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1.
Physician Leadership Journal ; 9(5):41-43, 2022.
Article in English | ProQuest Central | ID: covidwho-2033804

ABSTRACT

Prisma Health is working to deploy customer relationship management technology so that everyone in the organization knows which patients need, for example, a chatbot nudge to schedule a mammogram or a telephone call to check on their status. Adopting a single electronic medical record system for the entire system in 2017 set the foundation needed to be an early adopter of technology that moves care delivery closer to patients where they live says Pankaj Jandwani, MD, regional vice president for medical affairs and chief innovation officer. [...]experience, MidMichigan is currently working to implement a systemwide tele-ICU model to serve its smaller hospitals. In early 2022, the Centers for Medicare & Medicaid Services (CMS) certified that MyMichigan's Hospital at Home program met its stringent requirement for treating a specific subset of patients for an acute illness in their homes.

2.
BMJ Open ; 12(9):e067204, 2022.
Article in English | MEDLINE | ID: covidwho-2029507

ABSTRACT

INTRODUCTION: Despite a higher risk of severe COVID-19 disease in individuals with HIV, the interactions between SARS-CoV-2 and HIV infections remain unclear. To delineate these interactions, multicentre Electronic Health Records (EHR) hold existing promise to provide full-spectrum and longitudinal clinical data, demographics and sociobehavioural data at individual level. Presently, a comprehensive EHR-based cohort for the HIV/SARS-CoV-2 coinfection has not been established;EHR integration and data mining methods tailored for studying the coinfection are urgently needed yet remain underdeveloped. METHODS AND ANALYSIS: The overarching goal of this exploratory/developmental study is to establish an EHR-based cohort for individuals with HIV/SARS-CoV-2 coinfection and perform large-scale EHR-based data mining to examine the interactions between HIV and SARS-CoV-2 infections and systematically identify and validate factors contributing to the severe clinical course of the coinfection. We will use a nationwide EHR database in the USA, namely, National COVID Cohort Collaborative (N3C). Ultimately, collected clinical evidence will be implemented and used to pilot test a clinical decision support prototype to assist providers in screening and referral of at-risk patients in real-world clinics. ETHICS AND DISSEMINATION: The study was approved by the institutional review boards at the University of South Carolina (Pro00121828) as non-human subject study. Study findings will be presented at academic conferences and published in peer-reviewed journals. This study will disseminate urgently needed clinical evidence for guiding clinical practice for individuals with the coinfection at Prisma Health, a healthcare system in collaboration.

3.
Digital Innovation for Healthcare in COVID-19 Pandemic: Strategies and Solutions ; : 75-93, 2022.
Article in English | Scopus | ID: covidwho-2027779

ABSTRACT

The COVID-19 pandemic has catalyzed the pace and scope of digital technology (DIT) use in healthcare. It has facilitated health promotion, disease prevention, diagnosis and treatment of secondary health concerns, patient engagement, monitoring treatment adherence, and surveillance. COVID-19-related large databases and medical and public health research have been shared freely and rapidly. Continued adoption of technology can lead to better and faster diagnosis of health conditions and accelerate the attainment of sustainable development goals (SDGs). However, many barriers still remain. Key issues are high costs, lack of interoperability of technology, frequent need for software updates, training and development, concerns about privacy, technological disruption, and network coverage issues. Greater involvement of end users in the development and rollout of new digital technologies is needed to ensure faster and deeper implementation of technology in healthcare as uneven implementation can exacerbate the divide between the haves and the have-nots. © 2022 Elsevier Inc. All rights reserved.

4.
Telehealth and Medicine Today ; 6(4), 2021.
Article in English | ProQuest Central | ID: covidwho-2026479

ABSTRACT

Objectives: Like other areas of care affected by the COVID-19 pandemic, telehealth (both audio and video) was rapidly adopted in the obstetric setting. We performed a retrospective analysis of electronic health record (EHR) data to characterize the sociodemographic and clinical factors associated with telehealth utilization among patients who received prenatal care. Materials and Methods: The study period covered March 23rd, 2020 to July 2nd, 2020, during which time 2,521 patients received prenatal care at a large academic medical center. We applied a generalized logistic regression to measure the relationship between the patients’ sociodemographic factors (in terms of age, race, ethnicity, urbanization level, and insurance type), pregnancy complications (namely, type 2 diabetes, chronic hypertension, and fetal growth restriction), and telehealth usage, as documented in the EHR. Results: During the study period, 2,521 patients had 16,516 prenatal care visits. 938 (37.2%) of the patients participated in at least one of 1,934 virtual prenatal care visits. Prenatal visits were more likely to be conducted through telehealth for patients who were older than 25 years old and lived in rural areas. In addition, patients who were with type 2 diabetes were more likely to use telehealth in their prenatal care (adjusted Odds Ratio (aOR) 7.247 [95% Confidence Interval (95% CI) 4.244 – 12.933]). By contrast, patients from racial and ethnic minority groups were less likely to have a telehealth encounter compared to white or non-Hispanic patients (aOR 0.603 [95% CI 0.465 – 0.778] and aOR 0.663 [95% CI 0.471 – 0.927], respectively). Additionally, patients who were on state-level Medicaid were less likely to use telehealth (aOR 0.495 [95% CI 0.402 – 0.608]). Discussion: Disparities in telehealth use for prenatal care suggest further investigations into access barriers. Hispanic patients who had low English language proficiency may not willing to see doctors via virtual care. Availability of high-speed internet and/or hardware may hold these patients who were insured through state-level Medicaid back due to poverty. Future work is advised to minimize access barriers to telehealth in its implementation. Conclusions: While telehealth expanded prenatal care access for childbearing women during the COVID-19 pandemic, this study suggested that there were non-trivial differences in the demographics of patients who utilized such settings.

5.
Telehealth and Medicine Today ; 6(3), 2021.
Article in English | ProQuest Central | ID: covidwho-2026477

ABSTRACT

COVID19’s silver lining in healthcare technology ushered in a massive adoption of virtual care by health systems, clinicians, and patients. In the post pandemic world, as consumer/patient adoption for digital health access exponential continues to grow—Health systems, Insurers, and clinicians all need re-evaluate strategies create larger budgets, and commitments towards Digital health. The growth and rapid adoption seen during the early months of the pandemic was stimulated by removal of legislative, financial and reimbursement barriers. Healthcare systems must carefully and strategically evaluate secure, purpose built, and strategic technological investment.

6.
Telehealth and Medicine Today ; 6(1), 2021.
Article in English | ProQuest Central | ID: covidwho-2026466

ABSTRACT

For long-term and episodic telehealth, we start to see the “final mile experience” with home delivery of pharmaceuticals, durable medical equipment, and even direct-to-consumer lab testing. [...]I am optimistic that synergistic integration of telehealth services with big data, AI-powered algorithms and information from wearables or mobile devices will have the greatest positive impact on healthcare and its outcomes over the next 2–5 years (more than any digital technology alone). [...]rideshare companies bent the cost curve to the point where riders can stop paying high monthly parking fees (aka insurance premiums) and continue to get low-cost, safe, reliable transportation (aka virtual visits) when needed. [...]telehealth will follow the rideshare roadmap…or maybe we will just merge industries.2 Ingrid Vasiliu-Feltes Over the past few years, we have witnessed a significant increase in telehealth adoption and expansion. “Tele-XR-Health” (a telehealth clinic with VR powered medical treatments) has the potential to redefine and reshape medical education, medical training, virtual healthcare delivery, and virtual clinical trials.

7.
Telehealth and Medicine Today ; 6(1), 2021.
Article in English | ProQuest Central | ID: covidwho-2026465

ABSTRACT

The global COVID-19 pandemic demonstrated the vulnerability of healthcare delivery to patients worldwide and challenged healthcare providers—not only in treating patients with coronavirus but also in trying to maintain optimal care for non-COVID patients at the same time. But challenging times often provide a fertile environment for innovation, and we have certainly seen major transformation in health care this year, via technology and global models, with the goal to democratize health care and provide greater access and more efficient and effective delivery of healthcare services to patients, regardless of their income or geography. Some of the world’s top leaders and influencers in healthcare delivery transformation and health technologies, including blockchain and telehealth, converged at the 4th Annual CONV2X 2020 Symposium held virtually from November 10 to 12, to talk about healthcare transformation. By far, one of the most widely discussed topics in the many sessions that took place over the 2-day event was virtual health.

8.
Blockchain in Healthcare Today ; 5(Multimedia Special Issue), 2022.
Article in English | ProQuest Central | ID: covidwho-2026459

ABSTRACT

The annual ConV2X is a leading international health tech symposium driving real world evidence, strategy, research, operations and trends to create a blueprint for a new digital health era. The 2021 symposium featured a scientific program of academic/research presentations in addition to business and industry talks. The research track focused on exploring and sharing developments in blockchain and emerging technologies in health and clinical medicine. Submissions were based on original research, conceptual frameworks, proposed applications, position papers, case studies, and real-world implementation. Selection was based on a peer-review process. Faculty, students, and industry researchers were encouraged to submit s to present ideas before an informed and knowledgeable audience of industry leaders, policy makers, funders, and researchers. This presentation was selected by the scientific review committee. Submission Review Committee Dave Kochalko, CEO of ARTiFACTS Anjum Khurshid, UT Austin Carlos Caldas, UT Engineering Gil Alterovitz, Harvard Medical School Kayo Fujimoto, UT Health Houston Lei Zhang, University of Glasglow Sean Manion, CSciO of ConsenSys Health Vijayakuman Varadarajan, University of South Wales Vikram Dhillon, Wayne State University Yuichi Ikeda, Kyoto University

9.
British Journal of Neuroscience Nursing ; 18(4):165-168, 2022.
Article in English | CINAHL | ID: covidwho-2025621

ABSTRACT

Aims: To assess the quality of documentation of patients with a visual impairment within a neurosurgery department to see if they have a corresponding vision alert within their medical notes. Methods: Retrospective case note analysis over 3 years of neurosurgical patients diagnosed with a space occupying lesion involving the anterior fossa near the optic apparatus was conducted. Post-surgical clinical assessment validated by formal visual assessment revealed 56 patients had a visual impairment diagnosis. Visual acuity and visual field mean deviations in the best eye were studied, along with the documentation of a vision alert. A total of nine patients did not meet the inclusion criteria and were removed from the study. Results: Out of 47 patients, four were found to have a severe sight impairment. Only 11 (23.40%) patients had a vision alert on their medical records. Out of the 47 patients with a visual impairment, three patients certified as sight impaired and severely sight impaired (75%) did not have a vision alert on their medical record. Conclusions: Although visual impairment was common in this study population, most patients had useful vision. Documentation to alert clinicians and carers about visual impairment was poor and needs improvement.

10.
AACN Advanced Critical Care ; 33(3):253-261, 2022.
Article in English | CINAHL | ID: covidwho-2024642

ABSTRACT

Background: Clinical assessments of depth of sedation are insufficient for patients undergoing neuromuscular blockade during treatment of acute respiratory distress syndrome (ARDS). This quality initiative was aimed to augment objective assessment and improve sedation during therapeutic paralysis using the bispectral index (BIS). Methods: This quality improvement intervention provided education and subsequent implementation of a BIS monitoring and sedation/analgesia bundle in a large, urban, safety-net intensive care unit. After the intervention, a retrospective review of the first 70 admissions with ARDS assessed use and documented sedation changes in response to BIS. Results: Therapeutic neuromuscular blockade was initiated for 58 of 70 patients (82.8%) with ARDS, of whom 43 (74%) had BIS monitoring and 29.3% had bundled BIS sedation-titration orders. Explicit documentation of sedation titration in response to BIS values occurred in 27 (62.8%) of those with BIS recordings. Conclusions: BIS sedation/analgesia bundled order sets are underused, but education and access to BIS monitoring led to high use of monitoring alone and subsequent sedation changes.

11.
Journal of Clinical Medicine ; 11(17):4997, 2022.
Article in English | ProQuest Central | ID: covidwho-2023793

ABSTRACT

Background: To explore the feasibility and effectiveness of multifaceted quality improvement intervention based on the clinical decision support system (CDSS) in VTE prophylaxis in hospitalized patients. Methods: A randomized, department-based clinical trial was conducted in the department of respiratory and critical care medicine, orthopedic, and general surgery wards. Patients aged ≥18 years, without VTE in admission, were allocated to the intervention group and received regular care combined with multifaceted quality improvement intervention based on CDSS during hospitalization. VTE prophylaxis rate and the occurrence of hospital-associated VTE events were analyzed as primary and secondary outcomes. Results: A total of 3644 eligible residents were enrolled in this trial. With the implementation of the multifaceted quality improvement intervention based on the CDSS, the VTE prophylaxis rate of the intervention group increased from 22.93% to 34.56% (p < 0.001), and the incidence of HA-VTE events increased from 0.49% to 1.00% (p = 0.366). In the nonintervention group, the VTE prophylaxis rate increased from 24.49% to 27.90% (p = 0.091), and the incidence of HA-VTE events increased from 0.47% to 2.02% (p = 0.001). Conclusions: Multifaceted quality improvement intervention based on the CDSS strategy is feasible and expected to facilitate implementation of the recommended VTE prophylaxis strategies and reduce the incidence of HA-VTE in hospital. However, it is necessary to conduct more multicenter clinical trials in the future to provide more reliable real-world evidence.

12.
Journal of Clinical Medicine ; 11(16):4705, 2022.
Article in English | ProQuest Central | ID: covidwho-2023785

ABSTRACT

Background: Medication Regimen Complexity (MRC) refers to the combination of medication classes, dosages, and frequencies. The objective of this study was to examine the relationship between the scores of different MRC tools and the clinical outcomes. Methods: We conducted a retrospective cohort study at Roger William Medical Center, Providence, Rhode Island, which included 317 adult patients admitted to the intensive care unit (ICU) between 1 February 2020 and 30 August 2020. MRC was assessed using the MRC Index (MRCI) and MRC for the Intensive Care Unit (MRC-ICU). A multivariable logistic regression model was used to identify associations among MRC scores, clinical outcomes, and a logistic classifier to predict clinical outcomes. Results: Higher MRC scores were associated with increased mortality, a longer ICU length of stay (LOS), and the need for mechanical ventilation (MV). MRC-ICU scores at 24 h were significantly (p < 0.001) associated with increased ICU mortality, LOS, and MV, with ORs of 1.12 (95% CI: 1.06–1.19), 1.17 (1.1–1.24), and 1.21 (1.14–1.29), respectively. Mortality prediction was similar using both scoring tools (AUC: 0.88 [0.75–0.97] vs. 0.88 [0.76–0.97]. The model with 15 medication classes outperformed others in predicting the ICU LOS and the need for MV with AUCs of 0.82 (0.71–0.93) and 0.87 (0.77–0.96), respectively. Conclusion: Our results demonstrated that both MRC scores were associated with poorer clinical outcomes. The incorporation of MRC scores in real-time therapeutic decision making can aid clinicians to prescribe safer alternatives.

13.
International Journal of Molecular Sciences ; 23(17):9896, 2022.
Article in English | ProQuest Central | ID: covidwho-2023751

ABSTRACT

Pneumonia is an acute infectious disease with high morbidity and mortality rates. Pneumonia’s development, severity and outcome depend on age, comorbidities and the host immune response. In this study, we combined theoretical and experimental investigations to characterize pneumonia and its comorbidities as well as to assess the host immune response measured by TREC/KREC levels in patients with pneumonia. The theoretical study was carried out using the Columbia Open Health Data (COHD) resource, which provides access to clinical concept prevalence and co-occurrence from electronic health records. The experimental study included TREC/KREC assays in young adults (18–40 years) with community-acquired (CAP) (n = 164) or nosocomial (NP) (n = 99) pneumonia and healthy controls (n = 170). Co-occurring rates between pneumonia, sepsis, acute respiratory distress syndrome (ARDS) and some other related conditions common in intensive care units were the top among 4170, 3382 and 963 comorbidities in pneumonia, sepsis and ARDS, respectively. CAP patients had higher TREC levels, while NP patients had lower TREC/KREC levels compared to controls. Low TREC and KREC levels were predictive for the development of NP, ARDS, sepsis and lethal outcome (AUCTREC in the range 0.71–0.82, AUCKREC in the range 0.67–0.74). TREC/KREC analysis can be considered as a potential prognostic test in patients with pneumonia.

14.
International Journal of Environmental Research and Public Health ; 19(16):10347, 2022.
Article in English | ProQuest Central | ID: covidwho-2023671

ABSTRACT

Suicide is a major public-health problem that exists in virtually every part of the world. Hundreds of thousands of people commit suicide every year. The early detection of suicidal ideation is critical for suicide prevention. However, there are challenges associated with conventional suicide-risk screening methods. At the same time, individuals contemplating suicide are increasingly turning to social media and online forums, such as Reddit, to express their feelings and share their struggles with suicidal thoughts. This prompted research that applies machine learning and natural language processing techniques to detect suicidality among social media and forum users. The objective of this paper is to investigate methods employed to detect suicidal ideations on the Reddit forum. To achieve this objective, we conducted a literature review of the recent articles detailing machine learning and natural language processing techniques applied to Reddit data to detect the presence of suicidal ideations. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we selected 26 recent studies, published between 2018 and 2022. The findings of the review outline the prevalent methods of data collection, data annotation, data preprocessing, feature engineering, model development, and evaluation. Furthermore, we present several Reddit-based datasets utilized to construct suicidal ideation detection models. Finally, we conclude by discussing the current limitations and future directions in the research of suicidal ideation detection.

15.
Journal of Medical Internet Research ; 2022.
Article in English | ProQuest Central | ID: covidwho-2022384

ABSTRACT

Background: HIV and sexually transmitted infections (STIs) are major global public health concerns. Over 1 million curable STIs occur every day among people aged 15 years to 49 years worldwide. Insufficient testing or screening substantially impedes the elimination of HIV and STI transmission. Objective: The aim of our study was to develop an HIV and STI risk prediction tool using machine learning algorithms. Methods: We used clinic consultations that tested for HIV and STIs at the Melbourne Sexual Health Centre between March 2, 2015, and December 31, 2018, as the development data set (training and testing data set). We also used 2 external validation data sets, including data from 2019 as external “validation data 1” and data from January 2020 and January 2021 as external “validation data 2.” We developed 34 machine learning models to assess the risk of acquiring HIV, syphilis, gonorrhea, and chlamydia. We created an online tool to generate an individual’s risk of HIV or an STI. Results: The important predictors for HIV and STI risk were gender, age, men who reported having sex with men, number of casual sexual partners, and condom use. Our machine learning–based risk prediction tool, named MySTIRisk, performed at an acceptable or excellent level on testing data sets (area under the curve [AUC] for HIV=0.78;AUC for syphilis=0.84;AUC for gonorrhea=0.78;AUC for chlamydia=0.70) and had stable performance on both external validation data from 2019 (AUC for HIV=0.79;AUC for syphilis=0.85;AUC for gonorrhea=0.81;AUC for chlamydia=0.69) and data from 2020-2021 (AUC for HIV=0.71;AUC for syphilis=0.84;AUC for gonorrhea=0.79;AUC for chlamydia=0.69). Conclusions: Our web-based risk prediction tool could accurately predict the risk of HIV and STIs for clinic attendees using simple self-reported questions. MySTIRisk could serve as an HIV and STI screening tool on clinic websites or digital health platforms to encourage individuals at risk of HIV or an STI to be tested or start HIV pre-exposure prophylaxis. The public can use this tool to assess their risk and then decide if they would attend a clinic for testing. Clinicians or public health workers can use this tool to identify high-risk individuals for further interventions.

16.
JMIR Aging ; 5(3), 2022.
Article in English | ProQuest Central | ID: covidwho-2022370

ABSTRACT

Background: There are 15,632 nursing homes (NHs) in the United States. NHs continue to receive significant policy attention due to high costs and poor outcomes of care. One strategy for improving NH care is use of health information technology (HIT). A central concept of this study is HIT maturity, which is used to identify adoption trends in HIT capabilities, use and integration within resident care, clinical support, and administrative activities. This concept is guided by the Nolan stage theory, which postulates that a system such as HIT moves through a series of measurable stages. HIT maturity is an important component of the rapidly changing NH landscape, which is being affected by policies generated to protect residents, in part because of the pandemic. Objective: The aim of this study is to identify structural disparities in NH HIT maturity and see if it is moderated by commonly used organizational characteristics. Methods: NHs (n=6123, >20%) were randomly recruited from each state using Nursing Home Compare data. Investigators used a validated HIT maturity survey with 9 subscales including HIT capabilities, extent of HIT use, and degree of HIT integration in resident care, clinical support, and administrative activities. Each subscale had a possible HIT maturity score of 0-100. Total HIT maturity, with a possible score of 0-900, was calculated using the 9 subscales (3 x 3 matrix). Total HIT maturity scores equate 1 of 7 HIT maturity stages (stages 0-6) for each facility. Dependent variables included HIT maturity scores. We included 5 independent variables (ie, ownership, chain status, location, number of beds, and occupancy rates). Unadjusted and adjusted cumulative odds ratios were calculated using regression models. Results: Our sample (n=719) had a larger proportion of smaller facilities and a smaller proportion of larger facilities than the national nursing home population. Integrated clinical support technology had the lowest HIT maturity score compared to resident care HIT capabilities. The majority (n=486, 60.7%) of NHs report stage 3 or lower with limited capabilities to communicate about care delivery outside their facility. Larger NHs in metropolitan areas had higher odds of HIT maturity. The number of certified beds and NH location were significantly associated with HIT maturity stage while ownership, chain status, and occupancy rate were not. Conclusions: NH structural disparities were recognized through differences in HIT maturity stage. Structural disparities in this sample appear most evident in HIT maturity, measuring integration of clinical support technologies for laboratory, pharmacy, and radiology services. Ongoing assessments of NH structural disparities is crucial given 1.35 million Americans receive care in these facilities annually. Leaders must be willing to promote equal opportunities across the spectrum of health care services to incentivize and enhance HIT adoption to balance structural disparities and improve resident outcomes.

17.
Journal of Medical Internet Research ; 2022.
Article in English | ProQuest Central | ID: covidwho-2022319

ABSTRACT

Background: Care coordination is challenging but crucial for children with medical complexity (CMC). Technology-based solutions are increasingly prevalent but little is known about how to successfully deploy them in the care of CMC. Objective: The aim of this study was to assess the feasibility and acceptability of GoalKeeper (GK), an internet-based system for eliciting and monitoring family-centered goals for CMC, and to identify barriers and facilitators to implementation. Methods: We used the Consolidated Framework for Implementation Research (CFIR) to explore the barriers and facilitators to the implementation of GK as part of a clinical trial of GK in ambulatory clinics at a children’s hospital (NCT03620071). The study was conducted in 3 phases: preimplementation, implementation (trial), and postimplementation. For the trial, we recruited providers at participating clinics and English-speaking parents of CMC<12 years of age with home internet access. All participants used GK during an initial clinic visit and for 3 months after. We conducted preimplementation focus groups and postimplementation semistructured exit interviews using the CFIR interview guide. Participant exit surveys assessed GK feasibility and acceptability on a 5-point Likert scale. For each interview, 3 independent coders used content analysis and serial coding reviews based on the CFIR qualitative analytic plan and assigned quantitative ratings to each CFIR construct (–2 strong barrier to +2 strong facilitator). Results: Preimplementation focus groups included 2 parents (1 male participant and 1 female participant) and 3 providers (1 in complex care, 1 in clinical informatics, and 1 in neurology). From focus groups, we developed 3 implementation strategies: education (parents: 5-minute demo;providers: 30-minute tutorial and 5-minute video on use in a clinic visit;both: instructional manual), tech support (in-person, virtual), and automated email reminders for parents. For implementation (April 1, 2019, to December 21, 2020), we enrolled 11 providers (7 female participants, 5 in complex care) and 35 parents (mean age 38.3, SD 7.8 years;n=28, 80% female;n=17, 49% Caucasian;n=16, 46% Hispanic;and n=30, 86% at least some college). One parent-provider pair did not use GK in the clinic visit, and few used GK after the visit. In 18 parent and 9 provider exit interviews, the key facilitators were shared goal setting, GK’s internet accessibility and email reminders (parents), and GK’s ability to set long-term goals and use at the end of visits (providers). A key barrier was GK’s lack of integration into the electronic health record or patient portal. Most parents (13/19) and providers (6/9) would recommend GK to their peers. Conclusions: Family-centered technologies like GK are feasible and acceptable for the care of CMC, but sustained use depends on integration into electronic health records. Trial Registration: ClinicalTrials.gov NCT03620071;https://clinicaltrials.gov/ct2/show/NCT03620071

18.
Health Affairs ; 41(9):1353-1356, 2022.
Article in English | ProQuest Central | ID: covidwho-2021990
19.
BMJ Open ; 12(9), 2022.
Article in English | ProQuest Central | ID: covidwho-2020031

ABSTRACT

ObjectivesThe objective of this study was to assess the impact of electronic health records (EHRs) on health outcomes and care of displaced people with chronic health conditions and determine barriers and facilitators to EHR implementation in displaced populations.DesignA systematic review protocol was developed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Systematic Reviews.Data sourcesMEDLINE, Embase, PsycINFO, CINAHL, Health Technology Assessment, Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews was searched from inception to 12 April 2021.Eligibility criteria for selected studiesInclusion criteria were original research articles, case reports and descriptions of EHR implementation in populations of displaced people, refugees or asylum seekers with related chronic diseases. Grey literature, reviews and research articles unrelated to chronic diseases or the care of refugees or asylum populations were excluded. Studies were assessed for risk of bias using a modified Cochrane, Newcastle-Ottawa and Joanna Briggs Institute tools.Data extraction and synthesisTwo reviewers independently extracted data from each study using Covidence. Due to heterogeneity across study design and specific outcomes, a meta-analysis was not possible. An inductive thematic analysis was conducted using NVivo V.12 (QSR International, Melbourne, Australia). An inductive analysis was used in order to uncover patterns and themes in the experiences, general outcomes and perceptions of EHR implementation.ResultsA total of 32 studies across nine countries were included: 14 in refugee camps/settlements and 18 in asylum countries. Our analysis suggested that EHRs improve health outcomes for chronic diseases by increasing provider adherence to guidelines or treatment algorithms, monitoring of disease indicators, patient counselling and patient adherence. In asylum countries, EHRs resource allocation to direct clinical care and public health services, as well as screening efforts. EHR implementation was facilitated by their adaptability and ability to integrate into management systems. However, barriers to EHR development, deployment and data analysis were identified in refugee settings.ConclusionOur results suggest that well-designed and integrated EHRs can be a powerful tool to improve healthcare systems and chronic disease outcomes in refugee settings. However, attention should be paid to the common barriers and facilitating actions that we have identified such as utilising a user-centred design. By implementing adaptable EHR solutions, health systems can be strengthened, providers better supported and the health of refugees improved.

20.
7th International Conference on Communication and Electronics Systems, ICCES 2022 ; : 804-811, 2022.
Article in English | Scopus | ID: covidwho-2018813

ABSTRACT

Collecting important information helps physicians, specialists, and health care providers to simplify the care of their patients. However, because patients do not explicitly retain their data, autonomous possession and the right to protect personal data develop. This paper discovers the block chain's potential to improve health care by placing the patient at the center of the system and improving health data protection and collaboration. The main goal of this research work is to discover the vast power of BitCoin technology that can be applied to patient records and health record protection management. As a dispensed era, Blockchain can be very beneficial, giving sufferers control over their statistics and impartial identification. With the COVID-19 pandemic, existing health information exchange systems are being put through the ringer. There is an increase in patient information sharing, as well as the need to respond to medical data requests more efficiently. There are some limitations in the current health information technologies, including the inability to remotely share medical data beyond their protected, local data stores. As a result, a secure and user-centric approach to accessing and controlling sensitive medical data is provided that is based on Blockchain immutability and decentralization. An innovative peer-to-peer system underpins the framework. Information is distributed through smart contracts that are connected to a blockchain-based protocol to ensure data integrity and traceability. Implementing the framework over a pilot study demonstrates its effectiveness. © 2022 IEEE.

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