Philosophiae Doctor - PhD / This study sought to investigate the information needs of selected HIV and AIDS health organisations in Zimbabwe with a view to proposing a framework for developing an information access platform. ICTs can play a pivotal role in improving access to HIV and AIDS information and in coordinating HIV and AIDS activities in Zimbabwe. However, the development of ICTs in Zimbabwe’s health sector has been haphazard and idiosyncratic to a plethora of HIV and AIDS organisations operating in Zimbabwe. This study proposes a framework for the development of ICTs for accessing HIV and AIDS information in Zimbabwe. The needs-based framework was proposed after evaluating the information needs of healthcare workers and current health information technologies. An integrated theoretical framework incorporating the General System Theory, the Social Construction of Technology theory and the HOT-fit model was used to frame the study.

If knowledge has been gathered by the practitioners’ community in the area of health data warehousing evaluation, it is mostly relying on anecdotal evidence instead of academic research. Isolated dimensions have received more attention and benefit from definitions and performance measures. However, very few cases can be found in the literature which describe how the assessment of the technology can be made, and these cases do not provide insight on how to systematize such assessment. The research in this dissertation is aimed at bridging this knowledge gap by developing an evaluation framework, and conducting an empirical study to further investigate the state of health data warehousing evaluation and the use of the technology to improve healthcare efficiency, as well as to compare these findings with the proposed framework. The empirical study involved an exploratory approach and used a qualitative method, i.e. audio-taped semi-structured interviews. The interviews were conducted in collaboration with the Healthcare Data Warehousing Association and involved 21 participants who were members of the Association working in a mid- to upper-level management capacity on the development and implementation of health data warehousing. All audio-taped interviews were transcribed and transcripts were coded using a qualitative analysis software package (NVivo, QSR International). Results were obtained in three areas. First, the study established that current health data warehousing systems are typically not formally evaluated. Systematic assessments relying on predetermined indicators and commonly accepted evaluation methods are very seldom performed and Critical Success Factors are not used as a reference to guide the system’s evaluation. This finding appears to explain why a literature review on the topic returns so few publications. Second, from patient throughput to productivity tracking and cost optimization, the study provided evidence of the contribution of data warehousing to the improvement of healthcare systems’ efficiency. Multiple examples were given by participants to illustrate the ways in which the technology contributed to streamlining the care process and increase healthcare efficiency in their respective organizations. Third, the study compared the proposed framework with current practices. Because formal evaluations were seldom performed, the empirical study offered limited feedback on the framework’s structure and rather informed its content and the assessment factors initially defined. / Graduate

A interoperabilidade entre sistemas de informação em saúde está se tornando fundamental para o compartilhamento da informação num ambiente de saúde, onde normalmente as diversas especialidades que atuam no atendimento ao paciente armazenam seus dados, em sistemas computacionais distintos e em regiões geograficamente distribuídas. Devido à diversidade existente entre estes sistemas, a integração as vezes torna-se difícil. Os problemas de interoperabilidade podem ser técnicos, onde os componentes de computação dos sistemas não permitem a cooperação devido às diferenças nos protocolos de comunicação ou semânticos, ocasionados devido à diversidade de representação da informação transmitida. Este trabalho propõe uma arquitetura para facilitar ambos os aspectos de interoperabilidade, sendo que a interoperabilidade técnica é proporcionada pela utilização de um middleware e a semântica, pela utilização de sistemas de terminologia adotados internacionalmente. Para a implementação de referência foi utilizada como middleware a arquitetura CORBA e suas especificações para o domínio da saúde, sendo que uma das especificações CORBA para o domínio da saúde foi adotada para padronizar a comunicação com os sistemas de terminologia. Para validar a implementação, foi construído um aplicativo cliente baseado na análise de requisitos de uma UTI neonatal. O cliente foi utilizado também para acessar os componentes implementados e verificar dificuldades e ajustes que podem ser feitos na implementação. / The interoperability among health information systems are becoming fundamental to share the information in a health environment, here commonly the diverse medical specialties that act in the patient care store the data, in distinct computational systems and in geographically distributed regions.Because of the existing diversity among these information systems, the integration can be a difficult task. Interoperability problems can either be technical, when the communication components do not cooperate due to the diversity of the information representation. This work proposes an architecture to improve both interoperability aspects. The technical and partial semantic interoperability is achieved by the use if a middleware whereas the semantic interoperability by the use of internationally approved terminological systems. For the reference implementation was used the CORBA middleware architecture. One of the CORBA specifications in health care was adopted to standardize the communication with the terminological systems. To validate the implementation it was developed a client application based on the requirement analysis of neonatal ICU. The client application was also used to access the software components and to verify possible problems.

Esta pesquisa investigou o emprego da informação no sistema de trabalho das Equipes Saúde da Família (EqSF), nas Unidades Básicas de Saúde (UBS), visando identificar que fatores interferem no emprego da informação em um ambiente de alta complexidade, de difícil controle e descentralizado. Para responder essa questão, foram identificados o processo de tratamento e o uso das informações. Tem como objetivo também compreender a discrepância entre a intenção do uso e o uso efetivo das informações e suas causas. Foi utilizado o método de estudo de casos múltiplos e, para isso, foram estudadas sete EqSF que fazem parte de três UBS, gerenciadas por uma Organização Social (OS), a Fundação da Faculdade de Medicina da USP, na região oeste do município de São Paulo. As EqSF são grupos multiprofissionais que promovem a atenção básica e a prevenção à saúde para os pacientes de determinado território. Buscou-se compreender como, nesse contexto, são feitos a captura, o registro, a disponibilização e o emprego das informações, já que elas são recursos relevantes para a produção de serviço desses profissionais e são coletadas tanto no domicílio do paciente quanto na UBS. Para realizar o atendimento dentro dos níveis de qualidade previsto pela OS e Secretaria Municipal de Saúde (SMS), os profissionais criam diversos sistemas de informação paralelos (cadernos, planilhas, etc.) de uso individual, uma vez que os sistemas eletrônicos da SMS e do Ministério da Saúde não atendem suas necessidades e as informações que contém nem sempre são usadas. Isso acontece devido ao não alinhamento entre os sistemas de informação e a infraestrutura disponível (BOSTROM; HEINEN, 1997a), requisito que é superado por meio de esforços individuais e coletivos. Essa situação corrobora as considerações de DeLone e McLean (1992, 2002, 2003) que afirmam haver uma relação entre o uso da informação e a satisfação do usuário com a qualidade do sistema, a qualidade da informação e a qualidade do serviço informacional. Os profissionais costumam memorizar dados para registro posterior, possibilitando redundância, erros e perdas de detalhes. As informações são registradas de acordo com o interesse do profissional e não há um sistema estruturado para a consolidação das informações. / This research investigated the use of information in the work of the Family Health Teams (EqSF), the Basic Health Units (UBS), to identify factors that interfere with the use of information in an environment of high complexity, difficult to control and decentralized. To answer this question, it was identified the treatment process and use information. It aims also to understand the discrepancy between the intended use and effective use of information and its causes. We used the method of multiple case study and, therefore, we studied seven EqSF three that are part of UBS, managed by a Social Organization (OS), the Foundation of the Faculty of Medicine, USP, in the western region of São Paulo. The EqSF are multidisciplinary groups that promote primary and preventive health care for patients of the territory. We sought to understand how, in this context, are made to capture, registration, delivery and use of information resources as they are relevant to the production of professional service and are collected in both the patient\'s home and in UBS. To perform the service within the quality standards set by the OS and the Municipal Health Secretariat (SMS), professionals create several parallel information systems (notebooks, spreadsheets, etc.). Individual use, since the electronic systems of SMS and Ministry of Health did not meet their needs and the information it contains are not always used. This is due to non-alignment between information systems and infrastructure available (BOSTROM; HEINEN, 1997a), a requirement which is overcome through individual and collective efforts. This situation confirms the considerations of Delone and McLean (1992, 2002, 2003) who claim to be a relationship between information use and user satisfaction with system quality, information quality and service quality of information. Professionals tend to store data backlog, enabling redundancy, errors and loss of detail. Information is recorded according to the interest of professional and there is no structured system for the consolidation of information.

No começo do século XXI o Brasil iniciou mudanças importantes para o desenvolvimento de políticas de saúde bucal voltadas para necessidade da população brasileira, até então negligenciadas. A inserção das equipes de saúde bucal (ESB) na Estratégia de Saúde da Família (ESF) e a Política Nacional de Saúde Bucal constituíram-se importantes medidas em busca da transformação e do avanço das ações de saúde bucal no âmbito do Sistema Único de Saúde (SUS). Contudo, configura-se a necessidade em estabelecer uma estratégia de Vigilância em Saúde Bucal, com a institucionalização de meios de monitoramento e avaliação, através da inclusão de alguns indicadores de saúde bucal na atenção básica do SUS. Este estudo tem o propósito de fazer uma análise da saúde bucal no Brasil, a partir da coleta de dados secundários oficiais de 27 capitais brasileiras, disponíveis no Sistema de Informação da Atenção Básica (SIAB), no período entre 2012 e 2013. Trata-se de um estudo do tipo ecológico de caráter descritivo, onde foram calculados indicadores de saúde, como cobertura estimada de equipes de saúde bucal na Estratégia de Saúde da Família, e alguns indicadores de saúde bucal da Atenção Básica, que neste caso, devido a falhas no SIAB, a análise ficou restrita a 18 capitais. Os resultados mostraram grande variação na cobertura de ESB da ESF, de 1,23% (Belém) em 2012 a 87,68% (Teresina) em 2013. E em se tratando da análise dos indicadores de saúde bucal na Atenção Básica das 18 capitais, a média da ação coletiva escovação dental supervisionada foi 30,13% em 2012, e 29,03% em 2013; a cobertura média da primeira consulta odontológica programática foi de 10,35% em 2012, e 11,27% em 2013; e a média de atendimentos de urgência odontológica por habitante foi a mesma (0,03) em 2012 e 2013. Já o indicador que mede a capacidade do serviço em concluir os tratamentos odontológicas iniciados, o pior resultado foi encontrado em João Pessoa (0,06 e 0.11) e o melhor em Palmas (0,79 e 0,74); enquanto que a média de instalações de próteses dentárias foi baixa em todas as capitais, sendo as maiores (0,06) em João Pessoa e Campo Grande, no ano de 2012. No geral, houve pouca variação dos indicadores entre 2012 e 2013. A identificação de problemas na obtenção e registro de dados no SIAB compromete a utilização dos indicadores, e interfere na produção de informações consistentes e confiáveis que permitam a análise da atenção em saúde bucal no país. / In the early 21st century, Brazil initiated important changes to the development of oral health policies targeted to the needs of the Brazilian population, which were neglected until then. The inclusion of oral health teams in the Family Health Strategy and the National Oral Health Policy were important measures in the search for transformation and advancement of oral health actions in the Brazilian Public Health System (SUS). However, there is the need to establish a strategy of Oral Health Surveillance, with the establishment of means for monitoring and evaluation, by the inclusion of some oral health indicators in the basic care of SUS. This study aimed to analyze the oral health in Brazil, based on collection of official secondary data from 27 Brazilian capitals, available in the Primary Health Information System (SIAB), in the period between 2012 and 2013. This was an ecological descriptive study and involved calculation of health indicators, including the estimated coverage of oral health teams in the Family Health Strategy, and some oral health indicators in Basic Care, in which case the analysis was restricted to 18 capitals due to failures in SIAB. The results revealed great variation in the coverage of ESB in the ESF, from 1.23% (Belém) in 2012 to 87.68% (Teresina) in 2013. Concerning the analysis of oral health indicators in Basic Care of the 18 capitals, the mean of collective action of supervised toothbrushing was 30.13% in 2012, and 29.03% in 2013; the mean coverage of the first programmatic dental consultation was 10.35% in 2012, and 11.27% in 2013; and the mean number of dental emergency attendances per inhabitant was the same (0.03) in 2012 and 2013. With regard to the indicator that assesses the service capacity to complete initiated dental treatments, the worst outcome was observed in João Pessoa (0.06 and 0.11) and the best in Palmas (0.79 and 0.74); while the mean number of placement of dental prostheses was low in all capitals, being the highest (0.06) in João Pessoa and Campo Grande, in the year 2012. In general, there was little variation in the indicators between 2012 and 2013. The identification of problems in data achievement and registry in SIAB compromises the utilization of indicators and interferes with the production of consistent and reliable information that may allow the analysis of oral health care in the country.

No começo do século XXI o Brasil iniciou mudanças importantes para o desenvolvimento de políticas de saúde bucal voltadas para necessidade da população brasileira, até então negligenciadas. A inserção das equipes de saúde bucal (ESB) na Estratégia de Saúde da Família (ESF) e a Política Nacional de Saúde Bucal constituíram-se importantes medidas em busca da transformação e do avanço das ações de saúde bucal no âmbito do Sistema Único de Saúde (SUS). Contudo, configura-se a necessidade em estabelecer uma estratégia de Vigilância em Saúde Bucal, com a institucionalização de meios de monitoramento e avaliação, através da inclusão de alguns indicadores de saúde bucal na atenção básica do SUS. Este estudo tem o propósito de fazer uma análise da saúde bucal no Brasil, a partir da coleta de dados secundários oficiais de 27 capitais brasileiras, disponíveis no Sistema de Informação da Atenção Básica (SIAB), no período entre 2012 e 2013. Trata-se de um estudo do tipo ecológico de caráter descritivo, onde foram calculados indicadores de saúde, como cobertura estimada de equipes de saúde bucal na Estratégia de Saúde da Família, e alguns indicadores de saúde bucal da Atenção Básica, que neste caso, devido a falhas no SIAB, a análise ficou restrita a 18 capitais. Os resultados mostraram grande variação na cobertura de ESB da ESF, de 1,23% (Belém) em 2012 a 87,68% (Teresina) em 2013. E em se tratando da análise dos indicadores de saúde bucal na Atenção Básica das 18 capitais, a média da ação coletiva escovação dental supervisionada foi 30,13% em 2012, e 29,03% em 2013; a cobertura média da primeira consulta odontológica programática foi de 10,35% em 2012, e 11,27% em 2013; e a média de atendimentos de urgência odontológica por habitante foi a mesma (0,03) em 2012 e 2013. Já o indicador que mede a capacidade do serviço em concluir os tratamentos odontológicas iniciados, o pior resultado foi encontrado em João Pessoa (0,06 e 0.11) e o melhor em Palmas (0,79 e 0,74); enquanto que a média de instalações de próteses dentárias foi baixa em todas as capitais, sendo as maiores (0,06) em João Pessoa e Campo Grande, no ano de 2012. No geral, houve pouca variação dos indicadores entre 2012 e 2013. A identificação de problemas na obtenção e registro de dados no SIAB compromete a utilização dos indicadores, e interfere na produção de informações consistentes e confiáveis que permitam a análise da atenção em saúde bucal no país. / In the early 21st century, Brazil initiated important changes to the development of oral health policies targeted to the needs of the Brazilian population, which were neglected until then. The inclusion of oral health teams in the Family Health Strategy and the National Oral Health Policy were important measures in the search for transformation and advancement of oral health actions in the Brazilian Public Health System (SUS). However, there is the need to establish a strategy of Oral Health Surveillance, with the establishment of means for monitoring and evaluation, by the inclusion of some oral health indicators in the basic care of SUS. This study aimed to analyze the oral health in Brazil, based on collection of official secondary data from 27 Brazilian capitals, available in the Primary Health Information System (SIAB), in the period between 2012 and 2013. This was an ecological descriptive study and involved calculation of health indicators, including the estimated coverage of oral health teams in the Family Health Strategy, and some oral health indicators in Basic Care, in which case the analysis was restricted to 18 capitals due to failures in SIAB. The results revealed great variation in the coverage of ESB in the ESF, from 1.23% (Belém) in 2012 to 87.68% (Teresina) in 2013. Concerning the analysis of oral health indicators in Basic Care of the 18 capitals, the mean of collective action of supervised toothbrushing was 30.13% in 2012, and 29.03% in 2013; the mean coverage of the first programmatic dental consultation was 10.35% in 2012, and 11.27% in 2013; and the mean number of dental emergency attendances per inhabitant was the same (0.03) in 2012 and 2013. With regard to the indicator that assesses the service capacity to complete initiated dental treatments, the worst outcome was observed in João Pessoa (0.06 and 0.11) and the best in Palmas (0.79 and 0.74); while the mean number of placement of dental prostheses was low in all capitals, being the highest (0.06) in João Pessoa and Campo Grande, in the year 2012. In general, there was little variation in the indicators between 2012 and 2013. The identification of problems in data achievement and registry in SIAB compromises the utilization of indicators and interferes with the production of consistent and reliable information that may allow the analysis of oral health care in the country.

A interoperabilidade entre sistemas de informação em saúde está se tornando fundamental para o compartilhamento da informação num ambiente de saúde, onde normalmente as diversas especialidades que atuam no atendimento ao paciente armazenam seus dados, em sistemas computacionais distintos e em regiões geograficamente distribuídas. Devido à diversidade existente entre estes sistemas, a integração as vezes torna-se difícil. Os problemas de interoperabilidade podem ser técnicos, onde os componentes de computação dos sistemas não permitem a cooperação devido às diferenças nos protocolos de comunicação ou semânticos, ocasionados devido à diversidade de representação da informação transmitida. Este trabalho propõe uma arquitetura para facilitar ambos os aspectos de interoperabilidade, sendo que a interoperabilidade técnica é proporcionada pela utilização de um middleware e a semântica, pela utilização de sistemas de terminologia adotados internacionalmente. Para a implementação de referência foi utilizada como middleware a arquitetura CORBA e suas especificações para o domínio da saúde, sendo que uma das especificações CORBA para o domínio da saúde foi adotada para padronizar a comunicação com os sistemas de terminologia. Para validar a implementação, foi construído um aplicativo cliente baseado na análise de requisitos de uma UTI neonatal. O cliente foi utilizado também para acessar os componentes implementados e verificar dificuldades e ajustes que podem ser feitos na implementação. / The interoperability among health information systems are becoming fundamental to share the information in a health environment, here commonly the diverse medical specialties that act in the patient care store the data, in distinct computational systems and in geographically distributed regions.Because of the existing diversity among these information systems, the integration can be a difficult task. Interoperability problems can either be technical, when the communication components do not cooperate due to the diversity of the information representation. This work proposes an architecture to improve both interoperability aspects. The technical and partial semantic interoperability is achieved by the use if a middleware whereas the semantic interoperability by the use of internationally approved terminological systems. For the reference implementation was used the CORBA middleware architecture. One of the CORBA specifications in health care was adopted to standardize the communication with the terminological systems. To validate the implementation it was developed a client application based on the requirement analysis of neonatal ICU. The client application was also used to access the software components and to verify possible problems.

<p>HIV/AIDS is the largest and most serious global epidemic in the recent times. To date, the epidemic has affected approximately 40 million people (range 33 &ndash / 46 million) of whom 67%, that is, an estimated 27 million people are in the Sub Saharan Africa. The Sub Saharan Africa is also reported to have the highest regional prevalence of 7.2% compared to an average of 2% in other regions. A medical cure for HIV/AIDS remains elusive but use of antiretroviral therapy (ART) has resulted in improvement of quality and quantity of life as evidenced by the reduction of mortality and morbidity associated with the infection, hence longer and good quality life for HIV/AIDS patients on ART.</p>

In the light of an ageing society with shrinking economic resources, deinstitutionalization of elderly care is a general trend. As a result, homecare is increasing, and increasingly shared between different health and social care organizations. To provide a holistic overview about the patient care process, i.e. to be patient-centred, shared homecare needs to be integrated. This requires improved support for information sharing and cooperation between different actors, such as care professionals, patients and their relatives. The research objectives of this thesis are therefore to study information and communication needs for patient-centered shared homecare, to explore how integrated information and communication technology (ICT) can support information sharing, and to analyze how current standards for continuity of care and semantic interoperability meet requirements of patient-centered shared homecare. An action research approach, characterized by an iterative cycle, an emphasis on change and close collaboration with practitioners, patients and their relatives, was used. Studying one specific homecare setting closely, intersection points between involved actors and specific needs for information sharing were identified and described as shared information objects. An integration architecture making shared information objects available through integration of existing systems was designed and implemented. Mobile virtual health record (VHR) applications thereby enable a seamless flow of information between involved actors. These applications were tested and validated in the OLD@HOME-project. Moreover, the underlying information model for a shared care plan was mapped against current standards. Some important discrepancies were identified between these results and current standards for continuity of care, stressing the importance of evaluating standardized models against requirements of evolving healthcare contexts. In conclusion, this thesis gives important insights into the needs and requirements of shared homecare, enabling a shift towards patient-centered homecare through mobile access to aggregated information from current feeder systems and documentation at the point of need.

The Saudi ministry of health reported that government health care spending doubled from 2008 to 2011. To address increased demand, the government encouraged small to medium enterprise (SME) growth. However, SME leaders could not leverage technology as a growth enabler because they lacked strategies to address operating inefficiencies associated with technology. Only 50% of hospitals fully implemented information technology. The purpose of this phenomenological study was to explore lived experiences of SME leaders on strategies needed to accelerate technology implementation. This exploration drew on a conceptual framework developed from Wainwright and Waring's framework addressing issues of technology adoption. Data were collected from semistructured interviews of 20 SME leaders in Saudi Arabia. A modified van Kaam method was used to analyze participants' interview transcripts in search of common themes. The main themes were strategies to address human resources, clinical teams, funding, and organizational and leadership alignment to accelerate the diffusion of technology. Findings indicated that insurance companies influence SME operations, growth, and survival. Analysis of findings revealed the need for change in management, training, implementation follow up, and staff retention to accelerate technology implementation. Application of findings has the potential to promote positive social change in guiding SME leaders to be change agents and enabling them to create a reliable, sustainable health care delivery system.