BACKGROUND AND OBJECTIVE

There are mixed reports on nurses’ satisfaction with electronic medical records (EMR) in literature, and facilitators and barriers to its adoption were reported frequently. A Philippine public tertiary hospital developed an EMR to facilitate remote access to patient charts outside its COVID-designated areas during the pandemic. This study aims to assess nurses’ satisfaction with EMR use in order to improve their user experience. The Delone and McLean Information System (D&M IS) Success Model was used as its framework. This offers a unique perspective to EMR adoption by accounting for the effects of the pandemic.

A descriptive, cross-sectional, quantitatively driven, concurrent mixed-methods design was employed. Nurses from the hospital were recruited for the survey (n=353) and the focus group discussions (n=14). Ethical approval was obtained prior to its conduct. Analysis was done through descriptive statistics, multiple linear regression, and thematic analysis. Data were integrated to appreciate the differences in their experiences from the point of adoption up to their current experiences.

Nurses initially faced challenges with the EMR when it was introduced, but improvements and continuous use have led to their current high satisfaction. Despite mandatory use and high usage scores, some daily tasks are still done manually. Use, length of service, number of patients handled, designation, and area of assignment were found to be associated with satisfaction. Thematic analysis highlighted several adoption prerequisites in this setup, including assessment of user competence and experience, and the provision of training, structural necessities, and organizational support.

This study found high use and satisfaction scores, aligning with the D&M IS Success Model, despite initial adoption challenges. Recommendations include maintaining high EMR use and improving efficiency, communication, and collaboration. Emphasis was placed on the provisions of better training and continuous feedback gathering.

Background and Objective: There are mixed reports on nurses’ satisfaction with electronic medical records (EMR) in literature, and facilitators and barriers to its adoption were reported frequently. A Philippine public tertiary hospital developed an EMR to facilitate remote access to patient charts outside its COVID-designated areas during the pandemic. This study aims to assess nurses’ satisfaction with EMR use in order to improve their user experience. The Delone and McLean Information System (D&M IS) Success Model was used as its framework. This offers a unique perspective to EMR adoption by accounting for the effects of the pandemic. Methods: A descriptive, cross-sectional, quantitatively driven, concurrent mixed-methods design was employed. Nurses from the hospital were recruited for the survey (n=353) and the focus group discussions (n=14). Ethical approval was obtained prior to its conduct. Analysis was done through descriptive statistics, multiple linear regression, and thematic analysis. Data were integrated to appreciate the differences in their experiences from the point of adoption up to their current experiences. Results: Nurses initially faced challenges with the EMR when it was introduced, but improvements and continuous use have led to their current high satisfaction. Despite mandatory use and high usage scores, some daily tasks are still done manually. Use, length of service, number of patients handled, designation, and area of assignment were found to be associated with satisfaction. Thematic analysis highlighted several adoption prerequisites in this setup, including assessment of user competence and experience, and the provision of training, structural necessities, and organizational support. Conclusions This study found high use and satisfaction scores, aligning with the D&M IS Success Model, despite initial adoption challenges. Recommendations include maintaining high EMR use and improving efficiency, communication, and collaboration. Emphasis was placed on the provisions of better training and continuous feedback gathering.
Human ; electronic health records ; health information systems ; nurses ; pandemics ; Philippines

Objectives: This study explores the potential of the HeLe Service Delivery Model, a community-based newborn hearing screening (NHS) program supported by a web-based referral system, in improving provision of hearing care services. Methods: This prospective observational study evaluated the HeLe Service Delivery Model based on records review and user perspectives. We collected system usage logs from July to October 2018 and data on patient outcomes. Semi-structured interviews and review of field reports were conducted to identify implementation challenges and facilitating factors. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data, respectively. Results: Six hundred ninety-two (692) babies were screened: 110 in the RHUs and 582 in the Category A NHS hospital. Mean age at screening was 1.4±1.05 months for those screened in the RHU and 0.46±0.74 month for those in the Category A site. 47.3% of babies screened at the RHU were ≤1 month old in contrast to 86.6% in the Category A hospital. A total of 10 babies (1.4%) received a positive NHS result. Eight of these ten patients were referred via the NHS Appointment and Referral System; seven were confirmed to have bilateral profound hearing loss, while one patient missed his confirmatory testing appointment. The average wait time between screening and confirmatory testing was 17.1±14.5 days. Facilitating factors for NHS implementation include the presence of champions, early technology adopters, legislations, and capacity-building programs. Challenges identified include perceived inconvenience in using information systems, cost concerns for the patients, costly hearing screening equipment, and unstable internet connectivity. The lack of nearby facilities providing NHS diagnostic and intervention services remains a major block in ensuring early diagnosis and management of hearing loss in the community. Conclusion The eHealth-enabled HeLe Service Delivery Model for NHS is promising. It addresses the challenges and needs of community-based NHS by establishing a healthcare provider network for NHS in the locale, providing a capacity-building program to train NHS screeners, and deploying health information systems that allows for documentation, web-based referral and tracking of NHS patients. The model has the potential to be implemented on a larger scale — a deliberate step towards universal hearing health for all Filipinos.
Neonatal Screening ; Hearing Loss ; Health Information Systems ; Community Health Services ; Delivery of Health Care

Background: Health information systems (HIS) such as Electronic Medical Record (EMR) systems are essential in the integration of fragmented local health systems. Investing in HIS is crosscutting; it can address multiple interrelated health system gaps. However, public health authorities, especially those in resource-constrained communities, are often faced with the dual challenge of upgrading and digitalizing local HIS and addressing other more apparent health system gaps. Objectives: The study aimed to identify and document strategies that not only motivate policy change towards adoption of electronic HIS but also address other health system gaps. Methodology: The author, in his capacity as a local health official in a resource-constrained community, developed, implemented, and documented a social marketing strategy wherein community stakeholders were influenced to invest in an electronic medical record (EMR) system because it was shown to also have the capacity to address other priority health system gaps identified. Results: The strategy, based on situational, stakeholder, and risk analyses, prompted local governance to first invest in improving the delivery of services accredited by the national health insurance program (PhilHealth), for which reimbursements would require electronically submitted claim forms. Community stakeholders then supported the proposal to invest in an EMR system because they were persuaded that it can facilitate increased financing from PhilHealth claims reimbursements, which could be used to enable not only improvement in existing health services but to also initiate other health programs. Conclusion Social marketing using the perspective of health as an investment influenced stakeholders to invest in an EMR system.
Public Health ; Health Information Systems ; Health Communication ; Social Marketing

PURPOSE: An injury surveillance information system (ISIS) collects, analyzes, and distributes data on injuries to promote health care delivery. The present study aimed to review the data elements and functional requirements of this system. METHOD: This study was conducted in 2019. Studies related to injury surveillance system were searched from January 2000 to September 2019 via the databases of PubMed, Web of Knowledge, ScienceDirect, and Scopus. Articles related to the epidemiology of injury, population survey, and letters to the editor were excluded, while the review and research articles related to ISISs were included in the study. Initially 324 articles were identified, and finally 22 studies were selected for review. Having reviewed the articles, the data needed were extracted and the results were synthesized narratively. RESULTS: The results showed that most of the systems reviewed in this study used the minimum data set suggested by the World Health Organization injury surveillance guidelines along with supplementary data. The main functions considered for the system were injury track, data analysis, report, data linkage, electronic monitoring and data dissemination. CONCLUSION ISISs can help to improve healthcare planning and injury prevention. Since different countries have various technical and organizational infrastructures, it is essential to identify system requirements in different settings.
Datasets as Topic ; Delivery of Health Care ; Health Information Systems ; Health Planning ; Humans ; Public Health Surveillance ; methods ; Wounds and Injuries ; prevention & control

OBJECTIVE: To describe and compare the epidemiology of Sepsis-1 and Sepsis-3 in Yuetan Subdistrict of Beijing, and to estimate the incidence of Sepsis-3 in China. METHODS: A population-based cohort study was conducted. Through the database of Beijing Public Health Information System, the medical records of all adult residents hospitalized from July 1st, 2012 to June 30th, 2014 in Yuetan Subdistrict were reviewed. According to the clinical data of these patients, patients with Sepsis-1 and Sepsis-3 were enrolled in this analysis and the demographic characteristics of them were compared. Incidence and in-hospital mortality was calculated. Logistic regression method was used to analyze the risk factors of sepsis. RESULTS: Compared with non-septic patients with infections, patients with Sepsis-1 or Sepsis-3 were more likely to be male, older, had more comorbidities and lower body mass index (BMI), had more lower respiratory tract infections, more intra-abdominal infections and more blood flow infections, but had fewer urogenital tract infections, fewer upper respiratory tract infections, fewer gastrointestinal infections and fewer skin and soft tissue infections, and had pure prognosis with longer length of hospital stay [days, Sepsis-1 compared with non-Sepsis-1: 18 (10, 34) vs. 14 (9, 22), Sepsis-3 compared with non-Sepsis-3: 20 (11, 39) vs. 14 (9, 25)] and higher mortality [Sepsis-1 compared with non-Sepsis-1: 20.6% (353/1 716) vs. 2.5% (44/1 733), Sepsis-3 compared with non-Sepsis-3: 32.0% (299/935) vs. 3.9% (98/2 514), all P < 0.01]. Logistic regression analysis showed that male, elder (age ≥ 65 years old), low BMI, bed-rest state, and combined with cerebrovascular disease and hematological malignancies were risk factors for Sepsis-1 [all odds ratio (OR) > 1, all P < 0.05], while the male, elder (age ≥ 65 years old), low BMI, bed-rest state, and combined with cerebrovascular disease, rheumatic immune disease, malignant diseases of blood system and dementia were risk factors for Sepsis-3 (all OR > 1, all P < 0.05). Sepsis-3 was more common in males [OR = 1.19, 95% confidence interval (95%CI) was 1.01-1.40, P < 0.05] and elderly patients (age 65-84 years old: OR = 1.60, 95%CI was 1.28-1.99, P < 0.01; age ≥ 85 years old: OR = 1.76, 95%CI was 1.39-2.23, P < 0.01) as compared with Sepsis-1. After adjusted for gender and age, the standardized incidence of Sepsis-1 was 461 per 100 000 person-year, and that of Sepsis-3 was 236 per 100 000 person-year, with the standardized mortality of 79 per 100 000 person-year and 67 per 100 000 person-year, respectively, in Yuetan Subdistrict of Beijing. Corresponding to a speculative extrapolation of 4 856 532 new cases for Sepsis-1 and 2 487 949 new cases for Sepsis-3, there were 831 674 deaths and 700 437 deaths per year in China, respectively. CONCLUSIONS Male, elder, more comorbidities and low BMI were risk factors for sepsis. The standardized incidence of Sepsis-3 in Yuetan Subdistrict of Beijing was 236 per 100 000 person-year, and speculated there were 2.5 million new cases of Sepsis-3 per year, resulting in more than 700 000 deaths in China. According to the diagnostic criterion of Sepsis-3, 2.36 million new cases per year were reduced, and the mortality was increased by 11.4%, as compared with the criterion of Sepsis-1.
Adult ; Aged ; Aged, 80 and over ; Beijing/epidemiology* ; China ; Cohort Studies ; Health Information Systems ; Humans ; Male ; Retrospective Studies ; Sepsis/epidemiology*

BACKGROUND: The medical service delivery system in Korea works inefficiently and patients tend to visit tertiary hospitals by means of the emergency department (ED). Overcrowding of the ED threatens the health and life of emergency patients as a result of the inability to effectively distribute emergency medical resources in the community. To solve this problem, improvement in the medical delivery system and dispersion of patients by strengthening primary care may be helpful. In order to make policy decisions for this, it is necessary to estimate the scale of patients who can be distributed to primary care.METHODS: From January 1 to December 31, 2016, we analyzed the National Emergency Department Information System (NEDIS) data of patients who visited a tertiary ED to examine the proportion of patients eligible for primary medical care. The inclusion and exclusion criteria for primary care were made through the consensus of three physicians.RESULTS: A total of 65,061 NEDIS records were analyzed. Among them, by inclusion criteria, 29,818 cases were Korean Triage and Acuity Scale level 4 and 5, and 11,791 patients visited the ED during the day. After considering the exclusion criteria, there were 6,468 cases who may be suitable for primary medical care.CONCLUSION: Of the patients who visited the ED of tertiary hospitals, approximately 10% of them may be suitable for primary care. There should be a discussion and social consensus to reduce overcrowding in EDs and deliver better medical services.
Consensus ; Emergencies ; Emergency Service, Hospital ; Humans ; Information Systems ; Korea ; Primary Health Care ; Tertiary Care Centers ; Tertiary Healthcare ; Triage

OBJECTIVES: The objective of this case report is to introduce the development process, structure, characteristics, and effectiveness of the web database (DB) system developed for the hypertension management program in the primary health care setting in the low-income urban areas of Peru. METHODS: A Korean research team cooperated with a Peruvian IT startup company to develop a web DB system to improve the data management of the hypertension management program. The entire web application infrastructure was hosted using the Amazon Web Service. Two different web platforms were established for the user groups of health workers and researchers (program managers). RESULTS: A total of 2,827 program participants were registered in the web DB system until December 2017. Health professionals can input the participant data while providing consultation to the program participants, and the data is accumulated in the web DB in real time. Input errors or data loss is prevented by setting restrictions in the data entry system. During the 4-year project period, 7,696 hours of working time and USD 39,536.48 for data management were saved as the result of web DB system utilization. CONCLUSIONS: The developed web DB system contributed to improve the health condition of the health program participants by providing necessary information to the health professionals at the right time. This case report could be a reference for other researcher to develop web databases for their own context, especially in developing countries.
Developing Countries ; Electronic Health Records ; Health Information Systems ; Health Occupations ; Hypertension* ; Peru* ; Primary Health Care*

OBJECTIVES: In this study an enterprise architecture (EA) was developed for a health referral information system (HRIS) for individual healthcare in Indonesia with reference to the Open Group Architecture Framework (TOGAF) 9.1. The HRIS includes patient referrals for vertical and horizontal references (internal and external), specimen referrals, and health personnel referrals. METHODS: This research was a qualitative study that used the interview and observation method of the Primary Health Care Information System (SIMPUS) application developed by the Agency for Assessment and Application of Technology (BPPT). The interviews were conducted at South Tangerang City Government Health Office with five resource persons who were responsible for conducting health referral processes. RESULTS: The EA of the HRIS includes the principles of architecture, business, application, data, and technology architecture. Twelve principles, four referral processes, and three application reference modules and centralized applications comprise the architecture of the HRIS. The HRIS is a centralized integrated application that uses application program interface (API) to integrate with SIMPUS. CONCLUSIONS: The proposed architecture was developed in an integrated and comprehensive manner for the individual healthcare referral process, which can be implemented by regulators and healthcare facilities. This architecture can also help regulators and healthcare facilities to standardize and integrate health referral data and related processes.
Commerce ; Delivery of Health Care ; Health Information Systems ; Health Personnel ; Humans ; Indonesia* ; Information Systems ; Local Government ; Methods ; Primary Health Care ; Referral and Consultation*

PURPOSE: The vaccination level of rotavirus vaccine not supported by the government is not known. As vaccines not included in the national immunization schedule are not registered in the computerized national immunization registry system, their vaccination rate cannot be calculated according to the same method used in government-supported vaccines. Therefore, this study aimed to measure the status of the vaccination rate of rotavirus not included in the national immunization schedule. METHODS: The target population is the 0-year-old cohort. The survey population was composed of registered children born in 2017 enrolled in the Immunization Registry Information System. The survey was conducted through a computerized telephone survey method. The survey variables were as follows: vaccination order and date, provider, and data source. Factors related to complete vaccination were the child's sex, residence, birth order, and parents' age, educational level, and job status. RESULTS: Children's vaccination rates for the rotavirus vaccine by 2017 were 88.0%, 86.9%, and 96.6% for the first, second, and third doses, respectively. The rate of complete vaccination was 85.6%. The factors related to rotavirus complete vaccination were the child's sex and birth order, area of residence, parents' age and job status, and father's education level. CONCLUSION: In the future, it is necessary to conduct regular investigations on the rate of rotavirus vaccination as a tool for the development of the rotavirus infectious diseases control policy or as an evaluation tool for vaccine programs.
Birth Order ; Child ; Cohort Studies ; Communicable Diseases ; Education ; Health Services Needs and Demand ; Humans ; Immunization ; Immunization Schedule ; Information Storage and Retrieval ; Information Systems ; Methods ; Rotavirus ; Surveys and Questionnaires ; Telephone ; Vaccination ; Vaccines