Layperson Perceptions and Attitudes Towards a National Electronic Health Record Introduction in Saudi Arabia

Introduction: Since patients and the general public may interact with a national electronic health record (EHR), including them during implementation of an EHR is important. Such acceptance has been documented as one of the critical areas in the development of a national EHR. However, only a few studies have considered public perceptions and attitudes regarding use of their health information in a universal EHR. This is the first study that concentrated on Saudi patients and citizens’ attitudes regarding a national EHR. . Objectives: The purpose of this quantitative study was to understand perceptions and attitudes regarding the introduction of a national EHR among the Saudi citizenry. Methodology: This study used a cross-sectional survey, which was designed based on a literature review and interviews with a small subset of the target population. The final survey was distributed by hand as well as through the internet. Analysis: The data was analyzed by conducting descriptive, bivariate and logistic regression tests. Results: Most of the Saudi citizens supported the development of a national EHR system, which might be used for several services, such as healthcare, health services planning and health research. Twelve percent of respondents reported being undecided in their view and only 2% of them would be opposed to such a system. In terms of accessing health records in a national EHR, most were in favor of accessing their complete record. The study results also highlighted that more than 70% of respondents would be concerned about the security of their health record if it were to become part of a national EHR. The results also revealed significant differences in levels of support depending on sociodemographic characteristics. Working in health related jobs and level of education were important factors related to level of support for the development of a national EHR. Furthermore, it indicated that there is no significant relationship between preferences for access to a national EHR and demographic, education and health related characteristics. Conclusion: These findings support the need for expediting the incorporation of health information technology, especially an EHR in healthcare organizations in Saudi Arabia. Making a national EHR as an optimal goal before adoption of a local EHR in each healthcare institution will help to facilitate the complex implementation. Findings of this study can be generalized and extrapolated to other societies that have similar cultural factors. Furthermore, the results potentially benefit the policy makers in Saudi Arabia

Vortex of the Web. Potentials of the online environment

This volume compiles international contributions that explore the potential risks and chances coming along with the wide-scale migration of society into digital space. Suggesting a shift of paradigm from Spiral of Silence to Nexus of Noise, the opening chapter provides an overview on systematic approaches and mechanisms of manipulation – ranging from populist political players to Cambridge Analytica. After a discussion of the the juxtaposition effects of social media use on social environments, the efficient instrumentalization of Twitter by Turkish politicans in the course of the US-decision to recognize Jerusalem as Israel’s capital is being analyzed. Following a case study of Instagram, Black Lives Matter and racism is a research about the impact of online pornography on the academic performance of university students. Another chapter is pointing out the potential of online tools for the successful relaunch of shadow brands. The closing section of the book deals with the role of social media on the opinion formation about the Euromaidan movement during the Ukrainian revolution and offers a comparative study touching on Russian and Western depictions of political documentaries in the 2000s

Application of Lifetime Electronic Health Records: Are we ready yet?

Integrated care concepts can help to diminish demographic challenges. Therefore, the use of eHealth solutions is recognised as an efficient approach. Lifetime electronic health records (LEHRs) are expected to increase continuity, effectiveness, efficiency and thus quality of the care process. With respect to these benefits, an overarching implementation of LEHRs is desirable but non-existent. Hence, the aim of the article is to analyse the current LEHR implementation readiness of EU member states to derive implications for further LEHR research and development. Therefore, a case study on Denmark, Germany and Italy was conducted. The analysis shows that all countries fulfil the technical requirements but Denmark has great experiences and willingness to implement advanced eHealth measures like LEHRs. First Italian pilot projects are quite promising as well. The article paves the way for LEHR implementation and there with for integrated care

Complexities of health and acceptance of electronic health records for the Austrian elderly population

We examine the personal health situation and how the complexities thereof affect the elderly Austrians’ willingness to accept electronic health records (EHR). Using data from the sixth wave of the SHARE survey in Austria, we find the complexity of individual health problems and the social integration of individuals influencing the acceptance of EHR. The higher the degree of multimorbidity, the more medication is prescribed, and the higher the number of hospital admissions, the higher is the acceptance of EHR. Having a chronical illness has a positive effect on EHR acceptance, whereas a pessimistic attitude and lack of joy in life, as indicators of depressive mood, have a negative impact. The results are mainly driven by women and younger patients aged between 50 and 70. People with poor social connection express lower acceptance of EHR

Implementing Electronic Health Records in Germany: Lessons (Yet to Be) Learned

Introduction: Ensuring access to the right information at the right time can improve the safety, effectiveness and efficiency of care. A systematic and detailed collection of patient records, commonly known as electronic health records (EHRs), forms the core of the information system architecture in integrated health systems. Description: Since January 2021, seventeen years after the German legislation to implement EHRs (elektronische Patientenakte; ePA) came into force, the sickness funds in Germany have been offering their enrollees a downloadable application with which patients can access their personal EHRs through an electronic device. Looking at the ePA adoption process, it is now safe to argue that the deployment has been anything but successful. After two years of the launch, the number of ePA users amounts to not even 1% of the insured population in Germany, failing to move the needle on integrated care and health data integration. Based on a public policy theory, this article analyses the factors that are influencing the ePA implementation and secondary use of ePA data. Discussion: As the German experience shows, the feasibility of digital health projects depends on several contextual factors: countries with a high degree of self-governance and federal structures have to manage complex coordination processes that often slow down or otherwise impede digitalisation processes. In addition, cultural peculiarities such as concerns about data protection and security can be a hindering factor for digitalisation. Whereas the new German government and European initiatives such as the European Health Data Space (EHDS) create an advantageous situation for the ePA implementation and secondary use of health data, the structural and cultural issues in Germany should be acknowledged and tackled. Conclusion: Concerning the structural factors, a further reorganisation of the board of gematik, the key organisation of digital health solutions in Germany, should be considered. Cultural factors in Germany affect especially the secondary use of data; organising information campaigns, investing in (digital) health literacy of the population and designing a user-friendly ePA application are central in this context. Zusammenfassung Einleitung: Der Zugang zu den richtigen Informationen zur richtigen Zeit kann die Sicherheit, Wirksamkeit und Effizienz der Gesundheitsversorgung verbessern. Eine systematische und detaillierte Sammlung von Patientenakten, bekannt als Electronic Health Records (EHRs), bildet den Kern der Informationssystemarchitektur in integrierten Gesundheitssystemen. Beschreibung: Seit Januar 2021, siebzehn Jahre nach Inkrafttreten der deutschen Gesetzgebung zur Einführung der elektronischen Patientenakte (ePA), bieten die Krankenkassen eine zum Download verfügbare Anwendung an, mit der Patienten über ein elektronisches Gerät auf ihre persönliche elektronische Patientenakte zugreifen können; bisher jedoch mit wenig Erfolg. Zwei Jahre nach der Inbetriebnahme beläuft sich die Zahl der ePA-Nutzer auf weniger als 1 % der gesetzlich versicherten Bevölkerung in Deutschland; es ist also nicht gelungen, die integrierte Versorgung und Datenintegration voranzutreiben. Basierend auf einer politikwissenschaftlichen Theorie, werden in dieser Studie Faktoren analysiert, welche die ePA-Einführung und die sekundäre Nutzung von ePA-Daten beeinflussen. Diskussion: Wie die Erfahrungen mit der ePA in Deutschland zeigen, hängt die Umsetzbarkeit digitaler Gesundheitsprojekte von einer Vielzahl von kontextuellen Faktoren ab: Länder mit einem hohen Maß an Selbstverwaltung und föderalen Strukturen müssen komplexe Koordinationsprozesse bewältigen, die den Digitalisierungsprozess oft verlangsamen oder anderweitig behindern. Darüber hinaus können kulturelle Eigenheiten wie Datenschutz- und Sicherheitsbedenken die Digitalisierung behindern. Obwohl die neue Bundesregierung und europäische Initiativen, wie der Europäische Gesundheitsdatenraum (European Health Data Space; EHDS), die ePA-Implementierung und die Sekundärnutzung von Gesundheitsdaten begünstigen, sollten strukturelle und kulturelle Probleme in Deutschland berücksichtigt und angegangen werden. Schlussfolgerung: Im Hinblick auf die strukturellen Faktoren sollte eine weitere Umstrukturierung der gematik, des wichtigsten Entscheidungsorgans für digitale Gesundheitslösungen in Deutschland, in Betracht gezogen werden. Kulturelle Faktoren in Deutschland beeinflussen vor allem die Sekundärnutzung von Daten; in diesem Zusammenhang sind das Organisieren von Informationskampagnen, die Förderung der (digitalen) Gesundheitskompetenz der Bevölkerung und die Gestaltung einer nutzerfreundlichen ePA-Anwendung von zentraler Bedeutung. Schlüsselwörter: Elektronische Patientenakte; Akzeptanz von Innovationen; Verwaltung von Gesundheitsdaten; Integrierte Versorgung; Datenintegration; Nationales Gesundheitssystem; Deutschlan

A decade of the Swiss electronic vaccination record: Some insights based on an exploratory data analysis

Background: The importance of electronic health records (EHR) is apparent in the academic literature. An electronic vaccination record (EVR) is a particular type of EHR that aims to replace a traditional vaccination booklet. Purpose: This study investigates the adoption of the EVR by the Swiss population over the course of nearly a decade and shows what factors could be the potential reason for differences in the adoption of the EVR in different cantons. Method: An exploratory data analysis comprised of multiple data visualizations and cluster analysis was performed on a unique dataset collected from multiple sources. Main Findings: The overall rate of adoption was very limited (~3%) for the whole population in nearly a decade. The adoption had a noticeable rise in 2013, then a gradual decline till 2017 when the adoption took an increasing pattern onwards. Regional differences were found in the adoption of the Swiss EVR. These differences are very likely to be due to clear distinctions regarding pharmacies and physicians in those cantons. Conclusion: This study provides useful insights regarding the Swiss EVR that could be beneficial for the successful implementation of similar technological solutions

Pilot Evaluation of the Mexican Model of Dual TVET in the State of Mexico

Since the first public announcement of the Mexican Model of Dual TVET (MMFD) in June 2013, more than 5,000 apprentices have enrolled in the programme and around 2,000 already graduated. The Ministry of Education (SEP and CONALEP), the Chambers of Commerce (i.e. COPARMEX) and the German Cooperation Agencies (i.e. CAMEXA) have been collaborating with state authorities, families, schools and companies to turn this initial idea into a significant and sustainable initiative. Although the numbers are still small, it seemed necessary to undertake a pilot evaluation study of the implementation and impact of this program on its participants to inform those responsible for this policy. We decided to focus our study on the State of Mexico because of the higher number of apprentices in this state and because of the access that the CONALEP authorities gave us to the informants. The report that you are about to read is structured in four main sections. In the first one we reviewed the international evidence on the experiences of policy transfer of Dual TVET. Transferring international good practice sin TVET is always a complex process that requires careful attention to the experiences and lessons from those that tried to do it before. In the second section, we present the main characteristics of the Mexican Model of Dual TVET and the specificities of its implementation in the State of Mexico. In a federal country like Mexico, it is important to understand that national policies may largely vary across states in terms of design and implementation. The third section outlines the methodology of the study, which is inspired by the realist evaluation principles. Realist evaluation, not only tries to measure the impact of interventions on beneficiaries, but also to understand the causal mechanisms that explain why this policy is more effective in certain contexts and with certain beneficiary populations than in others. In the final section, the results of the interviews and the survey with 25 apprentices that completed their studies under the MMFD in the State of Mexico are presented. Obviously, the reduced sample of the study limits the representativeness of our findings but it will offer some expected and unexpected results that should not be ignored by those involved in this policy in the State of Mexico and nationally

Autonomy in nursing homes:Viewpoints of residents with physical impairments and staff

Introduction: Although the importance of maintaining autonomy for nursing home residents is recognised, little is known about this process in daily practice. Aim: The aim was to explore how residents maintain autonomy and how staff acts in relation to the autonomy of residents. Method: Shadowing, a non-participative observational method, including a short interview at the end, was used. Seventeen residents with physical impairments living in two different nursing homes were shadowed in their own environment during daily activities. Moreover, fifteen staff members, working in the same nursing homes, were shadowed. Field notes of the shadowing were typed out and the recorded interviews were transcribed verbatim resulting in a report per respondent. These were coded and thematically analysed. Results: Residents maintained autonomy by; ‘being able to decide and/or execute decisions’, ‘active involvement’, ‘transferring autonomy to others’, ‘using preferred spaces’, ‘choosing how to spend time in daily life’ and ‘deciding about important subjects’. Four activities of staff were identified; ‚getting to know each older adult as a person and responding to her/his needs‘, ‚encouraging an older adult to self-care‘, ‚stimulating an older adult to make choices‘ and ‚being aware of interactions‘. Discussion and Conclusion: Maintaining autonomy requires effort from both residents and staff. Although most residents with physical impairments experience restrictions in their autonomy because of the care-environment they live in, residents seemed to maintain autonomy in daily life. Moreover, staff consider it important to strengthen the autonomy of residents and use different activities to enhance autonomy. Relevance for research and practice: These insights help to improve autonomy of nursing home residents because the perspectives of both residents and staff are included. Therefore, the next step is to transfer these insights towards nursing home practice in such a way that it enhances staff and older adults to better maintain autonom