eHealth key issues in portuguese public hospitals

Hospital managers, health and IT Professionals have their work increasingly supported and dependent on information systems and technologies. To be more effective and efficient in the way health care is delivered, considerable improvements in health information systems and technologies still have to be made at the local and national levels. This is a study that seeks for a deeper understanding of the Portuguese hospitals main stakeholder’s concerns regarding their interaction with Information Technology, so opportunities for improvement can be later identified. Seven public hospitals have been selected to participate in this study. In each hospital, managers, IT and health professional were interviewed leading to the discussion of some global and shared perceptions that resulted in a list of eHealth key issues in public Portuguese hospitals.The authors would like to thank the Central Administration for Health Services (ACSS) of the Portuguese Health Ministry for sponsoring this study

Health information technology implementation - Impacts and policy considerations: a comparison between Israel and Portugal

The use of Information and Communications Technology (ICT) in health systems is increasing worldwide. While it is assumed that ICT holds great potential to make health services more efficient and grant patients more empowerment, research on these trends is at an early stage. Building on a study of the impact of ICT on physicians and patients in Israel, a Short Term Scientific Mission (STSM) sponsored by COST Net in conjunction with CIES/ISCTE IUL (Portugal) facilitated a comparison of ICT in health in Israel and Portugal. The comparison focused on patient empowerment, physician behavior and the role of government in implementing ICT. The research in both countries was qualitative in nature. In-depth interviews with the Ministry of Health (MOH), the private sector, patients associations, health plans and researchers were used to collect data. Purposeful sampling was used to select respondents, and secondary sources were used for triangulation. The findings indicate that respondents in both countries feel that patient empowerment has indeed been furthered by introduction of ICT. Regarding physicians, in both countries ICT is seen as providing more information that can be used in medical decision making. Increased access of patients to web-based medical information can strengthen the role of patients in decision making and improve the physician-patient relationship, but also shift the latter in ways that may require adjustments in physician orientation. Physician uptake of ICT in both countries involves overcoming certain barriers, such as resistance to change. At the national level, important differences were found between the two countries. While in Israel, ICT was promoted and adopted by the meso level of the health system, in particular the health plans and government intervention can be found in a later stage, in Portugal the government was the main developer and national strategies were built from the beginning. These two approaches present different advantages and disadvantages. Government involvement in earlier stages could provide benefit in terms of interoperability of systems between different healthcare organizations. However, innovation could be slowed down due to government bureaucracy or lack of leadership. The work provides information in order to understand and improve ICT services. Additionally, it provides input regarding impact of ICT on the physician/patient relationship and national policies in the area.info:eu-repo/semantics/publishedVersio

The Impact of eHealth and mHealth on doctor behavior and patient involvement: an Israeli and Portuguese comparative approach

Based on the experience of a Short Term Scientific Mission (STSM) promoted by COST Net and developed in CIES/ISCTE-IUL (Portugal), this paper presents a reflection about the implementation of Information & Communication Technologies (ICT) in the healthcare sector in Israel and Portugal. Specifically, we focus on the impacts of ICT or eHealth on patient empowerment, as perceived by doctors and managers in order to better comprehend the role of national policy and explore the options for building a national strategy regarding ICT in healthcare. The experience of the Portuguese healthcare system was selected and compared to the results found in a similar research in Israel. Methodologically, in-depth interviews with the Ministry of Health, the private sector, patients associations and researches were used to collect data. Purposeful sampling was used to select respondents, and secondary sources were used for triangulation. The findings of the research work show that the increased deployment of ICT has furthered patient empowerment (1). From the doctors' perspective, while ICT has provided more information in the long-run, changes of these magnitudes were not easy in the beginning. These findings were similar in both countries. The work concludes that ICT tools were successfully implemented and the general perception is that they have been beneficial. The work provides information in order to understand and improve ICT services. Additionally, the results suggest alternatives for future investments in these technologies.info:eu-repo/semantics/publishedVersio

Electronic health record portals in Portugal : a perspective from providers and patients

Dissertation presented as the partial requirement for obtaining a Master's degree in Information Management, specialization in Knowledge Management and Business IntelligenceHealthcare systems are becoming more patient centered, as today’s citizens are more active and more informed. In line with this trend, healthcare providers are promoting the use of online applications such as Electronic Health Record (EHR) portals. EHR portals can be defined as web based applications that combine an EHR system and a patient portal, with the potential of helping to achieve benefits for both patients and healthcare providers, which makes the adoption of EHR portals an important field to study and understand. The aim of this study is to characterize the view from providers and patients on EHR portals, having the Portuguese health system as scenario. The methodology was divided into a provider-centered and a patient-centered approach, being characterized as a mixed-methods research as qualitative and quantitative data collection procedures were followed. Results point out that EHR portals are considered by providers as crucial in the establishment of a digital relationship with patients, but efforts still need to be carried out for the users to adhere to these technologies. Also, the portals available in Portugal are heterogeneous in terms of functionalities offered, greatly differing in terms of number of functionalities. Patients view some functionalities of EHR portals more important than others and half of them are users of the portal developed by the public provider. The statistically determinants of adoption of EHR portals were verified. By having the perspective of providers and users, it was possible to provide insights that can be helpful to develop EHR portals that meet patient demands

A systematic review on the European legislation and policy of cross-border health care: barriers and facilitators

ABSTRACT - Background and Objectives: The legal basis of cross border health services in Europe is based on the Subsidiarity principle, which does not allow further integration of health or harmonization between Member States’ health systems. Even though there are instruments that address legal issues, governments remain responsible for health in their territory. The purpose of this systematic review is to identify and analyze the barriers and clarify facilitators of cross border collaboration and care in the European legal framework. To date, the evidence on strengths and weaknesses shows the difficulty to overcome legal and organizational barriers. However prior authorization of care abroad is against the European Union’s free movement and internal market principles, it is justified by the need for treatment and can be compensated through a reimbursement. Data Sources: A systematic review was built through an electronic search on PubMed, Web of Science, Scopus, Google Scholar, and grey literature. Study Eligibility Criteria and Methods: The aim was to include all legible articles in the English language, which connect legislation to barriers or facilitators, from 2009 to 2019. Two hundred and eighty (n=280) records were screened through the titles and abstracts and a final list of 21 papers was selected for the review. Primary data was the content of 9 studies and 12 studies used secondary data. Barriers and facilitators are linked and the second is a possible solution to the first. Results: The eight most influential barriers are connected to eHealth interoperability; member states' resistance to cooperate and exchange information; legal barrier and countries' political agenda; data protection legislation and liability and the economic barrier. The eight influential facilitators are related to possible solutions to the barriers, such as eHealth as a single market for healthcare; tools of Health Technology Assessment (HTA); European Public Health Program, and funded projects and research. Conclusions and implications of key findings: This review allows a legal and graphical analysis of the existing tools that can facilitate and improve cross borders health services. Evidence shows that the collaboration and receptivity of Member States can lead to better technology assessment, quality and common standards in health, liability, and a friendly single market for patients, that could give efficient answers in critical situations

The roadmap to healthcare digitalization: factors that affect the Portuguese approach to ehealth

Healthcare systems worldwide need to improve health outcomes while reducing costs. Increasing demand for chronic disease management, such as pulmonary disease, is driving digital transformation in healthcare. The Kata® inhalation app aims to improve patients' inhalation techniques through a data-based algorithm. This study aims to classify Portugal’s proneness to healthcare digitalization. Specifically, it investigates to which extent Portugal is lagging compared to digital pioneers and how it can keep up with advancements in a rapidly evolving technological world. The results suggest that Portugal is a positive example of eHealth but its main challenges are patients’ low digital trust and inoperability across infrastructures and health subsystems

Design, implementation and evaluation of a new eHealth pharmaceutical service for cooperative disease management using an interactive platform: opportunities to improve health systems performance

RESUMO Introdução: As doenças crónicas são a principal causa de mortalidade em toda a Europa. O aumento da prevalência de doenças crónicas está a gerar a necessidade de reformas nos sistemas de saúde. Estas reformas abordam a gestão de doenças crónicas com base em equipas multidisciplinares, com novos papéis atribuídos a profissionais não-médicos, como enfermeiros e farmacêuticos comunitários (CP). A comunicação entre profissionais e cidadãos é fundamental em todos os modelos multidisciplinares, o que torna o uso de Sistemas e Tecnologias de Informação (IST) cada vez mais indispensável. É de extrema importância para a ciência e a sociedade entender como serviços suportados por IST - eHealth - podem ser desenvolvidos e utilizados para enfrentar os constrangimentos e desafios dos futuros sistemas de saúde. Objetivo: O objetivo principal deste projeto foi o de desenvolver, implementar e avaliar um serviço farmacêutico de gestão de doença suportado por IST, no contexto da farmácia comunitária, utilizando a metodologia Design Science Research (DSRM) como metodologia de investigação. Métodos: A aplicação de DSRM decorre em seis fases, desde a definição e caracterização do problema até à avaliação da solução (ou artefacto). A primeira fase foi constituída por um exercício de cenarização, um estudo observacional de tempo e movimento e um questionário de preenchimento online, para avaliar as futuras possibilidades para os farmacêuticos comunitários no sistema de saúde, e a atual prestação de serviços farmacêuticos suportados por IST em farmácia comunitária. Na segunda fase, foram realizadas entrevistas qualitativas com utentes de serviços de saúde. Estas duas fases informaram o desenho da plataforma web de suporte ao serviço, que foi o objetivo da terceira fase. De seguida, nas duas etapas seguintes, a plataforma web foi testada e a usabilidade avaliada através de um estudo de caso com utentes selecionados numa universidade sénior. Resultados: A partir do exercício de cenarização, foi possível identificar as incertezas críticas que serão os “motores da mudança” para os farmacêuticos comunitários. Estas são a “capacidade de inovar e desenvolver serviços” e o “ambiente legislativo”. Tanto no estudo observacional como no inquérito, verificou-se que todas as farmácias utilizam os IST para a dispensa de medicamentos e tarefas administrativas; apenas 15% das farmácias respondentes usam os IST para responder a questões de saúde dos utentes; 50% do tempo diário do farmacêutico é despendido em interação com os utentes da farmácia e 38% em tarefas administrativas. Em média, os farmacêuticos observados têm 54 minutos de tempo livre por dia, maioritariamente em micropausas distribuídas pelo dia de trabalho. Os custos calculados para os serviços farmacêuticos observados foram muito semelhantes nas três farmácias. O custo médio do serviço de dispensa de medicamentos foi de €3,66 e do serviço de aconselhamento €1,34. Dos utentes entrevistados, 46% admitiram que procuraram o farmacêutico para informações sobre questões de saúde ligeiras antes de ir a um médico, enquanto a entrega de medicamentos ao domicílio foi o novo serviço mais solicitado. Na fase de demonstração da plataforma, verificou-se que o registo, monitorização e armazenamento de dados bioquímicos e fisiológicos, tanto pelo utente como pelo farmacêutico, contribuiu para aumentar o interesse comum na gestão da doença, o que poderá permitir uma melhoria nos resultados da saúde. Na avaliação de usabilidade, verificou-se a necessidade de melhorar o acesso rápido à informação, bem como a vi necessidade de melhorar a legibilidade da informação para melhorar a experiência de utilização dos utentes seniores. Conclusão: Atualmente, o uso de IST nas farmácias comunitárias portuguesas está principalmente focado na dispensa de medicamentos. Parece existir uma necessidade de reorganização interna das farmácias de forma a permitir aumentar a eficiência da prestação de serviços farmacêuticos e permitir a prestação de serviços farmacêuticos de eHealth. Para os serviços farmacêuticos de eHealth estarem mais integrados no modelo de negócio atual, é necessário melhorar o marketing do serviço, de forma a aumentar o recrutamento de utentes e demonstrar o valor do serviço para os doentes crónicos e médicos. A qualidade e usabilidade da plataforma eHealth é fundamental. No entanto, também o acompanhamento por um profissional de saúde e a integração dos serviços farmacêuticos com os cuidados de saúde primários são importantes para uma melhor gestão da doença. A DSRM demonstrou ser útil no desenvolvimento e implementação de serviços de eHealth, proporcionando um maior envolvimento dos utilizadores, aumentando a utilidade percebida do serviço. No próximo ciclo de DSRM, vão ser necessários os inputs de médicos de cuidados primários e outros profissionais de saúde, de modo a desenvolver um novo artefacto, para testar e avaliar o valor clínico e económico dos serviços farmacêuticos eHealth.Background: Chronic diseases are the main cause of mortality throughout Europe. The increasing prevalence of chronic diseases is leading to the necessity of health system reforms. These reforms address chronic-disease management based on multidisciplinary teams, with major roles for non-physicians, such as nurses and community pharmacists (CP). A cornerstone on every multidisciplinary model is the communication between stakeholders, for which the use of Information Systems and Technologies (IST) is increasingly indispensable. It is of importance to science and society to understand how IST supported services – eHealth - could be developed and used to address the challenges and constrains of future health systems. Aim: The main goal of this project was to design, implement and evaluate a disease management web-based interactive pharmaceutical service, within a community pharmacy setting, using Design Science Research Methodologies (DSRM). Methods: The application of DSRM six stages’ is described, from the definition and characterization of the problem to the evaluation of the artefact. The first stage consisted of a scenario exercise, a time and motion observational study and an online survey, to assess future roles for community pharmacists and current pharmaceutical services provision supported by IST in community pharmacy. In the second stage, qualitative interviews with health services’ users were performed. These two stages helped to inform the design of the web-platform, which was the goal in the third stage. After this, the web-platform was tested and the usability evaluated in the two following stages, through a case study with selected patients from the participant pharmacies and from a senior university. Results: The scenario exercise allowed to identify the critical uncertainties that will be the drivers of change for the Community Pharmacists. These were found to be the “Ability to develop Services”, and the “Legislative Environment”. From both the survey and observational study, it was found that pharmacies’ IST is mainly used for dispensing medicines and administrative tasks with only 15% of the respondent pharmacies using IST to answer patients’ queries; 50% of pharmacists daily time is spent with patients, 38% on administrative tasks, while still having an average of 54 minutes of idle time spread through the day, mainly in micro-pauses. The overall costs of Pharmaceutical services across three pharmacies were found to be very similar, with the average dispensing service cost at €3.66 and €1.34 for the counselling service; 46% of the interviewed users admitted that they sought healthcare provision with the CP for minor issues before going to a physician, while home delivery was the most requested new service. In the demonstration stage, we found that the registration, monitoring and storage of biochemical and physiological data, recorded by the CP and the patients in the platform, contributed to a common interest that may allow an improvement in patients’ health outcomes. From the usability evaluation, concerns about the quick access to information were perceived as well as the need to improve legibility, addressing senior users’ difficulties. Conclusion: The current state of IST usage in Portuguese community pharmacies is mainly focused on medicine dispensing. There seems to exist a need for internal reorganization of pharmacies allowing for more efficient pharmaceutical services provision and to enable eHealth pharmaceutical services provision. To make eHealthpharmaceutical services more integrated in the current pharmacy daily business, marketing efforts need to be done, to recruit and demonstrate value to the chronic patients and physicians. The quality and usability of the web-based platform is critical, as is the close professional follow-up and integration of pharmacy and primary care services focused in disease management. DSRM helps in developing and implementing eHealth services through a higher involvement of the stakeholders, increasing the perceived usefulness of the service. The next DSRM cycle will need to use the input of primary care physicians and other health professionals in order to develop an artifact to test and evaluate the clinical and economic value of eHealth pharmaceutical services

Interoperability between health information systems in the hospital context

The information systems had a positive effect on the health service by reducing the physical documentation, more available information to monitor the patient and safer data storage. On the other hand, there was a negative impact due to an increase of diverse systems operating which demanded more training and support to hospitals structure aligned with the lack of interoperability standards that promote the patient´s data sharing between them. Therefore, this dissertation focused on analysing the existent interoperability between information systems in the Portuguese health service, determine the key aspects to establish communication among them, and the consequences it has on the healthcare professional´s routines. Interviews were conducted with healthcare professionals and hospital suppliers to collect their experience on interacting with this technology, their opinion about the influence it has on the hospital´s routine, and the potential measures to improve the current situation. This research concluded that the lack of interoperability and an unfriendly interface generates a complex use of the systems with a high number of clicks and slower navigation to execute the tasks that can cause loss of time for healthcare professionals. Besides, the public hospital demonstrated to have a higher number of IS suppliers and lower levels of integration between systems compared with private hospitals. Lastly, it was demonstrated that an organisational culture oriented to the technology change and a strategic plan to adapt to the hospital's approach is necessary to a successful implementation of health information systems.Os sistemas de informação tiveram um efeito positivo no serviço de saúde com redução na documentação em papel, maior disponibilidade de informação sobre o paciente e segurança no armazenamento de dados. Por outro lado, houve um impacto negativo devido ao aumento na diversidade de sistemas a operar, que exigiram mais treino e apoio à estrutura hospitalar, associado à falta de padrões de interoperabilidade que promovam a partilha de dados do paciente. Assim, esta dissertação centra-se na análise da interoperabilidade existente entre os sistemas de informação no serviço de saúde português, em determinar os aspetos fundamentais para estabelecer a comunicação entre os mesmos e as consequências que têm na rotina do profissional de saúde. Foram realizadas entrevistas com profissionais da área e fornecedores hospitalares para recolher informação sobre a experiência na interação com esta tecnologia, a opinião sobre a influência que ela exerce na rotina hospitalar e as possíveis medidas para melhorar a atual situação. Esta investigação concluiu que a falta de interoperabilidade e uma interface pouco apelativo determinam um uso complexo destes sistemas com um elevado número de cliques e uma navegação mais lenta para executar as tarefas, que podem causar perda de tempo aos profissionais de saúde. Além disso, os hospitais públicos demonstram ter um maior número de fornecedores e menores níveis de integração entre os sistemas em comparação com os privados. Por fim, expõem-se que uma cultura organizacional direcionada para a mudança tecnológica e um plano estratégico de adaptação são necessários para o sucesso da implantação destes sistemas