The Impact of Leadership and Management on the Implementation of Electronic Health Record Systems in the Primary Healthcare Centers.

BACKGROUND: In the last three decades, Electronic Health Records Systems (EHRSs) have become one of the top priorities of policymakers globally. Nowadays, EHRS reform is fast becoming a priority in developed countries. The introduction of EHRSs in Saudi healthcare organizations is considered one of the highest priorities of policymakers. Saudi Arabian e-health strategy pays reasonable attention to the EHRS implementation project. According to Saudi Vision 2030, the e-health transformation will be on top of IT projects in the country. However, an estimated 50% of EHRS implementations have failed. Project leadership and type of project management have been found to be crucial components of effective EHRS implementation. AIM OF THE STUDY: To evaluate the role of centralized project management (CPM) in the implementation of large-scale EHRSs in Primary Healthcare Centers (PHCs) in Saudi Arabia (SA). METHODS: A sequential explanatory mixed-methods approach involving a survey and semi-structured qualitative interview methods were utilized. RESULTS: A total of 39 (75%) out of 53 policymakers at the Saudi Ministry of Health completed the survey, and 14 project team members were interviewed. Findings from both illustrated that adopting centralized project management approaches to implementation was beneficial in facilitating large-scale EHRS implementation and helped to overcome barriers that may have otherwise led to the failure of the project. EHRS interoperability and software selection were the factors that CPM influenced most positively.

Needs Assessment for a Leadership Course in Saudi Medical Schools: The Student Perspective.

Introduction: Leaders in healthcare no longer need to hold formal management positions; instead, leadership is perceived to be the responsibility of all healthcare professionals. Despite changes in curricula and teaching design, however, this review of the content taught in medical colleges in Saudi Arabia reveals a lack of leadership and a failure to equip young graduates to compete on the global stage. Medical students need leadership skills for patient care, cooperation, and navigating the complex healthcare system. Clinical management skills in hospitals require these talents also. The complexity of healthcare and the impact healthcare executives have on people's lives highlight the importance of these skills. Thus, healthcare practitioners must develop non-technical skills like proactivity, motivation, and change management to lead across professional boundaries and negotiate the increasingly complex healthcare landscape. Methods: This cross-sectional study combines a quantitative approach with a self-administered questionnaire-based survey. The sampling procedure is a non-probability convenience technique, adapted for 700 male and female undergraduate medical students from four medical colleges. Results: Of the students, 75.46% had minimal leadership experience and 22.69% had some leadership experience; 3.02% of 464 students considered themselves highly experienced in leadership. Conclusion: As the needs assessment and other relevant factors show, leadership should be introduced as a skilled subject. There will always be a growing demand for competent medical graduates, who are capable of becoming future leaders. Although elementary leadership concepts remain fundamentally the same, curricular development must focus on the needs of society and stakeholders.

From Validation to Assessment of e-Health Literacy: A Study among Higher Education Students in Portugal.

Despite their familiarity with technology, higher education students often lack the critical skills needed to assess the credibility of online health information, potentially impacting their health decisions and well-being. This study aims to validate and assess the e-Health Literacy Scale among those in Portuguese higher education. In addition, this study focused on measuring their e-health literacy levels and investigating how these skills relate to different sociodemographic variables. This cross-sectional study was conducted in two phases. Initially, the test-retest reliability and reproducibility of measured e-health literacy were assessed with a convenience sample of 20 participants. Subsequently, the e-health scale was applied to a group of 245 Portuguese higher education students. The research took place from January 2023 to April 2024. The scale exhibited robust internal consistency and reproducibility. Male gender consistently correlates with higher levels of e-health literacy. Students demonstrate good levels of e-health literacy (24/40), reflecting their ability to effectively navigate and utilize health information online. By integrating strategies to further enhance this literacy into university health programs, students can develop essential skills necessary for making informed decisions about their health. This proactive approach not only empowers students to access reliable health resources but also fosters a culture of health literacy that can positively impact their well-being both during their academic journey and beyond graduation.

Perceptions of students and faculty on NCAAA-accredited health informatics programs in Saudi Arabia: an evaluative study.

BACKGROUND: As the healthcare sector becomes increasingly reliant on technology, it is crucial for universities to offer bachelor's degrees in health informatics (HI). HI professionals bridge the gap between IT and healthcare, ensuring that technology complements patient care and clinical workflows; they promote enhanced patient outcomes, support clinical research, and uphold data security and privacy standards. This study aims to evaluate accredited HI academic programs in Saudi Arabia. METHODS: This study employed a quantitative, descriptive, cross-sectional design utilising a self-reported electronic questionnaire consisting of predetermined items and response alternatives. Probability-stratified random sampling was also performed. RESULT: The responses rates were 39% (n = 241) for students and 62% (n = 53) for faculty members. While the participants expressed different opinions regarding the eight variables being examined, the faculty members and students generally exhibited a strong level of consensus on many variables. A notable association was observed between facilities and various other characteristics, including student engagement, research activities, admission processes, and curriculum. Similarly, a notable correlation exists between student engagement and the curriculum in connection to research, attrition, the function of faculty members, and academic outcomes. CONCLUSION: While faculty members and students hold similar views about the institution and its offerings, certain areas of divergence highlight the distinct perspectives and priorities of each group. The perception disparity between students and faculty in areas such as admission, faculty roles, and internships sheds light on areas of improvement and alignment for universities.

Faculty and Students' Perspective of Health Informatics Programs in Saudi Arabia.

Background: Health Informatics is a discipline that deals with the acquisition, storage, retrieval and use of health data, information, and technologies for the purpose of improving healthcare quality. It involves the application of information science methods to analyse health information for improved problem solving and healthcare delivery. The use of information system applications in healthcare is increasingly popular and includes the use of applications like medical records, order entry, medical knowledge provision, imaging, as well as guidelines and other types of decision support. Aim: To examine health informatics undergraduate programs in Saudi Arabian government universities. Methods: This study follows a quantitative, descriptive cross-sectional design using a self-reported, electronic questionnaire. The data was collected using an online questionnaire via Google Forms. Probability stratified random sampling was utilized. Result and Conclusion: Findings revealed a response rate at 79% (n=184) of students and 67% (n=38) of faculty members. Variation was detected in the level of agreement toward the examined six variables. Both students and faculty members express same level of agreement toward all variables. A significant correlation was determined between facilities and other variables such as students' involvement, research, admission and curriculum. Similarly, there is a significant relationship between students' involvement and curriculum with research, demission, faculty members role and outcomes.

An examination of large-scale electronic health records implementation in Primary Healthcare Centers in Saudi Arabia: a qualitative study.

Introduction: Digital transformation has become a buzzword in almost every industry in the twenti first century. Healthcare is not an exception. In the healthcare industry, digital transformation includes the utilization of electronic health records (EHRs), telemedicine, health information exchange, mobile health, and other interactive platforms. The importance of digital transformation in healthcare cannot be overemphasized as it has proven to be critical in improving patient outcomes, making healthcare delivery more efficient, and reducing costs. The positive impact of electronic health records was noticed almost immediately in the field of primary healthcare. It has been suggested that implementing electronic health records will enhance the accessibility and the process of distribution of health records between authorized users. As part of Saudi vision 2030, all healthcare organizations in Saudi Arabia are going to shift to digital transformation. Methods: This study follows a qualitative, semi-structure, face-to-face interview approach. The collected data were analyzed using NVivo V10 software. Inductive thematic analysis approach was used to analyse the collected data from the interviews. Result: Seventeen project team members, from different positions and backgrounds were purposively chosen to be interviewed. Three main themes and 38 codes were generated from the analysis of transcripts. The informants describe the implementation of electronic health records in the PHCs based on two different experiences. The participants reported that a previous attempt failed due to inappropriate infrastructure, lack of technical support, and low level of user acceptance. Therefore, the policymakers adopted several steps to increase the level of success and avoid failure causes. They initially established well-defined requests for proposals followed by continuous commendation among the project team and conducted a consultation on multiple levels (country level; organizational level and individual level). Conclusion: This study concluded that the main causes that lead to the failure of the large-scale project were lack of connectivity, lack of technical support, and staff changes, particularly those who occupied high-level positions in the Saudi ministry of Health. The success rate of EHRs implementation can be directly impacted by the size of the project. Large-scale projects are complicated and may be subject to numerous challenges compared with small projects. Significant factors such as training, support, legal issues, and organizational workflow and redesign were a concern of the project team during the pre-implementation phase. In addition, other factors related to technology and end-users were included in the EHRs implementation plan.

People behavioral during health information searching in COVID-19 era: a review.

Background: The COVID-19 pandemic has led to an increase in health information-seeking behavior (HISB) on the Internet. Objective: This review aims to identify and synthesize the available evidence on health information-seeking behavior on the Internet during and after the COVID-19 pandemic. Methods: Electronic search of databases was conducted on PubMed, ScienceDirect, Scopus, and Taylor and Francis Online to identify relevant articles. Studies that examined health information-seeking behavior on the Internet during or after the COVID-19 pandemic were included. Data from the included studies were subjected to a thematic analysis. Results: A total of 355 articles were identified in the initial database search. After screening, 15 articles were included in this review paper, with a population of 33,326. Search engines, social media, and news portals were the most commonly used information sources. The primary motivators for seeking health information online were curiosity, catching up with updated information, and paying attention to the COVID-19 transmission. Participants' satisfaction with the information obtained online was positive in most studies. The online query for all items related to COVID-19 and health increased during the pandemic. The most searched topics were symptoms of COVID-19, restrictions, current prevalence/spread of COVID-19, and preventive measures. Higher scores in digital health literacy (DHL) were associated with a well-established and effective health information-seeking behavior. Conclusion: The findings of this review provide insight into the patterns and trends of health information-seeking behavior on the Internet during and after the COVID-19 pandemic. The results suggest that search engines, social media, and news portals remain key sources of information during the pandemic. It also assessed the relationship between the DHL and the HISB and found that having a good DHL generally meant a good HISB.

The gap between bachelor's degree graduates in health informatics and employer needs in Saudi Arabia.

BACKGROUND: In the field of health informatics (HI), there is a crucial gap between employers' needs and the output of academic programmes. Although industrial organisations and government agencies recognise the importance of training and education in the development and operation of health-information systems, advancements in educational programmes have been comparatively slow in terms of investment in healthcare information technology. This study aims to determine the gap between employer demands and academic programmes in HI in Saudi Arabia. METHODS: This mixed-methods study collected both qualitative and quantitative data. A qualitative content analysis was performed to identify the role of advertised HI jobs using two sources: Google and LinkedIn. In addition, university websites were searched to determine job opportunities for graduates with a bachelor's degree in HI. Next, a quantitative, cross-sectional self-report questionnaire was administered to validate the findings of the qualitative data. Data obtained were analysed using SPSS, N-Vivo, and Microsoft Excel. RESULTS: The study's data were obtained from four sources: Google search engine, LinkedIn, five Saudi university websites, and 127 HI experts. The results show a discrepancy between academic programmes' outputs and employer recruitment needs. In addition, the results reveal a preference for post-graduate degrees, either a master's or PhD degree, with a bachelor's degree in a health or medical discipline. CONCLUSIONS: Employers tend to prefer applicants with a bachelor's degree in computer science or information technology over those with a degree in HI. Academic programmes should incorporate more practical applications and provide students with a thorough understanding of the healthcare industry to better equip them as efficient future HI professionals.

Assessing primary health care readiness for large-scale electronic health record system implementation: Project team perspective.

INTRODUCTION: The introduction of information technology was one of the key priorities for policymakers in healthcare organisations over the last two decades, due to the potential benefits of this technology to improve healthcare services and quality. However, about 50% of those projects failed to achieve their intended aims. This was as a result of several factors and included the level of readiness to the new IT projects. AIM: The aim of the study was to assess the readiness of Saudi primary health care centres (PHCCs) readiness for the implementation of an electronic health record system (EHRS) from the project team perspective. METHODS: Explanatory mixed methods design was used with both qualitative and quantitative methods. Thirty-one members of project team at the ministry of health (MOH) participated in the online-based questionnaire, while 13 participants from the same population took part in the semi-structure interviews. Eight different readiness scales were quantitatively examined. These scales include resources, Knowledge, process, management structure and administrative support, end user, technology and values and goals. RESULT: Although, very high level of readiness has been recorded at the process, management structure and administrative support levels, readiness was average at the end user, technology and values and goals levels. Moreover, the study findings revealed that primary health care centres readiness for an electronic health record system must be considered in the early stages of implementation (pre-implementation phase), particularly readiness at a technical level, such as preparedness of the infrastructure. A positive significant correlation has been recorded between all readiness scales with centralization of management system and financial resources. CONCLUSION: Overall, the level of primary health care centres readiness recorded to be high, which indicates that primary health care centres are ready for implementation of the electronic health record system, and in this context, management structure, organizational process, financial recourses and administrative support play significant roles to increase the project success rate.

Determining Current Medications Usage within a Cohort of Patients in the UK-A Descriptive Retrospective Study.

Swansea University's United Kingdom (UK) Multiple Sclerosis (MS) Register is a platform that contains information on more than 17,600 people with MS living in the UK. The register has been in operation since 2011 and represents comprehensive information about people living with MS in the UK. It is considered the first register of its kind that can link information from patients to clinical data and has been established to answer different information needs about MS. Aim: To elucidate the trends in patterns of medicines currently used by people with MS in the UK MS register. Methods: This study follows an exploratory descriptive design using the UK MS register as data resource. A number of 4516 people completed the EQ-5D survey out of 8736 people who have given their consent to answer online questionnaires which represents around 52% of the register total population. Descriptive analysis and tests were performed with SPSS to address the research objectives. Results: There are several medicine names entered by people with MS in their profiles. These medicines are used either to manage MS symptoms or to treat its associated complications. Among the medicine types revealed in this study, disease modifying drugs (DMDs), muscle relaxants, and anticonvulsants are the medicine types mainly used by people with MS followed by antidepressant and antianxiety medicines. Conclusions: From the antidepressants used most widely, amitriptyline was chosen as a subject medicine for further investigation in the remaining studies of this research due to its high frequency use, the elevated depression rates discovered among people with MS who seek information on it online, and the high online content noted on websites about this medicine.

Exploring facilitators of the implementation of electronic health records in Saudi Arabia.

INTRODUCTION: The introduction of information technology was one of the key priorities for policy-makers in health care organisations over the last two decades due to the potential benefits of this technology to improve health care services and quality. However, approximately 50% of those projects failed to achieve their intended aims. This was a result of several factors, including the cost of these projects. The Saudi Ministry of Health (MoH) planned to implement an electronic health record system (EHRS) in approximately 2100 primary health care centres nationwide. It was acknowledged that this project may face hurdles, which might result in the failure of the project if implementation facilitators were not first determined. According to the Saudi MoH, previous electronic health record system implementation in primary health care centres failed as a consequence of several barriers, such as poor infrastructure, lack of connectivity and lack of interoperability. However, the facilitators of successful electronic health record system implementation in Saudi primary health care centres are not understood. AIM: To determine the facilitators that enhance the success of the implementation of an EHRS in public primary health care centres in SA. METHOD: A mixed methods approach was used with both qualitative and quantitative methods (qualitative using semistructured interviews and quantitative with a closed survey). The purpose of the utilisation of exploratory mixed methods was to identify a wide range of facilitators that may influence EHRS implementation. The data were obtained from two different perspectives, primary health care centre practitioners and project team members. A total of 351 practitioners from 21 primary health care centres participated in the online survey, and 14 key informants at the Saudi Ministry of Health who were directly involved in the electronic health record system implementation in the primary health care centres agreed to be interviewed face to face. RESULTS: The findings from both studies revealed several facilitators. Among these facilitators, financial resources were found to be the most influential factor that assisted in overcoming some barriers, such as software selection. The size of the primary health care centres was the second facilitator of successful implementation, despite the scale of the project. Perceived usefulness was another facilitator identified in both the interviews and the survey. More than 90% of the participants thought that the electronic health record system was useful and could contribute to improving the quality of health care services. While a high level of satisfaction was expressed towards the electronic health record system's usability and efficiency, low levels of satisfaction were recorded for organisational factors such as user involvement, training and support. Hence, system usability and efficiency were documented to be other facilitators of successful electronic health record system implementation in Saudi primary health care centres. CONCLUSION: The findings of the present study suggest that sufficient financial support is essential to enhance the success of electronic health record system implementation despite the scale of the project. Additionally, effective leadership and project management are core factors to overcome many obstacles and ensure the success of large-scale projects.

The impact financial resources on implementation of large-scale electronic health records in the Saudi Arabia's primary healthcare centers: Mixed methods.

Introduction: There is worldwide demand for the implementation of electronic health systems and a transformation to electronic transactions in healthcare organizations. This move to e-health transformation stems from the perceived positive impact that e-health systems have in improving the quality of healthcare and, in turn, reducing expenses. Despite this, more than half of previous Electronic Health Record System (EHRS) implementation projects have failed due to several barriers and challenges such as cost. Aim of the study: To evaluate the impact of financial resources (FR) on the implementation of the EHRS in PHCs in SA. Methods: A mixed methods approach was implemented. SPSS and AMOS-SEM are used to test reliability and validity and hypotheses. Thirty-one (59%) out of 51 policy makers at the MoH filled and returned the questionnaire while 13 policymakers were interviewed using semi-structure interviews. Results: Results revealed that both measurement model and structural models met the threshold. All scales are found reliable and valid. Furthermore financial resources have positive impact on EHRS implementation. Findings from both studies show that financial resources have a very positive impact to facilitate large-scale EHRs implementation and overcome barriers that may lead to the failure of the project.

The Impact of Job Stress, Role Ambiguity and Work-Life Imbalance on Turnover Intention during COVID-19: A Case Study of Frontline Health Workers in Saudi Arabia.

The main objective of the present study is to examine the impact of job stress, role ambiguity, work-life imbalance and burnout on employee turnover intention. Moreover, the mediating role of burnout between job stress, role ambiguity, work-life imbalance and turnover intention is also examined. The data collection for this quantitative research was conducted through the "Questionnaire" technique. The questionnaire was developed based on previously established questions available in the literature. The data were collected using simple random sampling from the healthcare workers of KSA. From the distributed questionnaire, 73.5% of the usable questionnaires were returned. This study used SPSS and PLS for the analysis of the data to highlight the most significant variables that impact the employees' turnover intentions among KSA health workers. The findings show that job burnout is clearly related to turnover intentions and is positively affected by both role stress and role ambiguity. Moreover, a statistically positive association is found between work-life imbalance and burnout among the healthcare workers in KSA. Furthermore, the mediating role of burnout is also confirmed in this study. The study also indicates that role ambiguity and role stress due to COVID-19 may create burnout among employees, which may lead to turnover intention among healthcare workers. There is a lack of research on the assessment of the impact of the novel COVID-19-related job stress, role ambiguity and work-life imbalance on the medical staff's turnover intentions in hospitals. This study fills the gap of the limited studies conducted regarding the identification of the factors that can create turnover intention among healthcare workers of KSA by providing empirical evidence from a Gulf country, Saudi Arabia. This study provides managerial implications for hospital management and health policymakers to develop a strategy to retain the employees. Furthermore, healthcare administrators need to pay close attention to front line workers' turnover intentions as these medical heroes are the vital part of our society who assist patients to receive their initial treatment during the COVID-19 pandemic.

Targeting Cytotoxin-Associated Antigen A, a Virulent Factor of Helicobacter pylori-Associated Gastric Cancer: Structure-Based In Silico Screening of Natural Compounds.

Gastric cancer is the fifth most frequent cancer and the third major cause of mortality worldwide. Helicobacter pylori, a bacterial infection linked with GC, injects the cytotoxin-associated antigen A (CagA; an oncoprotein) into host cells. When the phosphorylated CagA protein enters the cell, it attaches to other cellular components, interfering with normal cellular signaling pathways. CagA plays an important role in the progression of GC by interacting with phosphatidylserine of the host cell membrane. Therefore, disrupting the CagA-phosphatidylserine connection using small molecules appears to be a promising therapeutic approach. In this report, we screened the natural compounds from ZINC database against the CagA protein using the bioinformatics tools. Hits were initially chosen based on their physicochemical, absorption, distribution, metabolism, excretion, and toxicity (ADMET) characteristics, as well as other drug-like characteristics. To locate safe and effective hits, the PAINS filter, binding affinities estimation, and interaction analysis were used. Three compounds with high binding affinity and specificity for the CagA binding pocket were discovered. The final hits, ZINC153731, ZINC69482055, and ZINC164387, were found to bind strongly with CagA protein, with binding energies of -11.53, -10.67, and -9.21 kcal/mol, respectively, which were higher than that of the control compound (-7.25 kcal/mol). Further, based on binding affinity and interaction pattern, two leads (ZINC153731, ZINC69482055) were chosen for molecular dynamics (MD) simulation analysis. MD results showed that they displayed stability in their vicinity at 100 ns. This study suggested that these compounds could be used as possible inhibitors of CagA protein in the fight against GC. However, additional benchwork tests are required to validate them as CagA protein inhibitors.

A Qualitative Investigation of Factors Affecting Saudi Patients' Communication Experience with Non-Saudi Physicians in Saudi Arabia.

(1) Background: Communication is the main issue between the patient and physician. Communication gaps lead to medical errors, mistakes, and wrong diagnoses and treatments. It would certainly be a cause of patient dissatisfaction, the physicians' job dissatisfaction, and the increase in the cost of health services. (2) Objectives: The objective of the study was to explore the perception of Saudi patients when they meet non-Saudi consultants at hospitals. (3) Material and Methods: This study is exploratory in nature. Semi-structured face to face interviews were conducted. Study participants were patients from the outpatient department of the Hospitals of Qassim province, Saudi Arabia. A total of eight respondents, four male and four female, participated in the study. (4) Results: Interviews were transcribed verbatim and analyzed using a thematic analysis approach. Two main themes emerged: the first theme is encountering difference, with three sub-themes, while the second one is the absence of partnering, with four sub-themes. (5) Conclusions: The analysis of the patients' experiences of their medical encounters revealed that the effectiveness of the physician-patient communication was jeopardized by two challenges: encountering differences and the absence of partnering. (6) Limitations: This study was conducted in one site only and hence findings must be tested in application to other sites in other parts of Saudi Arabia and in other similar countries. A further limitation of this study was the cultural barrier that was encountered by the researcher during the interview process.