Decision time for clinical decision support systems

Clinical decision support systems are interactive software systems designed to assist clinicians with decision making tasks, such as determining a diagnosis or recommending a treatment for a patient. Clinical decision support systems are a widely researched topic in the Computer Science community but their inner workings are less well understood by and known to clinicians. In this article we provide a brief explanation of clinical decision support systems and provide some examples of real world systems. We also describe some of the challenges to implementing these systems in clinical environments and posit some of the reasons for limited adoption of decision support systems in practice. We aim to engage clinicians in the development of decision support system that can meaningfully help with their decision making tasks and open up a discussion about the future of automated clinical decision support as a part of healthcare delivery

Can the NHS learn about human factors from the Ministry of Defence?

The National Health Service (NHS) in England has ambitious plans to drive innovation in health information technology (HIT) to improve patient safety, quality and cost effectiveness. Acute trusts are complex socio-technical systems that are required to implement a number of large information technology projects in order to meet national targets for digital maturity. This research explored whether the Ministry of Defence (MOD) Human Factors Integration Model for the acquisition process could be applied to a HIT project. A qualitative research study was undertaken in a large English NHS acute trust using the experience of implementing an electronic observation system to explore transferability of the MOD approach to acute healthcare. Data were collected using semi-structured interviews and focus groups and analysed thematically with reference to SEIPS 2.0 (Holden et al, 2013) healthcare systems model and the MOD framework. Key findings included limited awareness of Human Factors in healthcare; information system design/specification to deliver positive outcomes around patient safety and financial savings. Human Factors negative systems issues included alert fatigue, changing mental models, inability to maximise data for patient benefit, system resilience, local and national interoperability issues

Optimum hardware, software and personnel requirements for a paperless health and demographic surveillance system: a case study of Cross River HDSS, Nigeria

Health and Demographic Surveillance Systems (HDSS) are a robust and rigorous data collection, validation, storage, analysis and reporting platforms for community-based data on vital events. These processes make high demands on paper and man-hours with attendant implications on running costs and environmental impact. However, with the rapid development of ICT and increasing affordability of computing devices, some of the manual processes can be replaced with ICT tools. This paper presents a case study of the Cross River HDSS in Akpabuyo Southern Nigeria with a view to highlighting the essential personnel, hardware and software requirements for running an IT-based paperless HDSS in low income settings. The DSA comprised of 22 contiguous EAs of 1370 households. The case study entailed four update rounds, each of which involved field workers visiting households and obtaining information on vital events. The first update round was purely paper-based involving the use of large collections of paper forms for interviews. The last three rounds were IT-based, devoid of paper questionnaires and ran on web-based open source software. Hardware was a set of high-end servers, desktops, tablet PCs and android phones for data collection.   The case study demonstrated the feasibility of running a paperless IT-based HDSS in a resource-poor setting using free and open source software, such as the web-based OpenHDS, MySQL, ODK, MirthConnect, etc. This overcomes the limitations of the popular HRS2 in terms of costs, complexities, and lack of compatibility with changing hardware and system software configurations. However, running IT-based paperless HDSS threw up some challenges, such as cases of poor internet connectivity, absence of GSM network connectivity using mobile devices, and having the right mix of staff with sufficient IT skills. This paper recommended solution strategies for overcoming these challenges. The need for the development of new set of protocols for data quality in a paperless HDSS is also discussed.   Keywords: Health, demographic surveillance system, information technology, paper, environment, enumeration area

Avaliação do desempenho funcional e qualidade técnica de um Sistema de Documentação Eletrônica do Processo de Enfermagem

Objetivo: evaluar el desempeño funcional y la calidad técnica del Sistema de Documentación Electrónica del Proceso de Enfermería del Hospital Universitario de la Universidad de Sao Paulo. Método: estudio exploratorio descriptivo. Se utilizó el Modelo de Calidad de la norma 25010 y el Proceso de Evaluación definido en la norma 25040, ambas de la International Organization for Standardization/International Electrotechnical Commission (Organización Internacional para Estandarización/Comisión Electrotécnica Internacional). Las características de calidad evaluadas fueron: adecuación funcional, confiabilidad, usabilidad, eficiencia de desempeño, compatibilidad, seguridad, facilidad de mantenimiento y portabilidad. La muestra fue constituida por 37 evaluadores. Resultados: en la evaluación de los especialistas en informática, apenas la característica usabilidad obtuvo menos de 70% de respuestas positivas. Para los enfermeros docentes, todas las características de calidad obtuvieron arriba de 70% de respuestas positivas. Los enfermeros asistenciales de las clínicas médica y quirúrgica (con experiencia en el uso del sistema) y enfermeros asistenciales de otras unidades del hospital y de otras instituciones de salud (sin experiencia en el uso del sistema) obtuvieron más de 70% de respuestas positivas referentes a la adecuación funcional, usabilidad y seguridad. Entre tanto, la eficiencia de desempeño, la confiabilidad y la compatibilidad obtuvieron índices abajo del parámetro establecido. Conclusión: el software alcanzó más de 70% de respuestas positivas en la mayoría de las características de calidad evaluadas.Objetivo: avaliar o desempenho funcional e a qualidade técnica do Sistema de Documentação Eletrônica do Processo de Enfermagem do Hospital Universitário da Universidade de São Paulo. Método: estudo exploratório-descritivo. Utilizou-se o Modelo de Qualidade da norma 25010 e o Processo de Avaliação definido na norma 25040, ambas da International Organization for Standardization/International Electrotechnical Commission (Organização Internacional para Padronização/Comissão Eletrotécnica Internacional). As características de qualidade avaliadas foram: adequação funcional, confiabilidade, usabilidade, eficiência de desempenho, compatibilidade, segurança, manutenibilidade e portabilidade. A amostra foi constituída por 37 avaliadores. Resultados: na avaliação dos especialistas em informática, apenas a característica usabilidade obteve menos de 70% de respostas positivas. Para os enfermeiros docentes, todas as características de qualidade obtiveram acima de 70% de respostas positivas. Os enfermeiros assistenciais das clínicas médica e cirúrgica (com experiência no uso do sistema) e enfermeiros assistenciais de outras unidades do hospital e de outras instituições de saúde (sem experiência no uso do sistema) obtiveram mais de 70% de respostas positivas referentes à adequação funcional, usabilidade e segurança. Entretanto, eficiência de desempenho, confiabilidade e compatibilidade obtiveram índices abaixo do parâmetro estabelecido. Conclusão: o software atingiu mais de 70% de respostas positivas na maioria das características de qualidade avaliadas.Objective: To evaluate the functional performance and the technical quality of the Electronic Documentation System of the Nursing Process of the Teaching Hospital of the University of São Paulo. Method: exploratory-descriptive study. The Quality Model of regulatory standard 25010 and the Evaluation Process defined under regulatory standard 25040, both of the International Organization for Standardization/International Electrotechnical Commission. The quality characteristics evaluated were: functional suitability, reliability, usability, performance efficiency, compatibility, security, maintainability and portability. The sample was made up of 37 evaluators. Results: in the evaluation of the specialists in information technology, only the characteristic of usability obtained a rate of positive responses of less than 70%. For the nurse lecturers, all the quality characteristics obtained a rate of positive responses of over 70%. The staff nurses of the medical and surgical clinics with experience in using the system) and staff nurses from other units of the hospital and from other health institutions (without experience in using the system) obtained rates of positive responses of more than 70% referent to the functional suitability, usability, and security. However, performance efficiency, reliability and compatibility all obtained rates below the parameter established. Conclusion: the software achieved rates of positive responses of over 70% for the majority of the quality characteristics evaluated

A Structural Equation Model for implementation of Smart Card Technology in public healthcare

The improvement of health care, efficiency, safety, and quality of delivery and access for patients highly portray a rather significant increase in public healthcare. The emergence of this proliferation of healthcare technology is then expected to grow. Therefore, Information technology (IT) has become significant part of providing consistent care quality by healthcare professionals to patients. The study seeks to explain on factors that influence the implementation of Smart Card Technology in South African public healthcare institutions. This was a cross-sectional study conducted in four Tshwane hospitals in Gauteng province, South Africa in 2021. A quantitative research method approach was used. respondents were selected using the purposive sampling method. using a self-administered questionnaire completed by (n=406) healthcare professionals from Steve Biko academic hospital, Tshwane District hospital, Kalafong hospital and Pretoria West Hospital were analysed. The structural equation modeling (SEM) and principal component analysis (PCA) methods in statistical package for social sciences (SPSS) were used to analyse the data. The factor analysis in this study used 15 variables were used for the conceptual framework. The findings generally supported the hypothesized model. The study recommends that a framework for the implementation of SCT be developed in public healthcare

What is the Safety Case for Health IT? A Study of Assurance Practices in England

Objective Health IT (HIT) systems are increasingly becoming a core infrastructural technology in healthcare. However, failures of these systems, under certain conditions, can lead to patient harm and as such the safety case for HIT has to be explicitly made. This study focuses on safety assurance practices of HIT in England and investigates how clinicians and engineers currently analyse, control and justify HIT safety risks. Methods Three workshops were organised, involving 34 clinical and engineering stakeholders, and centred on predefined risk-based questions. This was followed by a detailed review of the Clinical Safety Case Reports for 20 different national and local systems. The data generated was analysed thematically, considering the clinical, engineering and organisational factors, and was used to examine the often implicit safety argument for HIT. Results Two areas of strength were identified: establishment of a systematic approach to risk management and close engagement by clinicians; and two areas for improvement: greater depth and clarity in hazard analysis practices and greater organisational support for assuring safety. Overall, the dynamic characteristics of healthcare combined with insufficient funding have made it challenging to generate and explain the safety evidence to the required level of detail and rigour. Conclusion Improvements in the form of practical HIT-specific safety guidelines and tools are needed. The lack of publicly available examples of credible HIT safety cases is a major deficit. The availability of these examples can help clarify the significance of the HIT risk analysis evidence and identify the necessary expertise and organisational commitments

Exploring Strategies for Successful Implementation of Electronic Health Records

Adoption of electronic health records (EHR) systems in nonfederal acute care hospitals has increased, with adoption rates across the United States reaching as high as 94%. Of the 330 plus acute care hospital EHR implementations in Texas, only 31% have completed attestation to Stage 2 of the meaningful use (MU) criteria. The purpose of this multiple case study was to explore strategies that hospital chief information officers (CIOs) used for the successful implementation of EHR. The target population consists of 3 hospitals CIOs from a multi-county region in North Central Texas who successfully implemented EHRs meeting Stage 2 MU criteria. The conceptual framework, for this research, was the technology acceptance model theory. The data were collected through semistructured interviews, member checking, review of the literature on the topic, and publicly available documents on the respective hospital websites. Using methodological triangulation of the data, 4 themes emerged from data analysis: EHR implementation strategies, overcoming resistance to technology acceptance, strategic alignment, and patient wellbeing. Participants identified implementation teams and informatics teams as a primary strategy for obtaining user engagement, ownership, and establishing a culture of acceptance to the technological changes. The application of the findings may contribute to social change by identifying the strategies hospital CIOs used for successful implementation of EHRs. Successful EHR implementation might provide positive social change by improving the quality of patient care, patient safety, security of personal health information, lowering health care cost, and improvements in the overall health of the general population

A Structured Methodology for Systematically Describing Health Informatics Hazards

This research establishes a framework which uses simple language constructs, recognising the socio-technical context in which they exist to establish hazard descriptions that capture and reflect the harm-scenario, relative to the carepathway and focus on the credible patient harm outcome