Submitted by Cinthia Ferreira Costa (cinthiac.costa@gmail.com) on 2018-09-03T13:17:52Z No. of bitstreams: 1 TA_Cinthia Costa_versão final.pdf: 765367 bytes, checksum: f616f7fa6b7603c5ba1ac56f1db7dfbf (MD5) / Approved for entry into archive by Simone de Andrade Lopes Pires (simone.lopes@fgv.br) on 2018-09-03T19:51:28Z (GMT) No. of bitstreams: 1 TA_Cinthia Costa_versão final.pdf: 765367 bytes, checksum: f616f7fa6b7603c5ba1ac56f1db7dfbf (MD5) / Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-09-04T14:41:02Z (GMT) No. of bitstreams: 1 TA_Cinthia Costa_versão final.pdf: 765367 bytes, checksum: f616f7fa6b7603c5ba1ac56f1db7dfbf (MD5) / Made available in DSpace on 2018-09-04T14:41:02Z (GMT). No. of bitstreams: 1 TA_Cinthia Costa_versão final.pdf: 765367 bytes, checksum: f616f7fa6b7603c5ba1ac56f1db7dfbf (MD5) Previous issue date: 2018-07-30 / A segurança do paciente é uma preocupação mundial e de alta prioridade na agenda da Organização Mundial da Saúde (OMS) e seus países membros. Nesse contexto, a gestão de incidentes nos serviços de saúde tem papel essencial para a redução de riscos e danos aos pacientes. Esta pesquisa teve como objetivo conhecer como é realizada a gestão de incidentes nos hospitais paulistanos e qual a visão dos gestores sobre a segurança do paciente como um fator estratégico e de competitividade. Foi realizada pesquisa qualitativa, por meio de entrevistas semiestruturadas com o auxílio de roteiro de entrevista em oito hospitais, sendo cinco privados e três filantrópicos no período de março e abril de 2018. A pesquisa demonstrou um maior número de organizações com sistema de notificação de incidentes informatizado, o crescimento dos serviços de atendimento ao cliente como referência para o contato do paciente ou familiar quando da ocorrência de um incidente e o papel da direção na informação ao paciente e familiar sobre os incidentes ocorridos. Considerando que o movimento pela segurança do paciente é relativamente recente no Brasil, o nível de maturidade da cultura de segurança dos hospitais entrevistados demonstrou ser positiva. O uso de indicadores aponta a valorização do tema dentre as preocupações da gestão e, em alguns casos, da alta direção. Pelas respostas dos entrevistados, é possível afirmar que a segurança do paciente faz parte da estratégia das organizações participantes deste estudo, demonstrando um cuidado corporativo de direcionar os esforços da qualidade e da segurança. / Patient safety is a global concern and hight priority on the schedule of the World Health Organization (WHO) and its member countries. In this context, incident management in health services plays a key role in reducing risks and damaging patients. This research had as objective to know how the management of incidents at the hospitals in São Paulo is and what the managers' view on patient safety as a strategic and competitive factor. A qualitative research of an exploratory nature was carried out, through semi-structured interviews in eight hospitals, five private and three philanthropic in the period of March and April of 2018. The research demonstrated the largest number of organizations with computerized incident reporting system, the growth of customer service as a reference for patient or family contact when an incident occurred, the role of management in patient information and familiarity with the incidents. Considering that the patient safety movement is relatively recent in Brazil, the level of safety culture maturity of the hospitals interviewed demonstrated to be positive. The use of indicators points out the appreciation of the theme among the concerns of management and, in some cases, top management. From the respondents' answers, it is possible to affirm that patient safety is part of the strategy of the organizations participating in this study demonstrating a care corporate effort to direct quality and safety efforts.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-05-31T18:20:47Z No. of bitstreams: 1 iurimalinoskiteixeira.pdf: 1437690 bytes, checksum: c11d45074fef83b3318f92c12b425557 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-06-01T11:50:34Z (GMT) No. of bitstreams: 1 iurimalinoskiteixeira.pdf: 1437690 bytes, checksum: c11d45074fef83b3318f92c12b425557 (MD5) / Made available in DSpace on 2017-06-01T11:50:34Z (GMT). No. of bitstreams: 1 iurimalinoskiteixeira.pdf: 1437690 bytes, checksum: c11d45074fef83b3318f92c12b425557 (MD5) Previous issue date: 2013-02-26 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / A modelagem de dados clínicos para Sistemas de Informação em Saúde (SIS) demanda expertise de domínio. Técnicas de Desenvolvimento Dirigido por Modelos (DDM) permi tem uma melhor articulação entre especialistas de domínio e desenvolvedores de SISs e possibilitam reduzir o custo de desenvolvimento desses sistemas. Modelos de dados clí- nicos baseados em especificações padronizadas e abertas como a do openEHR facilitam sobremaneira a aplicação de técnicas de DDM para SISs. Contudo, o uso de modelos de dados clínicos não resolve sozinho o problema fundamental do alto custo de desenvolvi- mento de SISs. Uma das causas desse problema é a falta de informações arquiteturais nos modelos de dados clínicos. Sem essas informações arquiteturais, o custo de desenvolvi- mento é deslocado para a especificação das regras de transformação de modelos de dados clínicos em código de SIS (regras estas fundamentais nas técnicas de DDM), uma vez que cada novo SIS a ser gerado implica na especificação de um novo conjunto de regras). Neste contexto, este trabalho apresenta uma estratégia para geração de código de SISs ba seada na combinação entre modelos de dados clínicos e informações arquiteturais. Nessa estratégia, o desenvolvedor é capaz de categorizar SISs em diferentes famílias e definir um conjunto de regras de transformação comum a todos os SISs de uma família. Cada família é definida por um conjunto de SISs com estruturas arquiteturais semelhantes e modelos de dados clínicos distintos. O resultado esperado dessa estratégia é um melhor reuso das regras de transformação de modelos. Essa estratégia é empregada para se alcançar o ob jetivo principal deste trabalho, que é a concepção de um sistema de transformação para a síntese automática de Interfaces Gráficas de Usuário (GUI - Graphic User Interface) para SISs, considerando as especificações openEHR e algumas construções presentes em Linguagens de Descrição Arquitetural (ADL), como Acme. Como prova de conceito, esse framework é aplicado em algumas famílias de SIS. / The modeling of clinical data for Health Information Systems (HIS) requires domain expertise. Model-Driven Development (MDD) techniques provide a better articulation between domain experts and developers of HISes and enable the reduction in the develop ment cost of these systems. Clinical data models based on open standard specifications such as the openEHR facilitates the application of MDD techniques for HISes. Neverthe less, the use of clinical data models alone does not solve the fundamental problem of high development cost for HISes. One cause for this problem is the lack of architectural information in clinical data models. Without such architectural information, the develop ment cost is shifted to the specification of transformation rules from clinical data models to HIS code (these rules are fundamental in MDD techniques), since each new HIS to be generated involves the specification of a new set of rules. In this context, this work presents a strategy for code generation of HISes that combines clinical data models and architectural information. In this strategy, the developer is able to categorize HISes in distinct families and define a set of transformation rules that are common to all HISes in a family. Each family is defined by a set of systems with similar architectural structures and distinct clinical data models. The expected result of such a strategy is a better reuse of model transformation rules. This strategy is employed to achieve the main objective of this work, which is to design a transformation system for the automatic synthesis of graphical user interfaces (GUI) for HISes, considering openEHR specifications and some constructs present in architectural description languages (ADLs), such as Acme. As a proof of concept, this framework is applied to some HIS families.

Philosophiae Doctor - PhD / A review of the literature has shown that there is a lack of mental health information on which to base planning of mental health services and decisions concerning programme development for mental health services. Several studies have indicated that the use of an evidence-based health information system (HIS) reduces inappropriate clinical practices and promotes the quality of health care services. This study was aimed at developing a framework for a district-based mental health information management system, utilising the experiences of health care providers and caregivers about a district mental health information system (DMHIS). Activity Theory was used as the philosophical foundation of the information system for the study. A qualitative approach was employed using semi-structured individual interviews, Focus Group Discussions (FGDs), systematic review and document analysis. The intervention research design and development model of Rothman and Thomas (1994) was used to guide the study, which was conducted in the Cape Town Metropole area of the Western Cape. A purposive, convenient sampling method was employed to select study participants. Ethical clearance for the study was obtained from the University of the Western Cape, and permission to use the health facilities from the Department of Health. The data collection process involved 62 individual interview participants, from mental health nurses to district health managers, health information clerks, and patient caregivers/families and persons with stable mental conditions. Thirteen caregivers took part in the FGDs. Document review was conducted at three community mental health centres. The data were analysed manually using content analysis. Core findings of the interviews were lack of standardized information collection tools and contents for mental health, information infrastructure, capacity building, and resources. Information processing in terms of collection, compiling, analysing, feedback, access and sharing information were the major problems. Results from document analysis identified inconsistencies and inaccuracies of information recording and processing, which in turn affected the quality of information for decision making. Results from the systematic review identified five functional elements: organizational structure; information infrastructure; capacity building; inputs, process, output and feedback; and community and stakeholders’ participation in the design and implementation of a mental health information system (MHIS). The study has contributed a framework for a DMHIS based on the findings of the empirical and systematic review. It is recommended that there is a need to establish a HIS committee at district health facility level for effective implementation of the framework and quality information processing. There is a need to ensure that staffs have adequate knowledge and skills required for effective implementation of an information system. It is recommended that higher education institutions include a course on HISs in their curriculum. It is suggested that the South African Mental Health Policy be reviewed to include an MHIS and ensure involvement of the community and stakeholders in this system as well as adequate budget allocation.

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)

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)

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)