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1.
Rev Epidemiol Sante Publique ; 67(5): 337-344, 2019 Sep.
Artigo em Francês | MEDLINE | ID: mdl-31204149

RESUMO

BACKGROUND: Based on the observation of the misuse of ICD-10 to code the diagnoses in the RIM-P (lack of completeness, conformity and diversity), the Technical Agency for information on Hospital Care (ATIH), which provides tools for collecting medical information, conducted two actions in 2016. First, a chapter devoted to the instructions of coding has been written in the methodological guide of production of the RIM-P, second, a variable "type psy" was added to the ICD-10 nomenclature's file framing ICD-10 coding in the RIM-P. The purpose of this study is to describe the quality of diagnosis coding using ICD-10 in the RIM-P in 2015 and 2016. METHODS: The quality of diagnosis coding using ICD-10 in the summaries of activity of the RIM-P national databases was described in 2015 and 2016. The study focused on the completeness, the conformity and the diversity of coding. RESULTS: Between 2015 and 2016, the percentage of summaries without primary diagnosis ("DP") decreased slightly for full-time (5.2% vs. 3.8%), part-time (6.3% vs. 4.9%) inpatient stays and outpatient care (9.9% vs. 8.9%). ICD-10 codes used to code DP or associated diagnosis ("DA"), while prohibited, mainly belong to Chapter V Mental and behavioral disorders. Per year, only one-third of the summaries and one-half of patients had two or more ICD-10 codes reported for inpatient stays (one-fifth of the summaries and one-fourth of the patients for outpatient care). In addition, per year and per facility, the average number of distinct ICD-10 codes used to fill "DP" or "DA" was approximately half as important in part-time hospitalization, as in full-time hospitalization or for outpatient care. Moreover, 90% of the health facilities used<550 distinct ICD-10 codes in full-time inpatient stays,<270 in part-time inpatient stays and<950 for outpatient care to code the "DP" or the "DA". The diversity of ICD-10 codes used was low and similar between 2015 and 2016, especially to describe the socio-economic environment, resistance to treatment or non-compliance. CONCLUSION: This study emphasizes the need for a collective effort to improve the diversity of the diagnoses' coding in the RIM-P.


Assuntos
Confiabilidade dos Dados , Classificação Internacional de Doenças/normas , Sistemas Computadorizados de Registros Médicos/normas , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Bases de Dados Factuais/normas , Bases de Dados Factuais/estatística & dados numéricos , França/epidemiologia , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Sistemas de Informação Hospitalar/organização & administração , Sistemas de Informação Hospitalar/normas , Hospitalização/estatística & dados numéricos , Humanos , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Transtornos Mentais/classificação , Alta do Paciente/normas , Alta do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas
2.
JAMA Netw Open ; 2(3): e190393, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30848810

RESUMO

Importance: Cybersecurity is an increasingly important threat to health care delivery, and email phishing is a major attack vector against hospital employees. Objective: To describe the practice of phishing simulation and the extent to which health care employees are vulnerable to phishing simulations. Design, Setting, and Participants: Retrospective, multicenter quality improvement study of a convenience sample of 6 geographically dispersed US health care institutions that ran phishing simulations from August 1, 2011, through April 10, 2018. The specific institutions are anonymized herein for security and privacy concerns. Exposures: Simulated phishing emails received by employees at US health care institutions. Main Outcomes and Measures: Date of phishing campaign, campaign number, number of emails sent, number of emails clicked, and email content. Emails were classified into 3 categories (office related, personal, or information technology related). Results: The final study sample included 6 anonymized US health care institutions, 95 simulated phishing campaigns, and 2 971 945 emails, 422 062 of which were clicked (14.2%). The median institutional click rates for campaigns ranged from 7.4% (interquartile range [IQR], 5.8%-9.6%) to 30.7% (IQR, 25.2%-34.4%), with an overall median click rate of 16.7% (IQR, 8.3%-24.2%) across all campaigns and institutions. In the regression model, repeated phishing campaigns were associated with decreased odds of clicking on a subsequent phishing email (adjusted OR, 0.511; 95% CI, 0.382-0.685 for 6-10 campaigns; adjusted OR, 0.335; 95% CI, 0.282-0.398 for >10 campaigns). Conclusions and Relevance: Among a sample of US health care institutions that sent phishing simulations, almost 1 in 7 simulated emails sent were clicked on by employees. Increasing campaigns were associated with decreased odds of clicking on a phishing email, suggesting a potential benefit of phishing simulation and awareness. With cyberattacks increasing against US health care systems, these click rates represent a major cybersecurity risk for hospitals.


Assuntos
Segurança Computacional , Correio Eletrônico , Sistemas de Informação Hospitalar/normas , Recursos Humanos em Hospital/estatística & dados numéricos , Gestão de Riscos , Segurança Computacional/normas , Segurança Computacional/estatística & dados numéricos , Coleta de Dados , Hospitais/estatística & dados numéricos , Humanos , Melhoria de Qualidade , Estudos Retrospectivos , Gestão de Riscos/métodos , Gestão de Riscos/estatística & dados numéricos , Estados Unidos
3.
N Z Med J ; 132(1490): 10-16, 2019 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-30789884

RESUMO

BACKGROUND: Electronic whiteboards have largely replaced the use of traditional whiteboards in many hospital departments. They are used to electronically record and display a variety of patient information to streamline the admission process and the quality of handover between relevant staff. We assessed the impact of such a system upon the patient admission process in a busy general surgery department. METHODS: A survey of 12 qualitative questions was completed by surgical registrars working within a general surgery department in 2013 prior to the introduction of electronic whiteboards and again in 2016 after introduction. The questions compared the satisfaction of the admission process before and after its introduction. RESULTS: There was an improvement in staff satisfaction with the admissions process after the introduction of electronic whiteboards (78% vs 9% high level of satisfaction, p<0.05). A statistically non-significant rise was also seen in individual areas of the admissions and handover process. No change was seen in staff attitude to security of patient details (50% vs 42% high level of satisfaction, p=0.671). CONCLUSION: Electronic whiteboards assist in the process of admitting patients to a general surgical department. This strengthens the case for the introduction of electronic whiteboards across a range of hospital departments.


Assuntos
Eficiência Organizacional/estatística & dados numéricos , Registros Eletrônicos de Saúde/organização & administração , Admissão do Paciente/normas , Centro Cirúrgico Hospitalar , Atitude do Pessoal de Saúde , Sistemas de Informação Hospitalar/normas , Humanos , Comunicação Interdisciplinar , Nova Zelândia , Melhoria de Qualidade , Centro Cirúrgico Hospitalar/organização & administração , Centro Cirúrgico Hospitalar/normas , Inquéritos e Questionários
4.
Rev. cuba. inform. méd ; 10(2)jul.-dic. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1003908

RESUMO

Los sistemas de información hospitalaria cuentan con un volumen importante de datos, sin embargo, carecen de mecanismos que permitan analizar la ejecución de los procesos e identificar variabilidad. La variabilidad puede observarse en prácticamente cada paso del proceso asistencial y a varios niveles de agrupación: poblacional e individual. Desde el punto de vista poblacional se comparan tasas de realización de un procedimiento clínico, como pueden ser intervenciones quirúrgicas o ingresos hospitalarios en un período de tiempo. Las técnicas de minería de procesos analizan los datos reales de sistemas informáticos y son útiles para la detección de variabilidad en la ejecución de los procesos de negocio. La presente investigación propone la aplicación de técnicas de minería de procesos, seleccionadas a partir de un riguroso estudio del estado del arte, para el análisis de los procesos hospitalarios desde sus sistemas de información y materializadas en un modelo computacional. El Modelo para la Detección de Variabilidad (MDV) se instrumentó exitosamente en el sistema XAVIA HIS desarrollado por la Universidad de las Ciencias Informáticas UCI, donde fueron adaptadas e integradas las técnicas de minería de procesos. El modelo MDV contribuye al proceso de informatización de la salud en Cuba. La solución propicia la utilización de una tecnología emergente en áreas como la industrial y empresarial en el entorno sanitario. Esta beneficia importantes funciones gerenciales como la gestión, control y planificación de recursos y servicios sanitarios(AU)


The hospital information systems collect an important volume of data, however, they lack mechanisms to analyze the execution of the processes and identify variability. In practically every step of the care process and at various levels of grouping: population and individual the variability is present. From a population point of view, performance rates of a clinical procedure such as surgical interventions or hospital admissions, are compared over time. Process mining techniques analyze the real data of computer systems and are useful for the detection of variability in the execution of business processes. Based on a rigorous study of the state of the art, this research proposes the application of process mining techniques for the analysis of hospital processes from their information systems, providing a computational model. Model for Variability Detection (MDV) implemented successfully in the XAVIA HIS system developed by the UCI University of Informatics Sciences, where techniques of process mining were adapted and integrated. The MDV model contributes to the process of computerization of health in Cuba. The solution encourages the use of an emerging technology in areas such as industrial and business in the healthcare environment. This benefits important management functions such as control and planning of resources and health services(AU)


Assuntos
Humanos , Aplicações da Informática Médica , Linguagens de Programação , Sistemas de Informação Hospitalar/normas , Mineração de Dados/métodos , Cuba
5.
Rev. cuba. inform. méd ; 10(2)jul.-dic. 2018. tab, graf
Artigo em Espanhol | CUMED | ID: cum-74123

RESUMO

Los sistemas de información hospitalaria cuentan con un volumen importante de datos, sin embargo, carecen de mecanismos que permitan analizar la ejecución de los procesos e identificar variabilidad. La variabilidad puede observarse en prácticamente cada paso del proceso asistencial y a varios niveles de agrupación: poblacional e individual. Desde el punto de vista poblacional se comparan tasas de realización de un procedimiento clínico, como pueden ser intervenciones quirúrgicas o ingresos hospitalarios en un período de tiempo. Las técnicas de minería de procesos analizan los datos reales de sistemas informáticos y son útiles para la detección de variabilidad en la ejecución de los procesos de negocio. La presente investigación propone la aplicación de técnicas de minería de procesos, seleccionadas a partir de un riguroso estudio del estado del arte, para el análisis de los procesos hospitalarios desde sus sistemas de información y materializadas en un modelo computacional. El Modelo para la Detección de Variabilidad (MDV) se instrumentó exitosamente en el sistema XAVIA HIS desarrollado por la Universidad de las Ciencias Informáticas UCI, donde fueron adaptadas e integradas las técnicas de minería de procesos. El modelo MDV contribuye al proceso de informatización de la salud en Cuba. La solución propicia la utilización de una tecnología emergente en áreas como la industrial y empresarial en el entorno sanitario. Esta beneficia importantes funciones gerenciales como la gestión, control y planificación de recursos y servicios sanitarios(AU)


The hospital information systems collect an important volume of data, however, they lack mechanisms to analyze the execution of the processes and identify variability. In practically every step of the care process and at various levels of grouping: population and individual the variability is present. From a population point of view, performance rates of a clinical procedure such as surgical interventions or hospital admissions, are compared over time. Process mining techniques analyze the real data of computer systems and are useful for the detection of variability in the execution of business processes. Based on a rigorous study of the state of the art, this research proposes the application of process mining techniques for the analysis of hospital processes from their information systems, providing a computational model. Model for Variability Detection (MDV) implemented successfully in the XAVIA HIS system developed by the UCI University of Informatics Sciences, where techniques of process mining were adapted and integrated. The MDV model contributes to the process of computerization of health in Cuba. The solution encourages the use of an emerging technology in areas such as industrial and business in the healthcare environment. This benefits important management functions such as control and planning of resources and health services(AU)


Assuntos
Humanos , Aplicações da Informática Médica , Linguagens de Programação , Sistemas de Informação Hospitalar/normas , Mineração de Dados/métodos , Cuba
6.
J Healthc Eng ; 2018: 3689618, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30298099

RESUMO

The purpose of our study aimed to identify attributes capable of improving physicians' satisfaction levels with the use of a hospital information system (HIS). A model inclusive of system quality, information quality, and service quality related to an HIS is used to form antecedents of user satisfaction. Survey methodology was used to collect an attributive set representing the system quality, information quality, and service quality made available from 150 physicians at a large health-care system in southern Taiwan. Responses were segmented into low and high satisfaction and analyzed with partial least squares and importance-performance analysis. The results reveal that system quality, information quality, and service quality may be used to significantly predict physicians' satisfaction. Two system quality attributes (reliability and response time) were identified as the highest priorities for intervention by low- and high-satisfaction users. Low-satisfaction users further expect improvement of the HIS service quality to take place. The subject health-care system should produce coping interventions for those high priorities to enhance the satisfaction of physicians.


Assuntos
Sistemas de Informação Hospitalar/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Médicos/psicologia , Médicos/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
7.
Int J Med Inform ; 119: 47-53, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30342685

RESUMO

INTRODUCTION: Failure in the communication of information and partial communication of information between hospital information systems (HIS) and the Iranian electronic health record (SEPAS) reduces the quality of information. The objective of this study was to identify the errors and causes of failure in the communication of patients' information from HISs to SEPAS. METHODOLOGY: This record-review study was conducted in the first quarter of 2016. In this study, 882 records which had failed to be sent from three hospital information systems to SEPAS were reviewed and data were collected using a data collection form. Data were analyzed using descriptive and inferential statistics with SPSS.18. RESULTS: The review of 882 hospital records resulted in the identification of 1256 errors of 41 different types. These errors were classified into 4 categories: administrative-financial errors (61%), errors related to national codes (23%), clinical errors (9%), and other errors (7%). In total, errors were categorized into two generic types: "system level errors (65%) and operator-dependent errors (35%)". The number of errors was a significant difference in the studied hospitals (p < 0.0001). CONCLUSIONS: This study identified a large number of system and operator-dependent errors hampering communication of information from HIS to SEPAS. Results revealed that the same hospital information systems used in different hospitals could face dissimilar types and levels of errors when communicating with other information systems. The results of this study can be used by system designers and health center policymakers to prevent the problems of information communication between health information systems.


Assuntos
Barreiras de Comunicação , Registros Eletrônicos de Saúde/normas , Sistemas de Informação Hospitalar/normas , Hospitais/normas , Disseminação de Informação/métodos , Erros Médicos/prevenção & controle , Registros Médicos/normas , Humanos
8.
Int J Med Inform ; 119: 88-93, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30342691

RESUMO

CONTEXT: Despite widespread efforts to improve the quality and safety of healthcare through use of hospital information systems (HIS), many healthcare organizations face challenges in implementation and effective use of these applications, in particular when systems have been developed internationally (mainly in the US). Suppliers of these technologies also find it challenging to produce systems that work effectively across a range of geographical, cultural and institutional boundaries. In this paper, we seek to understand the strategies used by suppliers and adopters of HIS to overcome the challenges involved in the development and adoption of generic overseas systems. METHODS: We conducted a qualitative study, by interviewing 176 individuals (eight organizations), observing two user groups, and running a supplier focus group. We used inductive thematic analysis to assess emerging strategies in developing and implementing overseas packaged HIS in English settings. FINDINGS: The health sector in England has entered a period of potentially transformative change with many international HIS suppliers entering the market. This has provoked call for the 'Anglicization' of generic systems. This endeavor, has resulted in emergence of more or less aligned supplier and user strategies to overcome the difficulties in the process. This includes a continuous process of identification and classification of requests (by suppliers), and unification and voicing of needs (by adopters). CONCLUSIONS: The complexity of health service provision, drives calls for customization of technologies in this sector. Consequent tensions between 'standardization' and 'localization' are requiring suppliers of generic solutions to develop more sophisticated strategies as they pursue international growth of their market.


Assuntos
Comportamento de Escolha , Coleta de Dados/métodos , Prescrição Eletrônica/normas , Sistemas de Informação Hospitalar/normas , Pesquisa Qualitativa , Inglaterra , Humanos
9.
Int J Med Inform ; 118: 16-28, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30153917

RESUMO

Information systems (ISs) are one of the most widely used systems in different organizations especially hospitals. Improving the performance of a hospital information system (HIS) is one of the most important tasks for patient satisfaction and health. To do this, a mixed sustainability-resilience framework for evaluating HISs is proposed in this study in order to enhance their performance from a mixed sustainability-resilience view. First, a comprehensive framework including suitable sustainable and resilience indicators for performance enhancement of HISs is provided. Then, the importance weight of each indicator is achieved by using the best-worst method (BWM). Required data is obtained through a standard questionnaire. A data envelopment analysis (DEA) is applied to evaluate HIS performance in different departments of a real case study. Additionally, improvement actions are obtained by considering the effect of each selected indicator on the HIS performance through a sensitivity analysis. Also, appropriate strategies for improving the resilience and sustainability aspects of the HIS are presented using strengths-weaknesses-opportunities-threats (SWOT) matrix. Using the results, designers can build more intelligent HISs from both sustainability and resilience perspectives.


Assuntos
Assistência à Saúde/organização & administração , Sistemas de Informação Hospitalar/normas , Avaliação de Programas e Projetos de Saúde/métodos , Humanos , Satisfação do Paciente
10.
Stud Health Technol Inform ; 250: 193-194, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29857428

RESUMO

Based on the process and framework of nursing quality management in the "Third-level General Ho Accreditation Criteria", with the help of computer and mobile information technology, development of nursing quality control informatics system computer operation and mobile operating. The system has implanted PDCA several scientific management tools into the mobile applications, insteads of replace traditional paper methods, improve working efficiency in process control and Data Operation.


Assuntos
Sistemas de Informação Hospitalar/normas , Aplicativos Móveis , Informática em Enfermagem , Controle de Qualidade , Sistemas de Computação , Hospitais
11.
Rev Peru Med Exp Salud Publica ; 35(1): 25-31, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29924273

RESUMO

OBJECTIVES: . To identify the barriers to the quality of information in health facilities in the Amazon region, exploring the case of three health information systems: the epidemiological vigilance, the daily recording of service, and the registry of deaths linked to HIV/AIDS, hepatitis B, and congenital syphilis. MATERIALS AND METHODS: . A quali-quantitative methodology was applied. On the one hand, 57 semi-structured interviews were conducted with administrative and assistance staff at health facilities; on the other hand, a survey was apyplied. One hundred and twenty health facilities in the regions of Amazonas, Huánuco, Loreto, Madre de Dios, San Martín, and Ucayali. RESULTS: . Eight barriers were identified, which were linked mainly to the human resource, to sociocultural aspects, and weaknesses of the health system. CONCLUSIONS: . The barriers identified for the quality of the information in the selected information systems in health facilities in the Amazon region reflect a multidimensional problem, so strategies for improvement in the subject should be considered.


Assuntos
Infecções por HIV , Hepatite B , Sistemas de Informação Hospitalar/normas , Sífilis Congênita , Estudos Transversais , Humanos , Índios Sul-Americanos , Peru
12.
Int J Med Inform ; 114: 88-100, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29673609

RESUMO

BACKGROUNDS: Nowadays developing smart and fast services for patients and transforming hospitals to modern hospitals is considered a necessity. Living in the world inundated with information systems, designing services based on information technology entails a suitable architecture framework. OBJECTIVES: This paper aims to present a localized enterprise architecture framework for the Iranian university hospital. METHODS AND RESULTS: Using two dimensions of implementation and having appropriate characteristics, the best 17 enterprises frameworks were chosen. As part of this effort, five criteria were selected according to experts' inputs. According to these criteria, five frameworks which had the highest rank were chosen. Then 44 general characteristics were extracted from the existing 17 frameworks after careful studying. Then a questionnaire was written accordingly to distinguish the necessity of those characteristics using expert's opinions and Delphi method. The result showed eight important criteria. In the next step, using AHP method, TOGAF was chosen regarding having appropriate characteristics and the ability to be implemented among reference formats. In the next step, enterprise architecture framework was designed by TOGAF in a conceptual model and its layers. For determining architecture framework parts, a questionnaire with 145 questions was written based on literature review and expert's opinions. The results showed during localization of TOGAF for Iran, 111 of 145 parts were chosen and certified to be used in the hospital. CONCLUSION: The results showed that TOGAF could be suitable for use in the hospital. So, a localized Hospital Enterprise Architecture Modelling is developed by customizing TOGAF for an Iranian hospital at eight levels and 11 parts. This new model could be used to be performed in other Iranian hospitals.


Assuntos
Sistemas de Gerenciamento de Base de Dados/normas , Prestação Integrada de Cuidados de Saúde/organização & administração , Sistemas de Informação Hospitalar/organização & administração , Sistemas de Informação Hospitalar/normas , Hospitais Universitários/normas , Aplicações da Informática Médica , Adulto , Prova Pericial , Humanos , Irã (Geográfico) , Pessoa de Meia-Idade , Adulto Jovem
13.
Anesth Analg ; 127(1): 105-114, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29596094

RESUMO

For this special article, we reviewed the computer code, used to extract the data, and the text of all 47 studies published between January 2006 and August 2017 using anesthesia information management system (AIMS) data from Thomas Jefferson University Hospital (TJUH). Data from this institution were used in the largest number (P = .0007) of papers describing the use of AIMS published in this time frame. The AIMS was replaced in April 2017, making this finite sample finite. The objective of the current article was to identify factors that made TJUH successful in publishing anesthesia informatics studies. We examined the structured query language used for each study to examine the extent to which databases outside of the AIMS were used. We examined data quality from the perspectives of completeness, correctness, concordance, plausibility, and currency. Our results were that most could not have been completed without external database sources (36/47, 76.6%; P = .0003 compared with 50%). The operating room management system was linked to the AIMS and was used significantly more frequently (26/36, 72%) than other external sources. Access to these external data sources was provided, allowing exploration of data quality. The TJUH AIMS used high-resolution timestamps (to the nearest 3 milliseconds) and created audit tables to track changes to clinical documentation. Automatic data were recorded at 1-minute intervals and were not editable; data cleaning occurred during analysis. Few paired events with an expected order were out of sequence. Although most data elements were of high quality, there were notable exceptions, such as frequent missing values for estimated blood loss, height, and weight. Some values were duplicated with different units, and others were stored in varying locations. Our conclusions are that linking the TJUH AIMS to the operating room management system was a critical step in enabling publication of multiple studies using AIMS data. Access to this and other external databases by analysts with a high degree of anesthesia domain knowledge was necessary to be able to assess the quality of the AIMS data and ensure that the data pulled for studies were appropriate. For anesthesia departments seeking to increase their academic productivity using their AIMS as a data source, our experiences may provide helpful guidance.


Assuntos
Anestesiologia/normas , Pesquisa Biomédica/normas , Confiabilidade dos Dados , Mineração de Dados , Registros Eletrônicos de Saúde/normas , Sistemas de Informação Hospitalar/normas , Informática Médica/normas , Registro Médico Coordenado , Acesso à Informação , Anestesiologia/organização & administração , Pesquisa Biomédica/organização & administração , Mineração de Dados/normas , Data Warehousing/normas , Bases de Dados Factuais , Registros Eletrônicos de Saúde/organização & administração , Sistemas de Informação Hospitalar/organização & administração , Humanos , Disseminação de Informação , Informática Médica/organização & administração , Registro Médico Coordenado/normas , Interface Usuário-Computador , Fluxo de Trabalho
14.
Epidemiol Serv Saude ; 27(1): e201712811, 2018.
Artigo em Inglês, Português | MEDLINE | ID: mdl-29451610

RESUMO

OBJECTIVE: to assess the coverage, completeness and reliability of data on live births in public maternity wards in São Paulo, Brazil. METHODS: data recorded in the Information System on Live Births (Sinasc) were compared with data collected in a field study (gold standard) during three months in 2011 in four maternity wards in hospital from the SUS network; kappa coefficient was calculated to assess agreement. RESULTS: 5,785 birth records were analyzed; Sinasc coverage was 99.8% and completeness was 96.2%; kappa values showed excellent and good agreement for maternal age (0.99), type of pregnancy, sex and newborn sex and birth weight (0.98), type of delivery (0.97), 1 minute (0.96) and 5th (0.95) minutes, previous live births (0.87) and education level (0.62); regular agreement for prenatal care visits (0.60) and gestational age (0.56); and weak agreement for previous stillbirths (0.09). CONCLUSION: in the assessed hospitals, Sinasc presented high coverage, completeness and reliability.


Assuntos
Declaração de Nascimento , Sistemas de Informação Hospitalar/normas , Hospitais Públicos , Adolescente , Adulto , Peso ao Nascer , Brasil , Criança , Cidades , Estudos Transversais , Feminino , Idade Gestacional , Sistemas de Informação Hospitalar/estatística & dados numéricos , Humanos , Recém-Nascido , Nascimento Vivo , Masculino , Idade Materna , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Reprodutibilidade dos Testes , Adulto Jovem
15.
IEEE J Biomed Health Inform ; 22(3): 904-911, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-28436908

RESUMO

Current access control mechanisms of the hospital information system can hardly identify the real access intention of system users. A relaxed access control increases the risk of compromise of patient privacy. To reduce unnecessary access of patient information by hospital staff, this paper proposes a knowledge-constrained role-based access control (KC-RBAC) model in which a variety of medical domain knowledge is considered in access control. Based on the proposed Purpose Tree and knowledge-involved algorithms, the model can dynamically define the boundary of access to the patient information according to the context, which helps to protect patient privacy by controlling access. Compared with the role-based access control model, KC-RBAC can effectively protect patient information according to the results of the experiments.


Assuntos
Confidencialidade , Sistemas de Informação Hospitalar/normas , Algoritmos , Redes de Comunicação de Computadores , Humanos , Modelos Organizacionais
16.
Artif Intell Med ; 92: 71-81, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-27686851

RESUMO

INTRODUCTION: Clinical decision support systems (CDSSs) are being developed to assist physicians in processing extensive data and new knowledge based on recent scientific advances. Structured medical knowledge in the form of clinical alerts or reminder rules, decision trees or tables, clinical protocols or practice guidelines, score algorithms, and others, constitute the core of CDSSs. Several medical knowledge representation and guideline languages have been developed for the formal computerized definition of such knowledge. One of these languages is Arden Syntax for Medical Logic Systems, an International Health Level Seven (HL7) standard whose development started in 1989. Its latest version is 2.10, which was presented in 2014. In the present report we discuss Arden Syntax as a modern medical knowledge representation and processing language, and show that this language is not only well suited to define clinical alerts, reminders, and recommendations, but can also be used to implement and process computerized medical practice guidelines. METHODS: This section describes how contemporary software such as Java, server software, web-services, XML, is used to implement CDSSs based on Arden Syntax. Special emphasis is given to clinical decision support (CDS) that employs practice guidelines as its clinical knowledge base. RESULTS: Two guideline-based applications using Arden Syntax for medical knowledge representation and processing were developed. The first is a software platform for implementing practice guidelines from dermatology. This application employs fuzzy set theory and logic to represent linguistic and propositional uncertainty in medical data, knowledge, and conclusions. The second application implements a reminder system based on clinically published standard operating procedures in obstetrics to prevent deviations from state-of-the-art care. A to-do list with necessary actions specifically tailored to the gestational week/labor/delivery is generated. DISCUSSION: Today, with the latest versions of Arden Syntax and the application of contemporary software development methods, Arden Syntax has become a powerful and versatile medical knowledge representation and processing language, well suited to implement a large range of CDSSs, including clinical-practice-guideline-based CDSSs. Moreover, such CDS is provided and can be shared as a service by different medical institutions, redefining the sharing of medical knowledge. Arden Syntax is also highly flexible and provides developers the freedom to use up-to-date software design and programming patterns for external patient data access.


Assuntos
Sistemas de Apoio a Decisões Clínicas/organização & administração , Dermatologia/organização & administração , Sistemas Especialistas , Sistemas de Informação Hospitalar/organização & administração , Obstetrícia/organização & administração , Linguagens de Programação , Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas/normas , Dermatologia/normas , Lógica Fuzzy , Sistemas de Informação Hospitalar/normas , Humanos , Doença de Lyme/diagnóstico , Doença de Lyme/terapia , Informática Médica , Obstetrícia/normas , Guias de Prática Clínica como Assunto , Sistemas de Alerta
17.
Artif Intell Med ; 92: 88-94, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-26603750

RESUMO

OBJECTIVE: Most practically deployed Arden-Syntax-based clinical decision support (CDS) modules process data from individual patients. The specification of Arden Syntax, however, would in principle also support multi-patient CDS. The patient data management system (PDMS) at our local intensive care units does not natively support patient overviews from customizable CDS routines, but local physicians indicated a demand for multi-patient tabular overviews of important clinical parameters such as key laboratory measurements. As our PDMS installation provides Arden Syntax support, we set out to explore the capability of Arden Syntax for multi-patient CDS by implementing a prototypical dashboard for visualizing laboratory findings from patient sets. METHODS AND MATERIAL: Our implementation leveraged the object data type, supported by later versions of Arden, which turned out to be serviceable for representing complex input data from several patients. For our prototype, we designed a modularized architecture that separates the definition of technical operations, in particular the control of the patient context, from the actual clinical knowledge. Individual Medical Logic Modules (MLMs) for processing single patient attributes could then be developed according to well-tried Arden Syntax conventions. RESULTS: We successfully implemented a working dashboard prototype entirely in Arden Syntax. The architecture consists of a controller MLM to handle the patient context, a presenter MLM to generate a dashboard view, and a set of traditional MLMs containing the clinical decision logic. Our prototype could be integrated into the graphical user interface of the local PDMS. We observed that with realistic input data the average execution time of about 200ms for generating dashboard views attained applicable performance. CONCLUSION: Our study demonstrated the general feasibility of creating multi-patient CDS routines in Arden Syntax. We believe that our prototypical dashboard also suggests that such implementations can be relatively easy, and may simultaneously hold promise for sharing dashboards between institutions and reusing elementary components for additional dashboards.


Assuntos
Sistemas de Apoio a Decisões Clínicas/organização & administração , Sistemas Especialistas , Sistemas de Informação Hospitalar/organização & administração , Inteligência Artificial , Sistemas de Apoio a Decisões Clínicas/normas , Sistemas de Informação Hospitalar/normas , Humanos , Informática Médica , Linguagens de Programação , Centros de Atenção Terciária
18.
Artif Intell Med ; 92: 24-33, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-26706047

RESUMO

INTRODUCTION: The Allgemeines Krankenhaus Informations Management (AKIM) project was started at the Vienna General Hospital (VGH) several years ago. This led to the introduction of a new hospital information system (HIS), and the installation of the expert system platform (EXP) for the integration of Arden-Syntax-based clinical decision support systems (CDSSs). In this report we take a look at the milestones achieved and the challenges faced in the creation and modification of CDSSs, and their integration into the HIS over the last three years. MATERIALS AND METHODS: We introduce a three-stage development method, which is followed in nearly all CDSS projects at the Medical University of Vienna and the VGH. Stage one comprises requirements engineering and system conception. Stage two focuses on the implementation and testing of the system. Finally, stage three describes the deployment and integration of the system in the VGH HIS. The HIS provides a clinical work environment for healthcare specialists using customizable graphical interfaces known as parametric medical documents. Multiple Arden Syntax servers are employed to host and execute the CDSS knowledge bases: two embedded in the EXP for production and development, and a further three in clinical routine for production, development, and quality assurance. RESULTS: Three systems are discussed; the systems serve different purposes in different clinical areas, but are all implemented with Arden Syntax. MONI-ICU is an automated surveillance system for monitoring healthcare-associated infections in the intensive care setting. TSM-CDS is a CDSS used for risk prediction in the formation of cutaneous melanoma metastases. Finally, TacroDS is a CDSS for the manipulation of dosages for tacrolimus, an immunosuppressive agent used after kidney transplantation. Problems in development and integration were related to data quality or availability, although organizational difficulties also caused delays in development and integration. DISCUSSION AND CONCLUSION: Since the inception of the AKIM project at the VGH and its ability to support standards such as Arden Syntax and integrate CDSSs into clinical routine, the clinicians' interest in, and demand for, decision support has increased substantially. The use of Arden Syntax as a standard for CDSSs played a substantial role in the ability to rapidly create high-quality CDSS systems, whereas the ability to integrate these systems into the HIS made CDSSs more popular among physicians. Despite these successes, challenges such as lack of (consistent and high-quality) electronic data, social acceptance among healthcare personnel, and legislative issues remain. These have to be addressed effectively before CDSSs can be more widely accepted and adopted.


Assuntos
Sistemas de Apoio a Decisões Clínicas/organização & administração , Sistemas Especialistas , Sistemas de Informação Hospitalar/organização & administração , Linguagens de Programação , Inteligência Artificial , Infecção Hospitalar/prevenção & controle , Sistemas de Apoio a Decisões Clínicas/normas , Sistemas de Informação Hospitalar/normas , Humanos , Unidades de Terapia Intensiva/organização & administração , Transplante de Rim/métodos , Informática Médica , Melanoma/patologia , Metástase Neoplásica , Medição de Risco , Tacrolimo/uso terapêutico
19.
Int J Med Inform ; 108: 49-54, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29132631

RESUMO

INTRODUCTION: After implementation, evaluation of hospital information systems (HISs) is critical to ensure the fulfillment of the system goals. This study aimed to assess the success or failure of HISs in public hospitals affiliated with Zahedan University of Medical Sciences. MATERIALS AND METHODS: A cross-sectional descriptive and analytic study was performed in 2016. The study population comprised IT and HIS authorities and hospital information system users. The sample consisted of 468 participants. The data were collected using two questionnaires and analyzed with the SPSS software using descriptive and analytical statistics. RESULTS: The mean score of functional, behavioral, ethical, organizational, cultural and educational factors from the users' perspective was 3.14±0.66, 2.97± 0.60, 3.39±0.70, 2.96±0.642, 3.09±0.63, and 2.95±0.74, respectively. The mean score of organizational, behavioral, cultural, technological, educational and legal factors from IT and HIS authorities' perspective was 3.51±0.54, 3.35±0.45, 2.75±0.61, 3.58±0.32, and 3.96±0.59, respectively. CONCLUSIONS: The evaluated hospital information systems were considered relatively successful in terms of functional, ethical, and cultural factors but were considered as a relative failure in terms of behavioral, organizational, and educational factors form the users' perspective. Only the legal factor showed success, while organizational, behavioral, technical and educational factors showed relative success and the cultural factor showed relative failure from HIS and IT authorities' perspective. Therefore, assessing the users' needs before implementing the system, involving them in various stages of implementation, training them, and improving their computer skills seem to be necessary to achieve a better level of system success.


Assuntos
Implementação de Plano de Saúde , Sistemas de Informação Hospitalar/organização & administração , Hospitais Públicos/normas , Cultura Organizacional , Garantia da Qualidade dos Cuidados de Saúde/normas , Adulto , Estudos Transversais , Feminino , Sistemas de Informação Hospitalar/normas , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
20.
Int J Med Inform ; 107: 30-39, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-29029689

RESUMO

In 2011, the Ministry of Health and Welfare of Taiwan established the National Electronic Medical Record Exchange Center (EEC) to permit the sharing of medical resources among hospitals. This system can presently exchange electronic medical records (EMRs) among hospitals, in the form of medical imaging reports, laboratory test reports, discharge summaries, outpatient records, and outpatient medication records. Hospitals can send or retrieve EMRs over the virtual private network by connecting to the EEC through a gateway. International standards should be adopted in the EEC to allow users with those standards to take advantage of this exchange service. In this study, a cloud-based EMR-exchange prototyping system was implemented on the basis of the Integrating the Healthcare Enterprise's Cross-Enterprise Document Sharing integration profile and the existing EMR exchange system. RESTful services were used to implement the proposed prototyping system on the Microsoft Azure cloud-computing platform. Four scenarios were created in Microsoft Azure to determine the feasibility and effectiveness of the proposed system. The experimental results demonstrated that the proposed system successfully completed EMR exchange under the four scenarios created in Microsoft Azure. Additional experiments were conducted to compare the efficiency of the EMR-exchanging mechanisms of the proposed system with those of the existing EEC system. The experimental results suggest that the proposed RESTful service approach is superior to the Simple Object Access Protocol method currently implemented in the EEC system, according to the irrespective response times under the four experimental scenarios.


Assuntos
Computação em Nuvem , Assistência à Saúde/normas , Registros Eletrônicos de Saúde/normas , Implementação de Plano de Saúde , Sistemas de Informação Hospitalar/normas , Hospitais/normas , Integração de Sistemas , Sistemas de Computação , Feminino , Humanos , Masculino , Taiwan
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