Maturity Assessment of Hospital Information Systems Based on Electronic Medical Record Adoption Model (EMRAM)— Private Hospital Cases in Iran

Introduction: Today, information technology is considered as an important national development principle in each country which is applied in different fields. Health care as a whole and the hospitals could be regarded as a field and organizations with most remarkable IT applications respectively. Although different benchmarks and frameworks have been developed to assess different aspects of Hospital Information Systems (HISs) by various researchers, there is not any suitable reference model yet to benchmark HIS in the world. Electronic Medical Record Adoption Model (EMRAM) has been currently presented and is globally well-known to benchmark the rate of HIS utilization in the hospitals. Notwithstanding, this model has not been introduced in Iran so far. Methods: This research was carried out based on an applied descriptive method in three private hospitals of Isfahan—one of the most important provinces of Iran—in the year 2015. The purpose of this study was to investigate IT utilization stage in three selected private hospitals. Conclusion: The findings revealed that HIS is not at the center of concern in studied hospitals and is in the first maturity stage in accordance with EMRAM. However, hospital managers are enforced and under the pressure of different beneficiaries including insurance companies to improve their HIS. Therefore, it could be concluded that these types of hospitals are still far away from desirable conditions and need to enhance their IT utilization stage significantly.

Measuring the Success of Hospital Information System across Multispecialty Hospitals in Bahrain

Purpose： The aim of this paper is to measure the success of HISs （hospital information systems） in Bahrain from their end user’s perspectives. Methodology： a quantitative design using a questionnaire based on the DeLone and McLean Information System Success Model （2003） was employed to examine the key determinants comprise of SQ （system quality）, IQ （information quality）, SerQ （service quality） as the independent variables and their effect on the US （user satisfaction）, U （system use） and the perceived NB （net benefits） as the success measures. There are 324 respondents consisting of doctors, nurses, technicians, pharmacists and admin staff of hospitals. Data were analyzed using SPSS. Findings： SQ, IQ and SerQ are significantly positively related to US and U, and the two later are in turns significantly positively related to the perceived NB out of the system to both users and organizations. Research implications： the research reflects the experience of using innovative healthcare technologies in the Middle East and its results show the importance of improving the systems technical quality to ensure more satisfied users, more utilized technologies and to reach the optimal purpose of implementing these systems and reap out their prospected benefits. Moreover, sufficient training and full dependency on the systems are required to get more confident users and reduce the daily work load.

Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil

BACKGROUND Inflammatory bowel disease(IBD)is associated with complications,frequent hospitalizations,surgery and death.The introduction of biologic drugs into the therapeutic arsenal in the last two decades,combined with an expansion of immunosuppressant therapy,has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality(IHM)due to IBD.AIM To describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.METHODS This observational,retrospective,ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM.Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses.The following variables were analyzed:Number of deaths and hospitalizations,length of hospital stay,financial costs of hospitalization,sex,age,ethnicity and type of hospital admission.RESULTS There was a reduction in the number of IBD hospitalizations,from 6975 admissions in 1998 to 4113 in 2017(trend:y=-0.1682x+342.8;R^(2)=0.8197;P<0.0001).The hospitalization rate also decreased,from 3.60/100000 in 2000 to 2.17 in 2010.IHM rates varied during the 20-year period,between 2.06 in 2017 and 3.64 in 2007,and did not follow a linear trend(y=-0.0005049x+2.617;R^(2)=0,00006;P=0.9741).IHM rates also varied between regions,increasing in all but the southeast,which showed a decreasing trend(y=-0.1122x+4.427;R^(2)=0,728;P<0.0001).The Southeast region accounted for 44.29%of all hospitalizations.The Northeast region had the highest IHM rate(2.86 deaths/100 admissions),with an increasing trend(y=0.1105x+1.110;R^(2)=0.6265;P<0.0001),but the lowest hospitalization rate(1.15).The Midwest and South regions had the highest hospitalization rates(3.27 and 3.17,respectively).A higher IHM rate was observed for nonelective admissions(2.88),which accounted for 81%of IBD hospitalizations.The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5%compared to 2008.CONCLUSION There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years.IHM rates varied and did not follow a linear trend.

Hospital Information Systems Shortage in Sub-Saharan African Hospitals: Opportunities and Challenges

The HIS is recognised as an essential tool for optimising the management of a health establishment in particular and the health system in general. But it is still very little implemented in hospitals in the South. Open source HIS software, available on the Internet, can be a solution for starting a (HIS) project in these hospitals. A search on the Internet for open source HIS software allowed us to choose MedBoard, the second most popular open source software out of 381, to start an HIS project called PERFORMANCE at the Kara University Hospital in northern Togo. A questionnaire allowed us to assess the level of knowledge of health actors on hospital information systems. The results of this evaluation allowed us to strengthen our proposal. The analysis of the current computer park of the CHU Kara does not allow whatever the functionalities of MedBoard to implement PERFORMANCE at the CHU Kara. Logistics are needed to make PERFORMANCE work. The real difficulty to start and perpetuate HIS project is linked to the human factor.

Untying the Knot: Realization of Informed Consent in Hospitals

Guan Qiqian, a 42-year-old journalist in Yongqing of southeast China＇s Fujian Province, never expected his search for medical treatment of his psoriasis in 2000 ended up in hepatitis and uremia.

Implementation of Hybrid Particle Swarm Optimization for Optimized Regression Testing

Software test case optimization improves the efficiency of the software by proper structure and reduces the fault in the software.The existing research applies various optimization methods such as Genetic Algorithm,Crow Search Algorithm,Ant Colony Optimization,etc.,for test case optimization.The existing methods have limitations of lower efficiency in fault diagnosis,higher computa-tional time,and high memory requirement.The existing methods have lower effi-ciency in software test case optimization when the number of test cases is high.This research proposes the Tournament Winner Genetic Algorithm(TW-GA)method to improve the efficiency of software test case optimization.Hospital Information System(HIS)software was used to evaluate TW-GA model perfor-mance in test case optimization.The tournament Winner in the proposed method selects the instances with the best fitness values and increases the exploitation of the search to find the optimal solution.The TW-GA method has higher exploita-tion that helps to find the mutant and equivalent mutation that significantly increases fault diagnosis in the software.The TW-GA method discards the infor-mation with a lower fitness value that reduces the computational time and mem-ory requirement.The TW-GA method requires 5.47 s and the MOCSFO method requires 30 s for software test case optimization.

Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODSWe interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.RESULTSThe population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.CONCLUSIONGIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.

浅谈医院网络建设

计算机网络技术的发展推动了医疗行业各大医院信息化系统的建设,稳定的物理网络和优化的软件系统成为了关注的焦点。该文针对两种典型的建网方案进行了详细的描述,并对两种方案进行了详细的分析和对比,提出了医院网络建设方案选型的方法。

Study on syndrome distribution and medication characteristics of patients with rectal cancer in the real world

Objective:To explore the general characteristics,traditional Chinese medicine(TCM)syndromes and medication of patients with rectal cancer in China.Methods:The clinical data of inpatients with rectal cancer from the information system of 17 tertiary A‑level traditional Chinese medicine hospitals in China were collected.After data standardization,descriptive analysis was performed on the general information,syndrome distribution and medication characteristics of the included patients,and association rule analysis was performed on the drug usage.Results:A total of 15424 hospitalized patients with rectal cancer were included.The ratio of male to female patients was 1.6:1,the average age was 60.87 years old,and the age was mainly in the range of 50 to 79 years old.Among the 12146 patients with rectal cancer,the top 5 TCM syndromes were Qi and Yin deficiency syndrome(25%),phlegm and blood stasis syndrome(19%),spleen deficiency syndrome(14%),Qi stagnation and blood stasis syndrome(7%)and Qi and blood deficiency syndrome(6%).After excluding the anti‑tumor western medicine recommended by the guidelines,adrenal corticosteroids(43.55%),antibiotics(42.94%)and immunomodulatory drugs(42.66%)ranked the top three in the frequency of western medicine use.Dexamethasone(38.15%),metoclopramide tablets(20.51%)and furosemide injection(19.71%)were the three most commonly used western medicines.Among the three western medicines combined,cimetidine,granisetron hydrochloride dextrose injection+dexamethasone were the most common(support 8.23%,confidence 96.4%,and improvement 2.48%).Heat‑clearing and detoxifying agents(53.72%),Yiqi‑fuzheng agents(49.76%)and blood‑activating and stasis‑removing agents(15.68%)ranked the top 3 in the frequency of use of traditional Chinese medicine.Shenqi Fuzheng injection,Shenqi Fuzheng injection(21.59%),Compound Kushen injection(17.52%)and Aidi injection(11.96%)were the three most commonly used Chinese patent medicines.Conclusion:The main syndromes of patients with rectal cancer may be Qi and Yin deficiency syndrome,phlegm and blood stasis syndrome,and spleen deficiency syndrome,etc.The treatment needs to focus on the supplementation of vital essence,combination of dredging and tonifying method,and the integration of traditional Chinese and western medicine.

Best Practices and Innovative Scenarios of Integrated Patient Data Management to Improve Continuity of Care and Scientific Research

Clinical data have strong features of complexity and multi-disciplinarity. Clinical data are generated both from the documentation of physicians＇ interactions with the patient and by diagnostic systems. During the care process, a number of different actors and roles （physicians, specialists, nurses, etc.） have the need to access patient data and document clinical activities in different moments and settings. Thus, data sharing and flexible aggregation based on different users＇ needs have become more and more important for supporting continuity of care at home, at hospitals, at outpatient clinics. In this paper, the authors identify and describe needs and challenges for patient data management at provider level and regional- （or inter-organizational-） level, because nowadays sharing patient data is needed to improve continuity and quality of care. For each level, the authors describe state-of-the-art Information and Communication Technology solutions to collect, manage, aggregate and share patient data. For each level some examples of best practices and solution scenarios being implemented in the Italian Healthcare setting are described as well.

A study on building data warehouse of hospital information system

Background Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system. Methods To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers： datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information. Results Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making. Conclusions This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is required for further research.

Hospital management in China in a time of change

Chinese hospitals face complex challenges: allocating resources equitably and efficiently whilst moving to greater reliance on market mechanisms; maintaining quality despite declining government funding; exercising responsibility in some areas whilst tight government controls remain in others; and generating more revenue from user charges whilst ensuring access to care for the poor.

Network Structure and Reliability Analysis of a New Integrated Circuit Card Payment System for Hospital

This paper proposes a redundant network communication structure for the patient integrated circuit(IC)card payment system in a hospital information system(HIS),compares it with the network structure of normal hospital IC card system,and calculates the reliabilities of the related communications like the RS485communication and the Ethernet communication.The new structure can efectively promote the reliability of the hospital operation and ensure the payment collection when the Ethernet network is broken.The system is applied to a local hospital and the cost-performance rate is satisfactory during the application.

A project plan for construction and cabling of picture archiving and communication system network

Objective To determine a network solution to meet the network requirements of the heavy data flow, load balance, and potential network storms from expansion of picture archiving and communication system (PACS) application.Methods Intel Netstructure 480T Giga Switch was used as the main switch and connected to each building by fiber channel at 1 Giga speed to archive 100 MB/s to each port. At the same time, the in-dependence of the original network construction was physically kept. The layer 3 and 4 switchers were used as load balance to reduce the heavy load of the network, and all the cabling for PACS used the super CAT5 along with the Intel NetStructure 1520 to prepare for potential network storms.Results An advanced intranet was set up to fully meet the high standard requirement of the PACS. The foundation for upgrading the whole network system to 1 Giga application was built to achieve sharing and transmission of images, information, and patient data within the hospital. The base was established for the standardized management of the hospital.Conclusion Good planning is the first step in setting up PACS, and the equipment forms the necessary platform to run PACS and all kinds of hospital information system (HIS). The networking construction is the foundation of e-hospital.

Information Streams in Health Facilities: The Case of Uganda

With the prevailing COVID-19 pandemic, the lack of digitally-recorded and connected health data poses a challenge for analysing the situation. Virus outbreaks, such as the current pandemic, allow for the optimisation and reuse of data, which can be beneficial in managing future outbreaks. However, there is a general lack of knowledge about the actual flow of information in health facilities, which is also the case in Uganda. In Uganda, where this case study was conducted, there is no comprehensive knowledge about what type of data is collected or how it is collected along the journey of a patient through a health facility. This study investigates information flows of clinical patient data in health facilities in Uganda. The study found that almost all health facilities in Uganda store patient information in paper files on shelves. Hospitals in Uganda are provided with paper tools, such as reporting forms, registers and manuals, in which district data is collected as aggregate data and submitted in the form of digital reports to the Ministry of Health Resource Center. These reporting forms are not digitised and, thus, not machine-actionable. Hence, it is not easy for health facilities, researchers, and others to find and access patient and research data. It is also not easy to reuse and connect this data with other digital health data worldwide, leading to the incorrect conclusion that there is less health data in Uganda. The a FAIR architecture has the potential to solve such problems and facilitate the transition from paper to digital records in the Uganda health system.