Norma Técnica de Salud para la Gestión de la Historia Clínica (R.M. Nº 214-2018/MINSA y su modificatoria aprobada con R.M. Nº 265-2018/MINSA) / Technical Health Standard for the Management of Clinical History (R.M. Nº 214-2018/MINSA and its amendment approved with R.M. Nº 265-2018/MINSA)

La publicación normativa establece los procedimientos técnicos y administrativos para el manejo, conservación y eliminación de las Historias Clínicas, en las Instituciones Prestadoras de Servicios de Salud, así como, para el manejo estandarizado del contenido básico a ser registrado; en correspondencia con el conjunto de prestaciones que se ofertan y reciben los usuarios de salud, en el marco del modelo de atención integral de salud basado en familia y comunidad. Es así, que corresponde administrar correctamente el proceso y procedimientos que siguen las historias clínicas desde su apertura, usos, custodia, y eliminación, entre otros aspectos; de conformidad con la normativa vigente y actual contexto

Fracture liaison service utilising an emergency department information system to identify patients effectively reduce re-fracture rate is cost-effective and cost saving in Western Australia.

OBJECTIVES: To assess the benefits of the Emergency Department Information System (EDIS)-linked fracture liaison service (FLS). METHODS: Patients identified through EDIS were invited to attend an FLS at the intervention hospital, the Sir Charles Gairdner Hospital (SCGS-FLS). The intervention group was compared to usual care. Retrospective control (RC) at this hospital determined historical fracture risk (SCGH-RC). Prospective control (PC) was from a comparator, Fremantle Hospital (FH-PC). The main outcome measures were cost-effectiveness from a health system perspective and quality of life by EuroQOL (EQ-5D). Bottom-up cost of medical care, against the cost of managing recurrent fracture (weighted basket), was determined from the literature and 2013/14 Australian Refined Diagnosis Related Groups (AR-DRG) prices. Mean incremental cost-effectiveness ratios were simulated from 5000 bootstrap iterations. Cost-effectiveness acceptability curves were generated. RESULTS: The SCGH-FLS program reduced absolute re-fracture rates versus control cohorts (9.2-10.2%), producing an estimated cost saving of AUD$750,168-AUD$810,400 per 1000 patient-years in the first year. Between-groups QALYs differed with worse outcomes in both control groups (p < 0.001). The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $8721 (95% CI -$1218, $35,044) and $8974 (95% CI -$26,701, $69,929), respectively, per 1% reduction in 12-month recurrent fracture risk. The SCGH-FLS compared with SCGH-RC and FH-PC had a mean incremental cost of $292 (95% CI -$3588, $3380) and -$261 (95% CI -$1521, $471) per EQ-5D QALY gained at 12 months respectively. With societal willingness to pay of $16,000, recurrent fracture is reduced by 1% in >80% of patients. CONCLUSIONS: This simple and easy model of identification and intervention demonstrated efficacy in reducing rates of recurrent fracture and was cost-effective and potentially cost saving.

Monitoring vaccine safety using the vaccine safety Datalink: Assessing capacity to integrate data from Immunization Information systems.

BACKGROUND: The Vaccine Safety Datalink (VSD) uses vaccination data from electronic health records (EHR) at eight integrated health systems to monitor vaccine safety. Accurate capture of data from vaccines administered outside of the health system is critical for vaccine safety research, especially for COVID-19 vaccines, where many are administered in non-traditional settings. However, timely access and inclusion of data from Immunization Information Systems (IIS) into VSD safety assessments is not well understood. METHODS: We surveyed the eight data-contributing VSD sites to assess: 1) status of sending data to IIS; 2) status of receiving data from IIS; and 3) integration of IIS data into the site EHR. Sites reported separately for COVID-19 vaccination to capture any differences in capacity to receive and integrate data on COVID-19 vaccines versus other vaccines. RESULTS: All VSD sites send data to and receive data from their state IIS. All eight sites (100%) routinely integrate IIS data for COVID-19 vaccines into VSD research studies. Six sites (75%) also routinely integrate all other vaccination data; two sites integrate data from IIS following a reconciliation process, which can result in delays to integration into VSD datasets. CONCLUSIONS: COVID-19 vaccines are being administered in a variety of non-traditional settings, where IIS are commonly used as centralized reporting systems. All eight VSD sites receive and integrate COVID-19 vaccine data from IIS, which positions the VSD well for conducting quality assessments of vaccine safety. Efforts to improve the timely receipt of all vaccination data will improve capacity to conduct vaccine safety assessments within the VSD.

Patient-Reported Outcomes Measurement Information System (PROMIS) in Left Ventricular Assist Devices.

BACKGROUND: Appropriate collection of quality of life measurements for left ventricular assist device (LVAD) patients is challenging. Patient-Reported Outcomes Measurement Information System (PROMIS) is a popular tool that has been validated across multiple disciplines, but its applicability to the LVAD population remains unknown. METHODS: This single-center, retrospective review included LVAD patients who completed a PROMIS assessment and Kansas City Cardiomyopathy Questionnaire (KCCQ-12) survey at clinical encounters postoperatively. Patients completed computer adaptive PROMIS assessments for physical function, pain interference, and depression. All PROMIS domains are designed to follow a normal distribution (mean T-score 50, SD 10) in the general population. Assessments were aggregated over time and correlation between the KCCQ-12 summary score and each PROMIS domain was assessed individually. RESULTS: A total of 178 LVAD patients were included in the study. The median time between LVAD implantation and PRO collection was 16.5 [interquartile range, 7.9-37.8] months. Patients typically had worse physical function (T-score 38.8 [33.6-44.2]) but comparable pain (51.1 [38.7-59.2]) and depression (49.9 [41.7-57.5]) as the general population. The KCCQ-12 was more strongly correlated to PROMIS physical function (Spearman's ρ = 0.746) than pain (ρ = -0.539) or depression (ρ = -0.591). CONCLUSIONS: PROMIS provides a robust quality of life data collection system that can be implemented in a clinical setting without imposing a significant burden. Using this more holistic system may allow for better patient-centered care in order to address quality of life limitations imposed by LVAD support that are not directly related to heart failure symptoms.

Using Item Response Theory to Identify Responders to Treatment: Examples with the Patient-Reported Outcomes Measurement Information System (PROMIS®) Physical Function Scale and Emotional Distress Composite.

The reliable change index has been used to evaluate the significance of individual change in health-related quality of life. We estimate reliable change for two measures (physical function and emotional distress) in the Patient-Reported Outcomes Measurement Information System (PROMIS®) 29-item health-related quality of life measure (PROMIS-29 v2.1). Using two waves of data collected 3 months apart in a longitudinal observational study of chronic low back pain and chronic neck pain patients receiving chiropractic care, and simulations, we compare estimates of reliable change from classical test theory fixed standard errors with item response theory standard errors from the graded response model. We find that unless true change in the PROMIS physical function and emotional distress scales is substantial, classical test theory estimates of significant individual change are much more optimistic than estimates of change based on item response theory.

Agent-Oriented Goal Models in Developing Information Systems Supporting Physical Activity Among Adolescents: Literature Review and Expert Interviews.

BACKGROUND: Information and communication technologies (ICTs) are becoming increasingly popular in supporting the fight against low physical activity (PA) levels among adolescents. However, several ICT solutions lack evidence-based content. Therefore, there is a need to identify important features that have the potential to efficiently and consistently support the PA of adolescents using ICT solutions. OBJECTIVE: This study aims to create evidence-based models of requirements for ICT solutions supporting PA by combining scientific evidence from literature and health experts. In addition, we test the suitability of agent-oriented goal models in this type of modeling process. METHODS: A literature search of PubMed, Web of Science, and Scopus databases was conducted to identify evidence-based functional, quality, and emotional goals that have previously been proven to be relevant in supporting PAs among youth using ICT solutions. The identified goals were presented in the form of goal models. These models were used to collaborate with health experts to receive their input on the topic and suggestions for improvement. The initial goal models were improved based on the feedback from the experts. RESULTS: The results indicated that agent-oriented goal modeling is a suitable method for merging information from the literature and experts. One strength of agent-oriented goal models is that they present emotional requirements together with quality and functional requirements. Another strength is the possibility of presenting results from a literature review in a systematic manner and using them thereafter in the communication process with stakeholders. Agent-oriented goal models that were created were easy to understand for health experts without previous experience in requirements engineering, which facilitates and supports collaboration with nontechnical stakeholders. CONCLUSIONS: The proposed agent-oriented goal models effectively merged information from scientific literature and experts in the field and presented early functional, quality, and emotional requirements in a holistic and coherent manner. We believe that the created models have high potential to help requirements engineers and developers to provide more efficient ICT solutions that support PA among adolescents in the future.

One country's journey to interoperability: Tanzania's experience developing and implementing a national health information exchange.

BACKGROUND: Robust, flexible, and integrated health information (HIS) systems are essential to achieving national and international goals in health and development. Such systems are still uncommon in most low and middle income countries. This article describes a first-phase activity in Tanzania to integrate the country's vertical health management information system with the help of an interoperability layer that enables cross-program data exchange. METHODS: From 2014 to 2019, the Tanzanian government and partners implemented a five-step procedure based on the "Mind the GAPS" (governance, architecture, program management, and standards) framework and using both proprietary and open-source tools. In collaboration with multiple stakeholders, the team developed the system to address major data challenges via four fully documented "use case scenarios" addressing data exchange among hospitals, between services and the supply chain, across digital data systems, and within the supply chain reporting system. This work included developing the architecture for health system data exchange, putting a middleware interoperability layer in place to facilitate the exchange, and training to support use of the system and the data it generates. RESULTS: Tanzania successfully completed the five-step procedure for all four use cases. Data exchange is currently enabled among 15 separate information systems, and has resulted in improved data availability and significant time savings. The government has adopted the health information exchange within the national strategy for health care information, and the system is being operated and managed by Tanzanian officials. CONCLUSION: Developing an integrated HIS requires a significant time investment; but ultimately benefit both programs and patients. Tanzania's experience may interest countries that are developing their HIS programs.

Translation and psychometric validation of the traditional Chinese version of patient-reported outcomes measurement information system Pediatric-25 Profile version 2.0 (PROMIS-25) in Chinese Children with Cancer in Hong Kong.

PURPOSE: To translate and cross-cultural validate the PROMIS Pediatric-25 Profile 2.0 (PROMIS-25) into traditional Chinese, and to investigate its psychometric properties in children with cancer in Hong Kong. METHODS: The Functional Assessment of Chronic Illness Therapy translation methodology was adopted in this study. Three panel members evaluated the semantic equivalence and content validity. The psychometric properties were tested with 103 children with cancer (10-18 years). Internal consistency and structural validity were examined by Cronbach's alpha and Rasch analysis. Convergent and divergent validity were assessed by correlating it with traditional Chinese pediatric quality of life inventory™ 4.0 domains (traditional Chinese PedsQL™ 4.0), traditional Chinese Health Questionnaire-9 (C-PHQ-9), and the numeric pain rating scale (NPRS). RESULTS: The semantic equivalence score and content validity index were both 100%. All domains indicated good internal consistency (α = 0.83-0.88) and unidimensionality (variance explained > 55.5% and 1st contrast eigenvalues < 2.0). All items showed good item fit (0.6-1.4). For convergent validity, the traditional Chinese PROMIS-25 domains demonstrated moderate-to-large correlations with traditional Chinese PedsQL™ 4.0 domains (r ≥ ± 0.69), C-PHQ-9 Item-4 and total score (r = 0.75-0.80), except NPRS (r = 0.44). For divergent validity, traditional Chinese PROMIS-25 had low correlations with traditional Chinese PedsQL™ 4.0 domains (r < ± 0.21), C-PHQ-9 item-4 (r = 0.3), and NPRS (r = - 0.12). The traditional Chinese PROMIS-25 fatigue domain was weakly correlated with NPRS (r = 0.39). CONCLUSION: The traditional Chinese PROMIS-25 is semantically and conceptually like the original PROMIS-25 with satisfactory internal consistency, structural validity, and construct validity.

The role and utility of population-based cancer registries in cervical cancer surveillance and control.

Population-based cancer registries (PBCR) are vital to the assessment of the cancer burden and in monitoring and evaluating national progress in cervical cancer surveillance and control. Yet the level of their development in countries exhibiting the highest cervical cancer incidence rates is suboptimal, and requires considerable investment if they are to document the impact of WHO global initiative to eliminate cervical cancer as a public health problem. As a starting point we propose a comprehensive cancer surveillance framework, positioning PBCR in relation to other health information systems that are required across the cancer control continuum. The key concepts of PBCR are revisited and their role in providing a situation analysis of the scale and profile of the cancer-specific incidence and survival, and their evolution over time is illustrated with specific examples. Linking cervical cancer data to screening and immunization information systems enables the development of a comprehensive set of measures capable of assessing the short- and long-term achievements and impact of the initiative. Such data form the basis of national and global estimates of the cancer burden and permit comparisons across countries, facilitating decision-making or triggering cancer control action. The initiation and sustainable development of PBCR must be an early step in the scale-up of cervical cancer control activities as a means to ensure progress is successfully monitored and appraised.

[Current Status and Development of Drug Information Infrastructure System for the Public in Japan and Overseas].

With the progress of medical treatment, information on drugs, etc. is overflowing on the media and the Internet, and some of them are leading to uncertain information for the purpose of profit, and some of them are wrong information or inaccurate information, and the effect on the patient is regarded as a problem. In Japan, information on public pharmaceuticals for patients and consumers is provided on the Internet, but its utilization is not sufficient. In the Pharmaceuticals and Medical Devices Act, it is stated that "Citizens shall endeavor to use pharmaceuticals, etc., properly and deepen their knowledge and understanding of their efficacy and safety". On the other hand, there is a variety of information available on the Internet, and simply searching does not necessarily lead to reliable information. It is necessary to provide information with a mechanism to ensure that the information is reliable so that it can lead to appropriate medical care. Overseas, medical information infrastructure systems, including highly reliable public pharmaceuticals based on evidence, have been developed. Examples include National Health Service (NHS) in the United Kingdom, MedlinePlus in the United States, and National Prescribing Service (NPS) MedicineWise in Australia. In the era of digital health, it is necessary to discuss issues and prospects for the construction and dissemination of information provision infrastructure that meets the needs of patients and consumers from the perspective of industry, government, academia, and patients.

Preservação sistêmica para repositórios arquivísticos / Systemic preservation for archival repositories / Preservación sistémica para repositorios de archivo

Este estudo realiza uma reflexão sobre a preservação de documentos arquivísticos digitais em uma perspectiva sistêmica, pautada em padrões reconhecidos pela literatura científica. De tal forma, utiliza-se da visão holística para ressaltar a pertinência da preservação ser pensada em todo o ciclo de vida dos documentos. A metodologia parte do levantamento bibliográfico composto por artigos, livros e publicações técnicas, para assim, obter uma revisão narrativa. Ressalta-se que a preservação digital tem evoluído para novos patamares e requer o uso de padrões para implementar sistemas informatizados confiáveis. Com isso, pode-se envolver todo o ciclo vital em uma cadeia de custódia ininterrupta capaz de assegurar a autenticidade dos documentos digitais. Por fim, defende-se uma abordagem sistêmico-holística, em que os documentos são planejados e produzidos tendo em vista a preservação e o acesso em longo prazo.

This study reflects on the preservation of digital archival records from a systemic perspective, based on standards recognized by scientific literature. In such a way, it uses a holistic view to emphasize the relevance of preservation to be considered throughout the life cycle of records. The methodology is based on a bibliographic survey composed of articles, books, and technical publications, to obtain a narrative review. It is noteworthy that digital preservation has evolved to new heights, and requires the use of standards to implement reliable computer systems. With this, the entire life cycle can be involved in an uninterrupted chain of custody capable of ensuring the authenticity of digital records. Finally, a systemic-holistic approach is advocated, in which records are planned and produced with a view of the preservation and access in the long-term.

Este estudio reflexiona sobre la preservación de los documentos de archivo digital en una perspectiva sistémica, basada en normas y estándares reconocidos por la literatura científica. De esta manera, utiliza la visión holística para enfatizar la relevancia de la preservación a ser considerada a lo largo del ciclo de vida de los documentos. La metodología se basa en una encuesta bibliográfica compuesta de artículos, libros y publicaciones técnicas, para obtener una revisión narrativa. Es de destacar que la preservación digital ha evolucionado a nuevas alturas y requiere el uso de estándares para implementar sistemas informáticos confiables. Con esto, todo el ciclo de vida puede involucrarse en una cadena de custodia ininterrumpida capaz de garantizar la autenticidad de los documentos digitales. Finalmente, se aboga por un enfoque holístico-sistémico, en que los documentos se planifican y producen con miras la preservación y acceso a largo plazo.

Demands for multidimensional information on the work environment: A methodological framework for regular studies.

BACKGROUND: Development of methodologies for making economic decisions on designing work environment studies is a theoretical challenge for researchers in occupational health sciences. There are well-defined tools available in the relevant literature for analysis of cost-efficiency associated with the assessment of an occupational exposure of interest. However, these analytical tools are not appropriate for holistic studies of the work environment as a multidimensional reality. OBJECTIVE: This article introduces an appropriate methodology for designing cross-sectional comprehensive studies of the work environment, in order to optimize the production of information on the psychosocial, ergonomic, and physical dimensions of the work environment in regular studies. METHODS: The employment of a translog cost-utility function is suggested as a suitable way to provide cost-minimized designs for regular studies which are aimed at providing or developing multidimensional information systems of the work environment. RESULTS: The translog cost-utility function is not subject to predetermined restrictions, but has a flexibility property allowing it to be transformed to any specification that is adaptable to the specific work environmental characteristics and research requirements. CONCLUSION: The translog cost-utility function is an appropriate econometric model for optimizing the production of multidimensional information on occupational exposures in regular cross-sectional workplace studies.

Integrating nutrition into health systems: What the evidence advocates.

There is considerable evidence of positive health and nutrition outcomes resulting from integrating nutrition-specific interventions into health systems; however, current knowledge on establishing and sustaining effective integration of nutrition into health systems is limited. The objective of this review is to map the existing types of integration platforms and review the evidence on integrated health and nutrition programmes' impacts on specific nutrition outcomes. A literature search was conducted, and integrated nutrition programmes were examined through the lens of the six World Health Organization (WHO) building blocks, including the demand side. Forty-five studies were included in this review, outlining the integration of nutrition-specific interventions with various programmes, including integrated community case management and Integrated Management of Childhood Illness, Child Health Days, immunization, early child development, and cash transfers. Limited quantitative data were suggestive of some positive impact on nutrition and non-nutrition outcomes with no adverse effects on primary programme delivery. Through the lens of the six WHO building blocks, service delivery and health workforce were found to be well-integrated, but governance, information systems, finance and supplies and technology were less well-integrated. Integrating nutrition-specific interventions into health systems may ensure efficient service delivery while having an impact on nutrition outcomes. There is no single successful model of integration; it varies according to the context and demands of the particular setting in which integration occurs. There is a need for more well-planned programmes considering all the health systems building blocks to ensure compliance and sustainability.

A Health System-Wide Initiative to Decrease Opioid-Related Morbidity and Mortality.

BACKGROUND: The opioid overdose crisis now claims more than 40,000 lives in the United States every year, and many hospitals and health systems are responding with opioid-related initiatives, but how best to coordinate hospital or health system-wide strategy and approach remains a challenge. METHODS: An organizational opioid stewardship program (OSP) was created to reduce opioid-related morbidity and mortality in order to provide an efficient, comprehensive, multidisciplinary approach to address the epidemic in one health system. An executive committee of hospital leaders was convened to empower and launch the program. To measure progress, metrics related to care of patients on opioids and those with opioid use disorder (OUD) were evaluated. RESULTS: The OSP created a holistic, health system-wide program that addressed opioid prescribing, treatment of OUD, education, and information technology tools. After implementation, the number of opioid prescriptions decreased (-73.5/month; p < 0.001), mean morphine milligram equivalents (MME) per prescription decreased (-0.4/month; p < 0.001), the number of unique patients receiving an opioid decreased (-52.6/month; p < 0.001), and the number of prescriptions ≥ 90 MME decreased (-48.1/month; p < 0.001). Prescriptions and providers for buprenorphine increased (+6.0 prescriptions/month and +0.4 providers/month; both p < 0.001). Visits for opioid overdose did not change (-0.2 overdoses/month; p = 0.29). CONCLUSION: This paper describes a framework for a new health system-wide OSP. Successful implementation required strong executive sponsorship, ensuring that the program is not housed in any one clinical department in the health system, creating an environment that empowers cross-disciplinary collaboration and inclusion, as well as the development of measures to guide efforts.

Aportes del enfoque familiar y comunitario en los programas de atención en salud en Uruguay / Family and community focus contributions in health care programs in Uruguay / Família e comunidade concentram contribuições em programas de saúde no Uruguai

ntroducción: En todas las etapas de la vida, las familias y su participación activa son fundamentales para promover saludablemente su crecimiento y desarrollo. En Uruguay, el Sistema Nacional Integrado de Salud (SNIS), desde el nuevo modelo de atención, toma los ejes prioritarios de la Renovación de la APS lo cual surge un interés de trabajar en todos sus componentes. En la actualidad a través de las áreas programáticas del Ministerio de Salud (MS), los lineamientos prioritarios de los programas de Atención (Salud de la Niñez, Adolescencia, Juventud, Adulto y Adulto Mayor, entre otros) en cada una de ellas integran diferentes aspectos en cuanto al enfoque familiar. Sin embargo, desde las políticas de salud en nuestro país no hay un programa específico de Salud Fa-miliar o Atención Familiar. Como unidad de atención, la familia adquiere importancia dado que se encuentra en ella gran parte de los determinantes cotidianos del proceso salud-enfermedad.Objetivos: Evaluar la aplicación del componente familiar y comunitario en los programas de aten-ción del Sistema Nacional Integrado de Salud en Uruguay.Material y métodos: tipo evaluativo, cualitativo, con análisis de contenidos.Resultados: Enfatiza el Enfoque Familiar desde la integración del componente orientación fami-liar y comunitaria de la APS renovada y desde la presencia del enfoque familiar en el propósito, metas y objetivos de los programas.Conclusiones: La integración del Enfoque Familiar en los programas de atención a la salud to-mando como eje los lineamientos de la renovación de la APS, aporta una mirada necesaria en la profundización de sus contenidos y revisando a su vez los avances logrados.

Introduction: In all stages of life, families and their active participation are essential to healthily promote growth and development. In Uruguay, the National Integrated Health System (SNIS), based on the new care model, using as an axis the central concepts from the renewed APS, which gives rise to an interest to work in all its components. Currently, through the programmatic areas of the Ministry of Health (MS), the priority guidelines of the Assistance programs (Childhood, Adolescence and Youth, Adult and Older Adult Health, among others) each one of them integrate diff erent aspects regarding the Family Focus. However, from the health policies in our country there is no specifi c program for Family Health or Family Care. As an assistance unit, the family ac-quires importance given that it contains a large part of the daily determinants of the health-illness process.Objectives: To evaluate the application of the family and community component in the care pro-grams of the National Integrated Health System in Uruguay.Material and methods: evaluative, qualitative, with content analysis.Results: Emphasizes the Family Focus from the integration of the family and community orien-tation component of the Renewed APS and from the presence of the Family Focus in the purpose, goals and objectives of the Programs.Conclusions:  e integration of the Family Focus in health care programs, using as an axis the guidelines from the renewed APS, provides a necessary deeper look into its contents and in turn examines the progress made.

Introdução: Em todas as etapas da vida, as famílias e sua participação ativa são essenciais para pro-mover o crescimento e o desenvolvimento saudáveis. Em Uruguai, o Sistema Nacional Integrado de Saúde (SNIS), é baseado no novo modelo assistencial, e utiliza como eixo os conceitos centrais da APS renovada, portanto, é de relevância trabalhar em todos os seus componentes. Atualmente, por meio das áreas programáticas do Ministério da Saúde (MS), diferentes aspectos referentes ao enfoque na/- Família/Familiar são abordados em cada uma das diretrizes prioritárias dos programas de Assistência (Infância, Adolescência e Juventude, Saúde de Adultos e Idosos, entre outros). No entanto, nas políticas de saúde em nosso país não existe um programa específico para Saúde da Família ou Assistência à Família. Como unidade assistencial, a família adquire importância, pois engloba grande parte dos determinantes diários do processo saúde doença.Objetivos: Avaliar a aplicação do componente familiar e comunitário nos programas de atenção do Sistema Nacional Integrado de Saúde em Uruguai. Material e métodos: tipo avaliativo, qualitativo, e com análise dos conteúdos. Resultados: Destaca-se o enfoque na Família a partir da integração do componente de orientação familiar e comunitária da APS Renovada e da presença do enfoque na Família no propósito, metas e objetivos dos Programas. Conclusões: A integração do enfoque na Família nos programas de atenção à saúde, utilizando como eixo as diretrizes da APS renovada, fornece uma visão necessária de aprofundamento de seu conteúdo e, também, examina o progresso alcançado.

A targeted strategy for analyzing untargeted mass spectral data to identify lanostane-type triterpene acids in Poria cocos by integrating a scientific information system and liquid chromatography-tandem mass spectrometry combined with ion mobility spectrometry.

Rapid structural identification of natural compounds in the crude extract of traditional Chinese medicine by conventional liquid chromatography-mass spectrometry is complex and challenging. In particular, it is difficult to distinguish and identify structural isomers. In this work, we proposed a novel strategy that combines a typical ultrahigh-performance liquid chromatography-multidimensional mass spectrometry approach and the post-processing UNIFI scientific information system to rapidly identify lanostane analogs and isomers in Poria cocos. First, this strategy requires setting up a high-resolution key MS database and an in-house compound library. Then, ultrahigh-performance liquid chromatography coupled with high-resolution tandem data-independent mass spectrometry and ion mobility mass spectrometry was used to acquire untargeted multidimensional mass spectral data. Finally, a new and reliable multidimensional MS analytical workflow was developed to targeted filter the acquired data based on an in-house compound library via the UNIFI™ software. As result, a total of 121 lanostane-type triterpene acids were identified by high-resolution molecular mass, fragment ions, and collision cross-section values. Eight triterpene acids were unambiguously identified by comparing the retention time and MS/MS data with those of reference compounds. Three compounds were detected and reported for the first time based on their neutral losses, characteristic ions, and fragmentation pathways compared with those of known compounds. We anticipate that such an analytical approach can be extended to rapidly screen and characterize other herbal medicine compounds with multiple isomers.

Human Based Digital Intelligence Analyses for Health Care Ecosystems.

The maturity level of the digital transformation in health care ecosystems is heavily depending on human factors. Primarily the digital intelligence of the human beings - e.g. medical or nursing staff - should be taken seriously in the transformation processes. To derive sustainable strategies in a holistic manner an innovative, multi-dimensionaland human centred socio-economic capability model had to be developed and applied. By the use of our model health care ecosystems can be analysed, scored and benchmarked successfully. Furthermore, each ecosystems' digital intelligence based on their employees can be derived holistically from our four scoring scopes.

Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies.

BACKGROUND: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. RESULTS: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. CONCLUSIONS: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.

Toward a normalized clinical drug knowledge base in China-applying the RxNorm model to Chinese clinical drugs.

Objective: In recent years, electronic health record systems have been widely implemented in China, making clinical data available electronically. However, little effort has been devoted to making drug information exchangeable among these systems. This study aimed to build a Normalized Chinese Clinical Drug (NCCD) knowledge base, by applying and extending the information model of RxNorm to Chinese clinical drugs. Methods: Chinese drugs were collected from 4 major resources-China Food and Drug Administration, China Health Insurance Systems, Hospital Pharmacy Systems, and China Pharmacopoeia-for integration and normalization in NCCD. Chemical drugs were normalized using the information model in RxNorm without much change. Chinese patent drugs (i.e., Chinese herbal extracts), however, were represented using an expanded RxNorm model to incorporate the unique characteristics of these drugs. A hybrid approach combining automated natural language processing technologies and manual review by domain experts was then applied to drug attribute extraction, normalization, and further generation of drug names at different specification levels. Lastly, we reported the statistics of NCCD, as well as the evaluation results using several sets of randomly selected Chinese drugs. Results: The current version of NCCD contains 16 976 chemical drugs and 2663 Chinese patent medicines, resulting in 19 639 clinical drugs, 250 267 unique concepts, and 2 602 760 relations. By manual review of 1700 chemical drugs and 250 Chinese patent drugs randomly selected from NCCD (about 10%), we showed that the hybrid approach could achieve an accuracy of 98.60% for drug name extraction and normalization. Using a collection of 500 chemical drugs and 500 Chinese patent drugs from other resources, we showed that NCCD achieved coverages of 97.0% and 90.0% for chemical drugs and Chinese patent drugs, respectively. Conclusion: Evaluation results demonstrated the potential to improve interoperability across various electronic drug systems in China.