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

Using information from electronic patient records for clinical, epidemiological and health services research

Background: Improving current and future healthcare is heavily reliant on continuous research and the secondary use of data from patients' medical records, particularly from electronic records. Considerable amounts of data are collected during the care and treatment of a patient, and this data can offer many opportunities, not only for supporting and improving individual patient care or making important contributions to research, but also for investigating causes of diseases, establishing the prevalence of risk factors, and identifying populations at risk of adverse outcomes. However, the management of such data poses challenges, which many believe can be mitigated by storing it electronically. The traditional method of storing medical information in a paper-based format has severe limitations, especially concerning the amount of effort needed to extract information. In contrast, data from electronic patient records (EPRs) is much easier to extract and allows healthcare professionals access to the information needed in a timely manner to provide appropriate care to patients and improve the public’s health. The UK still faces the hurdle of balancing public interest with individual privacy. There is clearly a benefit regarding the use of EPRs but there is an increasing need for public education in order to be able to reap the maximum benefits they offer. This thesis examines the benefits and impact of EPRs in the contexts of clinical care and epidemiological and health services research. Methods: The methods used for this research project involved reviewing published materials available through electronic searching, grey literature and websites of bodies such as the Department of Health, and the Health and Social Care Information Centre. The use of the main national primary care databases and secondary care databases and their growth over time was also examined. Results: EPRs are extremely beneficial to research and have a significant potential to improve patient overall care. The use of EPRs is growing as technology advances and health systems move from paper to electronic records. Conclusions: The use of EPRs will only be successful when both the public, researchers and healthcare providers agree on their benefits. The use of EPRs will take healthcare to another level, where the accuracy of data entered is of very high quality and standardised, data security is well-controlled, and there is acceptance by the public concerning the use of their data both for providing clinical care and for other secondary uses.Open Acces

DICOM metadata: a useful resource for big data analytics

Postprint (published version

A framework for development of android mobile electronic prescription transfer applications in compliance with security requirements mandated by the Australian healthcare industry

This thesis investigates mobile electronic transfer of prescription (ETP) in compliance with the security requirements mandated by the Australian healthcare industry and proposes a framework for the development of an Android mobile electronic prescription transfer application. Furthermore, and based upon the findings and knowledge from constructing this framework, another framework is also derived for assessing Android mobile ETP applications for their security compliance. The centralised exchange model-based ETP solution currently used in the Australian healthcare industry is an expensive solution for on-going use. With challenges such as an aging population and the rising burden of chronic disease, the cost of the current ETP solution’s operational infrastructure is certain to rise in the future. In an environment where it is increasingly beneficial for patients to engage in and manage their own information and subsequent care, this current solution fails to offer the patient direct access to their electronic prescription information. The current system also fails to incorporate certain features that would dramatically improve the quality of the patient’s care and safety, i.e. alerts for the patient’s drug allergies, harmful dosage and script expiration. Over a decade old, the current ETP solution was essentially designed and built to meet legislation and regulatory requirements, with change-averting its highest priority. With little, if any, provision for future growth and innovation, it was not designed to cater to the needs of the ETP process. This research identifies the gap within the current ETP implementation (i.e. dependency on infrastructure, significant on-going cost and limited availability of the patient’s medication history) and proposes a framework for building a secure mobile ETP solution on the Android mobile operating system platform which will address the identified gap. The literature review part of this thesis examined the significance of ETP for the nation’s larger initiative to provide an improved and better maintainable healthcare system. The literature review also revealed the stance of each jurisdiction, from legislative and regulatory perspectives, in transitioning to the use of a fully electronic ETP solution. It identified the regulatory mandates of each jurisdiction for ETP as well as the security standards by which the current ETP implementation is iii governed so as to conform to those regulatory mandates. The literature review part of the thesis essentially identified and established how the Australian healthcare industry’s various prescription-related legislations and regulations are constructed, and the complexity of this construction for eTP. The jurisdictional regulatory mandates identified in the literature review translate into a set of security requirements. These requirements establish the basis of the guiding framework for the development of a security-compliant Android mobile ETP application. A number of experimentations were conducted focusing on the native security features of the Android operating system, as well as wireless communication technologies such as NFC and Bluetooth, in order to propose an alternative mobile ETP solution with security assurance comparable to the current ETP implementation. The employment of a proof-of-concept prototype such as this alongside / coupled with a series of iterative experimentations strengthens the validity and practicality of the proposed framework. The first experiment successfully proved that the Android operating system has sufficient encryption capabilities, in compliance with the security mandates, to secure the electronic prescription information from the data at rest perspective. The second experiment indicated that the use of NFC technology to implement the alternative transfer mechanism for exchanging electronic prescription information between ETP participating devices is not practical. The next iteration of the experimentation using Bluetooth technology proved that it can be utilised as an alternative electronic prescription transfer mechanism to the current approach using the Internet. These experiment outcomes concluded the partial but sufficient proofof- concept prototype for this research. Extensive document analysis and iterative experimentations showed that the framework constructed by this research can guide the development of an alternative mobile ETP solution with both comparable security assurance to and better access to the patient’s medication history than the current solution. This alternative solution would present no operational dependence upon infrastructure and its associated, ongoing cost to the nation’s healthcare expenditure. In addition, use of this mobile ETP alternative has the potential to change the public’s perception (i.e. acceptance from regulatory and security perspectives) of mobile healthcare solutions, thereby paving the way for further innovation and future enhancements in eHealth

Pharmacy Leadership and Management: A new high fidelity simulation to prepare students for their future practise

Objective: To design and deliver a synoptic experiential learning experience drawing on leadership and management skills coupled with clinical problem solving in a high fidelity simulation. Our vision is to produce world leading pharmacists by providing them with diverse opportunities to demonstrate and expand their knowledge, skills and behaviours and prepare them for the changing healthcare landscape of the future. Design: Pharmacy Leadership and Management (PLM) is based on the successful GIMMICS consortia blueprint. Development was informed by stakeholder events with local and national health commissioners, professionals, experts, patients and academic staff. Teams of six final-year students run their own primary care-based pharmacy business competing against four others over four blocks of three days through the year. Simulated patients and academics deliver approximately 180 acute scenarios over the module to each team, comprising face-to-face, telephone and email queries. Teams also have longer term challenges including development new services and tendering for contracts. The curriculum covers all areas of practice including communication with patients and professionals, business and people development, medicines supply, clinical practice, governance and patient safety and health promotion and public health. Assessment: Assessment uses a multi-format approach of OSCE for skills, reflective portfolio for longer term and attitudinal attributes and an online assessment for knowledge based elements. Conclusion: In this paper, we will present the development of this educational experience and describe our implementation and operationalisation of this highly complex module

The Stakeholder Experience of a large scale final year undergraduate social community research project

Objective: In 2014 The School of Pharmacy at the University of Nottingham needed to deliver individual research methods supervision by a small number of academic staff to a large number of final year students. There are limited opportunities for students to gain patient facing experience on this course. The learning initiative was designed to meet these needs. Design: Dissertation students were offered a unique opportunity to participate in a large scale community pharmacy research project. Eighty-two students collected standardised data from patients across 36 pharmacies in the Greater Nottingham area. Local data collection supervision was provided by the local community pharmacists at the data collection sites. Academic supervision was provided to students using a hub and spoke model with ‘hub’ supervision provided by two members of staff offering broad methodological support to the cohort. This was further supported by local supervisors providing individualised ‘spoke’ support to students. Students were able to examine and report on their local results. The data generated overall provides a mass dataset for further examination by academics. An independent evaluation of stakeholder experience was undertaken. Assessment: Students were assessed by a poster presentation and written report summarising one segment of local analysis. Conclusion: Academics saw the hub and spoke model of supervision as innovative and a positive and efficient use of their time. All participating stakeholders feel that students benefit from the timely development of their transferable skills for their professional career; skills cited as requirements for pharmacy education by the GPhC (2011)

Pharmacy Leadership and Management module: An evaluation of the student experience and its perceived usefulness for future employment

Background: Pharmacy Leadership and Management is a 12-day, final-year synoptic experiential learning simulation. Student teams of six run a primary care-based pharmacy business and are presented with approximately 180 scenarios and over 400 medicines-based exercises. This module is based on the successful model created by the GIMMICS consortia of universities. Aims: To evaluate the acceptability and perceived usefulness to students and their future employment. Method: An online 82-item questionnaire was sent to all 221 students on the module comprising open and closed questions about their module experiences. Two reminders were sent. Analysis consisted of frequency counts and percentages. Results: Sixty-five percent of students completed the survey (n=143). Ninety-two percent said the module challenged them (n=132/143). Eighty-nine percent said it made them more confident talking to patients (n=127/143); 84% reported that their team-working skills improved as the module progressed (n=110/131). Eighty nine percent of students stated that they thought the module consolidated their learning across the degree (n=117/131). Despite the nature of the module, over half felt that the business skills would not be useful to their future career (55%, n=71/131). Conclusion: This new module has assisted students to develop themselves by challenging them and assisting to consolidate their team-working skills. Despite the importance of understanding business and management, students still appear to lack appreciation of this topic, perhaps due to lack of practice exposure in the course. This is the first year the module has run and we will be following up with the now recent graduates to evaluate the module impact on the next stages of their career

Using performance and leadership mentors to support students during a simulated pharmacy business module

Objective: To design and deliver a synoptic experiential learning experience drawing on leadership and management skills coupled with clinical problem solving in a high fidelity simulation. To provide undergraduates with a mentor employed to support and coach groups and individuals to learn, practise and develop their leadership and team working skills. Design: Pharmacy Leadership and Management (PLM) is a module which provides an experiential learning simulation drawing on leadership and management skills coupled with clinical problem solving. Teams of six students run their own primary care based pharmacy business competing against each other, based on a successful model currently run by the GIMMICS consortia of universities across Europe. Working with the university graduate school, a job description and person specification was developed. Mentors were appointed, using a robust application and interview process. A bespoke leadership and management training programme was co-developed between the Pharmacy and Graduate schools. The mentors supported student-led group sessions, coaching them to reflect on performance, develop solutions and change initiatives. The performance mentors were able to monitor the progress of their clients and stimulate interventions to improve their performance. Assessment: Students are required to reflect on their team working and its development during the simulation via their reflective portfolios. Conclusion: In this paper, we will present the development of the mentors and the impact they had on student learning. Qualitative interviews are currently being conducted to determine the impact of the mentor role on recent graduates and their development as future leaders