Health Policy and Technology最新文献

Background

Several evaluation methods are used to determine the advantages and disadvantages of healthcare information systems and their contribution to attaining organizational goals. Despite the existence of many evaluation frameworks, there is no comprehensive set of indicators that evaluate different dimensions of information systems. This study aimed to develop a set of indicators for evaluating health information systems.

Methods

This research was conducted in three phases. First, based on a literature review of PubMed, Web of Science, Scopus, and Embase databases, studies using the health information system evaluation methods were extracted. Second, consecutive focus group meetings were held with scientific and executive experts to discuss the list of evaluation indicators extracted from the studies. In these meetings, the experts agreed on including, removing, adding, combining, and grouping the indicators. Third, the indicators were weighted using the Analytical Network Process (ANP) method, and the set of evaluation indicators was finalized.

Results

The review of 177 relevant articles resulted in the extraction of 360 indicators. During the focus group meetings, 174 overlapping and duplicate indicators were eliminated and 61 indicators were added to the model based on experts’ suggestions. The remaining 247 indicators were classified into a four-level hierarchy. The final set consisted of 4 dimensions, 16 criteria, 47 markers, and 180 indicators.

Conclusion

We developed a comprehensive general set of indicators that helps researchers, designers, and developers of health information systems to evaluate different dimensions of these systems. This set can also be used to improve the design of relevant systems.

Objectives

To introduce a novel visualization technique for evaluating the efficacy of clinical decision support system (CDSS) alerts as perceived by physicians and to differentiate between various alert categories for optimization.

Methods

We developed a visualization method, which segments into four distinct zones: Appropriate (+/+), Over-frequent yet Effective (−/+), Potentially Problematic (−/−), and Less Effective but Acceptably Frequent (+/−). Alerts from a 908-bed academic medical center in Northern Taiwan were collected over two years and classified using this technique, along with three perspectives: Safety, Completeness, and Response.

Results

We collected the viewpoints of 72 clinical physicians on the system's top 20 most frequent alerts. The proposed visualization technique offers a user-centric, adaptable method for assessing CDSS alerts. Roughly five alerts were categorized as Potentially Problematic, whereas another five were deemed Appropriate. Intriguingly, certain alerts, while not beneficial for patient safety, were found to assist physicians in completing clinical workflows.

Conclusions

This approach, emphasizing visual clarity and adaptability, diverges from traditional methods that lean heavily on expert opinions or statistics. It paves the way for diverse assessment perspectives, furnishing healthcare institutions with a valuable tool to improve CDSS alert systems, ensuring a harmonious balance between user efficiency and patient safety.

Background and aim

Healthcare organizations are becoming increasingly dependent on Information technology (IT) for the provision of routine services. IT failures within hospital systems can impact acute patient care, including emergency department (ED) closure operating room (OR) stops.. The aim of this study is to gain insight into the impact of hospital IT failures in the Netherlands on acute care delivery and to provide recommendations for improved IT failure preparedness and hospital resilience during such an event.

Methods

This is a systematic scoping review of major acute care disruptions in Dutch hospitals between 2000 and 2020. Incidence of etiology, duration, ED diversion, and closure of multiple locations was evaluated. IT failures were included when associated with the closure of hospital departments and/or evacuations.

Results

Thirty-nine IT failures resulting in acute care disruption were identified. The majority occurred between 2010 and 2020 (n = 37, 95 %). Of the 39 events, 33 (85 %) were primary IT failures and were mainly caused by computer network and/or hospital software failure. Secondary events predominantly resulted from power failure. Most events (n = 36, 92 %) were resolved within minutes to hours. All events were associated with an ED closure, 27 (69 %) with an operating room (OR) stop and two (5 %) with external hospital evacuation of one or more patients. Furthermore, 17 incidents (44 %) involved multiple hospital locations, and seven (41 %) of these involved closure of multiple locations with an ED.

Conclusion

The impact of IT failures on acute care disruptions in the Netherlands has considerably increased since 2010. This stresses the urge to improve IT security and business continuity in today's hospitals.

Biobanking has paved the way for significant biomedical advancements which could be very advantageous for a developing nation like the Philippines. Current challenges faced by the existing biobank in the country suggest the need for satellite biobanks. The main objective of this manuscript was to summarize various important factors to consider in the establishment of a regional biobank in a developing country. The paper also identified the various challenges to the sustainability of the biobank and highlighted potential solutions and opportunities that could address these concerns.

Western Visayas, Philippines is a viable site for a regional biobank due to its location, health situation, availability of human resources, and existing research infrastructures. The main obstacles to the establishment of this biobank are the participation of the public, the involvement of physicians and academic scientists, operational issues, and stable financial support. The success and sustainability of the regional biobank depend on multisectoral collaboration. Western Visayas institutions must increase their research collaborations and must form public-private partnerships to advance science, and maximize the benefits of a regional biobank. In general, a successful regional biobank should consider a framework focused on financial, operational, and social dimensions.

Public interest summary: Health research in developing countries may benefit from the establishment of human biobanks. Although biobanking studies in these developing nations have grown significantly over the last decade, challenges still exist that impede progress toward edifying it. Important factors like resources, acceptability, demand, implementation, and practicality should be considered in the establishment of a regional biobank in a developing country. Although implementation and practicality aspects appear to be viable, serious challenges encompassing human and capital resources, as well as social, legal, and ethical issues must be taken into consideration.

Objectives

Engaging in HIV care is key to maintaining successful health outcomes for persons with HIV (PWH). Barriers to care affect engagement and can include access to transportation. Telemedicine has been used to overcome geographical barriers in rural settings, and PWH in urban areas without public transportation can also benefit from this strategy. The aim of this research is to explore the attitudes of providers in one health system about telemedicine after receiving training.

Methods

From 2018–2020, a convenience sample of 112 providers at University of Florida Health in Jacksonville, FL were offered telemedicine training consisting of didactic, hands-on, and in-person support. Provider attitudes were assessed in pre- and post-training surveys, focus groups, and after telemedicine visits. Descriptive statistics and paired t-tests were used to analyze pre- and post-training surveys.

Results

Readiness and willingness to conduct telemedicine with PWH after training significantly increased among providers (n = 73). Providers reported increased readiness to conduct telemedicine visits (p < 0.0001), increased ability to communicate during telemedicine visits (p < 0.001), and increased confidence in troubleshooting technology issues (p < 0.0001). Of the 29 providers completing surveys after conducting telemedicine visits with PWH, 93 % reported that it was easy to access and use. Providers did report a sense of decreased patient-provider interaction via telemedicine.

Conclusion

Future research should further explore provider experiences with telemedicine training and delivery to improve telemedicine training and to identify best practices and strategies/activities that promote remote efficient patient-provider interaction.

Public interest summary

The use of telemedicine has increased in all areas of health care, especially since the COVID-19 pandemic. Training providers to successfully care for patients in remote settings is essential, especially as technology platforms and capabilities evolve or become more complex. Telemedicine trainings help providers increase capacity to conduct telemedicine visits. Trainings standardize visit protocols, control provider and patient expectations, identify how to incorporate remote visits into routine clinic flows, provide tools for increasing provider competency to interact with patients and use technology features, and increase understanding of types of ongoing support providers require, such as administrative. This paper describes the attitudes of providers from University of Florida Health in Jacksonville, FL receiving training to deliver telemedicine to persons with HIV residing in an urban setting.

Background

Patients managing chronic conditions often face significant treatment burdens due to the long-term nature of their care. Treatment burden refers to the workload associated with the self-management of chronic conditions. While telehealth is commonly used to support these patients, there is a growing concern about its impact on marginalized patient populations. Specifically, we lack a comprehensive overview on how and what types of telehealth can increase or minimize the perceived treatment burden among this patient population.

Objective

To synthesize evidence on the relationship between treatment burden and telehealth among patients with chronic conditions and their caregivers.

Methods

We used Arksey and O'Malley's five-step scoping review framework to identify relevant literature that was published from January 2004 to May 2023.

Results

Fifty-four studies were included in the review. We identified various ways telehealth increases or minimizes patients’ treatment burden. Some of the patient-reported benefits of telehealth regarding treatment burden were reducing time and cost associated with travel to the clinics. Conversely, some burdens associated with telehealth were making sense of the large volume of complex data generated by health technologies, and the extra work required to set up and learn about new technology.

Conclusion

Review findings emphasize the importance of considering the concept of treatment burden while introducing telehealth-based interventions to support patients and their caregivers with chronic conditions. Future research needs to identify how to minimize the treatment burden associated with telehealth while implementing new telehealth interventions.

This paper discusses the role of social media algorithms in the spread of misinformation during the COVID-19 pandemic. It aims to propose solutions to combat misinformation and promote accurate, evidence-based public health information.

Background

India has committed to formulating a roadmap for realising a resilient health system, with digital health being an important element. Following the successful implementation of a free telemedicine service, eSanjeevani, India published the Telemedicine Practice Guidelines in 2020 to scale telemedicine use in India. The current study aims to understand the perspective and use of telemedicine by medical doctors in India after the release of these guidelines.

Methods

Data were acquired through an anonymous, cross-sectional, internet-based survey of medical doctors (n = 444) at a pan-India level. Replies were subjected to statistical analysis.

Findings

Telemedicine was used for various non-mutually exclusive reasons, with the top two reasons being live audio or video consultations (60.4 %) and online payments (19.1 %), and smartphones were the most frequently used device type (60.6 %). Among various benefits of telemedicine, almost all respondents (93 %) recognised the potential for telemedicine to reduce COVID-19 infection risk for healthcare professionals. Interestingly, nearly 45 % of respondents felt that limited and fragmented insurance coverage was an important limitation to the practice of telemedicine in India, and 49 % believed reduced patient fees for teleconsultations could help incentivise telemedicine use.

Interpretation

This study helps to appraise the use of telemedicine in India after the publication of telemedicine guidelines in 2020. Furthermore, the findings can inform the development of telemedicine platforms, policies and incentives to improve the design and implementation of effective telemedicine in India.

Funding

No funding to report.

Background

The internet has become an important source of health information for the general population. Previous research has shown that online health information seeking is associated with medication adherence. However, the direction of this relationship is still a matter of dispute. Even less is known about the factors that moderate such a relationship.

Objective

To investigate the heterogeneous influences of online health information seeking on the use of aspirin in CVD prevention and the possible moderating factors among the applicable adult population in the U.S from 2016 to 2018.

Methods

Respondents aged 40 or older, based on guidelines for aspirin use, were sampled from the 2016 to 2018 National Health Interview Survey. Linear probability models were used to test the association between patients’ aspirin use behaviors and the variables of interest in four separate sub-populations.

Results

Aspirin use for CVD prevention was associated with online health information seeking in different ways. When patients received doctors’ advice to use aspirin, online information seeking has a negative influence on aspirin use, depending on whether the individual has CVD risk factors. However, for patients without recommendations from providers, the effects of online information seeking on self-initiated aspirin use depend on the different types of prevention (i.e., primary vs. secondary) and CVD risk factors.

Conclusions

Online health information might lead to both overuse and underuse of aspirin in CVD prevention. Online information seeking interacts with other information sources affecting consumers' decision making. Key consumer characteristics and risk factors may also moderate such a relationship.

Clinical decision support systems (CDSS) augmented with artificial intelligence (AI) models are emerging as potentially valuable tools in healthcare. Despite their promise, the development and implementation of these systems typically encounter several barriers, hindering the potential for widespread adoption. Here we present a case study of a recently developed AI-CDSS, Aifred Health, aimed at supporting the selection and management of treatment in major depressive disorder. We consider both the principles espoused during development and testing of this AI-CDSS, as well as the practical solutions developed to facilitate implementation. We also propose recommendations to consider throughout the building, validation, training, and implementation process of an AI-CDSS. These recommendations include: identifying the key problem, selecting the type of machine learning approach based on this problem, determining the type of data required, determining the format required for a CDSS to provide clinical utility, gathering physician and patient feedback, and validating the tool across multiple settings. Finally, we explore the potential benefits of widespread adoption of these systems, while balancing these against implementation challenges such as ensuring systems do not disrupt the clinical workflow, and designing systems in a manner that engenders trust on the part of end users.