Módulo Programas Médicos para el Sistema de Información Hospitalaria XAVIA HIS / Module Medical Programs for the XAVIA HIS Hospital Information System

La prestación personalizada de los servicios de salud resulta cada vez más atractiva y eficiente. El empleo de las herramientas informáticas para facilitar este propósito es una necesidad de las instituciones de salud. El Sistema de Información Hospitalaria XAVIA HIS es un ejemplo de la relación entre las necesidades de las instituciones de salud y la evolución funcional del mismo. Sin embargo, en el sistema no se ha concebido la posibilidad de planificar un protocolo que especifique los cuidados y procedimientos que deben realizarse en función del estado de salud del paciente. El trabajo presenta el desarrollo del módulo Programas Médicos para el sistema XAVIA HIS, que permite mejorar la gestión de la información generada durante el procesamiento de los programas médicos en las instituciones hospitalarias. Se realizó el análisis de los procesos de negocio asociados a la gestión de los programas médicos, se empleó como metodología de desarrollo AUP-UCI, JBoss Developer Studio, Java, JBoss como servidor de aplicaciones, PostgreSQL como sistema gestor de bases de datos y Visual Paradigm como herramienta CASE. Como resultado se obtuvo el módulo Programas médicos para el sistema XAVIA HIS, que permite la configuración de un programa médico a un paciente con una determinada enfermedad agrupando varios servicios, procedimientos, investigaciones clínicas por cada área del hospital(AU).

The health services personalized provision is becoming increasingly attractive and efficient. The computer tools used to facilitate this purpose is a necessity for health institutions. The Hospital Information System XAVIA HIS is an example of the relationship between the health institutions needs and its functional evolution. However, the system has not conceived the possibility of planning a protocol that specifies the care and procedures that must be performed depending on patient health condition. The paper presents the development of the Medical Programs module for the XAVIA HIS system, which allows to improve the management of information generated during the medical programs processing in hospital institutions. For this work development, an analysis of the business processes associated with the medical programs management was carried out; AUP-UCI was used as development methodology, JBoss Developer Studio, Java, JBoss as an application server, PostgreSQL as database management system and Visual Paradigm as a CASE tool. As a result, the Medical Programs module for the XAVIA HIS system was obtained, which allows the medical program configuration for a patient who has a certain disease, grouping several services, procedures, clinical investigations for each hospital area(AU)

The medical archive work process: new perspectives concerning health care. / O processo de trabalho no arquivo médico: novas perspectivas na produção do ato de cuidar em saúde.

Generally, medical archive studies are restricted to the analysis of documents. Its activities achieve little expressiveness beyond the theories of scientific management, hampering the perception that care production may occur during these activities. This study aims to analyze hospital medical archive sector professionals' work process from the dynamics of micro-policy articulated with institutional analysis. As a descriptive qualitative research theoretically based on micro-policy of the health work process and Institutional Analysis, this study identifies with analyzers daily issues of the medical archive that can disclose strategies developed by health workers and disputes that occur on a daily basis. Therefore, it was possible to recognize in two hospitals that these workers held important knowledge about the dynamics of the health work process. As facilitators of user care process, they establish their own strategies in the dynamics of care that reflect directly on the care dimension of these hospitals. In this perspective, the introduction of new investigations about this work process allows us to diversify the debate about health care and broaden the scope of research referred to public health.

O processo de trabalho no arquivo médico: novas perspectivas na produção do ato de cuidar em saúde / The medical archive work process: new perspectives concerning health care

Resumo Geralmente, estudos referidos ao arquivo médico se restringem à análise documental. Suas atividades alcançam pouca expressividade para além das teorias da administração científica, dificultando a percepção de que nestas possa ocorrer a produção do cuidado. O presente estudo propõe analisar o processo de trabalho dos trabalhadores do arquivo médico hospitalar a partir da dinâmica da micropolítica articulada à análise institucional. Enquanto pesquisa qualitativa descritiva, com referenciais da micropolítica do processo de trabalho em saúde e da Análise Institucional, o estudo identifica com analisadores questões do cotidiano do arquivo médico capazes de revelar estratégias elaboradas por seus trabalhadores e disputas que ocorrem no dia a dia. Assim, foi possível reconhecer em dois hospitais que estes trabalhadores detinham saberes importantes sobre a dinâmica do processo de trabalho em saúde. Como dinamizadores do processo de cuidado do usuário, estabelecem estratégias próprias na dinâmica de cuidar que incidem diretamente na dimensão cuidadora desses hospitais. Nesta perspectiva, introduzir novas investigações sobre este processo de trabalho possibilita diversificar o debate acerca do cuidado em saúde e ampliar o escopo de pesquisa referidas à saúde coletiva.

Abstract Generally, medical archive studies are restricted to the analysis of documents. Its activities achieve little expressiveness beyond the theories of scientific management, hampering the perception that care production may occur during these activities. This study aims to analyze hospital medical archive sector professionals' work process from the dynamics of micro-policy articulated with institutional analysis. As a descriptive qualitative research theoretically based on micro-policy of the health work process and Institutional Analysis, this study identifies with analyzers daily issues of the medical archive that can disclose strategies developed by health workers and disputes that occur on a daily basis. Therefore, it was possible to recognize in two hospitals that these workers held important knowledge about the dynamics of the health work process. As facilitators of user care process, they establish their own strategies in the dynamics of care that reflect directly on the care dimension of these hospitals. In this perspective, the introduction of new investigations about this work process allows us to diversify the debate about health care and broaden the scope of research referred to public health.

Business performance management in university hospitals: a diagnosis in Brazilian institutions / Evaluación del desempeño empresarial en hospitales universitarios: un diagnóstico en las instituciones brasileñas

ABSTRACT Objectives To investigate whether business performance management practices are used by Brazilian federal university hospitals, and if so, to determine which practices are used and explore characteristics that may be related to their adoption. Method Descriptive ex post facto research on the effects of the studied variables in relation to the technical procedures. Secondary data and survey resources were used. Results Four hospitals use practices to assess business performance. Three of them stated that they use two different types of practices and that 75 % of university hospitals with at least one business performance management practice also have a strategic plan that includes vision, mission, objectives and long-term operational plans. Among the hospitals that do not use business performance management practices, 55.6 % claim to have strategic planning composed at least of mission, vision and long-term objectives. However, they stated that the entity has no plans to adopt any method. Conclusions This diagnosis intends to draw the attention of managers and other actors in the field of public health on the possibilities offered by performance evaluation systems to promote administrative improvements in a complex internal scenario with a need for rationalization of hospital costs in order to direct these institutions towards achieving their social mission.(AU)

RESUMEN Objetivo Investigar si la evaluación del desempeño empresarial es una práctica utilizada por los hospitales federales brasileños, y en caso que haya instituciones que utilicen esta herramienta, verificar cuales prácticas son utilizadas e investigar las posibles características que permiten adoptar las mismas. Método El estudio utilizó la investigación descriptiva, siendo ex post facto en cuanto a los efectos en las variables estudiadas, y con relación a los procedimientos técnicos, se utilizaron datos secundarios y recursos de encuesta. Resultados Los resultados muestran que cuatro hospitales utilizan prácticas sobre la evaluación del desempeño empresarial; tres de ellos declararon que utilizan dos tipos de prácticas diferentes y que el 75 % de los hospitales universitarios que tienen al menos una práctica de evaluación del desempeño empresarial, también tienen un plan estratégico con visión, misión e objetivos y planes operativos a largo plazo. Entre los hospitales que no tienen prácticas sobre la evaluación del desempeño empresarial, el 55,6 % afirman tener una planificación estratégica compuesta al menos de misión, visión y objetivos a largo plazo. Sin embargo, declararon que la entidad no tiene planes de adoptar ningún método elencado. Conclusiones Este diagnóstico pretende llamar la atención a la gerencia y a los funcionarios del campo de la salud pública, sobre las posibilidades que ofrecen los sistemas de evaluación del desempeño de las entidades, para promover mejoras administrativas en un escenario interno complejo, así como la continua necesidad de racionalización de los costos hospitalarios, de forma tal que conduzca estas instituciones a alcanzar su misión social.(AU)

Analysis of Hospital Processes with Process Mining Techniques.

Process mining allows for discovery, monitoring, and improving processes identified in information systems from their event logs. In hospital environments, process analysis has been a crucial factor for cost reduction, control and proper use of resources, better patient care, and achieving service excellence. This paper presents a new component for event logs generation in the Hospital Information System or HIS, developed at University of Informatics Sciences. The event logs obtained are used for analysis of hospital processes with process mining techniques. The proposed solution intends to achieve the generation of event logs in the system with high quality. The performed analyses allowed for redefining functions in the system and proposed proper flow of information. The study exposed the need to incorporate process mining techniques in hospital systems to analyze the processes execution. Moreover, we illustrate its application for making clinical and administrative decisions for the management of hospital activities.

Nutritional Alert in hospitalized patients.

UNLABELLED: The objective of the study is to assess a nutritional risk alert using an Informatics System in hospitalized patients versus the conventional methodology. METHOD: We studied 400 medical patients at the Belgrano Hospital Critical Care Unit. We considered two groups of 200 patients. In the first the group (Control Group), nutritional risk was diagnosed in a traditional way. In the second group (Alarm Group), nutritional risk was diagnosed with an alert system. The alert was triggered when a patient showed low levels of, at least, two of the following variables: albumin, cholesterol, triglyceride, lymphocyte or low body mass index (BMI). RESULTS: Nutritional risk was detected in 20.3% of the Control Group patients while, in the Alert Group, nutritional risk was detected in 34.3% of the patients; the difference between the two groups was significant (p<0.001), with a sensitivity rate of 99% and a specificity rate of 98%. CONCLUSION: Malnutrition is more easily detected when using an alert system.

Architectural analysis of clinical ontologies for pHealth interoperability.

Comprehensive interoperability between eHealth/pHealth systems requires properly represented shared knowledge. Formal ontologies allow specifying the semantics of health knowledge representation in a well-defined and unambiguous manner. The objective of this paper is to formally analyze - from a system-theoretical architectural perspective - existing clinical ontologies. The paper defines important ontology requirements for semantically interoperable pHealth/eHealth systems. Then, based on those requirements, 17 criteria are defined and used for analyzing 129 clinical ontologies. Statistical results confirm that most ontologies do not meet the defined criteria. OBO foundry defines a good approach to meet all defined criteria, but it does not cover yet the clinical domain as a whole. SNOMED CT was found the more comprehensive one, despite several restrictions.

Process-oriented integration and coordination of healthcare services across organizational boundaries.

The paper presents a methodology that follows a top-down approach based on a Model-Driven Architecture for integrating and coordinating healthcare services through cross-organizational processes to enable organizations providing high quality healthcare services and continuous process improvements. The methodology provides a modeling language that enables organizations conceptualizing an integration agreement, and identifying and designing cross-organizational process models. These models are used for the automatic generation of: the private view of processes each organization should perform to fulfill its role in cross-organizational processes, and Colored Petri Net specifications to implement these processes. A multi-agent system platform provides agents able to interpret Colored Petri-Nets to enable the communication between the Healthcare Information Systems for executing the cross-organizational processes. Clinical documents are defined using the HL7 Clinical Document Architecture. This methodology guarantees that important requirements for healthcare services integration and coordination are fulfilled: interoperability between heterogeneous Healthcare Information Systems; ability to cope with changes in cross-organizational processes; guarantee of alignment between the integrated healthcare service solution defined at the organizational level and the solution defined at technological level; and the distributed execution of cross-organizational processes keeping the organizations autonomy.

Implementation and expansion of an electronic medical record for HIV care and treatment in Haiti: an assessment of system use and the impact of large-scale disruptions.

PURPOSE: System use is a key criterion of success in an electronic medical record (EMR) implementation, and there is little research on long-term use of systems following implementation. The aim of the paper was to describe the development, implementation and use of iSanté, Haiti's national HIV care and treatment EMR. METHODS: To build a picture of the history of iSanté, we interviewed 11 staff involved with the development and implementation of the EMR, and reviewed organization records. Data entry and report use were ascertained by querying the central patient database. RESULTS: By the end of 2010 there were 67 sites with iSanté installed, and the scope of the system had been expanded to include primary care and obstetrics and gynecology. New functionality includes data forms specific to subpopulations, the ability to transfer patient records among clinics, and integration with an electronic laboratory system. We observed fluctuations in use over time, with substantial reductions in the number of active sites during times of large-scale disruptions in Haiti. A surge in report use following the January 2010 earthquake suggests that clinics found the EMR to be a valuable source of data during the recovery phase. CONCLUSION: There is real potential for EMRs in developing countries to improve clinical practice and make data available for efficient reporting, quality improvement and other population health uses. An approach of continuous system improvement, combined with regular assessments of use, is necessary for achieving an effective, national implementation of a standardized EMR. We have achieved successes in terms of rolling out new functionality and expanding to new sites, but more work remains to be done to improve perceptions of data quality and increase use of population data for accurate and timely reporting.

Data for decision making: strategic information tools for hospital management during a pandemic.

OBJECTIVES: During the 2009 influenza A (H1N1) pandemic, Argentina's Hospital Nacional Profesor Alejandro Posadas, a referral center in the capital province of Buenos Aires, treated a large urban patient population. Beginning in April, after severe influenza had been reported in North America but before any suspected cases of H1N1 had been reported in Argentina, the authors formed a pandemic planning committee to direct our hospital's response. An important strategy of the management team was to create a single daily monitoring tool that could integrate multiple information sources. We describe our pandemic planning strategy so that it may serve as a template for other hospitals. METHODS: We describe our integrated data management system and the indicators it measured. We also describe the iterative process used to develop these tools and the current versions we use in surveillance for possible new waves of pandemic influenza. RESULTS: We present 3 examples of strategic decision making applied to data from our integrated information system. Daily pandemic surveillance data motivated the planning committee to reallocate hospital resources to care for patients during the peak pandemic period. CONCLUSIONS: This report illustrates the importance of pandemic planning and advanced integrated information tools for management of a health care facility during a pandemic.

Conceptualization of an electronic system for documentation of nursing diagnosis, outcomes, and intervention.

Electronic nursing documentation constitutes technical, scientific, legal, and ethical documents. The objective of this study was to develop an electronic nursing documentation system. The system was developed in four phases (conceptualization, detailing, prototype building, implementation), and the knowledge base was based on domains and classes according to the NANDA-I, NIC, and NOC unified framework. The result is an electronic system (PROCEnf--USP--Nursing Process Electronic Documentation System of the University of São Paulo) which allows documenting nursing process generating reports of nursing process, besides supporting decisions on nursing diagnosis, expected outcomes, and interventions. Integration of different fields of knowledge, as well as the institutional feature of valuing continuous theoretical and practical improvement of nursing process were factors of success of this technological project.

Implementação e avaliação de um sistema de gerenciamento de imagens médicas com suporte à recuperação baseada em conteúdo / Implementation and evaluation of a medical image management system with content-based retrieval support

OBJETIVO: Neste artigo são descritas a implementação e avaliação de um sistema de gerenciamento de imagens médicas com suporte à recuperação baseada em conteúdo (PACS-CBIR), integrando módulos voltados para a aquisição, armazenamento e distribuição de imagens, e a recuperação de informação textual por palavras-chave e de imagens por similaridade. MATERIAIS E MÉTODOS: O sistema foi implementado com tecnologias para Internet, utilizando-se programas livres, plataforma Linux e linguagem de programação C++, PHP e Java. Há um módulo de gerenciamento de imagens compatível com o padrão DICOM e outros dois módulos de busca, um baseado em informações textuais e outro na similaridade de atributos de textura de imagens. RESULTADOS: Os resultados obtidos indicaram que as imagens são gerenciadas e armazenadas corretamente e que o tempo de retorno das imagens, sempre menor do que 15 segundos, foi considerado bom pelos usuários. As avaliações da recuperação por similaridade demonstraram que o extrator escolhido possibilitou a separação das imagens por região anatômica. CONCLUSÃO: Com os resultados obtidos pode-se concluir que é viável a implementação de um PACS-CBIR. O sistema apresentou-se compatível com as funcionalidades do DICOM e integrável ao sistema de informação local. A funcionalidade de recuperação de imagens similares pode ser melhorada com a inclusão de outros descritores.

OBJECTIVE: The present paper describes the implementation and evaluation of a medical images management system with content-based retrieval support (PACS-CBIR) integrating modules focused on images acquisition, storage and distribution, and text retrieval by keyword and images retrieval by similarity. MATERIALS AND METHODS: Internet-compatible technologies were utilized for the system implementation with freeware, and C++, PHP and Java languages on a Linux platform. There is a DICOM-compatible image management module and two query modules, one of them based on text and the other on similarity of image texture attributes. RESULTS: Results demonstrate an appropriate images management and storage, and that the images retrieval time, always < 15 sec, was found to be good by users. The evaluation of retrieval by similarity has demonstrated that the selected images extractor allowed the sorting of images according to anatomical areas. CONCLUSION: Based on these results, one can conclude that the PACS-CBIR implementation is feasible. The system has demonstrated to be DICOM-compatible, and that it can be integrated with the local information system. The similar images retrieval functionality can be enhanced by the introduction of further descriptors.

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean / Estudio comparativo de la calidad y disponibilidad de la información sobre la salud usada para facilitar el análisis del nivel de costos de la diabetes y la hipertensión en el Caribe

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean. Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

OBJETIVO: Las enfermedades no comunicables (ENC) se cuentan entre las principales amenazas a la salud y el bienestar en el Caribe. Se llevó a cabo un estudio hacia finales de 2005, con el fin de computar la carga económica de la diabetes mellitus y la hipertensión dentro de la Comunidad y el Mercado Común del Caribe (CARICOM). Este reporte constituye un análisis crítico de la calidad y disponibilidad de información sobre la salud, que puede ser usada para facilitar el análisis del nivel de costos de la diabetes mellitus y la hipertensión. MÉTODOS: Se desarrolló y distribuyó un formulario para obtener datos acerca de la utilización de servicios de salud y servicios epidemiológicos. Posteriormente se realizaron visitas a siete países miembros de CARICOM con el propósito de recoger datos. RESULTADOS: Los resultados revelaron (i) algunas deficiencias en cuanto a la confiabilidad y la validez de los datos recibidos, en particular los necesarios para facilitar el análisis de las complicaciones costo-específicas, tales como la enfermedad cardíaca isquémica, la enfermedad cerebrovascular, el fallo renal crónico, la retinopatía hipertensiva y diabética, y las complicaciones circulatorias periféricas; (ii) los sistemas de administración de datos en los hospitales no estaban conectados para facilitar la producción de estimados de costo-efectividad y otras informaciones requeridas para comparar las opciones de inversión para la salud; (iii) a pesar de reiterados intentos de los gobiernos regionales por desarrollar y fortalecer los sistemas de información de salud en el área del Caribe, su sostenimiento ha sido obstaculizado significativamente a causa de restricciones en cuanto a recursos humanos, materiales y financieros, y por el hecho de que el monitoreo y la evaluación actuales son generalmente pobres. CONCLUSIÓN: Existen deficiencias en la calidad y disponibilidad de información sobre la salud, en cuanto a facilitar el análisis del nivel de la magnitud del costo de la hipertensión y la diabetes mellitus en el Caribe. Será necesario un fuerte compromiso por parte de los gobiernos del CARICOM para abordar estos problemas, si se ha de emprender evaluaciones económicas con mayor frecuencia, como parte del esfuerzo por reducir la morbilidad y la mortalidad por estas enfermedades.

[The hospital bed referral center under the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil: the case of hospitalization for ischemic heart disease]. / Central de regulação de leitos do SUS em Belo Horizonte, Minas Gerais, Brasil: avaliação de seu papel pelo estudo das internações por doenças isquêmicas do coração.

The hospital admissions center in Belo Horizonte, Minas Gerais State, Brazil, aims to assure fast, timely, and equitable access to hospitalization services through the Unified National Health System. However, many patients are admitted directly to the hospitals, without going through the admissions center. This study compared the characteristics of hospitalizations in Belo Horizonte in 2002 according to type of access. All admissions for acute myocardial infarction and acute coronary disease were included. Of 3,705 admissions, 24.9% were processed through the hospital admissions center and 75.1% through direct access. Direct hospitalizations were more common as compared to processing by the hospital admissions center for patients>70 years), those with presumptive diagnosis of acute coronary disease, to the surgical department, and on weekends. Admissions via the hospital admissions center were more common than direct access for patients residing outside Belo Horizonte, at non-public hospitals, and for the intensive care unit. Length-of-stay also varied according to type of access. The results confirm differences in the characteristics of admissions according to the two types of access.

Central de regulação de leitos do SUS em Belo Horizonte, Minas Gerais, Brasil: avaliação de seu papel pelo estudo das internações por doenças isquêmicas do coração / The hospital bed referral center under the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil: the case of hospitalization for ischemic heart disease

A Central de Internações de Belo Horizonte, Minas Gerais, Brasil, visa tornar ágil o acesso às internações pelo Sistema Único de Saúde (SUS). Entretanto, muitas internações ocorrem diretamente nos hospitais, sem intermediação da Central de Internação. O estudo comparou as características das internações realizadas em 2002, com relação à via de acesso. Foram selecionadas internações com hipótese diagnóstica de infarto agudo do miocárdio e insuficiência coronariana aguda. De 3.705 internações, 24,9 por cento foram realizadas pela Central de Internação e 75,1 por cento por via direta. As proporções de internações via direta foram maiores que pela Central de Internação para pacientes > 70 anos, internados por insuficiência coronariana aguda, na clínica cirúrgica e no fim de semana. Os percentuais das internações via Central de Internação foram maiores que os feitos por via direta para residentes em outros municípios, em hospitais não públicos e com utilização de UTI. O número de dias de internação também foi diferente entre as vias. O estudo mostrou diferenças nas características das internações realizadas pelas duas vias de acesso.

The hospital admissions center in Belo Horizonte, Minas Gerais State, Brazil, aims to assure fast, timely, and equitable access to hospitalization services through the Unified National Health System. However, many patients are admitted directly to the hospitals, without going through the admissions center. This study compared the characteristics of hospitalizations in Belo Horizonte in 2002 according to type of access. All admissions for acute myocardial infarction and acute coronary disease were included. Of 3,705 admissions, 24.9 percent were processed through the hospital admissions center and 75.1 percent through direct access. Direct hospitalizations were more common as compared to processing by the hospital admissions center for patients > 70 years ), those with presumptive diagnosis of acute coronary disease, to the surgical department, and on weekends. Admissions via the hospital admissions center were more common than direct access for patients residing outside Belo Horizonte, at non-public hospitals, and for the intensive care unit. Length-of-stay also varied according to type of access. The results confirm differences in the characteristics of admissions according to the two types of access.

[Probabilistic record linkage: an application to severe maternal morbidity (near miss) and maternal mortality]. / Relacionamento probabilístico de registros: uma aplicação na área de morbidade materna grave (near miss) e mortalidade materna.

This article presents an experience with record linkage from the Brazilian Hospital Information System (SIH) with the Mortality Information System (SIM), and the SIH with itself, applied to severe maternal morbidity (near miss) and maternal mortality. This was an empirical study using Brazilian data for the state capitals and Federal District in 2002. For the two linkages separately applied in each capital, a three simple step blocking strategy was established, plus related multiple steps and also two clerical review strategies. From the total number of true pairs found after the two linkages, simple steps failed to find fewer than 8%, while the multiple step strategy failed to find only 0.7%. This approach allowed exploring the issue of severe maternal morbidity and mortality in these databases. The number of pairs found and reviewed under the multiple steps strategy was lower than the sum of pairs obtained with the three simple steps, and fewer pairs were lost. However, for the record linkage of the SIH with itself, both strategies are suggested.

A comparative study of the quality and availability of health information used to facilitate cost burden analysis of diabetes and hypertension in the Caribbean.

OBJECTIVE: Non-communicable Diseases (NCDs) are leading threats to health and well-being in the Caribbean. A study was undertaken in the latter part of 2005 to compute the economic burden of diabetes mellitus and hypertension within the Caribbean Community and Common Market (CARICOM). This report critiques the quality and availability of health information which can be used to facilitate cost burden analysis of diabetes mellitus and hypertension. METHODS: A form was developed and disseminated to obtain epidemiological and health service utilization data. Subsequent visits were made to seven CARICOM member countries to collect the data. RESULTS: The results revealed (i) a number of deficiencies in the reliability and validity of the data received, in particular, those needed to facilitate the analysis of cost-specific complications such as ischaemic heart disease, cerebrovascular disease, chronic renal failure, hypertensive and diabetic retinopathy and peripheral circulatory complications; (ii) data management systems in hospitals were not linked to facilitate generation of cost-effectiveness estimates and other information required to compare options for health investment; (iii) despite repeated attempts by regional governments to develop/strengthen Health Information Systems within the Caribbean, sustainability has been significantly hampered by human, material and financial resource constraints and ongoing monitoring and evaluation is generally poor. CONCLUSION: There are deficiencies in the quality and availability of health information to facilitate cost burden analysis of hypertension and diabetes mellitus in the Caribbean Strong commitment from CARICOM governments will be necessary to address these concerns if economic evaluations are to be undertaken more frequently as part of the effort to reduce the morbidity and mortality from these diseases.

Medical Image distribution and visualization in a hospital using CORBA.

In this work it is presented the solution adopted by the Heart Institute (InCor) of Sao Paulo for medical image distribution and visualization inside the hospital's intranet as part of the PACS system. A CORBA-based image server was developed to distribute DICOM images across the hospital together with the images' report. The solution adopted allows the decoupling of the server implementation and the client. This gives the advantage of reusing the same solution in different implementation sites. Currently, the PACS system is being used on two different hospitals each one with three different environments: development, prototype and production.