Electronic health records implementation in Morocco: Challenges of silo efforts and recommendations for improvements.

OBJECTIVE: Electronic Health Records (EHRs) interventions hold the promise for enabling better healthcare. However, the implementation of EHR systems has been scarce in developing countries. The objective of this study is to investigate the state of EHRs implementation in Morocco; and draw insights for potential improvements. MATERIALS AND METHODS: University Medical Centers, known by locals in French as Centres Hospitalier Universitaires (CHU), are the largest and most advanced public healthcare centers in Morocco. A two-phase qualitative study was conducted in four out of the five CHUs. Phase One involved data collection through semi-structured interviews with 27 clinician champions, administrators, and medical directors. Phase Two included a brainstorming session during a health informatics conference held in Fes, Morocco. The data were analyzed using inductive analysis. RESULTS: We identified five main categories of challenges due to silo strategies: (1) EHRs selection and weak bargaining power, (2) identical errors repeated across silos, (3) a lack of interoperability standards, (4) insufficient human and financial, and (5) missed cooperation and collaboration opportunities. DISCUSSION: While identifying these silo challenges is an important milestone, proposing guidelines to address these challenges can bring Morocco and similar developing countries a step closer to improving healthcare through the use of health informatics and EHRs. Our recommendations for public healthcare organizations are threefold: (1) recognize the power of partnerships among all CHUs, (2) establish an e-health framework, and (3) seek national and international collaborations to drive and shape the eHealth agenda. Furthermore, we align our recommendations with the World Health Organization toolkit for an eHealth strategy to further benefit developing countries. CONCLUSION: This study identifies the challenges faced by the Moroccan EHRs implementation silo-ed strategy, and it proposes practical and fundamental guidelines to address these challenges and develop an interoperable and sustainable national eHealth system in Morocco and similar developing countries.

Dynamics of a Global Zoonotic Research Network Over 33 Years (1980-2012).

OBJECTIVE: The increasing rate of outbreaks in humans of zoonotic diseases requires detailed examination of the education, research, and practice of animal health and its connection to human health. This study investigated the collaboration network of different fields engaged in conducting zoonotic research from a transdisciplinary perspective. METHODS: Examination of the dynamics of this network for a 33-year period from 1980 to 2012 is presented through the development of a large scientometric database from Scopus. In our analyses we compared several properties of these networks, including density, clustering coefficient, giant component, and centrality measures over time. We also elicited patterns in different fields of study collaborating with various other fields for zoonotic research. RESULTS: We discovered that the strongest collaborations across disciplines are formed among the fields of medicine; biochemistry, genetics, and molecular biology; immunology and microbiology; veterinary; agricultural and biological sciences; and social sciences. Furthermore, the affiliation network is growing overall in terms of collaborative research among different fields of study such that more than two-thirds of all possible collaboration links among disciplines have already been formed. CONCLUSIONS: Our findings indicate that zoonotic research scientists in different fields (human or animal health, social science, earth and environmental sciences, engineering) have been actively collaborating with each other over the past 11 years.

Networks of preparedness and response during Australian H1N1 outbreak.

OBJECTIVE: New theoretical and practical approaches were used to determine the outcome of complex interorganizational networks during the 2009 H1N1 outbreak in Australia. METHODS: Seventy health professionals from different skill sets and organizational positions who participated in the 2009 swine influenza H1N1 outbreak in Australia were surveyed. Interviews were designed to collect both qualitative and quantitative data to build a comprehensive and in-depth understanding of the dynamics of interorganizational networks that evolve during the coordinated response to the H1N1 outbreak. Three main components of network theory, ie, degree centrality, connectedness, and tie strength, were used to construct a performance model for assessing networks of preparedness and response. RESULTS: We observed that increasing communication frequency and diversifying the tiers of the interorganizational links enhanced the overall network's performance in the case of formal coordination. Network measures such as centrality, connectedness, and tie strength were relevant and resulted in improving the entire network's performance during the outbreak. CONCLUSION: In the context of a disease outbreak in a complex environment and a large geographical area, this investigation has provided a new perspective for understanding how the structure of a collaborative network of personnel affects the performance of the overall network.

Resilient information networks for coordination of foodborne disease outbreaks.

Foodborne disease outbreaks are increasingly being seen as a greater concern by public health authorities. It has also become a global research agenda to identify improved pathways to coordinating outbreak detection. Furthermore, a significant need exists for timely coordination of the detection of potential foodborne disease outbreaks to reduce the number of infected individuals and the overall impact on public health security. This study aimed to offer an effective approach for coordinating foodborne disease outbreaks. First, we identify current coordination processes, complexities, and challenges. We then explore social media surveillance strategies, usage, and the power of these strategies to influence decision-making. Finally, based on informal (social media) and formal (organizational) surveillance approaches, we propose a hybrid information network model for improving the coordination of outbreak detection.

Evolutionary longitudinal network dynamics of global zoonotic research.

At global and local levels, we are observing an increasing range and rate of disease outbreaks that show evidence of jumping from animals to humans, and from food to humans. Zoonotic infections (i.e. Hendra, swine flu, anthrax) affect animal health and can be deadly to humans. The increasing rate of outbreaks of infectious diseases transferring from animals to humans (i.e. zoonotic diseases) necessitates detailed understanding of the education, research and practice of animal health and its connection to human health. These emerging microbial threats underline the need to exploring the evolutionary dynamics of zoonotic research across public health and animal health. This study investigates the collaboration network of different countries engaged in conducting zoonotic research. We explore the dynamics of this network from 1980 to 2012 based on large scientific data developed from Scopus. In our analyses, we compare several properties of the network including density, clustering coefficient, giant component and centrality measures over time. We also map the network over different time intervals using VOSviewer. We analyzed 5182 publication records. We found United States and United Kingdom as the most collaborative countries working with 110 and 74 other countries in 1048 and 599 cases, respectively. Our results show increasing close collaboration among scientists from the United States, several European countries including United Kingdom, Italy, France, Netherland, Switzerland, China and Australia with scientists from other parts of the world.

The dynamics of shared leadership: building trust and enhancing performance.

In this study, we examined how the dynamics of shared leadership are related to group performance. We propose that, over time, the expansion of shared leadership within groups is related to growth in group trust. In turn, growth in group trust is related to performance improvement. Longitudinal data from 142 groups engaged in a strategic simulation game over a 4-month period provide support for positive changes in trust mediating the relationship between positive changes in shared leadership and positive changes in performance. Our findings contribute to the literature on shared leadership and group dynamics by demonstrating how the growth in shared leadership contributes to the emergence of trust and a positive performance trend over time.