Wait-time reporting systems for elective surgery in Canada: a content analysis of provincial and territorial initiatives.

BACKGROUND: In Canada, a substantial barrier to the accessibility of surgical procedures is wait times. The objective of this study was to develop and describe an inventory of wait-time reporting systems for elective surgical procedures. METHODS: Between June and August 2019, we searched all Canadian provincial and territorial ministry of health websites to identify the wait-time reporting systems in place. We conducted content analysis and used a qualitative descriptive approach to compare the variables of interest across the provinces and territories. RESULTS: There were websites available for assessment in all 13 provinces and territories. Seven provinces have comprehensive, centralized wait-time reporting systems. The rest of the provinces have highly decentralized wait-time reporting, and the territories do not have wait-time reporting systems in place. There is substantial variation in the comprehensiveness, purpose, data sources and data collection methods among the wait-time reporting systems across the provinces and territories. INTERPRETATION: Wait-time reporting for elective surgery in Canada is diverse, and it varies in comprehensiveness across the provinces and territories. The present findings can help direct future investigations of Canadian reporting systems, which would provide useful information for policy-makers and those interested in reducing wait times in Canada.

Factors related to the adoption of the Brazilian National Immunization Program Information System.

BACKGROUND: One way to optimize the adoption and use of technological innovations is to understand how those involved perceive, assess and decide to use them. This study aims to analyze the attributes that influence the adoption and use of the Brazilian National Immunization Program Information System (NIPIS) from the perspective of vaccination room workers. METHODS: This is a mixed method research, and a quantitative cross-sectional analytical study, with concomitant triangulation of data, carried out in a region of Brazil by using the Diffusion of Innovation Theory. We used a questionnaire with 183 nursing professionals who work at vaccination rooms in 12 municipalities. To test the research model, partial least squares structural equation modeling (PLS-SEM) and SmartPLS 2.3.0 have been applied to estimate the model. The qualitative research had a descriptive-exploratory character, using interviews (n = 18) analyzed through thematic analysis. RESULTS: The model proposed showed a mean correlation between the perceived attributes in the adoption and use of NIPIS. The results of the multiple regression indicated that the attributes "relative advantage" and "image" have a significant effect at 5% level (T > 1.97), positively influence the adoption and use of NIPIS; the attribute "voluntary use" negatively influences the adoption and use of the system; the attributes "experimentation", "compatibility", "profitability", and "ease of use" did not influence the adoption and use of NIPIS. Emphasis has been placed on aspects that weaken the adoption and use of NIPIS such as lack of good quality internet and resistance to use the technology by some professionals. Workers perceive the importance of NIPIS for the municipality and point out that technological innovation provides data at an individual level, inserted in real time, which makes it possible to assess vaccination coverage. Lack of an unstable internet compromises data release due to system slowness. CONCLUSIONS: The mixed method allowed an in-depth analysis of the adoption and use of NIPIS in the Western Health Macroregion of Minas Gerais State, and similarities were observed in the results. The attribute "relative advantage" is the one that most influences the adoption and use of NIPIS, which is the strongest predictor of innovation adoption rate.

Los sistemas de información y la salud digital en la pandemia de COVID-19: examen posterior a la acción de los 100 primeros días de cuarentena / COVID-19 information systems and digital health: after-action review of the first 100 days in quarantine

En apenas unos meses, la pandemia de COVID-19 ha alterado profundamente todos los sectores de la sociedad: nuestra forma de vivir, de gobernarnos, de desplazarnos, de trabajar y de estudiar, así como la manera en que las naciones y nosotros mismos manejamos la salud. En resumen, ha alterado muchas estructuras sociales que creíamos firmemente establecidas. En el caso del sector de la salud pública, se han extraído muchas enseñanzas que permitirán mejorar la respuesta a las pandemias en el futuro, además de mejorar el sistema de salud desde la perspectiva de los sistemas de información para la salud y, finalmente, de la salud digital.

In just a few months, the COVID-19 pandemic has had a disruptive impact on all sectors of society: on how we live, how we govern ourselves, how we mobilize, how we work, how we educate ourselves, and how nations manage and how we manage our health ourselves. In short, it has targeted many social structures that we believed to be fixed. As for the public health sector, many lessons have emerged to improve the response to future pandemics but also to improve the health system from the perspective of information systems for health and finally of digital health.

Design and Preliminary Experience of a Tele-Radiotherapy System for a Medical Alliance in China.

Background: The medical alliance and telemedicine are considered to be important means to solve the imbalance between regions and shortage of professionals and promote the homogenization of medical services. Sichuan Provincial People's Hospital Group (SPPHG) is a network of hospitals with different levels of expertise, and all the members with radiotherapy form a radiotherapy network (RTN). Addressing the inadequacy and imbalance of radiotherapy services of Sichuan Province, China, a tele-radiotherapy system for RTN-SPPHG is designed, which includes the business model and corresponding technical implementation of an information system. Materials and Methods: In the RTN-SPPHG, a distributed remote collaboration business model is explored and a tele-radiotherapy information system is customized for this telemedicine model. Both the business model and tailored information system were evaluated in actual use. Results: Based on the tele-radiotherapy system of RTN-SPPHG, multitype hospitals are linked together and serve as a whole. Through the internet, the experience of experts of Sichuan Provincial People's Hospital is effectively deployed to member hospitals at the grassroot level. Conclusions: A close-knit medical alliance based on a tele-radiotherapy system should be a way to rapidly improve radiotherapy services and promote the homogenization of service in a region.

Sistema Integrado de Informações Mais Médicos: uma ferramenta de suporte à gestão baseada em evidências / More Doctors Integrated Information System: a tool to support evidence-based management / Sistema integrado de información de Más Médicos: una herramienta de apoyo a la gestión basada en la evidencia

O presente trabalho busca detalhar uma experiência pioneira de desenvolvimento de um sistema de informação em saúde voltado para subsidiar a gestão com base em evidências junto à atenção primária à saúde (APS). O processo de estruturação de programas e políticas públicas muitas vezes se dá sem acesso às melhores evidências científicas. Nesse contexto, o Sistema Integrado de Informações Mais Médicos (SIMM), aqui descrito, materializou um esforço para suprir a lacuna de informações para a gestão em saúde. Criado com objetivo de integrar os dados das principais fontes de informação relativas ao Projeto de Cooperação entre governo brasileiro e Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/ OMS) para provimento de médicos no Programa Mais Médicos (PMM), o SIMM buscou otimizar a geração e a consolidação de informações que possam subsidiar decisões, além de apoiar o controle administrativo e financeiro. A experiência ilustra o desenvolvimento de uma solução auxiliar que pode ser ampliada para monitorar parâmetros de recursos humanos em saúde não apenas no PMM, mas na APS como um todo. A expertise desenvolvida criou condições para que o sistema pudesse ser configurado como um bem público, para além do suporte à gestão de um projeto em específico. O sistema pode ser adaptado e replicado em outros países das Américas para melhorar a disponibilidade e a qualidade das informações utilizadas por tomadores de decisão.(AU)

The present work provides details about a novel experience involving the development of a health information system focused on supporting evidence-based management at the primary health care (PHC) level. The process of structuring public health programs and policies is often developed without access to the best available scientific evidence. In this context, the proposed system (Sistema Integrado de Informações Mais Médicos, SIMM) materializes the effort to bridge the information gap for health management. Created with the aim of integrating data from the main information sources associated with the Cooperation Project between the Brazilian federal government and the Pan American Health Organization/World Health Organization (PAHO/ WHO) for provision of physicians for the More Doctors Program, SIMM strove to optimize the generation and consolidation of information to support decision-making, in addition to providing support for administrative and financial control. The experience illustrates the development of an ancillary solution that can be expanded to monitor human resources for health parameters across the entire PHC setting, far beyond the More Doctors Program. The resulting expertise created conditions for the system to be configured as a public asset, rather than being restricted to providing managerial support for a specific project. SIMM may be adapted and replicated in other American countries to improve the availability and quality of the information used by decision makers.(AU)

En el presente trabajo se detalla una experiencia pionera de desarrollo de un sistema de información de salud centrado en apoyar la gestión basada en la evidencia en el nivel de la atención primaria de salud. Muchas veces, el proceso de estructuración de los programas y políticas públicas se realiza sin acceso a las mejor evidencia científica. En ese contexto, el sistema integrado de información de Mais Médicos (SIMM) que se describe aquí materializó un esfuerzo para suplir la carencia de información para la gestión en materia de salud. El SIMM, creado con el objetivo de integrar los datos de las principales fuentes de información relativas al proyecto de cooperación entre el Gobierno del Brasil y la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) para la provisión de médicos destinados al programa Más Médicos, se utilizó para optimizar la generación y consolidación de información a fin de sustentar las decisiones, además de servir de apoyo para el control administrativo y financiero. La experiencia ilustra el desarrollo de una solución complementaria que puede ampliarse para observar los parámetros de recursos humanos en salud no solo en el programa Más Médicos, sino en todo el ámbito de la atención primaria de salud. La pericia adquirida creó condiciones propicias para poder configurar el sistema como un bien público, con miras a ampliar su alcance más allá del apoyo a la gestión de un proyecto específico. Es posible adaptar y reproducir el sistema en otros países de la Región de las Américas para mejorar la disponibilidad y la calidad de la información utilizada por los responsables de tomar decisiones.(AU)

Impacto das ações de alimentação dos sistemas de informação da atenção primária sobre a atenção aos indivíduos e comunidade / The impact of data inputting in the primary health care information systems related to the individuals and community care / Impacto de las acciones de alimentación de los sistemas de información de la atención primaria sobre la atención a los individuos y la comunidad

Objetivo: Avaliar a influência das ações de alimentação dos Sistemas de Informação utilizados na Atenção Primária a Saúde (APS) sobre os cuidados de enfermagem ao indivíduo ou comunidade. Método: Pesquisa quantitativa, com enfermeiros da Atenção Primária. Utilizaram-se os testes ANOVA one-way, Kruskal-Wallis e correlação de Spearman com significância de 5% e confiança de 95%. Resultados: A maioria dos enfermeiros era mulher (94,5%), 34,4 anos de idade, 8,8 anos de formação, sendo 7,6 anos atuando na atenção primária, especialista e concursada. Observou-se associação negativa (p-valor = 0,008) entre tempo destinado às atividades de alimentação dos sistemas e o tempo de atenção aos pacientes. Conclusão: O estudo aponta a influência das ações gerenciais voltadas aos sistemas de informação sobre a atenção prestada aos indivíduos/comunidade

Objective: To evaluate the influence of the feeding actions of the Information Systems used in Primary Health Care (PHC) on nursing care to the individual or community. Methods: Quantitative research with primary care nurses. One-way ANOVA, Kruskal-Wallis and Spearman correlation with significance of 5% and 95% confidence were used. Results: The majority of the nurses were women (94.5%), 34.4 years old, 8.8 years of training, and 7.6 years working in primary care, specialist and bankrupt. A negative association (p-value = 0.008) was observed between time spent feeding the systems and patient care time. Conclusion: The study points out the influence of the managerial actions directed to the information systems on the attention given to the individuals / community

Objetivo: Evaluar la influencia de las acciones de alimentación de los Sistemas de Información utilizados en la Atención Primaria a la Salud (APS) sobre los cuidados de enfermería al individuo o comunidad. Método: Investigación cuantitativa, con enfermeros de la Atención Primaria. Se utilizaron las pruebas ANOVA de una forma, Kruskal-Wallis y correlación de Spearman con significancia del 5% y confianza del 95%. Los resultados: La mayoría de los enfermeros eran mujeres (94,5%), 34,4 años de edad, 8,8 años de formación, siendo 7,6 años actuando en la atención primaria, especialista y concursada. Se observó asociación negativa (p-valor = 0,008) entre tiempo destinado a las actividades de alimentación de los sistemas y el tiempo de atención a los pacientes. Conclusión: El estudio apunta la influencia de las acciones gerenciales dirigidas a los sistemas de información sobre la atención prestada a los individuos / comunidad

Estado del arte de la Auditoría de Información / State of the Art of Information Audit

RESUMEN La Auditoría Informacional consiste en evaluar y examinar, periódicamente, los recursos informativos que poseen las entidades para identificar la información, sus flujos y elementos como parte de los procesos organizacionales, para comprender la entidad y sus capacidades. Además, permite determinar cuáles son las fuentes informativas que poseen, cuáles son las que realmente se necesitan, cuáles las que no se tienen y las que generan costos inútiles, es decir, valora la efectividad y la eficacia del sistema informacional. Por lo anterior, la presente investigación tiene como objetivo: realizar una revisión de lo publicado sobre Auditoría de Información en EBSCO, SciELO, RedAlyc, Google, Google Académico y el Google Trends. A partir del análisis de la literatura se obtuvo la tendencia sobre el tema a partir de los países y años más productivos e idiomas más frecuentes. Se observó que aún se desarrollan varios estudios de casos sobre la temática y que las metodologías de los autores Bryson (1997), Artiles (2015) y González, Pintoy Ponjuán (2017), son las más citadas.

ABSTRACT The Informational Audit consists of periodically evaluating and examining the information resources that the entities possess to identify the information, its flows and elements that are part of the organizational processes, and thus the entity and its capacities are better understood. In addition, it allows to determine which are the informative sources that are possessed, which are the ones that are really needed, which are the ones that are not available and those that generate useless costs, that is, value the effectiveness and efficiency of the informational system. The present investigation has like objective: to realize a revision of the published thing on Information Audit in EBSCO, SciELO, RedAlyc, Google, Google Scholar and the Google Trends. From the analysis of the literature, the trend was obtained on the subject from the most productive countries and years and most frequent languages. It was observed that several case studies are still being developed on the subject and that the methodologies of the authors Bryson (1997), Artiles (2015) and González, et al (2017), are the most cited.

Avaliação da implantação do Sistema de Informações sobre Mortalidade no estado de Pernambuco em 2012 / Evaluación de la implantación del sistema de información sobre mortalidad en el estado de Pernambuco, Brasil, en 2012 / Evaluation of the implantation of the Mortality Information System in Pernambuco state, Brazil, in 2012

Objetivo: avaliar a implantação do Sistema de Informações sobre Mortalidade (SIM) em Pernambuco, Brasil. Métodos: pesquisa avaliativa; utilizaram-se dados primários (questionários) e secundários (SIM) referentes aos municípios para estimar o grau de implantação (GI), confrontando indicadores de estrutura e processo aos de resultado; consolidaram-se os dados por região e estado. Resultados: o SIM estava parcialmente implantado no estado (70,6%) e regiões (66,3 a 74,8%); 'gestão' (75,1%), 'emissão e preenchimento' (79,1%) e 'processamento' (71,7%), parcialmente implantados; 'coleta' (80,7%), implantada; 'distribuição e controle' (49,7%) e 'análise e divulgação' (58,0%), com implantação incipiente; encontraram-se valores superiores a 90% para cobertura, óbitos com causa básica definida, municípios com transferência de dados mensal e declarações de óbito digitadas e enviadas oportunamente; verificou-se coerência entre GI e indicadores de resultado, estes melhores quanto maior o GI. Conclusão: o SIM mostrou-se parcialmente implantado, por inadequações na distribuição, controle, análise e divulgação, influenciando desfavoravelmente os efeitos observados.

Objetivo: evaluar la implantación del Sistema de Informaciones sobre Mortalidad (SIM) en Pernambuco, Brasil. Métodos: investigación evaluativa de implantación; se utilizaron datos primarios (cuestionarios) y secundarios (SIM) de los municipios para estimar el grado de implantación (GI), comparando indicadores de estructura y proceso a los de resultado; los datos fueron consolidados por región y estado. Resultados: el SIM se encontraba parcialmente implantado en el estado (70,6%) y regiones (66,3% a 74,8%); 'gestión' (75,1%), 'emisión y llenado' (79,1%) y 'procesamiento' (71,7%), parcialmente implantados; 'colecta' (80,7%), implantada; 'distribución y control' (49,7%) y 'análisis y divulgación' (58,0%), con implantación incipiente; se observó más del 90% de cobertura para óbitos con causa básica definida, municipios con transferencia de datos mensuales y declaraciones de defunción digitadas y enviadas oportunamente; se verificó coherencia entre GI e indicadores de resultado, siendo estos mejores cuanto mayor es el GI. Conclusión: el SIM se mostró parcialmente implantado, en razón de inadecuaciones en la distribución, control, análisis y divulgación, influenciando desfavorablemente los efectos observados.

Objective: to evaluate the implantation of the Mortality Information System (SIM) in Pernambuco, Brazil. Methods: this was an evaluation study; primary data (questionnaires) and secondary data (SIM) were used for the municipalities to estimate the degree of implantation (DI), comparing structure and process indicators with outcome indicators; data were consolidated by region and state. Results: SIM was partially implanted in the state (70.6%) and its regions (66.3% to 74.8%); 'management' (75.1%), 'issuing and filling in' (79.1%), and 'processing' (71.7%) were partially implanted; 'collection' (80.7%) was implanted; while 'distribution and control' (49.7%) and 'analysis and dissemination' (58.0%) had incipient implantation; more than 90% coverage was found for deaths with defined underlying causes, as well as for municipalities with monthly data transfer, and death certificates typed and sent on a timely basis; consistency was found between DI and outcome indicators, which improved as DI increased. Conclusion: SIM was found to be only partially implanted owing to inadequacies in distribution, control, analysis and dissemination, thus influencing unfavorably the effects observed.

Produção e disseminação de informação em um centro de pesquisa de referência na América Latina / Producción y diseminación de información en un centro de investigación de referencia en América Latina / Production and dissemination of information in a reference research center in Latin America

Objetivo: aprofundar a compreensão sobre o processo de produção e disseminação de informação no âmbito organizacional, recorrendo à análise de uma organização intensiva em conhecimento. Métodos: a organização escolhida foi um Centro de Pesquisa e Desenvolvimento na área de Tecnologias da Informação e Comunicação. Tal organização é referência em seu segmento, por possuir um dos maiores programas de Pesquisa e Desenvolvimento da América Latina em sua área de atuação, sendo seus processos de produção e disseminação de informação passíveis de serem aplicados em outras organizações intensivas em conhecimento, como instituições de pesquisa no campo das ciências da saúde. Para tanto, foi realizada uma pesquisa qualitativa de campo, empregando a técnica de entrevistas. Foram entrevistados três profissionais de unidades organizacionais cujas atividades-fim relacionavam-se diretamente com a produção e a disseminação de informação organizacional. Resultados: apenas uma das unidades organizacionais possuía as atividades de produção e disseminação de informação descritas como um processo formal da organização. Conclusão: os resultados apontaram que as maiores dificuldades das unidades organizacionais foram a definição do público-alvo e, principalmente, a avaliação do uso da informação. Também indicaram a adoção de boas práticas na organização, como definição clara das necessidades informacionais e adequação do uso das Tecnologias da Informação e Comunicação no processo de produção e disseminação de informação(AU)

Objetivo: profundizar en la comprensión sobre el proceso de producción y diseminación de información en el ámbito organizacional, mediante el análisis de una organización intensiva en conocimiento. Métodos: la organización elegida fue un Centro de Investigación y Desarrollo en el área de las Tecnologías de la Información y la Comunicación. Tal organización es referencia en su segmento, por poseer uno de los mayores programas de Investigación y Desarrollo de América Latina en su área de actuación. Sus procesos de producción y diseminación de información pueden ser aplicados en otras organizaciones intensivas en conocimiento, como instituciones de investigación en el campo de las ciencias de la salud. Se realizó una investigación cualitativa de campo, empleando la técnica de entrevistas. Se entrevistaron a tres profesionales de unidades organizativas cuyas actividades se relacionaban directamente con la producción y la diseminación de información organizacional. Resultados: solo una de las unidades organizativas poseía las actividades de producción y diseminación de información descritas como un proceso formal de la organización. Conclusión: los resultados apuntaron que las mayores dificultades de las unidades organizacionales fueron la definición del público objetivo y, principalmente, la evaluación del uso de la información. También indicaron la adopción de buenas prácticas en la organización, como definición clara de las necesidades informacionales y adecuación del uso de las tecnologías de la información y la comunicación en el proceso de producción y diseminación de información(AU)

Objective: the purpose of the study was to broaden understanding of the process of production and dissemination of information in the organizational environment by means of the analysis of a knowledge intensive organization. Methods: the organization chosen was a Research and Development Center from the field of information and communication technologies. This center is a reference organization in its sector, for it has one of the largest research and development programs for this field in Latin America. Its processes for production and dissemination of information may be applied in other knowledge intensive organizations, as may be the case of health sciences research institutions. To achieve this aim, a qualitative field study was conducted which was based on interviews. The interviewees were three professionals from organizational units whose work was directly related to production and dissemination of organizational information. Results: in only one of the organizational units activities related to the production and dissemination of information were described as a formal process of the organization. Conclusion: the results pointed out that the main difficulties in organizational units have to do with the definition of the target audience, and mainly the evaluation of the use of information. They also point to the adoption of best practices in the organization, such as a clear definition of the information needs, and the adequacy of the use of information and communication technologies in the process of production and dissemination of information(AU)

Assessing the feasibility of a mobile health-supported clinical decision support system for nutritional triage in oncology outpatients using Arden Syntax.

BACKGROUND: Nutritional screening procedures followed by regular nutrition monitoring for oncological outpatients are no standard practice in many European hospital wards and outpatient settings. As a result, early signs of malnutrition are missed and nutritional treatment is initiated when patients have already experienced severe weight loss. OBJECTIVE: We report on a novel clinical decision support system (CDSS) for the global assessment and nutritional triage of the nutritional condition of oncology outpatients. The system combines clinical and laboratory data collected in the clinical setting with patient-generated data from a smartphone application for monitoring the patients' nutritional status. Our objective is to assess the feasibility of a CDSS that combines the aforementioned data sources and describe its integration into a hospital information system. Furthermore, we collected patients' opinions on the value of the system, and whether they would regard the system as a useful aid in coping with their condition. MATERIALS AND METHODS: The system implements the Patient-Generated Subjective Global Assessment (PG-SGA) to monitor nutritional status in the outpatient setting. A smartphone application is used to collect patient-generated data by performing weekly mini-surveys on patients concerning their eating habits, weight, and overall well-being. Data are uploaded on completion of each mini-survey and stored on a secure server at the Medical University of Vienna (MUV). The data are then combined with relevant clinical information from the Vienna General Hospital (VGH) information system. The knowledge base for the CDSS is implemented in medical logic modules (MLMs) using Arden Syntax. A three-month pilot clinical trial was performed to test the feasibility of the system. Qualitative questionnaires were used to obtain the patients' opinions on the usability and personal value of the system during the four-week test period. RESULTS: We used the existing separation between the scientific and clinical data domains in the secured network environment (SNE) at the MUV and VGH to our advantage by importing, storing, and processing both patient-generated and routine data in the scientific data domain. To limit exposure to the SNE, patient-generated data stored outside the SNE were imported to the scientific domain once a day. The CDSS created for nutritional assessment and triage comprised ten MLMs, each including either a sub-assessment or the final results of the PG-SGA. Finally, an interface created for the hospital information system showed the results directly in clinical routine. In all 22 patients completed the clinical study. The results of the questionnaires showed that 91% of the patients were generally happy with the usability of the system, 91% believed that the application was of additional value in detecting cancer-related malnutrition, and 82% found it helpful as a long-term monitoring tool. DISCUSSION AND CONCLUSION: Despite strict protection of the clinical data domain, a CDSS employing patient-generated data can be integrated into clinical routine. The CDSS discussed in this report combined the information entered into a smartphone application with clinical data in order to inform the physician of a patient's nutritional status and thus permit suitable and timely intervention. The initial results show that the smartphone application was well accepted by patients, who considered it useful, but not many oncological outpatients were willing to participate in the clinical study because they did not possess an Android phone or lacked smartphone expertise. Furthermore, the results indicate that patient-generated data could be employed to augment clinical data and calculate metrics such as the PG-SGA without excessive effort by using a secure intermediate location as the locus of data storage and processing.

Data-driven knowledge acquisition, validation, and transformation into HL7 Arden Syntax.

OBJECTIVE: The objective of this study is to help a team of physicians and knowledge engineers acquire clinical knowledge from existing practices datasets for treatment of head and neck cancer, to validate the knowledge against published guidelines, to create refined rules, and to incorporate these rules into clinical workflow for clinical decision support. METHODS AND MATERIALS: A team of physicians (clinical domain experts) and knowledge engineers adapt an approach for modeling existing treatment practices into final executable clinical models. For initial work, the oral cavity is selected as the candidate target area for the creation of rules covering a treatment plan for cancer. The final executable model is presented in HL7 Arden Syntax, which helps the clinical knowledge be shared among organizations. We use a data-driven knowledge acquisition approach based on analysis of real patient datasets to generate a predictive model (PM). The PM is converted into a refined-clinical knowledge model (R-CKM), which follows a rigorous validation process. The validation process uses a clinical knowledge model (CKM), which provides the basis for defining underlying validation criteria. The R-CKM is converted into a set of medical logic modules (MLMs) and is evaluated using real patient data from a hospital information system. RESULTS: We selected the oral cavity as the intended site for derivation of all related clinical rules for possible associated treatment plans. A team of physicians analyzed the National Comprehensive Cancer Network (NCCN) guidelines for the oral cavity and created a common CKM. Among the decision tree algorithms, chi-squared automatic interaction detection (CHAID) was applied to a refined dataset of 1229 patients to generate the PM. The PM was tested on a disjoint dataset of 739 patients, which gives 59.0% accuracy. Using a rigorous validation process, the R-CKM was created from the PM as the final model, after conforming to the CKM. The R-CKM was converted into four candidate MLMs, and was used to evaluate real data from 739 patients, yielding efficient performance with 53.0% accuracy. CONCLUSION: Data-driven knowledge acquisition and validation against published guidelines were used to help a team of physicians and knowledge engineers create executable clinical knowledge. The advantages of the R-CKM are twofold: it reflects real practices and conforms to standard guidelines, while providing optimal accuracy comparable to that of a PM. The proposed approach yields better insight into the steps of knowledge acquisition and enhances collaboration efforts of the team of physicians and knowledge engineers.

Population-level intervention and information collection in dynamic healthcare policy.

We develop a general framework for optimal health policy design in a dynamic setting. We consider a hypothetical medical intervention for a cohort of patients where one parameter varies across cohorts with imperfectly observable linear dynamics. We seek to identify the optimal time to change the current health intervention policy and the optimal time to collect decision-relevant information. We formulate this problem as a discrete-time, infinite-horizon Markov decision process and we establish structural properties in terms of first and second-order monotonicity. We demonstrate that it is generally optimal to delay information acquisition until an effect on decisions is sufficiently likely. We apply this framework to the evaluation of hepatitis C virus (HCV) screening in the general population determining which birth cohorts to screen for HCV and when to collect information about HCV prevalence.

The Virgin Islands National Information Systems for Health: vision, actions, and lessons learned for advancing the national public health agenda / Sistemas Nacionales de Información para la Salud de las Islas Vírgenes: visión, acciones y lecciones aprendidas para avanzar en la agenda nacional de salud pública / Os sistemas nacionais de informação para a saúde das Ilhas Virgens: visão, ações e lições aprendidas para o avanço da agenda nacional de saúde pública

ABSTRACT The British Virgin Islands (BVI) Ministry of Health and Social Development (MOHSD) recently identified the need for an updated strategy to advance the country's vision for Information Systems for Health (IS4H) ("Informed decision-making for better health outcomes"). Since the early 1990s, the MOHSD has recognized the importance of having strong conceptual foundations and mechanisms for its information systems, and the need to strengthen the production and use of good-quality health data to enable fulfillment of the territory's health goals. Therefore, in May 2017, BVI requested technical assistance from the Pan American Health Organization (PAHO) to develop a plan/"road map" for strengthening the MOHSD's stewardship capacity for IS4H. This resulted in a bilateral, country-led collaboration between PAHO and the Ministry to carry out two assessments of BVI's National Information Systems for Health (NISH): 1) a rapid assessment to map NISH policy, to develop a short- and medium-term workplan for strengthening and updating it, and 2) a maturity assessment, using PAHO's IS4H Maturity Model tool, to evaluate the implementation of NISH policy thus far and determine next steps. This article describes 1) the steps taken in this bilateral collaboration to update BVI's NISH policy and fine-tune its IS4H vision, including the development of a national plan/road map, and 2) lessons learned.

RESUMEN El Ministerio de Salud y Desarrollo Social de las Islas Vírgenes Británicas identificó recientemente la necesidad de tener una estrategia actualizada para avanzar la visión del país en el ámbito de los sistemas de información para la salud (IS4H) ("Toma de decisiones informadas para obtener mejores resultados de salud"). Desde principios de la década de 1990, el Ministerio ha reconocido la importancia de tener sólidos fundamentos conceptuales y mecanismos para sus sistemas de información, así como la necesidad de fortalecer la producción y el uso de datos de salud de buena calidad para permitir el cumplimiento de los objetivos de salud del territorio. En este contexto, en mayo de 2017 las Islas Vírgenes Británicas solicitaron la asistencia técnica de la Organización Panamericana de la Salud (OPS) para desarrollar un plan u "hoja de ruta" para fortalecer su capacidad de administración en el ámbito de los IS4H. Esto resultó en una colaboración bilateral, dirigida por el país, entre la OPS y el Ministerio para llevar a cabo dos evaluaciones de los Sistemas Nacionales de Información para la Salud: 1) una evaluación rápida para mapear la política de estos sistemas, y desarrollar un plan de trabajo a corto y mediano plazo para fortalecerlos y actualizarlos y 2) una evaluación de madurez, utilizando la herramienta Modelo de Madurez de IS4H de la OPS, para evaluar la implementación de la política de Sistemas Nacionales de Información para la Salud hasta el momento y determinar los próximos pasos. Este artículo describe 1) los pasos dados en esta colaboración bilateral para actualizar la política de Sistemas Nacionales de Información para la Salud de las Islas Vírgenes Británicas y ajustar su visión del IS4H, incluido el desarrollo de un plan nacional u hoja de ruta, y 2) las lecciones aprendidas durante este proceso.

RESUMO O Ministério da Saúde e Desenvolvimento Social das Ilhas Virgens Britânicas identificou recentemente a necessidade de uma estratégia atualizada para avançar a visão do país para os Sistemas de Informação para a Saúde (IS4H) ("Tomada de decisão informada para melhores resultados de saúde"). Desde o início dos anos 1990, o Ministerio reconheceu a importância de ter fortes fundamentos conceituais e mecanismos para seus sistemas de informação, e a necessidade de fortalecer a produção e o uso de dados de boa qualidade em saúde para permitir o cumprimento das metas de saúde do território. Portanto, em maio de 2017, as Ilhas Virgens Britânicas solicitaram assistência técnica da Organização Pan-Americana da Saúde (OPAS) para desenvolver um plano/roteiro para o fortalecimento da capacidade de administração do Ministerio para a IS4H. Isso resultou em uma colaboração bilateral entre a OPAS e o Ministério, liderada pelo país, para conduzir duas avaliações dos Sistemas Nacionais de Informação para a Saúde das Ilhas Virgens Britânicas: 1) uma avaliação rápida para mapear a política do Sistemas Nacionais de Informação para a Saúde, e desenvolver uma estratégia de curto e médio prazo e um plano de trabalho para fortalecê-los e atualizá-los; e 2) uma avaliação de maturidade, utilizando a ferramenta Modelo de Maturidade IS4H da OPAS, para avaliar a implementação da política do Sistemas Nacionais de Informação para a Saúde até o momento e determinar os próximos passos. Este artigo descreve 1) os passos dados nessa colaboração bilateral para atualizar a política de Sistemas Nacionais de Informação para a Saúde das Ilhas Virgens Britânicas e ajustar sua visão de IS4H, incluindo o desenvolvimento de um plano nacional/roteiro, e 2) as lições aprendidas neste processo.

Análise do Sistema de Informação da Vigilância de Eventos Adversos Pós-Vacinação no Brasil, 2014 a 2016 / Analysis of the Vaccine Adverse Event Reporting System in Brazil, 2014 to 2016 / Análisis del Sistema de Información de Vigilancia de Eventos Adversos Posvacunación en Brasil, 2014 a 2016

RESUMO Objetivo Descrever as características das notificações de eventos adversos pós-vacinação (EAPV) no Sistema de Informação da Vigilância de EAPV (SI-EAPV) on-line nos primeiros 2 anos de operação do sistema. Método Foi realizado um estudo descritivo dos registros de EAPV notificados no SI-EAPV entre julho de 2014 e junho de 2016. Resultados Durante o período do estudo, foram registradas 24 732 notificações. De 5 570 municípios brasileiros, 2 571 (46,2%) realizaram notificação de algum EAPV. Entretanto, somente 1 622 (6,6%) notificações estavam encerradas no momento do estudo; dessas, 89,9% não apresentaram gravidade. Entre as notificações encerradas, 19,7% não tiveram o preenchimento da variável "atendimento médico" e 98,7% não apresentaram registro de exames laboratoriais. As manifestações clínicas sistêmicas neurológicas foram as mais frequentes entre os eventos adversos graves encerrados, correspondendo a 59,5% dos sinais e sintomas. Em relação à idade, os maiores coeficientes de notificação foram registrados entre os menores de 4 anos. Conclusão O SI-EAPV mostra-se útil no monitoramento da segurança das vacinas. Contudo, os municípios precisam ampliar a adesão ao sistema, bem como realizar as investigações e notificações dos EAPV, preenchendo a ficha de notificação de forma adequada e oportuna. O conhecimento sobre EAPV pode ser aplicado na prática dos serviços de vigilância em saúde, melhorando a segurança de utilização dos imunobiológicos.

ABSTRACT Objective To describe the characteristics of vaccine adverse events (VAE) reports in the online VAE Reporting System (VAE-RS) after 2 years of operation. Method A descriptive analysis of VAE reports entered into the VAE-RS between July 2014 and June 2016 was performed. Results During the study period, 24 732 VAE were reported. Of 5 570 Brazilian municipalities, 2 571 (46.2%) reported at least one VAE; however, only 1 622 (6.6%) reports had been completed/closed at the end of the study period. Of these, 89.9% referred to mild VAE. Among the completed reports, 19.7% did not provide information on "type of medical care provided," and 98.7% had no information regarding laboratory tests. Systemic neurological symptoms were the most frequent serious VAE among closed reports (59.5% of serious signs/symptoms). Concerning age, the highest VAE reporting coefficients were recorded for children aged ≤ 4 years. Conclusion The VAE-RS is useful to monitor immunization safety. However, municipal services must increase adherence to the system and perform the required investigation and reporting of VAE, with timely and adequate completion of the VAE-RS form. Knowledge regarding VAE can be used in the daily routine of surveillance services, improving the safety of immunobiological agents.

RESUMEN Objetivo Describir las características de las notificaciones de eventos adversos posvacunación (EAPV) en el Sistema de Información de Vigilancia de EAPV (SI-EAPV, un sistema en línea, durante los primeros 2 años de ejecución del sistema. Método Se realizó un estudio descriptivo de los registros de EAPV notificados en el SI-EAPV entre julio de 2014 y junio de 2016. Resultados Durante el período del estudio, se registraron 24 732 notificaciones. De 5 570 municipios brasileños, 2 571 (46,2%) notificaron algún EAPV. Sin embargo, solamente 1 622 (6,6%) notificaciones estaban cerradas al momento del estudio; de ellas, el 89,9% no presentó gravedad. Respecto a las notificaciones cerradas, en el 19,7% no fue anotada la variable "atención médica" y el 98,7% no presentó registro de exámenes de laboratorio. Entre los eventos adversos graves cerrados, las manifestaciones clínicas sistémicas neurológicas fueron las más frecuentes, representado el 59,5% de los signos y síntomas. En cuanto a la edad, los mayores coeficientes de notificación se registraron entre los menores de 4 años. Conclusión El SI-EAPV es útil para el monitoreo de la seguridad de las vacunas. Sin embargo, los municipios necesitan ampliar la adhesión al sistema, así como realizar las investigaciones y notificaciones de los EAPV, llenando la ficha de notificación de forma adecuada y oportuna. El conocimiento sobre EAPV puede ser aplicado en la práctica de los servicios de vigilancia en salud, mejorando la seguridad en la utilización de los productos inmunobiológicos.

Innovative Information Technology-Powered Population Health Care Management Improves Outcomes and Reduces Hospital Readmissions and Emergency Department Visits.

BACKGROUND: Patients with chronic conditions are often the most frequent users of health care. Moreover, adapting to developments in one's illness, understanding how to self-manage a chronic illness, and sharing information between primary care and specialty providers, can be a full-time job for someone with a chronic illness. In response to these challenges, Christiana Care Health System (Wilmington, Delaware) developed Care Link, an information technology (IT)-enhanced care management support to enable populations of patients to achieve better clinical outcomes at lower cost. METHODS: In 2012 Christiana Care received a grant to design a generalizable, scalable, and replicable IT-driven care model that would integrate disparate clinical and registry data generated from routine care to support longitudinal care management for patients with ischemic heart disease. The single-disease care management program was expanded beginning in mid-2015 to serve risk-based models for many diseases and chronic conditions. RESULTS: More than 8,600 patients in several surgical and medical populations, including joint replacement, cervical spine surgery, and congestive heart failure, have been supported by Care Link. For example, preoperative assessment of patients with elective joint replacement to predict post-acute care needs led to an increase in the volume of patients discharged to home with self-care or with home health care by 30%-from 61% to 80%. CONCLUSION: Care Link IT functions can be replicated to address the unique longitudinal care needs of any population. Care Link's next steps are to continue to increase the number of patients served throughout the region and to expand the scope of care management programming.

Using an Electronic Perioperative Documentation Tool to Identify Returns to Operating Room (ROR) in a Tertiary Care Academic Medical Center.

BACKGROUND: The metric "Unplanned returns to operating room (ROR)" is being tracked in surgical quality dashboards; 70% of unplanned RORs may be related to surgical complications. With increasing regionalization of trauma and complex surgical care at tertiary care academic centers, it is unclear if a simple ROR metric is a valid assessment of surgical quality at such centers. METHOD: A real-time electronic tool was used to identify all RORs-planned and unplanned-in a high-volume, high-complexity academic surgical practice at Mayo Clinic-Rochester within 45 days of the index operation. Analysis by ROR type and indication was performed. RESULTS: During the analysis period (June 2014-February 2015) 44,031 operations were performed, with 5,552 subsequent RORs (13%). Of all RORs, 51% (n = 2,818) were planned staged returns, 29% (n = 1,589) were unrelated, 15% (n = 830) were unplanned and 6% (n = 315) were planned because of previous complications. Overall, unplanned reoperations were uncommon (n = 830, 2% of all operations). The most common indications for unplanned RORs included "other" (32%, n = 266), bleeding related (24%, n = 198) and wound complications (20%, n = 166). CONCLUSION: In a high-volume, high-complexity academic surgical practice, RORs occurred after 13% of cases. Unplanned returns were infrequent and usually were associated with complications; most RORs were planned staged or unrelated returns. A simple ROR metric that does not consider planned/unrelated returns is likely not a valid surgical quality measure. Electronic tools designed specifically to identify in real-time RORs, associated indication, and clinical validation should provide more reliable data for public reporting and quality improvement efforts.