Technological development in telemedicine: bibliometric analysis, research gaps, and literature trends / Desenvolvimento tecnológico na telemedicina: análise bibliométrica, lacunas de pesquisa e tendências na literatura / Desarrollo tecnológico en telemedicina: análisis bibliométrico, lagunas en la investigación y tendencias en la literatura

The aim of this article was to analyze the literature on technological development in telemedicine through bibliometrics, by identifying the state of the art, research gaps, and trends in the literature. The analysis covers a total of 67 articles related to the field of study, published between 2010-2020 in the Springer Link, Science Direct, Wiley Online Library, Web of Science, and Scopus databases. The data was processed using the software StArt, Excel, IBM SPSS Statistics, and Iramuteq. The results presented bibliometric analysis of the articles, classified into the areas of Management (52.2%), IT (25.4%), and Medicine (22.4%), along with a Table of 34 suggestions for future research. Literature trends encompassed six study clusters (health, study, service, technology, patient, and telemedicine), which further subdivided into nine research themes (digital platform, telemedicine service management, telemedicine service operation, end-user perception, business opportunities, healthcare professional perception, covid-19, regulation, and robotics). An observed outcome was a significant increase in the number of publications in the area due to covid-19.

O objetivo deste artigo foi analisar a literatura acerca do desenvolvimento tecnológico na telemedicina, por meio da bibliometria, ao identificar o estado da arte, lacunas de pesquisa e tendências na literatura. Analisou-se 67 artigos relacionados ao campo de estudo, publicados entre 2010-2020 nas bases de dados Springer Link, Science Direct, Wiley Online Library, Web of Science e Scopus. O tratamento dos dados se deu por meio dos softwares StArt, Excel, IBM SPSS Statistics e Iramuteq. Os resultados apresentaram a análise bibliométrica dos artigos, classificados nas áreas de Gestão (52,2%), TI (25,4%) e Medicina (22,4%), e uma tabela com 34 sugestões para pesquisas futuras. As tendências da literatura envolveram seis classes de estudo (saúde, estudo, serviço, tecnologia, paciente e telemedicina), que se subdividiram em nove temas de pesquisa (plataforma digital, gestão do serviço de telemedicina, operação do serviço de telemedicina, percepção do usuário final, oportunidades de negócios, percepção de profissionais de saúde, covid-19, regulamentação e robótica). Observou-se aumento significativo no número de publicações na área devido à covid-19.

El objetivo de este artículo fue analizar la literatura sobre el desarrollo tecnológico en la telemedicina me-diante bibliometría, identificando el estado del arte, las lagunas de investigación y las tendencias en la literatura. Se analizaron un total de 67 artículos relacionados con el campo de estudio, publicados entre 2010-2020 en las bases de datos de Springer Link, Science Direct, Wiley Online Library, Web of Science y Scopus. Los datos fueron procesados utilizando los programas StArt, Excel, IBM SPSS Statistics e Iramuteq. Los resultados presentaron un análisis bibliométrico de los artículos, clasificados en las áreas de Gestión (52,2%), TI (25,4%) y Medicina (22,4%), junto con una tabla de 34 sugerencias para futuras investiga-ciones. Las tendencias en la literatura abarcaron seis clases de estudio (salud, estudio, servicio, tecnología, paciente y telemedicina), que se subdividieron en nueve temas de investigación (plataforma digital, gestión del servicio de telemedicina, operación del servicio de telemedicina, percepción del usuario final, oportuni-dades de negocio, percepción de los profesionales de la salud, covid-19, regulación y robótica). Un resultado observado fue un aumento significativo en el número de publicaciones en el área debido al covid-19.

Perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19: resultados da DIABETES / Profile of people with diabetes who used telepharmacy during the covid-19 pandemic: results from DIABETES / Perfil de personas con diabetes que usaron telefarmacia durante la pandemia de covid-19: resultados de DIABETES

O objetivo foi analisar o perfil das pessoas com diabetes que utilizaram a telefarmácia na pandemia de covid-19. Trata-se de um estudo transversal com dados oriundos da websurvey DIABETESvid que ocorreu nos meses de setembro e outubro de 2020. Verificou-se que 45 participantes recorreram à telefarmácia, sendo que 55,6% eram do sexo masculino, 42,2% tinham idade compreendida entre 18 e 34 anos e 46,7% estudaram 12 ou mais anos. Além disso, 48,9% autorreferiram diabetes mellitus tipo 1. A maioria usava insulina (55,6%) e obteve os medicamentos para o diabetes em farmácias do sistema público de saúde (60%). Ademais, as pessoas que tiveram o diagnóstico de covid-19 buscaram mais pela telefarmácia (RP=2,20; IC95% 1,23­3,94). Sabe-se que os medicamentos são essenciais para o tratamento do diabetes. Logo, no período estudado em que se preconizava o distanciamento físico, os participantes apropriaram-se da telefarmácia a fim de obter a integralidade do cuidado

The objective was to analyze the profile of people with diabetes who used telepharmacy during the covid-19 pandemic. This is a cross-sectional study with data from the DIABETESvid websurvey that took place in September and October 2020. It was found that 45 participants used telepharmacy, 55.6% of whom were male, 42.2% were between 18 and 34 years-old and 46.7% studied 12 or more years. In addition, 48.9% self-reported type 1 diabetes mellitus. Most used insulin (55.6%) and obtained their diabetes medication from pharmacies in the public health system (60%). Also, people diagnosed with covid-19 used telephar-macy more often (PR=2.20; 95%CI 1.23­3.94). It is known that drugs are essential for the treatment of diabetes. Therefore, in the period studied in which physical distancing was advocated, the participants used telepharmacy to obtain comprehensive care

El objetivo fue analizar el perfil de las personas con diabetes que utilizaron la telefarmacia durante la pandemia del covid-19. Estudio transversal con datos de la encuesta por internet DIABETESvid realizada en septiembre y octubre de 2020. Se encontró que 45 participantes recurrieron a la telefarmacia, de los cuales el 55,6% eran hombres, el 42,2% tenían entre 18 y 34 años y el 46,7% estudiaban 12 o más años. Además, el 48,9% se autorrefirió diabetes mellitus tipo 1. La mayoría utilizaba insulina (55,6%) y recibía su medicación antidiabética en farmacias del sistema público (60%). Además, las personas diagnosticadas con covid-19 buscaron telefarmacia con más frecuencia (RP = 2,20; IC 95% 1,23­3,94). Los medicamentos son esenciales para el tratamiento de la diabetes. Por lo tanto, en el período estudiado en el que se propugnaba el distanciamiento físico, los participantes se apropiaron de la telefarmacia para la atención integral

Analysis on influencing factors of e-health literacy of college students based on the Anderson model / 中国职业医学

{L-End}Objective To analyze the current status of e-health literacy (e-HL) among college students and its influencing factors based on the Anderson model. {L-End}Methods A total of 7 230 college students from Guangdong Province, Hebei Province, Jiangsu Province and other places were selected as the study subjects using the convenient sampling method based on the theoretical framework of the Anderson model. The e-HL level, anxiety symptoms and depression symptoms were investigated using the e-Health Literacy Scale, the 7-item Generalized Anxiety Scale and the Patient Health Questionnaire-9 items. {L-End}Results The score of e-HL was (29.2±6.7), with the pass rate of 42.8%. The result of multiple linear regression analysis showed that college students with lower class rank, higher average monthly family income, better online health information judgment ability, and lower degree of depression symptoms had higher e-HL level (all P<0.01). College students living in urban areas had higher e-HL levels than those living in rural areas (P<0.01). College students who engaged in regular physical exercise had higher e-HL levels than those who did not (P<0.01). College students with mild anxiety symptoms had lower e-HL levels than those without anxiety symptoms (P<0.01). {L-End}Conclusion The e-HL level of college students needs to be improved. From the perspective of the Anderson model, predisposing characteristics (class grade ranking), resources (place of residence, online health information judgment ability, regular physical exercise), demand factors (anxiety symptoms, depression symptoms) affect the level of e-HL of college students.

A história da telemedicina no Brasil: desafios e vantagens / The history of telemedicine in Brazil: challenges and advantages

Resumo A utilização de novas tecnologias de informação para um atendimento mais efetivo e à distância é algo que se impõe no contexto de serviços em saúde, no atual panorama sociopolítico. Entretanto, o Brasil ainda está receoso em integrar de forma permanente esses avanços. Esta pesquisa tem como objetivo revisar os marcos da história da telemedicina no Brasil, destacando as questões éticas e legislativas, bem como evidenciar os desafios para sua implantação e gerar uma proposta para superá-los. Trata-se de uma revisão integrativa da literatura acerca da história, dos desafios e da realidade da telemedicina no cenário brasileiro. A telemedicina é uma atividade recente no Brasil, defrontando-se com resistências por parte dos profissionais, em especial médicos, que diversas vezes não vislumbram claramente seus benefícios. Apesar das dificuldades previstas em aceitar este modelo, é relevante ressaltar as vantagens que esse padrão abarca, como ampliar e facilitar o acesso à assistência de saúde. Propor alternativas para superar resistências e alcançar um padrão otimizado é essencial e abrange maior abertura no campo político, legislativo e educacional.

Abstract The use of new information technologies for a more effective remote service is required in the context of health services, especially when it comes to the current socio-political panorama. Nevertheless, Brazil is still afraid to permanently integrate these advances. This research aims to review the milestones in the history of telemedicine in Brazil, highlighting the ethical and legislative issues, as well as evidencing the challenges for its implementation and generating a proposal to overcome them. It is an integrative literature review about the history, challenges, and reality of telemedicine in the Brazilian scenario. Telemedicine is a recent activity in Brazil, facing resistance from professionals, especially doctors, who often do not clearly see its benefits. Despite the anticipated difficulties in accepting this model, it is important to highlight the advantages that this standard encompasses, such as expanding and facilitating access to health care. Proposing alternatives to overcome resistance and reach an optimized standard is essential and encompasses greater openness in the political, legislative, and educational fields.

Estudio piloto de un programa basado en Internet para la prevención e intervención temprana de la depresión en adolescentes / Feasibility and effectiveness of an Internet-based program for the prevention and early intervention of depression inInternet adolescents

Resumen Antecedentes: la alta prevalencia de depresión en la adolescencia y sus graves consecuencias, asociadas a su falta de detección y tratamiento, estimulan el interés en la investigación respecto a su prevención e intervención tempranas. Las intervenciones basadas en las tecnologías de la información y la comunicación (TIC), dada su flexibilidad y capacidad de difusión, representan oportunidades innovadoras; no obstante, en Latinoamérica hay poca evidencia sobre su impacto y eficacia. Objetivo y metodología: se realiza un estudio piloto cuantitativo cuasiexperimental que busca evaluar la factibilidad del programa basado en Internet "Cuida tu Ánimo", mediante las variables de uso y aceptabilidad, y la estimación del efecto, en 215 adolescentes (103 grupo activo, 112 grupo control) de dos instituciones educativas de la ciudad de Medellín. Se evaluaron las interacciones de los adolescentes con el Programa, su uso-aceptabilidad, el nivel de sintomatología depresiva y otros aspectos relacionados. Resultados: los adolescentes reportan alta aceptación y uso muy moderado del Programa. Señalan el aprendizaje sobre depresión y detección temprana del riesgo que les proporcionó el Programa; y recomiendan aumentar la interactividad de la plataforma web, generar contenidos más diversos y entretenidos, y aumentar los niveles de presencialidad de la intervención. Conclusiones: los programas basados en las TIC pueden ser un complemento favorable para la prevención e intervención tempranas de la depresión en adolescentes. Dada la dificultad de asociar la estimación del efecto del Programa con su uso, se recomienda en estudios futuros utilizar un diseño que permita relacionar los indicadores de uso con los de resultado (dosis-efecto).

Abstract Background: the high prevalence of depression in adolescence and its serious consequences, associated with its lack of detection and treatment, stimulate interest in research regarding its early prevention and intervention. Interventions based on information and communication technologies (ICT), given their flexibility and capacity for dissemination, represent innovative opportunities; however, in Latin America there is little evidence on their impact and efficacy. Objective and Methods: a quasi-experimental quantitative pilot study was carried out to evaluate the feasibility, through the variables of use and acceptability, and the estimated effect of the Internet-based program "Cuida tu Ánimo", in 215 adolescents (103 active group, 112 control group) from two educational institutions. The adolescents' interactions with the program, its use-acceptability, and the level of depressive symptomatology and other related aspects were evaluated. Results: the adolescents report high acceptance and very moderate use of the Program. They point out that the program allowed them to learn about depression and early detection of risk; also, they recommend increasing the interactivity of the web platform, designing more diverse and entertaining content, and increasing the presence of the intervention. Conclusions: Internet-based programs such as Cuida tu Ánimo can be a favorable complement for the prevention and early intervention of depression in adolescents. Considering the difficulty in relating the estimation of the Program's effect with its use, it is recommended that future studies include a design that permits associating the use indicators with the outcome indicators (dose-effect).

Innovation in the Italian National Health System and the Cost-Reducing Impact of E-Health and Telemedicine: The special case of the Telemedicine Project of the Casa Sollievo della Sofferenza Hospital (Apulia Region)—When Information and Communication Technology Comes to the Aid of the Territory

The recent events of the COVID-19 pandemic, caused by the SARS-CoV-2 virus, have dramatically and suddenly changed the dynamic interactions among the various elements of the complex social and economic texture of most countries around the globe, such as Italy, accelerating the digital transformation in many areas of human activity and in particular in the health care sector. After having defined e-health (Figure 1) and some of its applications, with particular reference to telemedicine, the following important research question is addressed: what are the factors that contribute to the successful introduction of telemedicine? To answer this question, this article focuses on the recent efforts of the Italian Health Legislation to increase e-health literacy and to incentivize the health care system to adopt the new tools of information and communication technologies. In particular, the role of telemedicine is highlighted for its cost-reducing effect, particularly when dealing with patients affected by chronic, noncommunicable diseases. For this purpose, the author considers as a special case study the implementation strategy of the Telemedicine project of the Casa Sollievo della Sofferenza, a private Catholic hospital in Southern Italy, as an example of excellence.

Salud móvil: conceptos generales y potencialidades de implementación en Cuba

Introducción: Actualmente el uso de las Tecnologías de la Información y las Comunicaciones forma parte del quehacer diario de la sociedad. La salud móvil es una de las que más desarrollo presenta, por un lado, debido a la nueva normalidad generada por la pandemia de la COVID-19, pero en gran medida, por las ventajas que tienen los dispositivos móviles frente a otras tecnologías. Objetivo: Sistematizar las teorías acerca de la salud móvil y evaluar las potencialidades de desarrollo en Cuba. Método: Se realizó un análisis documental respondiendo a las necesidades informativas de los autores, comprendido en tres fases: exploración del área de interés y problemática actual, determinación de las ideas esenciales de los documentos consultados y que aportan el significado general de estos y, la tercera fase, que incluyó la sistematización de la información para actualizar la nueva información contenida en el actual artículo. Resultados: Se describieron aspectos generales, tales como: Salud móvil en Cuba de la mano del desarrollo tecnológico del país, Seguridad y compatibilidad de uso, Aspectos legales de desarrollo; aspectos que inciden en el proceso de creación de las aplicaciones de salud móvil. Se propuso, además, la plataforma Mobincube, como herramienta de fácil aprendizaje y manejo para los profesionales de salud, permitiéndoles crear sus propias aplicaciones sin necesidad de programar. Conclusiones: Cuba cuenta con el desarrollo tecnológico e intelectual suficiente para incursionar en el desarrollo de la salud móvil. El reto fundamental es ganar en cultura informática suficiente por parte de los profesionales de la salud cubanos en materia de salud móvil.

Introduction: The use of Digital and Communication Technologies are currently part of the daily activities of society. Mobile health (mHealth) is one of the most developed nowadays, on one hand, due to the new normality generated by the COVID-19 pandemic, but also far away, due to the relevant advantages acquired for mobile telephone technologies over other technologies. Objective: To systematize the theories concerning mobile health and to assess its developing potential in Cuba. Method: A documentary analysis was carried out in response to the authors' information needs, comprising three phases: exploration of the priority areas and the current problematic issues, determination of the essential ideas sit in the documents consulted and which provide the general meaning included in those documents and, as a third phase implemented, it was included the systematization of the information obtained to update the new information contained in the current article. Results: General aspects, such as: Mobile health in Cuba in line with the country's technological development, Safety and use compatibility, legal aspects for properly development were described; aspects which help in the process of creating mobile health applications. It was also proposed the Mobincube platform, as an easy to learn and use tool for health professionals, allowing them to create their own applications without the need for programming. Conclusions: Cuba has sufficient technological and intellectual development to venture into the development of mobile health field. The main challenge is to gain sufficient informatics culture among Cuban health professionals in the field of mobile health.

Introdução: Atualmente o uso das Tecnologias de Informação e Comunicação faz parte do cotidiano da sociedade. A saúde móvel é uma das mais desenvolvidas, por um lado, devido à nova normalidade gerada pela pandemia do COVID-19, mas, em grande medida, pelas vantagens que os dispositivos móveis têm sobre outras tecnologias. Objetivo: Sistematizar as teorias sobre saúde móvel e avaliar o potencial de desenvolvimento em Cuba. Método: Foi realizada uma análise documental respondendo às necessidades informativas dos autores, composta por três fases: exploração da área de interesse e problemas atuais, determinação das ideias essenciais dos documentos consultados e que fornecem o significado geral de estas e, a terceira fase, que incluiu a sistematização das informações para atualização das novas informações contidas no artigo atual. Resultados: Foram descritos aspectos gerais, tais como: Saúde móvel em Cuba de mãos dadas com o desenvolvimento tecnológico do país, Segurança e compatibilidade de uso, Aspectos legais do desenvolvimento; aspectos que afetam o processo de criação de aplicativos móveis de saúde. Além disso, a plataforma Mobincube foi proposta como uma ferramenta de fácil aprendizado e gerenciamento para profissionais de saúde, permitindo que eles criem seus próprios aplicativos sem programação. Conclusões: Cuba tem desenvolvimento tecnológico e intelectual suficiente para se aventurar no desenvolvimento da saúde móvel. O desafio fundamental é ganhar suficiente cultura informática por parte dos profissionais de saúde cubanos no campo da saúde móvel.

Experiencias sobre la implementación del Expediente Clínico Electrónico / Experiences on the implementation of the Electronic Medical Record

Resumen Introducción. Un elemento de la e-salud que ha cobrado gran relevancia es el Expediente Clínico Electrónico (ECE) ya que es un medio para lograr mejores resultados en la práctica médica. Al momento, han sido pocas las investigaciones que se han centrado en analizar e identificar la situación de esta estrategia en el mundo. Por ello, el objetivo de esta investigación es analizar el panorama actual del ECE en diversos países considerando las ventajas, desventajas, desafíos y factores de éxito en su implementación. Metodología: Se realizó una revisión de la literatura existente sobre el ECE en base de datos especializadas. Para obtener estos estudios se utilizó la base de datos de scopus y sciencedirect , utilizando palabras de búsqueda como como registro electrónico de salud, registro médico electrónico o expediente clínico electrónico; se seleccionaron solamente aquellos estudios con un alto factor de impacto, mismo que se refiere al número de veces que se hayan citado los artículos consultados. Se seleccionaron y analizaron 64 estudios académicos. Resultados. Se encontró que aún existen importantes desafíos y desventajas en la implementación del ECE como la interoperabilidad semántica y el estrés laboral que genera en los usuarios este sistema. Conclusiones. Existen cuestiones importantes que aún quedan por resolver para una implementación eficaz del ECE. Es necesario integrar a todos los involucrados en el proceso de cambio, así como establecer las medidas de seguridad necesarias para garantizar la privacidad de la información.

Abstract Introduction. An element of e-health that has gained great relevance is the Electronic Medical Record (ECE) since it is a means to achieve better results in medical practice. At the moment, few investigations have focused on analyzing and identifying the situation of this strategy in the world. Therefore, the objective of this research is to analyze the current panorama of ECE in various countries considering the advantages, disadvantages, challenges and success factors in its implementation. Methodology. A review of the existing literature on ECE was carried out in specialized databases. To obtain these studies, the scopus and sciencedirect databases were used, using search words such as "electronic health record", "electronic medical record" or "electronic medical record"; Only those studies with a high impact factor were selected, which refers to the number of times the articles consulted have been cited. 64 academic studies were selected and analyzed. Results. It was found that there are still important challenges and disadvantages in the implementation of ECE such as semantic interoperability and the work stress that this system generates in users. Conclusions. There are important issues that remain to be resolved in the effective implementation of the ECE. It is necessary to integrate all those involved in the change process as well as to establish the necessary security measures to guarantee the privacy of the information.

Telemedicina para seguimiento de pacientes renales trasplantados durante la pandemia por COVID-19

Contexto: la pandemia por COVID-19 generó la reestructuración de los servicios de salud en el mundo. La teleconsulta ofrece el acceso a la atención en salud a distancia como estrategia de mitigación a la propagación del virus y como una forma flexible de telemedicina. Objetivo: describir los resultados de atención en salud por modalidad de teleconsulta en pacientes trasplantados durante el inicio de la pandemia por COVID-19. Metodología: estudio descriptivo de corte transversal que describe la experiencia del uso de la teleconsulta en el inicio de la pandemia por COVID-19 en un centro de trasplante de órganos en Colombia. La información fue obtenida mediante la recolección directa de la atención en el mes de abril de 2020 y a través del envío de un cuestionario electrónico, estructurado para los pacientes atendidos por teleconsulta. Resultados: un total de 1139 pacientes con trasplante renal fueron valorados en la modalidad de teleconsulta. Alrededor del 50 % de los pacientes atendidos vivían fuera de áreas metropolitanas (n = 564) y un total de 292 (de 800 contactados) respondieron la encuesta enviada con una media de edad de 48 años. Los pacientes presentaron altos porcentajes de satisfacción con el modelo de teleconsulta (n = 278, lo que equivale al 94 %). Se presentaron dos casos sospechosos de COVID-19, los cuales fueron negativos al realizar la prueba de PCR-RT. Conclusiones: la teleconsulta es una herramienta útil en la mitigación de la emergencia sanitaria, con un alto potencial que genera mayor acceso y oportunidad de atención en salud, presentando altos índices de aceptación.

Introduction: The COVID-19 pandemic led to the restructuring of health services around the world. Teleconsultation offers access to remote health care and a mitigation strategy. Purpose: Describe the results of a teleconsultation program in a transplant center at the beginning of the COVID-19 pandemic. Methodology: Descriptive cross-sectional study describing the experience of the use of teleconsultation during the beginning of the COVID-19 pandemic at an organ transplant center in Colombia. The information was obtained by directly collecting the total number of patients treated during April 2020 and by sending a structured electronic questionnaire to the patients involved in the care. Results: A total of 1139 renal transplant patients were assessed by teleconsultation. The geographical distribution of patients in metropolitan areas and outside the metropolitan area were similar (n=575 and n=564, respectively). Of the total, 292 patients responded to the survey sent with an average age of 48 years. The patients had high satisfaction with the teleconsultation model (n=278, 94%). There were 2 suspected cases of COVID-19, which were negative when performing the PCR-RT test. Conclusions: Teleconsultation is a useful tool in the mitigation of the health emergency, with a high potential, which generates greater access and health care opportunity, presenting high acceptance rates.

Discoursing terminology standards and interoperability in relation to the Philippine eHealth Strategy

Background@#eHealth is the use of information and communication technologies (ICT) for health. It helps in improving the flow of information, through electronic means, in support of the delivery of health services, and the management of health systems. eHealth is used as the strategic context and tool in achieving population health, improved health system status, and socio-economic development goals. @*Objectives@#This study is aimed at looking at the Philippine National eHealth Strategy, particularly the components of Terminology Standards and Interoperability concerning the eHealth strategy in the Philippines, and to assess the barriers and gaps in the integration of these two components. @*Methods@#This study used secondary literature, internet search, Philippine laws, administrative orders, memorandum circulars, and grey literature to discourse terminology standards and interoperability in the Philippine eHealth system, and issues and gaps related to these components that may impede the delivery of Universal Health Coverage in the country. @*Results@#The current Philippine National eHealth strategy includes the following sector governance, legislation, policy and compliance, eHealth solution (i.e., services and applications), strategy and investment, infrastructure (government), human resources, and standards and interoperability. Philippine Health Information Exchange (PHIE) is a software platform in the country that aims to connect many isolated electronic health systems. The proposed interoperability layer across health systems and services in the Philippines includes Patient’s Primary Healthcare Consultation at the Rural Health Unit, health research, legal information, patient healthcare at tertiary hospital, and health insurance claims. The study results showed that issues and gaps related to the interoperability of eHealth in the Philippines include technical issues such as lack of common semantics, lack of an institutional mechanism to regulate EMR, lack of incentives among eHealth providers and stakeholders to adopt standards for interoperability.@*Conclusion@#The effort of the Philippines to achieve interoperability and standards in eHealth goals can be characterized as a work in progress. The government, private sector, physician, patient, and other stakeholders are deemed to continuously develop a shared vision and interoperate under a standardized guide as eHealth is a complex endeavor that covers many aspects.

Systematic and Collaborative Review of E-health Ecological Networks (SCREEN) Model

@#Due to the Covid-19 pandemic, occupational therapy services in the Philippines experienced a shift in service delivery. As face-to-face services were halted, E-health became the key solution for rendering rehabilitation services. Practitioners relied on their clinical judgment in accepting clients for this type of service delivery. The Systematic and Collaborative Review of E-health Ecological Networks or SCREEN is a model that may aid occupational therapists practicing in the pediatric setting and providing services through E-health. The SCREEN model will assist practitioners in deciding what type of service delivery would be beneficial for the client and if the therapist is equipped to provide E-health as a service. SCREEN model includes the framework and a decision tree for its usability and application to OT practice, particularly in E-health.

Prática avançada de enfermagem na estratégia saúde da família: necessidade de aplicativo para a comunicação entre enfermeiro e usuário / Advanced practice nursing in the family health strategy: the need for an application for communication between nurse and user

A Estratégia Saúde da Família é uma das portas de entrada para o Sistema Único de Saúde, onde a Enfermagem atua com foco na prevenção, promoção e reabilitação à saúde em conformidade com a legislação vigente do Ministério da Saúde e respaldo do Conselho Federal de Enfermagem. As práticas desenvolvidas pelos Enfermeiros no âmbito da Atenção Primária atendem às características de Práticas Avançadas de Enfermagem estabelecidas por diretrizes do Conselho Internacional de Enfermeiros. A comunhão entre a tecnologia e comunicação em saúde vem favorecendo qualidade e segurança no cuidado em saúde; de modo especial, os aplicativos para dispositivos móveis como ferramenta e estratégia para conectar profissional e paciente estão transformando positivamente o sistema de saúde. O uso de tecnologias digitais permite que a população conheça, acesse e solicite os procedimentos de práticas avançadas de enfermagem, resultando em redução das filas de atendimento e um acompanhamento individual do profissional sobre o estado de saúde do paciente em tempo real. Dessa forma, este estudo foi desenvolvido em duas fases: mapeamento de ações de Práticas Avançadas de Enfermagem implementadas no contexto da Estratégia Saúde da Família e avaliação do conhecimento de profissionais acerca do aplicativo DigiSUS e da necessidade de desenvolvimento de software para comunicação entre profissionais de enfermagem e usuários da Estratégia Saúde da Família. Os dados foram coletados por meio de formulário eletrônico encaminhado aos participantes do estudo, atuantes na Estratégia Saúde da Família em um município localizado no interior de Minas Gerais. Participaram do estudo 39 enfermeiros, com idade entre 24 e 50 anos, a maioria (82%) do sexo feminino. Pode-se identificar que estes profissionais desenvolvem ações de Enfermagem de Prática Avançada, entre elas: prescrição de medicamentos, solicitação e avaliação de exames complementares, diagnóstico de enfermagem, acolhimento nas unidades de saúde e procedimentos de enfermagem conforme protocolos assistenciais de enfermagem estabelecidos no contexto em que estão inseridos. A maioria dos enfermeiros 24 (61,5%) informaram conhecer as tecnologias disponibilizadas pelo Ministério da Saúde (MS); no entanto, 25 (64,1%) não conhecem o aplicativo do DigiSUS e 29 (74,4%) referiram não utilizar nenhuma tecnologia para comunicação com o usuário da ESF e que gostariam de utilizar um aplicativo/software para facilitar a comunicação com os usuários cadastrados na ESF em que atua. Conclui-se pela necessidade e expectativa dos enfermeiros terem acesso a um protótipo de aplicativo que facilite a comunicação com os usuários da Estratégia Saúde da Família do Sistema Único de Saúde

The Family Health Strategy (FHS) is one of the gateways to the Unified Health System, where Nursing works with a focus on health prevention, promotion and rehabilitation in accordance with the current legislation of the Ministry of Health and support of the Federal Council of Nursing. The practices developed by nurses within the scope of Primary Care meet the characteristics of Advanced Practice Nursing established by the guidelines of the International Council of Nurses (ICN). The correlation between technology and communication in health has been favoring quality and safety in health care; in particular, the use of smartphones as a tool and strategy to connect professionals and patients is positively changing the health system. The use of digital technologies provides an opportunity to the population to know, access and request advanced practice nursing procedures, resulting in a reduction in service queues and in an individual follow-up of the professional on the patient's health status in real time. Thus, this study was developed in two phases: the mapping of Advanced Practice Nursing activities performed in the context of the Family Health Strategy; and the evaluation of professionals' knowledge about the DigiSUS application and the need to develop a software for communication between nursing professionals and users of the Family Health Strategy. Data were collected through an electronic form sent to study participants who work in the Family Health Strategy in a city located in the countryside of Minas Gerais state. Thirty-nine nurses participated in the study, aged between 24 and 50 years, and the majority (82%) were female. It can be identified that these professionals develop activities related to Advanced Practice Nursing, including: drug prescription, request and evaluation of complementary exams, nursing diagnosis, reception in the health units and nursing procedures according to nursing care protocols established in the context in which they are working. Most nurses 24 (61.5%) reported knowing the technologies made available by the Ministry of Health (MS). However, 25 nurses (64.1%) do not know the DigiSUS application; 29 nurses (74.4%) reported not using any technology to communicate with the FHS user and that they would like to use an application/software to facilitate communication with the users registered in the FHS where they work. It is concluded that nurses need and expect access to an application prototype that facilitates communication with users of the Family Health Strategy of the Unified Health System

Use of digital technologies in mental health during COVID-19 / Uso de tecnologias digitais na saúde mental durante a COVID-19

Most countries did not have a consolidated digital health structure before the pandemic. Both social distancing and mental health problems resulting from the situation justify the urgency of discussions on web-mediated interventions. The objective of this work is to present the panorama of technological mediation in mental health services and their specificities in the context of the pandemic. This paper is grounded on a critical look at the migration from face-to-face care to the Internet environment, highlighting: the international experiences using digital technologies in the pandemic context; the challenges in online consultations, emphasizing the importance of the ethical, technical/technological, and clinical domains, which are recurring issues in the international literature; the challenges and perspectives in the use of technologies. It is essential to develop strategies aligned with government incentives, aiming at the quality of the offered services and the guarantee of an adequate hybrid qualification.

A maioria dos países não possuía uma estrutura de saúde digital consolidada antes da pandemia. Tanto o distanciamento social quanto os agravos psicológicos decorrentes da própria situação justificam a urgência de discussões científicas sobre intervenções mediadas pela web. O objetivo deste trabalho é apresentar o panorama da mediação tecnológica nos serviços de saúde mental e suas especificidades no contexto da pandemia. Parte-se de um olhar crítico diante da migração do cuidado face a face ao ambiente da Internet, ressaltando: experiências internacionais no uso das tecnologias digitais no contexto da pandemia; desafios nas consultas online, com destaque à importância dos domínios ético, técnico/tecnológico e da clínica recorrentes na literatura internacional; desafios e perspectivas do uso das tecnologias. É imprescindível desenvolver estratégias com incentivo governamental, visando a qualidade dos serviços oferecidos e a garantia de formação híbrida adequada.

Módulo Medios diagnósticos para el Sistema de Información Hospitalaria XAVIA HIS / Diagnostic Means Module for the XAVIA HIS Hospital Information System

El Sistema de Información Hospitalaria XAVIA HIS desarrollado por el Centro de Informática Médica (CESIM) está compuesto por módulos que aseguran la informatización de los procesos de las áreas de la institución hospitalaria. En la actualidad la gestión de los principales medios de diagnóstico se realiza de forma dispersa en diferentes módulos o sistemas. En este trabajo se presenta el módulo de Medios de Diagnóstico, desarrollo que permite la gestión de informes de solicitudes y resultados de forma configurable, así como la planificación de horarios y gestión de citas. Se analizó el proceso de negocio asociado a la gestión de información de medios de diagnóstico, se realizó un estudio de sistemas existentes con propósitos similares y se evaluaron tecnologías para su implementación. Se utilizó AUP-UCI como metodología de desarrollo, Java como lenguaje de programación y otras tecnologías libres y multiplataforma. El patrón arquitectónico implementado fue modelo-vista-controlador. El módulo de Medios de Diagnóstico del sistema XAVIA HIS, permite el soporte de los procesos de atención al paciente y la integración de la información sobre los medios de diagnóstico, además fomenta un aumento en la calidad del servicio. El módulo facilita la configuración de aspectos de solicitud e informe de las pruebas diagnósticas y la planificación de horarios y citas(AU)

Hospital Information System XAVIA HIS developed by the Medical Informatics Center (CESIM) is made up of modules that ensure the computerization of hospital institution areas processes. Currently, the management of the main diagnostic means is realized in a dispersed way in different modules or systems. This paper presents the Diagnostic Means module, development that allows the requests and results reports management in a configurable way, as well as the schedules planning and appointments management. The business process associated with the diagnostic means information management was analyzed, an existing systems study with similar purposes was carried out, and technologies for their implementation were evaluated. AUP-UCI were used as development methodology, Java as programming language and other free and multiplatform technologies. The architectural pattern implemented was model-view-controller. The XAVIA HIS system Diagnostic Means module, allows the patient care processes support and integration of information regarding diagnostic means, also encourages an increase in the service quality. The module facilitates the request and report aspects configuration of the diagnostic tests and the schedules and appointments planning(AU)

Módulo Programas Médicos para el Sistema de Información Hospitalaria XAVIA HIS / Module Medical Programs for the XAVIA HIS Hospital Information System

La prestación personalizada de los servicios de salud resulta cada vez más atractiva y eficiente. El empleo de las herramientas informáticas para facilitar este propósito es una necesidad de las instituciones de salud. El Sistema de Información Hospitalaria XAVIA HIS es un ejemplo de la relación entre las necesidades de las instituciones de salud y la evolución funcional del mismo. Sin embargo, en el sistema no se ha concebido la posibilidad de planificar un protocolo que especifique los cuidados y procedimientos que deben realizarse en función del estado de salud del paciente. El trabajo presenta el desarrollo del módulo Programas Médicos para el sistema XAVIA HIS, que permite mejorar la gestión de la información generada durante el procesamiento de los programas médicos en las instituciones hospitalarias. Se realizó el análisis de los procesos de negocio asociados a la gestión de los programas médicos, se empleó como metodología de desarrollo AUP-UCI, JBoss Developer Studio, Java, JBoss como servidor de aplicaciones, PostgreSQL como sistema gestor de bases de datos y Visual Paradigm como herramienta CASE. Como resultado se obtuvo el módulo Programas médicos para el sistema XAVIA HIS, que permite la configuración de un programa médico a un paciente con una determinada enfermedad agrupando varios servicios, procedimientos, investigaciones clínicas por cada área del hospital(AU).

The health services personalized provision is becoming increasingly attractive and efficient. The computer tools used to facilitate this purpose is a necessity for health institutions. The Hospital Information System XAVIA HIS is an example of the relationship between the health institutions needs and its functional evolution. However, the system has not conceived the possibility of planning a protocol that specifies the care and procedures that must be performed depending on patient health condition. The paper presents the development of the Medical Programs module for the XAVIA HIS system, which allows to improve the management of information generated during the medical programs processing in hospital institutions. For this work development, an analysis of the business processes associated with the medical programs management was carried out; AUP-UCI was used as development methodology, JBoss Developer Studio, Java, JBoss as an application server, PostgreSQL as database management system and Visual Paradigm as a CASE tool. As a result, the Medical Programs module for the XAVIA HIS system was obtained, which allows the medical program configuration for a patient who has a certain disease, grouping several services, procedures, clinical investigations for each hospital area(AU)

Propuesta de nuevas funcionalidades para la gestión de la Historia Clínica Electrónica en el sistema XAVIA HIS / New features proposal to the Electronic Health Record management in the XAVIA HIS system

La digitalización de la historia clínica, documento indispensable en la atención de salud y que posee carácter legal, es uno de los focos de atención en la e-Salud. El sistema XAVIA HIS compuesto por módulos que informatizan los procesos e interconectan las diferentes áreas de una institución hospitalaria, posee como atributo fundamental, una historia clínica electrónica única por paciente. Esta se compone por documentos basados en el estándar HL7-CDA. Sin embargo, el sistema XAVIA HIS presenta algunas limitantes en la interacción con otras aplicaciones que gestionen la información de salud. En el trabajo se presentan las modificaciones a realizar al Sistema de Información Hospitalaria XAVIA HIS para mejorar la capacidad de gestión de las historias clínicas electrónicas del sistema. Se realizó un análisis de la literatura disponible sobre la gestión de las HCE y se evaluó el mecanismo que emplean sistemas homólogos nacionales e internacionales. Para guiar el desarrollo de la propuesta se empleó la metodología AUP-UCI; UML se empleó para el modelado de los artefactos de ingeniería y BPMN como lenguaje de notación para los procesos de negocio. Las modificaciones que se presentan, le permitirán al sistema XAVIA HIS interactuar con sistemas externos que generen documentos HL7-CDA. Adicionalmente, se añaden funcionalidades para mejorar la impresión de documentos clínicos que se exportan, así como la generación de resúmenes de la historia clínica(AU)

One of the e-Health approaches is the digitalization of the medical record, an essential document in health care and with a legal character. The XAVIA HIS system, made up of modules to manage the processes and interconnect the different areas of a hospital institution, has as a fundamental attribute, a unique electronic medical record per patient. It is made up of documents based on the HL7-CDA standard. However, the XAVIA HIS system presents some limitations to interaction with other applications also managing health information. This paper presents the new features and changes to be made to the Hospital Information System XAVIA HIS to improve the electronic medical records management of the mentioned system. An analysis of the available literature on EHR management was carried out and the mechanism used by national and international counterpart systems was evaluated. To guide the development of the proposal, the AUP-UCI methodology was used; UML was used for modeling the engineering artifacts and BPMN as a notation language for business processes. The modifications that are presented will allow the XAVIA HIS system to interact with external systems which also generate HL7-CDA documents. Additionally, functionalities are added to improve the printing of clinical documents that are exported, as well as the generation of summaries of the medical record(AU)

Accelerating implementation of district health information systems: perspectives from healthcare workers from KwaZulu-Natal, South Africa

Background: Although electronic health record systems are critical for healthcare management, there has been genuine concern about the quantity and quality of data generated by these systems inhibiting its full implementation. Objectives: The purpose of this article was to explore the experiences of healthcare workers (HCWs) and challenges facing the acceleration of the District Health Information System (DHIS) in the KwaZulu-Natal (KZN) province of South Africa. Methods: In this study, an interpretive research paradigm was followed to explore the current state of electronic health in South Africa from the experiences of HCWs in the KZN province. Semi-structured focus group interviews conducted with 20 participants drawn from the district office, clinical nurse practitioners and data capturers allowed thematic analysis of data using a systems approach to link the perspectives HCWs to the design of the DHIS. Results: The participants held the view that e-health is crucial for monitoring disease trends, policy development, planning and allocation of infrastructure, information technology (IT), financial and human resources. Nevertheless, the participants highlighted a concern surrounding e-health regulations, ethics and data confidentiality; data quality and lack of interoperability of Health Information Systems (HIS). This concern was attributed to data fragmentation, internal politics and lack of coordination of the data system. Conclusions: The study suggests that good quality data ­ from an integrated DHIS, is highly critical for the effective utilisation, implementation and acceleration of e-health systems in the province to support epidemiological surveillance and modelling of outbreaks, such as the COVID-19 pandemic.

Aspectos éticos de la pandemia por COVID-19 en pediatría / Ethical aspects of the COVID-19 pandemic in pediatrics

Resumen: La pandemia por COVID-19 ha puesto de relieve diversos dilemas éticos propios de la atención de los pacientes en el día a día. Se analiza el contexto de crisis generado por la pandemia y se evalúan aspectos generales del análisis ético en la práctica clínica y en contexto de crisis sanitaria. Se revisan algunos aspectos éticos relevantes relacionados a la proporcionalidad de las medidas implementadas, al manejo paliativo y a propósito de los desafíos generados en el contexto de la escasez de recursos y los deberes profesionales, en relación a los pacientes infectados por COVID-19 y aquellos pacientes crónicos que ven postergada su atención ambulatoria.

Abstract: The COVID-19 pandemic has highlighted different ethical dilemmas inday-to-day patient care. We analyzed the crisis caused by the pandemic and evaluate general aspects of ethical analysis in clinical practice and the context of the health crisis. In addition, we review some relevant ethical aspects related to the proportionality of the implemented measures, the palliative care management, and the challenges generated due to the lack of resources and professional duties, in relation to patients infected with COVID-19 and those chronic patients whose outpatient control is delayed.

Knowledge, attitudes, and practices of telemedicine in Ophthalmology in a Tertiary Hospital: A cross-sectional survey

Objective@#The purposes of this study were to (1) describe the perceptions and practices of telemedicine among ophthalmologists in a tertiary hospital; and (2) evaluate knowledge, satisfaction, and perceived patient outcomes in using telemedicine to provide eye care in a time of a global pandemic.@*Methods@#This was a descriptive, cross-sectional study using a self-administered online survey. Thirty-two (32) ophthalmology consultants and residents-in-training in a single tertiary, private hospital who practiced telemedicine participated in this study. Descriptive statistics was used to summarize the data. Responses to open-ended questions were analyzed thematically@*Results@#The respondents were somewhat knowledgeable (75%) and somewhat confident (72%) in using telemedicine. Respondents strongly conveyed their satisfaction with telemedicine outcomes (56%). Majority also believed that their patients were satisfied with teleconsults (69%). Majority agreed that telemedicine can be effective for select types of care [i.e., chronic condition management (66%), follow- up care (62%), and acute non-emergency care (53%)]. Telemedicine also proved to be a boon during a pandemic due to its convenience (59%) and efficiency (63%). However, it is limited by the imperative need for face-to-face consults (69%) and technological constraints (44%).@*Conclusions@#Telemedicine was perceived to be a valuable solution during the present pandemic due to its convenience, safety, and ability to provide remote diagnosis and management of urgent and non-urgent cases. Although the current practice of telemedicine still has plenty of room for improvements in the standardization of training, connectivity and technological constraints, and addressing liability concerns, it can serve as an adjunct to face-to face consultations to provide optimal care for patients.

Enhancing smoking cessation in Mexico using an e-Health tool in primary healthcare / Uso de una herramienta electrónica para la cesación del tabaquismo en el primer nivel de atención en México

Abstract: Objective: To evaluate an e-Health tool designed to enhance smoking cessation in Mexico in primary healthcare. Materials and methods: Smokers 18 years of age and older were recruited in the waiting room of two primary healthcare clinics in Mexico City. Participants used an e-Health smoking cessation tool that included smoking-related assessments, education on pharmacotherapy, and motivational videos. A follow-up assessment was conducted at 12 weeks week on smoking status. Logistic regression models were performed to identify factors associated with smoking cessation or consumption reduction. Results: A total of 132 smokers were enrolled in the study. At follow-up, 23.5% of participants self-reported smoking cessation. Among those who did not quit smoking, 65.0% decreased the number of cigarettes. Factors associated significantly with smoking cessation were: being a non-daily smoker, being interested in quitting smoking, having low level of physical dependence, and participating in cessation treatment. Conclusions: The e-Health tool produced a high rate of smoking cessation. Better outcomes are obtained when this tool is used with conventional cessation programs.

Resumen: Objetivo: Evaluar una herramienta electrónica diseñada para promover la cesación tabáquica en México en el primer nivel de atención. Material y métodos: Fumadores de 18 años de edad o más fueron reclutados en el área de espera de dos unidades de atención primaria en la Ciudad de México. Los participantes utilizaron una herramienta interactiva para dejar de fumar que incluía cuestionarios relacionados con el tabaquismo, educación sobre tratamientos farmacológicos y videos motivacionales. Una evaluación de seguimiento acerca de consumo de tabaco se realizó a las 12 semanas. Se realizaron modelos de regresión logística para identificar los factores asociados con cesación tabáquica o reducción de consumo. Resultados: Un total de 132 fumadores se inscribieron al estudio. Al seguimiento, 23.5% de los participantes autorreportaron cesación tabáquica. Entre quienes no cesaron, 65.0% redujo su consumo de cigarros al día. Los factores asociados significativamente con cesación tabáquica fueron ser un fumador ocasional, estar interesado en cesar, tener un bajo nivel de dependencia física y participar en tra tamientos de cesación. Conclusión: La herramienta electrónica produjo una alta tasa de cesación. Mejores resultados se obtienen cuando la herramienta se utiliza con programas de cesación convencionales.