Provider perspectives on sexual health services used by Bangladeshi women with mHealth digital approach : a qualitative study

Cases of sexually transmitted infections (STIs) are underreported in Bangladesh. Women in general suffer from poor sexual health outcomes due to a lack of access to sexual health services. mHealth, a digital approach to STI services, is an easier and cheaper way to disseminate health information in Bangladesh. However, women have less autonomy in accessing STI services and it is important to learn if, how and/or why women use mHealth. A qualitative study was conducted with 26 medical doctors to explore their perceptions of the mHealth STI services used by Bangladeshi women. Themes were grouped under four categories: (1) provider perceptions of mHealth for sexual healthcare; (2) the health literacy of women clients; (3) cost and maintaining timeliness in providing mHealth services; (4) mHealth service accessibility. Data suggest that mHealth can play a significant role in improving the awareness and utilization of STI services in Bangladeshi women. Successful opportunities for STI service expansion using mHealth were identified, depending on the quality and type of service delivery options, awareness of challenges related to health literacy framework, cost, accessibility to information and availability of culturally competent health experts to disseminate health information. We identify the need to increase access and use of mHealth services for sexual health, as it provides an innovative platform to bridge the health communication gaps in sexual health for Bangladeshi women

Effects of critical success factors on maturity level of Hospital information systems

Hospitals are regarded as the most important part of a healthcare system. Generally, hospitals use Hospital Information System (HIS) as an infrastructure for recording, retrieval, and transmission of data, facilitation of decision-making processes, and other healthcare-related functions. An issue in HIS is that the implementation of the system in hospitals has always been associated with a high risk of failure. This study, therefore, aims to first assess the maturity of HIS in Iranian hospitals and then, examine the related Critical Success Factors (CSF) in order to mitigate the implementation risks of HISs to the authorities. Eleven hospitals under the administration of Medical University of Isfahan, Iran, were selected. Data was collected through a checklist designed based on Electronic Medical Record Adoption Model (EMRAM) expectations. Questionnaires were distributed to employees of the eleven identified hospitals using stratified sampling method in which 126 completed questionnaires were returned. The results revealed that all of the hospitals have reached to elementary stages of (EMRAM). In addition, 26 CSFs were found to be effective in HIS implementation success in the hospitals but some factors were found to be higher in the level of effectiveness. The findings were then evaluated by 14 experts who are familiar with the selected hospitals, the HIS concept and project implementation. The final results which included a comprehensive picture about the initial maturity status of HIS and also 12 more effective CSFs for successful implementation of HIS in the hospitals can provide guidance for hospital top managers and healthcare policy makers in developing appropriate strategic IT plans and HIS implementation frameworks

Σχεδιασμός και ανάπτυξη βάσης δεδομένων ασθενών με νευρολογικές και μυοσκελετικές παθήσεις σε κέντρο αποκατάστασης και αποθεραπείας

Εισαγωγή: Η υιοθέτηση και προώθηση της τεχνολογίας των πληροφοριών και επικοινωνιών (ΤΠΕ), συμπεριλαμβανομένου του συστήματος ηλεκτρονικών ιατρικών αρχείων, στις υπηρεσίες υγείας αυξάνεται με ταχύ ρυθμό στις περισσότερες χώρες παγκοσμίως. Οι νέες τεχνολογικές εξελίξεις δημιουργούν μια πληροφοριακή υποδομή η οποία ανταποκρίνεται πλήρως στις απαιτήσεις των χρηστών με στόχο να επιτευχθεί καλύτερη υποστήριξη στον τομέα της Υγείας Σκοπός: Η συγκεκριμένη εργασία επικεντρώνεται στην υλοποίηση και εφαρμογή ενός διαδικτυακού συστήματος βάσεων δεδομένων. Σκοπός της παρούσας διπλωματικής εργασίας είναι η διαχείριση της κλινικής πληροφορίας των ασθενών που επισκέπτονται το πρότυπο κέντρο αποκατάστασης με την εφαρμογή, την ανάπτυξη και τη σχεδίασης ενός ευέλικτου μοντέλου για την εύκολη πρόσβαση των εμπλεκόμενων επαγγελματιών υγείας κ την ταυτοποίηση των ασθενών . Μεθοδολογία: Πρόκειται για μία ερμηνευτική μελέτη περίπτωση, κατά την οποία συλλέχθηκαν δεδομένα από τους χρήστες και τους διαχειριστές του συστήματος χρησιμοποιώντας εις βάθος ημιδομημένες συνεντεύξεις ανοιχτού τύπου , παρατηρήσεις και επικεντρωμένες ομαδικές συζητήσεις με τη μεθοδολογία focus group.Μεγάλη βαρύτητα δόθηκε στην αρχιτεκτονική πρόταση υλοποίησης της εφαρμογής αξιοποιώντας τις τεχνολογικές προσεγγίσεις περί ανάπτυξης συστημάτων βασισμένων στην αξιοποίηση ανοιχτών τεχνολογιών. Το μοντέλο κύκλοι ζωής λογισμικού που υιοθετήθηκε για την παρούσα εφαρμογή είναι αυτό του καταρράκτη που ανήκει στις μεθοδολογίες δομημένης σχεδίασης .Προκειμένου να πραγματοποιηθεί η ανάλυση των απαιτήσεων πραγματοποιήθηκε εκτενής μελέτη των διαδικασιών του κέντρου αποκατάστασης ,έγινε χρήση της γλώσσας UMLκαι προέκυψε το διάγραμμα Οντοτήτων –Συσχετίσεων (EER) της βάσης δεδομένων.Introduction: The adoption and promotion of Information and Communication Technology (ICT), including Electronic Health Records (EHR) system, in healthcare delivery is growing rapidly in most countries worldwide. The new technological developments have established a type of information system that fully satisfies the needs of its users so that a better support system can be achieved in the Health sector. Aim: This assignment focuses on the materialization and application of an internet data based system. The aim of this dissertation is the clinical data management of patients who visit a standard rehabilitation center with the application, development and design of a flexible model to facilitate the access of all professionals and practitioners of the health sector to it. Methods: It is about an interpretative study case, in which data of patients and users of the system have been collected with the use of open type- semi structured interviews, observations as well as thematically-linked based discussions with the methodology of focus-group. A particular interest was given to the architectural proposal regarding the utilization of the application by exploiting the technological approaches of systems development based on the use of new open technologies. The life span of the software model adopted for this case is that of ‘waterfall’, which belongs to structural designed methodologies. To achieve an optimum result of the study demands, a detailed analysis of the procedures of the rehabilitation center was conducted, with the use of UML language leading to the EER diagram(the Enhanced Entity-Relationship) of the data base

A model on factors affecting nurses adoption of health information technology

Healthcare organisations are using Health Information Technology (HIT) to improve efficiency, reduce cost and reduce medical errors. This study focused on the factors that influence the acceptance of HIT among nurses in Saudi hospitals. This research used a 6 stage mixed-methods research approach. Literature was used to search for established models and frameworks of technology acceptance, and the many factors that could play a role. In the field study, the nature of practical HIT issues at the Prince Sultan Military Medical City (PSMMC) and the Heraa Hospital were studied, and combined with literature to create a HIT Implementation Issues Framework. The framework consolidates elements from the Technological, Organisational, Environmental and Human dimensions. The researcher participated in further PSMMC projects in the design and implementation of the new Cardio Pulmonary Resuscitation System and the Nurses and Pharmacists’ Communication System. From the implementation experience, pertinent factors were added to the Technology Acceptance Model and the “Nurses Acceptance Model” was proposed. The proposed model has eleven independent parameters, two dependent parameters, as well as seven moderators of key relationships. A questionnaire with 71 entries was distributed to over 2800 nurses in 52 wards in PSMMC. SPSS was used for data screening and descriptive statistics. The SmartPLS software was used for analysis and testing of the proposed hypotheses. The findings refined the “Nurses Acceptance Model” and highlight the significance of User Involvement and Training. The “Nurses Acceptance Model” enhances the scientific understanding of variables that affect technology acceptance among nurses in Saudi hospitals. The HIT Implementation Issues Framework helps hospital decision makers to plan HIT projects to improve the likelihood of successful adoption

Issues of the adoption of HIT related standards at the decision-making stage of six tertiary healthcare organisations in Saudi Arabia

Due to interoperability barriers between clinical information systems, healthcare organisations are facing potential limitations with regard to acquiring the benefits such systems offer; in particular, in terms of reducing the cost of medical services. However, to achieve the level of interoperability required to reduce these problems, a high degree of consensus is required regarding health data standards. Although such standards essentially constitute a solution to the interoperability barriers mentioned above, the level of adoption of these standards remains frustratingly low. One reason for this is that health data standards are an authoritative field in which marketplace mechanisms do not work owing to the fact that health data standards developed for a particular market cannot, in general, be applied in other markets without modification. Many countries have launched national initiatives to develop and promote national health data standards but, although certain authors have mapped the landscape of the standardisation process for health data in some countries, these studies have failed to explain why the healthcare organisations seem unwilling to adopt those standards. In addressing this gap in the literature, a conceptual model of the adoption process of HIT related standards at the decision-making stage in healthcare organisations is proposed in this research. This model was based on two predominant theories regarding IT related standards in the IS field: Rogers paradigm (1995) and the economics of standards theory. In addition, the twenty one constructs of this model resulted from a comprehensive set of factors derived from the related literature; these were then grouped in accordance with the Technology-Organisation Environment (TOE), a well-known taxonomy within innovation adoption studies in the IS field. Moving from a conceptual to an empirical position, an interpretive, exploratory, multiple-case study methodology was conducted in Saudi Arabia to examine the proposed model. The empirical qualitative evidence gained necessitated some revision to be made to the proposed model. One factor was abandoned, four were modified and eight new factors were added. This consistent empirical model makes a novel contribution at two levels. First, with regard to the body of knowledge in the IS area, this model offers an in-depth understanding of the adoption process of HIT related standards which the literature still lacks. It also examines the applicability of IS theories in a new area which allows others to relate their experiences to those reported. Secondly, this model can be used by decision makers in the healthcare sector, particularly those in developing countries, as a guideline while planning for the adoption of health data standards

MATURITY MODEL FOR HEALTHCARE CLOUD SECURITY

Management of security across eHealth cloud services is a major organizational challenge that healthcare organizations seek to resolve in order to aid their trusts in cloud and increase the adoption of cloud services in healthcare. The organizational challenges regarding implementations of technical security solutions are the major limiting factors for the adoption of the eHealth cloud. As such, the aim of this research will focus on developing a security maturity model, which will help healthcare organizations to provide a description of the application of their cloud security services, and an assessment and improvement of their cloud security services over time, as well as to guide and educate relevant stakeholders concerning the optimization of their security practices. The identified gaps in the review are in the aspect of adoption – the maturity models are either too complicated to implement, or they require the healthcare organization’s processes to be refined to suit the maturity model’s implementation. The Maturity Model for Healthcare Cloud Security (M2HCS) was developed using the Design Science Research Methodology (DSRM). It was validated using a formulated case study, web-based survey and interviews with practitioners, DSRM framework, and feedback from scientific community. The novel contribution of this research is the proposal of the model. M2HCS is a high level, holistic model that can be used to support and promote healthcare organization’s usable security practices against cyber and cloud security attacks

‘The Going Digital Study’ – The implementation of electronic patient records in a paediatric tertiary hospital: Understanding the benefits and challenges for patients, parents and staff and the practical, ethical and legal implications

BACKGROUND: The Going Digital Study uniquely captured the experiences of all user groups before and after digital transformation of Great Ormond Street Hospital for Children (GOSH) whilst implementing an electronic patient record (EPR) system with a tethered patient portal in April 2019. This was critical and core to GOSH becoming a digital hospital, with benefits anticipated, yet challenges for all. AIM: To investigate the practical, ethical and legal considerations of implementing an EPR in a children’s tertiary hospital involving three stakeholder groups: children and young people (CYP), parents and staff. METHODS: A three phase, concurrent mixed methods, pre/post study design was utilised including both quantitative (survey) and qualitative (World Café workshops/interviews/focus group) data collection, analysis and synthesis. A systematic review of the literature was also conducted and was key to informing the examination of the experiences of users of an electronic patient record system in a children’s hospital setting and interpretation of the findings. RESULTS: Despite the challenges experienced by all stakeholders, including ethical and legal issues associated with CYP and parents accessing health data for the first time through the patient portal, meaningful portal access can be achieved from the age of 12 years of age. Families need support accessing health information via the portal. Clinicians need to have early conversations with parents about truth-telling and sharing diagnoses and/or prognoses, supporting families through the process of disclosure. Staff need prolonged support to balance clinical demands during implementation of and adjustment to the new clinical system, whilst continuing care provision and managing families’ expectations. CONCLUSION: Implementation and transition to an EPR system with a tethered patient portal is complex and takes time to embed. Setting realistic expectations and involving all stakeholders at all stages is paramount if benefits for all are to be fully realised. Managing this change process well, with prolonged engagement over time with all stakeholders, is essential if future utility is to be achieved. This requires an inclusive culture, in which the voice of all children and young people and parents is valued, and enabled through investment of appropriate resources, with equity of access a key priority

The development and implementation of e-health services for the Libyan NHS: case studies of hospitals and clinics in both urban and rural areas

This thesis provides an assessment of the readiness levels within both urban and rural hospitals and clinics in Libya for the implementation of E-health systems. This then enabled the construction of a framework for E-health implementation in the Libyan National Health Service (LNHS). The E-health readiness study assessed how medications were prescribed, how patients were referred, how information communication technology (ICT) was utilised in recording patient records, how healthcare staff were trained to use ICT, and how the ways in which consultations were carried out by healthcare staff. The research was done in five rural clinics and five urban medical centres and focused on the E-health readiness levels of the technology, social attitudes, engagement levels and any other needs that were apparent. Collection of the data was carried out using a mixed methods approach with qualitative interviews and quantitative questionnaires. The study indicated that any IT equipment present was not being utilised for clinical purposes and there was no evidence of any E-health technologies being employed. This implies that the maturity level of the healthcare institutions studied was at level zero in the E-health maturity model used in this thesis. In order for the LNHS to raise its maturity levels for the implementation of E-health systems, it needs to persuade LNHS staff and patients to adopt E-health systems. This can be carried out at a local level throughout the LNHS, though this will need to be coordinated at a national level through training, education and programmes to encourage compliance and providing incentives. In order to move E-health technology usage in the participating Libyan healthcare institutions from Level 0 to Level 2 in the E-health Maturity Model levels, an E-health framework was created that is based on the findings of this research study. The primary aim of the LNHS E-Health Framework is the integration of E-health services for improving the delivery of healthcare within the LNHS. To construct the framework and ensure that it was creditable and applicable, work on it was informed directly by the findings from document analysis, literature review, and expert feedback, in conjunction with the primary research findings presented in Chapter Five. When the LNHS E-Health Framework was compiled there were several things taken into consideration, such as: the abilities of healthcare staff, the needs of healthcare institutions and the existing ICT infrastructure that had been recorded in the E-readiness assessment which was carried out in the healthcare institutions (Chapter 5). The framework also provides proposals for E-health systems based on the infrastructure network that will be developed. The processes addressed are electronic health records, E-consultations, E-prescriptions, E-referrals and E-training. The researcher has received very positive, even enthusiastic, feedback from the LNHS and other officals, and that expect the framework to be further developed and implemented by the LNHS in the near future

JoinSTNassistant Framework: An Agile Holistic Framework for Assisting Decision in Healthcare Facilities to Join Saudi Telemedicine Network

In 2011, the Saudi Arabian Ministry of Health (MOH) launched the Saudi Telemedicine Network (STN) as the first national project for telemedicine in the KSA, which is planned to be completed by 2020. The benefits associated with the STN will only be realised through its successful implementation within the Healthcare Facilities (HCFs) across the Kingdom of Saudi Arabia (KSA). There is a high failure rate of implementation projects of telemedicine within other countries (approximately 75% globally, and 90% in developing countries). Furthermore, there is high failure rate of implementation projects of complex Health Information Technology (HIT) systems within HCFs of the KSA (roughly 80%). These dramatic statistics demonstrate the great need for a suitable framework to assist the STN implementation and increase the likelihood of its successful implementation. Prior studies have asserted that there could not be a one-size-fits-all framework that could be applicable and used by all countries for assisting the implementation of telemedicine. To the best of our knowledge, there is not any existing framework that has been specifically developed for assisting the STN implementation. Thus, this research is aimed at developing a novel, agile, holistic framework, referred to as “JoinSTNassistant Framework”, aimed to assist HCFs across the KSA regarding their organisational decision to join the STN. It must be ensured that this JoinSTNassistant Framework is theoretically rigorous, as well as relevant specifically to the context and the needs of the KSA, its HCFs, and the STN roadmap. Therefore, the JoinSTNassistant Framework has been developed through three-sequential phases. The First Phase of development defines and applies the theoretical and philosophical foundations of the JoinSTNassistant Framework. In this First Phase, 56-selected studies from an extensive literature review were analysed. The Second and Third phases of development reflect the practical and pragmatic requirements of the JoinSTNassistant Framework. These two phases must be considered as two stages of validation of the findings of the First Phase, involving as many potential users as possible in the development of the Framework, so as to ensure that it reflects their expectations and meets their needs. The Second Phase of development involved interviews with 81 strategic-level decision makers of HCFs within the KSA. The Third Phase implemented an even higher level of validation, involving as many as 905 potential users, forming a representative sample size of the decision makers of all HCFs across the KSA. In addition, a web-based application (i.e., Portal) for the JoinSTNassistant Framework, referred to as “JoinSTNassistant Portal” was developed for modifying and adjusting the JoinSTNassistant Framework in order to be applicable for each one of HCFs across the KSA, for assisting and guiding them in reaching a decision to join the STN. This research is part of the STN project and is collaborating with the National eHealth Strategy and Change Management Office in the MOH of KSA, and with the STN agency, who is the sponsor and the owner of the STN project