Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic.

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.

Health Information System's Responses to COVID-19 Pandemic in China: A National Cross-sectional Study.

OBJECTIVE: After the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Chinese hospitals and health information technology (HIT) vendors collaborated to provide comprehensive information technology support for pandemic prevention and control. This study aims to describe the responses from the health information systems (HIS) to the COVID-19 pandemic and provide empirical evidence in the application of emerging health technologies in China. METHODS: This observational descriptive study utilized a nationally representative, cross-sectional survey of hospitals in China (N = 1,014) from 30 provincial administrative regions across the country. Participants include hospital managers, hospital information workers, and health care providers. RESULTS: Among all the responses, the most popular interventions and applications include expert question-and-answer sessions and science popularization (61.74%) in online medical consultation, online appointment registration (58.97%) in online medical service, and remote consultation (75.15%) in telehealth service. A total of 63.71% of the participating hospitals expanded their fever clinics during the pandemic, 15.38% hospitals used new or upgraded mobile ward rounds systems, and 44.68% hospitals applied online self-service systems. Challenges and barriers include protecting network information security (57.00%) since some hospitals experienced cybersecurity incidents. 71.79% participants hope to shorten wait time and optimize the treatment process. Health care workers experienced increased amount of work during the pandemic, while hospital information departments did not experience significant changes in their workload. CONCLUSION: In the process of fighting against the COVID-19, hospitals have widely used traditional and emerging novel HITs. These technologies have strengthened the capacity of prevention and control of the pandemic and provided comprehensive information technology support while also improving accessibility and efficiency of health care delivery.

Perceptions and Experiences of Hospital Nurses During Transition to an Electronic Handover Informatics System.

An effective patient transfer, or handover, among healthcare professionals can help prevent communication-related medical errors, and a reliable electronic handover informatics system can standardize the handoff process. Adapting to a new handover system may cause stress for nurses. This descriptive qualitative study aimed to explore the perceptions and transition experiences of hospital nurses in adopting and adapting to a new handover informatics system. Thirty-eight nurses at a medical center in Taiwan participated in the study from December 2016 to January 2017. The researcher conducted five focus group interviews and analyzed all responses using content analysis. Results showed three major themes: "Perceptions of challenges and barriers related to the transition to a new handover informatics system," "Perceptions of benefits and strategies to the transition to a new handover informatics system," and "Suggestions for successful implementation of a new handover informatics system." Five subthemes emerged from the first theme, and six subthemes emerged from the second theme. The results of this study could enhance our understanding of nurses' perceptions and experiences with transition to a new handover informatics system and could provide a reference for hospitals to develop individualized strategies to facilitate the implementation of a handover informatics system.

Respiratory medicine in Iraq - from the primitive to the advanced.

Healthcare in Iraq has seen significant decline over the past few decades. Political instability coupled with austerity due to conflict and war has become a major obstacle in the transition needed to restore acceptable healthcare standards. Respiratory medicine had remained under developed despite the potential benefit it could offer to many people suffering diseases of high prevalence. A dedicated team of experts carried out a feasibility study to create a specialist respiratory centre, ThiQar lung diseases (TQLD). Equipped with advanced diagnostic equipment, a paperless hospital information system and staff trained by specialists from the UK, the centre has reduced a significant healthcare gap. It now serves a large population catchment area and has helped offer people an alternative to seeking healthcare abroad.

Anesthesia Information Management Systems.

Anesthesia information management systems (AIMS) have evolved from simple, automated intraoperative record keepers in a select few institutions to widely adopted, sophisticated hardware and software solutions that are integrated into a hospital's electronic health record system and used to manage and document a patient's entire perioperative experience. AIMS implementations have resulted in numerous billing, research, and clinical benefits, yet there remain challenges and areas of potential improvement to AIMS utilization. This article provides an overview of the history of AIMS, the components and features of AIMS, and the benefits and challenges associated with implementing and using AIMS. As AIMS continue to proliferate and data are increasingly shared across multi-institutional collaborations, visual analytics and advanced analytics techniques such as machine learning may be applied to AIMS data to reap even more benefits.

Assessing the impact of the introduction of an electronic hospital discharge system on the completeness and timeliness of discharge communication: a before and after study.

BACKGROUND: Hospital discharge summaries are a key communication tool ensuring continuity of care between primary and secondary care. Incomplete or untimely communication of information increases risk of hospital readmission and associated complications. The aim of this study was to evaluate whether the introduction of a new electronic discharge system (NewEDS) was associated with improvements in the completeness and timeliness of discharge information, in Nottingham University Hospitals NHS Trust, England. METHODS: A before and after longitudinal study design was used. Data were collected using the gold standard auditing tool from the Royal College of Physicians (RCP). This tool contains a checklist of 57 items grouped into seven categories, 28 of which are classified as mandatory by RCP. Percentage completeness (out of the 28 mandatory items) was considered to be the primary outcome measure. Data from 773 patients discharged directly from the acute medical unit over eight-week long time periods (four before and four after the change to the NewEDS) from August 2010 to May 2012 were extracted and evaluated. Results were summarised by effect size on completeness before and after changeover to NewEDS respectively. The primary outcome variable was represented with percentage of completeness score and a non-parametric technique was used to compare pre-NewEDS and post-NewEDS scores. RESULTS: The changeover to the NewEDS resulted in an increased completeness of discharge summaries from 60.7% to 75.0% (p < 0.001) and the proportion of summaries created under 24 h from discharge increased significantly from 78.0% to 93.0% (p < 0.001). Furthermore, five of the seven grouped checklist categories also showed significant improvements in levels of completeness (p < 0.001), although there were reduced levels of completeness for three items (p < 0.001). CONCLUSION: The introduction of a NewEDS was associated with a significant improvement in the completeness and timeliness of hospital discharge communication.

Visualising emergency department capacity in an 'Emergency Department Capacity Clock': A novel tool to assess and communicate overcrowding and access block.

Hospital-wide engagement is required to alleviate the problem of ED crowding and its associated adverse effects. To this end, the article describes a novel visualisation termed 'the ED Capacity Clock', which can be formatted using business intelligence software. This radial diagram represents ED capacity and its consumption in a format that can be understood intuitively and at a glance. The ED Capacity Clock is designed to promote common understanding and discussion between relevant hospital services and also acts as an auditing tool to monitor processes implemented to alleviate ED crowding.

Hospital Characteristics are Associated With Readiness to Attain Stage 2 Meaningful Use of Electronic Health Records.

PURPOSE: To examine the difference between rural and urban hospitals as to their overall level of readiness for stage 2 meaningful use of electronic health records (EHRs) and to identify other key factors that affect their readiness for stage 2 meaningful use. METHODS: A conceptual framework based on the theory of organizational readiness for change was used in a cross-sectional multivariate analysis using 2,083 samples drawn from the HIMSS Analytics survey conducted with US hospitals in 2013. FINDINGS: Rural hospitals were less likely to be ready for stage 2 meaningful use compared to urban hospitals in the United States (OR = 0.49) in our final model. Hospitals' past experience with an information exchange initiative, staff size in the information system department, and the Chief Information Officer (CIO)'s responsibility for health information management were identified as the most critical organizational contextual factors that were associated with hospitals' readiness for stage 2. Rural hospitals lag behind urban hospitals in EHR adoption, which will hinder the interoperability of EHRs among providers across the nation. The identification of critical factors that relate to the adoption of EHR systems provides insights into possible organizational change efforts that can help hospitals to succeed in attaining meaningful use requirements. CONCLUSION: Rural hospitals have increasingly limited resources, which have resulted in a struggle for these facilities to attain meaningful use. Given increasing closures among rural hospitals, it is all the more important that EHR development focus on advancing rural hospital quality of care and linkages with patients and other organizations supporting the care of their patients.

2016 MOST WIRED.

This year's IT survey shows that hospitals are aggressively fighting cyber crime and looking for ways to use data to help in the transition to value-based care. Find out who made the 2016 lists of Most Wired, Most Advanced, Most Improved and Most Wired-Small and Rural.

The Rise of Ransomware.

As more cyber criminals make records-for-ransom demands, physicians need to be more vigilant than ever against attacks, tightening digital security and taking other precautions.

Anatomy of an Extensible Open Source PACS.

The conception and deployment of cost effective Picture Archiving and Communication Systems (PACS) is a concern for small to medium medical imaging facilities, research environments, and developing countries' healthcare institutions. Financial constraints and the specificity of these scenarios contribute to a low adoption rate of PACS in those environments. Furthermore, with the advent of ubiquitous computing and new initiatives to improve healthcare information technologies and data sharing, such as IHE and XDS-i, a PACS must adapt quickly to changes. This paper describes Dicoogle, a software framework that enables developers and researchers to quickly prototype and deploy new functionality taking advantage of the embedded Digital Imaging and Communications in Medicine (DICOM) services. This full-fledged implementation of a PACS archive is very amenable to extension due to its plugin-based architecture and out-of-the-box functionality, which enables the exploration of large DICOM datasets and associated metadata. These characteristics make the proposed solution very interesting for prototyping, experimentation, and bridging functionality with deployed applications. Besides being an advanced mechanism for data discovery and retrieval based on DICOM object indexing, it enables the detection of inconsistencies in an institution's data and processes. Several use cases have benefited from this approach such as radiation dosage monitoring, Content-Based Image Retrieval (CBIR), and the use of the framework as support for classes targeting software engineering for clinical contexts.

THE 2016 ENVIRONMENTAL SCAN.

Every year, the American Hospital Association compiles the Environmental Scan to provide hospital leaders with insight and information about market forces that are likely to affect the health care field. One common theme this year is the pace of change.

Future trends in Picture Archiving and Communication System (PACS).

This research investigates the opinions of radiologists regards requirements for improving current Picture Archiving and Communication System (PACS). Responses to a questionnaire were collected from 120 of the 200 radiologists in five governmental hospitals of Kuwait. The study the determines the importance of the solutions for future PACS from the radiologists point of view as: PACS must be integrated with other hospital information systems (100%); there must be multi hospital PACS access across different organizations (99%); web based PACS solutions (97%) and PACS applications in mobile phones (97%) are seen as an improved solution for future PACS. Whereas, the radiologists expressed strong concerns over the barriers for implementing web PACS solutions including: technical issues (91%); lack of training (85%); and cost (76%).

[The experience of medical information system implementation into multi-field outpatient facility].

The main prospective line of development of information technologies implemented into medical facilities is working out and approbation of complex solutions for work automatiozation. It is necessary to mention the experience of implementation of industrial integrated medical information system into the 9h diagnostic and treatment centre of the Ministry of Defence of the Russian Federation. In 2008 implementation of the information systems was funded by extra budgetary accounts of the facility. The basis of medical information system for the diagnostic and treatment centre was "Interin PROMIS". The article presents the main tasks, stages and difficulties that emerged in the process of implementation. One of the main tasks was to create the database of attached contingents. Conducted work allowed to increase access to healthcare, to develop transparent technologies for providing the healthcare to patients in different subunits. Implemented system is a very prospective for other military-medical facilities and has a unique functional capacity, system customizability, provides access to all activities of the medical facility.