Introduction to health information exchange

To support health care and public health in managing the array of information available about patients and populations, health systems have adopted a variety of information and communications technologies (ICT). Examples include electronic health record systems that document patient symptoms, diseases, and medications as well as health care processes. Yet, many ICT systems operate as islands unto themselves, unable to connect or share information with other ICT systems. Such fragmentation of data and information is an impediment to achieving the goal of efficient, coordinated health care delivery. It was further a major challenge during the COVID-19 pandemic when information was rapidly needed yet challenging to access. Health information exchange (HIE) seeks to address the challenges of connecting disparate ICT systems, enabling information to be available when and where it is needed by clinicians, administrators, and public health authorities. This chapter robustly defines HIE, including its core components and various forms. This chapter further discusses the role of HIE in supporting care delivery and public health. © 2023 Elsevier Inc. All rights reserved.

COVID-19 emergency operator support: Bologna Local Health Unit Prevention and Protection Service

At the start of the Covid-19 pandemic, the Bologna Local Health Unit Prevention and Protection Service began to receive a number of various requests. From this, the idea of setting up a programme for colleagues emerged, and a phone number was established to address the needs of operators. After an initial evaluation, operators were referred to specific professional figures. The service's psychologists dealt with the requests received by offering different types of interventions. This report presents and discusses the results of this experience regarding the operators who used the service, the interventions implemented and the feedback received. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) All'inizio della pandemia da COVID-19 sono iniziate a pervenire numerose richieste di diversa natura presso il Servizio Prevenzione e Protezione dell'AUSL di Bologna. Da questi elementi e nata l'idea di pianificare un percorso dedicato ai colleghi attraverso l'istituzione di un numero telefonico per l'accoglienza dei bisogni degli operatori. A una prima accoglienza si rimandava a figure professionali specifiche. Gli psicologi del Servizio hanno preso in carico le richieste pervenute offrendo diverse tipologie di interventi. Nel presente elaborato sono presentati e discussi i risultati di questa esperienza relativi ai lavoratori che hanno usufruito del servizio, gli interventi attuati e i feedback ricevuti. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Appropriateness of frequent use of emergency departments: A retrospective analysis in Rome, Italy.

Background: Frequent users (FUs) are patients who repeatedly and inappropriately visit the emergency department (ED) for low-grade symptoms that could be treated outside the hospital setting. This study aimed to investigate the phenomenon of the FU in Rome by profiling such users and analyzing ED attendance by FUs. Methods: The analysis was carried out for attendance in 2021 at 15 EDs in the Local Health Authority Roma 1 geographical area. A digital app collected data, including information on the following variables: number of attendance, demographic characteristics, emergency medical service (EMS) usage, triage code, and appropriateness of attendance. COVID-19 diagnosis was also studied to analyze any possible influence on ED attendance. Differences between FUs and non-FUs were investigated statistically by t-test and chi-square test. Univariate analysis and multivariable logistic regression were performed to analyze the associated factors. Results: A total of 122,762 ED attendance and 89,036 users were registered. The FU category represented 2.9% of all users, comprising 11.9% of total ED attendance. There was a three times higher frequency of non-urgent codes in attendance of FU patients (FU: 9.7%; non-FU: 3.2%). FUs were slightly more likely to have used the EMS (13.6% vs. 11.4%) and had a lower frequency of appropriate ED attendance (23.8% vs. 27.0%). Multivariate logistic analysis confirmed a significant effect of triage code, gender, age, EMS usage, and COVID-19 diagnosis for the appropriateness of attendance. The results were statistically significant (p < 0.001). Conclusion: The FU profile describes mostly non-urgent and inappropriate attendance at the ED, including during the COVID-19 pandemic. This study represents an important tool for strengthening preventive policies outside the hospital setting. The Italian National Recovery and Resilience Plan represents an excellent opportunity for the development of new strategies to mitigate the phenomenon of FUs.

Exploring indirect impacts of COVID-19 on local health systems from the perspectives of health workers and higher education stakeholders in the Philippines using a phenomenological approach

Background: Our study aimed to explore the experiences of stakeholders from local government units, health facilities and higher education institutions on the delivery of non-COVID-19 health services after the initial wave of the pandemic. Methods: Twenty-nine public health workers, thirteen university staff, and four hospital administrators in the Philippines participated. Using a descriptive phenomenological approach, we analysed transcripts from six focus group discussions conducted online between March and June 2021. Findings: The COVID-19 pandemic made the routine health programs inaccessible due to hesitancy among patients to visit health facilities, a shift in public health priorities, and lack of students to augment the existing workforce. Public health workers reported stress and mental health exhaustion. Apart from fear of infection during service provision, public health workers and university staff experienced work overload, pressure to learn new technology, and webinar fatigue. Mental health problems have surfaced as health workers and young people have become more affected while support services remain insufficient. Public health workers have reported actions to maintain service delivery in the new normal such as use of telehealth and social media. However, issues on workforce wellbeing and digital equity posed adaptation challenges. Participants suggested partnership with higher education institutions as pivotal to position local health systems towards recovery. Interpretation: The rapid change in the service landscape highlights the importance of sustainable partnerships, effective workforce management, equitable digital innovations, and promoting mental wellbeing to preserve community, school, and occupational health and rebuild resilient local health systems in low-resourced areas. Funding: This research is proudly supported by the Australia-ASEAN Council, Australian Government Department of Foreign Affairs and Trade. © 2022 The Author(s)

URBAN ENVIRONMENT – A NEW PERSPECTIVE FROM THE GENERAL PRINCIPLES OF LAW DUE TO THE COVID-19 EFFECTS

Objective: This paper discusses the urban dimension of the social right of health and how this right and fundamental guarantee could be reconciled with the right of building and housing in the face of new requirements due to the effects of the coronavirus pandemic (COVID 19) and also to turn to future needs. Methodology: This paper will adopt exploratory research, considering jurisprudential and doctrinal studies by the deductive method, starting from the general norms of urban law, especially the principles of urbanism, proceeding to those that could forsee the future health needs of people regarding coronavirus pandemic, given the possibility of having future innovations that can help humanity. Results: In view of the statement of the Supreme Court, in order to confirm that the common competence of Art. 23 of the Federal Constitution, not only federal national power is entitled for the implementation of policies and decisions that seem more effective in terms of social procedures or even other health measures, in view of the local reality and the number of beds and medical equipment available in the local hospital. Another federative entities were granted the power to decide in certain conditions, mainly in epidemic situations, also in terms of vaccine procurement. Contributions: In the future the local public administrators should consider the experience today lived by the population, in terms of home office and social distancing. Thus, urbanism was affected, and municipalities must contemplate, in future policies, the reality that residences have become continuations of business activity. Thus, the domestic infrastructure must contemplate items that can contemplate reality and provide these facilities to residents. Also, it shall be considered health measures regarding the experience gained with the present pandemic situation. The land location to be established in present and future enterprises, previously indicated in urban norms, must include safe distances between the various units created for better safety of their users or residents. © 2022, Centro Universitario Curitiba - UNICURITIBA. All rights reserved.

COVID-19: yesterday, today and tomorrow. The quality of COVID-19 management and the evaluation of the "Health" chapter of the Recovery Plan.

Introduction: The COVID-19 pandemic represented an unprecedented challenge for the healthcare world and the introduction of a new stronger and believable project plays a fundamental role for the quality of work and the provision of qualitative care. Aim: The survey provided by Italian Association for the Quality of Health and Social Care (ASIQUAS) aims to examines the impact of "Health" chapter included in the Recovery Plan, through the assessment of management quality of the COVID-19 pandemic. Methods: Starting from a literature review, in September 2021, a web-based survey has been conducted and administered by e-mail. It has been taken into account measures widely used by different healthcare structures in order to analyze the projects implemented in the face of pandemic and to evaluate the new real possibility to invest funds in new healthcare structures and projects. Results: The survey consists of 19 multiple choices and respondents were from different types of structures, including regional departments and regional health agencies (1.4%), universities, research centers and scientific hospitalization and treatment institutes (IRCCS) (11%), hospitals and university polyclinics (34.2%), Local Health Authorities (39.7%), socio-health organizations and Others (13.7%). The pandemic has highlighted many vulnerabilities at both hospitals and territorial level. The major weaknesses revealed by the survey are mainly due to the lack of support from new staff units and poor availability of specific training tools for COVID-19 procedures. The Recovery Plan is still unclear with a lot of concern about the implementation and many limits of diffusion. Conclusions: It becomes essential to guarantee a new effective and interoperative model of integration. Today we can start more aware for the implementation of a system closer to everyone's needs, making shortcomings the new strength and starting point.

Reasons for Turnover of Kansas Public Health Officials during the COVID-19 Pandemic.

Public health officials played a critical role in COVID-19 mitigation and response efforts. In Kansas, 51 local health department (LHD) administrators and/or local health officers left their positions due to the pandemic between 15 March 2020 and 31 August 2021. The purpose of this study was to identify factors that led to turnover of Kansas local public health officials during the COVID-19 pandemic. Those eligible to participate in this study included former LHD administrators and/or health officers who were employed at or contracted by a Kansas LHD on 15 March 2020 and resigned, retired, or were asked to resign prior to 31 August 2021. Researchers used a demographic survey, a focus group, and key informant interviews to collect data. Twelve former LHD leaders participated in this study. Four themes emerged from phenomenological analysis: politicization of public health; a perceived lack of support; stress and burnout; and the public health infrastructure not working. The findings of this study can guide the Kansas public health system to address the issues leading to turnover of leadership and prevent future turnover. Future research must explore strategies for mitigating leadership turnover and identify alternative public health structures that could be more effective.

Enumeration of the Public Health Workforce in New York State: Workforce Changes in the Wake of COVID-19.

The governmental public health workforce in the United States has faced staffing shortages for over a decade that have been exacerbated by the COVID-19 pandemic. To assess this critical issue, the Region 2 Public Health Training Center collaborated with the New York State Association of County Health Officials to enumerate the city and county public health workforce in New York State. The organizations used an online survey to: (1) count employees and full-time equivalent (FTEs) staff in local health departments in 2021; (2) assess workforce trends since the COVID-19 pandemic; and, (3) identify challenges local health departments encounter in recruiting and retaining qualified public health workers. To assess trends, findings were compared with secondary data from 2019. Despite playing a central role in COVID-19 mitigation, local health departments experienced no overall increase in staffing in 2021 compared to 2019, with many health departments experiencing large increases in vacant positions. Recruitment challenges include noncompetitive salaries, difficulties finding qualified candidates, and lengthy hiring processes. This study complements accumulating evidence indicating that long-term investment in local public health infrastructure is needed to bolster the workforce and ensure that communities are protected from current and future health threats.

Exploring indirect impacts of COVID-19 on local health systems from the perspectives of health workers and higher education stakeholders in the Philippines using a phenomenological approach

Summary Background Our study aimed to explore the experiences of stakeholders from local government units, health facilities and higher education institutions on the delivery of non-COVID-19 health services after the initial wave of the pandemic. Methods Twenty-nine public health workers, thirteen university staff, and four hospital administrators in the Philippines participated. Using a descriptive phenomenological approach, we analysed transcripts from six focus group discussions conducted online between March and June 2021. Findings The COVID-19 pandemic made the routine health programs inaccessible due to hesitancy among patients to visit health facilities, a shift in public health priorities, and lack of students to augment the existing workforce. Public health workers reported stress and mental health exhaustion. Apart from fear of infection during service provision, public health workers and university staff experienced work overload, pressure to learn new technology, and webinar fatigue. Mental health problems have surfaced as health workers and young people have become more affected while support services remain insufficient. Public health workers have reported actions to maintain service delivery in the new normal such as use of telehealth and social media. However, issues on workforce wellbeing and digital equity posed adaptation challenges. Participants suggested partnership with higher education institutions as pivotal to position local health systems towards recovery. Interpretation The rapid change in the service landscape highlights the importance of sustainable partnerships, effective workforce management, equitable digital innovations, and promoting mental wellbeing to preserve community, school, and occupational health and rebuild resilient local health systems in low-resourced areas. Funding This research is proudly supported by the Australia-ASEAN Council, Australian Government Department of Foreign Affairs and Trade.

Community's Mask Wearing Practice and Its Associated Factors for COVID-19 prevention in Metropolitan city, Northwest, Ethiopia

Background: Corona virus Disease, 2019 has been pandemic all over the world due to its strong human to human transmission. A number of measures have been put in place to prevent its spread among the population. However, for these preventive measures to be effective, the population should practice an appropriate COVID-19 prevention method. To our knowledge, there is no study yet done in the Amhara region. Thus, this study was aimed at assessing mask wearing practice and its associated factors for COVID-19 prevention among residents of metropolitan towns in the Amhara region, Ethiopia. Methods: A community-based cross-sectional study was conducted from June 20 to July 10, 2020. A total of 413 residents of metropolitan towns of the Amhara region, Ethiopia were enrolled in the study. A systematic sampling technique was used to collect data from selected households. Data were entered into EPI-DATA version 3.1 and then exported to SPSS version 24.0 for analysis. To identify the factors of mask wearing practice for COVID-19 prevention, multiple binary logistic regression analysis was used. Statistical significance was declared at p-value<0.05. An adjusted odds ratio with 95% confidence intervals was used to assess the direction and strength of associations. Results: Four hundred thirteen residents were participated in the study with a response rate of 97.6%. Of these, 234 (56.6%) were female, 229 (55.4%) were lay in the age group of 31–45 years old, and 321 (77.7%) were married. The proportion of residents who had good mask wearing practice in the current study was 57.1% [(95%CI: 52.35%, 61.94%)]. Having formal education [AOR = 5.046, 95% CI (2.713, 9.385], employed [AOR = 1.827, 95% CI (1.172, 2.848)], having good knowledge [AOR = 3.125, 95% CI (1.361, 7.178)], and having positive attitude [AOR = 2.279, 95% CI (1.09, 4.767)] were significantly associated with mask wearing practice. Conclusion: more than half of the study respondents had good mask wearing practice regarding COVID-19 prevention. Having formal education, being employed, having good knowledge, and having positive attitude were significantly associated with mask wearing practice. It is recommended that local health authorities should implement interventions such, residents training and awareness creation activities to enhance residents to develop mask wearing practice.

Perceived impact of COVID-19 on prevention, treatment, harm reduction, and recovery services for opioid use disorder: National survey of local health departments.

Background: US local health departments (LHDs) have faced the COVID-19 pandemic and the opioid epidemic simultaneously. This article investigates the perceived impact of COVID-19 on the continuation of locally available services for addressing opioid use disorder (OUD). Methods: A national survey of US LHDs was conducted from November to December 2020. The survey asked key personnel in LHDs about the availability of OUD services in their jurisdiction, and how COVID-19 impacted such availability (i.e., whether terminated or continued at a reduced, the same, or an increased level after the arrival of COVID-19). Proportions for each impact category were estimated for prevention, treatment, harm reduction, and recovery services. Logistic regression tested for rural-urban and regional differences in perceived service impact. Results: An 11.4% (214 out of 1873) response rate was attained. Of the returned surveys, 187 were used in the analysis. Reported terminations were generally low, especially for treatment services. School-based prevention initiatives had the highest termination rate (17.2%, 95% CI = 11.4-25.1%). Prevention services had the highest proportions for continuing at a reduced level, except for recovery mutual help programs (53.9%, 95% CI = 45.2-62.4%). LHDs reported continuing services at an increased level at a higher frequency than terminating. Notably, 72.2% (95% CI = 62.7-80.0%) continued telehealth/telemedicine options for OUD at an increased level, and 23.8% (95% CI = 17.8-31.1%) and 10.0% (95% CI = 5.7-16.7%) reported doing the same for naloxone distribution and medications for opioid use disorder (MOUD), respectively. More harm reduction services were continued at the same versus at a reduced level. Service continuation differed little between rural-urban LHDs or by region. Conclusions: The impacts of COVID-19 on OUD service availability in LHD jurisdictions may depend on the specific area of opioid response while the long-term consequences of these changes remain unknown.

Past local government health spending was not correlated with COVID-19 control in US counties.

CONTEXT: Wide variation in state and county health spending prior to 2020 enables tests of whether historically better state and locally funded counties achieved faster control over COVID-19 in the first 6 months of the pandemic in the Unites States prior to federal supplemental funding. OBJECTIVE: We used time-to-event and generalized linear models to examine the association between pre-pandemic state-level public health spending, county-level non-hospital health spending, and effective COVID-19 control at the county level. We include 2,775 counties that reported 10 or more COVID-19 cases between January 22, 2020, and July 19, 2020, in the analysis. MAIN OUTCOME MEASURE: Control of COVID-19 was defined by: (i) elapsed time in days between the 10th case and the day of peak incidence of a county's local epidemic, among counties that bent their case curves, and (ii) doubling time of case counts within the first 30 days of a county's local epidemic for all counties that reported 10 or more cases. RESULTS: Only 26% of eligible counties had bent their case curve in the first 6 months of the pandemic. Government health spending at the county level was not associated with better COVID-19 control in terms of either a shorter time to peak in survival analyses, or doubling time in generalized linear models. State-level public spending on hazard preparation and response was associated with a shorter time to peak among counties that were able to bend their case incidence curves. CONCLUSIONS: Increasing resource availability for public health in local jurisdictions without thoughtful attention to bolstering the foundational capabilities inside health departments is unlikely to be sufficient to prepare the country for future outbreaks or other public health emergencies.

Barriers to Dissemination of Local Health Data Faced by US State Agencies: Survey Study of Behavioral Risk Factor Surveillance System Coordinators.

BACKGROUND: Advances in information technology have paved the way to facilitate accessibility to population-level health data through web-based data query systems (WDQSs). Despite these advances in technology, US state agencies face many challenges related to the dissemination of their local health data. It is essential for the public to have access to high-quality data that are easy to interpret, reliable, and trusted. These challenges have been at the forefront throughout the COVID-19 pandemic. OBJECTIVE: The purpose of this study is to identify the most significant challenges faced by state agencies, from the perspective of the Behavioral Risk Factor Surveillance System (BRFSS) coordinator from each state, and to assess if the coordinators from states with a WDQS perceive these challenges differently. METHODS: We surveyed BRFSS coordinators (N=43) across all 50 US states and the District of Columbia. We surveyed the participants about contextual factors and asked them to rate system aspects and challenges they faced with their health data system on a Likert scale. We used two-sample t tests to compare the means of the ratings by participants from states with and without a WDQS. RESULTS: Overall, 41/43 states (95%) make health data available over the internet, while 65% (28/43) employ a WDQS. States with a WDQS reported greater challenges (P=.01) related to the cost of hardware and software (mean score 3.44/4, 95% CI 3.09-3.78) than states without a WDQS (mean score 2.63/4, 95% CI 2.25-3.00). The system aspect of standardization of vocabulary scored more favorably (P=.01) in states with a WDQS (mean score 3.32/5, 95% CI 2.94-3.69) than in states without a WDQS (mean score 2.85/5, 95% CI 2.47-3.22). CONCLUSIONS: Securing of adequate resources and commitment to standardization are vital in the dissemination of local-level health data. Factors such as receiving data in a timely manner, privacy, and political opposition are less significant barriers than anticipated.

Collaboration Between a School Nurse Task Force and the Local Health Department in Illinois: Development of a COVID-19 Toolkit.

Multidisciplinary collaboration for healthy student outcomes is not a new concept for school nurses nor is working with public health officials in promoting school-community initiatives. The SARS-CoV-2 (COVID-19; severe acute respiratory syndrome coronavirus 2, coronavirus disease 2019) virus further highlighted the need to work together to promote best practice strategies to arm the community with information and guidance to prevent illness. The McHenry County Health Department recognized the expertise school nurses have in school health and formed a voluntary School Nurse Task Force. This collaboration worked to implement requirements for operating a school during a pandemic. The task force adapted those concepts into a toolkit to assist schools to meet health requirements throughout the most significant pandemic in over 100 years.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

Characterization of community-wide transmission of SARS-CoV-2 in congregate living settings and local public health-coordinated response during the initial phase of the COVID-19 pandemic.

BACKGROUND: Clusters of COVID-19 cases amplify the pandemic and are critical targets for intervention, but comprehensive cluster-level data are not collected systematically by federal or most state public health entities. This analysis characterizes COVID-19 clusters among vulnerable populations housed in congregate living settings across an entire community and describes early mitigation efforts. METHODS: The Cuyahoga County Board of Health identified and interviewed COVID-19 cases and exposed contacts, assessing possible connections to congregate living facilities within its jurisdiction from March 7, 2020, to May 15, 2020, during the first phase of the pandemic, while state of Ohio stay-at-home orders were in effect. A multi-disciplinary team-based response network was mobilized to support active case finding and develop facility-focused containment strategies. RESULTS: We identified a cascade of 45 COVID-19 clusters across community facilities (corrections, nursing, assisted living, intermediate care, extended treatment, shelters, group homes). Attack rates were highest within small facilities (P < .01) and large facilities requiring extensive support to implement effective containment measures. For 25 clusters, we identified an index case who frequently (88%) was a healthcare worker. Engagement of clinical, community, and government partners through public health coordination efforts created opportunities to rapidly develop and coordinate effective response strategies to support the facilities facing the dawning impact of the pandemic. CONCLUSIONS: Active cluster investigations can uncover the dynamics of community transmission affecting both residents of congregate settings and their caregivers and help to target efforts toward populations with ongoing challenges in access to detection and control resources.