South Africa is plagued by severe HIV and tuberculosis (TB) epidemics. Despite integration policies, health services’ reporting follows largely disease-specific vertical patterns, resulting in parallel data flows. This qualitative case study investigated how the health information system (HIS) is engaged with and perceived by health system employees. We conducted in-depth interviews with individuals (n=28) working in key roles at different levels of the health system in Cape Town, South Africa. Data from direct observation and document review complemented the interviews. All data were coded and analysed using thematic analysis. The key challenges reported included large amount of reporting in general, duplication of data elements, health governance and tensions over data collection tools. The vast amount of collected data was not considered holistic or fit-for-purpose. In conclusion, the HIS in South Africa causes work duplication and waste of efforts in times of scarce resources, and does not sufficiently support integration policies. Holistic approaches to studying, developing and implementing HIS are needed.

Information is at the heart of healthcare because all stakeholders need fit-for-purpose information to make decisions. However, producing and utilizing information in the data-intensive and ever-changing health environment requires various skills. In the particular context of low- and middle-income countries, this study, consisting of a scoping review and a qualitative case study, explores the information and ICT skills of health professionals. Our review identifies challenges in several areas of health professionals’ skills, including computer skills; skills required for using the routine health information system; data security skills; and data management and analysis skills. Our South African case study, based on interviews, adds a more nuanced understanding of the different types of training needs. This assessment shows that training and education aimed at improving the ICT and information skills of health professionals have to be versatile and cater to different groups with varying needs.

Purpose: The American Academy of Neurology (AAN) quality indicators for epilepsy are designed to monitor quality, identify gaps, and ultimately drive improvements in clinical care. Appreciation of electronic patient records (EPR) to support such performance management is growing.This study aimed to demonstrate the use of an epilepsy-specific EPR in applying the AAN measures to objectively monitor clinical performance.Method: A sample of out-patient clinics at Beaumont Hospital, Dublin was benchmarked against 4 of the AAN quality indicators.Results: 88% (142/160) of clinical encounters met the requirement to explicitly document seizure type and seizure frequency at each visit; aetiology or epilepsy syndrome was documented/updated for 58% (93/160); evidence of counselling about antiepileptic drug side effects was present in 34% (54/160) of records; counselling for women of childbearing potential was documented in 33% (18/57) of relevant records.Conclusion: The EPR makes performance monitoring efficient and objective. Results suggest either failure to carryout recommended clinical tasks or poor documentation. Whichever is the case, a baseline is provided against which improvement goals can be set. (C) 2013 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

introduction Share on Introduction to the Special Issue on Information Quality: The Challenges and Opportunities in Healthcare Systems and Services Editors: John O’Donoghue University College Cork, Ireland University College Cork, IrelandView Profile , Jane Grimson Trinity College Dublin, Ireland Trinity College Dublin, IrelandView Profile , Katherine Seelman University of Pittsburg University of PittsburgView Profile Authors Info & Claims Journal of Data and Information QualityVolume 4Issue 1October 2012 Article No.: 1pp 1–4https://doi.org/10.1145/2378016.2378017Online:01 October 2012Publication History 1citation467DownloadsMetricsTotal Citations1Total Downloads467Last 12 Months16Last 6 weeks2 Get Citation AlertsNew Citation Alert added!This alert has been successfully added and will be sent to:You will be notified whenever a record that you have chosen has been cited.To manage your alert preferences, click on the button below.Manage my AlertsNew Citation Alert!Please log in to your account Save to BinderSave to BinderCreate a New BinderNameCancelCreateExport CitationPublisher SiteGet Access

Agents are self-contained software entities which act faithfully and autonomously on behalf of a body of knowledge. They can operate in a standalone capacity, or as part of a social group collaborating and coordinating activities with other software agents. To access their knowledge, agents are interfaced with using message passing communication. The principle behind medical communications is to provide a means for exchanging information and knowledge from one computerised location to another, whilst preserving its true meaning and understanding between the listener and sender. Agent communication is similar to medical communications, but must provide an additional framework element to allow agents to interact at a social and operational level. Social aspects relate to agents collaborating on shared objectives, and operational aspects relate to coordination of tasks between the loosely coupled agents working as part of a group. Medical communications focus on data exchanges specific to the medical domain, while agent communication was designed for a much broader audience. Therefore, it is essential to verify if agent communications can support standard medical data exchanges. This paper investigates current forms of agent based communications and demonstrates they can support medical communication, yet retain their social and interaction information exchange functionality.

This chapter explores an approach to international development ­programming as a negotiated process, rather than one which is either imposed or contested. The authors posit this ‘negotiated’ development paradigm as one which aligns well with key features of good development practice as currently understood (such as responsiveness to needs, local ownership of projects, participatory planning and a focus on sustainability), as well as with the recent and growing emphasis among international donors on aid effectiveness and focus on results. Side by side with this, the contribution of higher education to international development is also discussed in some detail, and attention drawn to its potential to underpin the negotiated development approach with a firm evidence base.

Guidelines are self-contained documents which healthcare professionals reference to obtain specific disease or medical condition knowledge for a particular population cohort. They view these documents and apply known facts about their patients to access useful supportive information to aid in developing a diagnosis or manage a condition. Traditional CIG models decompose these guidelines into workflow plans, which are then called using certain motivational trigger conditions controlled by a centralised management engine. Therefore, CIG guidelines are not self-contained documents, which specialise in a particular condition or disease, but are effectively a list of workflow plans, which are called and used when the patient information is available. The software BDI agent offers an alternative approach which more closely matches the modus operandi of narrative based medical guidelines. An agent’s beliefs capture information attributes, plans capture the deliberative and action attributes, and desire captures the motivational attributes of the guideline in a self-contained autonomous software module. This synergy between the narrative guideline and the BDI agent offers an improved solution for computerising medical guidelines when compared to the CIG

Purpose: The purpose of this study is to investigate the feasibility of applying the openEHR archetype approach to modelling the data in the database of an existing proprietary biobank information management system. A biobank information management system stores the clinical/phenotypic data of the sample donor and sample related information. The clinical/phenotypic data is potentially sourced from the donor's electronic health record (EHR). The study evaluates the reuse of openEHR archetypes that have been developed for the creation of an interoperable EHR in the context of biobanking, and proposes a new set of archetypes specifically for biobanks. The ultimate goal of the research is the development of an interoperable electronic biomedical research record (eBMRR) to support biomedical knowledge discovery.Methods: The database of the prostate cancer biobank of the Irish Prostate Cancer Research Consortium (PCRC), which supports the identification of novel biomarkers for prostate cancer, was taken as the basis for the modelling effort. First the database schema of the biobank was analyzed and reorganized into archetype-friendly concepts. Then, archetype repositories were searched for matching archetypes. Some existing archetypes were reused without change, some were modified or specialized, and new archetypes were developed where needed. The fields of the biobank database schema were then mapped to the elements in the archetypes. Finally, the archetypes were arranged into templates specifically to meet the requirements of the PCRC biobank.Results: A set of 47 archetypes was found to cover all the concepts used in the biobank. Of these, 29 (62%) were reused without change, 6 were modified and/or extended, 1 was specialized, and 11 were newly defined. These archetypes were arranged into 8 templates specifically required for this biobank. A number of issues were encountered in this research. Some arose from the immaturity of the archetype approach, such as immature modelling support tools, difficulties in defining high-quality archetypes and the problem of overlapping archetypes. In addition, the identification of suitable existing archetypes was time-consuming and many semantic conflicts were encountered during the process of mapping the PCRC BIMS database to existing archetypes. These include differences in the granularity of documentation, in metadata-level versus data-level modelling, in terminologies and vocabularies used, and in the amount of structure imposed on the information to be recorded. Furthermore, the current way of modelling the sample entity was found to be cumbersome in the sample-centric activity of biobanking.The archetype approach is a promising approach to create a shareable eBMRR based on the study participant/donor for biobanks. Many archetypes originally developed for the EHR domain can be reused to model the clinical/phenotypic and sample information in the biobank context, which validates the genericity of these archetypes and their potential for reuse in the context of biomedical research. However, finding suitable archetypes in the repositories and establishing an exact mapping between the fields in the PCRC BIMS database and the elements of existing archetypes that have been designed for clinical practice can be challenging and time-consuming and involves resolving many common system integration conflicts. These may be attributable to differences in the requirements for information documentation between clinical practice and biobanking. This research also recognized the need for better support tools, modelling guidelines and best practice rules and reconfirmed the need for better domain knowledge governance. Furthermore, the authors propose that the establishment of an independent sample record with the sample as record subject should be investigated. The research presented in this paper is limited by the fact that the new archetypes developed during this research are based on a single biobank instance. These new archetypes may not be complete, representing only those subsets of items required by this particular database. Nevertheless, this exercise exposes some of the gaps that exist in the archetype modelling landscape and highlights the concepts that need to be modelled with archetypes to enable the development of an eBMRR. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Purpose: Examination of electronic patient record (EPR) implementation at the socio-technical interface. This study was based on the introduction of an anti-epileptic drug (AED) management module of an EPR in an epilepsy out-patient clinic. The objective was to introduce the module to a live clinical setting within strictly controlled conditions to evaluate its usability and usefulness.Methods: Qualitative and quantitative methods were employed in an observational field study. A purposeful sample of specialists in epilepsy care (2 doctors and 2 nurses) was recruited. Perception of usefulness and ease of use of the AED module, impact on work processes, and accuracy of use were evaluated using feedback meetings, evaluation forms, ethnographic analysis and data validation techniques. Emerging issues were grouped into three key themes: human, organisational and technological.Results: The electronic patient record use was studied for 49 patients over the course of 18 out-patient clinics. While participants varied in their approach to interacting with the AED module, they expressed satisfaction with its usability and performance. The necessary co-existence of the paper and electronic record, and changes to customary work practice were considered the biggest challenges. 82% accuracy in the use of the electronic record was determined.Conclusions: Achieving successful electronic patient record implementation is complex. While technical challenges exist, it is possibly more important to acknowledge the social considerations. Initially, an increase in medical record fragmentation and disruption to workflow can arise with the introduction of the technology. Realising the benefits of electronic patient records will require the management of a lengthy transition phase. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Care settings for older people, such as nursing homes, can have low levels of social interaction, which has been shown in many studies as being crucial to both the mental and physical well-being of older adults. Furthermore, increased social interaction has been shown to have a positive effect on adjustment in institutions for the aged. However, these social connections can be lost due to movement within the care system, with residents regularly relocating for a variety of reasons including cost and medical issues. Eleven health professionals and six residents living in a care home in Ireland were interviewed about their social activities and levels of engagement within the home. Storyboards were then developed and presented to the residents based on these interviews. Findings from the interviews indicate that activity levels among the more cognitively able residents are quite low due to activities catering for the less able residents. Furthermore, a lack of access to information and resources (such as books and newspapers) means that these more able residents reported experiencing long periods of boredom. Technology can potentially allow residents access to such information and resources, enabling them to pursue activities in their personal time which can then also be used as the basis for group discussions. The use of technology could, in addition, allow those residents who had moved out of the home to continue to participate and collaborate in activities with the other residents.

Background: Epilepsy is a chronic neurological disease affecting people of every age, gender, race and socio-economic background. The diagnosis and optimal management relies on contribution from a number of healthcare disciplines in a variety of healthcare settings.Objective: To explore the interface between primary care and specialist epilepsy services in Ireland.Methods: Using appreciative inquiry, focus groups were held with healthcare professionals (n = 33) from both primary and tertiary epilepsy specialist services in Ireland.Results: There are significant challenges to delivering a consistent high standard of epilepsy care in Ireland. The barriers that were identified are: the stigma of epilepsy, unequal access to care services, insufficient human resources, unclear communication between primary-tertiary services and lack of knowledge. Improving the management of people with epilepsy requires reconfiguration of the primary-tertiary interface and establishing clearly defined roles and formalised clinical pathways. Such initiatives require resources in the form of further education and training and increased usage of information Communication technology (ICT).Conclusion: Epilepsy services across the primary-tertiary interface can be significantly enhanced through the implementation of a shared model of care underpinned by an electronic patient record (EPR) system and information communication technology (ICT). Better chronic disease management has the potential to halt the progression of epilepsy with ensuing benefits for patients and the healthcare system. (C) 2009 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

The discovery of biomarkers and the underlying causes of diseases are enabled through the analysis of biological samples and data stored in biobanks. Biological samples and their associated data are expensive to collect and maintain, and it is important to store and manage them efficiently. During processing, samples and data go through a number of procedures and techniques, which are often in different locations and by individuals with different access permissions. It is essential to maintain the link between the samples and their associated data throughout the processes they undergo. This paper presents a novel system of tracking samples and data from collection through processing to storage and retrieval, which is based on Radio Frequency Identification (RFID) technology. This system ensures the security and reliability of sample data as well as location-independent recording and updating of sample data, as they move along the workflow.

This study's objective was to assess the usability of the epilepsy history module of the electronic patient record, developed at Beaumont Hospital, and to identify opportunities for improvement. Observation, interview and document analysis methods were used. Results indicated that the module was useable but the design did not work as well in practice as anticipated by theory. The next iteration of the module included identified enhancements; this iteration is currently in use.

The health-care sector is highly heterogeneous, widely distributed and fragmented, and has strong local autonomy.1 Individual patient information is scattered throughout the sector, residing anywhere from primary care physicians’ offices to clinical laboratories and specialist centers. From the clinical perspective, delivering appropriate patient care requires access to relevant patient information. Frequently, such information is not available when and where it is needed. This lack results in multiple requests to patients for personal data, unnecessary duplication of tests and other investigations, and ultimately delays in the patients receiving appropriate care.2 Fundamentally, the information that must be available at the point of care is the patient’s record. Yet, currently, an individual’s cradle-to-grave, longitudinal healthcare record is fragmented, distributed among all the care providers with whom the patient has ever had contact. Increasingly, this information is stored in electronic form. What is required, therefore, is a means to integrate this information and make it available to those health professionals who need it. The Internet’s ubiquity and the Web’s ease of access offer a potential solution to such integration, provided the approach is scalable and sufficiently generic to apply in many different clinical domains. The solution must also be easily integrated into existing health computing environments and must guarantee security and quality of service. This article presents a novel approach to sharing electronic health-care records that leverages the Internet and the Web, developed as part of two European Commission-funded projects, Synapses and SynEx. The approach provides an integrated view of patient data from heterogeneous, distributed information systems and presents it to users electronically. The solution is generic, and prototypes have been validated in a variety of clinical domains and health-care settings.

Agents are self-contained software entities which act faithfully and autonomously on behalf of a body of knowledge. They can operate in a standalone capacity, or as part of a social group collaborating and coordinating activities with other software agents. To access their knowledge, agents are interfaced with using message passing communication. The principle behind medical communications is to provide a means for exchanging information and knowledge from one computerised location to another, whilst preserving its true meaning and understanding between the listener and sender. Agent communication is similar to medical communications, but must provide an additional framework element to allow agents to interact at a social and operational level. Social aspects relate to agents collaborating on shared objectives, and operational aspects relate to coordination of tasks between the loosely coupled agents working as part of a group. Medical communications focus on data exchanges specific to the medical domain, while agent communication was designed for a much broader audience. Therefore, it is essential to verify if agent communications can support standard medical data exchanges. This paper investigates current forms of agent based communications and demonstrates they can support medical communication, yet retain their social and interaction information exchange functionality.