Information Systems Resilience: The Role of Flexibility and Stability

This paper contributes to conceptualization of information system resilience. By building upon and extending the framework of Heeks and Ospina (2019), we argue that an information system's ability to be resilient lies in its balance between stability and flexibility. Based on empirical findings we suggest that a stable core and flexibility to change is crucial when a digital system is faced with unforeseen adversities. We hope to contribute to more theorizing of the information system resilience and inspire further research on this subject. The paper may also have practical value for stakeholders working with implementation of national information systems in the health sector. This is a qualitative case study conducted together with the Health Information Systems Programme (HISP) at the Institute of Informatics, University of Oslo. Our findings are based on empirical insights related to the DHIS2 software during the Covid-19 response. © 2022 Owner/Author.

Development of a Web-Portal Health Information System for Barangay

In the Philippines, a barangay is the smallest administrative unit serving as suburban neighborhoods' first line of defense. According to Bautista, barangays conduct a manual file-based process of storing the community's health information. Therefore, the need for a single platform enables a small government unit to manage its resources while being transparent to its community. The study aims to develop a web- based barangay health information system portal for Barangay 69 District 1 in Tondo Manila. The system would be a reference tool for barangays as their platform provides inventory management, the barangay's health programs, and a dashboard for data visualization inventory management, tracking of Covid cases, administration of health activities, and a dashboard for data visualization. As a result, the web portal is functional, and different test scenarios show above-average results. The study concludes that the system provided a platform for the barangay and its residents. It also concludes that it is user-friendly and efficiently disseminates the barangay's health programs and activities. © 2023 IEEE.

Identification of Key Factors for Optimized Health Care Services: Protocol for a Multiphase Study of the Dubai Vaccination Campaign.

BACKGROUND: Mass vaccination of the global population against the novel COVID-19 outbreak posed multiple challenges, including effectively administering millions of doses in a short period of time while ensuring public safety and accessibility. The government of Dubai launched a mass campaign in December 2020 to vaccinate all its citizens and residents, targeting the population aged >18 years against COVID-19. The vaccination campaign involved a transformation of multiple commercial spaces into mass vaccination centers across the city of Dubai, the largest of which was the Dubai One Central (DOC) vaccination center. It was operational between January 17, 2021, and 27 January 27, 2022. OBJECTIVE: The multiphase research study aims to empirically explore the opinions of multiple health care stakeholders, elicit the key success factors that can influence the effective delivery of emergency health care services such as a COVID-19 mass vaccination center, and explore how these factors relate to one another. METHODS: To understand more about the operations of the DOC vaccination center, the study follows a multiphase design divided into 2 phases. The study is being conducted by the Institute for Excellence in Health Professions Education at Mohammed Bin Rashid University of Medicine and Health Sciences between December 2021 and January 2023. To elicit the key success factors that contributed to the vaccination campaign administered at DOC, the research team conducted 30 semistructured interviews (SSIs) with a sample of staff and volunteers who worked at the DOC vaccination center. Stratified random sampling was used to select the participants, and the interview cohort included representatives from the management team, team leaders, the administration and registration team, vaccinators, and volunteers. A total of 103 people were invited to take part in the research study, and 30 agreed to participate in the SSIs. To validate the participation of various stakeholders, phase 2 will analytically investigate one's subjectivity through Q-methodology and empirically investigate the opinions obtained from the research participants during phase 1. RESULTS: As of July 2022, 30 SSIs were conducted with the research participants. CONCLUSIONS: The study will provide a comprehensive 2-phase approach to obtaining the key success factors that can influence the delivery of high-quality health care services such as emergency services launched during a global pandemic. The study's findings will be translated into key factors that could support designing future health care services utilizing evidence-based practice. In line with future plans, a study will use data, collected through the DOC vaccination center, to develop a simulation model outlining the process of the customer journey and center workflow. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42278.

Status of the health information system in Ireland and its fitness to support health system performance assessment: a multimethod assessment based on stakeholder involvement.

BACKGROUND: Between 2019 and 2021, the first Irish health system performance assessment (HSPA) framework was developed. As routinely collected health data are necessary to continuously populate indicators of an HSPA framework, a purpose-driven assessment of the health information system (HIS) in Ireland and its fitness to support the implementation of an HSPA framework was conducted. This study reports on the status of the Irish HIS through a multimethod assessment based on continuous broad stakeholder involvement. METHODS: Between May and November 2020, over 50 informants were engaged in individual and group interviews and stakeholder consultation workshops as part of the HIS assessment process. Descriptive themes and high-level data availability heatmaps were derived from interview and workshop data using thematic analysis. Indicator "passports" for the HSPA framework were populated during stakeholder consultation workshops and analysed using univariate descriptive statistics. RESULTS: The HIS in Ireland was able to provide administrative, survey and registry-based data for public sector acute care services, focusing on structure, process and output metrics. Significant data availability gaps, most notably from primary care, private hospitals and community care, were reported, with little availability of electronic health record and people-reported data. Data on outcome metrics were mostly missing, as were linkage possibilities across datasets for care pathway monitoring. The COVID-19 pandemic highlighted the national HIS's shortcomings but also the capacity for rapid development and improvement. CONCLUSIONS: A tailor-made assessment of the HIS in Ireland, involving a broad set of relevant stakeholders, revealed strengths, weaknesses and areas for improvement in the Irish health data landscape. It also contributed to the development of a national HSPA framework and momentum to further strengthen data infrastructure and governance, while working towards a more data-driven and person-centred healthcare system. This work demonstrates the utility of an inclusive HIS assessment process and is applicable beyond Ireland, where this case study was conducted.

A Unified Health Information System Framework for Connecting Data, People, Devices, and Systems

The COVID-19 pandemic has heightened the necessity for pervasive data and system interoperability to manage healthcare information and knowledge. There is an urgent need to better understand the role of interoperability in improving the societal responses to the pandemic. This paper explores data and system interoperability, a very specific area that could contribute to fighting COVID-19. Specifically, the authors propose a unified health information system framework to connect data, systems, and devices to increase interoperability and manage healthcare information and knowledge. A blockchain-based solution is also provided as a recommendation for improving the data and system interoperability in healthcare.

IoT-based systems for COVID-19 like pandemic screening

Healthcare worldwide is experiencing significant change. Concerns at soaring healthcare costs, effective care of chronically sick and rural patients, and the necessity for early discovery of diseases have all resulted in the noticeable change in IoT designs and their rapid acceptance over the last few years. The healthcare industry continues to lead the way in adopting and using information and communication technologies (ICT) for effective healthcare management and treatment. Recent advances in ICT and the advent of the Internet of Things (IoT) have opened up new opportunities for research and research in all fields, including medicine and healthcare. The Internet of Things creates smart objects, an essential building block in developing health information systems. This paper will look at the various challenges of IoT-based health services and determine how we can contribute to economic development and society in preventive care from covid-19. It also explores intelligent collaborative security models to minimize security risks and discusses how various innovations such as big data, environmental intelligence, and wearable devices can be used in healthcare environments. © 2022 Nova Science Publishers, Inc.

Severe acute respiratory infection surveillance in Brazil: the role of public, private and philanthropic healthcare units.

Epidemiological surveillance and notification of respiratory infections are important for management and control of epidemics and pandemics. Fact-based decisions, like social distancing policies and preparation of hospital beds, are taken based on several factors, including case numbers; hence, health authorities need quick access to reliable and well-analysed data. We aimed to analyse the role of the Brazilian public health system in the notification and hospitalization of patients with severe acute respiratory infection (SARI). Data of SARI cases in Brazil (2013-20) were obtained from SIVEP-Gripe platform, and legal status of each healthcare unit (HCU) responsible for case notification and hospitalization was obtained from the National Registry of Health Facilities (CNES) database. HCUs that are part of the hospital network were classified as 'Public Administration', 'Business Entities', 'Philanthropic Entities' or 'Individuals'. SARI notification data from Brazilian macro-regions (North, Northeast, Midwest, Southeast and South) were analysed and compared between administrative spheres. This study reveals that hospitalizations due to SARI increased significantly in Brazil during the coronavirus disease 2019 (COVID-19) pandemic, especially in HCUs of Public Administration. In the Southeast and South, where incidence of SARI is high, philanthropic HCUs also contribute to hospitalization of SARI cases and attend up to 7.4% of the cases notified by the Public Administration. The number of cases is usually lower in other regions, but in 2020 the Northeast showed more hospitalizations than the South. In the South, SARI season occurs later; however, in 2020, an early peak was observed because of COVID-19. Notably, the contribution of each administrative sphere that manages hospital networks in Brazil in the control and management of SARI varies between regions. Our approach will allow managers to assess the use of public resources, given that there are different profiles of healthcare in each region of Brazil and that the public health system has a major role in notifying and attending SARI cases.

Physicians' Perceptions as Predictors of the Future Use of the National Death Information System in Peru: Cross-sectional Study.

BACKGROUND: A computer application called the National Death Information System (SINADEF) was implemented in Peru so that physicians can prepare death certificates in electronic format and the information is available online. In 2018, only half of the estimated deaths in Peru were certified using SINADEF. When a death is certified in paper format, the probability being entered in the mortality database decreases. It is important to know, from the user's perspective, the factors that can influence the successful implementation of SINADEF. SINADEF can only be successfully implemented if it is known whether physicians believe that it is useful and easy to operate. OBJECTIVE: The aim of this study was to identify the perceptions of physicians and other factors as predictors of their behavioral intention to use SINADEF to certify a death. METHODS: This study had an observational, cross-sectional design. A survey was provided to physicians working in Peru, who used SINADEF to certify a death for a period of 12 months, starting in November 2019. A questionnaire was adapted based on the Technology Acceptance Model. The questions measured the dimensions of subjective norm, image, job relevance, output quality, demonstrability of results, perceived usefulness, perceived ease of use, and behavioral intention to use. Chi-square and logistic regression tests were used in the analysis, and a confidence level of 95% was chosen to support a significant association. RESULTS: In this study, 272 physicians responded to the survey; 184 (67.6%) were men and the average age was 45.3 (SD 10.1) years. The age range was 24 to 73 years. In the bivariate analysis, the intention to use SINADEF was found to be associated with (1) perceived usefulness, expressed as "using SINADEF avoids falsifying a death certificate" (P<.001), "using SINADEF reduces the risk of errors" (P<.001), and "using SINADEF allows for filling out a certificate in less time" (P<.001); and (2) perceived ease of use, expressed as "I think SINADEF is easy to use" (P<.001). In the logistic regression, perceived usefulness (odds ratio [OR] 8.5, 95% CI 2.2-32.3; P=.002), perceived ease of use (OR 10.1, 95% CI 2.4-41.8; P=.001), and training in filling out death certificates (OR 8.3, 95% CI 1.6-42.8; P=.01) were found to be predictors of the behavioral intention to use SINADEF. CONCLUSIONS: The behavioral intention to use SINADEF was related to the perception that it is an easy-to-use system, the belief that it improves the performance of physicians in carrying out the task at hand, and with training in filling out death certificates.

Measuring the Success of PeduliLindungi Application Use for Supporting COVID-19 Prevention: A Case Study among College Students in Jakarta, Indonesia

The Indonesian Government has launched PeduliLindungi (PL) mobile apps as a COVID-19 preventive tool. This study aimed to describe the PL utilization and determine the factors influencing its successful use among college students. This study used a cross-sectional design and a total population sampling at a university in the Special Capital Region of Jakarta, Indonesia. The Delone and Mclean Information System Success Model was adopted to measure the use of the apps. The Spearman's rank correlation test was performed to determine the relationship between two variables. Furthermore, 354 respondents participated in this study. The respondents used the apps mostly to display the vaccination certificate and check in/out from public facilities. The overall user satisfaction value towards the application was 3.83 +/- 0.76. The system quality (rho = 0.621, p-value<0.001) and information quality (rho = 0.626, p-value<0.001) were associated with the user satisfaction while the user satisfaction (rho = 0.471, p-value<0.001), was correlated to the perceived benefit. In brief, perceived benefit was positively correlated with the user's satisfaction, whereas user satisfaction was positively correlated with self-efficacy, system quality, and information quality.

The Social, Behavioral, and Ethical Modalities of COVID-19 on HIV Care in South Africa: A Systematic Review.

The profound public health impact of the novel outbreak of the SARS-CoV-2 virus in 2019 has been unparalleled in the last century. Rapid spread of the disease and a high death toll fueled the development and global rollout of effective vaccines regardless of the massive inequitable access. However, some public health measures intended to control COVID-19 have had collateral effects on the control of other infectious diseases. In this systematic review, we analyze the impact of the COVID-19 pandemic on efforts to control HIV in South Africa, emphasizing the social, ethical, and behavioral ramifications. The SCOPUS, PubMed, Ovid, PsychINFO, and Cochrane Library databases were searched for publications between March 2020 and January 2022. Of the 854 articles identified, 245 were found duplicated, and 609 were screened, 241 of which were potentially eligible, and 15 of which were ultimately included. Although no studies on the ethical implications were eligible for our study criteria due to insufficient primary data to perform an analysis on, we explored this topic in the Discussion section of this paper. We confirm declines in ART, PrEP, and HIV testing during the initial lockdown period, with slight variations across the South African provinces. Protecting routine services and reducing the disease burden on high-risk nations such as South Africa is imperative moving forward with the pandemic.

Experiences and expectation with the use of health data: a qualitative interview study in primary care.

BACKGROUND: Health data is important, however, not always well managed. The aim of this study was to investigate the experiences of patients and primary care physicians, their expectations and the obstacles encountered when using health data - both patient-generated as well as physician-generated. METHODS: We conducted a qualitative interview study. We included adult persons who were ready to talk about the topic. Participants were recruited from primary care. The interviews were recorded using a dictaphone, transcribed verbatim and analysed using a content analysis method. RESULTS: Altogether, we conducted 14 individual interviews, with patients (n = 7) and with physicians (n = 7). We found that both patients and physicians emphasized the importance of easy access to health data in digital health information systems. However, patients may not always understand medical terminology and physicians found that the quality of medical documents needs inspection. Both parties found that patient-generated data is a useful source of information, and that it should be used more often. CONCLUSIONS: The pandemic has highlighted the value of easy access to health data. The development of a health information system is useful to health care providers and patients, enables the transfer of evidence-based medicine, and supports health literacy.

Digital Health Profile of South Korea: A Cross Sectional Study.

(1) Backgroud: For future national digital healthcare policy development, it is vital to collect baseline data on the infrastructure and services of medical institutions' information and communication technology (ICT). To assess the state of medical ICT across the nation, we devised and administered a comprehensive digital healthcare survey to medical institutions across the nation. (2) Methods: From 16 November through 11 December 2020, this study targeted 42 tertiary hospitals, 311 general hospitals, and 1431 hospital locations countrywide. (3) Results: Since 2015, most hospitals have implemented electronic medical record (EMR) systems (90.5 percent of hospitals, which is the smallest unit, and 100 percent of tertiary hospitals). The rate of implementation of personal health records (PHRs) varied significantly between 61.9 percent and 2.4 percent, depending on the size of the hospital. Hospitals have implemented around three to seven government-sponsored information/data transmission and receiving systems for statistical or investigative objectives. For secondary usage of medical data, more than half of tertiary hospitals have implemented a clinical data warehouse or shared data model. However, new service establishments utilizing modern medical technologies such as artificial intelligence or lifelogging were scarce and in the planning stages. (4) Conclusion: This study shows that the level of digitalization in Korean medical institutions is significant, despite the fact that the development and spending in ICT infrastructure and services provided by individual institutions imposes a significant cost. This illustrates that, in the face of a pandemic, strong government backing and policymaking are essential to activate ICT-based medical services and efficiently use medical data.

Impact of the COVID-19 pandemic on malaria cases in health facilities in northern Ghana: a retrospective analysis of routine surveillance data.

BACKGROUND: The COVID-19 pandemic and its collateral damage severely impact health systems globally and risk to worsen the malaria situation in endemic countries. Malaria is a leading cause of morbidity and mortality in Ghana. This study aims to describe the potential effects of the COVID-19 pandemic on malaria cases observed in health facilities in the Northern Region of Ghana. METHODS: Monthly routine data from the District Health Information Management System II (DHIMS2) of the Northern Region of Ghana were analysed. Overall outpatient department visits (OPD) and malaria case rates from the years 2015-2019 were compared to the corresponding data of the year 2020. RESULTS: Compared to the corresponding periods of the years 2015-2019, overall visits and malaria cases in paediatric and adult OPDs in northern Ghana decreased in March and April 2020, when major movement and social restrictions were implemented in response to the pandemic. Cases slightly rebounded afterwards in 2020, but stayed below the average of the previous years. Malaria data from inpatient departments showed a similar but more pronounced trend when compared to OPDs. In pregnant women, however, malaria cases in OPDs increased after the first COVID-19 wave. CONCLUSIONS: The findings from this study show that the COVID-19 pandemic affects the malaria burden in health facilities of northern Ghana, with declines in inpatient and outpatient rates except for pregnant women. They may have experienced reduced access to insecticide-treated nets and intermittent preventive malaria treatment in pregnancy, resulting in subsequent higher malaria morbidity. Further data, particularly from community-based studies and ideally complemented by qualitative research, are needed to fully determine the impact of the pandemic on the malaria situation in Africa.

Teenage births and pregnancies in South Africa, 2017 - 2021 - a reflection of a troubled country: Analysis of public sector data

Articles on teenage pregnancies have been proliferating in both the popular press and the medical media. We analysed data available in the public sector database, the District Health Information System, from 2017 to 2021. During this time, the number of births to young teenagers aged 10 - 14 years increased by 48.7% (from a baseline of 2 726, which is very high by developed-country standards) and the birth rate per 1 000 girls in this age category increased from 1.1 to 1.5. These increases occurred year on year in most provinces. In adolescent girls aged 15 - 19, the number of births increased by 17.9% (from a baseline of 114 329) and the birth rate per 1 000 girls in this age category increased from 49.6 to 55.6. These increases also occurred year on year in a continuous upward trend as well as in all provinces, but at different rates. Generally, rates were higher in the more rural provinces such as Limpopo, Mpumalanga and Eastern Cape than in more urban provinces such as Gauteng and Western Cape. The increases during the past 2 years were particularly large and may be due to disruption of health and school services with decreased access to these as a result of COVID-19. These metrics pose serious questions to society in general and especially to the health, education and social sectors, as they reflect socioeconomic circumstances (e.g. sexual and gender-based violence, economic security of families, school attendance) as well as inadequate health education, life skills and access to health services.

Improving morbidity information in Portugal: Evidence from data linkage of COVID-19 cases surveillance and mortality systems.

BACKGROUND: COVID-19 rapidly spread around the world, putting health systems under unprecedented pressure and continuous adaptations. Well-established health information systems (HIS) are crucial in providing data to allow evidence-based policymaking and public health interventions in the pandemic response. This study aimed to compare morbidity information between two databases for COVID-19 management in Portugal and identify potential complementarities. METHODS: This is an observational study using records from both COVID-19 cases surveillance (National Epidemiological Surveillance System; SINAVE) and related deaths (National e-Death Certificates Information System; SICO) systems, which were matched on sex, age, municipality of residence and date of death. After the linkage, morbidity reported in SINAVE and identified in SICO, through the application of Charlson and Elixhauser comorbidity indexes algorithms, were compared to evaluate agreement level. RESULTS: Overall, 2285 matched cases were analyzed, including 53.9% males with a median age of 84 years. According to the method of data reporting assessment, the presence of any morbidity ranged between 26.3% and 62.5%. The reporting of ten morbidities could be compared between the information reported in SINAVE and SICO databases. The proportion of simultaneous reporting in both databases ranged between 5.7% for diabetes and 0.0% for human immunodeficiency virus infection or coagulopathy. Minimal or no agreement was found when assessing the similarity of the morbidity reporting in both databases, with neoplasms showing the highest level of agreement (0.352, 95% IC: 0.277-0.428; p < 0.001). CONCLUSION: Different information about reported morbidity could be found in two HIS used to monitor COVID-19 cases and related deaths, as data are independently collected. These results show that the interoperability of SICO and SINAVE databases would potentially improve available HIS and improve available information to decision-making and address COVID-19 pandemic management.

Acceptance of the District Health Information System Version 2 Platform for Malaria Case-Based Surveillance By Health Care Workers in Botswana: Web-Based Survey.

BACKGROUND: Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform. OBJECTIVE: We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful. METHODS: The study's design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020. RESULTS: Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants' survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform. CONCLUSIONS: Participants' responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana.

Regulatory information: The principles and prospects of development at the stage of creating a single digital contour in health care

Aim. The aim of the study was to consolidate the principles and rules for building a regulatory and reference space based on the analysis of previous phases of implementation to prioritize the development and to create a single digital contour in health care. Information sources. Data were obtained from the Regulatory Service at the Federal Registry of Regulatory and Reference Information (RRI), regulations of the Russian Ministry of Health in the field of information technology development, and the methodical and conceptual documents of the federal project “Creation of the integrated digital contour in healthcare based on the uniform state health information system”. Results. The stages of creating a single system of regulatory and reference information in the health sector over the past decade were analyzed taking into account the continuity of goals and objectives consistently presented in the conceptual and strategic documents that define the process of creating unique state health information system, as well as the experience of their solution. The analysis allowed to formulate the basic principles of development, namely: central management, structural unity, functional unity, information unity, and prioritization of tasks. Consolidation of principles and rules provided the basis for a scientific and methodical approach to further development of a single RRI system at the stage of creating a single digital contour in health care and shaping priorities of the development. Conclusion. At the stage of creating a single digital contour in health care, which has been approached by many countries, including Russia, the importance of a ubiquitous language of communication increases dramatically and, as the events associated with the COVID-19 pandemic have shown, the readiness of information systems directly determines the readiness of society to meet challenges and to protect the population. © 2020 Tomsk State University. All right reserved.

Toward an Agile System: Iranian Information System for Covid-19-Affected Patients Data Collection from Iranian Hospitals.

COVID-19's rapid spreads has caused a global pandemic. On 19th February 2020, Iran reported its first confirmed cases of infections in Qom City and the number of diagnosed cases and the death toll rose exponentially in March [1-3]. Managing the disease, which is considered a pandemic according to the World Health Organization (WHO) [4], requires definite approaches differing according to various factors in each country, which may also lead to (in)effective dealing with the disease. In addition, using international data and information, and WHO advice, especially in the crisis and therapeutic procedures, is one of the best crisis management strategies [5]. For every plan by governances, the first step is collecting information on epidemic distribution for the purpose of isolating provinces and cities at a national scale. Thus, Ministry of Health and Medical Education of Iran (MOHME) attempted to collect the minimum required data on the infection-affected patients based on medical records and epidemiological factors, such as demographic data (gender, age and national code), exposure history (close contact with the infected, suspect patients or even having traveled) and signs and symptoms (fever, cough, shortness or difficulties in breathing, fatigue, anorexia, hemoptysis, sputum production, dyspnea, Myalgia, Pharyngalgia, nausea, vomiting, Diarrhea, Headache, Abdominal pain, Dizziness, etc.). Therefore, to ensure accuracy and validity, and to speed up data collection in an area, Information Technology (IT) tools were required [6]. In this regard, developing an information system with a simple format and user-friendly interface in the shortest possible time was the aim. This study presents the local information system developed in March 2020, which has been registering hospitalized Covide-19-affected patients in Iranian hospitals up till now. In other words, this paper introduces features and procedures of one of the national systems as a health registry that includes clinical information on admitted Covid-19 patients in Iranian hospitals from admission to discharge or death. This system is supported by MOHME, and along with outpatient Point of Care Information Systems (POCS), feeds the national and international pandemic reports and decisions.

Health Information Systems in the COVID-19 Pandemic: A Short Survey of Experiences and Lessons Learned From the European Region.

Introduction: The COVID-19 crisis provides an opportunity to reflect on what worked during the pandemic, what could have been done differently, and what innovations should become part of an enhanced health information system in the future. Methods: An online qualitative survey was designed and administered online in November 2020 to all the 37 Member States that are part of the WHO European Health Information Initiative and the WHO Central Asian Republics Information Network. Results: Nineteen countries responded to the survey (Austria, Belgium, Croatia, Czech Republic, Finland, Greece, Iceland, Ireland, Israel, Italy, Kazakhstan, Latvia, Lithuania, Romania, Russian Federation, Sweden, Turkey, United Kingdom, and Uzbekistan). The COVID-19 pandemic required health information systems (HIS) to rapidly adapt to identify, collect, store, manage, and transmit accurate and timely COVID-19 related data. HIS stakeholders have been put to the test, and valuable experience has been gained. Despite critical gaps such as under-resourced public health services, obsolete health information technologies, and lack of interoperability, most countries believed that their information systems had worked reasonably well in addressing the needs arising during the COVID-19 pandemic. Conclusion: Strong enabling environments and advanced and digitized health information systems are vital to controlling epidemics. Sustainable finance and government support are required for the continued implementation and enhancement of HIS. It is important to promote digital solutions beyond the COVID-19 pandemic. Now is the time to discuss potential solutions to obtain timely, accurate, and reliable health information and steer policy-making while protecting privacy rights and meeting the highest ethical standards.

COVID-19 and the global need for knowledge on nurses' health.

AIM: To emphasize that nurses need to be fully protected to carry out their vital role, particularly during pandemics, yet the lack of a standardized and systematic collection of high-quality disaggregated data on nurses health inhibits our ability to assess this within and across countries. BACKGROUND: Nurses are the largest workforce group in the health sector, yet only 59 countries worldwide report on nurse COVID-19 infections and related deaths, and the standardized, systematic collection of disaggregated health data is not yet in place. SOURCES OF EVIDENCE: Medline, International Council of Nurses, World Health Organization, Centers of Disease Control and Prevention and the experiences of the authors. DISCUSSION: Inconsistent recording and definitions of nurses, precarious and informal employment conditions, limited transparent and reliable data, lack of mass testing and long-standing structural issues and biases have affected nursing for too long. CONCLUSIONS: These issues are reflected in the limited capacity of many national public health information systems to collect, monitor and report on the health of the largest group of health workers. Political will, accountability and public data transparency at different levels are essential to adequately protect nurses at work. IMPLICATIONS FOR NURSING PRACTICE, AND NURSING AND HEALTH POLICY: Building on current momentum in the nursing field, immediate political action is required to strengthen existing nursing and midwifery policies, standards and regulatory capacity, as well as existing public health services and information and surveillance systems. The generation of up-to-date, context-specific knowledge is needed to inform and monitor political decisions related to the protection of nurses, and the improvement of their employment conditions, as well as to strengthen accountability for these areas at various levels.