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Objectives: To quantify the burden of communicable diseases and characterize the most reported infections during public health emergency of floods in Pakistan., Methods: The study's design is a descriptive trend analysis. The study utilized the disease data reported to District Health Information System (DHIS2) for the 12 most frequently reported priority diseases under the Integrated Disease Surveillance and Response (IDSR) system in Pakistan., Results: In total, there were 1,532,963 suspected cases during August to December 2022 in flood-affected districts (n = 75) across Pakistan; Sindh Province reported the highest number of cases (n = 692,673) from 23 districts, followed by Khyber Pakhtunkhwa (KP) (n = 568,682) from 17 districts, Balochistan (n = 167,215) from 32 districts, and Punjab (n = 104,393) from 3 districts. High positivity was reported for malaria (79,622/201,901; 39.4%), followed by acute diarrhea (non-cholera) (23/62; 37.1%), hepatitis A and E (47/252; 18.7%), and dengue (603/3245; 18.6%). The crude mortality rate was 11.9 per 10 000 population (1824/1,532,963 [deaths/cases])., Conclusion: The study identified acute respiratory infection, acute diarrhea, malaria, and skin diseases as the most prevalent diseases. This suggests that preparedness efforts and interventions targeting these diseases should be prioritized in future flood response plans. The study highlights the importance of strengthening the IDSR as a Disease Early Warning System through the implementation of the DHIS2.

Health information technology systems have the capacity to improve health outcomes for the patients thus ensuring quality and efficient services. Health information systems (HIS) are important tools in guidance towards patient safety and better outcomes. However, still, morbidity and mortality attributed to medical errors remain an important issue that needs to be addressed. The objective of the present study was to assess the health information system in terms of technological, environmental, organizational and human factors affecting the adoption as well as the perceptions of stakeholders along with barriers and constraints related to successful implementation. A descriptive cross-sectional study design was used. Prospective data was collected from primary sources by self-administering the pre-validated questionnaires as well as by physical verification of the availability of equipment. After data collection, data was analyzed to assess the health information management systems. The results of the present study showed that the health information system in Pakistan is not up to the mark. The equipment was mostly unavailable at the primary healthcare facilities. The staff was also unsatisfied with the available services. Administrative, financial and human constraints were identified as the major barriers towards successful implementation and management of HIS. The present study concluded that the health information system of Pakistan needs to be revamped. Health information management system partially existed at district and sub-district offices, while was completely absent at tertiary, secondary and primary healthcare levels. The poor adoption of health information technology systems at healthcare facilities might largely be attributed to insufficient human resources with limited resources and budget allocation for health in Pakistan. Effective and timely strategies involving all important stakeholders and healthcare professionals must be designed and implemented at the National level to restructure an affordable, resilient and quality healthcare system., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Communication networks among professionals can be pathways for accelerating the diffusion of innovations if some local health departments (LHDs) drive the spread of knowledge. Such a network could prove valuable during public health emergencies such as the novel coronavirus disease 2019 (COVID-19) pandemic. Our objective was to determine whether LHDs in the United States were tied together in an informal network to share information and advice about innovative community health practices, programs, and policies., Methods: In January and February 2020, we conducted an online survey of 2,303 senior LHD leaders to ask several questions about their sources of advice. We asked respondents to rank up to 3 other LHDs whose practices informed their work on new public health programs, evidence-based practices, and policies intended to improve community health. We used a social network analysis program to assess answers., Results: A total of 329 LHDs responded. An emergent network appeared to operate nationally among 740 LHDs. Eleven LHDs were repeatedly nominated by peers as sources of advice or examples (ie, opinion leaders), and 24 acted as relational bridges to hold these emergent networks together (ie, boundary spanners). Although 2 LHDs played both roles, most LHDs we surveyed performed neither of these roles., Conclusion: Opinion leading and boundary spanning health departments can be accessed to increase the likelihood of affecting the rate of interest in and adoption of innovations. Decision makers involved in disseminating new public health practices, programs, or policies may find our results useful both for emergencies and for practice-as-usual.

Objective: After the outbreak of the coronavirus disease 2019 (COVID-19) pandemic, Chinese hospitals and health information technology (HIT) vendors collaborated to provide comprehensive information technology support for pandemic prevention and control. This study aims to describe the responses from the health information systems (HIS) to the COVID-19 pandemic and provide empirical evidence in the application of emerging health technologies in China., Methods: This observational descriptive study utilized a nationally representative, cross-sectional survey of hospitals in China ( N  = 1,014) from 30 provincial administrative regions across the country. Participants include hospital managers, hospital information workers, and health care providers., Results: Among all the responses, the most popular interventions and applications include expert question-and-answer sessions and science popularization (61.74%) in online medical consultation, online appointment registration (58.97%) in online medical service, and remote consultation (75.15%) in telehealth service. A total of 63.71% of the participating hospitals expanded their fever clinics during the pandemic, 15.38% hospitals used new or upgraded mobile ward rounds systems, and 44.68% hospitals applied online self-service systems. Challenges and barriers include protecting network information security (57.00%) since some hospitals experienced cybersecurity incidents. 71.79% participants hope to shorten wait time and optimize the treatment process. Health care workers experienced increased amount of work during the pandemic, while hospital information departments did not experience significant changes in their workload., Conclusion: In the process of fighting against the COVID-19, hospitals have widely used traditional and emerging novel HITs. These technologies have strengthened the capacity of prevention and control of the pandemic and provided comprehensive information technology support while also improving accessibility and efficiency of health care delivery., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: The Patient-Reported Outcomes Measurement Information System Ⓡ (PROMIS Ⓡ ) is a dynamic system of psychometrically sound patient-reported outcome (PRO) measures. There has been a recent increase in the use of PROMIS measures, yet little has been written about the reporting of these measures in the field of orthopedics. The purpose of this study was to conduct a systematic review to determine the uptake of PROMIS measures across orthopedics and to identify the type of PROMIS measures and domains that are most commonly used in orthopedic research and practice., Methods: We searched PubMed, Embase, and Scopus using keywords and database-specific subject headings to capture orthopedic studies reporting PROMIS measures through November 2018. Our inclusion criteria were use of PROMIS measures as an outcome or used to describe a population of patients in an orthopedic setting in patients ≥ 18 years of age. We excluded non-quantitative studies, reviews, and case reports., Results: Our final search yielded 88 studies published from 2013 through 2018, with 57% (50 studies) published in 2018 alone. By body region, 28% (25 studies) reported PROMIS measures in the upper extremity (shoulder, elbow, hand), 36% (32 studies) reported PROMIS measures in the lower extremity (hip, knee, ankle, foot), 19% (17 studies) reported PROMIS measures in the spine, 10% (9 studies) reported PROMIS measures in trauma patients, and 6% (5 studies) reported PROMIS measures in general orthopedic patients. The majority of studies reported between one and three PROMIS domains (82%, 73 studies). The PROMIS Computerized Adaptive Test (CAT) approach was most commonly used (81%, 72 studies). The most frequently reported PROMIS domains were physical function (81%, 71 studies) and pain interference (61%, 54 studies)., Conclusion: Our review found an increase in the reporting of PROMIS measures over the recent years. Utilization of PROMIS measures in orthopedic populations is clinically appropriate and can facilitate communication of outcomes across different provider types and with reduced respondent burden., Registration: The protocol for this systematic review was designed in accordance with the PRISMA guidelines and is registered with the PROSPERO database (CRD42018088260).

A critical barrier to addressing health disparities among minorities is the lack of data, particularly on Pacific Islanders. Typically, national health surveillance systems do not have the resources to ensure proper representation of these small population groups. This study reports factors that guided the cultural adaptation and administration of the National Cancer Institute's Health Information Trends National Survey (HINTS) for a United States-dwelling Pacific Islander population in Hawai'i. To adapt the survey, four focus groups were conducted with 32 purposively-selected Micronesian migrants. Themes on health, healthcare barriers, cancer and methods to implement the survey were extracted from the analyses of the focus group narratives. Key cultural factors were identified that impact health practices, including religious and cancer fatalism, racism, health locus of control and other barriers. Using information from the focus group participants, the HINTS questionnaire was modified and the survey was implemented. The survey data provided will inform the future delivery of health promotion strategies for this unique medically underserved population., (©Copyright 2020 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Communication is a core component of effective healthcare that impacts many patient and doctor outcomes, yet is complex and challenging to both analyse and teach. Human-based coding and audit systems are time-intensive and costly; thus, there is considerable interest in the application of artificial intelligence to this topic, through machine learning using both supervised and unsupervised learning algorithms. In this article we introduce health communication, its importance for patient and health professional outcomes, and the need for rigorous empirical data to support this field. We then discuss historical interaction coding systems and recent developments in applying artificial intelligence (AI) to automate such coding in the health setting. Finally, we discuss available evidence for the reliability and validity of AI coding, application of AI in training and audit of communication, as well as limitations and future directions in this field. In summary, recent advances in machine learning have allowed accurate textual transcription, and analysis of prosody, pauses, energy, intonation, emotion and communication style. Studies have established moderate to good reliability of machine learning algorithms, comparable with human coding (or better), and have identified some expected and unexpected associations between communication variables and patient satisfaction. Finally, application of artificial intelligence to communication skills training has been attempted, to provide audit and feedback, and through the use of avatars. This looks promising to provide confidential and easily accessible training, but may be best used as an adjunct to human-based training., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2020. Published by Elsevier Ltd.)

Background Mobile health (mHealth) technologies can deliver interventions to prevent and manage cardiovascular disease (CVD), but mHealth uptake among those with or at risk for CVD remains incompletely explored. Therefore, in this group, we assessed the prevalence of mHealth access and usage, and the association between CVD risk and mHealth uptake. Methods and Results Data were from 3248 adults in the 2018 Health Information National Trends Survey. We defined CVD risk as reporting a heart condition, diabetes mellitus, hypertension, and/or current smoking (n=1903). Multivariable logistic regression, adjusting for demographics, was used to assess the relationship between CVD risk and mHealth uptake. Most individuals with CVD risk owned a smartphone (73%, 95% CI: 69%-76%) and 48% (95% CI: 44%-52%) had a health app. Among men, those with CVD risk were more likely to use a wearable device (odds ratio 2.43, 95% CI: 1.44-4.10) than those without CVD risk, while there was no difference among women. In both sexes, CVD risk was associated with sharing information from a smartphone/wearable with a clinician (odds ratio 1.63, 95% CI 1.12-2.35 in women; odds ratio 3.99, 95% CI 2.30-6.95 in men). However, there was no difference in the odds of using mHealth to track health progress, make health decisions, aid healthcare discussions, or text a clinician. Conclusions In a nationally representative sample, there was high prevalence of smartphone ownership but incomplete mHealth uptake. Having CVD or its risk factors was associated with sharing information from smartphone/wearables, suggesting potential to leverage clinically validated mHealth interventions for CVD prevention.

Objective: To describe the four types of horizon scanning (HS) outputs developed by the National Committee for Health Technology Incorporation (CONITEC) and show their main repercussions on the decision-making processes of the Brazilian Ministry of Health (MH)., Methods: Descriptive study based on participant observation and document analysis of HS outputs (internal reports, alert reports, briefs and sections for CONITEC recommendation reports) developed between January 2014 and July 2018., Results: Fifteen internal reports, six alert reports, two briefs and 57 HS sections were produced. Each output has a specific structure according to its purpose. The methodological approach adopted for developing HS outputs in Brazil is described by EuroScan International Network. The outputs had institutional and international repercussions. The activities resulted in the inclusion of HS as a tool for reducing health lawsuits in the legal framework of the MH. One of the internal reports on a high-cost drug not approved in Brazil for a rare disease was requested by the Health Technology Assessments Network for the Americas (RedETSA), showing the international relevance of the outputs. The HS sections in recommendation reports influenced discussions about incorporating technologies into the Unified Health System., Conclusions: The developed outputs have purposes ranging from helping build arguments for defense of the MH in cases of health judicialization to inform decision-making processes. In addition, HS sections in recommendation reports have grown in importance recently. CONITEC's HS system has been structured, and its role as a tool to inform health managers has shown to be been relevant.

Background: The patient's history of present illness provides an important part of the data with which clinicians diagnose and treat. Once surgical patients are discharged, the ability to incorporate direct observation requires coordinating patient and provider for a clinical visit. Mobile technologies offer the ability to gather and organize the patient's history, supplement that history with photographs and other clinical observations, and convey those data accurately and rapidly to the entire clinical team. Methods: We review our experience with patient-generated health data in surgical site infection, draw parallels with similar work in other domains, and identify principles we have found useful. Results: Health information system implementations require substantial changes in provider workflow. Shared expectations between the patient and the surgical team, an incremental approach to change in clinical processes, and an emphasis on clinical utility all support successful implementation. Conclusions: The data collection and rapid information exchange afforded by monitoring post-operative, post-discharge patients using mobile technologies can support the expectations of both patients and providers and may provide a novel data source for public health surveillance of surgical site infection. Both uses of these data require careful attention to introducing changes in clinical workflow.

Given the importance of the health-care industry and the promise of health information systems, researchers are encouraged to build on the shoulders of giants as the saying goes. The health information systems field has a unique opportunity to learn from and extend the work that has already been done by the highly correlated information systems field. As a result, this research article presents a past, present and future meta-analysis of health information systems research in information systems journals over the 2000-2015 time period. Our analysis reviewed 126 articles on a variety of topics related to health information systems research published in the "Senior Scholars" list of the top eight ranked information systems academic journals. Across the selected information systems academic journals, our findings compare research methodologies applied, health information systems topic areas investigated and research trends. Interesting results emerge in the range and evolution of health information systems research and opportunities for health information systems researchers and practitioners to consider moving forward.

Background: Merging United Network for Organ Sharing (UNOS) and Pediatric Health Information Systems databases has enabled a more granular analysis of pediatric heart transplant outcomes and resource utilization. We evaluated whether transplant indication at time of transplantation was associated with mortality, resource utilization, and inpatient costs during the first year after transplantation., Methods and Results: We analyzed transplant outcomes and resource utilization from 2004 to 2015. Patients were categorized as congenital (CHD), myocarditis, or cardiomyopathy based on UNOS-defined primary indication. CHD complexity subgroup analyses (single-ventricle, complex, and simple biventricular CHD) were also performed. Of 2251 transplants (49% CHD, 5% myocarditis, 46% cardiomyopathy), CHD recipients were younger (2 [IQR 0-10], 6 [IQR 0-12], and 7 [IQR 1-14] years, respectively; P < .001) and less likely to have a ventricular assist device (VAD) at transplantation (3%, 27%, and 13%, respectively; P < .001). Patients with single-ventricle CHD had the longest time on the waitlist and were least likely to receive a VAD before transplantation. After adjusting for patient-level factors, transplant recipients with single-ventricle CHD had the greatest mortality during transplantation admission and within 1 year (odds ratio [OR] 11.8 [95% confidence interval (CI) 5.9-23.6] and OR 6.0 [95% CI 3.6-10.2], respectively, vs cardiomyopathy). Mortality was similar between patients with myocarditis and cardiomyopathy. Post-transplantation length of stay (LOS) was longer in transplant recipients with CHD than myocarditis or cardiomyopathy (25 [interquartile range [IQR] 15-45] vs 21 [IQR 12-35] vs 16 [IQR 12-25] days; P < .001), related in part to longer duration of intensive care unit-level care (ICU LOS 8 [IQR 4-20] vs 6 [IQR 4-13] vs 5 [IQR 3-8] days; P < .001). Similarly, patients with CHD had higher median post-transplantation costs than myocarditis or cardiomyopathy ($415K [IQR $201K-503K] vs $354K [IQR $179K-390K] vs $284K [IQR $145K-319K]; P < .001) that persisted after adjusting for patient-level factors (adjusted cost ratio 1.4 [95% CI 1.4-1.5], CHD vs cardiomyopathy) and was primarily driven by longer LOS. More than 50% were readmitted during the first year after transplantation, although readmission rates were similar across transplant indications (P = .42)., Conclusions: Children with CHD, particularly single-ventricle patients, require substantially greater hospital resource utilization and have significantly worse outcomes during the first year after heart transplantation compared with other indications. Further work is aimed at identifying modifiable pre-transplantation risk factors, such as pre-transplantation conditioning with VAD support and cardiac rehabilitation, to improve post-transplantation outcomes and reduce resource utilization in this complex population., (Copyright © 2018. Published by Elsevier Inc.)

Background: Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality., Objectives: The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments., Review Process and Outcomes: In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms., Conclusion: Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results., (© 2018 Health Libraries Group.)

Objective: To analyze the diffusion of e-SUS Primary Care innovation in Family Health Teams., Method: A qualitative approach case study, based on Innovation Diffusion Theory and Technology Acceptance Model. We conducted 62 interviews and observation of professionals from Family Health Teams in six municipalities of Minas Gerais State, between March 2016 and January 2017. The data were treated through Categorical Thematic Content Analysis and, systematized, with Atlas.ti software ., Results: It was verified that although the e-SUS Primary Care strategy is recognized as a technological innovation, situations predominate that weaken its acceptance as: incompatibilities with the work process; sudden deployment, poor training; work overload; resistance; and negative impacts on health care., Conclusion: The diffusion of the e-SUS Primary Care strategy as a technological innovation has presented potential situations of its rejection, conforming as challenges to be overcome.

Background: Post-traumatic hydrocephalus (PTH) is a potentially treatable cause of poor recovery from traumatic brain injury (TBI) that remains poorly understood, particularly among children., Objective: To better understand the risk factors for pediatric PTH using a large, multi-institutional database., Methods: We conducted a retrospective cohort study using administrative data from 42 pediatric hospitals participating in the Pediatric Health Information System. All patients ≤21 yr surviving a hospitalization with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for TBI were identified. The primary outcome was PTH, defined by an ICD-9-CM procedure code for surgical management of hydrocephalus within 6 mo. Data were analyzed using multivariable logistic regression., Results: We identified 91 583 patients ≤21 yr with TBI, 846 of whom developed PTH. Odds of PTH were significantly higher in children <1 yr compared to older age groups. A total of 48.7% of PTH cases were victims of abuse (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 2.16-3.18). PTH was more common after craniotomy (aOR 1.60, 95% CI 1.30-1.97). Craniectomy without early cranioplasty was associated with markedly increased odds of PTH (aOR 3.67, 95% CI 2.66-5.07), an effect not seen in those undergoing cranioplasty within 30 d (aOR 1.19, 95% CI 0.75-1.89)., Conclusion: PTH was seen in 0.9% of children who sustained a TBI and was more common in those <1 yr. Severe injury, abuse, and craniectomy with delayed cranioplasty were associated with greatly increased likelihood of PTH. Early cranioplasty in children who require craniectomy may reduce the risk for PTH.

In anthropology, interest in how values are created, maintained and changed has been reinvigorated. In this case study, we draw on this literature to interrogate concerns about the relationship between data collection and the delivery of patient care within global health. We followed a pilot study conducted in Kayunga, Uganda that aimed to improve the collection of health systems data in five public health centres. We undertook ethnographic research from July 2015 to September 2016 in health centres, at project workshops, meetings and training sessions. This included three months of observations by three fieldworkers; in-depth interviews with health workers (n = 15) and stakeholders (n = 5); and six focus group discussions with health workers. We observed that measurement, calculation and narrative practices could be assigned care-value or data-value and that the attempt to improve data collection within health facilities transferred 'data-value' into health centres with little consideration among project staff for its impact on care. We document acts of acquiescence and resistance to data-value by health workers. We also describe the rare moments when senior health workers reconciled these two forms of value, and care-value and data-value were enacted simultaneously. In contrast to many anthropological accounts, our analysis suggests that data-value and care-value are not necessarily conflicting. Actors seeking to make changes in health systems must, however, take into account local forms of value and devise health systems interventions that reinforce and enrich existing ethically driven practice., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This article is part of the Focus Theme of Methods of Information in Medicine on the German Medical Informatics Initiative. Funded by the German Federal Ministry of Education and Research with about 150 million Euro in its currently starting development and networking phase this initiative has already a significant impact on the development of health information systems in Germany. In this Focus Theme two editorials introduce this initiative, one from the viewpoint of its funding institution and one from the initiative's accompanying institutions. Then the initiative's four consortia DIFUTURE (Data Integration for Future Medicine), HiGHmed (Heidelberg-Göttingen-Hannover Medical Informatics), MIRACUM (Medical Informatics in Research and Care in University Medicine), and SMITH (Smart Medical Information Technology for Healthcare) present their concepts and plans. For better readability their manuscripts all contain three major sections on governance and policies, on architectural framework and methodology, and on use cases. As the German Medical Informatics Initiative is a large national experiment, we are convinced that communicating on this initiative already at this early stage to an international audience is of importance., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Schattauer GmbH.)

Chile made several legal, practical and educational changes to the organ donation and transplant system in recent years, to improve its results. However, studies evaluating these reforms and suggesting further corrections are still pending. Our aim is to assess the new regulations and their reception by both the population and health care providers. Proposals are made to promote the development of a model of Chilean transplantation able to respond to the needs of the population.

Objective: This article objective is to highlight implementation characteristics, concerns, or limitations over role-based access control (RBAC) use on health information system (HIS) using industry-focused literature review of current publishing for that purpose. Based on the findings, assessment for indication of RBAC is obsolete considering HIS authorization control needs., Method: We have selected articles related to our investigation theme "RBAC trends and limitations" in 4 different sources related to health informatics or to the engineering technical field. To do so, we have applied the following search query string: "Role-Based Access Control" OR "RBAC" AND "Health information System" OR "EHR" AND "Trends" OR "Challenges" OR "Security" OR "Authorization" OR "Attacks" OR "Permission Assignment" OR "Permission Relation" OR "Permission Mapping" OR "Constraint". We followed PRISMA applicable flow and general methodology used on software engineering for systematic review., Results: 20 articles were selected after applying inclusion and exclusion criteria resulting contributions from 10 different countries. 17 articles advocate RBAC adaptations. The main security trends and limitations mapped were related to emergency access, grant delegation, and interdomain access control., Conclusion: Several publishing proposed RBAC adaptations and enhancements in order to cope current HIS use characteristics. Most of the existent RBAC studies are not related to health informatics industry though. There is no clear indication of RBAC obsolescence for HIS use.

Along with an increase in self-care and self-medication practices, the use of health foods as primary and secondary methods of disease prevention has increased. Consumers are aware only of the health benefits of dietary ingredients, although the potential risks associated with most ingredients are unknown. Adverse events associated with the use of health foods have been reported, and in some cases they were due to inappropriate use such as the concomitant use of several health foods or health foods and drugs. It is important that healthcare professionals, especially pharmacists, provide reliable, evidence-based information to ensure the safe and appropriate use of dietary supplements by their patients. Thus, we constructed an online database, the "Health Foods Network (HFNet)" that compiles reports on the safety and effectiveness of health foods and their ingredients. It serves to disseminate information based on scientific research not only in Japan but also worldwide. This article provides an overview of the HFNet. Additionally, findings from our recent survey and educational interventions among college students are discussed. We hope that this article will be helpful for pharmacists and other healthcare professionals who provide consultations on the use of health foods.

Introduction: Launched in 1987, the National Health Information System (NHIS) in the Democratic Republic of the Congo (DR Congo) was evaluated in 2009 and 2015 using the HMN (Health Metrics Network) assessment tool. This study aimed to estimate the progress made between these two evaluations., Methods: We performed an analysis of the secondary data from the evaluations of the NHIS, which was based on the comparison of the satisfaction level between the six components of this tool between 2009 and 2015, namely: resources, indicators, data sources, data management, information products, dissemination and use of data., Results: Between 2009 and 2015, respondents' satisfaction level changed as follow: resouces 49% vs 61%; indicators 73% vs 88%; data sources 52% vs 61%; data management 41% vs 45%; information products 74% vs 77%; dissemination and use of data 51% vs 51%. In general the average score increased from 59% to 64% with "satisfactory" mark., Conclusion: Our study shows that the NHIS in the DR Congo has not changed significantly between 2009 and 2015 and that it couldn't provide real-time reliable health information for decision-making and health program planning.

A complete understanding of the experience of health requires information relevant not merely to the health indicators of mortality and morbidity but also to functioning-that is, information about what it means to live in a health state, "the lived experience of health." Not only is functioning information relevant to healthcare and the overall objectives of person-centered healthcare but to the successful operation of all components of health systems.In light of population aging and major epidemiological trends, the health strategy of rehabilitation, whose aim has always been to optimize functioning and minimize disability, will become a key health strategy. The increasing prominence of the rehabilitative strategy within the health system drives the argument for the integration of functioning information as an essential component in national health information systems.Rehabilitation professionals and researchers have long recognized in WHO's International Classification of Functioning, Disability and Health the best prospect for an internationally recognized, sufficiently complete and powerful information reference for the documentation of functioning information. This paper opens the discussion of the promise of integrating the ICF as an essential component in national health systems to secure access to functioning information for rehabilitation, across health systems and countries.

Objectives: Access to the Internet has grown dramatically over the past two decades. Using data from a population-based survey, we aimed to determine the prevalence and predictors of (i) access to the Internet, and (ii) use of the Internet to search for health information., Methods: We analyzed data from the 2011-12 California Health Interview Survey (CHIS) and included all individuals 18 years of age and older. Our outcomes were (i) prior use of the Internet, and (ii) use of the Internet to find health or medical information within the past year. We performed survey-weighted logistic regression models on our outcomes to adjust for potentially confounding demographic and socioeconomic factors., Results: Our study included an unweighted and survey-weighted sample of 42,935 and 27,796,484 individuals, respectively. We found that 81.5% of the weighted sample reported having previously used the Internet. Among Internet users, 64.5% stated that they used the Internet within the past year to find health or medical information. Racial/ethnic minorities, older individuals, and those who lived in lower income households and rural areas were less likely to have access to and use the Internet to search for health information. Conversely, English-proficiency and increasing levels of education were positively associated with online health information-seeking., Conclusions: We found that most Californians have access to and use the Internet to search for health information, but still noted a persistent digital divide. Interventions to narrow the divide are needed, otherwise this may lead to a continued widening of existing healthcare disparities., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: Return visits (RVs) and RVs with admission (RVAs) are commonly used emergency department quality measures. Visit- and patient-level factors, including several social determinants of health, have been associated with RV rates, but hospital-specific factors have not been studied., Objective: To identify what hospital-level factors correspond with high RV and RVA rates., Setting: Multicenter mixed-methods study of hospital characteristics associated with RV and RVA rates., Data Source: Pediatric Health Information System with survey of emergency department directors., Measurements: Adjusted return rates were calculated with generalized linear mixed-effects models. Hospitals were categorized by adjusted RV and RVA rates for analysis., Results: Twenty-four hospitals accounted for 1,456,377 patient visits with an overall adjusted RV rate of 3.7% and RVA rate of 0.7%. Hospitals with the highest RV rates served populations that were more likely to have government insurance and lower median household incomes and less likely to carry commercial insurance. Hospitals in the highest RV rate outlier group had lower pediatric emergency medicine specialist staffing, calculated as full-time equivalents per 10,000 patient visits: median (interquartile range) of 1.9 (1.5-2.1) versus 2.9 (2.2-3.6). There were no differences in hospital population characteristics or staffing by RVA groups., Conclusion: RV rates were associated with population social determinants of health and inversely related to staffing. Hospital-level variation may indicate population-level economic factors outside the control of the hospital and unrelated to quality of care., (© 2017 Society of Hospital Medicine)

The Internet is a valuable tool that continues to revolutionize many aspects of our lives; however, the ability to disseminate diverse data across populations and nations presents both opportunities and challenges. Online resources are increasingly used in health care, providing wider access to information for patients, researchers, and clinicians. At the turn of the millennium, the National Cancer Institute (NCI) predicted that Internet-based technologies would create a revolution in communication for oncology professionals and patients with cancer. Herein, findings from the NCI's Health Information National Trends Survey are reviewed to give insight into how Internet trends related to oncology patients are evolving. Future trends are discussed, including examples of 'connected health' in oncology; the spread of mobile and ubiquitous access points to Internet-hosted information; the diffusion of devices, sensors, and apps; the spread of personal data sharing; and an evolution in how networks can support person-centred and family-centred care.

This article presents and illustrates the main features of a proposed process-oriented approach for patient information distribution in future health care information systems, by using a prototype of a process support system. The development of the prototype was based on the Visuera method, which includes five defined steps. The results indicate that a visualized prototype is a suitable tool for illustrating both the opportunities and constraints of future ideas and solutions in e-Health. The main challenges for developing and implementing a fully functional process support system concern both technical and organizational/management aspects., (© The Author(s) 2015.)

Epidemiology has made advances, thanks to the availability of real-time surveillance data and by leveraging the geographic analysis of incidents. There are many health information systems that visualize the symptoms of influenza-like illness on a digital map, which is suitable for end-users, but it does not afford further processing and analysis. Existing systems have emphasized the collection, analysis, and visualization of surveillance data, but they have neglected a modular and interoperable design that integrates high-resolution geo-location with real-time data. As a remedy, we have built an open-source project and we have been operating an open service that detects flu-related symptoms and shares the data in real-time with anyone who wants to built upon this system. An analysis of a small number of precisely geo-located status updates (e.g. Twitter) correlates closely with the Google Flu Trends and the Centers for Disease Control and Prevention flu-positive reports. We suggest that public health information systems should embrace an open-source approach and offer linked data, in order to facilitate the development of an ecosystem of applications and services, and in order to be transparent to the general public interest., (© The Author(s) 2015.)

Nearly five decades ago in 1970, Simone de Beauvoir's "The Coming of Age" painted a broad-strokes picture of urgent issues affecting the welfare of elders in many cultures. Using her agenda and others, this panel will attempt to sketch what specific technological advances and applications offer to older citizens, clients and patients - over these 50 years and into the future. Rapid aging societies warrants the need to transform health systems to be focused on preventions and patient engagement rather than the curative care.

Background: Cardiac catheterization is the standard of care procedure for diagnosis, choice of therapy, and longitudinal follow-up of children and adults with pulmonary hypertension (PH). However, the procedure is invasive and has risks associated with both the procedure and recovery period., Objectives: The purpose of this study was to identify risk factors for catastrophic adverse outcomes in children with PH undergoing cardiac catheterization., Methods: We studied children and young adults up to 21 years of age with PH undergoing 1 or more cardiac catheterization at centers participating in the Pediatric Health Information Systems database between 2007 and 2012. Using mixed-effects multivariable regression, we assessed the association between pre-specified subject- and procedure-level covariates and the risk of the composite outcome of death or initiation of mechanical circulatory support within 1 day of cardiac catheterization after adjustment for patient- and procedure-level factors., Results: A total of 6,339 procedures performed on 4,401 patients with a diagnosis of PH from 38 of 43 centers contributing data to the Pediatric Health Information Systems database were included. The observed risk of composite outcome was 3.5%. In multivariate modeling, the adjusted risk of the composite outcome was 3.3%. Younger age at catheterization, cardiac operation in the same admission as the catheterization, pre-procedural systemic vasodilator infusion, and hemodialysis were independently associated with an increased risk of adverse outcomes. Pre-procedural use of pulmonary vasodilators was associated with reduced risk of composite outcome., Conclusions: The risk of cardiac catheterization in children and young adults with PH is high relative to previously reported risk in other pediatric populations. The risk is influenced by patient-level factors. Further research is necessary to determine whether knowledge of these factors can be translated into practices that improve outcomes for children with PH., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Srinagarind Hospital has 150-200 patients with cleft lip and palate each year. When patients are admitted to hospital for surgery patients and family feel they are in a crisis of life, they feel fear anxiety and need to know about how to take care of wound, they worry if patient will feel pain, how to feed patients and many things about patients. Information is very important for patients/family to prevent complications and help their decision process, decrease parents stress and encourage better co-operation., Objective: To develop information system for patients with cleft lip-palate undergoing operation., Material and Method: This is an action research divided into 3 phases. Phase 1 Situation review: in this phase we interview, nursing care observation, and review nursing documents about the information giving. Phase 2 Develop information system: focus groups, for discussion about what nurses can do to develop the system to give information to patients/parents. Phase 3 evaluation: by interviewing 61 parents using the structure questionnaire., Results: 100 percent of patients/parents received information but some items were not received. Patients/parents satisfaction was 94.9 percent, no complications., Conclusion: The information system development provides optimal care for patients and family with cleft lip and palate, but needs to improve some techniques or tools to give more information and evaluate further the nursing outcome after.

Background: A systematic review of evidence is the research method which underpins the traditional approach to evidence-based health care. As systematic reviews follow a rigorous methodology, they can take a substantial amount of time to complete ranging in duration from 6 months to 2 years. Rapid reviews have been proposed as a method to provide summaries of the literature in a more timely fashion., Aim: The aim of this paper is to outline our experience of developing evidence summaries in the context of a point of care resource as a contribution to the emerging field of rapid review methodologies., Methods: Evidence summaries are defined as a synopsis that summarizes existing international evidence on healthcare interventions or activities. These summaries are based on structured searches of the literature and selected evidence-based healthcare databases. Following the search, all studies are assessed for internal validity using an abridged set of critical appraisal tools. Once developed, they undergo three levels of peer review by internal and external experts., Results: As of November 2014, there are 2458 evidence summaries that have been created across a range of conditions to inform evidence-based healthcare practices. In addition, there is ongoing development of various new evidence summaries on a wide range of topics. Approximately 60-70 new evidence summaries are published every month, covering research in various medical specialty areas. All summaries are updated annually., Linking Evidence to Action: Systematic reviews, although the ideal type of research to inform practice, often do not meet the needs of users at the point of care. This article describes the development framework for the creation of evidence summaries, a type of rapid review. Although evidence summaries may result in a less rigorous process of development, they can be useful for improving practice at the point of care., (© 2015 Sigma Theta Tau International.)

Telecare medical information systems (TMIS), with the explosive growth of communication technology and physiological monitoring devices, are applied increasingly to enable and support healthcare delivery services. In order to safeguard patients' privacy and tackle the illegal access, authentication schemes for TMIS have been investigated and designed by many researchers. Many of them are promising for adoption in practice, nevertheless, they still have security flaws. In this paper, we propose a novel remote authentication scheme for TMIS using self-certified public keys, which is formally secure in the ID-mBJM model. Besides, the proposed scheme has better computational efficiency. Compared to the related schemes, our protocol is more practical for telemedicine system.

The Telecare Medicine Information Systems (TMISs) provide an efficient communicating platform supporting the patients access health-care delivery services via internet or mobile networks. Authentication becomes an essential need when a remote patient logins into the telecare server. Recently, many extended chaotic maps based authentication schemes using smart cards for TMISs have been proposed. Li et al. proposed a secure smart cards based authentication scheme for TMISs using extended chaotic maps based on Lee's and Jiang et al.'s scheme. In this study, we show that Li et al.'s scheme has still some weaknesses such as violation the session key security, vulnerability to user impersonation attack and lack of local verification. To conquer these flaws, we propose a chaotic maps and smart cards based password authentication scheme by applying biometrics technique and hash function operations. Through the informal and formal security analyses, we demonstrate that our scheme is resilient possible known attacks including the attacks found in Li et al.'s scheme. As compared with the previous authentication schemes, the proposed scheme is more secure and efficient and hence more practical for telemedical environments.

The demand for evidence-based health informatics and benchmarking of 'good' information systems in health care gives an opportunity to continue reporting on recent papers in the German journal GMS Medical Informatics, Biometry and Epidemiology (MIBE) here. The publications in focus deal with a comparison of benchmarking initiatives in German-speaking countries, use of communication standards in telemonitoring scenarios, the estimation of national cancer incidence rates and modifications of parametric tests. Furthermore papers in this issue of MIM are introduced which originally have been presented at the Annual Conference of the German Society of Medical Informatics, Biometry and Epidemiology. They deal as well with evidence and evaluation of 'good' information systems but also with data harmonization, surveillance in obstetrics, adaptive designs and parametrical testing in statistical analysis, patient registries and signal processing.