Getting ready for the European Health Data Space (EHDS): IDERHA's plan to align with the latest EHDS requirements for the secondary use of health data.

Objective: The European Health Data Space (EHDS) shapes the digital transformation of healthcare in Europe. The EHDS regulation will also accelerate the use of health data for research, innovation, policy-making, and regulatory activities for secondary use of data (known as EHDS2). The Integration of heterogeneous Data and Evidence towards Regulatory and HTA Acceptance (IDERHA) project builds one of the first pan-European health data spaces in alignment with the EHDS2 requirements, addressing lung cancer as a pilot. Methods: In this study, we conducted a comprehensive review of the EHDS regulation, technical requirements for EHDS2, and related projects. We also explored the results of the Joint Action Towards the European Health Data Space (TEHDAS) to identify the framework of IDERHA's alignment with EHDS2. We also conducted an internal webinar and an external workshop with EHDS experts to share expertise on the EHDS requirements and challenges. Results: We identified the lessons learned from the existing projects and the minimum-set of requirements for aligning IDERHA infrastructure with EHDS2, including user journey, concepts, terminologies, and standards. The IDERHA framework (i.e., platform architecture, standardization approaches, documentation, etc.) is being developed accordingly. Discussion: The IDERHA's alignment plan with EHDS2 necessitates the implementation of three categories of standardization for: data discoverability: Data Catalog Vocabulary (DCAT-AP), enabling semantics interoperability: Observational Medical Outcomes Partnership (OMOP), and health data exchange (DICOM and FHIR). The main challenge is that some standards are still being refined, e.g., the extension of the DCAT-AP (HealthDCAT-AP). Additionally, extensions to the Observational Health Data Sciences and Informatics (OHDSI) OMOP Common Data Model (CDM) to represent the patient-generated health data are still needed. Finally, proper mapping between standards (FHIR/OMOP) is a prerequisite for proper data exchange. Conclusions: The IDERHA's plan and our collaboration with other EHDS initiatives/projects are critical in advancing the implementation of EHDS2.

Medical Interpreting Services for Refugees in Canada: Current State of Practice and Considerations in Promoting this Essential Human Right for All.

Language barriers, specifically among refugees, pose significant challenges to delivering quality healthcare in Canada. While the COVID-19 pandemic accelerated the emergence and development of innovative alternatives such as telephone-based and video-conferencing medical interpreting services and AI tools, access remains uneven across Canada. This comprehensive analysis highlights the absence of a cohesive national strategy, reflected in diverse funding models employed across provinces and territories, with gaps and disparities in access to medical interpreting services. Advocating for medical interpreting, both as a moral imperative and a prudent investment, this article draws from human rights principles and ethical considerations, justified in national and international guidelines, charters, codes and regulations. Substantiated by a cost-benefit analysis, it emphasizes that medical interpreting enhances healthcare quality and preserves patient autonomy. Additionally, this article illuminates decision-making processes for utilizing interpreting services; recognizing the pivotal roles of clinicians, interpreters, patients and caregivers within the care circle; appreciating intersectional considerations such as gender, culture and age, underscoring the importance of a collaborative approach. Finally, it provides recommendations at provider, organizational and system levels to ensure equitable access to this right and to promote the health and well-being of refugees and other individuals facing language barriers within Canada's healthcare system.

Local Data Quality Assessments on EHR-Based Real-World Data for Rare Diseases.

The project "Collaboration on Rare Diseases" CORD-MI connects various university hospitals in Germany to collect sufficient harmonized electronic health record (EHR) data for supporting clinical research in the field of rare diseases (RDs). However, the integration and transformation of heterogeneous data into an interoperable standard through Extract-Transform-Load (ETL) processes is a complex task that may influence the data quality (DQ). Local DQ assessments and control processes are needed to ensure and improve the quality of RD data. We therefore aim to investigate the impact of ETL processes on the quality of transformed RD data. Seven DQ indicators for three independent DQ dimensions were evaluated. The resulting reports show the correctness of calculated DQ metrics and detected DQ issues. Our study provides the first comparison results between the DQ of RD data before and after ETL processes. We found that ETL processes are challenging tasks that influence the quality of RD data. We have demonstrated that our methodology is useful and capable of evaluating the quality of real-world data stored in different formats and structures. Our methodology can therefore be used to improve the quality of RD documentation and to support clinical research.

Implementation of Interoperable Healthcare Standards for Community Healthcare.

Building an integrated data model that includes not only clinical data but also personal health records has become increasingly important. We aimed to build a big data healthcare platform by developing a common data model that can be utilized in the healthcare field. To this end, we acquired health data from various communities to establish community care digital healthcare service models. Further, to improve personal health data interoperability, we ensured conformance to international standards, namely, the Systemized Nomenclature of Medicine Clinical Terms (SNOMED-CT) and transmission standards, namely, Health Level 7 Fast Healthcare Interoperability Resource (HL7 FHIR). Furthermore, FHIR resource profiling was designed to transmit and receive data, following the HL7 FHIR R4 guidelines.

National quality standards for neuro rehabilitation in a community setting: Do they achieve their purpose?

RATIONALE: There is known variation in neuro-rehabilitation service provision, however, the extent of service variation and impact on people who experience an acquired brain injury (ABI) is not articulated in the literature. The aim of this study was to assess and determine the extent to which neuro-rehabilitation services in one part of the United Kingdom (UK) are meeting national quality standards. METHOD: A mixed method design, across five community neuro-rehabilitation providers and six districts in South London, comprised of ABI population incidence data, web-based surveys to determine compliance with the National Institute for Health and Care Excellence (NICE) Head Injury Quality Standard, and focus groups to understand the patient perspective of community neuro-rehabilitation service provision. RESULTS: The population incidence of ABI amongst districts demonstrated differences between the datasets analyzed, resulting in an inability to determine whether service variation was based on population need. The web-based surveys revealed that five community neuro-rehabilitation providers have variations between the models of care provided, including clinical referral criteria, duration, intensity of therapy interventions, and overall cost per patient, which was correlated with workforce capacity and patient waiting times. Focus group discussion highlighted current key challenges of service restraints, disconnect between services and limited professional support, as well as improvement opportunities pertaining to access, flexible, local and timely health and social care services. CONCLUSION: This study indicates that despite the publication of the NICE Head Injury Quality Standard, there is variation in the local provision of community neuro-rehabilitation across six districts in South London. Each district partly meets the recommendations, highlighting variability in the model of care delivered, that impacts consumers/carers accessing quality neuro-rehabilitation services. A disconnect remains between evidence-based quality standards and implementation. No standardized ABI data set is available in the UK, which impacts planning for future clinical service delivery.

An appraisal of healthcare accreditation agencies and programs: similarities, differences, challenges and opportunities.

BACKGROUND: The study, following similar reviews in 2000 and 2010, presents an update of knowledge about external evaluation agencies and accreditation programs. OBJECTIVE: The study aim was to investigate the current profile of external evaluation agencies identifying their program features, and significant changes and challenges.

A micro credential for interoperability.

In the midst of a global pandemic the need for health and social care providers to commit to, and deliver on, integrated patient-centered care services has been accelerated. Globally, health and social care programme administrators are turning to digital devices and applications to provide supporting infrastructure which can offer safe access to health information at the point of care. Digitalisation is increasingly considered a key requirement to support diagnostics and therapeutic care services in health care delivery. The open source community are responding to this need to advance integrated care and digital services by providing targeted resources to address the interoperability challenge. Addressing interoperability in health systems is a core part of achieving sustainable enterprise wide integrated care. Using Open Innovation 2.0 methods for advancing knowledge on interoperability, this paper describes the development of a micro credential for knowledge transfer on interoperability created by the Centre for eIntegrated Care (CeIC). Designed and developed to signpost interested stakeholders to targeted material and build understanding and capacity on the topic. The design approach and initial resource content are explained through the lens of a specific research project funded by an Elite S Fellowship to advance leadership and standardisation for Information and Communications Technology (ICT) in Europe.

Knowledge and Attitudes about Helsinki Declaration on Patient Safety among Anaesthesiologists in Turkey: A Questionnaire Study.

OBJECTIVE: The Helsinki Declaration on Patient Safety in Anaesthesiology is an important document for anaesthesiologists. This study aimed to evaluate the knowledge and experiences of anaesthesiologists in Turkey on the "Helsinki Declaration on Patient Safety." METHODS: After the ethics committee approval and participants' consent, electronic questionnaires were sent to anesthetists working in Turkey. The questionnaire included 48 questions. RESULTS: The mean age of the participants was 44.28±8.01 years, and 52.1% were women (n=142). The mean time spent in the field of anesthesiology was 12.83±7.76 years. The percentage of participants working in private hospitals was 13.4%. A total of 58.5% of the participants were educated on patient safety out of whom 57% said that their knowledge was sufficient, 37.3% said that it was limited, and 5.6% felt that it was insufficient. The knowledge of participants about the Helsinki Declaration was sufficient in 31.7%, limited in 39.4%, insufficient in 9.2%, and 19.7% had no knowledge. A total of 27% of participants believed that implementation of the Helsinki Declaration improved patient safety. It has been stated that the minimum patient monitoring standards recommended by the European Board of Anaesthesiology has been complied in operating rooms and recovery units (90.8% and 78.2%, respectively). CONCLUSION: The findings of this survey might guide not only the individual anesthetists but also hospital administrators to develop strategies to improve patient safety and thus quality of care in the light of the recommendations listed in the Helsinki Declaration.

Compliance with standard precautions in inpatient healthcare settings in the Czech Republic: a cross-sectional survey.

OBJECTIVE: The study evaluates compliance with declared hygienic standards carried out by healthcare professionals in clinical practice within their scope of direct patient care and the maintenance of medical tools and devices in healthcare facilities in the Czech Republic. METHODS: Cross-sectional questionnaire study focused on the standards of safe health care. All 80 addressed healthcare providers were also involved in the 2018 Adverse Event Reporting System (AERS) pilot project. Responses were scored on a 6-level scale, from "always" (100 points) to "never" (0 points). The evaluation was performed according to the frequency of responses and the average index (max. 100 points). Data analysis was performed using IBM SPSS Statistics version 22 (level of significance 1% and 5%). RESULTS: There were statistically processed 2,016 questionnaires (100%). Most respondents stated their job classification as non-medical healthcare professionals (NHP) working at a patient's bedside (73%), physicians (16%), or other NHP (11%). As per their medical specialty, 43% of the respondents practice internal medicine, 28% surgery, 14% psychiatry, 9% long-term inpatient care, and 6% stated other fields of medicine. The lowest declared compliance was registered in the statement "I use a face mask when exposure to air-transmitted pathogens is anticipated" (rating index 80 points). The highest compliance (99.4 points) was registered in the statement: "I discard used sharp materials into sharps containers." CONCLUSION: In the surveyed healthcare facilities within the Czech Republic, overall compliance with hygiene standards is at a good level. Declared differences in compliance with hygiene standards in the selected items of the questionnaire are influenced by multiple factors. Generally, a higher level of compliance is linked to increasing age, years of practice, and a higher level of education. When comparing professional groups, a higher level of compliance with hygiene standards was registered in the NHP group.

A systematic review and consensus definitions for standardised end-points in perioperative medicine: pulmonary complications.

BACKGROUND: There is a need for robust, clearly defined, patient-relevant outcome measures for use in randomised trials in perioperative medicine. Our objective was to establish standard outcome measures for postoperative pulmonary complications research. METHODS: A systematic literature search was conducted using MEDLINE, Web of Science, SciELO, and the Korean Journal Database. Definitions were extracted from included manuscripts. We then conducted a three-stage Delphi consensus process to select the optimal outcome measures in terms of methodological quality and overall suitability for perioperative trials. RESULTS: From 2358 records, the full texts of 81 manuscripts were retrieved, of which 45 met the inclusion criteria. We identified three main categories of outcome measure specific to perioperative pulmonary outcomes: (i) composite outcome measures of multiple pulmonary outcomes (27 definitions); (ii) pneumonia (12 definitions); and (iii) respiratory failure (six definitions). These were rated by the group according to suitability for routine use. The majority of definitions were given a low score, and many were imprecise, difficult to apply consistently, or both, in large patient populations. A small number of highly rated definitions were identified as appropriate for widespread use. The group then recommended four outcome measures for future use, including one new definition. CONCLUSIONS: A large number of postoperative pulmonary outcome measures have been used, but most are poorly defined. Our four recommended outcome measures include a new definition of postoperative pulmonary complications, incorporating an assessment of severity. These definitions will meet the needs of most clinical effectiveness trials of treatments to improve postoperative pulmonary outcomes.

Recognising and responding to in-hospital clinical deterioration: An integrative review of interprofessional practice issues.

AIMS AND OBJECTIVES: To identify, appraise and synthesise current evidence regarding organisation-wide interprofessional practice issues that facilitate or inhibit effective recognition and response to clinical deterioration, using a theoretical rapid response system model. BACKGROUND: Recognition and response to clinical deterioration, in adult general medical-surgical ward patients, is embedded as routine interprofessional practice in acute healthcare organisations worldwide. The process of care escalation is complex and sometimes involves multiple health professionals from different disciplines with varying levels of expertise. While a theoretical rapid response system model offers a formalised structured approach to escalate patient care, it is unclear how the implementation of this model, or similar, influences rapid response system-wide interprofessional practices to effectively recognise and respond to clinical deterioration. DESIGN: An integrative review. METHODS: This review was conducted using key words to systematically search four electronic bibliographic databases (PubMed, CINAHL, ProQuest Central, Cochrane Library). Twenty-nine eligible full-text papers were identified. Quality appraisal of methods was performed using recommended guidelines. Study findings were narratively coded, themed and conceptualised in the context of an organisation-wide rapid response system using an interprofessional collaborative practice framework. RESULTS: Five main themes aligned with the four interprofessional collaborative practice competency domains and a learning continuum of professional development: Organisational culture, Role perceptions and professional accountability, Communication of clinical needs, Team-based practices, and Interprofessional learning opportunities in recognising and responding to clinical deterioration. Within these themes, three notable interprofessional practice issues were highlighted: professional reporting hierarchies (inhibiting), critical care outreach services (facilitating) and interprofessional relationships (facilitating). CONCLUSIONS: A unique approach for exploring organisation-wide interprofessional practice issues has been presented using an interprofessional collaborative practice framework. Further interpretive organisation-wide research is necessary to develop a more in-depth and meaningful understanding of interprofessional collaborative practice issues that facilitate or inhibit effective recognition and response to clinical deterioration. RELEVANCE TO CLINICAL PRACTICE: This review presents a unique system-wide approach for exploring how health professionals interprofessionally collaborate in practice to effectively recognise and respond to clinical deterioration.

Is the introduction of an accreditation program likely to generate organization-wide quality, change and learning?

OBJECTIVE: This research assesses whether integration of Accreditation Canada's program brings about change and organizational learning. METHODS: Two health organizations, the Health Authority of Anguilla and the Ca' Foncella Opetale di Treviso, are studied on three levels: (1) members; (2) accreditation teams; and (3) organization. The methods used to collect data consisted of individual questionnaires administered to team members, semi-formal interviews with team leaders and quality coordinators, a documentation review and periodic assessments of compliance with the standards. RESULTS: The findings indicate that the organizations made strategic, organizational and relational changes. They improved their systems and management practices as well as their internal and external communications. There was also useful learning by individuals, teams and the organizations. Individual learning involved quality practice, client-focused approach, risk management, ethics, participatory management and assessment of services. The "self-assessment" and "make improvements and follow up on recommendations" stages of the accreditation cycle contributed the most to change and organizational learning. The interdisciplinary accreditation teams were the preferred vehicle for achieving these changes and this learning. CONCLUSIONS: The Health Authority of Anguilla and Ca' Foncella Opetale di Treviso have gradually improved their level of compliance with the standards in all quality dimensions. However, improvement in the overall compliance level was below the program's minimum requirements to obtain accreditation status without major restrictions. The scope of the changes and learning achieved raises the issue of the capacity of organizations to formalize this new knowledge throughout the organization. Copyright © 2015 John Wiley & Sons, Ltd.

Public sector physiotherapists believe that staff supervision should be broad ranging, individualised, structured, and based on needs and goals: a qualitative study.

QUESTION: What do physiotherapists consider to be the structure and content of an effective clinical supervision program for public sector staff? DESIGN: Qualitative study using emergent-systematic focus group design. PARTICIPANTS: 46 physiotherapists and six physiotherapy assistants from a large, regional, Australian health service participated in one of seven focus groups. RESULTS: Data were represented by three major categories: the content of supervision; the structure of supervision; and participants' roles and attributes. The content of supervision should encompass all issues affecting workplace experience and performance; supervision should be individualised and needs based. For the structure of supervision, a variety of methods and formats should be available, including: scheduled and unscheduled supervision (unscheduled supervision addresses needs as they arise but its usefulness can be restricted by supervisor availability); the environment should be organised to facilitate supervision; supervision should be integrated into existing practices; and supervision should be adequately prioritised and resourced to enable sustainability. In relation to participants' roles and attributes, respondents recommended: clearly defined supervisor and supervisee roles, responsibilities, skills and attributes are required to facilitate a constructive relationship on which successful supervision depends; the supervisee should take primary responsibility for leading and organising their supervision; the supervisor provides support and accountability and assists with goal setting and attainment; and successful supervision requires considerable knowledge and skills from the supervisee and supervisor (supervision education and training might be necessary). CONCLUSION: The physiotherapists' perspectives that were identified in this study are important to consider when assessing current clinical supervision models, as well as when designing and implementing effective physiotherapy supervision programs.

Against all odds? Understanding the emergence of accreditation of the Danish hospitals.

Despite intense critique from various parts of the medical professions, Danish hospitals have been subjected to a mandatory accreditation system known as the Danish Quality Model (Den Danske Kvalitetsmodel, DDKM) since 2009. The notion of government assemblage is employed to understand how and why, in the face of these obstacles, DDKM was ultimately implemented. It is argued that DDKM is the result of the emergence of hospital quality management assemblage in 1980s and 1990s made up by new methods of categorizing disease treatments, computerization of such treatments, concerns over cost-effectiveness, complaint registration, the availability of international hospital quality assessment systems, the mobilization of organized medical interest groups, and a tradition of consultative policymaking procedures. This assemblage was crucial for identifying quality as a problem in need of administrative intervention and for shaping the political struggle over how best to assure the quality of hospital services.

What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs.

BACKGROUND: Disease management programs (DMP) aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs. RESEARCH DESIGN AND METHODS: Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (n=316) and data from electronic medical records (EMR) (n=9023), and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard. RESULTS: On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. Ninety-six percent contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs. CONCLUSION: Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.