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Cited by 5 publications
References 7 publications
Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study
Background Digital health has been a tool of transformation for the delivery of health care services globally. An electronic health record (EHR) system can solve the bottleneck of paper documentation in health service delivery if it is successfully implemented, but poor implementation can lead to a waste of resources. The study of EHR system implementation in low- and middle-income countries (LMICs) is of particular interest to health stakeholders such as policy makers, funders, and care providers because of the efficiencies and evidence base that could result from the appropriate evaluation of such systems. Objective We aimed to develop a theory of change (ToC) for the implementation of EHRs for maternal and child health care delivery in LMICs. The ToC is an outcomes-based approach that starts with the long-term goals and works backward to the inputs and mediating components required to achieve these goals for complex programs. Methods We used the ToC approach for the whole implementation’s life cycle to guide the pilot study and identify the preconditions needed to realize the study’s long-term goal at Festac Primary Health Centre in Lagos, Nigeria. To evaluate the maturity of the implementation, we adapted previously defined success factors to supplement the ToC approach. Results The initial ToC map showed that the long-term goal was an improved service delivery in primary care with the introduction of EHRs. The revised ToC revealed that the long-term change was the improved maternal and child health care delivery at Festac Primary Health Center using EHRs. We proposed a generic ToC map that implementers in LMICs can use to introduce an optimized EHR system, with assumptions about sustainability and other relevant factors. The outcomes from the critical success factors were sustainability: the sustained improvements included trained health care professionals, a change in mindset from using paper systems toward digital health transformation, and using the project’s laptops to collect aggregate data for the District Health Information System 2–based national health information management system; financial: we secured funding to procure IT equipment, including servers, laptops, and networking, but the initial cost of implementation was high, and funds mainly came from the funding partner; and organizational: the health professionals, especially the head of nursing and health information officers, showed significant commitment to adopting the EHR system, but certain physicians and midwives were unwilling to use the EHR system initially until they were persuaded or incentivized by the management. Conclusions This study shows that the ToC is a rewarding approach to framing dialogue with stakeholders and serves as a framework for planning, evaluation, learning, and reflection. We hypothesized that any future health IT implementation in primary care could adapt our ToC approach to their contexts with necessary modifications based on inherent characteristics.
Implementing Electronic Health Records in Primary Care Using the Theory of Change: Nigerian Case Study
Background Digital health has been a tool of transformation for the delivery of health care services globally. An electronic health record (EHR) system can solve the bottleneck of paper documentation in health service delivery if it is successfully implemented, but poor implementation can lead to a waste of resources. The study of EHR system implementation in low- and middle-income countries (LMICs) is of particular interest to health stakeholders such as policy makers, funders, and care providers because of the efficiencies and evidence base that could result from the appropriate evaluation of such systems. Objective We aimed to develop a theory of change (ToC) for the implementation of EHRs for maternal and child health care delivery in LMICs. The ToC is an outcomes-based approach that starts with the long-term goals and works backward to the inputs and mediating components required to achieve these goals for complex programs. Methods We used the ToC approach for the whole implementation’s life cycle to guide the pilot study and identify the preconditions needed to realize the study’s long-term goal at Festac Primary Health Centre in Lagos, Nigeria. To evaluate the maturity of the implementation, we adapted previously defined success factors to supplement the ToC approach. Results The initial ToC map showed that the long-term goal was an improved service delivery in primary care with the introduction of EHRs. The revised ToC revealed that the long-term change was the improved maternal and child health care delivery at Festac Primary Health Center using EHRs. We proposed a generic ToC map that implementers in LMICs can use to introduce an optimized EHR system, with assumptions about sustainability and other relevant factors. The outcomes from the critical success factors were sustainability: the sustained improvements included trained health care professionals, a change in mindset from using paper systems toward digital health transformation, and using the project’s laptops to collect aggregate data for the District Health Information System 2–based national health information management system; financial: we secured funding to procure IT equipment, including servers, laptops, and networking, but the initial cost of implementation was high, and funds mainly came from the funding partner; and organizational: the health professionals, especially the head of nursing and health information officers, showed significant commitment to adopting the EHR system, but certain physicians and midwives were unwilling to use the EHR system initially until they were persuaded or incentivized by the management. Conclusions This study shows that the ToC is a rewarding approach to framing dialogue with stakeholders and serves as a framework for planning, evaluation, learning, and reflection. We hypothesized that any future health IT implementation in primary care could adapt our ToC approach to their contexts with necessary modifications based on inherent characteristics.
Interoperability of health information systems is a challenge due to the heterogeneity of existing systems at both the technological and semantic levels of their data. The lack of existing data about interoperability disrupts intra-unit and inter-unit medical operations as well as creates challenges in conducting studies on existing data. The goal is to exchange data while providing the same meaning for data from different sources. To find ways to solve this challenge, this research paper proposes an interoperability solution for the tuberculosis treatment and follow-up scenario in Brazil using Semantic Web technology supported by an ontology. The entities of the ontology were allocated under the definitions of Basic Formal Ontology. Brazilian tuberculosis applications were tagged with entities from the resulting ontology. An interoperability layer was developed to retrieve data with the same meaning and in a structured way enabling semantic and functional interoperability. Health professionals could use the data gathered from several data sources to enhance the effectiveness of their actions and decisions, as shown in a practical use case to integrate tuberculosis data in the State of São Paulo.
BACKGROUND The semantic interoperability of health care information has been a critical challenge in medical informatics and has influenced the integration, sharing, analysis, and use of medical big data. International standard organizations have developed standards, approaches, and models to improve and implement semantic interoperability. The openEHR approach—one of the standout semantic interoperability approaches—has been implemented worldwide to improve semantic interoperability based on reused archetypes. OBJECTIVE This study aimed to verify the feasibility of implementing semantic interoperability in different countries by comparing the openEHR-based information models of 2 acute coronary syndrome (ACS) registries from China and New Zealand. METHODS A semantic archetype comparison method was proposed to determine the semantics reuse degree of reused archetypes in 2 ACS-related clinical registries from 2 countries. This method involved (1) determining the scope of reused archetypes; (2) identifying corresponding data items within corresponding archetypes; (3) comparing the semantics of corresponding data items; and (4) calculating the number of mappings in corresponding data items and analyzing results. RESULTS Among the related archetypes in the two ACS-related, openEHR-based clinical registries from China and New Zealand, there were 8 pairs of reusable archetypes, which included 89 pairs of corresponding data items and 120 noncorresponding data items. Of the 89 corresponding data item pairs, 87 pairs (98%) were mappable and therefore supported semantic interoperability, and 71 pairs (80%) were labeled as “direct mapping” data items. Of the 120 noncorresponding data items, 114 (95%) data items were generated via archetype evolution, and 6 (5%) data items were generated via archetype localization. CONCLUSIONS The results of the semantic comparison between the two ACS-related clinical registries prove the feasibility of establishing the semantic interoperability of health care data from different countries based on the openEHR approach. Archetype reuse provides data on the degree to which semantic interoperability exists when using the openEHR approach. Although the openEHR community has effectively promoted archetype reuse and semantic interoperability by providing archetype modeling methods, tools, model repositories, and archetype design patterns, the uncontrolled evolution of archetypes and inconsistent localization have resulted in major challenges for achieving higher levels of semantic interoperability.
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