Digital Health Solutions and State of Interoperability: Landscape Analysis of Sierra Leone.

BACKGROUND: The government and partners have invested heavily in the health information system (HIS) for service delivery, surveillance, reporting, and monitoring. Sierra Leone's government launched its first digital health strategy in 2018. In 2019, a broader national innovation and digital strategy was launched. The health pillar direction will use big data and artificial intelligence (AI) to improve health care in general and maternal and child health in particular. Understanding the number, distribution, and interoperability of digital health solutions is crucial for successful implementation strategies. OBJECTIVE: This paper presents the state of digital health solutions in Sierra Leone and how these solutions currently interoperate. This study further presents opportunities for big data and AI applications. METHODS: All the district health management teams, all digital health implementing organizations, and a stratified sample of 72 (out of 1284) health facilities were purposefully selected from all health districts and surveyed. RESULTS: The National Health Management Information System's (NHMIS's) aggregate reporting solution populated by health facility forms HF1 to HF9 was, by far, the most used tool. A health facility-based weekly aggregate electronic integrated disease surveillance and response solution was also widely used. Half of the health facilities had more than 2 digital health solutions in use. The different digital health software solutions do not share data among one another, though aggregate reporting data were sent as necessary. None of the respondents use any of the health care registries for patient, provider, health facility, or terminology identification. CONCLUSIONS: Many digital health solutions are currently used at health facilities in Sierra Leone. The government can leverage current investment in HIS from surveillance and reporting for using big data and AI for care. The vision of using big data for health care is achievable if stakeholders prioritize individualized and longitudinal patient data exchange using agreed use cases from national strategies. This study has shown evidence of distribution, types, and scale of digital health solutions in health facilities and opportunities for leveraging big data to fill critical gaps necessary to achieve the national digital health vision.

Oncology Patients' Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada.

BACKGROUND: With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients' experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. OBJECTIVE: The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta's unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. METHODS: This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. RESULTS: Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta's patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants' broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient-provider relationship. CONCLUSIONS: Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them.

Estratégias de posicionamento para profissionais de saúde nas mídias: um manual em podcast / Positioning strategies for healthcare professionals in the media: a podcast manual

Resumo: Introdução: trata-se de estudo que faz parte da linha de pesquisa em Gerenciamento de Serviços de Saúde e Enfermagem e do projeto de extensão Saúde nas Mídias da Universidade Federal do Paraná. Aborda a elaboração de um manual em formato de podcast, com estratégias de comunicação para profissionais de saúde no uso das mídias sociais digitais. Desenvolvido a partir da compreensão da relevância da comunicação como instrumento laboral dos profissionais de saúde, com destaque para o enfermeiro e da necessidade de desenvolver e aprimorar a comunicação dialógica nos diferentes espaços sociais, em específico nas mídias sociais digitais. A pesquisa teve a seguinte questão norteadora: Como elaborar um manual com estratégias de comunicação para profissionais de saúde no uso das mídias sociais digitais com vistas à informação científica em saúde? Trajetória metodológica: O estudo contempla duas etapas. A primeira, revisão integrativa, cujos resultados subsidiaram o desenvolvimento do produto. A busca por artigos aconteceu em junho e julho de 2020, na base de dados Biblioteca Virtual em Saúde. Selecionaram-se artigos publicados nos últimos 5 anos, em inglês, espanhol e português. A segunda, de desenvolvimento dos podcasts conforme as etapas de produção, gravação, edição, publicação e distribuição. Resultados da etapa de pesquisa: Total de 199 artigos foram selecionados após leitura e análise dos títulos e resumos por três pesquisadores e pré-selecionados por ao menos 2. Assim, os 39 artigos restantes foram lidos integralmente, restando 10 artigos para análise. À análise, surgiram as categorias: estratégias para engajamento público, necessidade de mais estudos sobre comunicação em saúde nas mídias sociais digitais , planejamento e avaliação da comunicação em saúde nas mídias sociais digitais e preocupações com a divulgação de notícias falsas. Resultados da etapa de desenvolvimento do produto: Uma temporada de podcast abordando estratégias de comunicação voltadas para profissionais de saúde, principalmente enfermeiros, com 6 episódios, alternando 3 podcasts narrativos: Adaptação da linguagem científica para o público, superando a síndrome do impostor e elaborando roteiro de divulgação científica, plano de comunicação; e 3 videocasts com profissionais que atuam em comunicação, com o tema Falando com quem sabe. Os episódios foram gravados em estúdio isolado acusticamente. A edição foi realizada por profissional de sonorização usando os softwares Adobe Audition e Audition e Adobe Premiere. O material produzido foi publicado e divulgado semanalmente nas redes sociais do projeto: Instagram e Facebook (@saúde_nas_midias), Spotify, Google e Apple Podcasts Saúde nas Mídias e Youtube Saúde nas Mídias UFPR. A distribuição nas principais plataformas de streaming de podcasts foi feita pelo Anchor. Considerações finais: A principal contribuição deste estudo é a produção de uma temporada do podcast por profissional enfermeiro, e baseado em evidências científicas. A necessidade de promover o conhecimento em saúde por meio do uso eficiente das mídias sociais digitais é uma realidade e os profissionais de saúde interessados em divulgar ciência precisam ser competentes tanto em conhecimentos técnicocientíficos quanto no manejo das mídias sociais digitais colaborando ativamente na interface entre saúde e comunicação.

Abstract: Introduction: This is a study that is part of the line of research in Healthcare Services Management and Nursing and extension project Health in Media of the Federal University of Paraná. It approaches the elaboration of a manual in podcast format, with communication strategies for healthcare professionals in the use of digital media. It developed from the perception of the relevance of communication as a work tool for healthcare professionals, with emphasis on Nurses, and the need to develop and improve dialogic communication in different social spaces, specifically in digital media. The research had the following guiding question: How to prepare a manual in podcast format with communication organization for health professionals in the use of digital media with a view to scientific health information? Methodological trajectory: The study contemplates two stages. The first, Integrative Review, the results of which have subsidised the development of the product. The search for articles took place in June and July 2020, in the Biblioteca Virtual em Saúde database. Articles published in the last 5 years in English, Spanish and Portuguese were selected. The second stage was the development of podcasts according to the stages of production, recording, editing, publication and distribution. Results of the research stage: A total of 199 articles were selected after the titles and abstracts were read and analysed by three researchers and pre-selected by at least 2. Thus, the remaining 39 articles were read in full, resulting in 10 articles for analysis. The categories that emerged from the analysis were: strategies for public engagement, the need for more studies on health communication in social media, planning and evaluation of health communication in social media, and concerns about the spread of false news. Results of the product development stage: A podcast season addressing communication strategies for health professionals, mainly nurses, with 6 episodes, alternating 3 narrative podcasts: Adaptation of scientific language to the public, overcoming the impostor syndrome and elaborating a scientific dissemination script, communication plan; and 3 interview podcasts with professionals working in communication, with the theme Talking to those who know. The episodes were recorded in an acoustically isolated studio with the help of the Blackmagic recorder. The editing was done by a sound professional using Adobe Audition and Adobe Premiere software. The material produced was published and released weekly on the social networks of the project: Instagram and Facebook @saúde_nas_midias, Spotify Saúde nas Mídias and Youtube Saúde nas Mídias UFPR. The distribution on the main podcast streaming platforms was done by Anchor. Final considerations: The mais contribution of this study is the production of an evidencebased podcast by a nurse. The need to promote health knowledge through the efficient use of digital media is a reality, and for this, healthcare professionals interested in disseminating science need to be competent in both their technicalscientific knowledge and in the management of digital social media by actively collaborating on the interface between health and communication.

Impactos das tecnologias de informação e comunicação em saúde na segurança do paciente / Impacts of health information and communication technologies on patient safety

O intenso desenvolvimento tecnológico na medicina torna a segurança do paciente um complexo desafio que requer esforços de hospitais para reduzirem riscos desnecessários associados à assistência em saúde, mediante prevenção, mitigação de eventos adversos; fomento, e avaliação da cultura de segurança do paciente. Tal avaliação mede condições organizacionais, identifica áreas problemáticas e fornece informações relevantes ao planejamento de melhorias na estrutura, processos e resultados. E a crescente incorporação das tecnologias de informação e comunicação em saúde (TICS) justifica ser imprescindível conhecer como elas impactam a cultura de segurança do paciente. Estudo metodológico, qualitativo, cujos objetivos foram: realizar revisão integrativa sobre o impacto das TICs na segurança do paciente; e desenvolver etapas teóricas da Tradução e Adaptação Transcultural - ATC da Seção suplementar Health Information Technology Patient Safety Supplemental Item Set (HITPSSIS) do Hospital Survey on Patient Safety Culture (HSOPSC), para a realidade brasileira. Entre abril a julho de 2020 desenvolveram-se as etapas da Revisão integrativa: identificação do tema e seleção da questão de pesquisa; estabelecimento de critérios para inclusão e exclusão de estudos; definição das informações a serem extraídas e categorização dos estudos; avaliação dos estudos incluídos; interpretação dos resultados; e apresentação da revisão e síntese do conhecimento. As bases de dados utilizadas foram BVS, PUBMED, CINAHL, SCOPUS e Web of Science; e os descritores utilizados foram: registros eletrônicos em saúde; segurança do paciente e tecnologia de informação. Recomendações do PRISMA foram utilizadas para a identificação, triagem, elegibilidade e inclusão dos artigos. Foram incluídos 11 artigos internacionais produzidos entre julho de 2015 a julho de 2020. Emergiram três categorias analíticas: aspectos sociais e técnicos que impactam o uso seguro de TICS; evidências de incidentes de segurança do paciente relacionados a registros eletrônicos em saúde; inovações no uso de TICS que impactam o cuidado seguro. Concluiu-se que para impactarem favoravelmente a segurança do paciente, TICs devem ser apropriadamente projetadas para a realidade em que se inserem, baseadas em evidências científicas e considerarem experiências dos usuários, interoperabilidade e segurança no uso. Na ATC do HITPSSIS (em inglês) para a realidade brasileira realizada entre julho a agosto de 2020, desenvolveram-se as etapas teóricas, segundo Beaton (2007): Tradução inicial, Síntese das traduções, Retrotradução e Comitê de especialistas. Nestas, participaram dois tradutores, dois retrotradutores, e um total de sete membros do Comitê de especialistas. O Comitê realizou análises das versões de cada etapa precedente, buscando identificar duplo sentido nas palavras empregadas/dificuldades gramaticais no texto (análise semântica); expressões coloquiais de difícil tradução (análise idiomática); diferenças culturais nas expressões utilizadas (análise cultural); conceitos divergentes entre as culturas que necessitariam serem aproximados, visando integridade do instrumento (análise conceitual). A versão final do instrumento em português apresentou índices de concordância e semelhanças às concepções originais do HITPSSIS, superiores a 90%. Como produto, este estudo oferece à sociedade brasileira o SOPS™ Tecnologia da Informação em Saúde, conjunto de itens suplementares para a segurança do paciente, traduzido, adaptado ao idioma português e adequado para ser submetido à futura investigação empírica quantitativa, observacional, para ser utilizado em hospitais brasileiros.

Abstract: The intense technological development in medicine makes patient safety a complex challenge that requires efforts by hospitals to reduce unnecessary risks associated with health care, through prevention, mitigation of adverse events; promotion and assessment of the patient safety culture. Such assessment measures organizational conditions, identify problem areas and provides relevant data to planning improvements in structure, processes, and results. The increasing incorporation of health information and communication technologies (ICT) justifies that knowing how they impact the patient safety culture is essential. Methodological qualitative study was accomplished, which aimed to carry out an integrative review of the impact of ICT on patient safety; and develop the theoretical steps of Translation and crosscultural adaptation - of the Health Information Technology Patient Safety Supplemental Item Set (HITPSSIS) section of the Hospital Survey on Patient Safety Culture (HSOPSC), for the Brazilian reality. Between April and July, 20a20, the steps of the Integrative Review were developed, such as theme identification and selection of the research question; establishment of criteria for inclusion and exclusion of studies; definition of data to be extracted and categorization of studies; evaluation of included studies; interpretation of results; and presentation of the review and synthesis of knowledge. The databases used were BVS, PUBMED, CINAHL, SCOPUS and Web of Science, and the descriptors used were electronic health records; patient safety and information technology. PRISMA recommendations were used for the identification, screening, eligibility, and inclusion of articles. Eleven international articles produced between July, 2015 and July, 2020 were selected. Three categories emerged from analysis: social and technical aspects that impact the safe use of ICT; evidence of patient safety incidents related to electronic health records; innovations in the use of ICT that impact safe care. ICT must be appropriately designed for the reality in which they are operated, based on scientific evidences and the user experiences, on interoperability and safety in the use. At the HITPSSIS Transcultural Translation and Adaptation (in English) for the Brazilian reality, held between July and August, 2020, the theorical steps were developed, according to Beaton (2007): Initial translation, Synthesis of translations, Backtranslation and Experts Committee. In these, two translators, two back-translators, and a total of seven members participated in the Experts Committee. The Committee carried out analyzes of the versions of each previous step, seeking to identify a double meaning in the words used / grammatical difficulties in the text (semantic analysis); colloquial expressions that are difficult to translate (idiomatic analysis); cultural differences in the expressions used (cultural analysis); divergent concepts between cultures that would need to be approximated, aiming at the integrity of the instrument (conceptual analysis).The final version of the instrument in Portuguese showed concordance rates and similarities to the original HITPSSIS conceptions, greater than 90%. As a product, this study offers the Brazilian society the SOPS™ Health Information Technology, a set of supplementary items for patient safety, translated, adapted to the Portuguese language and suitable to be submitted to future quantitative, observational empirical research, to be used in Brazilian hospitals.

A Proof of Concept of a Mobile Health Application to Support Professionals in a Portuguese Nursing Home.

Over the past few years, the rapidly aging population has been posing several challenges to healthcare systems worldwide. Consequently, in Portugal, nursing homes have been getting a higher demand, and health professionals working in these facilities are overloaded with work. Moreover, the lack of health information and communication technology (HICT) and the use of unsophisticated methods, such as paper, in nursing homes to clinically manage residents lead to more errors and are time-consuming. Thus, this article proposes a proof of concept of a mobile health (mHealth) application developed for the health professionals working in a Portuguese nursing home to support them at the point-of-care, namely to manage and have access to information and to help them schedule, perform, and digitally record their tasks. Additionally, clinical and performance business intelligence (BI) indicators to assist the decision-making process are also defined. Thereby, this solution aims to introduce technological improvements into the facility to improve healthcare delivery and, by taking advantage of the benefits provided by these improvements, lessen some of the workload experienced by health professionals, reduce time-waste and errors, and, ultimately, enhance elders' quality of life and improve the quality of the services provided.

Readiness to accept health information and communication technologies: A population-based survey of community-dwelling older adults.

INTRODUCTION: The development of health information and communication technologies (HICTs) could modify the quality and cost of healthcare services delivered to an aging population. However, the acceptance of HICTs - a prerequisite for users to benefit from them - remains a challenge. This population-based study aimed to 1) explore the acceptance of HICTs by community-dwelling older adults as well as the factors associated to the overall acceptance/refusal of HICTs; 2) identify the factors associated with confidentiality (i.e., access to data allowed to physicians only versus to all caregivers) in the subgroup of older adults willing to accept HICTs. METHODS: A total of 3195 community-dwelling 69-83 year-old members of the Lausanne cohort 65+ were included. In 2017, participants filled out a 9-item questionnaire to assess their acceptance of HICTs ("yes without reluctance"; "yes but with reluctance"; "no"). A bivariate analysis was conducted to examine gender and age differences in the acceptance of HICTs. A multivariable logistic regression was performed to model 1) accepting all or rejecting all HICTs items; 2) willing to share HICTs items with physicians only versus all caregivers. RESULTS: The answer "acceptance without reluctance" ranged from 26.4% to 70.4% across HICTs and was the most frequent answer to six out of nine HICT items. For every HICT item, the acceptance rate decreased across age categories in women. Overall, 20.2% accepted all the HICTs without reluctance and 9.9% rejected them all. Older age and a lower level of education were significantly associated with both accepting all HICTs without reluctance (OR = 0.78 and OR = 0.65, respectively) and rejecting all HICTs (OR = 1.54 and OR = 2.89, respectively). Women and participants with health vulnerability (depressive symptoms, difficulty in activities of daily living (ADLs)) were less likely to accept data accessibility to non-physicians. CONCLUSION: Acceptance of HICTs was relatively high. To deploy HICTs in the older population, demographic, socioeconomic and health profiles, alongside confidentiality concerns, should be considered.

A ativação de redes sociotécnicas na cidade estrutural/DF, Brasil: construindo um território saudável e sustentável / The activation of socio-technical networks in the Estrutural city/DF Brazil: building a healthy and sustainable territory

Resumo A partir do compromisso assumido pelo Brasil para o cumprimento da Agenda 2030 e de seus 17 Objetivos de Desenvolvimento Sustentável (ODS), a Secretaria de Saúde do Distrito Federal (SES/DF) e a Fundação Oswaldo Cruz - Fiocruz Brasília, constituíram parceria para tratar do ODS 3: "Assegurar uma vida saudável e promover o bem-estar para todas e todos, em todas as idades". Por se tratar de um ODS que permeia os demais, as ações governamentais direcionadas à saúde e bem-estar são de extrema relevância para o êxito na implementação da Agenda 2030. Neste artigo, descrevem-se as iniciativas para a ativação de redes sociotécnicas na localidade denominada Cidade Estrutural, no Distrito Federal, como estratégia para a implementação da Agenda 2030, tendo a perspectiva de tornar o território Saudável e Sustentável a partir da referência do novo processo de produção local. Neste sentido, adotou-se um modelo de inteligência cooperativa que pode mensurar os determinantes de saúde para o monitoramento e a avaliação das situações de risco e vulnerabilidade social e ambiental, de modo que o território possa ter informações sobre si mesmo.

Abstract Based on Brazil's commitment to the fulfillment of the Agenda 2030 and its 17 Sustainable Development goals (ODS), the State Secretariat for health of the Federal District, sought partnerships to address the ODS 3-Health and welfare "securing healthy and promote welfare for all, at all ages". Because it is an ODS that permeates all others, governmental actions directed to health and well-being are of extreme relevance to the success in the implementation of Agenda 2030. In this article we present the initiatives for the activation of social networks in the locality called the Estrutural city, in the Federal District, as a strategy for measuring health determinants, the implementation of a monitoring approach and cooperative evaluation of risk situations and social and environmental vulnerability of the territory, having the prospect of making it healthy and sustainable from the reference of the new local production process and the Agenda 2030 of the development goals sustainable.

Ethnic origin and access to electronic health services.

E-health holds the promise of changing the delivery of health care by extending and enhancing its reach, and democratizing and improving the access of disadvantaged groups to health care services. This study investigated ethnic inequalities in access to e-health information, communication and electronic services in Israel. Based on the diversification hypothesis, we expected that disadvantaged ethnic groups would be more likely to use e-health services to compensate for their lack of social capital. Data gathered from a representative sample of Internet users in Israel (n=1371) provided partial support for the hypothesis, indicating that in multicultural societies, disadvantaged groups are more motivated than the majority group to use the Internet to access medical information. However, despite expectations, minority groups were less likely to access e-health services. Implications of the findings are discussed.