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The purpose of the study was to describe the effects of an EMR on patient management in selected HIV clinics in Johannesburg. A quantitative, descriptive, cross-sectional study was undertaken in four HIV clinics in Johannesburg. The subjects (N=44) were the healthcare workers selected by stratified random sampling. Consent was requested from each subject and from the clinics in Johannesburg. Data was collected using structured questionnaires. Median age of subjects was 36, 82% were female. 86% had tertiary qualifications. 55% were clinicians. 52% had 2-3 years work experience. 80% had computer experience, 86% had over one year EMR experience. 90% used the EMR daily, 93% preferred EMR to paper. 93% had EMR training, 17% used EMR to capture clinical data. 87% perceived EMR to have more benefits; most felt doctor-patient relationship was not interfered with. 89% were satisfied with the EMR’s overall performance. The effects of EMR benefit HIV patient management. / Health Studies / MA (Public Health)

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

我國全民健康保險制度自2004年1月1日開始使用健保IC卡後，醫療資訊電子化的趨勢，某種意義上來說，已經如凱撒（Gaius Julius Caesar）渡過盧比孔河（Crossing the Ribucon）時所說：「骰子已經投下（the die is cast）」一般，只能前進不能後退了！ 時至今日，電腦、網路連線、憑證簽章已經成為任何一間醫療院所從事醫療行為時的開門七件事之一，民眾用健保IC掛號、醫師用電腦下診斷作病歷、行政人員用健保VPN申報費用等，皆成為醫療實務中的標準模式。而我國衛生署也信心滿滿地希望能於2011年達到全國80%醫院實施電子病歷、60%醫院可為院際交換互動之目標。在此「全民電子病歷」旋將施行之當下，相關隱私權之配套對於病人之保障是否足夠，即成為該政策是否受到國人支持之關鍵所在。 本研究透過整理衛生署自2000年迄今所有與電子病歷相關之專案計畫，以及與電子病歷領域，產、官、學界共9位受訪者進行深度訪談後發現，我國現行電子病歷政策推廣有架構、標準、法制、補助、動機等五大問題，其中關於法制規範及隱私保障不足所造成的民眾疑慮與醫事人員躊躇，已成為電子病歷發展上的一大阻礙，而其中計畫推行的電子病歷索引交互中心，更可能對於病人資訊隱私權產生重大危害與影響。另一方面，若回頭省視司法院大法官釋字第603號解釋，大法官們其實已對涵蓋電子病歷等個人資料之資訊隱私權，有過相當明確的闡釋。其所強調「個人自主控制其個人資料之資訊隱私權」，若能配合2010年5月26日修正通過但尚未施行之個人資料保護法，並非不能為電子病歷提供一個基本、框架式的法律基礎。 在此前提之下，本文提出「電子病歷自主控制機制」之概念，主張在現行憲法資訊隱私權之精神下，應該讓病人在充分瞭解到其權益後，得以選擇「是否將病歷電子化」、「電子病歷儲存場所」、「是否放於交換區」、「是否留存索引紀錄」、「是否允目的外利用」，並能透過管道隨時查詢其「電子病歷使用紀錄」。本文並認為，藉由「推力理論（Nudge）」中「自動加入（Opt-in）」與「主動加入（Opt-out）」等「預設值（Default）」概念之運用，資訊科技中「隱私偏好選項（Privacy Preference）」與「電子病歷使用紀錄明細」等系統之設立與使用，以及國際相關隱私及安全規範之借鏡，與我國健保IC卡推行之在地經驗，或許能夠解決論者對於電子病歷自主控制機制，在參與度、決定能力、行政成本、法規及技術架構、多元價值上的各項疑慮與爭論，並進而證明該構想之初步可行性。 / After implementation of the National Health Insurance (NHI) IC Card on January 1, 2004, the trend of e-health, including enforcing a national electronic medical record (EMR) system in Taiwan, is reminiscent of Julius Caesar’s words when he crossed the Rubicon, “The die is cast.” The return point has been passed; there is no return. Nowadays in Taiwan it has become routine in hospitals and clinics for medical practitioners to use a digital authentication or signature transmitted via a computer scan of an NHI IC card to register patients for diagnosis and treatment, and for administrtive staff using Virtual Private Network (VPN) to file fee claims. Furthermore, the Taiwan Department of Health has announced its implementation of the EMR system and has pledged that, in 2011, 80 percent of hospitals and clinics will start to use a more comprehensive EMR system and 60 percent of hospitals will be able to exchange EMRs. However, while Taiwan’s government is very proud and eager to enforce the EMR system, an increasing number of people doubt that adequate regulations have been put in place to protect against the violation of patients’ information privacy rights. This paper first reviews all former DOH projects related to EMRs, and interviews nine industry, government, and academic professionals who have EMR experience. It next argues that the current laws and regulations in Taiwan cannot provide sufficient protection of patients’ privacy rights, especially with regard to information privacy and autonomy. This is a cause for concern for patients and practitioners who are leery of further EMR implementation or development. This paper proposes a controlling mechanism for patients’ autonomy that will empower patients to determine if they want to electronize their medical records, where they will store their EMRs, and if it is in their best interests to set up an index and allow the transmission of additional EMRs. Moreover, patients will have unrestricted access to a log of all users and uses made of their EMRs and be able to set up their own privacy preferences with opt-in and opt-out choices. This paper concludes that the controlling mechanism for patients’ autonomy will solve the current concerns about the implemenation of a national EMR system and improve patients’ ability to enforce their information privacy and information autonomy rights.

The purpose of the study was to describe the effects of an EMR on patient management in selected HIV clinics in Johannesburg. A quantitative, descriptive, cross-sectional study was undertaken in four HIV clinics in Johannesburg. The subjects (N=44) were the healthcare workers selected by stratified random sampling. Consent was requested from each subject and from the clinics in Johannesburg. Data was collected using structured questionnaires. Median age of subjects was 36, 82% were female. 86% had tertiary qualifications. 55% were clinicians. 52% had 2-3 years work experience. 80% had computer experience, 86% had over one year EMR experience. 90% used the EMR daily, 93% preferred EMR to paper. 93% had EMR training, 17% used EMR to capture clinical data. 87% perceived EMR to have more benefits; most felt doctor-patient relationship was not interfered with. 89% were satisfied with the EMR’s overall performance. The effects of EMR benefit HIV patient management. / Health Studies / MA (Public Health)

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-28T11:44:16Z No. of bitstreams: 2 Dissertação - Lísia Gomes Martins de Moura Tomich - 2016.pdf: 2901743 bytes, checksum: 22cd41bfc4499cfd4754d856635357af (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2016-09-28T11:44:45Z (GMT) No. of bitstreams: 2 Dissertação - Lísia Gomes Martins de Moura Tomich - 2016.pdf: 2901743 bytes, checksum: 22cd41bfc4499cfd4754d856635357af (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2016-09-28T11:44:45Z (GMT). No. of bitstreams: 2 Dissertação - Lísia Gomes Martins de Moura Tomich - 2016.pdf: 2901743 bytes, checksum: 22cd41bfc4499cfd4754d856635357af (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-08-15 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / INTRODUCTION: Routine infant immunization with meningococcal C conjugate vaccine (MenC-V) started in Brazil in November 2010, administered at three, five and 12 months of age with no catch-up for older age-groups. However, by March 2010, a vaccination campaign with MenC-V was performed in Salvador in individuals under five years-old, and from 10 to 24 yearsold. In São Paulo state, the outbreaks occurred in teenagers and young adults prompting one-time vaccination campaign from 2010 to 2014 targeting these age-groups. OBJECTIVE: To assess the direct and indirect impact (herd effect) of vaccination on invasive meningococcal disease (MD) for capsular group C (MenC) four years after the introduction of MenC-V in three scenarios: i) Brazil as a whole (routine vaccination in childhood only); ii) Brazil except for Salvador (vaccination campaign with teenagers during the year of MenC-V introduction); and iii) São Paulo state (vaccination campaign for adolescents and young adults during 2010-2014 to control outbreaks). METHODS: We performed an ecological quasi-experimental design from 2008 to 2014 using data from the National Reference Laboratory for Meningitis, and data from the National Information System for Notifiable Diseases. A deterministic linkage was performed between the two databases to improve the accuracy of the detection of MD, especially in capsular groups. An interrupted time-series analysis was conducted using the Holt-Winters technique to control for pre-existing trends and seasonal variations. The MenC vaccination impact was evaluated as the percentage of reduction in the incidence rates of MenC in the post-vaccination period (2012 to 2014), using the pre-vaccination period (2008 to 2010) to estimate what would be expected on the post-vaccination period, whether the vaccination had not been introduced. For Salvador, we analyzed the effect of the vaccination on the number of MenC cases. RESULTS: A total of 18,136 invasive MD cases were analyzed. For Brazil as a whole, the vaccination reduced 67.4% (lower 95%CI 42.5%) the rates for MenC for infants under 12 months, 92.3% (lower 95%CI 77.7%) for the age-group 12-23 months, and 65.7% (lower 95%CI 28%) for children aged 2-4 years. Indirect impact (20-24.7%) was observed in the age-group 5-19 years. When excluding Salvador from the analysis of Brazil, the indirect impact was observed only for children in the age-group 5-9 years. In the scenario of São Paulo state, similarly to Brazil, significant impact was observed in the target age-groups, in addition to indirect impact in the age group 5-9 years. In Salvador, in addition to the effect on the vaccinated population a sharp and sustainable decline of MenC cases was observed in all age-groups not target for vaccination. Overall, 1,170 cases of MenC were averted in Brazil after the introduced of Men-C vaccination. CONCLUSION: The strategy of catch-up for adolescents and young adults, especially during the year of MenC-V introduction may lead to rapid and sustainable herd effect. / A vacina meningocócica conjugada contra o grupo capsular C (MenC-V) foi introduzida no calendário de imunização infantil brasileiro em novembro de 2010, sendo administrada aos três, cinco e 12 meses de idade sem catch-up para os demais grupos etários. Entretanto, em março de 2010, uma campanha de vacinação com MenC-V foi realizada em Salvador para indivíduos menores de cinco anos de idade e de 10 a 24 anos. No estado de São Paulo os surtos ocorreram em adolescentes e adultos jovens, determinando campanhas de vacinações de bloqueio nessa faixa etária nos anos de 2010 a 2014. OBJETIVO: Avaliar o impacto direto e indireto (rebanho) da vacinação nas taxas de incidência de doença meningocócica (DM) invasiva pelo grupo capsular C (MenC) após quatro anos da introdução da MenC-V em três cenários: i) Brasil como um todo (imunização de rotina somente de crianças); ii) Brasil exceto Salvador (campanha de vacinação em adolescentes no ano de introdução da MenCV); e iii) estado de São Paulo (vacina de rotina na infância e vacinações de bloqueio em adolescentes e adultos jovens para controlar surtos). MÉTODOS: Foi realizado um estudo ecológico quasi-experimental para avaliar o impacto da vacinação em série histórica de 2008 a 2014 usando os bancos de dados do Laboratório Nacional de Referência para Meningites Bacterianas, Instituto Adolfo Lutz (IAL) e o Sistema de Informação de Agravos de Notificação (Sinan). Um processo de vinculação (linkage) determinístico entre as duas bases foi realizado para melhorar a acurácia da detecção de casos de DM, especialmente de grupo capsulares. Uma análise de série temporal interrompida foi conduzida utilizando a técnica de Holt-Winters para controlar por tendência pré-existente e variações sazonais. O desfecho foi taxa de MenC. O impacto da vacinação foi avaliado pelo percentual de redução da incidência de MenC no período pós-vacinal (2012 a 2014), utilizando o período pré-vacinal (2008 a 2010) para estimar o que seria esperado no período pós-vacinal, caso a vacinação não tivesse sido introduzida. Para Salvador foi analisado o efeito da MenC-V no número de casos de MenC. RESULTADOS: Um total de 18.136 casos de DM invasiva foram analisados. Para o Brasil como um todo, a vacinação reduziu significativamente a DM por MenC na faixa etária alvo, com redução de 67,4% (limite inferior do IC95% 42,5%) em menores de 12 meses, 92,3% (limite inferior do IC95% 77,7%) para faixa etária de 12-23 meses e 65,7% (limite inferior do IC95% 28%) em crianças de 2-4 anos, e efeito rebanho foi observado na faixa etária de 5 a 19 anos com 20-24,7%. Quando se exclui Salvador na análise do Brasil, impacto indireto significativo foi observado somente em crianças de 5-9 anos. No cenário São Paulo, semelhante ao Brasil, observou-se impacto estatisticamente significante nas faixas etárias alvo do PNI, além do efeito rebanho na faixa etária de 5-9 anos de idade. Para Salvador, o impacto da vacinação apresentou um declínio acentuado e sustentável em todas as faixas etárias fora do alvo da vacinação. Ao todo, 1.170 casos de MenC foram evitados no período estudado. CONCLUSÃO: A estratégia de vacinação de catch-up em adolescentes e adultos jovens, especialmente no ano de introdução da MenC-V, promoveu um rápido e sustentável rebanho.

Opportunistic infections (OIs) have been identified as a leading cause of poor outcomes in the ARV therapy (ART) programme. In order to reduce OIs, the Malawi, MoH introduced routine prescription of cotrimoxazole preventive therapy (CPT) in 2005. The MoH also started scaling up a point-of-care electronic medical record (EMR) system in 2007 to improve monitoring and evaluation. This study had the following objectives: i) to quantify prescription of CPT before and after implementing EMR; ii) to compare the difference in CPT prescription before and after implementing EMR. A historically controlled study design was used to compare CPT prescriptions one year before, and one year after implementation of the EMR at two health facilities. The data indicated that there was a significant (P <0.001) decrease in CPT prescribing at one health facility and a significant increase in CPT prescription at another. / Health Studies / M.A. (Public Health)

Hospital environments are ranked as one of the most stressful contemporary work environments for their employees, and this especially concerns nurses (Nejati et al. 2016). One of the core problems comprises the notion that the current technology adopted in hospitals does not support the mobile nature of medical work and the complex work environment, in which people and information are distributed (Bardram 2003). The employment of inadequate technology and the strenuous access to information results in a decrease in efficiency regarding the fulfilment of medical tasks, and puts a strain on the attention of the medical personnel. This thesis proposes a solution to the aforementioned problems through the design of ambient displays, that inform the medical personnel with the health statuses of patients whilst requiring minimal allocation of attention. The ambient displays concede a hierarchy of information, where the most essential information encompasses an overview of patients’ vital signs. Data regarding the vital signs are measured by biometric sensors and are embodied by shape-changing interfaces, of which the ambient displays consist. User-authentication permits the medical personnel to access a deeper layer within the hierarchy of information, entailing clinical data such as patient EMRs, after gesture-based interaction with the ambient display. The additional clinical information is retrieved on the user’s PDA, and can subsequently be viewed in more detail, or modified at any place within the hospital.In this thesis, prototypes of shape-changing interfaces were designed and evaluated in a hospital environment. The evaluation was focused on the interaction design and user-experience of the shape-changing interface, the capabilities of the ambient displays to inform users through peripheral awareness, as well as the remote communication between patient and healthcare professional through biometric data. The evaluations indicated that the required attention allocated for the acquisition of information from the shape-changing interface was minimal. The interaction with the ambient display, as well as with the PDA when accessing additional clinical data, was deemed intuitive, yet comprised a short learning curve. Furthermore, the evaluations in situ pointed out that for optimised communication through the ambient displays, an overview of the health statuses of approximately eight patients should be displayed, and placed in the corridors of the hospital ward.

<p>Information technology (IT) has been applied in every aspect in common everyday experience. Most industries have changed from paper based to digitally supported processes. The implementation of IT has resulted in lower costs, faster operations, and faster response to consumer demands, thus achieving economies of scale and major advancements in the quality of products introduced to the consumer.</p> <p>In healthcare, IT has led to extensive advances in many different aspects of medicine. IT has enhanced diagnostic equipment, laboratory result accuracy, research methodologies and analysis advancements, and has resulted in more effective prescription of medications. These advances have increased the overall quality of life for patients.</p> <p>Despite the fact that the adoption rate of Electronic Medical Record systems (EMRs) in European countries has reached more than 90%, the adoption of EMRs by primary care physicians in Canada lags far behind at a rate closer to 30%. Much of this low adoption rate can be attributed to barriers due to resistance to change. Many adoption projects in IT fail, even after change has occurred. These failures have occurred in many different industries, including healthcare. EMR adoption in primary care requires a focus on change management and sustainability for primary care physicians, the target audience of change.</p> <p>This thesis research investigates the reasons for the low rate of adoption of EMRs in the primary care environment in Canada. A change management model dedicated to the Canadian primary healthcare environment for the management and sustainability of change is created and discussed in detail. This study is based on a thorough literature review of change management models; a qualitative analysis of interviews with industry leaders from different backgrounds such as consultancy, government, and vendors; and a quantitative analysis of data through an online primary care physician questionnaire.</p> / Master of Science (MSc)

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