Predicting Multimorbidity Using Saudi Health Indicators (Sharik) Nationwide Data: Statistical and Machine Learning Approach.

The Saudi population is at high risk of multimorbidity. The risk of these morbidities can be reduced by identifying common modifiable behavioural risk factors. This study uses statistical and machine learning methods to predict factors for multimorbidity in the Saudi population. Data from 23,098 Saudi residents were extracted from the "Sharik" Health Indicators Surveillance System 2021. Participants were asked about their demographics and health indicators. Binary logistic models were used to determine predictors of multimorbidity. A backpropagation neural network model was further run using the predictors from the logistic regression model. Accuracy measures were checked using training, validation, and testing data. Females and smokers had the highest likelihood of experiencing multimorbidity. Age and fruit consumption also played a significant role in predicting multimorbidity. Regarding model accuracy, both logistic regression and backpropagation algorithms yielded comparable outcomes. The backpropagation method (accuracy 80.7%) was more accurate than the logistic regression model (77%). Machine learning algorithms can be used to predict multimorbidity among adults, particularly in the Middle East region. Different testing methods later validated the common predicting factors identified in this study. These factors are helpful and can be translated by policymakers to consider improvements in the public health domain.

Impact of Implementing Electronic Health Records on Medication Safety at an HIMSS Stage 6 Hospital: The Pharmacist's Perspective.

Background: Medication errors can cause severe injuries and may lead to death. Electronic health records (EHRs) that are well designed and implemented could help to reduce medication errors. The medication management process needs close study to understand how medication safety metrics evolve as hospitals mature in terms of their EHR implementation. Objective: To examine the effect of adopting EHRs on medication errors at the Royal Commission Hospital in Jubail, Saudi Arabia, a Health Information Management System Society (HIMSS) stage 6 hospital. Methods: This study had a quasi-experimental time-series design. Retrospective data were collected for 1.5-year periods before and after implementation of EHRs. The variables analyzed were obtained from various units in the study setting. Data on medication errors were collected from the risk management section of the quality department. The medication management process was studied qualitatively. The quantitative data were analyzed using descriptive and inferential statistics. Results: The median number of medication orders per patient showed a significant decrease, from 22.76 before EHR implementation to 18.76 after implementation (p < 0.001). The median number of incidents per patient showed a significant increase, from 0.029 before to 0.040 after implementation (p = 0.004). The qualitative analysis of processes involved in the medication management process helped to explain these changes. Conclusion: Contrary to expectations, this study showed that an HIMSS stage 6 hospital could experience an increase in medication errors following implementation of EHRs. Qualitative analysis showed that the increase in medication error reporting rate could be attributed to an increase in detection following improvement in the medication management process. This has implications for interpreting quality metrics as hospitals mature in terms of their EHR implementation.

Contexte: Les erreurs de médication peuvent causer des blessures graves et entraîner la mort. La bonne conception et la mise en place de dossiers de santé électroniques (DSE) pourraient aider à les réduire. Le processus de gestion des médicaments doit faire l'objet d'un examen attentif pour comprendre comment les paramètres de sécurité relatifs aux médicaments évoluent à mesure que les hôpitaux se modernisent grâce à la mise en place de DSE. Objectifs: Examiner l'effet de l'adoption des DSE sur les erreurs de médication au Royal Commission Hospital de Jubail, en Arabie saoudite, un hôpital de stade 6 de la Health Information Management System Society (HIMSS). Méthodes: Cette étude utilisait une méthodologie de série chronologique quasi expérimentale. Des données rétrospectives ont été recueillies pendant des périodes de 1,5 an avant et 1,5 an après la mise en place des DSE. Les variables analysées ont été obtenues à partir de diverses unités dans le cadre de l'étude. Les données sur les erreurs de médication ont été recueillies auprès de la section de gestion des risques du service qualité. Le processus de gestion des médicaments, quant à lui, a été étudié de manière qualitative. Les données quantitatives ont été analysées à l'aide de statistiques descriptives et inférentielles. Résultats: Le nombre médian d'ordonnances médicales par patient a fortement diminué, passant de 22,76 avant à 18,76 après la mise en place des DSE (p < 0,001). Le nombre médian d'incidents par patient a quant à lui augmenté de manière importante et est passé de 0,029 avant à 0,040 après la mise en place des DES (p = 0,004). Les résultats de l'analyse qualitative des étapes du processus de gestion des médicaments expliquent en partie ces changements. Conclusion: Contrairement aux attentes, cette étude a montré qu'un hôpital de stade 6 de la HIMSS pourrait connaître une augmentation des erreurs de médication à la suite de la mise en place de DSE. L'analyse qualitative a montré que l'augmentation du taux de déclaration des erreurs de médication pouvait être attribuée à une augmentation de la détection suivant l'amélioration du processus de gestion des médicaments. Ce constat a des implications pour l'interprétation des indicateurs de la qualité à mesure que les hôpitaux se modernisent en mettant en place des DSE.

What is the current status of childhood obesity in Saudi Arabia?: Evidence from 20,000 cases in the Eastern Province: A cross-sectional study.

The prevalence rate of those overweight, as well as obesity among children in Saudi Arabia, keeps rising. The aim of the study was to estimate childhood obesity in the Eastern Province, Saudi Arabia. Over the period 2016 to 2017, a cross-sectional campaign was carried out in the Eastern Province of Saudi Arabia. Data were collected from over 20,000 boys' and girls' schools. The campaign collected data on birthday/age, weight, height, sex, district in which the school is located, level of education, and blood pressure level. The findings from the present study indicated a prevalence of 25.7% for overweight and obesity among high school-age students. More importantly, ≈35% of the study's students have either elevated blood pressure or hypertension. The significant predictors of childhood obesity were education level, age, glucose level, and blood pressure. The children in higher school levels originally from the Eastern Province had a high prevalence of overweight and obesity. Recommendations are made on the need of regular screening program among school-age children, as well as to continue raising awareness about childhood obesity.

Effects of routinely collected health information system variables on the readmission of patients with type 2 diabetes.

OBJECTIVES: This research explores the association between variables routinely collected in a health information system and the readmission of patients with type 2 diabetes within 30 days of discharge. METHODS: This retrospective cohort study was conducted at King Fahd Hospital of the University (KFHU) in Al-Khobar, KSA. The study population comprised patients with type 2 diabetes who were admitted to the hospital from January 2016 to November 2016. Data were obtained from the hospital's information system at KFHU. The association between the readmission of patients with type 2 diabetes and routinely collected health information system variables such as demographics, type of diabetes, length of stay, and discharge type were analyzed. RESULTS: A total of 497 cases met the inclusion criteria. Of these, 31 (6.2%) cases were readmitted within 30 days. Type 2 diabetes was the only variable found to be significantly associated with readmission within 30 days (χ2 (1, N = 497) = 6.116, p = 0.0134). Diabetes type (p = 0.0133) and discharge type (p = 0.0403) were the only variables that displayed significance utilizing a logistic regression model. CONCLUSION: Overall, the routinely collected demographic, diagnostic, and administrative variables were found to be poor predictors of 30-day readmission for type 2 diabetes at the institution studied. Nonetheless, the only significant variables in the prediction of 30-day readmission were diabetes type and discharge type. To determine the predictors of readmission, it is recommended that future studies include height and weight to the routinely collected health information system variables. We also suggest that future studies be based on data collected over several years or on pooled data collected from several hospitals.

Evaluation of Official Healthcare Informatics Applications in Saudi Arabia and their Role in Addressing COVID-19 Pandemic.

OBJECTIVE: The purpose of this study was to examine official healthcare informatics applications in Saudi Arabia in the context of their role in addressing the coronavirus disease 2019 (COVID-19) pandemic. METHODS: This is a case study of official healthcare informatics programs and applications (apps) developed in Saudi Arabia before and during the COVID-19 pandemic. The qualitative content analysis (QCA) method was used. Data collection consisted of two components: a desktop review of documents and actual testing of the programs. According to the QCA method, we developed a matrix for abstracting information on different apps and programs in order to categorize the data. The compilation of information and discussion were based on information summarized in the matrix. RESULTS: Six apps in total were developed before the COVID-19 pandemic. With the advent of the COVID-19 pandemic, three of the apps, SEHA, Mawid, and Sehaty were modified to address different aspects of the pandemic. Both SEHA and Mawid included information about COVID-19 awareness. During the COVID-19 pandemic, three official apps were developed: Tawakkalna, Tetamman, and Tabaud. The Tawakkalna app is mandatory for all citizens and residents to activate when visiting stores and institutions. It has a wide range of COVID-19 and other health-related functions. The Tetamman app provides COVID-19 test results and allows one to check his or her daily symptoms. It also has an educational content library and provides alerts. The Tabaud app notifies individuals if they have been exposed to COVID-19. The features, advantages, and disadvantages of all of the apps were examined. CONCLUSIONS: Overall, there were more strengths than shortcomings in the role played by healthcare informatics in the handling of the COVID-19 pandemic in Saudi Arabia.

How feasible is the life expectancy target in the Saudi Arabian vision for 2030?

BACKGROUND: Over the period 2016-2030, Saudi Arabia seeks to increase life expectancy at birth by 6 years. AIM: The main aim was to analyse the feasibility of this gain using the demographic literature. METHODS: The demographic literature on recorded high gains in life expectancy and the determinants of these gains were reviewed. The findings were examined considering the Saudi Arabian context. RESULTS: Explanations covered demographic and behavioural factors, inequalities, health care delivery system, public health provision, health-related policies and advancements in science and technology. However, the crucial factor is the country's position in the "cardiovascular revolution" (which combines smoking prevalence, obesity, lifestyle and related policies). CONCLUSION: In countries where life expectancy is in the 70s, average yearly gains are less than 0.31 years, much lower that the Saudi Arabian target of 0.43 years. For Saudi Arabia, an average yearly gain of about half this is achievable provided the fundamental drivers of life expectancy are addressed.

Evaluation of a mobile social networking application for improving diabetes Type 2 knowledge: an intervention study using WhatsApp.

AIM: The aim of this study is to evaluate the WhatsApp social networking application for improving knowledge, self-efficacy and awareness about diabetes management. METHODOLOGY: The study was conducted with intervention and control groups at Teaching Hospital in Al-Khobar, Saudi Arabia. The intervention group received weekly educational messages using WhatsApp, while the control group received regular care. RESULTS: Statistically, compared with the control group, the diabetes knowledge and self-efficacy of the intervention group increased significantly after the intervention with the WhatsApp application. CONCLUSION: The WhatsApp application can be effectively used for enhancing diabetes knowledge, self-efficacy and awareness among the Saudi population.

Comparison of Three Internship Training Sites for an Undergraduate Health Information Management Program in Saudi Arabia.

OBJECTIVES: While internship training is well established for medical records and for healthcare quality improvement, it is not quite so for training related to IT/health informatics. A comparison was made on the hospital-based IT/health informatics internship training received by students completing their training at the Imam AbdulRahman Bin Faisal University (IAU) in the Eastern province of Saudi Arabia. METHODS: The three hospitals studied all have the Joint Commission International accreditation and advanced Electronic Health Record (EHR) systems. Over the period from 2011 to 2015, interns from the IAU prepared 120 reports based on their training at these three hospitals. Data abstraction was done on the internship reports, and the results were summarized and interpreted. RESULTS: The study found wide differences in the training received at these hospitals. The main reason for the differences is whether or not the EHR system used in the hospital was a commercial one or developed in-house. CONCLUSIONS: The hospital that had developed its own EHR system made more use of health information management interns during their IT rotation in comparison to hospitals which had adopted commercial EHR systems. Recommendations are made of both local relevance and of international relevance.

Pilot Study of Reimbursement Practices in Private Healthcare Centers in the Eastern Province of Saudi Arabia: To What Extent Do They Meet International Best Practices?

This pilot study examines reimbursement practices in private healthcare centers in the Eastern Province of Saudi Arabia. The objective of the study was to assess the extent to which the private healthcare sector in Saudi Arabia follows international best practices in reimbursement, as identified in a literature review. The study examined reimbursement practices in a sample of six private healthcare facilities through the use of similar questionnaire guidelines with each facility. Similarities among the facilities' practices included the use of contracts with insurance companies and the availability of a chargemaster. Differences included the types of reimbursement software used. Bundled payment systems were identified in four facilities but were not examined in all of the facilities studied. International best practices that were not present in any of the facilities in the study included electronic transfer protocols to link healthcare facilities, insurance companies, and banks; the use of reimbursement key performance indicators; the use of diagnosis-related groups; and the integration of disease coding into the reimbursement process. Major findings of this pilot study are that diverse types of reimbursement systems are in use in Saudi healthcare facilities and that these systems are preliminary and are largely unregulated. The authors suggest that regulation and standardization would therefore be easier at this stage than at later stages of the development of private healthcare systems in Saudi Arabia.

Annual survey on the level and extent of usage of electronic health records in government-related hospitals in Eastern Province, Saudi Arabia.

This study aims to determine the level and extent of usage of electronic health records (EHRs) in government-related hospitals in Eastern Province, Saudi Arabia. Another aim is to develop a Web site to serve as a forum of exchange on the development of EHRs in Saudi Arabia. All government hospitals (n = 19) in the province were included. The information technology (IT) managers in those hospitals made up the target population. An online questionnaire was developed, and the IT managers in all 19 government hospitals were invited to participate in the survey. The responses from the online survey were downloaded and analyzed using descriptive statistics. Of the 19 hospitals, only three (15.8 percent) use EHRs. These hospitals were established in 1984, 1995, and 2005. All three of these hospitals have implemented the same EHR software and were using it successfully, and all three were using the three core features of laboratory, radiology, and pharmacy electronic modules. Some modules were present in the EHR system but were underutilized. Some of the main challenges faced by the IT managers in implementing EHRs in their hospitals were related to the uncooperative attitudes of some physicians and nurses toward EHRs. In fulfillment of the second aim of the study, a Web site, http://ehr2011.weebly.com, was developed to serve as a forum for exchange of information on the development of EHRs in Saudi Arabia. The government of Saudi Arabia has prioritized the development of eHealth (health information technology) and allocated committed funding for it during 2008-2011. During this period, some sectors of government made highly commendable efforts in developing eHealth services. Along these lines, we had hoped to see higher uptake of EHRs than the 15.8 percent found in this study. The rate of implementing EHRs in government hospitals should be accelerated. The aim should be on achieving some basic EHR functionality in these hospitals, and once this has been achieved, additional functionality can be pursued in stages.

Multiple forces working in unison: the case of rapid improvement of vital statistics in South Africa post-1996.

In a period of about five years, from 1997 to 2002, South Africa remarkably improved the coverage and production of its vital statistics. This period witnessed the entrance of South Africa into the select league of countries that publish statistics on multiple causes of death and that make use automatic coding of causes of death. These achievements were accomplished through multiple forces working in unison. Some of the important factors contributing to the achievement were lessons learned from study tours to Australia, Sweden and the U.S.A. The paper describes these lessons and how they were adapted to suit the South African reality. Comparison is made between the status of demographic statistics by the end of apartheid and in the post-apartheid era. Stakeholder relationships that shaped the transformation of demographic statistics in the new South Africa are also discussed.