Showing papers in "Journal of Health Informatics in Developing Countries in 2011"

Factors Affecting Adoption, Implementation and Sustainability of Telemedicine Information Systems in Uganda

Abstract: Telemedicine has become a method of choice for improved access to quality healthcare services world over. The technology, which has been used for decades in the developed world, is now being diffused to developing countries. However, many initiatives have not lived to their expectations. In this paper, we present some of the main hindrances to telemedicine adoption, implementation and sustainability in Uganda. Case studies were carried out in two hospitals that have attempted to use the technology. Both qualitative and quantitative research methods were used to collect and analyze the data. Our findings indicate that the key factors affecting telemedicine in Uganda were lack of telemedicine policy, knowledge and skills and resistance to change by members of staff in the hospitals. A discussion of the findings inline with some selected technology adoption theories and models is done. We have also identified and discussed the key requirements for sustainable telemedicine in Uganda.

Utilization of ICTs for Accessing Health Information by Medical Professionals in Kenya: A Case Study of Kenyatta National Hospital

Abstract: Background: The study was conceived with the aim of investigating the availability and utilization of information and communication technology for accessing health information by medical professionals in Kenya. The study started from the premise that access to relevant information and knowledge is critical to the delivery of effective healthcare services. Objectives: These were to: identify the information needs of the medical professionals; determine the sources and channels of information used by the medical professionals; identify the factors for which they require ICT support in accessing health information; establish the extent of the current usage and level of adoption of ICTs among the medical professionals; determine the potential challenges and prospects of utilization of ICTs in health information access; and suggest and recommend measures to be taken into account in the improvement, adoption and use of ICTs in health information access by the medical professionals. Design: Semi-structured qualitative interview study. Data were collected on individual occurrences of the phenomenon. Grounded theory approach was used as an analytical tool. Setting: The research was exploratory in nature and used Kenyatta National Hospital as a case study Results: Major themes that emerged from the data are highlighted. The key findings of the study were that: medical professionals needed information continuously in the course of their clinical work. Clinical governance, care of patients and professional updating on the current medical practices were the main reasons for needing and seeking information. When the medical professionals needed clinical information, they turned to colleagues. Text books and journals were also frequently used sources of information. However, there was a substantial preference for e-searching for information from the internet and e-journals. The findings revealed lack of library and information services, inadequate access and use of electronic information resources and inadequate ICT skills among the medical professionals. Conclusions: Many critical information needs of the medical professionals were not being met adequately. Improved usage of ICT was viewed as the only realistic strategy for enhancing information access and information sharing among the medical professionals at the hospital. Recommendations for enhancing access to health information at KNH include: establishment of a hospital library and information services; appointment of information professionals with skills and capabilities to conduct online information searches to assist in clinical decision-making and ability to train clinicians in ICT skills; formulation of ICT strategies and policy; capital investments in the form of internet and supporting ICT infrastructure; involvement of all stakeholders; and allocation of adequate financial resources for improved access to health information by the medical professionals. A framework for establishing an e-health library was proposed and presented.

Hospital Information Systems User Needs Analysis: A Vendor Survey

Abstract: This study was conducted to evaluate the hospital information system (HIS) software based on user requirements in Iran. Through a descriptive study 5 vendors which had the best selling software products among the university hospitals were selected. HIS softwares were evaluated based on checklist and through the observation in 8 hospitals according to defined criteria. SPSS and descriptive statistics were employed to analyze the collected data. Maximum user's expectations were supported by Tarrahan Boali. However, Tarrahan Bali has not efficiently met user expectations in all departments; medical records (74.5%), pharmacy (58.6%), laboratory (74.5%), nursing (23.3%), radiology (51.4%) and financial (65.4%). Minimum user requirements (29%) have been met by Microafzar Qeshm. There was no HIS software to meet the end users expectations in all departments completely. Failure to meet the user expectations among software that addresses all user expectations appropriately could be ascribed to poor user participation and revealed that HIS adoption in Iran is still in infancy. Conducting periodical evaluation; employing a comprehensive tool for HIS evaluation is crucial to ensure their effective implementation and improvement.

The Use of Mobile Phone as a Tool for Capturing Patient Data in Southern Rural Tamil Nadu, India

Abstract: The present pilot study was conducted to investigate the effectiveness and efficiency gains in collect outpatient health information from primary health centres and health sub centres through mobile applications for detecting disease outbreaks in near-real-time. The researchers were also interested in evaluating the difficulties in implementing mobile health technology with health workers of lesser technical experience in electronically submitting patient data. "Evaluating a Real Time Biosurveillance Program: A pilot project" was conducted in Thiruppathur block of Sivaganga district in southern rural Tamil Nadu in India from July 2008 to July 2010. During the first year, the researchers and technicians interacted with the health workers to develop the technology. Thereafter, digital data submission using the mHealthSurvey, from the 28 rural health care centres, began in June 2009. The digitized data was analysed for unusual patterns using the TCWI (T-Cube Web Interface). Adverse events detected through TCWI were disseminated via SMS, Email, and Web with the Sahana Alerting Broker web-based software. Averages of 217 health records were collected each day for detection of adverse epidemiological events. A major advantage of the mobile phone patient data collection method was the improved timeliness for real-time detection of any disease outbreak. Besides the delays of digitizing data because of the parallel routine labor intensive paper work, the health workers in Tamil Nadu were able to submit reliable patient health data using mobile phone, which makes it a friendly, efficient, and cost effective tool of data collection.

Challenges in Health Information Systems Integration: Zanzibar Experience

Abstract: The health care milieu of most developing countries is characterized by multiplicity of vertical programs supported by myriad of donors. Often, the vertical programs maintain their own uncoordinated information systems which are in conflict with the primary health care goals of integrated district based health information systems. While some countries have managed to integrate the vertical reporting systems into the national HIS, ensuring reliance and continuous use of the integrated HIS by the programs’ managers is still a big challenge. The fragmentation of the HIS after integration, ensuing from the non reliance and compliance to the integrated system, has not received much attention empirically or analytically. Most of the contemporary research in HIS integration focused on the challenges in the process of achieving integration. The paper advocates the need to understand the nit gritty of what goes on after implementation which as the case suggests, presents enormous challenges to the HIS integration initiative. By drawing on an empirical case, the study revealed the tensions that exists between the ministry of health which strived to standardize and integrate the HIS and the vertical programs which pushed the agenda to maintain their systems alongside the national HIS. However, as implied from the study, attaining integration entails the ability to strike a balance between the two forces, which can be achieved by strengthening communication and collaboration linkages between the stakeholders and making use of gateways.

Role of ICTs in the Health Sector in Developing Countries: A Critical Review of Literature

Abstract: This paper explores the domain of literature on information systems or electronic health (e-health) in the rural healthcare in developing countries. The main aim of this paper is to contribute to the development informatics community literature by bridging a knowledge gap. Based on secondary data, the study analyses the key policy debates and presents previous research finding. It shows that ICTs play a marginal role in access to health information due to the health vulnerabilities and limited information resources of the poor. This paper concludes that no ICTs will work in a resource-poor setting unless livelihood-based approach is intervened.

Lack of Interoperable Health Information Systems in Developing Countries: An Impact Analysis

Abstract: Progress of health information system (HIS) in recent years has made significant impact on both developed and developing countries. HIS has played a very important role in the hospital. Construction and employment of HIS can improve the efficiency and quality of healthcare work. But the development of HIS has some problems inherent in them such as non-standard hospital management, poor standardization, and lack of interoperable software development. As a result, HIS run is not able to share medical information and therefore, can’t meet the needs of reform in healthcare system delivery. In the future, for the sake of medical information sharing, teleconsulation, hospital efficiency enhancement, all the independent systems will realize interoperability. This paper however, seeks to analyze and address factors militating against interoperability in software systems the healthcare domain and recommends the adoption of service oriented architecture (SOA) within the domain.

Mobile for Health (mHealth) in Developing Countries: Application of 4 Ps of Social Marketing

Abstract: Mobile technology is emerging as the first extensive form of electronic communication which is culturally and socially feasible and appropriate for strengthening health system. As a public health intervention, the world of mobile is just beginning. The essay analyses the role of mobile technology for public health by using 4 Ps of marketing mix-products and services, price, place, and promotion from social marketing perspective and also show how it helps for democratizing public health programs in the developing world.

Medical Imaging Trends and Implementation : Issues and Challenges for Developing Countries

Abstract: To meet the increasing demand for radiological services over the past few years there has been a growing trend toward introducing medical imaging across hospitals worldwide Medical imaging technologies consist of a number of components including PACS (Picture Archiving Communication Systems), RIS (Radiology Information Systems) and HIS (Hospital Information Systems) which are typically linked and interfaced through a computer network In this paper, we present an overview of global trends in the deployment of medical imaging and highlight some of the key issues and challenges which are faced by developing countries in its implementation

A Web-Based Electronic Medical Records and Hospital Information System for Developing Countries

Abstract: We researched the infrastructure and current medical data management systems in Vietnam and designed an electronic medical record keeping system to acquire, process, store and share health information in a fully automated computer network-based system. The modules in the system have automated data acquisition from Ultrasound, Digital Radiography, CT scanner, MRI and Laboratory stations, and manage pharmacy and financial information and other related activities in the hospital. Database servers currently store personal information along with text data, image data and will store video data in the future. The system will allow the patient to login and review online their medical records at home. The system was tested in the Biomedical Informatics Laboratory at the Hanoi University of Science and Technology and implemented in Khanh Luong hospital in Hanoi, Vietnam. It meets the needs for healthcare in developing countries with low investment cost, ease of implementation, and convenience for doctors and medical staff.

Enhancing health policymakers' capacity to use information and communication technology in Nigeria

Abstract: Information and communication technologies (ICTs) are tools that have the potential to improve access to vital health information necessary for effective evidence-informed policy. In this study the ICT competence among health policymakers was assessed and an ICT capacity enhancement intervention training workshop was conducted for the policymakers and other stakeholders of the health sector in south-eastern Nigeria. Pre-workshop survey indicated grossly deficient ICT competence among the policymakers particularly the use of internet. The post-workshop survey indicated a significant improvement in ICT competence over the pre-workshop status. ICT training workshop can improve policymakers’ capacity to acquire and apply evidence which is requisite for policymaking.

Mutual Isolation and the Fight for Care An Ethnography of South African Home- based Healthcare Contexts

Abstract: With the increasing pressure created by HIV/AIDS and chronic illness, home-based healthcare (HBHC) has become a vital counter-service in developing countries. Yet, initial observations in several HBHC setups in the Western Cape of South Africa have indicated that caregivers lacked proper support structures. This was either in the form of patient data administration, finances, emotional counseling, or informal educational opportunities. These challenges in turn may inspire a range of probable ‘solutions’, ICT and otherwise. These circumstances are the rationale, then, behind a full ethnographic undertaking. Indeed, an in-depth understanding of HBHC in its variety of contexts must precede any (abstract) solutions, be it in ICT, social development, or health provision. This paper sets out to elucidate some of the social and cultural factors that are pertinent in this environment, to explore the needs and desires of caregivers – particularly informational and educational – and to lay the early foundation for possible communication technology-based solutions (or counter-actions).

Fuzzy Rule-Base Expert System for Evaluation Possibility of Fatal Asthma

Abstract: Asthma, a chronic lung disease, has increasing rate in developing countries. Fatal asthma as a sudden exacerbation of asthma threatens the life of asthmatic patients, even patients with a condition of good-controlled asthma. So prediction the risk of fatal asthma is a great contribution decreasing the possibility of asthma mortality and morbidity. In this paper a fuzzy expert system is developed for prediction of fatal asthma. Fuzzy-rules, modular representation of variables in regard to patients’ perception of the disease, and minimizing the need for laboratory data are the most important features of this system. Main variables of viral infection, Exposure to irritants/allergens, Duration of asthma, Response to treatment, Instability of asthma, Degree of nocturnal symptoms, Intensity of current treatment, Peripheral blood eosinophilia, and Intensity of exacerbation make antecedents of the rules. Output of this system is possibility of fatal asthma determined in the interval (0-10). Evaluating the performance of this system at asthma, allergy, immunology research center of Emam Khomeini hospital reinforces the good efficiency of this fuzzy expert system for prediction of possibility of fatal asthma.

Correlation Analysis of Attitudes towards SMS Technology and Blood Donation Behaviour in Malawi

Abstract: In this paper we use SMS technology acceptance models to assess the relationship between attitude towards SMS technology and blood donation behaviour in a predominantly associative culture. Firstly, we show that blood donors at the Malawi Blood Transfusion Services in Malawi have a positive attitude towards both the SMS technology and the content of the SMS message. However, the attitude towards the content of SMS message is moderated by level of education. Furthermore, we show that the level of education affected the perceived ease of use of SMS technology, informativeness and irritation of the SMS message. Secondly, we establish that there is a positive and statistically significant relationship between blood donation behaviour and attitude towards SMS technology and attitude towards the SMS message content. However, these relationships are moderated by gender, age and level of education. Specifically, subjective norms which depict social forces are related to socially accepted behaviour such as blood donation among the old or less educated donors in a predominantly associative culture like Malawi. However, this research was limited to blood donation behaviour which is a socially accepted behaviour. It will be interesting to relate attitude towards SMS technology and other behaviours which may not necessarily be socially accepted. Furthermore, the study was limited to blood donors who had received SMS reminders.

Adapting Information Technology (IT) in healthcare for Quality patient care - Study conducted in a Hospital in South India

Abstract: The earliest use of computers in health care was in administration. In recent years, the cost of providing high quality services and patient satisfaction in hospitals has increased tremendously. Using information system in healthcare has become one of the best solutions for hospital management to decrease cost, increase patient satisfaction, to improve hospital processes and to provide high quality patient care. The role of digital technology in medical care and its delivery has expanded at an ever-increasing pace. Information technology has brought about a big revolution in the health care industry. This paper shares our experience in implementing upgraded Hospital Information System (HIS) software into an already existing computerized system. The implications of having adopted multiple software modules specific to different clinical and special purpose applications has been highlighted. In an era of rapid advances in science and technology, dependability on biomedical equipments and the software that they support has become inevitable for taking decisions in healthcare delivery. There is a need to consider information technology (IT) compatibility at the very beginning, which is at the time of buying these high-end equipments, else the implementation and functioning of IT in hospitals will be in piece meal. In conclusion the benefits of implementing IT in healthcare in terms of productivity, cost, effectiveness etc may never be realized if we are not open to the future needs. That is adapting an ‘open system architecture’ which can be sensitized to the ever changing information technology.

An ICT Enhanced Life Quality for the Elderly in Developing Countries: Analysis Study Applied to Sri Lanka

Abstract: In the recent years, the entire world has seen a tremendous increase in the elderly population. Even though countries differ in the numerical criterion for defining the old age, the UN has agreed that the cutoff of 60+ years refers to the older population. When the percentage of older population increases in a country, the country faces new challenges in the form of economical as well as social impacts. The economic impacts are felt in the form of a shortfall in labor supply, income, household savings while an increase in the payment of retirement benefits and healthcare expenditures. On the social side, the elderly population feels continuously isolated due to the changes in the value system. The United Nations has identified five quality of life characteristics for the elderly in its 1991 resolution named the United Nations Principles for Older Persons. In this paper the authors initially look at the trends in the increase of aged population in Asia in general and Sri Lanka in particular. Then they discuss how the quality of life characteristics can be achieved in a cost effective way through the use of Information and Communication Technology (ICT). The authors take an in depth look at the recent developments in field of ICT and its penetration in developing countries especially Sri Lanka with special emphasis to constraints and challenges in adopting ICT for the improving the quality of life of elderly.

Medical Librarians and New Web Technologies: How Familiar are we with Web Facilities and Use of Library Services Applications?

Abstract: Objective: In recent years, new information technology has changed the nature of services Offered by libraries around the world. Librarians are considered to be the link between the source of information and the end users. It is therefore necessary for the librarians to be fully versed in the process and workings of the system applications in order to provide the required services in libraries. The research carried out here has concentrated on the medical librarian's knowledge, about the new generations of World Wide Web, as well as the use of new applications and facilities in library services. The research method: A descriptive Research Survey Method has been applied in this study. The comprehensive questioner had been designed for collection and collation of data which was distributed between 60 medical librarians, working in central and faculty libraries in three Medical & Sciences Universities. The data was collated and processed by SPSS software. Result: The findings concluded the fact that, minority of Medical librarians in the conducted survey were reasonably familiar with facilities and applications of new web generations such as pod casts, video-casts, electronic discussion groups … and were able to use these facilities in library services and the he majority were well versed and had sufficient knowledge in respect to general internet facilities like, Internet browsers, search engines and e-mails. Furthermore, the research has shown that about 90% of respondents believe that they need to continue their career development programs (CDP) and associated Education courses about web innovations. Conclusion: As results show, the level of familiarity with the new web generations and use of the web applications in library services is relatively low. Holding relevant courses and encouraging medical librarians to use these technologies in all library departments, including reference library services, should be encouraged and serious consideration must be implemented by relevant department managers.

Real Time Health Informatics System for Early Detection and Monitoring of malaria in desert district, Jaisalmer, India

Abstract: Paper describes the development and implementation of an Interactive Voice Response System (IVRS) Technology based health informatics system which can collect information for malaria from grass root level health workers through their mobile phones, save data on database server, generate online analytical and graphical reports and can link data with Geographical Information System (GIS) maps. The Block Pokaran of district Jaisalmer was selected as study area. The system developed has been installed at Desert Medicine Research Centre, Jodhpur and attached to a toll free telephone. The developed system is in operation for more than a year. The grass root level health workers of study area are submitting the primary malaria data through mobile phones to the above system as per the given questionnaire format. 92% of the total data generated was found authentic. The system received 98% reporting from 4 PHCs and 76% reporting from 1 PHC. The system could identify the 8 prime villages out of 181 contributing to 60% of total malaria occurrence, right at initial stage. The developed system has reported disease information in real-time. It is found faster, cost effective, flexible, easy to implement and expandable. The system provides online analytical and graphical reports, facilitate to understand the epidemiology of the disease, its early detection & monitoring, which helps decision makers to take appropriate control measures to intervene before there is any epidemic.

Improvement of Service Capabilities Following the Establishment of an Electronic Database to Evaluate AIDS in Central Africa

Abstract: Background: HIV care and treatment scale up has, in some instances, resulted in the development of electronic health records that have improved service delivery in resource-constrained settings The International Epidemiological Databases to Evaluate HIV/AIDS (IeDEA) has enabled the establishment of a network of local site investigators and solid research infrastructure in participating regions through the creation of an international research consortium to address unique and evolving research questions in HIV/AIDS currently unanswerable by single cohorts Objectives: We provide an example of how establishing an electronic database to evaluate HIV/AIDS in the Central Africa region has improved service capabilities and patient care Methods: The IeDEA Central Africa region cohort includes adult data from 10 HIV treatment centers and pediatric data from four treatment centers in Burundi, Cameroon, and the Democratic Republic of Congo (DRC) Three research tools were developed while establishing the cohort: data collection forms, an electronic data management system and an accompanying reporting instrument Results: Data have been collected from 19,200 HIV-positive adults and from 470 HIV-positive children Though unintended by research objectives, many participating health facilities independently decided to adopt the IeDEA Central Africa region research forms and accompanying electronic data management system (DMS) as their routine patient medical record system Conclusions: The creation of clinical data forms, an electronic data management system and an accompanying reporting instrument have improved patient management, continuity of care and capability to fulfill reporting requirements The establishment of the IeDEA Central Africa region database has enabled physicians and researchers in this region to establish adult and pediatric cohorts for the purpose of describing regional trends in HIV/AIDS, quickly identify populations at risk for dropping out of care and treatment, and has provided data needed to develop strategies for addressing gaps in behavioral implementation science

NetAIDS: Digital Learning Environment for HIV/AIDS Education in Ugandan Schools

Abstract: In this research, we analyze the first design efforts taken to create a web-based learning environment, called NetAIDS, for use by Ugandan teenage school children and teachers. We present the features of the first implemented version of the environment followed by evaluation results of NetAIDS gained from the Ugandan high school students and teachers. The components of NetAIDS environment include online lessons for HIV/AIDS education, online discussion forums and games. We used questionnaires to evaluate NetAIDS. The results of the quantitative evaluations indicate that NetAIDS environment influences the learning process of the students which in turn influences the learning outcomes. More than 80% of the students were satisfied with their experiences of using the environment. The evaluation results provide concrete steps for the future development of the environment.