بررسی مشکلات و موانع موجود در پیاده سازی سیستم آرشیو و انتقال تصاویر پزشکی (PACS) در بیمارستان امام خمینی ارومیه

زمینه و هدف: سیستم آرشیو و انتقال تصاویر (PACS) امکان ذخیره سازی و ارسال تصاویر پزشکی را بصورت الکترونیکی در واحدهای مختلف مراکز آموزشی درمانی فراهم می سازد. هدف اساسی این مطالعه تعیین مشکلات و موانع موجود در پیاده سازی PACS در بیمارستان امام خمینی ارومیه بود. مواد و روشها: در این مطالعه توصیفی 88 نفر از پزشکان،پرستاران بخشها ، پرتو کاران، کارکنان مدارک پزشکی و مدیران اجرائی بیمارستان امام خمینی ارومیه مورد بررسی قرار گرفتند. حجم نمونه منطبق بر حجم جامعه بوده و از روش سرشماری در نمونه گیری استفاده گردید. گردآوری داده ها بوسیله دو پرسشنامه صورت گرفت. روایی پرسشنامه ها از طریق روایی محتوا و پایائی آنها از روش آزمون- بازآزمون تعیین گردید با استفاده از این پرسشنامه ها چهارحوزه: نیروی انسانی، مدیریتی، سازمانی و عوامل تکنولوژیکی مورد ارزیابی قرار گرفت. نتایج با استفاده از آمار توصیفی مورد تجزیه و تحلیل قرار گرفت. نتایج: نتایج در چهار محور مورد بررسی در این تحقیق نشان داد که میزان آشنایی کارکنان و مدیران با مفهوم PACS به ترتیب 43/1 و 83/3 درصد بود. یافته ها همچنین میزان استقبال کارکنان و مدیران از پیاده سازی چنین سیستمی را به ترتیب 80 و66/7 درصد نشان داد. مشخص شد که هم مدیران و هم کارکنان عدم آگاهی دست اندرکاران اجرائی بیمارستان از مزایای PACS را مهم ترین مانع در پیاده نشدن PACS عنوان کرده بودند. نتیجه گیری: با توجه به پیشرفت حوزه انفورماتیک پزشکی و کاربردهای سیستم های اطلاعاتی بهداشتی ضروری است که مدیران اجرائی از ورود این گونه سیستم ها در بیمارستانها استقبال نمایند

Digital health policy and programs for hospital care in Vietnam: scoping review

Background: There are a host of emergent technologies with the potential to improve hospital care in low- and middle-income countries such as Vietnam. Wearable monitors and artificial intelligence–based decision support systems could be integrated with hospital-based digital health systems such as electronic health records (EHRs) to provide higher level care at a relatively low cost. However, the appropriate and sustainable application of these innovations in low- and middle-income countries requires an understanding of the local government’s requirements and regulations such as technology specifications, cybersecurity, data-sharing protocols, and interoperability. Objective: This scoping review aims to explore the current state of digital health research and the policies that govern the adoption of digital health systems in Vietnamese hospitals. Methods: We conducted a scoping review using a modification of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. PubMed and Web of Science were searched for academic publications, and Thư Viện Pháp Luật, a proprietary database of Vietnamese government documents, and the Vietnam Electronic Health Administration website were searched for government documents. Google Scholar and Google Search were used for snowballing searches. The sources were assessed against predefined eligibility criteria through title, abstract, and full-text screening. Relevant information from the included sources was charted and summarized. The review process was primarily undertaken by one researcher and reviewed by another researcher during each step. Results: In total, 11 academic publications and 20 government documents were included in this review. Among the academic studies, 5 reported engineering solutions for information systems in hospitals, 2 assessed readiness for EHR implementation, 1 tested physicians’ performance before and after using clinical decision support software, 1 reported a national laboratory information management system, and 2 reviewed the health system’s capability to implement eHealth and artificial intelligence. Of the 20 government documents, 19 were promulgated from 2013 to 2020. These regulations and guidance cover a wide range of digital health domains, including hospital information management systems, general and interoperability standards, cybersecurity in health organizations, conditions for the provision of health information technology (HIT), electronic health insurance claims, laboratory information systems, HIT maturity, digital health strategies, electronic medical records, EHRs, and eHealth architectural frameworks. Conclusions: Research about hospital-based digital health systems in Vietnam is very limited, particularly implementation studies. Government regulations and guidance for HIT in health care organizations have been released with increasing frequency since 2013, targeting a variety of information systems such as electronic medical records, EHRs, and laboratory information systems. In general, these policies were focused on the basic specifications and standards that digital health systems need to meet. More research is needed in the future to guide the implementation of digital health care systems in the Vietnam hospital setting

Improving access to ultrasound imaging in northern, remote communities

Access to healthcare services—including access to medical imaging—is an important determinant of health outcomes. This thesis aims to improve understanding of and address gaps in access to ultrasound imaging for patients in northern, remote communities, and advance a novel ultrasound technology with the ultimate goal of improving patient care and health outcomes. This thesis first brings greater understanding of patients’ perceptions of access and factors which shape access to ultrasound imaging in northern, remote communities in Saskatchewan, Canada. A qualitative study was performed using interpretive description as a methodological approach and a multi-dimensional conceptualization of access to care as a theoretical framework. The study identified barriers which patients in northern, remote communities face in accessing ultrasound imaging, and demonstrated that geographic remoteness from imaging facilities was a central barrier. To determine whether disparities in access to ultrasound imaging resulted in disparities in utilization of ultrasound services, two population-based studies assessed the association between sociodemographic and geographic factors and obstetrical and non-obstetrical ultrasound utilization in Saskatchewan. In the first study investigating obstetrical ultrasound utilization, multivariate logistic regression analysis demonstrated that women living in rural areas, remote areas, and low income neighbourhoods, as well as status First Nations women, were less likely to have a second trimester ultrasound, an important aspect of prenatal care. In a second study investigating non-obstetrical ultrasound utilization across the entire provincial population, multivariate Poisson regression analysis similarly demonstrated lower rates of non-obstetrical ultrasound utilization among individuals living in rural and remote areas, individuals residing in low income neighbourhoods, and status First Nations persons. To address the barriers which patients in northern, remote communities face in accessing ultrasound imaging and to minimize disparities in ultrasound imaging utilization as identified in previous studies in this thesis, telerobotic ultrasound technology was investigated as a solution to improve access to ultrasound imaging. Using this technology, radiologists and sonographers could remotely manipulate an ultrasound probe via a robotic arm, thereby remotely performing an ultrasound exam while patients remained in their home community. A clinical trial comparing conventional and telerobotic ultrasound approaches was undertaken, validating this technology for obstetrical ultrasound imaging. To determine the feasibility of using telerobotic technology to establish an ultrasound service delivery model to remotely provide diagnostic ultrasound exams in underserved communities, pilot telerobotic ultrasound clinics were developed in three northern, remote communities. Telerobotic ultrasound exams were sufficient for diagnosis in the majority of cases, minimizing travel or reducing wait times for these patients. This technology was subsequently evaluated during a COVID-19 outbreak in northern Saskatchewan, demonstrating the potential of this technology to provide critical ultrasound services to an underserved northern population and minimize health inequities during the COVID-19 pandemic. An economic evaluation was performed to compare a service delivery model using telerobotic ultrasound technology to alternative service delivery models. Telerobotic ultrasound combined with an itinerant sonographer service was found to be the lowest cost option from both a publicly funded healthcare payer perspective and a societal perspective for many northern, remote communities. This thesis provides key insights for health system leaders seeking improved understanding and novel solutions to improve access to ultrasound imaging in northern, remote communities. Findings suggest that telerobotic ultrasound is a viable solution to improve access to ultrasound imaging and reduce costs associated with ultrasound service delivery. Evidence in this thesis may be used to help improve ultrasound services and health equity for patients in underserved northern, remote communities. Continued respectful collaboration with northern, remote, Indigenous peoples and communities will be a critical aspect to ensure that ultrasound services meet community needs

Investigating factors that hinder the adoption and use of primary healthcare information systems (phcis) in the western cape of South Africa

Magister Commercii (Information Management) - MCom(IM)In the past, the Western Cape Department of Health had no formal or technologically enabled system for patient administration. This resulted in an administrative burden, increased waiting times for patients and doctors who needed results back from other sections, and missing patient files within the community health institutions such as clinics and hospitals. The Primary Healthcare Information System (PHCIS) was developed to solve this problem. However, it was later discovered that even though the PHCIS had been installed across the Western Cape clinics, there was a limited adoption and use of the PHCIS. Hence, the aim of this study was to investigate the factors that hinder the adoption and use of PHCIS by healthcare workers in the public healthcare clinics in the Khayelitsha sub-district in the Western Cape Provinc