Information Systems and Health Care XIII: Examining the Critical Requirements, Design Approaches and Evaluation Methods for a Public Health Emergency Response System

Research pertaining to emergency response systems has accelerated over the past few years, particularly since 9/11 events, and more recently due to Hurricane Katrina and concern of the avian flu pandemic. This study examines the requirements that are the most demanding with respect to software and hardware, and the associated design strategies for a public health emergency response system (ERS) for electronic laboratory diagnostics consultation. In addition, this study illustrates ways to evaluate the design decisions. An important goal of a public health ERS is to improve the communication and notification of life-threatening diseases and harmful agents. The system under study is called Secure Telecommunications Application Terminal Package or STATPack. STATPack supports distributed laboratories to communicate information and make decisions regarding biosecurity situations. The intent of the system is to help hospital laboratories enhance their preparedness for a bioterrorism event or other public health emergency. The practical nature of this research concerns how an ERS diagnostic and consultation system was designed to alert and support first responders and Subject Matter Experts (SMEs). The academic nature of the research centers on the critical requirements of an ERS and how these unique needs can be met through careful design. Understanding the critical requirements will assist developers to better meet the expectations of the users. Specifically, I conducted a thirteen month study analyzing the requirements, design, and implementation of the system

Baseline study for improving diagnostic stewardship at secondary health care facilities in Nigeria

Background: Blood culture diagnostics are critical tools for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess reported sepsis case finding, blood culture diagnostics, antimicrobial susceptibility testing (AST) and antimicrobial use at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria. Methods: A cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, Federal Capital Territory (FCT) and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Data were then prospectively extracted on all patients with reported suspected sepsis from electronic medical records from selected departments at two facilities in the Federal Capital Territory from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests. Results: In the online survey, 32% (8/25) of facilities reported performing blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, the incidence of suspected sepsis cases reported was 7.1% (2924/41066). A majority of these patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]: 7.5, 95% CI: 4.6–12.3) and patients from the urban health care facility (aOR:16.9, 95% CI: 8.1–41.4) were significantly more likely to have a blood culture requested. Conclusion: Low blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care, AMR surveillance and antibiotic use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.Peer Reviewe

A manifesto for a socio-technical approach to NHS and social care IT-enabled business change - to deliver effective high quality health and social care for all

80% of IT projects are known to fail. Adopting a socio-technical approach will help them to succeed in the future. The socio-technical proposition is simply that any work system comprises both a social system (including the staff, their working practices, job roles, culture and goals) and a technical system (the tools and technologies that support and enable work processes). These elements together form a single system comprising interacting parts. The technical and the social elements need to be jointly designed (or redesigned) so that they are congruent and support one another in delivering a better service. Focusing on one aspect alone is likely to be sub-optimal and wastes money (Clegg, 2008). Thus projects that just focus on the IT will almost always fail to deliver the full benefits

ASM LabCap’s contributions to disease surveillance and the International Health Regulations (2005)

The revised International Health Regulations [IHR(2005)], which requires the Member States of the World Health Organization (WHO) to develop core capacities to detect, assess, report, and respond to public health threats, is bringing new challenges for national and international surveillance systems. As more countries move toward implementation and/or strengthening of their infectious disease surveillance programs, the strengthening of clinical microbiology laboratories becomes increasingly important because they serve as the first line responders to detect new and emerging microbial threats, re-emerging infectious diseases, the spread of antibiotic resistance, and the possibility of bioterrorism. In fact, IHR(2005) Core Capacity #8, “Laboratory”, requires that laboratory services be a part of every phase of alert and response

Report to Congress on internal laboratory activities of CDC and associated funding levels

Thomas R. Frieden."5/8/2012" - date from document propertiesTitle from title frame of pdf file; viewed 29 May 2012."In Senate Report 112-84, which accompanied the Fiscal Year (FY) 2012 appropriations bill for the U.S. Departments of Health and Human Services, Labor, Education, and related agencies, the Senate Committee on Appropriations stated, 'The Committee requests a report to Congress no later than 120 days after the enactment of this act that details CDC's various internal laboratory activities and associated funding levels.' The Centers for Disease Control and Prevention (CDC) has prepared this report in response to the committee's request. The body of the report is organized into 21 sections that correspond with the standard format of the CDC budget documents with which the Committee is familiar. Each section addresses a specific CDC budget activity and its associated internal laboratory activities. The report encompasses the majority of CDC's laboratory activities. Relevant definitions and descriptions of laboratory activities not addressed appear in the Explanation and Definition of CDC's Laboratory Activities section that follows." - p. [1]Mode of access: Internet via the World Wide Web as an Acrobat .pdf file (1.94 MB, 49 p.)

How research can support efforts to control avian flu in developing countries: first steps towards a research action plan

Report of an international consultation — The Research Community’s Response to Avian Influenza, with Special Reference to the Needs of Developing Countries, held 14-16 June 2006 in Nairobi, Kenya — organised by the International Food Policy Research Institute (IFPRI) and the International Livestock Research Institute (ILRI)

POCT Testing and Importance of Operator Lock-out

Point-of-Care Testing (POCT) is usually performed at the patient’s bedside by healthcare providers other than laboratory- trained professionals. Rapid growth of POCT is supported by numerous factors which include healthcare provider efficiency, improving diagnostic insight and better patient outcomes. This project study is done to make sure POCT users have adequate training to ensure and enhance the quality and patient safety. The individual performing these tests to be trained properly before he/she is approved to operate the POC devices. One method to ensure POCT operators have met the required training is the lock out approach which will not allow them to perform testing until they have completed the required training. The more recent POCT devices have built in operator lock-out features. This added feature of lock-out alerts the user of the operational time lag. Non-competent users can be locked out with the help of this software and this will ensure an un-trained user will not perform testing. The operator lock-out minimizes error, ensures patient safety and is an important feature for quality control improvement. In this study, we conducted surveys with health care providers who perform POCT in two hospitals: University of California at San Francisco (UCSF) and San Francisco General Hospital (SFGH). The result of the study showed operators of the POCT devices were interested in ensuring proper training and competency of the operators. They were interested in having a lock out process and the ability to use an emergency release code during an emergency situation so that the testing can be done in a timely method. Maintaining a valid competency for all operators through a competency assessment plan and a continuous educational program will ensure un-interrupted services to the needed patients and avoid the use of the lock-out feature. Providing a special code to be used by locked-out operator during emergencies, is an added benefit to the patient care. The future is promising with this technology, so it is important to have a good system in place. Operator lock-out is a safeguard to the patient care beside it is a compliance and one of the quality improvement tool