Barriers in access to services and information gaps by genders and key populations in the national Tuberculosis programme in Cambodia.

Approximately 34% of people with tuberculosis (TB) were undiagnosed in Cambodia in 2017. This study explored barriers in access to TB services and information gaps by genders and key populations in the Cambodian national TB programme. In 2017, we conducted a consensus and validation workshop, desk reviews, 19 in-depth interviews, and 30 focus group discussions with representatives of stakeholder groups, affected populations, and communities. Content analyses were performed for qualitative interviews. We employed the consensus development methods during the workshop to define and prioritise key populations. Key themes that inhibited access to TB services included the lack of knowledge, awareness, time and financial means, and gender-specific vulnerabilities. Systemic barriers included inconsistencies in policy and guideline implementation and lack of resources required for effective TB management. We did not find indications of coercive practices against women and key populations. However, stigma and discrimination did exist in healthcare institutions, the workplace, and the community. There were significant gaps in gender and key population-specific data and reporting systems at all levels. Data availability is vital for understanding gender and key population-specific gaps, and they should be duly utilised. Mechanisms to ensure equality and inclusivity are necessary to end TB in Cambodia.

Recomendação nº 024, de 30 de agosto de 2021: recomenda a adoção de medidas relativas à substituição do SARGSUS pelo sistema Digisus / Recommendation nº 024, of August 30, 2021: recommends the adoption of measures related to the replacement of SARGSUS by the Digisus system

Recomenda ad referendum do Pleno do Conselho Nacional de Saúde ao Ministério da Saúde: I - Que submeta para análise e deliberação do Conselho Nacional de Saúde a substituição do SARGSUS pelo sistema Digisus para subsidiar a elaboração do Relatório Anual de Gestão anteriormente disciplinado pela Resolução CNS nº 459, de 10 de outubro de 2012; II - Que alimente o Sistema Digisus com os instrumentos de planejamento e respectivas informações da gestão federal do SUS; e III - Que garanta a participação do Conselho Nacional de Saúde tanto no processo de desenvolvimento dos módulos do Digisus e de outros sistemas de informação de saúde relacionados aos instrumentos de planejamento e gestão do SUS, como no acesso às informações federais, quanto às informações estaduais e municipais. Aos Conselhos Estaduais e Municipais de Saúde: I - Que envidem esforços junto aos gestores municipais e estaduais para a regularização das pendências na alimentação das informações no Digisus, bem como para terem acesso às informações existentes nesse sistema; e II - Que envidem esforços no âmbito interno dos Conselhos para implementar e/ou acelerar os processos de análise e deliberação sobre os instrumentos de planejamento e sobre os relatórios de prestação de contas do SUS.

Health Care Cybersecurity Challenges and Solutions Under the Climate of COVID-19: Scoping Review.

BACKGROUND: COVID-19 has challenged the resilience of the health care information system, which has affected our ability to achieve the global goal of health and well-being. The pandemic has resulted in a number of recent cyberattacks on hospitals, pharmaceutical companies, the US Department of Health and Human Services, the World Health Organization and its partners, and others. OBJECTIVE: The aim of this review was to identify key cybersecurity challenges, solutions adapted by the health sector, and areas of improvement needed to counteract the recent increases in cyberattacks (eg, phishing campaigns and ransomware attacks), which have been used by attackers to exploit vulnerabilities in technology and people introduced through changes to working practices in response to the COVID-19 pandemic. METHODS: A scoping review was conducted by searching two major scientific databases (PubMed and Scopus) using the search formula "(covid OR healthcare) AND cybersecurity." Reports, news articles, and industry white papers were also included if they were related directly to previously published works, or if they were the only available sources at the time of writing. Only articles in English published in the last decade were included (ie, 2011-2020) in order to focus on current issues, challenges, and solutions. RESULTS: We identified 9 main challenges in cybersecurity, 11 key solutions that health care organizations adapted to address these challenges, and 4 key areas that need to be strengthened in terms of cybersecurity capacity in the health sector. We also found that the most prominent and significant methods of cyberattacks that occurred during the pandemic were related to phishing, ransomware, distributed denial-of-service attacks, and malware. CONCLUSIONS: This scoping review identified the most impactful methods of cyberattacks that targeted the health sector during the COVID-19 pandemic, as well as the challenges in cybersecurity, solutions, and areas in need of improvement. We provided useful insights to the health sector on cybersecurity issues during the COVID-19 pandemic as well as other epidemics or pandemics that may materialize in the future.

Health Information Management Reimagined: Assessing Current Professional Skills and Industry Demand.

This paper examines the changes affecting the health information management (HIM) professional skill set and industry demand to determine differences affecting practitioners. As the industry continues to experience technological innovation, the responsibilities of the HIM professional are in flux, affecting the required skill set of the changing environment. This research used the American Health Information Management Association salary survey and current job postings to determine whether the workforce has experienced deskilling and whether a theory-practice-gap exists. It also assesses if industry competencies align with the Health Information Management Reimaged perspectives. The results indicate that the workforce has not experienced deskilling, that a theory-practice gap does exist, and that Health Information Management Reimaged is aligned with industry needs.

Delinquent Medical Records: Who Are the Stakeholders for Timely Medical Documentation?

The explosion of electronic documentation associated with Meaningful Use-certified electronic health record systems has led to a massive increase in provider workload for completion and finalization of patient encounters. Delinquency of required documentation affects multiple areas of hospital operations. We present the major stakeholders affected by delinquency of the electronic medical record and examine the differing perspectives to gain insight for successful engagement to reduce the burden of medical record delinquency.

COVID-19: Need for Equitable and Inclusive Pandemic Response Framework.

When a new infectious disease emerges as an epidemic or pandemic, strict and appropriate mitigation strategies are critical. Appropriate steps that facilitate defining of cases, carrying out accurate clinical diagnoses, and forming a powerful health surveillance that addresses public health policies and procedures are necessary. Tracking the number of COVID-19 cases over time and flattening the curve is another important element to establish research settings and identify therapeutic components to expedite and develop effective interventions. Addressing the various sections of the society in a philanthropic way is crucial to acquiring the public cooperation that is essential to controlling a disease like COVID-19. In this study, we discuss various strategies and measures adopted by Kerala, an Indian state, to combat the COVID-19 outbreak. Regular and timely updates by government public relations and health departments were used in many of the adopted strategies. The engagement of health information systems, together with the application of decentralized governance and community engagement, has contributed to effective population health management and surveillance of the pandemic.

Centers for Disease Control and Prevention 2019 novel coronavirus disease (COVID-19) information management: addressing national health-care and public health needs for standardized data definitions and codified vocabulary for data exchange.

OBJECTIVE: The 2019 novel coronavirus disease (COVID-19) outbreak progressed rapidly from a public health (PH) emergency of international concern (World Health Organization [WHO], 30 January 2020) to a pandemic (WHO, 11 March 2020). The declaration of a national emergency in the United States (13 March 2020) necessitated the addition and modification of terminology related to COVID-19 and development of the disease's case definition. During this period, the Centers for Disease Control and Prevention (CDC) and standard development organizations released guidance on data standards for reporting COVID-19 clinical encounters, laboratory results, cause-of-death certifications, and other surveillance processes for COVID-19 PH emergency operations. The CDC COVID-19 Information Management Repository was created to address the need for PH and health-care stakeholders at local and national levels to easily obtain access to comprehensive and up-to-date information management resources. MATERIALS AND METHODS: We introduce the clinical and health-care informatics community to the CDC COVID-19 Information Management Repository: a new, national COVID-19 information management tool. We provide a description of COVID-19 informatics resources, including data requirements for COVID-19 data reporting. RESULTS: We demonstrate the CDC COVID-19 Information Management Repository's categorization and management of critical COVID-19 informatics documentation and standards. We also describe COVID-19 data exchange standards, forms, and specifications. CONCLUSIONS: This information will be valuable to clinical and PH informaticians, epidemiologists, data analysts, standards developers and implementers, and information technology managers involved in the development of COVID-19 situational awareness and response reporting and analytics.

Determinants of improved data consistency across routine immunization data tools for health facilities in Kano State, Nigeria.

INTRODUCTION: in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. METHODS: between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at <+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy <10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. RESULTS: data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). CONCLUSION: low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.

Evaluating people's concern about their health information privacy based on power-responsibility equilibrium model: A case of Taiwan.

To address the issue of rising expenditure of healthcare service and to fulfill the skyrocketing demand for quality healthcare, the electronic medical records (EMR) exchange has become a vital and indispensable solution for healthcare facilities in terms of being able to share medical information among healthcare providers. Hence, EMR exchange was expected to improve the quality of healthcare and reduce the cost of repetitive medical check-ups and unnecessary treatments. However, recent reports affirming EMR data leaks and compromises have ignited major worldwide privacy concerns over the security of the EMR systems. How to effectively diminish patients' concern for EMR privacy has thus become an important issue that healthcare institution managers/stakeholders have to address urgently. This study leverages the power-responsibility equilibrium perspective to investigate the antecedents and consequences of concerns for the EMR exchange. A survey using 391 responses collected from medical centers, regional and district hospitals in Taiwan was used to conduct this study. The results show that government regulations have a positive effect on hospital privacy policies. Furthermore, both government regulations and hospital privacy policy are negatively associated with concern for EMR information privacy. Additional reports gathered from this study also showed that concern for EMR information privacy could result in patients' protective responses including refusal to provide personal health information (PHI), removal of PHI, negative word of mouth, complaining directly to the hospital, or complaining indirectly to third-party organizations. These findings demonstrate the need for healthcare facilities to formulate robust privacy policies in order to alleviate patients' concern for EMR information privacy based on governmental regulations. This regulation is top-priority as the incapability of reducing patients' concern for EMR information privacy may lead to the collapse of the campaign for the full-adoption of EMR or possibly jeopardize the promotion and application of EMR among healthcare facilities.

[What place for French morbidity registries in the era of big data?] / Quelle place pour les registres de morbidité à l'ère des données massives de santé ?

The recent opening of massive health databases, as well as the development of methods and tools adapted to their data processing, questions the French model of "morbidity registry". In France in 2019, nearly 61 health registries were operating. As defined by law, these registries identify exhaustively all patients with a given disease in a given territory. Established several decades ago, these registries are part of the French surveillance system that is used for research and evaluation purposes. Since the advent of recent technological progress, large-scale databases are made available to researchers and it is possible with these databases to answer questions initially assigned to the registries. What is the place of such registries in this new context: are they obsolete or still useful? Should they be opposed to the new tools or are they complementary to them, and if so, what is their place in the new French public health ecosystem? The objective of this work was to assess the roles and missions of existing registries and to reflect on their positioning in this new environment. The French model of registry is sometimes questioned because of the complexity of its circuits, requiring a significant amount of human resources. However, the data that constitute them, validated by cross-checking information from several sources, are of very high quality, and make it possible to validate the data in the new databases (National Health Data System (NSDS) or Hospital Data Warehouses). Registries and new databases are in fact complementary, and far from jeopardizing this model, the recent opening of these databases represents an opportunity for registries to modernize their operations and respond to new missions.

A qualitative evaluation of clinically coded data quality from health information manager perspectives.

BACKGROUND: It is essential that clinical documentation and clinical coding be of high quality for the production of healthcare data. OBJECTIVE: This study assessed qualitatively the strengths and barriers regarding clinical coding quality from the perspective of health information managers. METHOD: Ten health information managers and clinical coding quality coordinators who oversee clinical coders (CCs) were identified and recruited from nine provinces across Canada. Semi-structured interviews were conducted, which included questions on data quality, costs of clinical coding, education for health information management, suggestions for quality improvement and barriers to quality improvement. Interviews were recorded, transcribed and analysed using directed content analysis and informed by institutional ethnography. RESULTS: Common barriers to clinical coding quality included incomplete and unorganised chart documentation, and lack of communication with physicians for clarification. Further, clinical coding quality suffered as a result of limited resources (e.g. staffing and budget) being available to health information management departments. Managers unanimously reported that clinical coding quality improvements can be made by (i) offering interactive training programmes to CCs and (ii) streamlining sources of information from charts. CONCLUSION: Although clinical coding quality is generally regarded as high across Canada, clinical coding managers perceived quality to be limited by incomplete and inconsistent chart documentation, and increasing expectations for data collection without equal resources allocated to clinical coding professionals. IMPLICATIONS: This study presents novel evidence for clinical coding quality improvement across Canada.

Understanding health information management practices in public hospitals in Kuwait.

BACKGROUND: Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries. OBJECTIVE: (i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them. METHOD: This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles. RESULTS: Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients. CONCLUSION: Evidence underscored the importance of proper information management driven by clear centralised strategic plans. IMPLICATIONS: With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.

The importance of clinical documentation improvement for Australian hospitals.

Clinical documentation improvement (CDI) is a recent initiative gaining increased momentum in Australia. The benefits surrounding its success internationally include improved quality and patient safety outcomes and increased reimbursement. The premise of CDI is simple: engage clinicians to improve the clinical documentation in the medical record in "real time" so that it is fit for reporting, analysis and reimbursement. Every country has differing healthcare systems and this article has focused on validating the relevancy of CDI for the Australian healthcare environment.

Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review.

INTRODUCTION: The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. OBJECTIVE: This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland. METHODS: Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. RESULTS: Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. CONCLUSION: This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.

Diabetes Care Editors' Expert Forum 2018: Managing Big Data for Diabetes Research and Care.

Technological progress in the past half century has greatly increased our ability to collect, store, and transmit vast quantities of information, giving rise to the term "big data." This term refers to very large data sets that can be analyzed to identify patterns, trends, and associations. In medicine-including diabetes care and research-big data come from three main sources: electronic medical records (EMRs), surveys and registries, and randomized controlled trials (RCTs). These systems have evolved in different ways, each with strengths and limitations. EMRs continuously accumulate information about patients and make it readily accessible but are limited by missing data or data that are not quality assured. Because EMRs vary in structure and management, comparisons of data between health systems may be difficult. Registries and surveys provide data that are consistently collected and representative of broad populations but are limited in scope and may be updated only intermittently. RCT databases excel in the specificity, completeness, and accuracy of their data, but rarely include a fully representative sample of the general population. Also, they are costly to build and seldom maintained after a trial's end. To consider these issues, and the challenges and opportunities they present, the editors of Diabetes Care convened a group of experts in management of diabetes-related data on 21 June 2018, in conjunction with the American Diabetes Association's 78th Scientific Sessions in Orlando, FL. This article summarizes the discussion and conclusions of that forum, offering a vision of benefits that might be realized from prospectively designed and unified data-management systems to support the collective needs of clinical, surveillance, and research activities related to diabetes.

Genetic Variations and Precision Medicine.

The time and costs associated with the sequencing of a human genome have decreased significantly in recent years. Many people have chosen to have their genomes sequenced to receive genomics-based personalized healthcare services. To reach the goal of genomics-based precision medicine, health information management (HIM) professionals need to manage and analyze patients' genomic data. Two important pieces of information from the genome sequence are the risk of genetic diseases and the specific medication or pharmacogenomic results for the individual patient, both of which are linked to a patient's genetic variations. In this review article, we introduce genetic variations, including their data types, relevant databases, and some currently available analysis methods and systems. HIM professionals can choose to use these databases, methods, and systems in the management and analysis of patients' genomic data.