BACKGROUND: Audit and feedback interventions have the potential to improve clinical care. Electronically captured administrative and clinical data routinely collected in Canadian hospitals may be used to provide feedback to physicians in general medicine in-patient care. The computation of appropriate quality indicator requires patient care to be attributed to individual physician(s). The appropriate attribution method in contexts where multiple physicians are involved in the care with varying degree of responsibilities that change over time is not straight forward. There has so far been little guidance in the literature of how to best accomplish this. The objective of this study is to identify trade-offs of different physician attribution methods by applying them to the same large clinical dataset. METHODS: A retrospective cohort study was conducted using the GEMINI dataset consisting of administrative and clinical data of hospitalized patients discharged from General Medicine service between April 1, 2010 and October 31, 2017 extracted from electronic systems at 7 hospitals in the Greater Toronto Area. A set of four quality indicators (length of stay, 30-day re-admission, in-patient mortality, use of advanced imaging) used in an audit and feedback intervention was calculated for each physician using 5 different physician attribution methods: STRICT (only patients with the same admitting, discharging, and most responsible physician with length of stay less than 14 days were included to capture those patients whose care was provided by only 1 physician), ADMIT (attribute care to admitting physician), DISCHARGE (attribute care to discharging physician), MRP (attribute care to most responsible physician), and ANY (attribute care to admitting, discharging, and most responsible physicians). The comprehensiveness and comparability of each attribution method were calculated. The actual differences of the indicator value and physician ranking for each indicator was compared between each pair of attribution methods. RESULTS: 222,490 hospitalization cared for by 203 physicians were included. STRICT attribution method was least comprehensive, capturing only 40% of patients cared for by a physician), while ADMIT, DISCHARGE, and MRP captured 70% of patients. All attribution methods produced patient populations for individual physicians that were comparable to those seen at each hospital. STRICT attribution method resulted in length of stay values 4.7 to 6.8 days shorter than other attribution methods and had poor rank correlation of physicians when compared to other attribution methods (spearman rank correlation 0.27 to 0.52). Absolute differences for the other 3 indicators were small between all attribution methods, and relative ranking of physicians were reasonably preserved (strong or very strong rank correlation). INTERPRETATION: Different attribution methods have different comprehensiveness, but all produced mostly comparable patient populations for physicians. Certain attribution method can affect apparent physician performance for some quality indicators but not others. The impact of physician attribution methods deserve consideration during the design of audit and feedback interventions. / Graduate

In its theoretical part, this work deals with hospital information systems, their properties and development trends in the world, in Czech Republic and in the faculty Hospital in Plzeň in particular. A special reason for taking up this subject was the on-going transition to digital operation at the RTG departament of said hospital. Pictorial documentacion in digital form is presently becoming standard part of the medical do-cumentacion. The X-ray photographs can now be viewed at any client station of the hospital information system. As the existing stations were not originally intended for visualisation of pictorial medical documentacion, image quality tests have been carried out to determine the suitability of the station monitors for such operation. The main target of this work was to identify, using the technical tools available ath the RTG departament, a suitable image quality test, to verify its informative value and compare the existing hospital information system stations with dedicated diagnostic work station primarily intended for visualisation of medical X-ray documentation. The practical part of this work consisted of two tests using special graphic images and real patient`s X-ray picture including a specific diagnostic feature. A method of controlled interview was then used to establish the image quality and the degree of certainty with which that the doctors could identify the subject diagnostic feature. The test results were subject to statistical analysis using the linear regression analytic method whereby the informative value of the tests was determined. Finally, the operational properties of diagnostic work stations were compared to those of the hospital information system. In consideration of the small number of stations subjects to tests, the statistic analysis of this comparison was not carried out.

Este estudo apresenta um método para consulta de informações sobre internações hospitalares psiquiátricas através do banco de dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) via Internet e analisou dados obtidos com o uso desse método para construir o perfil de internações psiquiátricas do município de Ribeirão Preto, no período de 1993 a 2002. Com base na metodologia descritiva, construiu-se um guia para a obtenção de dados secundários utilizando o site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Descreveu-se o procedimento para obtenção das informações passo a passo, através dos principais comandos, de telas e de exemplos que ilustram o percurso a ser seguido pelo interessado (estudante, pesquisador ou profissional) na aquisição de dados de internação hospitalar. O perfil em Ribeirão Preto mostrou que houve diminuição do número e aumento do tempo de permanência das internações hospitalares psiquiátricas, onde houve prevalência de pessoas do sexo masculino, entre 20 aos 49 anos e com diagnósticos relacionados à esquizofrenia. Com os indicadores de saúde verificou-se o aumento do custo e confirmou-se a diminuição das internações psiquiátricas. O conhecimento produzido é um recurso que auxilia a construção do quadro situacional de saúde mental, permitindo aos profissionais de saúde, entre eles os enfermeiros, o acesso aos subsídios norteadores de suas ações no ensino, na pesquisa e na assistência em psiquiatria e saúde mental. / This study presented a method to obtain information about psychiatric hospitalization through the database of the Single Health System Hospital Information System (SIH-SUS), using the Internet. Data obtained through this method were analyzed in order the profile of psychiatric hospitalizations in Ribeirão Preto, between 1993 and 2002, to be constructed. On the basis of descriptive methodology, we elaborated a manual to obtain secondary data through the site of the Single Health System Information Technology Department (DATASUS). A step by step description was given about how to obtain the information through the main commands and screens as well as examples to illustrate how people interested (students, researchers or professionals) can acquire hospitalization data. The Ribeirão Preto profile showed that the number of hospitalizations decreased, while length of psychiatric hospitalizations increased, with prevalence of diagnoses related to schizophrenia, the age range between 20 and 49 years and male patients. Health indicators showed an increase in cost and confirmed a decrease in psychiatric hospitalizations. The produced knowledge is of help to get a picture of the mental health situation, allowing health professionals, what includes nurses, to access resources to guide their actions in teaching, research and care in psychiatry and mental health.

Os Sistemas de Informação Hospitalar podem ser definidos como uma rede integrada de informações, projetada para gerenciar aspectos assistenciais, administrativos e jurídicos em organizações de saúde. No contexto da busca pela melhoria da qualidade na assistência à saúde, proporcionada pelos avanços significativos das tecnologias da informação e comunicação, insere-se a necessidade da abordagem da sepse enquanto importante tema de saúde pública mundial. A sepse pode ser definida como síndrome de anormalidades fisiológicas, patológicas e bioquímicas induzidas por um processo infeccioso. A equipe multiprofissional de saúde deve atuar no reconhecimento precoce dos pacientes com quadro sugestivo de infecção e suas potenciais complicações, que podem culminar em síndrome séptica, estabelecendo medidas que garantam seu controle, manuseio precoce, intervenção eficaz e segura, por meio de uma assistência integral e contínua. O objetivo neste estudo foi verificar a contribuição dos Sistemas de Informação Hospitalar para a identificação precoce e o manejo da sepse em pacientes cirúrgicos de um hospital universitário. Trata-se de pesquisa com delineamento quantitativo, retrospectivo, descritivo e correlacional. A coleta de dados foi realizada por meio dos Sistemas de Informação Hospitalar, mediante aprovação do Comitê de Ética em Pesquisa. A população foi composta de 28 pacientes que atenderam os critérios de inclusão da pesquisa. Na caracterização sociodemográfica desses pacientes, constatou-se predominância do sexo masculino (17; 60,7%), brancos (26; 92,9%), com 60 anos ou mais (21; 75,0%). Quanto à análise clínica do paciente, 11 apresentaram predominância do diagnóstico oncológico (39,3%) na admissão hospitalar, assim como 24 (85,7%) tiveram histórico de somente uma internação hospitalar no período. No final do período de internação (desfecho), predominantemente 20 pacientes (71,4%) evoluíram para óbito. Quanto ao tempo de internação, 13 pacientes (46,4%) permaneceram internados por tempo superior a 30 dias, com média de 30,5 (DP=25,0), a maioria dos pacientes (18; 64,8%) passou pelo procedimento cirúrgico até o quinto dia de internação, com média de 8,25 dias (DP=15,2). Da mesma forma, apresentaram predominância de desenvolvimento dos primeiros sinais de SIRS e de disfunção orgânica também até o quinto dia de internação 19 pacientes (67,8%), com média de 5,2 dias (DP=4,8), e 15 (53,6%), com média de 9,14 dias (DP=12,23), respectivamente. A confirmação ou hipótese do diagnóstico de sepse ocorreu até o décimo dia de internação com 15 pacientes (53,5%), com média de 11,6 (DP=13,4). Na análise da evolução dos pacientes para óbito, identificou-se significância estatística em relação à idade, à especialidade do diagnóstico na admissão e ao tempo de internação. O conteúdo dos registros realizados diariamente pela equipe multidisciplinar evidenciou que os primeiros sinais de SIRS foram identificados, predominantemente, no sistema de monitorização dos pacientes (26; 92,9%), enquanto os primeiros sinais de disfunção orgânica foram descritos nas evoluções da equipe de enfermagem (24; 85,7%). Os resultados evidenciam a importância da qualidade dos registros de enfermagem nos Sistemas de Informações Hospitalares, para identificação dos riscos, reconhecimento precoce e manejo adequado da sepse em pacientes submetidos a procedimentos cirúrgicos, enquanto integrantes da equipe multidisciplinar, visando o alcance de maior efetividade das ações de gerenciamento dos processos de assistência à saúde / Hospital information systems can be defined as an integrated network of information, designed to manage assistance, administrative and legal aspects in healthcare organizations. In the context of the quest for quality improvement in health care, provided by the significant advances of information and communication technologies, the need of sepsis as an important theme of global public health. Sepsis can be defined as abnormalities syndrome, pathological and physiological biochemical induced by an infectious process. The multidisciplinary team of health should act in the early recognition of patients with suggestive of infection and its potential complications, which can lead to septic syndrome, establishing measures to ensure the control, early intervention handling effective and safe, through a full and continuous assistance. The objective of this study was to verify the contribution of hospital information systems for early identification and management of sepsis in surgical patients in a university hospital. This is a quantitative, descriptive, retrospective and correlational research. The data collection was performed through hospital information systems, subject to the approval of the Research Ethics Committee. The population was composed of 28 patients who attended the inclusion criteria of the survey. In demographic characterization of these patients, there was a predominance of males (17; 60.7%), white (26; 92.9%), 60 years or older (21; 75.0%). For the clinical analysis of patient, 11 showed predominance of oncological diagnostics (39.3%) in hospital admission, as well as 24 (85.7%) had a history of only one hospitalization. At the end of the period of hospitalization (outcome), predominantly 20 patients (71.4%) evolved to death. Regarding length of stay 13 patients (46.4%) remained hospitalized for more than 30 days, with an average of 30.5 (SD = 25.0), most patients (18; 64.8%) passed the surgical procedure until the fifth day of hospitalization, averaging 8.25 days (SD = 15.2). Similarly, showed a predominance of development of the first signs of SIRS and organic dysfunction, too, until the fifth day of hospitalization 19 patients (67.8%), with an average of 5.2 days (DP = 4.8), and 15 (53.6%), with an average of 9.14 days (SD = 12.23), respectively. Confirmation or chance of diagnosis of sepsis occur until the tenth day of hospitalization with 15 patients (53.5%), with an average of 11.6 (SD = 13.4). In the analysis of the evolution of the patients to death, statistical significance was identified in relation to age, the speciality of the diagnosis on admission and length of stay. The contents of the records held daily by the multidisciplinary team showed that the first signs of SIRS were identified, predominantly, in the system of monitoring of the patients (92.9%), while 26; the first signs of organic dysfunction were described in the evolutions of the nursing staff (24; 85.7%). The results highlight the importance of the quality of nursing records in hospital information systems, to identify the risks, early recognition and appropriate management of sepsis in patients undergoing surgical procedures, while members of the multidisciplinary team, aiming at the achievement of greater effectiveness of the actions of management of care processes health

Hospital Information System (HIS) is considered as an important factor in health care sector for managing the administrative, financial and clinical aspects of a hospital. A large number of hospitals from both developing and developed countries are adopting hospital information system to bring efficiency in their current system. Current study is conducted to contribute to the literature regarding HIS implementation in developing country settings as there is scarce literature. This study attempts to improve the understanding of HIS implementation in developing countries.  In this study, socio technical model is used to understand the current working system of cardiology department of Combined Military Hospital (CMH). Qualitative case study is conducted for this research. Data is collected with the help of interviews done online via Skype and some secondary data resources to highlight the problems and solutions before HIS implementation. The data collection, generation of results and analysis is done on the basis of structure, people, technology, and process perspective originating from the socio-technical model. Findings of this study are presented in the form of recommendations which need to be considered for making a HIS implementation plan.

User participation has long been considered as one important factor which affects the development of information management systems performance. It is believed that the cooperation between users and developers contributes to higher satisfaction and acceptance. Service has become the main economic activities in the modern society and traditional good-dominant logic has been replaced by service - dominant logic. Based on this concept, information system development can also be considered a service in which the final value determined by the extent to which the project can meet the predefined goal and fit users¡¦ needs. To maximize the value created, users should be viewed as co-producer and play a more active role in the system development process. The main research purpose of this study is to understand how users can act as value co-production in different types of information system development project. We studied three different hospital information system projects: user-initiated internal project, IT department initiated the project, and outsourcing development project. We then explored how users can co-create value under different contexts. By using case study approach and based on service-dominant logic concept, we identified the importance of user co-production and clarify the role that users may play. The results of this study can contribute to system development project and serve as a reference for subsequent research.

The present study investigated the electronic medical record system (EMR) of Zonguldak Karaelmas University Hospital which is used for six years now. The advantages and disadvantages of an EMR system in comparison with paper medical records were evaluated based on the user&amp / #146 / s opinion. The recommendations for the development of EMR and more efficient use of the system are principle goals of this study. The purposes of this thesis include promoting the implantation of EMR by introducing the advantages and disadvantages from the user&amp / #146 / s point of view. The main source of information used in this analysis is gathered from a questionnaire. Hundred and twenty six users of EMR selected voluntarily and randomly from the hospital staffs are included in this survey. The hospital staffs including physicians, nurses, clinicians, administrative clerks and technicians were included in this survey. Implementation for certain medical tasks and efficiency of using these tasks in EMR are evaluated. The advantages and disadvantages of the system were surveyed from the user&#039 / s point of view. In spite of the fact that health care professionals understand the benefits of electronic medical records, barriers to the use of EMR are also important for the current impediments in EMR introduction. While the successful applications of EMR systems are evident in western word, the implementation of EMR to a hospital information system is a new topic in Turkey. There are mainly attempts to convert the paper-based medical record systems to the fully automated electronic record systems. Our study is a pioneering attempt to analyze the users&amp / #146 / opinion for a fully integrated EMR system in a Turkish academic hospital. The suggestions such as restricting the the access, improving the hardware, integrating to the internet are made for the improvement of the system in future.

No description available.

Este estudo apresenta um método para consulta de informações sobre internações hospitalares psiquiátricas através do banco de dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS) via Internet e analisou dados obtidos com o uso desse método para construir o perfil de internações psiquiátricas do município de Ribeirão Preto, no período de 1993 a 2002. Com base na metodologia descritiva, construiu-se um guia para a obtenção de dados secundários utilizando o site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Descreveu-se o procedimento para obtenção das informações passo a passo, através dos principais comandos, de telas e de exemplos que ilustram o percurso a ser seguido pelo interessado (estudante, pesquisador ou profissional) na aquisição de dados de internação hospitalar. O perfil em Ribeirão Preto mostrou que houve diminuição do número e aumento do tempo de permanência das internações hospitalares psiquiátricas, onde houve prevalência de pessoas do sexo masculino, entre 20 aos 49 anos e com diagnósticos relacionados à esquizofrenia. Com os indicadores de saúde verificou-se o aumento do custo e confirmou-se a diminuição das internações psiquiátricas. O conhecimento produzido é um recurso que auxilia a construção do quadro situacional de saúde mental, permitindo aos profissionais de saúde, entre eles os enfermeiros, o acesso aos subsídios norteadores de suas ações no ensino, na pesquisa e na assistência em psiquiatria e saúde mental. / This study presented a method to obtain information about psychiatric hospitalization through the database of the Single Health System Hospital Information System (SIH-SUS), using the Internet. Data obtained through this method were analyzed in order the profile of psychiatric hospitalizations in Ribeirão Preto, between 1993 and 2002, to be constructed. On the basis of descriptive methodology, we elaborated a manual to obtain secondary data through the site of the Single Health System Information Technology Department (DATASUS). A step by step description was given about how to obtain the information through the main commands and screens as well as examples to illustrate how people interested (students, researchers or professionals) can acquire hospitalization data. The Ribeirão Preto profile showed that the number of hospitalizations decreased, while length of psychiatric hospitalizations increased, with prevalence of diagnoses related to schizophrenia, the age range between 20 and 49 years and male patients. Health indicators showed an increase in cost and confirmed a decrease in psychiatric hospitalizations. The produced knowledge is of help to get a picture of the mental health situation, allowing health professionals, what includes nurses, to access resources to guide their actions in teaching, research and care in psychiatry and mental health.

Avec l’essor des technologies de l’information et de la communication, la société et les organisations se transforment, serecomposent tous secteurs confondus. On appelle communément disruption, le changement de paradigme économique etorganisationnel lié aux TIC, plus précisément, à la digitalisation des processus.Les modes d’échanges entre les hommes ont évolué. Notre mémoire de master 2 (Numérique, recomposition organisationnelles et appropriation des TIC, Gravereaux, 2013) nous aura permis de comprendre que les véritables changements qui opèrent en organisation se situent au-delà des usages des espaces numériques de travail et des outils TIC.Notre thèse s’inscrit dans la continuité de ce travail préliminaire qui nous avait offert de questionner, de manière introductive, quelle pouvait être la portée de la dimension politique dans l’appropriation des technologies numériques.Cette thèse de doctorat a pour but de saisir, d’identifier, d’analyser et de conceptualiser, tant sur le plan théorique que pratique, le processus de transition organisationnelle qui opère dans les établissements de santé traversés par l’informatisation du dossier de soin et par la maturation des Systèmes d’Information Hospitalier. Après avoir compris qu’il fallait dépasser les usages pour comprendre l’appropriation des TIC, nous orienterons nos réflexions et enquêtes de façon à confronter ce point de vue et à lui donner une portée opérationnelle.Les phénomènes communicationnels liés aux changements et aux transformations en organisations constituent un élément central de ces recompositions. Le chercheur doit enquêter pour questionner et saisir ces phénomènes à l’aune de la compréhension particulière d’un établissement de santé.Le regard communicationnel porté sur un espace, un vécu, en transition, tentera de mettre à jour les conditions qui participent de l’appropriation des nouveaux outils liés à la traçabilité des soins : la forme informatisée du dossier patient.Notre thèse de doctorat se propose d’apporter une contribution à des problématiques de recherches actuelles en questionnant l’individu au travail au regard des questions politico-organisationnelles liées à l’appropriation du dossier patient informatisé.Ces acteurs que nous sommes venus « étudié », soignants, médecins, personnels administratif, sont au coeur, vivent, en même temps que l’organisation, ce phénomène de disruption qui affecte l’intégralité du dispositif organisationnel.À partir d’une rupture disruptive, de nouvelles formes d’organisation du travail, liées aux changements de pratiques del’information médicale, apparaissent, émerge des dissonances. De la même façon, pour accompagner cette organisation émergente, les formes et normes de management en santé, sont amenées à se recomposer et donc à se spécialiser.Nous assistons à une recomposition globale de la Santé, dont les composantes du dispositif tendent à faire de la contribution, de la collaboration, de l’autonomie et de la traduction, les nouveaux fondamentaux du management en organisations de santé accompagnant la métamorphose digitale des routines des acteurs. / With the growth of information and communication technologies, society and organizations are transforming, recomposing all sectors combined. The common paradigm shift is to change the economic and organizational paradigm linked to ICT, more precisely, to the digitalization of processes.The modes of exchange between men have evolved. Our Master 2 thesis (Digital, Organizational Reorganization andAppropriation of ICTs, Gravereaux, 2013) allowed us to understand that the real changes that operate in organization arebeyond the use of digital workspaces and ICT tools.Our thesis is part of the continuation of this preliminary work which offered us to question, in an introductory way, what could be the scope of the political dimension in the appropriation of digital technologies.This doctoral thesis aims at capturing, identifying, analyzing and conceptualizing, both theoretically and practically, the process of organizational transition that operates in the healthcare institutions through which the computerization of the care file And by the maturation of Hospital Information Systems. Having understood that we need to go beyond the uses to understand ICT appropriation, we will orient our reflections and investigations in order to confront this point of view and to give it an operational scope.The communicationa phenomena linked to changes and transformations in organizations are a central element of theserecompositions. The researcher must investigate and question these phenomena in terms of the particular understanding of a healthcare institution.The communicative look at a space, a experience, in transition, will try to update the conditions that participate in the appropriation of the new tools related to the traceability of care: the computerized form of the patient record.Our doctoral thesis proposes to make a contribution to current research questions by questioning the individual at work withregard to the politico-organizational issues related to the appropriation of the computerized patient record.These actors, who have come to be "studied", caregivers, doctors and administrative staff, are at the heart of this phenomenon of disruption, which affects the entire organizational system, at the same time as the organization.From a disruptive rupture, new forms of work organization, linked to changes in the practices of medical information, emerge, emerging from dissonances. In the same way, to support this emerging organization, the forms and standards of health management, are led to recompose and therefore to specialize.We are witnessing a global recomposition of health, whose components of the system tend to make contribution, collaboration, autonomy and translation, new fundamentals of management in health organizations accompanying the digital metamorphosis of routines actors.