User-centered design improves the usability of drug-drug interaction alerts: Experimental comparison of interfaces.

Clinical Decision Support Systems can alert health professionals about drug interactions when they prescribe medications. The Hospital Italiano de Buenos Aires in Argentina developed an electronic health record with drug-drug interaction alerts, using traditional software engineering techniques and requirements. Despite enhancing the drug-drug interaction knowledge database, the alert override rate of this system was very high. We redesigned the alert system using user-centered design (UCD) and participatory design techniques to enhance the drug-drug interaction alert interface. This paper describes the methodology of our UCD. We used crossover method with realistic, clinical vignettes to compare usability of the standard and new software versions in terms of efficiency, effectiveness, and user satisfaction. Our study showed that, compared to the traditional alert system, the UCD alert system was more efficient (alerts faster resolution), more effective (tasks completed with fewer errors), and more satisfying. These results indicate that UCD techniques that follow ISO 9241-210 can generate more usable alerts than traditional design.

Understanding WHO SMART Guidelines: Narrative Review of an Innovative Global Digital Health Approach.

The growing challenges of healthcare systems pose a unique opportunity to leverage evidence-based digital health interventions. The WHO's SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines represent a significant advancement in this domain. This paper aims to summarize SMART guidelines authoring and implementation process, drawing on a comprehensive literature analysis. Our findings highlight critical success factors for national implementation, including stakeholder engagement, customization to local contexts, and leveraging international standards and digital technologies. We conclude with recommendations for countries aiming to implement WHO SMART guidelines, underscoring the need for a multi-disciplinary approach and the potential challenges to be navigated.

Mobile Application for Home Healthcare: Physician's Expectations and Perceptions.

The aging of the population and the increase in chronic diseases generated the need for care at home for pluripathological patients, who can no longer access outpatient care due to functional and social problems. The use of Electronic Medical Records (EMR) improves continuity of care, simplifies data collection, decreases overhead costs, and reduces mortality in chronically ill patients. The use of an App to check and record data in the EMR during the home visit saves time for professionals and helps to avoid transcription errors. This article shares our experience with the design and implementation of a Mobile Application with EMR functionalities for the Homecare setting of the Hospital Italiano de Buenos Aires network.

An Improved Immunization Record to Support Vaccination During the COVID-19 Pandemic at a University Hospital in Argentina.

WHO and UNICEF highlight vaccination as the most cost-effective method of prevention of infectious diseases. An effective public health strategy requires efficient tracking of vaccination to assess coverage, safety, and efficacy of these vaccines. Paper-based immunization records are still being used in most low and middle-income countries. Adequate Electronic Logistic Management Information Systems, Immunization Registries and Records are crucial for proper data collection and analysis, and for making better decisions at an individual and at a population level. In this paper we share our experience in the redesign of an interoperable immunization record to track vaccination, including the recently developed vaccines for the novel coronavirus SARS-CoV-2 (COVID-19).

Tana, a Healthcare Chatbot to Help Patients During the COVID-19 Pandemic at a University Hospital in Argentina.

A Chatbot or Conversational Agent is a computer application that simulates the conversation with a human person (by text or voice), giving automated responses to people's needs. In the healthcare domain, chatbots can be beneficial to help patients, as a complement to care by health personnel, especially in times of high demand or constrained resources such as the COVID-19 Pandemic. In this paper we share the design and implementation of a healthcare chatbot called Tana at the Hospital Italiano de Buenos Aires. Considering best practices and being aware of possible unintended consequences, we must take advantage of information and communication technologies, such as chatbots, to analyze and promote useful conversations for the health of all people.

Using FHIR to Support COVID-19 Vaccine Safety Electronic Case Reports in America.

During the COVID-19 pandemic, the Pan American Health Organization (PAHO) promoted several activities to strengthen the countries' emergency response. Vaccines represented a breakthrough in the pandemic evolution, even though they have not been equitably distributed. As most vaccines have received emergency authorizations for their timely delivery, vaccine safety surveillance has been highlighted for detecting early signals of potential adverse events following immunization (AEFI, also known as ESAVI). The objective of this article is to share the different steps, methodologies, and preliminary results of a regional policy to strengthen the ESAVI surveillance system in the Americas, including the adoption of HL7 FHIR for health information exchange between countries and PAHO.

Electronic Medical Records Virtual Course. Strategies for an Effective Training.

The Introductory Course to the Electronic Medical Records (EMR) is part of the Digital Health Strategy of the Ministry of Health's Universal Health Coverage (UHC). One of its principles is achieving interoperability between different electronic medical records systems. The healthcare workforce training in these subjects is essential. During 2018, six editions of the course were developed in the Moodle Virtual Health Platform with 850 approved participants. We analysed the previous experience to reformulate the learning materials and create new instances for pedagogical support.

Master Patient Index Standardization Patient Search Identification Service (PSIS) of the National Directorate of Health Information Systems (DNSIS) Argentina.

Correct patient identification is the cornerstone for the proper implementation of electronic health records. Up to 20% of the registered patients are duplicated in most systems. Strong identification policies and robust systems can minimize such errors. In this poster we share the Ministry of Health recommendations for the Master Patient Index improvement using search algorithms.

Results of the Use of the Teleconsultation Platform After 2 Months of Implementation.

The Ministry of Health (MoH) set the National Digital Health Strategy 2018-2024 as a state policy. It included a National TeleHealth Plan to enhance access and quality of healthcare in a wide territory like Argentina, leveraging more than 20 years of national telemedicine experiences and coordinating it with the territorial integrated health service networks proposed by the Universal Health Coverage strategy. In collaboration with the Ministry of Modernisation, the MoH developed and implemented a new TeleHealth Web Platform to perform eReferrals and eConsultations nationwide. This poster describes the first 2 months of usage.

Argentinian Digital Health Strategy.

Digital Health is one of the three pillars for the effective implementation of Universal Health Coverage in Argentina. The Ministry of Health published the National Digital Health Strategy 2018-2024 in order to establish the conceptual guidelines for the design and development of interoperable health information systems as a state policy. The World Health Organization "National eHealth Strategy Toolkit", "Global Strategy on Digital Health" and other international and local evidence and expert recommendations were taken into account. The path to better healthcare involves adopting systems at the point of care, allowing for the primary recording of information and enabling information exchange through real interoperability. In that way, people, technology and processes will synergize to enhance integrated health service networks. In this paper, we describe the plan and the first two years of implementation of the strategy.

Mi Argentina/Mi Salud: The Argentinian Citizen Digital Health Portal.

The Ministry of Health (MoH) stated the National Digital Health Strategy 2018-2024 in order to establish the conceptual guidelines for the design and development of interoperable health information systems. It included the creation of a National Digital Health Network, and a Citizen Health Portal to inform and empower patients about their rights. For instance, the Digital Vaccination Card is already available and has equal legal validity as its paper version. The platform also works as a personal privacy manager, to configure the consent for Health Information Exchange through the network, or to check the access logs. This paper outlines the implementation experience of this powerful tool at a national level.

Implementation of a New Traceability Process for Breast Milk Feeding.

Many newborns at the neonatal intensive care unit are unable to feed themselves, and receive human milk through enteric nutrition devices such as orogastric or nasogastric probes. The mothers extract their milk, and the nursing staff is responsible for the fractionation, storage and administration when prescribed by physicians. It is very important to remind that it is a bodily fluid that carries the risk of disease transmission if misused. Health information technologies can enhance patient safety by avoiding preventable adverse events. Barcoding technology could track every step of the milk manipulation. Many processes must be addressed to implement it. Our goal is to explain our planning and implementation process in an academic tertiary hospital.

Improving Patient Safety Through the Design and Development of a Computerized Provider Order Entry for Parenteral Nutrition Linked to a Barcode Medication Administration Record.

Among adverse events related to medication errors, the defects in parenteral nutrition administration pose a special threat to patient safety. Two high impact strategies to reduce these errors require implementing a Computerized Provider Order Entry and the use of bedside bar-code verification prior to medication administration. In this study, we share the deep field analysis of the current workflow performed to include inpatient bedside barcoding verification for parenteral nutrition administration in a large academic health center. Then, we propose a process optimization and a new parenteral nutrition ordering tool embedded in the prescription module. Structuring physicians' ordering and the bar-code verification of administration can increase patient safety. The next steps would involve the creation of a Clinical Decision Support System to improve patient nutrient goals.

User-Centered Design Improves the Usability of Drug-Drug Interaction Alerts: A Validation Study in the Real Scenario.

Decision support systems can alert physicians to the existence of drug interactions. The Hospital Italiano de Buenos Aires, Argentina, has an in-house electronic health record with computerized physician order entry and clinical decision support. It includes a drug-drug interaction alert system, initially developed under traditional engineering techniques. As we detected a high alert override rate, we rebuilt the knowledge database and redesigned the alert interface with User-Centered Design techniques. A laboratory crossover study using clinical vignettes showed that new alerts were more usable than traditional ones.This paper aimed to validate these results through a controlled and randomized experimental study with two branches (old vs. new design) in a real setting. We analyzed, quantitatively, every fired alert between April 2015 and September 2016. Finally, we performed user surveys and qualitative interviews to inquire about their satisfaction and perceptions.In real scenarios, user-centered design alerts were more usable, being more effective and satisfactory, but less efficient than traditional alerts. "Safe omission", as a new concept, emerged from our stratified analyses and interviews.

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.