two displaying a significant drop in ferritin (P=.004 and P<.001). One of the five centers did not record liver and spleen size on palpation, but of the remaining four centers, two witnessed a large drop in liver and spleen size (P<.01), one witnessed moderate drop (P=.05 for liver; P=.03 for spleen size), while the fourth witnessed a moderate increase in liver size (P=.08) and insignificant change in spleen size (P=.12).

Conclusions

Implementation of computer-assisted treatment planning and performance assessment consistently and positively impacted indexes reflecting effective delivery of care to patients suffering from severe thalassemia in LMIC.

A Systematic Review of Open Source Clinical Software on GitHub for Improving Software Reuse in Smart Healthcare

The plethora of open source clinical software offers great reuse opportunities for developers to build clinical tools at lower cost and at a faster pace. However, the lack of research on open source clinical software poses a challenge for software reuse in clinical software development. This paper aims to help clinical developers better understand open source clinical software by conducting a thorough investigation of open source clinical software hosted on GitHub. We first developed a data pipeline that automatically collected and preprocessed GitHub data. Then, a deep analysis with several methods, such as statistical analysis, hypothesis testing, and topic modeling, was conducted to reveal the overall status and various characteristics of open source clinical software. There were 14,971 clinical-related GitHub repositories created during the last 10 years, with an average annual growth rate of 55%. Among them, 12,919 are open source clinical software. Our analysis unveiled a number of interesting findings: Popular open source clinical software in terms of the number of stars, most productive countries that contribute to the community, important factors that make an open source clinical software popular, and 10 main groups of open source clinical software. The results can assist both researchers and practitioners, especially newcomers, in understanding open source clinical software.

Nurses' Attitudes Toward the Use of an Electronic Health Information System in a Developing Country

The electronic-based documentation system is considered a major transformation in health care in many hospitals worldwide. Successful implementation of the system makes nurses' jobs easier, saves time, and improves the quality of care that is delivered to patients. However, little is known about the adoption of electronic health information systems in developing countries. The purpose of this study was to understand and evaluate nurses' acceptance and attitudes about implementation of an electronic health information system in Palestinian hospitals. A descriptive, cross-sectional study was conducted with 191 nurses in three governmental hospitals in Palestine. A majority of these nurses understood the need for and accepted the computer-based documentation as demonstrated by their scores on the attitude questionnaire. Inclusion of nurses in early phases of planning and implementation is important. Other developing countries can learn from the Palestinian experience with implementation of electronic health records.