Integrating Laboratory Testing Results at Point-of-Care in Hospital@Home Care Settings: A FHIR-Based Approach.

The care model Hospital@Home offers hospital-level treatment at home, aiming to alleviate hospital strain and enhance patient comfort. Despite its potential, integrating digital health solutions into this care model still remains limited. This paper proposes a concept for integrating laboratory testing at the Point of Care (POC) into Hospital@Home models to improve efficiency and interoperability. METHODS: Using the HL7 FHIR standard and cloud infrastructure, we developed a concept for direct transmission of laboratory data collected at POC. Requirements were derived from literature and discussions with a POC testing device producer. An architecture for data exchange was developed based on these requirements. RESULTS: Our concept enables access to laboratory data collected at POC, facilitating efficient data transfer and enhancing interoperability. A hypothetical scenario demonstrates the concept's feasibility and benefits, showcasing improved patient care and streamlined processes in Hospital@Home settings. CONCLUSIONS: Integration of POC data into Hospital@Home models using the HL7 FHIR standard and cloud infrastructure offers potential to enhance patient care and streamline processes. Addressing challenges such as data security and privacy is crucial for its successful implementation into practice.

Surveillance system integration: reporting the results of a global multicountry survey.

OBJECTIVES: Currently, there is no comprehensive picture of the global surveillance landscape. This survey examines the current state of surveillance systems, levels of integration, barriers and opportunities for the integration of surveillance systems at the country level, and the role of national public health institutes (NPHIs). STUDY DESIGN: This was a cross-sectional survey of NPHIs. METHODS: A web-based survey questionnaire was disseminated to 110 NPHIs in 95 countries between July and August 2022. Data were descriptively analysed, stratified by World Health Organization region, World Bank Income Group, and self-reported Integrated Disease Surveillance (IDS) maturity status. RESULTS: Sixty-five NPHIs responded. Systems exist to monitor notifiable diseases and vaccination coverage, but less so for private, pharmaceutical, and food safety sectors. While Ministries of Health usually lead surveillance, in many countries, NPHIs are also involved. Most countries report having partially developed IDS. Surveillance data are frequently inaccessible to the lead public health agency and seldomly integrated into a national public health surveillance system. Common challenges to establishing IDS include information technology system issues, financial constraints, data sharing and ownership limitations, workforce capacity gaps, and data availability. CONCLUSIONS: Public health surveillance systems across the globe, although built on similar principles, are at different levels of maturity but face similar developmental challenges. Leadership, ownership and governance, supporting legal mandates and regulations, as well as adherence to mandates, and enforcement of regulations are critical components of effective surveillance. In many countries, NPHIs play a significant role in integrated disease surveillance.

Achieving COVID-19 and Routine Immunization Data Systems Integration on the Electronic Management of Immunization Data System in Nigeria.

BACKGROUND: In 2021, Nigeria developed a novel Electronic Management of Immunization Data (EMID) system to address COVID-19 data management challenges and ensure the successful implementation of its COVID-19 vaccine deployment plan. The EMID system was envisioned to be interoperable with the DHIS2 national data management system and serve as a gateway into the integration of other primary health care (PHC) service data management. However, the EMID system faced challenges, including inability to filter reports, missing or loss of data, and difficulties with data synchronization, which curtailed its potential to meet the country's needs for COVID-19 data management and negatively impacted system scalability to enable integration with other PHC data systems. METHODS: Multilayered stakeholder interviews were conducted to determine the optimal functionality requirements for the EMID system. Based on these findings, an optimization plan was designed and implemented to address identified gaps and create a more stable and scalable system to enable further system integrations. Following optimization, a routine immunization module was developed and integrated with the EMID system as a first step to achieving an integrated data management system for PHC services in Nigeria. RESULTS: The integrated system currently provides an opportunity to address data fragmentation and strengthen PHC service delivery in Nigeria. By allowing 1 health care worker to deliver both vaccinations, there is also potential for reduction in cost and redundancies, informing redistribution of the health workforce and overall system strengthening. CONCLUSION: The journey from the initial challenges faced by the EMID system to the development of an integrated system for PHC services in Nigeria has been a transformative one. Through a thorough optimization process, training and capacity-building, stakeholder-driven improvements, and an elicitation exercise, the EMID system has evolved into a powerful tool for addressing data fragmentation and enhancing public health service delivery in the country.

Modeling the Application of IHE QRPH Profiles in Data Integration Centers: A Practical Approach with 3LGM2.

The Data Integration Centers (DICs), all part of the German Medical Informatics Initiative (MII), prepare routine care data captured in university hospitals to enable its reuse in clinical research. Tackling this challenging task requires them to maintain multiple data stores, implement the necessary transformation processes, and provide the required terminology services, all while also addressing the use case specific needs researchers might have. An MII wide application of the standardized profiles defined in the IHE QRPH domain might therefore be able to drastically reduce the overhead at any one DIC. The MII DIC reference model built in 3LGM2, a method to describe complex information system architectures, serves as a starting point to evaluate whether such an application is possible. We first extend the IHE modeling capabilities of 3LGM2 to also support the five profiles from the QRPH domain that our experts evaluated as relevant in the MII DIC context. We then expand the DIC reference model by some IHE QRPH actors and transactions, showing that their application could be beneficial in the MII DIC context, provided they surpass their trial status.

Reflections on the history of interoperability in hospitals.

OBJECTIVE: To discuss the origins of HL7 and its subsequent impact on interoperability in hospitals. PROCESS: Reconstruction of historical events from review of personal notes, interviews with key participants and review of relevant publications. CONCLUSIONS: The first versions of HL7 were based on the StatLAN protocol developed at the University of California, San Francisco and later commercialized by Simborg Systems Corporation. With the emergence of specialty clinical and departmental systems in the 1990s, a debate ensued between proponents of "open architecture" vs. "single vendor" systems. Although HL7 became the most widely used data-interchange protocol worldwide in healthcare, open architecture did not prevail in healthcare as it did in other industries. This is due to the unique market characteristics of the healthcare provider industry. The result today is the dominance of the healthcare IT marketplace by a small number of large vendors with relatively few options for in-depth specialty clinical systems.

Initial Experience of 10 Imaging Vendors with the IHE SHARAZONE: a New Multivendor Peer-to-Peer Test Service for DICOM Objects.

Alignment of DICOM (Digital Imaging and Communications in Medicine) capabilities among vendors is crucial to improve interoperability in the healthcare industry and advance medical imaging 2. However, a sustainable model for sharing DICOM samples is not available. To address this issue, Integrating the Healthcare Enterprise (IHE) has introduced the IHE SHARAZONE, a continuous cross-vendor DICOM data sharing test service. IHE is a highly regarded organization known for profiling standards such as DICOM, HL7 v2 (Health Level Seven, version 2), HL7 CDA (Clinical Document Architecture), and HL7 FHIR (Fast Healthcare Interoperability Resources) into practical solutions for clinical practice. The primary goal of the IHE SHARAZONE is to provide a reliable and consistent cross-vendor DICOM data sharing system. To evaluate its effectiveness, a 5-month pilot was conducted with ten imaging vendors. The pilot concluded with a participant survey, which yielded valuable insights into the initial experience with the IHE SHARAZONE. These findings can inform future improvements and developments to this important service.

Integrating Cross-Departmental Data.

Developing smart clinical decision support systems requires integrating data from several medical departments. This short paper outlines the challenges we faced in cross-departmental data integration for an oncological use case. Most severely, they have led to a significant reduction in case numbers. Only 2,77% of cases meeting the initial inclusion criteria of the use case were present in all accessed data sources.

Informe de gestión 2020 / Management Report 2020

El informe contiene el desarrollo de los siguientes puntos: 1. RESUMEN; 2. JUNTOS SOMOS MÁS FUERTES: RESPUESTA A LA PANDEMIA COVID-19; 3. INTEGRACIÓN REGIONAL EN SALUD: PROMOCIÓN DEL DERECHO A LA SALUD; 4. AGENDA SANITARIA: INICIATIVAS INTERNACIONALES MEDIANTE LA ARTICULACIÓN DE LAS AGENDAS DE ORGANISMOS INTERNACIONALES; FORTALECIMIENTO INSTITUCIONAL DE SALUD DE LOS PAÍSES MEDIANTE EL INTERCAMBIO DE EXPERIENCIAS Y ORIENTACIÓN DE POLÍTICAS NACIONALES; 6. PRIORIDADES ANDINAS: ESTRATEGIAS Y MECANISMOS DE ARTICULACIÓN CON ENFOQUE DE DERECHOS, PROMOCIÓN, PREVENCIÓN, DETERMINANTES SOCIALES E INTERCULTURALIDAD; 7. DERECHOS DE NIÑAS, NIÑOS Y ADOLESCENTES; 8. PROGRAMA "FORTALECIMIENTO DEL DIAGNÓSTICO DE LABORATORIO DE TUBERCULOSIS EN LAS AMÉRICAS" ; 9. COMUNICACIÓN E IMAGEN INSTITUCIONAL

Anaerobic-aerobic treatment of wastewater and leachate: A review of process integration, system design, performance and associated energy revenue.

Hybrid anaerobic-aerobic biological systems are an environmentally sustainable way of recovering bioenergy during the treatment of high-strength wastewaters and landfill leachate. This study provides a critical review of three major categories of anaerobic-aerobic processes such as conventional wetland, high-rate and integrated bioreactor systems applied for treatment of wastewaters and leachate. A comparative assessment of treatment mechanisms, critical operating parameters, bioreactor configurations, process control strategies, efficacies, and microbial dynamics of anaerobic-aerobic systems is provided. The review also explores the influence of wastewater composition on treatment performance, ammonium nitrogen removal efficacy, impact of mixing leachate, energy consumption, coupled bioenergy production and economic aspects of anaerobic-aerobic systems. Furthermore, the operational challenges, prospective modifications, and key future research directions are discussed. This review will provide in-depth understanding to develop sustainable engineering applications of anaerobic-aerobic processes for effective co-treatment of wastewaters and leachate.

Integrating System Dynamics Into Action Research: Drivers and Challenges in a Synergetic Complementarity Comment on "Insights Gained From a Re-analysis of Five Improvement Cases in Healthcare Integrating System Dynamics Into Action Research".

This commentary discusses the paper by Holmström et al that explored how system dynamics (SD) may contribute effectively to an action research (AR) process to improve five health case studies. Accordingly, we reviewed some of the methodological aspects of the proposed integration of SD into AR using ongoing debates on multi-methodology and mixed methods research. In a systemic evaluation of the proposed design, we concentrated on some of the common distinct features of SD and AR, and the challenges as well as the expected outcomes of this integration. Finally, we tried to position the suggested framework within the multi-methodology efforts and to pave the way for developing it in future research and practice.

Integrated approach for noncommunicable disease management in the Americas

[ABSTRACT]. An overview of an integrated approach to improve noncommunicable disease (NCD) management is pre- sented, along with tools on integrating NCD management as part of health system strengthening in the Americas. The study is based on an analysis of Pan American Health Organization/World Health Organization (PAHO/WHO) data and publicly available information on NCD care and capacity, disruptions in NCD services, and guidance on NCD management. Gaps in NCD care are highlighted, in which an estimated 43.0% of men and 28.0% of women with hypertension in Latin America remain undiagnosed; and for those with diabetes, 32.8% in Central and South America are undiagnosed. Yet, only 17/35 countries (49%) in the Americas report having evidence-based national guidelines for NCD management through a primary care approach and only 7/35 countries (20%) report provision of drug therapy, including glycaemic control for eligible persons. To improve NCD management, an integrated approach is needed to coordinate and deliver care across the levels of the health system. This includes increasing primary care capacity and competencies to address multiple chronic conditions, and integration with other complementary programs to avoid missing opportunities for NCD diagnosis and management. An integrated approach to NCD management, and implementation of avail- able tools, should be part of rebuilding health systems after the COVID-19 pandemic.

[RESUMEN]. En este artículo se presenta una visión general de un enfoque integrado para mejorar el manejo de las enfer- medades no transmisibles (ENT), así como herramientas para integrar el manejo de las ENT como parte del fortalecimiento de los sistemas de salud en la Región de las Américas. El estudio se basa en un análisis de datos de la Organización Panamericana de la Salud/Organización Mundial de la Salud (OPS/OMS) y en información disponible para el público sobre la atención de las ENT y la capacidad, las interrupciones en los servicios y la orientación sobre el manejo de las ENT. Se destacan las brechas en la atención de estas enfer- medades; se estima que 43,0% de los hombres y 28,0% de las mujeres con hipertensión en América Latina siguen sin recibir un diagnóstico, mientras que entre las personas con diabetes, 32,8% en América Central y del Sur no están diagnosticadas. Sin embargo, únicamente 17 de 35 países de la Región (49%) afirman disponer de pautas nacionales basadas en la evidencia para el manejo de las ENT mediante un enfoque de atención primaria, y solo 7 de 35 países (20%) refieren la provisión de farmacoterapia —por ejemplo, para el control glucémico— para las personas que reúnen los requisitos. Para mejorar el manejo de las ENT, es necesario un enfoque integrado para coordinar y brindar atención en todos los niveles del sistema de salud. Esto supone el aumento de la capacidad y las competencias de la atención primaria para abordar diversas enfermedades crónicas y su integración con otros programas complementarios y así no perder oportunidades de diagnosticar y gestionar las ENT. Un enfoque integrado para el manejo de las ENT y la aplicación de las herramientas disponibles deben formar parte de la reconstrucción de los sistemas de salud después de la pandemia de COVID-19.

[RESUMO]. O documento apresenta uma visão geral de uma abordagem integrada para melhorar o manejo de doenças não transmissíveis (DNT), bem com ferramentas para posicionar o manejo das DNT como parte integrante do fortalecimento dos sistemas de saúde nas Américas. O estudo tem como base uma análise dos dados da Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) e informações dis- poníveis publicamente sobre cuidados e capacidade de atendimento a DNT, interrupções nos serviços de DNT e orientações sobre o manejo de DNT. São destacadas as lacunas na atenção às DNT. Estima-se que 43,0% dos homens e 28,0% das mulheres com hipertensão na América Latina permanecem sem diagnóstico, e entre aqueles com diabetes, 32,8% na América Central e do Sul permanecem sem diagnóstico. Apenas 17 de 35 países (49%) nas Américas relatam ter diretrizes nacionais baseadas em evidências para o manejo de DNT na atenção primária e apenas 7 de 35 países (20%) relatam o fornecimento de terapia medicamentosa, incluindo medicamentos para o controle glicêmico para pessoas elegíveis. Para melhorar o manejo das DNT, é necessária uma abordagem integrada para coordenar e prestar cuidados em todos os níveis do sistema de saúde. Isso inclui o aumento da capacidade e da competência da atenção primária para atender pessoas com múltiplas doenças crônicas e a integração com outros programas complementares para evitar a perda de oportunidades para o diagnóstico e o manejo das DNT. Uma abordagem integrada ao manejo das DNT e a implementação das ferramentas disponíveis devem fazer parte da reconstrução dos sistemas de saúde após a pandemia de COVID-19.

Heterogeneous Autonomous Robotic System in Viticulture and Mariculture: Vehicles Development and Systems Integration.

There are activities in viticulture and mariculture that require extreme physical endurance from human workers, making them prime candidates for automation and robotization. This paper presents a novel, practical, heterogeneous, autonomous robotic system divided into two main parts, each dealing with respective scenarios in viticulture and mariculture. The robotic components and the subsystems that enable collaboration were developed as part of the ongoing HEKTOR project, and each specific scenario is presented. In viticulture, this includes vineyard surveillance, spraying and suckering with an all-terrain mobile manipulator (ATMM) and a lightweight autonomous aerial robot (LAAR) that can be used in very steep vineyards where other mechanization fails. In mariculture, scenarios include coordinated aerial and subsurface monitoring of fish net pens using the LAAR, an autonomous surface vehicle (ASV), and a remotely operated underwater vehicle (ROV). All robotic components communicate and coordinate their actions through the Robot Operating System (ROS). Field tests demonstrate the great capabilities of the HEKTOR system for the fully autonomous execution of very strenuous and hazardous work in viticulture and mariculture, while meeting the necessary conditions for the required quality and quantity of the work performed.

MEMORIA DEL ORGANISMO ANDINO DE SALUD CONVENIO HIPÓLITO UNANUE 1971­2021: ORAS-CONHU 2022 / 5 0 a ñ o s t r a b a ja n d o p o r la s a lu d, e l b ie n e s t a r y la in t e g r a c ió n a n d in a / ANNUAL REPORT OF THE ANDEAN HEALTH AGENCY HIPÓLITO UNANUE AGREEMENT 1971 ­ 2021 ORAS-CONHU; 2022

La presente publicación da cuenta de los principales hitos y logros obtenidos a través de las diferentes gestiones institucionales en los últimos cincuenta años. Estos sintetizan las apuestas y retos en la búsqueda de salud para todos, con sistemas nacionales de salud más accesibles y con el fortalecimiento de la ciudadanía en este terreno, coadyuvando a superar las brechas para alcanzar mayores niveles de equidad y bienestar para cada una de las personas. Ello permitirá enfrentar la actual pandemia con mayor eficacia, en estos tiempos, marcados por la emergencia, la experiencia y el compromiso de servicio, el ORAS-CONHU seguirá contribuyendo en responder los nuevos retos de los países andinos

New horizons in the stormy sea of multimodal single-cell data integration.

While measurements of RNA expression have dominated the world of single-cell analyses, new single-cell techniques increasingly allow collection of different data modalities, measuring different molecules, structural connections, and intermolecular interactions. Integrating the resulting multimodal single-cell datasets is a new bioinformatics challenge. Equally important, it is a new experimental design challenge for the bench scientist, who is not only choosing from a myriad of techniques for each data modality but also faces new challenges in experimental design. The ultimate goal is to design, execute, and analyze multimodal single-cell experiments that are more than just descriptive but enable the learning of new causal and mechanistic biology. This objective requires strict consideration of the goals behind the analysis, which might range from mapping the heterogeneity of a cellular population to assembling system-wide causal networks that can further our understanding of cellular functions and eventually lead to models of tissues and organs. We review steps and challenges toward this goal. Single-cell transcriptomics is now a mature technology, and methods to measure proteins, lipids, small-molecule metabolites, and other molecular phenotypes at the single-cell level are rapidly developing. Integrating these single-cell readouts so that each cell has measurements of multiple types of data, e.g., transcriptomes, proteomes, and metabolomes, is expected to allow identification of highly specific cellular subpopulations and to provide the basis for inferring causal biological mechanisms.

Integrated bioinformatics and network pharmacology to identify the therapeutic target and molecular mechanisms of Huangqin decoction on ulcerative Colitis.

Huangqin decoction (HQD) is a Traditional Chinese Medicine formula for ulcerative colitis. However, the pharmacology and molecular mechanism of HQD on ulcerative colitis is still unclear. Combined microarray analysis, network pharmacology, and molecular docking for revealing the therapeutic targets and molecular mechanism of HQD against ulcerative colitis. TCMSP, DrugBank, Swiss Target Prediction were utilized to search the active components and effective targets of HQD. Ulcerative colitis effective targets were obtained by microarray data from the GEO database (GSE107499). Co-targets between HQD and ulcerative colitis are obtained by Draw Venn Diagram. PPI (Protein-protein interaction) network was constructed by the STRING database. To obtain the core target, topological analysis is exploited by Cytoscape 3.7.2. GO and KEGG enrichment pathway analysis was performed to Metascape platform, and molecular docking through Autodock Vina 1.1.2 finished. 161 active components with 486 effective targets of HQD were screened. 1542 ulcerative colitis effective targets were obtained with |Log2FC|> 1 and adjusted P-value < 0.05. The Venn analysis was contained 79 co-targets. Enrichment analysis showed that HQD played a role in TNF signaling pathway, IL-17 signaling pathway, Th17 cell differentiation, etc. IL6, TNF, IL1B, PTGS2, ESR1, and PPARG with the highest degree from PPI network were successfully docked with 19 core components of HQD, respectively. According to ZINC15 database, quercetin (ZINC4175638), baicalein (ZINC3871633), and wogonin (ZINC899093) recognized as key compounds of HQD on ulcerative colitis. PTGS2, ESR1, and PPARG are potential therapeutic targets of HQD. HQD can act on multiple targets through multi-pathway, to carry out its therapeutic role in ulcerative colitis.