Follow-Up Decision Support Tool for Public Healthcare: A Design Research Perspective

Potential facilitators and inhibitors to the implementation and sustainability of the community-based tuberculosis care interventions. A case study from Moshupa, Botswana

BACKGROUND

Eliminating Tuberculosis is one of the targets of Sustainable Development Goal Three. Decentralizing TB care beyond health facilities by leveraging community involvement is crucial for safeguarding effective tuberculosis care. In this study, we explored potential facilitators and inhibitors of the implementation and sustainability of community-based interventions for the prevention and treatment of TB in the Moshupa district, Botswana.

METHODS

This study adopted a qualitative approach using a collective case design. An interpretive paradigm based on relativist ontology and subjectivist epistemology along with abductive research logic was used. The study enrolled treatment supporters of tuberculosis patients diagnosed with drug-susceptible tuberculosis between January 2019 and December 2019 in Moshupa Village for semi-structured interviews, Health care professionals for in-depth interviews, and e community leaders for focus group discussions. Clinic-based observations in Mma-Seetsele clinic were also conducted to corroborate the participants' views. The data collected was analyzed using the NVivo version 12 software package, and statements of the participants were presented as quotes to substantiate the issues discussed.

RESULTS

This study highlighted effective partnerships between health services and external stakeholders, community empowerment, and the availability of policies and standard operating procedures as facilitators of community TB implementation and sustainability. However, Insufficient funding, low service provider training, policies not embracing age and educational eligibility for treatment supporters, shortage of equipment, medicines, and supplies, inadequate transport availability and incentives to meet clients' basic needs, paper-based systems, inadequate supervision, incomplete data reporting, and low service quality affected the Community TB program efficacy and sustainability in Moshupa. We also found that there was low service provider motivation and retention and that clients had low trust in treatment supporters.

CONCLUSION

The findings of this study imply that the operational effectiveness of the community TB care approach to disease elimination is compromised; therefore, initiatives addressing the key components, including the availability of resources, governance arrangements and supportive systems for community health workers, are required for successful community TB implementation and sustainability.

Integrated Personal Health Record in Indonesia: Design Science Research Study

BACKGROUND

Personal health records (PHRs) are consumer-centric tools designed to facilitate the tracking, management, and sharing of personal health information. PHR research has mainly been conducted in high-income countries rather than in low- and middle-income countries. Moreover, previous studies that proposed PHR design in low- and middle-income countries did not describe integration with other systems, or there was no stakeholder involvement in exploring PHR requirements.

OBJECTIVE

This study developed an integrated PHR architecture and prototype in Indonesia using design science research. We conducted the research in Indonesia, a low- to middle-income country with the largest population in Southeast Asia and a tiered health system.

METHODS

This study followed the design science research guidelines. The requirements were identified through interviews with 37 respondents from health organizations and a questionnaire with 1012 patients. Afterward, the proposed architecture and prototype were evaluated via interviews with 6 IT or eHealth experts.

RESULTS

The architecture design refers to The Open Group Architecture Framework version 9.2 and comprises 5 components: architecture vision, business architecture, application architecture, data architecture, and technology architecture. We developed a high-fidelity prototype for patients and physicians. In the evaluation, improvements were made to add the stakeholders and the required functionality to the PHR and add the necessary information to the functions that were developed in the prototype.

CONCLUSIONS

We used design science to illustrate PHR integration in Indonesia, which involves related stakeholders in requirement gathering and evaluation. We developed architecture and application prototypes based on health systems in Indonesia, which comprise routine health services, including disease treatment and health examinations, as well as promotive and preventive health efforts.

Dynamic Demand-Centered Process-Oriented Data Model for Inventory Management of Hemovigilance Systems

Objectives

This paper presents a reference data model for blood bank management to control blood inventories considering real-world uncertainties and constraints. It helps information systems identify blood product status for various critical decisions (such as replenishment, assignment, and issuing) instantly. Additionally, some significant optimization concepts of the inventory management literature for blood wastage and shortage reduction, such as clearance sale and substitution based on medical priorities, are applied in the model.

Methods

The proposed model was constructed by object-oriented and ICAM (Integrated Computer Aided Manufacturing) definition φ (IDEF0) techniques for function modeling. Through semi-structured questionnaires and interviews, the research team elicited and classified user requirements. Then, the demand-centered sub-processes and comprehensive functions were mapped to manage the process.

Results

The model captures and integrates the top-level features of the inventory system entities. It also provides insights into a developed data dictionary to understand the system’s elements and attributes, where a data item fits in the structure, and what values it may contain. For designing the system’s process and following-up data, the main relevant inputs are considered.

Conclusions

A flexible and applicable demand-centered framework for managing a typical blood bank’s inventory process was developed by focusing on user requirements. The proposed model can be applied to design and monitor inventory information and decision-support systems. The model provides real-time iterative dynamic process insights. It can also provide the data needed for logistic planning systems and the design of blood operational infrastructure.

Real-Time Monitoring System to Manage Mental Healthcare Emergency Unit

Objectives

Real-time relevant information helps guide the healthcare decision-making process in daily clinical practice as well as the management and optimization of healthcare processes. However, proprietary business intelligence suite solutions supporting the production of decision-making information requires investment that is out of reach of small and medium-sized healthcare facilities or those with limited resources, particularly in developing countries. This paper describes our experience in designing and implementing a real-time healthcare monitoring system solution to manage healthcare emergency units.

Methods

Through the use of free Business Intelligence tools and Python data science language we designed a real-time monitoring system, which was implemented to explore the Electronic Medical Records system of a university mental health emergency unit and render an electronic dashboard to support health professional daily practice.

Results

Three main dashboards were created to monitor patient waiting time, to access the clinical notes summary for the next waiting patient, and to obtain insights into activity during the last 24 hours.

Conclusions

The designed system could serve as a monitoring support model using free and user-friendly data science tools, which are good alternatives to proprietary business intelligence solutions and drastically reduce cost. Still, the key to success in decision-making systems is based on investment in human resources, business intelligence skills training, the organizational aspect of the decision-making process, and data production quality insurance.