A mixed methods approach to prioritizing components of Uganda’s eHealth environment

Introduction: Globally the use of information and communication technologies (ICTs) in healthcare,  eHealth, is on the increase. This increased use is accompanied with several challenges requiring uniformly understood and accepted regulations. Developing such regulations requires the engagement of all stakeholders. In this manuscript we explored the priorities of various eHealth stakeholders in Uganda to inform the eHealth policy review process.Methods: We used a Delphi approach during the initial programmed plenary of a consultative workshop in which participants were asked to identify and post their topmost priority related to eHealth under one of the seven components of the eHealth environment as described in the WHO national eHealth toolkit. We used an additional qualitative analytical method to further group the participant sorted priorities into sub clusters to support additional interpretation using the toolkit.Results: The components of the eHealth environment ranked as follows with respect to descending number of postings: information services and applications (36 postings), information and technology standard (31 postings), leadership and governance (22 postings), strategic planning (21 postings), infrastructure(14 postings), financial management (2 postings) and others (6 postings).Conclusion: Uganda's eHealth environment is in the developing and building up stage (II). In this environment the policy and implementation strategy should strengthen linkages in core systems, create a foundation for investment, ensure  legal certainty and create a strong eHealth enabling environment.Key words: Information and communications technologies, policy, eHealt

The Iranian Integrated Care Electronic Health Record

E-health plays a crucial role in E-government by proposing healthcare services based on information technology. However, the way to administer these services by using E-health solutions is one of the challenging issues. One of these significant challenges is how one integrates heterogeneous healthcare information of the different point of care systems. This paper introduces the Iranian integrated care electronic health record using the information gathered from several point-of-care systems in healthcare enterprises in Iran. This service-oriented architecture has a remarkable characteristic - its accessibility to medical knowledge and medical concepts through archetypes and ontology, respectively. The Ministry of Health and Medical Education of the Islamic Republic of Iran has designed and implemented this national architecture

What’s Past Is Prologue: A Scoping Review of Recent Public Health and Global Health Informatics Literature

Objective: To categorize and describe the public health informatics (PHI) and global health informatics (GHI) literature between 2012 and 2014. Methods: We conducted a semi-systematic review of articles published between January 2012 and September 2014 where information and communications technologies (ICT) was a primary subject of the study or a main component of the study methodology. Additional inclusion and exclusion criteria were used to filter PHI and GHI articles from the larger biomedical informatics domain. Articles were identified using MEDLINE as well as personal bibliographies from members of the American Medical Informatics Association PHI and GHI working groups. Results: A total of 85 PHI articles and 282 GHI articles were identified. While systems in PHI continue to support surveillance activities, we identified a shift towards support for prevention, environmental health, and public health care services. Furthermore, articles from the U.S. reveal a shift towards PHI applications at state and local levels. GHI articles focused on telemedicine, mHealth and eHealth applications. The development of adequate infrastructure to support ICT remains a challenge, although we observed a small but growing set of articles that measure the impact of ICT on clinical outcomes. Discussion: There is evidence of growth with respect to both implementation of information systems within the public health enterprise as well as a widening of scope within each informatics discipline. Yet the articles also illuminate the need for more primary research studies on what works and what does not as both searches yielded small numbers of primary, empirical articles. Conclusion: While the body of knowledge around PHI and GHI continues to mature, additional studies of higher quality are needed to generate the robust evidence base needed to support continued investment in eHealth by governmental health agencies

Managing diabetes mellitus using information technology: A systematic review

Objective: To review published evidences about using information technology interventions in diabetes care and determine their effects on managing diabetes. Design: Systematic review of information technology based interventions. Research design and methods: MEDLINE®/PubMed were electronically searched for articles published between 2004/07/01 and 2014/07/01. A comprehensive, electronic search strategy was used to identify eligible articles. Inclusion criteria were defined based on type of study and effect of information technology based intervention in relation to glucose control and other clinical outcomes in diabetic patients. Studies must have used a controlled design to evaluate an information technology based intervention. A total of 3613 articles were identified based on the searches conducted in MEDLINE from PubMed. After excluding duplicates (n = 6), we screened titles and abstracts of 3607 articles based on inclusion criteria. The remaining articles matched with inclusion criteria (n = 277) were reviewed in full text, and 210 articles were excluded based on exclusion criteria. Finally, 67 articles complied with our eligibility criteria and were included in this study. Results: In this study, the effect of various information technology based interventions on clinical outcomes in diabetic patients extracted and measured from selected articles is described and compared to each other. Conclusion: Information technology based interventions combined with the usual care are associated with improved glycemic control with different efficacy on various clinical outcomes in diabetic patients. © 2015 Riazi et al

eHealth Conversations : using information management, dialogue, and knowledge exchange to move toward universal

The publication of eHealth Conversations, developed with the support of the Spanish Agency for International Development Cooperation (AECID), represents a major step forward for the PAHO/WHO Strategy, since it explores ways of implementing regional mechanisms with free and equitable access to information and knowledge sharing. These initiatives aim to advance the goals of more informed, equitable, competitive, and democratic societies, where access to health information is considered a basic right. This publication is one of the instruments used by PAHO/WHO to develop the initiatives outlined in the Strategy, which coincides with the global eHealth strategy. One of the fundamental needs for the improvement of eHealth is the dissemination of information, and PAHO/WHO is assuming a leading role in this effort. The development of this new electronic publication is a key step in disseminating information that will be useful for decision makers on applying these technologies for the health of the Americas. This electronic book is one of the products of PAHO/WHO’s project: “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health.” Participants in these conversations included experts on electronic health and other specialties. Through virtual dialogues, the experts contributed with knowledge and reflections on the present and the future of eHealth in the Americas, analyzed the situation, and made recommendations for the implementation of electronic health initiatives. These recommendations are not only intended for PAHO/ WHO, but also for governments and the private sector. The aim of the project is to guarantee the convergence of local, national, and regional initiatives regarding the adoption and application of ICTs for public health, with special attention on critical issues in this field. It also intends to strengthen individual and collective capacities of health workers and institutions, connecting them in a network of on-line health networks, as well as to reinforce the PAHO/WHO eHealth program.Acknowledge the Spanish Agency for International Development Cooperation (AECID) for its financial support in preparing this publication and developing the project titled “eHealth Conversations: Using Information Management, Dialogue, and Knowledge Exchange to Move Toward Universal Access to Health;

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

Angiotensin enzyme inhibitors and angiotensin receptor blockers as protective factors in COVID-19 mortality: a retrospective cohort study

Targeting the renin-angiotensin system is proposed to affect mortality due to coronavirus disease 2019 (COVID-19). We aimed to compare the mortality rates in COVID-19 patients who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) and those who did not. In this retrospective cohort study, mortality was considered as the main outcome measure. All underlying diseases were assessed by the chronic use of medications related to each condition. We defined two main groups based on the ACEIs/ARBs administration. A logistic regression model was designed to define independent predictors of mortality as well as a Cox regression analysis. In total, 2553 patients were included in this study. The mortality frequency was higher in patients with a history of underlying diseases (22.4 vs 12.7, P value < 0.001). The mortality rate in patients who received ACEIs/ARBs were higher than non-receivers (29.3 vs. 19.5, P value = 0.013, OR = 1.3, 95 CI 1.1, 1.7) in the univariate analysis. However, the use of ACEIs/ARBs was a protective factor against mortality in the model when adjusted for underlying conditions, length of stay, age, gender, and ICU admission (P value < 0.001, OR = 0.5, 95 CI 0.3, 0.7). The Kaplan�Meier curve showed an overall survival of approximately 85.7 after a 120-day follow-up. ACEIs/ARBs are protective factors against mortality in COVID-19 patients with HTN, and these agents can be considered potential therapeutic options in this disease. The survival probability is higher in ACEIs/ARBs receivers than non-receivers. © 2020, Società Italiana di Medicina Interna (SIMI)

Healthcare Access

Adequate healthcare access not only requires the availability of comprehensive healthcare facilities but also affordability and knowledge of the availability of these services. As an extended responsibility, healthcare providers can create mechanisms to facilitate subjective decision-making in accessing the right kind of healthcare services as well various options to support financial needs to bear healthcare-related expenses while seeking health and fulfilling the healthcare needs of the population. This volume brings together experiences and opinions from global leaders to develop affordable, sustainable, and uniformly available options to access healthcare services

Assessing the readiness of public healthcare facilities to adopt health information technology (hit)/e-health: a case study of Komfo Anokye Teaching Hospital, Ghana

Most health information technology (HIT)/e-Health initiatives in developing countries are still in project phases and few have become part of routine healthcare delivery due to the lack of clear implementation roadmap. Ghana has been piloting a number of e-Health initiatives, which have not guaranteed a sustainable implementation of such systems. The objective of this research study was to explore the information technology (IT) readiness of public healthcare institutions (primary, secondary and tertiary) in Ghana to adopt e-Health in order to develop a standard HIT/e-Health readiness assessment model. For a population of 28,678,251 people there are only 2,615 medical doctors on the Ministry of Health’s (MoH) payroll as at 2013 and 1818 public hospitals. Consequently, the doctor to population ratio is extremely low as compared to other developing countries, which falls far below the WHO revised standard of 1:600. Under these circumstances there is evidence in developed countries that adoption of health informatics technologies can contribute to improving the situation. An extensive review of literature on e-health in developing countries has identified a general lack of adoption due to a lack of readiness to incorporate the technology into the healthcare environment. Literature provides myriad but fragmented models/frameworks of health information technology (HIT)/e-Health adoption readiness assessment limited measuring tools to assess factors of HIT readiness. This risks the outcomes of HIT/e-Health readiness assessment, which eventually limits knowledge about the strategic gaps warranting the need for the implementation of HIT/e-Health systems in public healthcare institutions in Ghana. Whiles previous studies acknowledge the existence of HIT readiness assessment factors, there exist very limited measuring items for these factors. Simply put, there is not just limited studies on HIT readiness assessment, but there is also no standard guiding readiness assessment model. This study has identified the lack of standard assessment model/framework as well as their accompanying measuring tools for effective outcomes as major gaps. Thus, there was the need for gaining a deeper understanding of existing readiness factors and their applicability in the context of the readiness of public healthcare facilities in Ghana and how they promote or impede HIT/e-Health adoption in order to develop standard HIT readiness assessment model, which comprises readiness factors and most importantly their measuring tools. This study used a mixed method approach, specifically the exploratory sequential design (the exploratory design) where the outcome of qualitative data collected from 13 senior health CIOs and leaders of e-Health initiatives in Ghana analysed built to quantitative data collection instrument. The survey instrument was used to collect quantitative data from 298 clinical and non-clinical staff (Administration/Management leadership) Komfo Anokye Teaching Hospital (KATH) in a form of case study to confirm the findings of the initial exploratory study. This was because the mixed method is rooted in the pragmatism of philosophical assumptions, which guide the direction of the collection and analysis of data and the mixture of qualitative and quantitative approaches in many phases of the research process. Furthermore, mixed research methods design strategy provides a powerful mechanism for IS researchers in dealing with the rapidly changing environment of ICT. An initial standard regression analysis using IBM SPSS version 23 established that five factors (Technology readiness (TR); Operational resource readiness (ORR); Organizational cultural readiness (OCR); Regulatory policy readiness (RPR); and Core readiness (CR)) and 63 indicators (measuring tools) promote and/or impede HIT/e-Health adoption readiness in public healthcare facilities in Ghana. Consequently, these factors were used in developing a standard HIT readiness assessment model. Whiles these five factors all proved to have strong association with the dependent variable Health Information Technology readiness (HITR) in the standard regression, (R2 = 0.971) the findings of a latter PLS-SEM, an advanced regression analysis deployed suggest that Regulatory policy readiness (RPR) and remarkably Core readiness (CR) did not impact on the readiness of KATH to adopt e-Health/HIT. As many public healthcare organizations in Ghana have already begun the process of implementing various HIT/e-Health systems without any reliable HIT/e-Health regulatory policy in place, there is a critical need for reliable HIT/e-Health regulatory policies (RPR) and some improvement in HIT/e-Health strategic planning (core readiness). The final model (R2 = 0.558 and Q2= 0.378) suggest that TR, ORR, and OCR explained 55.8% of the total amount of variance in health information technology/e-Health readiness in the case of KATH, partially supporting the hypotheses of this study. Although no formal hypotheses were proposed for the relationships/effects, which exist between exogenous/independent constructs in the model structure, the SmartPLS3 model path analysis did show that there exist such relationships. For instance, the significant paths from regulatory policy readiness (RPR) to organizational resource readiness (ORR) (t = 23.891; Beta = 0.774) and from technological readiness (TR) to operational resource readiness (ORR) (t = 11.667; Beta = 0.624) obtained from SmartPLS3 bootstrap procedure indicate the presence of mediation. Fit values (SRMR = 0.054; NFI = 0.739). Generally, the GoF for this SEM are encouraging and can substantially be improved when public healthcare facilities in Ghana intending to implement HIT/e-Health pay equal attention to relevant regulatory policies and strategic planning. The readiness assessment model developed this study essentially offers a useful basis for healthcare organizations to enhance the conditions under which HIT/eHealth is launched in order to achieve successful and sustainable adoption with particularly attention being paid to HIT/e-Health regulatory policies and strategic planning. When evaluations such as this are carried out effectively, there could be a circumvention of large losses in money effort and time, delays and disappointments among planners, staff and users of services whiles facilitating the process of change in the institutions and communities involved. This study was conducted with selected subjects and selected public healthcare facilities in the southern cities/parts of Ghana. Therefore, a replication or transfer of this study to other parts of Ghana especially the rural areas and the private healthcare environment should consider the potential differences resulting from varying cultural, socioeconomic and political backgrounds since healthcare is a much-institutionalised industry. The same caution must be exercise when replicating this study in other developing countries and across the globe