Use of alternative care sites during the COVID-19 pandemic in the city of Buenos Aires, Argentina.

OBJECTIVES: In large cities, where a large proportion of the population live in poverty and overcrowding, orders to stay home to comply with isolation requirements are difficult to fulfil. In this article, the use of alternative care sites (ACSs) for the isolation of patients with confirmed COVID-19 or persons under investigation (PUI) in the City of Buenos Aires during the first wave of COVID-19 are described. STUDY DESIGN: This is a cross-sectional study. METHODS: All patients with COVID-19 and PUI with insufficient housing resources who could not comply with orders to stay home and who were considered at low clinical risk in the initial triage were referred to refurbished hotels in the City of Buenos Aires (Ciudad Autónoma de Buenos Aires [CABA]). ACSs were divided into those for confirmed COVID-19 patients and those for PUI. RESULTS: From March to August 2020, there were 58,143 reported cases of COVID-19 (13,829 of whom lived in slums) in the CABA. For COVID-19 positive cases, 62.1% (n = 8587) of those living in slums and 21.4% (n = 9498) of those living outside the slums were housed in an ACS. In total, 31.1% (n = 18,085) of confirmed COVID-19 cases were housed in ACSs. In addition, 7728 PUI were housed (3178 from the slums) in an ACS. The average length of stay was 9.0 ± 2.5 days for patients with COVID-19 and 1.6 ± 0.7 days for PUI. For the individuals who were housed in an ACS, 1314 (5.1%) had to be hospitalised, 56 were in critical care units (0.22%) and there were 27 deaths (0.1%), none during their stay in an ACS. CONCLUSIONS: Overall, about one-third of all people with COVID-19 were referred to an ACS in the CABA. For slum dwellers, the proportion was >60%. The need for hospitalisation was low and severe clinical events were rare. This strategy reduced the pressure on hospitals so their efforts could be directed to patients with moderate-to-severe disease.

[Implementation of telemedicine in the Americas: Barriers and facilitatorsBarreiras e facilitadores para a implementação da telemedicina nas Américas]. / Barreras y facilitadores a la implementación de la telemedicina en las Américas.

With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers-especially technological, human and social, psychosocial, anthropological, economic, and governance-related-have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.

Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.

Causes of appointment attendance, nonattendance, and cancellation in outpatient consultations at a university hospital.

BACKGROUND: Nonattendance to scheduled appointments in outpatient clinics is a frequent problem in ambulatory medicine with an impact on health systems and patients' health. The characterization of nonattendance is fundamental for the design of appropriate strategies for its management. AIMS: To identify causes of nonattendance of scheduled ambulatory medical appointments by adult patients. METHODS: Case and two controls study nested in a prospective cohort. A telephone-administered questionnaire was applied within the first 72 hours to identify the causes of attendance, nonattendance, or cancellation in patients who had a scheduled appointment to which they had been present, absent, or cancelled. RESULTS: A total of 150 absences (cases), 176 attendances, and 147 cancellations (controls) in a prospective cohort of 160 146 scheduled appointments (2012/2013) were included. According to self-reports in telephone interviews, the most frequent causes of nonattendance were forgetting 44% (66), unexpected competing events 15.3% (23), illness or unwellness 12% (18), work-related inconvenience 5.3% (8), transport-related difficulties 4.7% (4), and cause that motivated appointment scheduling already resolved 4.7% (4). DISCUSSION: The main cause of nonattendance is forgetting the scheduled appointment, but there is a proportion of different causes that do not respond to reminders but could respond to different strategies.

Recommendations of the International Medical Informatics Association (IMIA) on Education in Biomedical and Health Informatics: Second Revision.

BACKGROUND: The purpose of educational recommendations is to assist in establishing courses and programs in a discipline, to further develop existing educational activities in the various nations, and to support international initiatives for collaboration and sharing of courseware. The International Medical Informatics Association (IMIA) has published two versions of its international recommendations in biomedical and health informatics (BMHI) education, initially in 2000 and revised in 2010. Given the recent changes to the science, technology, the needs of the healthcare systems, and the workforce of BMHI, a revision of the recommendations is necessary. OBJECTIVE: The aim of these updated recommendations is to support educators in developing BMHI curricula at different education levels, to identify essential skills and competencies for certification of healthcare professionals and those working in the field of BMHI, to provide a tool for evaluators of academic BMHI programs to compare and accredit the quality of delivered programs, and to motivate universities, organizations, and health authorities to recognize the need for establishing and further developing BMHI educational programs. METHOD: An IMIA taskforce, established in 2017, updated the recommendations. The taskforce included representatives from all IMIA regions, with several having been involved in the development of the previous version. Workshops were held at different IMIA conferences, and an international Delphi study was performed to collect expert input on new and revised competencies. RESULTS: Recommendations are provided for courses/course tracks in BMHI as part of educational programs in biomedical and health sciences, health information management, and informatics/computer science, as well as for dedicated programs in BMHI (leading to bachelor's, master's, or doctoral degree). The educational needs are described for the roles of BMHI user, BMHI generalist, and BMHI specialist across six domain areas - BMHI core principles; health sciences and services; computer, data and information sciences; social and behavioral sciences; management science; and BMHI specialization. Furthermore, recommendations are provided for dedicated educational programs in BMHI at the level of bachelor's, master's, and doctoral degrees. These are the mainstream academic programs in BMHI. In addition, recommendations for continuing education, certification, and accreditation procedures are provided. CONCLUSION: The IMIA recommendations reflect societal changes related to globalization, digitalization, and digital transformation in general and in healthcare specifically, and center on educational needs for the healthcare workforce, computer scientists, and decision makers to acquire BMHI knowledge and skills at various levels. To support education in BMHI, IMIA offers accreditation of quality BMHI education programs. It supports information exchange on programs and courses in BMHI through its Working Group on Health and Medical Informatics Education.

Patients' Experience and Assessment on the Transition from Paper to Electronic Medical Records.

By the implementation of the EMR in the Primary Care Centers of the City of Buenos Aires, it has been claimed that there is a need to obtain systematic and accurate information about the assessment that patients have about such incorporation. A qualitative research has been carried out in order to answer this query.

Electronic Health Records as a Facilitator for the Implementation of a Strategy for the Reduction of Maternal and Child Morbi-Mortality in Buenos Aires City.

This paper describes how an Electronic Health Records (EHR) allowed for the implementation of a strategy to reduce maternal and child morbidity and mortality in outpatient settings of hospitals in the public healthcare system of Buenos Aires City.

Representation of the Transgender Population in Electronic Health Records: Implementation Strategy in the Public Health Care System of Buenos Aires City.

Electronic Health Records (EHR) face the challenge of collecting data about patient's gender identity in order to provide standardized and quality data to manage public policies in order to improve health disparities of the Trans population. Innovation in Health Information Technologies (HIT) develops in the midst of a cultural change process related to social representations of gender in favor of a diversity perspective. Understanding the health field as a complex adaptive system, the changes in the systems must consider multiple factors in every stage of the process. It is relevant to consider the people involved in it and the culture in which they are embedded. This article describes the implementation strategies of functionality that represents the transgender population in the EHR of the Public Health Care System of the Buenos Aires City.

Age and Nationality: Two Variables That Challenge the Univocal Identification of People in the Health System of the Autonomous City of Buenos Aires.

The univocal identification of people is fundamental for the longitudinal monitoring of health status. The impossibility of all people to credit their identity via their identity document generates temporary records that make it difficult to record the continuity of care. This paper analyzes the Patient Index of the Ministry of Health of the Buenos Aires City and describes how the age and nationality variables influence the creation of temporary records.

Implementation and Support of an Electronic Health Record in Youth Olympic Games in Buenos Aires 2018.

On October 2018, Buenos Aires hosted the Youth Olympic Games. The organization asked the Health Information System Office to provide the health stations and clinics with an Electronic Health Record (EHR) and bring support during the duration of the games. Four hundred and fifty healthcare professionals from different disciplines were trained in the use of the EHR.

Workforce Development Strategy for Health Information System Implementation at the Public Health System of Buenos Aires.

One of the challenges of implementing health information and communication technology is the need for a skilled workforce that understands health care and ITC. There are also people and organizational challenges involved. This work describes the strategies to create such a workforce for the public network of healthcare facilities in the City of Buenos Aires, which include promoting the adoption of technologies and providing lines of contention for continuous training.

Creation and evaluation of a terminology server for the interactive coding of discharge summaries.

Free text entry versus structured data has been proposed as models in data entry in health information systems. A new user interface was developed with the objective of improving data capture. It also implemented a modification of the discharge summary data entry user interface that allowed the selection of already coded terms from a local terminology in the context of an inpatient electronic medical record. This software interacts online with a terminology server to provide feedback on data entry to clinical users in order to automatically code data. To evaluate the impact of this new software, we measured user satisfaction and the impact on autocodification rate. The new system had good acceptance from the users who ranked it high using QUIS (Questionnaire for User Interaction Satisfaction) and the auto codification rate improved from 61.5% to 88.39%.

Evaluation of the Association Between Different Patient Indexing Strategies and Effective Indexing in Health Centers of the Public System of the Autonomous City of Buenos Aires: An Exploratory Study.

During the implementation of an electronic health record (EHR) system in the public system of the city of Buenos Aires, Argentina, different patient indexing strategies were devised and implemented. We sought to assess the association between these strategies and effective indexing (proportion of patients who are indexed and have a consultation registered in the EHR). Strategies were grouped into three modalities (High, Intermediate, and Low intensity). We estimated hazard ratios (HR) comparing the High and Low intensity to the Intermediate strategies. The crude analyses showed a significant difference between the curves (p < 0.0001). In the multivariate analysis, the HRs of High and Low intensity interventions showed on average, values above 1 from 0 to 90 days compared to the Intermediate intensity strategy (High: 2.08 (1.65, 2.52); Low: 2.59 (2.29, 2.9)). From that point on, the HRs of both strategies were not different from 1.

Change Management Strategies: Transforming a Difficult Implementation into a Successful One.

The implementation of health Information Technologies (IT) contributes to improve quality of care and management processes. In spite, evidence shows that the rates of IT adoption are not the expected ones. Since 2004, Public Healthcare System of Buenos Aires city has been implementing a Healthcare Information System with a difficult adoption in clinical setting. In December 2015, the Government made some changes that allowed the implementation of an Electronic Health Record in 20 Primary Care Centers. This paper describes the change management strategies that were designed in order to transform a difficult implementation into a successful one. The combination of timely approach to change management, good governance and specialized human resources were keys to achieve this goal.

[Variations between 2 ECG as predictors of atrial fibrillation: Cohort study]. / Diferencias entre 2 electrocardiogramas sinusales como predictoras de fibrilación auricular: estudio de cohorte.

OBJETIVE: To evaluate the association between delta variations in the parameters of 2 sinusal ECG with atrial fibrillation (AF) onset. METHOD: Retrospective cohort of 9,975 adult patients and members of the prepaid system at Hospital Italiano de Buenos Aires from Argentina, who had at least 2 sinusal ECG between 2006 and 2011. Population was followed up for detection of AF. All measurements and electrocardiographic deltas (differences between the 2 ECG) were standardized. Hazard ratio (HR) was estimated for the development of AF for each delta of the different ECG parameters using a Cox regression model. RESULTS: During a median follow up of 3.5 years, 189 patients (1.89%) developed AF. Heart rate delta, ST interval delta and P wave amplitude were predictors of AF. Hazard ratio Adjusted for clinical characteristics and ECGbasal values was 0,86 (CI95%: 0.75-0.98, p=0.024) for heart rate delta, 1.12 (CI95%: 0.98-1.27, p=0.082) for ST interval delta and 1.21 (CI95%: 1.05-1.38, p=0.006) for P wave amplitude delta. CONCLUSION: Differences of heart rate and P wave amplitude between ECG's measurements may predict AF, independently of clinical features and ECGbasal values.

Barreras y facilitadores a la implementación de la telemedicina en las Américas

[RESUMEN]. Con millones de personas en el mundo en situación de distanciamiento físico por el COVID-19, las tecnologías de la información y comunicaciones (TICs) se han posicionado como uno de los medios principales de interacción y colaboración. Ya al inicio de este milenio se empezaban a mencionar las siguientes ventajas: mayor acceso a la información y a la prestación de servicios; fortalecimiento educativo; control de calidad de los programas de detección y reducción de los costos de la atención de en salud. Sin embargo, entre las principales barreras de adopción de la telemedicina se encuentran las de índole: tecnológicas; humanas y sociales; psicosociales y antropológicas; de Gobernanza y económicas. En estos 20 años se logró un aumento en los recursos y capacidad técnica, una mejora en la educación digital, un empoderamiento del paciente en su tratamiento y un mayor interés público en esta área. En especial se considera exitosa la conformación de equipos interdisciplinarios, las redes académicas y profesionales y las consultas médicas virtuales. Después de revisar el estado de la telemedicina en la Región de las Américas, los autores recomiendan adoptar medidas urgentes para poner en práctica políticas y programas nacionales de telemedicina, incluyendo el marco normativo y presupuesto necesario, cuya implementación se realice de manera integral e interoperable y que se sustente de redes académicas, de colaboración e instituciones especializadas. Dichas políticas deben generar un contexto habilitante que den sostenibilidad al avance logrado, considerando los aspectos mencionados en las posibles barreras.

[ABSTRACT]. With millions of people in the world in situations of physical distancing because of COVID-19, information and communication technology (ICT) has become as one of the principal means of interaction and collaboration. The following advantages of ICT have been cited since the start of the new millennium: increased access to information and service delivery, educational strengthening, quality control of screening programs, and reduction of health care costs. In the case of telemedicine, however, a number of barriers—especially technological, human and social, psychosocial, anthropological, economic, and governance-related—have stood in the way of its adoption. The past 20 years have seen an increase in the availability of resources and technical capacity, improvements in digital education, empowerment of patients regarding their treatment, and increased public interest in this area. Successes have included the use of interdisciplinary teams, academic and professional networking, and virtual medical consultations. After reviewing the state of telemedicine in the Region of the Americas, the authors recommend the urgent adoption of measures aimed at implementing national telemedicine policies and programs, including a regulatory framework and adequate funding. Implementation of the measures should be integrated and interoperable and include the support of academic networks and the collaboration of specialized institutions. The policies should generate an enabling context that ensures sustainability of the progress achieved, bearing in mind the possible barriers mentioned.

[RESUMO]. Com milhões de pessoas no mundo em situação de distanciamento físico devido à COVID-19, as tecnologias da informação e comunicação (TICs) se enquadraram como um dos meios principais de interação e colaboração. Já no início deste milênio, começaram a ser mencionadas as seguintes vantagens: maior acesso à informação e à prestação de serviços; fortalecimento da educação; controle de qualidade dos programas de detecção e redução dos custos na atenção à saúde. No entanto, entre as principais barreiras de adoção da telemedicina se encontram as de caráter: tecnológico; humano e social; psicossocial e antropológico; de governança e econômico. Nestes 20 anos, houve um aumento nos recursos e na capacidade técnica, uma melhora na educação digital, um empoderamento do paciente em seu tratamento e um maior interesse público nessa área. Em especial, são consideradas bem-sucedidas a constituição de equipes interdisciplinares e as redes acadêmicas e profissionais, e as consultas médicas virtuais. Após revisar o estado da telemedicina na Região das Américas, os autores recomendam a adoção de medidas urgentes para implementar políticas e programas nacionais de telemedicina, incluindo o marco normativo e o orçamento necessário. Essa implementação deve ser realizada de maneira integral e interoperável e sustentada por redes acadêmicas, de parceria e instituições especializadas. Tais políticas devem gerar um contexto favorável, dando sustentabilidade ao avanço obtido e considerando os aspectos mencionados nas possíveis barreiras.

Barreras y facilitadores a la implementación de la telemedicina en las Américas / Barriers and facilitators to the implementation of the telemedicine in the Americas

Con millones de personas en el mundo en situación de distanciamiento físico por el COVID-19, las tecnologías de la información y comunicaciones (TICs) se han posicionado como uno de los medios principales de interacción y colaboración. Ya al inicio de este milenio se empezaban a mencionar las siguientes ventajas: mayor acceso a la información y a la prestación de servicios; fortalecimiento educativo; control de calidad de los programas de detección y reducción de los costos de la atención de en salud. Sin embargo, entre las principales barreras de adopción de la telemedicina se encuentran las de índole: tecnológicas; humanas y sociales; psico-sociales y antropológicas; de Gobernanza y económicas. En estos 20 años se logró un aumento en los recursos y capacidad técnica, una mejora en la educación digital, un empoderamiento del paciente en su tratamiento y un mayor interés público en esta área. En especial se considera exitosa la conformación de equipos interdisciplinarios, las redes académicas y profesionales y las consultas médicas virtuales. Después de revisar el estado de la telemedicina en la Región de las Américas, los autores recomiendan adoptar medidas urgentes para poner en práctica políticas y programas nacionales de telemedicina, incluyendo el marco normativo y presupuesto necesario, cuya implementación se realice de manera integral e interoperable y que se sustente de redes académicas, de colaboración e instituciones especializadas. Dichas políticas deben generar un contexto habilitante que den sostenibilidad al avance logrado, considerando los aspectos mencionados en las posibles barreras

Health Information Systems: evaluation and performance of a Help Desk.

UNLABELLED: A Help Desk (HD) is crucial in a computerized hospital. OBJECTIVE: to describe the performance of a HD. DESIGN: retrospective cohort study. RESULTS: the sociodemographic characteristics of users, as well as their relationship with the institution influence behaviour when requesting support to a HD. Also we observed a relationship between the flow of users request and the functioning of hospital services. CONCLUSIONS: complexity of HD process realizes the need to identify and define standards to ensure quality of service.

Patient Safety at Transitions of Care: Use of a Compulsory Electronic Reconciliation Tool in an Academic Hospital.

Medication errors are responsible for most inpatient adverse events. Medication reconciliation emerged as an effective strategy to decrease these problems, enhancing patient safety. Electronic health records with reconciliation tools could improve the process, but many aspects should be considered in order to reach expected outcomes. In this paper we analyzed how a compulsory, electronic reconciliation application was used at Hospital Italiano in Buenos Aires, through admission and discharge processes. We evaluated all medications that were reconciled during patient admission and discharge since its implementation, from February to November 2014. During that period, there were 78,714 reconciled medications regarding 37,741 admissions (2.08 reconciled medications per hospitalization), of 27,375 patients (2.88 medications per patient). At admission, 63% of medications were confirmed and the remaining were paused or deleted. At discharge, 41% of all medications were reconfirmed. In the creation of the best possible medication history, the use of an electronic reconciliation tool would clean overloaded lists, but at the same time medications could be erroneously deleted.

Serious Games: A Concise Overview on What They Are and Their Potential Applications to Healthcare.

Younger generations are extensive users of digital devices; these technologies have always existed and have always been a part of their lives. Video games are a big part of their digital experience. User-centered design is an approach to designing systems informed by scientific knowledge of how people think, act, and coordinate to accomplish their goals. There is an emerging field of intervention research looking into using these techniques to produce video games that can be applied to healthcare. Games with the purpose of improving an individual's knowledge, skills, or attitudes in the "real" world are called "Serious Games". Before doctors and patients can consider using Serious Games as a useful solution for a health care-related problem, it is important that they first are aware of them, have a basic understanding of what they are, and what, if any, claims on their effectiveness exist. In order to bridge that gap, we have produced this concise overview to introduce physicians to the subject at hand.

Communication problems between end-users and technicians through a Help Desk in a Health Information System.

Communication between users and technicians is crucial for improving Help Desk performance. The objective of this study is to know and understand perceptions, and needs of users and help desk technicians. A qualitative study based on interviews was performed. The emergent topics were communication, workload and misperceptions between end-users and technicians. There are false perceptions between them that affect their interaction and work dynamics.