Towards malaria elimination: a reflection about digital notification modules to improve malaria cases notification speed and follow-up in the Brazilian Amazon region.

BACKGROUND: Health information systems (HIS) are a pivotal element in epidemiological surveillance. In Brazil, malaria persists as a public health challenge, with 99% of its occurrences concentrated in the Amazon region, where cases are reported through the HIS Sivep-Malaria. Recent technological advancements indicate that case notifications can be expedited through more efficient systems with broader coverage. The objective of this study is to analyse opportunities for notification within Sivep-Malaria and explore the implementation of mobile electronic devices and applications to enhance the performance of malaria case notifications and use. METHODS: This descriptive study analyses data on malaria-positive cases in the Brazilian Amazon from 2004 to 2022. Malaria Epidemiological Surveillance System (Sivep-Malaria) data were used. The Brazilian Amazon region area is approximately 5 million km2 across nine different states in Brazil. Data entry opportunities were assessed by considering the time difference between the 'date of data entry' and the 'date of notification.' Descriptive statistics, including analyses of means and medians, were conducted across the entire Amazon region, and for indigenous population villages and gold mining areas. RESULTS: Between 2004 and 2022, 6,176,878 new malaria cases were recorded in Brazil. The average data entry opportunity throughout the period was 17.9 days, with a median of 8 days. The most frequently occurring value was 1 day, and 99% of all notifications were entered within 138 days, with 75.0% entered within 20 days after notification. The states with the poorest data entry opportunities were Roraima and Tocantins, with averages of 31.3 and 31.0 days, respectively. For indigenous population villages and gold mining areas, the median data entry opportunities were 23 and 15 days, respectively. CONCLUSIONS: In malaria elimination, where surveillance is a primary strategy for evaluating each reported case, reducing notification time, enhancing data quality and being able to follow-up cases through computerized reports offer significant benefits for cases investigation. Technological improvements in Sivep-Malaria could yield substantial benefits for malaria control in Brazil, aiding the country in achieving disease elimination and fulfilling the Sustainable Development Goals.

Validating the Delone and Mclean's model in a developing country's infectious disease pandemic context.

BACKGROUND: This study aimed at validating the updated DeLone and McLean's information systems success model (D&MISS) in a developing country's infectious disease pandemic preparedness and response context. The findings from this study are relevant to inform policies and actions for enhancing developing countries' the Health Information System's (HIS) performance, and specifically to improve their future pandemic readiness and response. The study sought to respond to a key research question: to what extent can the D&MISS model provide evidence to enhance the HIS's infectious disease pandemic readiness and response in developing countries? METHOD: A cross-sectional study design that involved a multi-stage probability sampling approach to select eligible healthcare workers was applied. Conducted in Nigeria and Liberia, 576 primary healthcare workers, out of the proposed 600, participated, representing a response rate of 96%. The D&MISS model served as the theoretical underpinning for this study, and nine hypothesized relationships were stated before the study based on the interconnectedness of the model's six dimensions. Structural Equation Modelling (SEM) data analysis using the Partial Least Square approach was used to determine if hypothesized relationships were supported. RESULTS: 70% of the observed variance in the Net Benefit construct was explained by the predictive influence of the Use and User Satisfaction constructs. The Use construct had a slightly more substantial predictive influence than the User Satisfaction construct. Eight of the nine hypothesized relationships were supported, except for the relationship between Information Quality and Use. The relationships between System Quality and Use and User Satisfaction and Net Benefit had the highest beta coefficient, statistically significant at p < 0.05. CONCLUSION AND RELEVANCE: The D&MISS model demonstrated its relevance in providing evidence on the gaps of the HISs regarding future pandemic preparedness and response. However, from a future research opportunity, its enhancement and modifications with context-specific dimensions peculiar to developing countries will improve its ability to provide more context-specific evidence to improve pandemic preparedness and response for developing countries.

Trends in caesarean section rates in Europe from 2015 to 2019 using Robson's Ten Group Classification System: A Euro-Peristat study.

OBJECTIVE: To assess changes in caesarean section (CS) rates in Europe from 2015 to 2019 and utilise the Robson Ten Group Classification System (TGCS) to evaluate the contribution of different obstetric populations to overall CS rates and trends. DESIGN: Observational study utilising routine birth registry data. SETTING: A total of 28 European countries. POPULATION: Births at ≥22 weeks of gestation in 2015 and 2019. METHODS: Using a federated model, individual-level data from routine sources in each country were formatted to a common data model and transformed into anonymised, aggregated data. MAIN OUTCOME MEASURES: By country: overall CS rate. For TGCS groups (by country): CS rate, relative size, relative and absolute contribution to overall CS rate. RESULTS: Among the 28 European countries, both the CS rates (2015, 16.0%-55.9%; 2019, 16.0%-52.2%) and the trends varied (from -3.7% to +4.7%, with decreased rates in nine countries, maintained rates in seven countries (≤ ± 0.2) and with increasing rates in 12 countries). Using the TGCS (for 17 countries), in most countries labour induction increased (groups 2a and 4a), whereas multiple pregnancies (group 8) decreased. In countries with decreasing overall CS rates, CS tended to decrease across all TGCS groups, whereas in countries with increasing rates, CS tended to increase in most groups. In countries with the greatest increase in CS rates (>1%), the absolute contributions of groups 1 (nulliparous term cephalic singletons, spontaneous labour), 2a and 4a (induction of labour), 2b and 4b (prelabour CS) and 10 (preterm cephalic singletons) to the overall CS rate tended to increase. CONCLUSIONS: The TGCS shows varying CS trends and rates among countries of Europe. Comparisons between European countries, particularly those with differing trends, could provide insight into strategies to reduce CS without clinical indication.

Health information management systems and practices in conflict-affected settings: the case of northwest Syria.

BACKGROUND: In conflict settings, as it is the case in Syria, it is crucial to enhance health information management to facilitate an effective and sustainable approach to strengthening health systems in such contexts. In this study, we aim to provide a baseline understanding of the present state of health information management in Northwest Syria (NWS) to better plan for strengthening the health information system of the area that is transitioning to an early-recovery stage. METHODS: A combination of questionnaires and subsequent interviews was used for data collection. Purposive sampling was used to select twenty-one respondents directly involved in managing and directing different domains of health information in the NWS who worked with local NGOs, INGOs, UN-agencies, or part of the Health Working Group. A scoring system for each public health domain was constructed based on the number and quality of the available datasets for these domains, which were established by Checci and others. RESULTS & CONCLUSIONS: Reliable and aggregate health information in the NWS is limited, despite some improvements made over the past decade. The conflict restricted and challenged efforts to establish a concentrated and harmonized HIS in the NWS, which led to a lack of leadership, poor coordination, and duplication of key activities. Although the UN established the EWARN and HeRAMS as common data collection systems in the NWS, they are directed toward advocacy and managed by external experts with little participation or access from local stakeholders to these datasets. RECOMMENDATIONS: There is a need for participatory approaches and the empowerment of local actors and local NGOs, cooperation between local and international stakeholders to increase access to data, and a central domain for planning, organization, and harmonizing the process. To enhance the humanitarian health response in Syria and other crisis areas, it is imperative to invest in data collection and utilisation, mHealth and eHealth technologies, capacity building, and robust technical and autonomous leadership.

Quality, Usability, and Trust Challenges to Effective Data Use in the Deployment and Use of the Bangladesh Nutrition Information System Dashboard: Qualitative Study.

BACKGROUND: Evidence-based decision-making is essential to improve public health benefits and resources, especially in low- and middle-income countries (LMICs), but the mechanisms of its implementation remain less straightforward. The availability of high-quality, reliable, and sufficient data in LMICs can be challenging due to issues such as a lack of human resource capacity and weak digital infrastructure, among others. Health information systems (HISs) have been critical for aggregating and integrating health-related data from different sources to support evidence-based decision-making. Nutrition information systems (NISs), which are nutrition-focused HISs, collect and report on nutrition-related indicators to improve issues related to malnutrition and food security-and can assist in improving populations' nutritional statuses and the integration of nutrition programming into routine health services. Data visualization tools (DVTs) such as dashboards have been recommended to support evidence-based decision-making, leveraging data from HISs or NISs. The use of such DVTs to support decision-making has largely been unexplored within LMIC contexts. In Bangladesh, the Mukto dashboard was developed to display and visualize nutrition-related performance indicators at the national and subnational levels. However, despite this effort, the current use of nutrition data to guide priorities and decisions remains relatively nascent and underused. OBJECTIVE: The goal of this study is to better understand how Bangladesh's NIS, including the Mukto dashboard, has been used and areas for improvement to facilitate its use for evidence-based decision-making toward ameliorating nutrition-related service delivery and the health status of communities in Bangladesh. METHODS: Primary data collection was conducted through qualitative semistructured interviews with key policy-level stakeholders (n=24). Key informants were identified through purposive sampling and were asked questions about the experiences and challenges with the NIS and related nutrition dashboards. RESULTS: Main themes such as trust, data usability, personal power, and data use for decision-making emerged from the data. Trust in both data collection and quality was lacking among many stakeholders. Poor data usability stemmed from unstandardized indicators, irregular data collection, and differences between rural and urban data. Insufficient personal power and staff training coupled with infrastructural challenges can negatively affect data at the input stage. While stakeholders understood and expressed the importance of evidence-based decision-making, ultimately, they noted that the data were not being used to their maximum potential. CONCLUSIONS: Leveraging DVTs can improve the use of data for evidence-based decision-making, but decision makers must trust that the data are believable, credible, timely, and responsive. The results support the significance of a tailored data ecosystem, which has not reached its full potential in Bangladesh. Recommendations to reach this potential include ensuring a clear intended user base and accountable stakeholders are present. Systems should also have the capacity to ensure data credibility and support ongoing personal power requirements.

Development of a communication platform for patients with head and neck cancer for effective information delivery and improvement of doctor-patient relationship: application of treatment journey-based service blueprint.

BACKGROUND: Effective communication and information delivery enhance doctor-patient relationships, improves adherence to treatment, reduces work burden, and supports decision-making. The study developed a head and neck cancer (HNC) communication platform to support effective delivery of information about HNC treatment and improve the doctor-patient relationship. METHODS: This study was structured in three main phases: 1) The requirement elicitation phase sought an understanding of the HNC treatment journey and service failure points (FPs) obtained through patient/medical staff interviews and observations, along with a review of the electronic health record system; 2) The development phase involved core needs analysis, solutions development through a co-creation workshop, and validation of the solutions through focus groups; and 3) the proposed HNC communication platform was integrated with the current treatment system, and the flow and mechanism of the interacting services were structured using a service blueprint (SB). RESULTS: Twenty-two service FPs identified through interviews and observations were consolidated into four core needs, and solutions were proposed to address each need: an HNC treatment journey map, cancer survivor stories, operation consent redesign with surgical illustrations, and a non-verbal communication toolkit. The communication platform was designed through the SB in terms of the stage at which the solution was applied and the actions and interactions of the service providers. CONCLUSIONS: The developed platform has practical significance, reflecting a tangible service improvement for both patients and medical staff, making it applicable in hospital settings.

Explaining predictors of discharge destination assessed along the patients' acute stroke journey.

INTRODUCTION: Accurate prediction of outcome destination at an early stage would help manage patients presenting with stroke. This study assessed the predictive ability of three machine learning (ML) algorithms to predict outcomes at four different stages as well as compared the predictive power of stroke scores. METHODS: Patients presenting with acute stroke to the Canberra Hospital between 2015 and 2019 were selected retrospectively. 16 potential predictors and one target variable (discharge destination) were obtained from the notes. k-Nearest Neighbour (kNN) and two ensemble-based classification algorithms (Adaptive Boosting and Bootstrap Aggregation) were employed to predict outcomes. Predictive accuracy was assessed at each of the four stages using both overall and per-class accuracy. The contribution of each variable to the prediction outcome was evaluated by the ensemble-based algorithm and using the Relief feature selection algorithm. Various combinations of stroke scores were tested using the aforementioned models. RESULTS: Of the three ML models, Adaptive Boosting demonstrated the highest accuracy (90%) at Stage 4 in predicting death while the highest overall accuracy (81.7%) was achieved by kNN (k=2/City-block distance). Feature importance analysis has shown that the most important features are the 24-hour Scandinavian Stroke Scale (SSS) and 24-hour National Institutes of Health Stroke Scale (NIHSS) scores, dyslipidaemia, hypertension and premorbid mRS score. For the initial and 24-hour scores, there was a higher correlation (0.93) between SSS scores than for NIHSS scores (0.81). Reducing the overall four scores to InitSSS/24hrNIHSS increased accuracy to 95% in predicting death (Adaptive Boosting) and overall accuracy to 85.4% (kNN). Accuracies at Stage 2 (pre-treatment, 11 predictors) were not far behind those at Stage 4. CONCLUSION: Our findings suggest that even in the early stages of management, a clinically useful prediction regarding discharge destination can be made. Adaptive Boosting might be the best ML model, especially when it comes to predicting death. The predictors' importance analysis also showed that dyslipidemia and hypertension contributed to the discharge outcome even more than expected. Further, surprisingly using mixed score systems might also lead to higher prediction accuracies.

Current Practice, Safety and Efficacy of Interventions for Recurrent Respiratory Papillomatosis: Evidence From a UK Registry.

OBJECTIVES: To determine the current practice, safety and efficacy of interventions used in the management of recurrent respiratory papillomatosis (RRP) in the UK NHS. DESIGN: Prospective registry (recruitment between 1st April 2018 and 31st August 2022, retrospective data from 1st January 2015 permitted with consent). Sub-group data-linked to Hospital Episode Statistics for additional follow-up (until 31st July 2022). SETTING: UK NHS hospitals treating RRP patients. PARTICIPANTS: Children and adults diagnosed with RRP and managed in an NHS hospital. MAIN OUTCOME MEASURES: Disease severity (Derkay, voice handicap and GRBAS scores), management (type and frequency of surgical and adjuvant intervention) and complications (cancer, death). RESULTS: Three hundred and thirty patients were entered into the registry; 304 (including 65 children) were eligible for analysis. Children had more severe disease than adults (median Derkay score 10 vs. 5). Microdebrider was the most common surgical intervention, particularly in children (86% of children, 49% of adults). Additionally, lasers (CO2, KTP and pulsed dye) were used in 34% of adults. Gardasil was the most common adjuvant therapy (21 children, 23 adults). Procedural complications were rare (10.8% children, 5.9% adults). Five patients developed laryngeal malignancy; there were six deaths during follow-up period. CONCLUSIONS: This is the largest UK RRP study to date. RRP is more aggressive in children than adults, and treatment choice differs between age groups. Overall, management was safe with minimal complications reported, and generally effective in maintaining a safe airway. Standardised reporting is required to objectively monitor disease progression and safety over time. TRIAL REGISTRATION: NCT03465280, ISRCTN36100560.

From disease- to people-centred pandemic management: organized communities, community-oriented primary care and health information systems.

BACKGROUND: The COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response. METHODS: This analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted. RESULTS: Togo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers. DISCUSSION: Since trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities, community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances. CONCLUSIONS: The difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.

RESUMEN: ANTECEDENTES: La pandemia de COVID-19 expuso la brecha de equidad en salud dentro y entre países. Los países occidentales fueron los primeros en recibir vacunas y la mortalidad fue mayor entre las poblaciones indígenas, minoritarias y socialmente desfavorecidas dentro de los países. Sorprendentemente, muchos países subsaharianos reportaron un exceso de mortalidad bajo. Estos países comparten experiencias de organización y participación comunitaria en salud. El objetivo es analizar si y cómo este papel central de las personas puede promover una respuesta exitosa a la pandemia. MéTODOS: Este análisis se basa en parte en las experiencias locales y nacionales compartidas durante una conferencia internacional y latinoamericana sobre la atención centrada en las personas y comunidades en 2021. Además, se consultó los datos de exceso de mortalidad y los datos relevantes para el control de la pandemia, así como la literatura sobre la respuesta a la pandemia de países con un exceso de mortalidad inesperadamente bajo. RESULTADOS: Togo, Mongolia, Tailandia y Kenia tuvieron un exceso de mortalidad promedio por 2020 y 2021 siete veces menor que los Estados Unidos de América. Se observaron respuestas pandémicas más exitosas en entornos con experiencia en el manejo de epidemias como el ébola y el VIH, redes comunitarias bien establecidas, una filosofía nacional de ayuda mutua, asistencia financiera del gobierno, más recursos humanos para atención primaria y trabajadores de salud comunitarios remunerados. DISCUSIóN: Dado que la confianza en autoridades y las necesidades en salud varían mucho, se necesitan estrategias locales para complementar las respuestas nacionales e internacionales a la pandemia. Se identificaron tres palancas clave para promover la gestión de pandemias adaptada localmente: comunidades bien organizadas, atención primaria orientada a la comunidad y sistemas de información de salud. Una estructura comunitaria organizada surge de una comprensión ética compartida que concibe a la humanidad interconectada entre sí y con el medio ambiente. Esta estructura facilita la ayuda mutua y la participación en la toma de decisiones. La atención primaria orientada a la comunidad incluye la atención a la salud comunitaria colectiva y las formas de mejorar la salud desde sus raíces. Un sistema de información de salud puede apoyar el análisis de la salud colectiva y la equidad en salud al presentar las necesidades de salud estratificadas por privación social, etnicidad y circunstancias de la comunidad. CONCLUSIONES: La diferencia en el exceso de mortalidad entre países durante la pandemia de COVID-19 y las experiencias de varios países, demuestran el potencial de las palancas para promover una respuesta de emergencia sanitaria más justa y eficaz. Estas mismas palancas y estrategias pueden promover sistemas de salud más inclusivos y socialmente justos.

Intersection of policy and Immunization Information Systems (IIS).

BACKGROUND: Immunization information systems (IIS) are confidential, population-based computerized databases that record vaccination doses administered to persons residing within a given geopolitical area. We sought to highlight the evolution of IIS policy over the last two decades, as IIS play a pivotal role in achieving equitable and high vaccine uptake. METHODS: Legal epidemiological research methods were used to assess relevant IIS statutes and administrative codes across all 50 states, the District of Columbia, Philadelphia, and New York City. Where relevant, laws were cross-checked or supplemented with state and local health department resources. Comparisons to previous legal studies enabled evaluation of trends in IIS laws over time. RESULTS: The compilation of current laws provides an updated overview of the diverse interstate and intrastate policies within the US that govern the capabilities and implementation of IIS. The findings of this study show the progress that has been made in the past decade in improving policies that enable IIS to be utilized across the life-course. Conversely, gaps in IIS data collection, limited interoperability with local and national health information systems, and inconsistent access to view or utilize IIS records due to existing policies, continue to limit the full potential of IIS. CONCLUSIONS: In the United States (US), IIS are implemented and managed at the state and local level, creating variability in IIS policies and implementation. Findings from this study serve as a comprehensive benchmark of current IIS laws that may aid policy stakeholders who are exploring amendments to jurisdictional IIS laws.

Use of routine health information systems data in developing and monitoring district and facility health plans: a scoping review.

BACKGROUND: Routine Health Information Systems data should be used in a systematic and institutionalised manner to support the making of plans, the monitoring of plans and in supportive supervision. To explore to what extent there is discussion about the linkage between planning, monitoring and supervision of sub-national programs using routine data we conducted a scoping review. The review question was: How are routine health information systems used in developing and monitoring health plans at district and facility level? METHODS: From a search of Ovid Medline (all), EMBASE and Web of Science along with a review of grey literature and involving a number of key stakeholders in identifying any missing resources a total of over 2200 documents were reviewed and data from 13 documents were extracted. RESULTS: Overall, there are many descriptions of how to implement and strengthen systems, ways to assess and improve data availability and quality, tools to improve the data use context, training in data use and mechanisms to involve stakeholders and strengthen infrastructure. However, there are gaps in examples of routine health data being used in the development, monitoring and supervision of plans at district and facility level. CONCLUSIONS: There appears to be no institutionalised obligation of planners to monitor plans, very little guidance on how to practically monitor programs and minimal discussion about how to use the routinely available data to supportively supervise the implementation of the plans. To overcome these shortcomings, we recommend that practical procedures to ensure linkage of existing district plans to regular monitoring of priority programs are institutionalised, that mechanisms for making managers institutionally accountable for monitoring and supervising these plans are put in place, and that practical guidelines for linking plans with routine health information system data and regular monitoring and supportive supervision are developed.

Exploring the feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Jordan.

BACKGROUND: Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and variable in quality across different humanitarian settings. To address this gap in data quality, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes in humanitarian settings, and assessed their feasibility in the field in Jordan, in addition to three other countries; with the goal of aggregating information from global consultations and field-level assessments to reach consensus on a set of core SRMNCAH indicators for services and outcome evaluation in humanitarian settings among WHO global partners. METHODS: The feasibility assessment in Jordan focused on the following constructs: relevance/usefulness, feasibility of measurement, systems and resources, and ethical issues. The multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, facility assessments, and observational sessions. RESULTS: Findings suggest that there is widespread support among regional, national, as well as global stakeholders for developing a core list of SRMNCAH indicators for monitoring and evaluation of services and outcomes in humanitarian settings in Jordan. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome. CONCLUSIONS: Despite stakeholder support in developing a core set of indicators, this would only be useful if it has the buy-in from the international community. Greater harmonization and coordination, alongside increased resource allocation, would improve data collection efforts and allow stakeholders to meet indicators' reporting requirements.

Perceived Impact of Digital Health Maturity on Patient Experience, Population Health, Health Care Costs, and Provider Experience: Mixed Methods Case Study.

BACKGROUND: Health care organizations understand the importance of new technology implementations; however, the best strategy for implementing successful digital transformations is often unclear. Digital health maturity assessments allow providers to understand the progress made toward technology-enhanced health service delivery. Existing models have been criticized for their lack of depth and breadth because of their technology focus and neglect of meaningful outcomes. OBJECTIVE: We aimed to examine the perceived impacts of digital health reported by health care staff employed in health care organizations across a spectrum of digital health maturity. METHODS: A mixed methods case study was conducted. The digital health maturity of public health care systems (n=16) in Queensland, Australia, was examined using the quantitative Digital Health Indicator (DHI) self-assessment survey. The lower and upper quartiles of DHI scores were calculated and used to stratify sites into 3 groups. Using qualitative methods, health care staff (n=154) participated in interviews and focus groups. Transcripts were analyzed assisted by automated text-mining software. Impacts were grouped according to the digital maturity of the health care worker's facility and mapped to the quadruple aims of health care: improved patient experience, improved population health, reduced health care cost, and enhanced provider experience. RESULTS: DHI scores ranged between 78 and 193 for the 16 health care systems. Health care systems in the high-maturity category (n=4, 25%) had a DHI score of ≥166.75 (the upper quartile); low-maturity sites (n=4, 25%) had a DHI score of ≤116.75 (the lower quartile); and intermediate-maturity sites (n=8, 50%) had a DHI score ranging from 116.75 to 166.75 (IQR). Overall, 18 perceived impacts were identified. Generally, a greater number of positive impacts were reported in health care systems of higher digital health maturity. For patient experiences, higher maturity was associated with maintaining a patient health record and tracking patient experience data, while telehealth enabled access and flexibility across all digital health maturity categories. For population health, patient journey tracking and clinical risk mitigation were reported as positive impacts at higher-maturity sites, and telehealth enabled health care access and efficiencies across all maturity categories. Limited interoperability and organizational factors (eg, strategy, policy, and vision) were universally negative impacts affecting health service delivery. For health care costs, the resource burden of ongoing investments in digital health and a sustainable skilled workforce was reported. For provider experiences, the negative impacts of poor usability and change fatigue were universal, while network and infrastructure issues were negative impacts at low-maturity sites. CONCLUSIONS: This is one of the first studies to show differences in the perceived impacts of digital maturity of health care systems at scale. Higher digital health maturity was associated with more positive reported impacts, most notably in achieving outcomes for the population health aim.

Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians: a national representative sample.

BACKGROUND: Physicians' work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations. METHODS: We used representative survey data on Finnish physicians' (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions. RESULTS: Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1-5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b = .23 [95% CI: .16-.30]), facilitates access to patient information (b = .15 [.07-.23]), and supports decision-making (b = .11 [.05-.18]). Disagreement with accelerated clinical encounters (b = .12 [.04-.20]), and agreements with patients' more active role in care (b = .11 [.04-.19]) and interprofessional collaboration (b = .10 [.02-.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06-1.48]) and agreeing with patients' active role (OR = 1.19 [1.02-1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure. CONCLUSIONS: Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians' satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.

Interoperability of heterogeneous health information systems: a systematic literature review.

BACKGROUND: The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources. Accordingly, there is an urgent need to develop integration mechanisms among the various health information systems. The aim of this review was to investigate the interoperability requirements for heterogeneous health information systems and to summarize and present them. METHODS: In accordance with the PRISMA guideline, a broad electronic search of all literature was conducted on the topic through six databases, including PubMed, Web of science, Scopus, MEDLINE, Cochrane Library and Embase to 25 July 2022. The inclusion criteria were to select English-written articles available in full text with the closest objectives. 36 articles were selected for further analysis. RESULTS: Interoperability has been raised in the field of health information systems from 2003 and now it is one of the topics of interest to researchers. The projects done in this field are mostly in the national scope and to achieve the electronic health record. HL7 FHIR, CDA, HIPAA and SNOMED-CT, SOA, RIM, XML, API, JAVA and SQL are among the most important requirements for implementing interoperability. In order to guarantee the concept of data exchange, semantic interaction is the best choice because the systems can recognize and process semantically similar information homogeneously. CONCLUSIONS: The health industry has become more complex and has new needs. Interoperability meets this needs by communicating between the output and input of processor systems and making easier to access the data in the required formats.

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium.

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.

[Digital transformation as a strategy to strengthen essential public health functions in the AmericasTransformação digital como estratégia de fortalecimento das funções essenciais de saúde pública nas Américas]. / La transformación digital como estrategia para el fortalecimiento de las funciones esenciales de salud pública en las Américas.

This article systematizes the main actions taken to address the essential public health functions (EPHF) in the context of the digital transformation of health systems. A narrative review was conducted, in which the conceptual framework of the renewed EPHF was linked to the eight guiding principles of the digital transformation of the health sector.In the selected publications, the main actions in digital transformation included electronic health records, telemedicine, digital health legislation, digital literacy, patient portals, open-source technologies, and data governance. These actions make it possible to increase the quality and efficiency of health systems, promote accessibility, and improve health outcomes.

Este artigo sistematiza as principais ações de transformação digital (TD) dos sistemas de saúde relacionadas às funções essenciais de saúde pública (FESP). Foi realizada uma revisão narrativa, inter-relacionando o marco conceitual das FESP renovadas com base nos os oito princípios orientadores da transformação digital do setor da saúde.Nas publicações selecionadas, constatou-se que as principais ações de TD incluem prontuários eletrônicos, telemedicina, legislação de saúde digital, letramento digital, portais para pacientes, tecnologias de código aberto e governança de dados. Essas ações permitem aumentar a qualidade e a eficiência dos sistemas de saúde, aprimorar a acessibilidade e melhorar os resultados de saúde.

[How to optimize Audit&Feedback: experience from the EASY-NET programme]. / Come rendere più efficace l'Audit&Feedback: riflessioni dal programma di rete EASY-NET.

This is the second of a series of papers dedicated to the EASY-NET research programme (NET-2016-02364191). The rationale, structure and methodologies are described in the previous contribution. Scientific literature demonstrated that Audit & Feedback (A&F) is an effective strategy for continuous quality improvement and its effectiveness varies considerably according to factors that are currently little known. Some recent publication pointed out, with the contribution of an international group of experts, 15 suggestions to optimize A&F and developed a tool to evaluate their application. This tool, called REFLECT-52, includes 52 items related to the 15 suggestions and organized into four categories relating to the "Nature of the desired action", to the "Nature of the data available for feedback", to the "Feedback Display" and to the "Intervention delivery". Then, the aim of this work was to evaluate the level of adherence of A&F interventions tested in EASY-NET to suggestions from the literature by using a slightly adapted version of the REFLECT-52 tool, in its original language. In EASY-NET, 14 A&F interventions with different characteristics and in different clinical and organizational contexts were tested in seven Italian regions, each of these was evaluated by the respective research groups. Overall, the level of adherence was high in three of the four categories analysed, with some difficulties reported regarding the nature of the data available for feedback. In fact, contrary to what the literature suggests, it was not possible to send repeated feedback for some interventions and, in some cases, the data available for feedback presented a delay longer than one year. In summary, this analysis has confirmed a high level of compliance of the interventions tested with the suggestions from the literature, but it has also allowed researchers to identify critical aspects that need to be addressed for the future development of these strategies.

Leveraging PEPFAR-Supported Health Information Systems for COVID-19 Pandemic Response.

Since 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has supported implementation and maintenance of health information systems for HIV/AIDS and related diseases, such as tuberculosis, in numerous countries. As the COVID-19 pandemic emerged, several countries conducted rapid assessments and enhanced existing PEPFAR-funded HIV and national health information systems to support COVID-19 surveillance data collection, analysis, visualization, and reporting needs. We describe efforts at the US Centers for Disease Control and Prevention (CDC) headquarters in Atlanta, Georgia, USA, and CDC country offices that enhanced existing health information systems in support COVID-19 pandemic response. We describe CDC activities in Haiti as an illustration of efforts in PEPFAR countries. We also describe how investments used to establish and maintain standards-based health information systems in resource-constrained settings can have positive effects on health systems beyond their original scope.

Hospitalizations and deaths related to adverse drug events worldwide: Systematic review of studies with national coverage.

PURPOSE: Adverse drug events are related to negative outcomes in healthcare, including hospitalization, increased duration of hospital stay and death. The aim of this study was to conduct a systematic review to evaluate hospitalizations and deaths related to adverse drug events worldwide, reported in studies with national coverage. METHODS: The protocol was registered in PROSPERO (CRD42020157008). We performed a systematic search on Medline, Embase, CINAHL, LILACS, and the Cochrane Library (until March 2020) using pre-specified terms. We included published studies that reported data on hospitalizations and/or deaths related to adverse drug events from a national perspective and the use of secondary data as a source of information. Two reviewers independently extracted and synthesized data. The quality of the studies was assessed using an adapted version of the Joanna Briggs Institute critical appraisal checklist for prevalence studies. Narrative summaries of findings were undertaken. RESULTS: Among 59,336 citations, 62 studies were included for data extraction and synthesis. Among these studies, 41 studies included the outcome of hospitalization, 16 included the death outcome, and five included both outcomes. Administrative databases regarding discharges and registries of vital statistics were the most common sources of information. The relative frequency of hospitalizations ranged from 0.03% to 7.3%, and from 9.7 to 383.0/100,000 population, whereas mortality rate ranged from 0.1 to 7.88/100,000 population. CONCLUSION: Our study highlights information about adverse drug events using large administrative databases in a national scenario and provides an overview of databases and methods implemented to detect adverse drug events.