No description available.

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

La gestion électronique des données médicales consiste autant dans le simple traitement automatisé des données personnelles que dans le partage et l'échange de données relatives à la santé. Son encadrement juridique est assuré, à la fois, par les règles communes au traitement automatisé de toutes les données personnelles et par celles spécifiques au traitement des données médicales. Cette gestion, même si elle constitue une source d'économie, engendre des problèmes de protection de la vie privée auxquels le gouvernement français tente de faire face en créant l'un des meilleurs cadres juridiques au monde, en la matière. Mais, de grands chantiers comme celui du dossier médical personnel attendent toujours d'être réalisés et le droit de la santé se voit devancer et entraîner par les progrès technologiques. Le développement de la télésanté bouleverse les relations au sein du colloque singulier entre le soignant et le soigné. L'extension des droits des patients, le partage de responsabilité, l'augmentation du nombre d'intervenants, le secret médical partagé constituent de nouveaux enjeux avec lesquels il faut, désormais compter. Une autre question cruciale est celle posée par le manque d'harmonisation des législations augmentant les risques en cas de partage transfrontalier de données médicales / The electronic management of medical data is as much in the simple automated processing of personal data in the sharing and exchange of health data . Its legal framework is provided both by the common rules to the automated processing of all personal data and those specific to the processing of medical data . This management , even if it is a source of economy, creates protection issues of privacy which the French government tries to cope by creating one of the best legal framework in the world in this field. However , major projects such as the personal health record still waiting to be made and the right to health is seen ahead and lead by technological advances . The development of e-health disrupts relationships within one dialogue between the caregiver and the patient . The extension of the rights of patients , sharing responsibility , increasing the number of players , the shared medical confidentiality pose new challenges with which we must now count. Another crucial question is posed by the lack of harmonization of legislation increasing the risks in cross-border sharing of medical

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

Text in English with summaries in English, Afrikaans and Zulu / Bibliography: leaves 102-115 / The study investigated the management of medical records in the Primary Health Care services (PHCs) of Diepsloot. The study investigated the regulatory framework, records infrastructure, records security, records management staff skills and the filing system. A qualitative design guided by the interpretive paradigm was used to guide the case study. Interviews, focus groups, and observations generated data from 50 participants. The study revealed that the regulatory instruments used to manage records lack implementation and compliance. There was a lack of security measures, a shortage of records management infrastructure and inconsistency in the filing system. There is a low level of skill in the records management staff. The study recommended the implementation of a regulatory policy that will guide and ensure effective governance of records in PHCs. Records should be secure from misuse by unscrupulous individuals. PHC records need to be managed by experienced professionals. The filing system should be easily accessible. / Die studie het ondersoek ingestel na die bestuur van mediese rekords in die Primêre Gesondheidsorgdienste (PHC's) van Diepsloot. Die studie het ondersoek ingestel na die regulatoriese raamwerk, rekord van infrastruktuur, rekord sekuriteit, vaardighede vir rekordbestuur en die liasseerstelsel. 'n Kwalitatiewe ontwerp gelei deur die interpretatiewe paradigma is gebruik om die gevallestudie te lei. Onderhoude, fokusgroepe en waarnemings het gegewens van 50 deelnemers gegenereer. Die regulatoriese instrumente wat gebruik word om rekords te bestuur, het geen implementering en nakoming nie. Die studie het aan die lig gebring dat daar 'n gebrek aan veiligheidsmaatreëls was, 'n tekort aan infrastruktuur vir rekordbestuur en teenstrydigheid in die liasseringstelsel. Die personeel in rekordbestuur het 'n lae vlak van vaardigheid. Die studie het die implementering van 'n regulatoriese beleid aanbeveel wat die doeltreffende bestuur van rekords in PHC's sal lei en verseker. Rekords moet beskerm word teen misbruik deur gewetenlose individue. PHC-rekords moet deur ervare professionele persone uitgevoer word. Die liasseerstelsel moet maklik toeganklik wees. / Lolu cwaningo luphenywe ngokuphathwa kwamarekhodi ezokwelashwa emnyangweni Wezokunakekelwa kwempilo okuyisisekelo (i-PHCs) eDiepsloot. Ucwaningo luphenywe ngohlaka lokulawula, ingqalasizinda yamarekhodi, ukuphepha kwamarekhodi, amakhono okuphathwa kwamarekhodi nohlelo lokufayila. Umklamo olungaqanjwa uqondiswa yi-paradigm yokutolika wasetshenziselwa ukuqondisa ucwaningo lwesigameko. Izingxoxo, amaqembu okugxila kanye nokubukwa kukhiqize idatha evela kubahlanganyeli abangu 50. Izinsizakusebenza zokulawula ezisetshenziselwa ukuphatha amarekhodi zingenakho ukusebenza nokuhambisana. Ucwaningo luveze ukuthi bekukhona ukuntuleka kwezindlela zokuphepha, ukushoda kwengqalasizinda yokuphathwa kwamarekhodi kanye nokungahambelani ohlelweni lokugcwalisa. Kunezinga eliphansi lekhono kubasebenzi bokuphathwa kwamarekhodi. Ucwaningo lincome ukusetshenziswa kwenqubomgomo yokulawula ezohola futhi iqinisekise ukuphathwa kwamarekhodi kuma-PHCs ngendlela efanele. Amarekhodi kufanele avikeleke ekusetshenzisweni kabi ngabantu abangathembekile. Amarekhodi we-PHC adinga ukuqhutshwa ngochwepheshe abanolwazi. Uhlelo lokufayila kufanele lutholakale kalula. / Information Science / M. Inf.

Sepsis is the leading cause of death among critically ill patients and the 10th most common cause of death overall in the United States. The mortality rates increase with severity of the disease, ranging from 15% for sepsis to 60% for septic shock. Patient with sepsis can present varied clinical symptoms depending on the personal predisposition, causal microorganism, organ system involved, and disease severity. To facilitate sepsis diagnosis, the first sepsis consensus definitions was published in 1991 and then updated in 2001. Early recognition of a sepsis patient followed with timely and appropriate treatment and management strategies have been shown to significantly reduce sepsis-related mortality, and allows care to be provided at lower costs. Despite the rapid progress in the knowledge of pathophysiological mechanisms of sepsis and its treatment in the last two decades, identifying patient with sepsis and therapeutic approaches to sepsis and its complications remains challenging to critical care clinicians. Hence, the objectives of this thesis were to 1) evaluate the test characteristics of the two sepsis consensus definitions and delineate the differences in patient profile among patients meeting or not meeting sepsis definitions; 2) determine the relationship between the changes in several physiological parameters before sepsis onset and sepsis, and to determine whether these parameters could be used to identify sepsis in critically ill adults; 3) evaluate the effect of corticosteroids therapy on patient mortality. Data used in this thesis were prospectively collected from an electronic medical record system for all the adult patients admitted into the seven critical care units (ICUs) in a tertiary medical center. Besides analyzing data at the ICU stay level, we investigated patient information in various time frames, including 24-hour, 12-hour, and 6-hour time windows. In the first study of this thesis, the 1991 sepsis definition was found to have a high sensitivity of 94.6%, but a low specificity of 61.0%. The 2001 sepsis definition had a slightly increased sensitivity but a decreased specificity, which was 96.9% and 58.3%, respectively. The areas under the ROC curve for the two consensus definitions were similar, but less than optimal. The sensitivity and area under the ROC curve of both definitions were lower at the 24-hour time window level than those of the unit stay level, though the specificity increased slightly. At the time window level, the 1991 definitions performed slightly better than the 2001 definition. In the second study, minimum systolic blood pressure performed the best, followed by maximum respiratory rate in discriminating sepsis patients from SIRS patients. Maximum heart rate and maximum respiratory rate can differentiate sepsis patients from non-SIRS patients fairly well. The area under ROC of the combination of five physiological parameters was 0.74 and 0.90 for comparing sepsis to non-infectious SIRS patients and comparing sepsis to non-SIRS patients, respectively. Parameters typically performed better in 24-hour windows compared to 6-hour or 12-hour windows. In the third study, significantly increased hospital mortality and ICU mortality were observed in the group treated with low-dose corticosteroids than the control group based on the propensity score matched comparisons, and multivariate logistic regression analyses after adjustment for propensity score alone, covariates, or propensity score (in deciles) and covariates. This thesis advances the existing knowledge by systemically evaluating the test characteristics for the 1991 and 2001 sepsis consensus definitions, delineating physiological signs and symptoms of deterioration in the preceding 24 hours prior to sepsis onset, assessing the prediction performances of single or combined physiological parameters, and examining the use of corticosteroids treatment and survival among septic shock patients. In addition, this thesis sets an innovative example on how to use data from electronic medical records as these surveillance systems are becoming increasingly popular. The results of these studies suggest that a more parsimonious set of definitional criteria for sepsis diagnosis are needed to improve sepsis case identification. In addition, continuously monitored physiological parameters could help to identify patients who show signs of deterioration prior to developing sepsis. Last but not least, caution should be used when considering a recommendation on the use of low dose corticosteroids in clinical practice guidelines for the management of sepsis.

Healthcare is a complex system under great pressure for meeting the patients’ needs. Implementing technology at inpatient wards might possibly support healthcare professionals and improve quality of care. However, these technologies might come with issues and the system might not be used as intended. This master thesis project investigates how healthcare professionals communicate at an inpatient ward and how this might be affected by implementing a Mobile Healthcare Solution (MHS). Further, it sought to question why healthcare professions might, or might not, use the MHS as a support of their daily work and what some reasons for this might be. Research methods were of qualitative approach. Field studies were performed at an inpatient ward and further, two healthcare professionals were interviewed. Grounded Theory (GT) was chosen as a method to process the data and obtain understanding for communication at the inpatient ward. The results showed that healthcare professionals communicate verbally, written and by reading, using different tools. The most prominent ways of communication were verbally, where it was common to report or discuss about a patient. The means for communication did not get drastically affected by implementing the MHS and reasons for this were of social, technical and organizational types. Some reasons for not using the MHS were habits and due to healthcare professionals perceiving the MHS as more time consuming than manual handling. However, a specific investigation of whether this might affect the usage of the MHS is yet needed

Colorectal cancer (CRC) is a health challenge worldwide and early detection of the disease is crucial to improve patient prognosis. It is common for the first contact with care to occur in primary care centers where general practitioners often face the challenge of distinguishing CRC from other diseases with similar symptoms. In this master thesis, patient records from primary care were used to create, optimize, and evaluate a machine learning model that classifies patients with CRC for early detection of the disease. The data used in the project included parts of electronic health records (EHRs) from both public (SLSO) and privately run (Capio and Praktikertjänst) primary care centers in the Stockholm region. The available dataset was cleaned and pre- processed, and then tested on four separate models. After selecting and optimizing the most promising model, LightGBM, a detailed evaluation of the model was performed. To simulate realistic clinical conditions, data from the three months prior to diagnosis were excluded from two of the datasets. The results were then compared with a baseline machine learning model that utilized ICD codes extracted from EHRs in primary care for early detection of CRC.The results showed that the final developed model had a generally good performance with an AUROC score of a maximum of 85.8%, which indicates very good ability to distinguish between the classes. The performance dropped when using the datasets with 3 months of data removed, but the ROC curves still showed a better ability than random classification to distinguish between the classes with a AUROC score of maximum 60,8%. The results also showed that the model developed in this master thesis outperforms the baseline model, which was based on ICD codes, from a performance perspective. For future development and before a possible clinical implementation, a larger data set should be used for training and testing. / Tjock- och ändtarmscancer, kolorektal cancer (KRC) är en hälsoutmaning över hela världen och tidig upptäckt av sjukdomen är avgörande för att förbättra patientens prognos. Det är vanligt att den första kontakten med vården inträffar på vårdcentraler där allmänläkare ofta står inför utmaningen att skilja KRC från andra sjukdomar med liknande symtom. I denna masteruppsats kommer patientjournaler från primärvården att användas för att skapa, optimera och utvärdera en maskininlärningsmodell som klassificerar patienter med KRC för tidig upptäckt av sjukdomen.De data som använts i projektet omfattade delar av elektroniska patientjournaler (EHR) från både offentliga (SLSO) och privatägda (Capio och Praktikertjänst) primärvårdscentraler i Stockholmsregionen. Den tillgängliga datamängden städades och förbehandlades, och testades sedan på fyra separata modeller. Efter att ha valt ut och optimerat den mest lovande modellen, LightGBM, utfördes en detaljerad utvärdering av modellen. För att simulera realistiska kliniska tillstånd utvärderades modellen på två datamängder där data från tre månader före diagnos uteslöts. Resultaten jämfördes sedan med en baslinjemodell som använde ICD-koder som hämtats från journalsystem inom primärvården för tidig upptäckt av CRC.Resultaten visade att den slutliga utvecklade modellen hade en generellt bra prestanda med en AUROC-poäng på högst 85,8%, vilket indikerar mycket god förmåga att skilja mellan klasserna. Prestandan sjönk vid användning av datasatserna med 3 månaders data borttagen, men ROC-kurvorna visade fortfarande en bättre förmåga än slumpmässig klassificering att skilja mellan klasserna med en AUROC-poäng på högst 60,8%. Resultaten visade också att den modell som utvecklats i denna masteruppsats överträffar baslinjemodellen, som baserades på ICD-koder, ur ett prestationsperspektiv. För framtida utveckling och före en eventuell klinisk implementation bör en större datamängd användas för träning och testning av modellen.

Research in risk awareness has been relatively neglected in the health informatics literature, which tends largely to examine project managers’ perspectives of risk awareness; very few studies explicitly address the perspectives held by senior executives such as directors. Another limitation evident in the current risk literature is that studies are often based on American data and/or they are restricted to American culture. Both factors highlight the need to examine how senior executives (i.e., directors) who oversee or direct eHealth projects in Canada perceive risk awareness. This research explores and discusses the perspectives of risk awareness (i.e., identification, analysis, and prioritization) held by directors and project managers who implement Canadian eHealth projects. Semi-structured interviews with nine directors and project managers uncovered six key distinctions in these two groups’ awareness of risk. First, all project managers valued transparency over anonymity, whereas directors believed that an anonymous reporting system for communicating risks had merit. Secondly, most directors emphasized the importance of evidence-based planning and decision making when balancing risks and opportunities, an aspect none of the project managers voiced. Thirdly, while project managers noted that the level of risk tolerance may evolve from being risk-averse to risk-neutral, directors believed that risk tolerance evolved toward risk-seeking. Directors also noted the importance of employing risk officers, a view that was not shared by project managers. Directors also believed the risk of too little end-user engagement and change management was the most important risk, whereas project managers ranked it as the least important. Finally, when directors and project managers were asked to identify and define the root cause(s) of eHealth risks, directors identified the complexity of health care industry, while project managers attributed it to political pressure and a lack of resources where eHealth projects are concerned. This research proposes that the varied perspectives of risk awareness held by directors and project managers must be considered and integrated to properly align expectations and build partnerships for successful eHealth project outcomes. Understanding risk awareness offers a means to systematically identify and analyze the complex nature of eHealth projects by embracing uncertainties, thereby enabling forward thinking (i.e., staying one step ahead of risks) and the ability to prevent avoidable risks and seize opportunities. / Graduate / 0723 / 0489 / 0454 / randbpark@gmail.com

Bakgrund: I Sverige pågår för närvarande stora projekt för att utforma och införa framtidens vårdinformationssystem. Dessa system utvecklas för att effektivisera hälso- och sjukvårdens processer och IT-miljöer. Elektroniska patientjournalsystem är den mest använda typen av vårdinformationssystem. Andra exempel är system för prover och svar, patientadministration och läkemedelsförskrivning. Trots att vårdinformationssystem har visat sig kunna bidra till ökad patientsäkerhet och kvalitet har implementering av nya system i hälso- och sjukvården en historia av att ofta misslyckas. Enligt ramverket Technology, People, Organizations and Macroenvironmental factors (TPOM), påverkar ett antal områden hur väl implementering av vårdinformationssystem faller ut.  Sjuksköterskor är den största legitimerade yrkeskåren inom hälso- och sjukvård. De ansvarar för omvårdnaden av en individ och hela dennes situation vilket bidrar till att sjuksköterskor är de som använder vårdinformationssystem mest frekvent. För att bidra till lyckad utveckling, implementering och förvaltning av vårdinformationssystem behöver sjuksköterskors upplevelser av utmaningar och möjligheter med vårdinformationssystem och vårddokumentation beskrivas.   Syfte: Studiens syfte är att beskriva sjuksköterskors upplevelser av utmaningar och möjligheter med vårdinformationssystem och vårddokumentation utifrån tekniska, personliga, organisatoriska och samhälleliga områden.  Metod: Kvalitativa semistrukturerade intervjuer genomfördes med tio legitimerade sjuksköterskor från olika verksamheter. Analys av insamlad data skedde genom kvalitativ innehållsanalys med deduktiv ansats utifrån huvudkategorierna i ramverket TPOM.  Resultat: Utmaningar och möjligheter inom områdena teknik, person, organisation och samhälle identifierades och beskrevs. Totalt tio subkategorier identifierades under huvudkategorierna. Respondenternas upplevelser av liknande utmaningar och möjligheter oavsett arbetsplats och vårdinformationssystem tyder på att resultatet kan appliceras och tas i beaktande vid utveckling, implementering och förvaltning oavsett vårdinformationssystem. / Background: Currently in Sweden, there are a number of ongoing extensive projects aiming towards development and adoption of futures’ health information technology (HIT). These systems are formed to make the processes and IT environment of health care more effective. Electronic health records are the most used type of health information technology. Other examples are systems for laboratory testing, patient administration and prescription of medications. Even though HIT has proven to contribute to effectiveness and quality of care, the implementations of such systems has a history of failing. According to the Technology, People, Organizations and Macroenvironmental factors framework (TPOM), a number of dimensions has an impact to determine the success of HIT implementation.  Nurses are the largest group of registered health care practitioners in Sweden. Nursing care include caring for the individual in whole, which leads to nurses extensive, and frequent use of HIT. To contribute to successful development, implementation and continuous management of HIT, nurses’ experiences of challenges and possibilities in HIT and documentation must be described further.  Aim: This study aims to describe nurses’ experiences of challenges and possibilities in Health information technology and documentation in the perspective of Technology, People, Organizations and Macroenvironmental factors.  Method: Qualitative, semistructured interviews was conducted with ten registered nurses coming from different types of care. Data was analyzed based on deductive approached qualitative content analysis, using the TPOM framework.  Results: Challenges and possibilites within technology, people, organizations and macroenvironmental domains were identified and described. A total of ten subcategories were identified. The respondendts experienced similar challenges and possibilites, regardless of workplace and health information technology. This implicates that the result of this study might be considered in development, implementation and management of HIT.