Interoperability in a Post-Roe Era: Sustaining Progress While Protecting Reproductive Health Information.

This Viewpoint proposes a solution to better safeguard reproductive health information in patient records that are now more complete owing to the interoperability of health information exchange networks.

Propuesta de sistema innovador de comunicación digital utilizando IoT para equipo biomédico de monitoreo de pacientes: de interés sector salud pública / Innovative digital communication system proposal using IoT in biomedical equipment for patient monitoring: interest in public health sector

La presente propuesta de diseño busca la interoperabilidad de datos en salud por medio de la integración de un sistema de comunicación a equipos especializados, utilizando las TI (Tecnologías de la Información) y el IoT (Internet de las Cosas) en los equipos biomédicos especializados o monitor que está siendo utilizado actualmente en los centros hospitalarios público a nivel nacional para la medición de signos vitales, con el objetivo de poder brindar una atención sanitaria a pacientes con padecimientos médicos y que necesitan de una constante supervisión y vigilancia. En los centros hospitalarios se cuenta con equipo biomédico especializado que carece de dichas funcionalidades. Esto repercute u obliga al responsable especialista a tener que estar frente al monitor y paciente para poder observar las mediciones o lecturas que presenta un paciente.

This design proposal seeks the interoperability of health data through the integration of a communication system to specialized equipment, using IT (Information Technology) and IoT (Internet of Things) in specialized biomedical equipment or monitor that is currently being used in public hospitals nationwide for the measurement of vital signs, in order to provide health care to patients with medical conditions and who need constant surveillance. Hospitals have specialized biomedical equipment that lacks these functionalities. This forces the responsible specialist to have to be in front of the monitor and the patient to be able to observe the measurements or readings that a patient presents.

Impact of interoperability of smart infusion pumps and an electronic medical record in critical care.

PURPOSE: To describe the benefits of smart infusion pump interoperability with an electronic medical record (EMR) system in an adult intensive care unit (ICU) setting. SUMMARY: In order to assess the impact of smart infusion pump and EMR interoperability, we observed whether there were changes in the frequency of electronic medication administration record (eMAR) documentation of dose titrations in epinephrine and norepinephrine infusions in the ICU setting. As a secondary endpoint, we examined whether smart pump/EMR interoperability had any impact on the rate of alerts triggered by the dose-error reduction software. Pharmacist satisfaction was measured to determine the impact of smart pump/EMR interoperability on pharmacist workflow. In the preimplementation phase, there were a total of 2,503 administrations of epinephrine and norepinephrine; 13,299 rate changes were documented, for an average of 5.31 documented rate changes per administration. With smart pump interoperability, a total of 13,024 rate changes were documented in association with 1,401 administrations, for an average of 9.29 documented rate changes per administration (a 74.9% increase). A total of 1,526 dose alerts were triggered in association with 76,145 infusions in the preimplementation phase; there were 820 dose alerts associated with 48,758 autoprogammed infusions in the postimplementation phase (absolute difference, -0.32%). ICU pharmacists largely agreed (75% of survey respondents) that the technology provided incremental value in providing patient care. CONCLUSION: Interoperability between the smart pump and EMR systems proved beneficial in the administration and monitoring of continuous infusions in the ICU setting. Additionally, ICU pharmacists may be positively impacted by improved clinical data accuracy and operational efficiency.

Importância de fortalecer os sistemas de informação / COVID-19 y la importancia de fortalecer los Sistemas de Información / COVID-19 and the importance of strengthening Information Systems

Why are information systems key for pandemic response? During a pandemic, more than in any other public health situation, information systems play a critical role in managing data and other information at the speed the situation requires. They provide essential evidence for taking action, making the most informed decisions possible, and adjusting policies to allow for better intelligence on actions to improve health. Emerging technologies and automation have the potential to improve public health like never before in the history of humankind. Information systems provide immediate, expeditious, and coordinated data access and sharing, and they facilitate the prioritization of care, access, and response, especially for people in conditions of vulnerability. With properly disaggregated health data, it is possible to plan actions that reduce potential health inequities at all levels of care, and facilitate the implementation of strategies to address such inequities.

¿Por qué los sistemas de información son claves para responder a la pandemia? Durante una pandemia, más que en ninguna otra situación de salud pública, los sistemas de información juegan un papel crítico para gerenciar los datos y la información necesaria a la velocidad que la situación lo requiere. Asimismo, son clave para disponer de evidencia para la acción, tomar decisiones lo más informadas posibles y adecuar políticas que permitan una mejor inteligencia en acciones de salud. Por otro lado, las tecnologías emergentes y las posibilidades que ofrece la automatización pueden suponer beneficios para la salud pública como nunca antes en la historia de la humanidad. Los sistemas de información permiten el acceso e intercambio inmediato, ágil y coordinado a los datos y la priorización en la atención, el acceso y la respuesta, sobre todo a aquellos en situación de vulnerabilidad. Los datos de salud adecuadamente desagregados permiten planificar acciones que reduzcan las posibles inequidades en salud en los distintos niveles de atención y facilitan la implementación de estrategias para abordarlos.

Por que os sistemas de informação são cruciais para responder à pandemia? Durante uma pandemia, mais que em nenhuma outra situação de saúde pública, os sistemas de informação cumprem um papel crucial no gerenciamento dos dados e das informações necessárias com a rapidez exigida pela situação. Além disso, são essenciais para dispor de evidências para agir, tomar decisões o mais bem embasadas possíveis e adequar políticas que permitam uma melhor inteligência nas ações de saúde. Por outro lado, as tecnologias emergentes e as possibilidades que a automatização oferece podem trazer benefícios para a saúde pública como nunca antes na história da humanidade. Os sistemas de informação permitem o acesso e intercâmbio imediato, ágil e coordenado dos dados e a priorização da atenção, do acesso e da resposta, sobretudo às pessoas em situação de vulnerabilidade. Os dados de saúde devidamente desagregados permitem planejar ações que reduzam as possíveis desigualdades em saúde nos diferentes níveis da atenção e facilitam a implementação de estratégias para abordá-los.

Hospital adoption of multiple health information exchange approaches and information accessibility.

OBJECTIVE: Hospital engagement in electronic health information exchange (HIE) has increased over recent years. We aimed to 1) determine the change in adoption of 3 types of information exchange: secure messaging, provider portals, and use of an HIE; and 2) to assess if growth in each approach corresponded to increased ability to access and integrate patient information from outside providers. METHODS: Panel analysis of all nonfederal, acute care hospitals in the United States using hospital- and year-fixed effects. The sample consisted of 1917 hospitals that responded to the American Hospital Association Information Technology Supplement every year from 2014 to 2016. RESULTS: Adoption of each approach increased by 9-15 percentage points over the study period. The average number of HIE approaches used by each hospital increased from 1.0 to 1.4. Adoption of each approach was associated with increased likelihood that providers routinely had necessary outside information of 4.2-12.7 percentage points and 4.5-13.3 percentage points increase in information integration. Secure messaging was associated with the largest increase in both. Adoption of 1 approach increased the likelihood of having outside information by 10.3 percentage points, while adopting a second approach further increased the likelihood by 9.5 percentage points. Trends in number of approaches and integration were similar. DISCUSSION/CONCLUSION: No single HIE tool provided high levels of usable, integrated health information. Instead, hospitals benefited from adopting multiple tools. Policy initiatives that reduce the complexity of enabling high value HIE could result in broader adoption of HIE and use of information to inform care.

Design and testing of Medivate, a mobile app to achieve medication list portability via Fast Healthcare Interoperability Resources.

OBJECTIVES: To describe the architecture, design, and testing of an innovative mobile application (Medivate) that facilities accurate sharing of medication lists with linked education. SETTING: The deployment and testing of this app occurred in both the community and hospital settings in Pittsburgh, PA. PRACTICE INNOVATION: Medivate is an iOS smartphone application and cloud architecture for patients and providers to keep medication and vaccine lists accurate by providing a method and tool to easily exchange these data. Medications are added directly to the app from the electronic health record (EHR) or by the patient manually. Quick response (QR) code technology is used to trigger the secure transfer and sharing of medications on demand via HL-7 Fast Healthcare Interoperability Resources-based data transfer. An iterative user-centered design process involving patients and student pharmacists practicing in community settings was used to develop and refine functionality. PRACTICE DESCRIPTION: Adults with an iPhone were approached for participation in the design and evaluation of Medivate. Its functionality and integration into clinical workflow at hospital discharge or vaccine administration in the community were determined. EVALUATION: In the community setting, interviews of pharmacists were conducted. In the hospital, metrics of study participation and experience with app deployment were determined. RESULTS: The app was deployed in the community for patients that received vaccinations. Interviews provided insight into barriers and logistics for successful engagement. The app was integrated into hospital workflow and demonstrated interoperability with the inpatient EHR. Thirteen patients were provided the app before discharge. Engagement with the app was evident through medication list shares, education access, and changes to medication lists. Patients noted strong agreement with usefulness of the app to learn more about the purposes and adverse effects of medications prescribed. CONCLUSION: A mobile app to achieve medication and vaccine list portability was successfully designed and integrated into the inpatient and community settings.

Setting the scene for the future: implications of key legal regulations for the development of e-health interoperability in the EU.

E-health has experienced a dynamic development across the European Union in the recent years and enjoys support from the European Commission that seeks to achieve interoperability of national healthcare systems in order to facilitate free movement. Differences that can be observed between the member states in legal regulations, cultural approaches and technological solutions may hinder this process. This study compares the legal standing of e-health in Denmark, Poland, Spain and the UK, along with key legal acts and their implications. The academic literature review along with an analysis of materials found through the desk study research (reports, legal acts, press articles, governmental web pages and so on) was performed in order to identify aspects relevant to e-health interoperability. The approach to legal regulation of e-health substantially differs by country. So do the procedures that they have developed regarding the requirement for patient's consent for the processing of their data, their rights to access to the medical data, to change the data, data confidentiality and types of electronic health records. The principles governing the assignment of responsibility for data protection are also different. These legal and technological differences must be reconciled if interoperability of European national e-health systems is to be achieved. Copyright © 2016 John Wiley & Sons, Ltd.

[Standardization and modeling of surgical processes]. / Standardisierung und Modellierung von Operationsprozessen.

BACKGROUND: Due to the technological developments around the operating room, surgery in the twenty-first century is undergoing a paradigm shift. OBJECTIVE: Which technologies have already been integrated into the surgical routine? How can a favorable cost-benefit balance be achieved by the implementation of new software-based assistance systems? METHODS: This article presents the state of the art technology as exemplified by a semi-automated operation system for otorhinolaryngology surgery. The main focus is on systems for implementation of digital handbooks and navigational functions in situ. RESULTS: On the basis of continuous development in digital imaging, decisions may by facilitated by individual patient models thus allowing procedures to be optimized. The ongoing digitization and linking of all relevant information enable a high level of standardization in terms of operating procedures. This may be used by assistance systems as a basis for complete documentation and high process reliability. CONCLUSION: Automation of processes in the operating room results in an increase in quality, precision and standardization so that the effectiveness and efficiency of treatment can be improved; however, care must be taken that detrimental consequences, such as loss of skills and placing too much faith in technology must be avoided by adapted training concepts.