Three evaluations of e-health technologies in developing countries found promising results:
1) Systems that improved communication between institutions helped order and manage medications and monitor patients who may abandon care.
2) Personal digital assistants and mobile devices were effective at improving data collection time and quality.
3) Donors and funders should require and sponsor outside evaluations to ensure future e-health investments are well-targeted.
Using real-world evidence to investigate clinical research questionsKarin Verspoor
Adoption of electronic health records to document extensive clinical information brings with it the opportunity to utilise that information to support clinical research, and ultimately to support clinical decision making. In this talk, I discuss both these opportunities and the challenges that we face when working with real-world clinical data, and introduce some of the strategies that we are adopting to make this data more usable, and to extract more value from it. I specifically discuss the use of natural language processing to transform clinical documentation into structured data for this purpose.
An AI-based Decision Platform built using unified data model, incorporating systems biology topics for unit analysis using semi-supervised learning models
NLP (Natural Language Processing) shows a great deal of potential for many applications in the healthcare industry. This document shares 6 promising use cases for NLP to manage Epilepsy treatment effectively.
Using real-world evidence to investigate clinical research questionsKarin Verspoor
Adoption of electronic health records to document extensive clinical information brings with it the opportunity to utilise that information to support clinical research, and ultimately to support clinical decision making. In this talk, I discuss both these opportunities and the challenges that we face when working with real-world clinical data, and introduce some of the strategies that we are adopting to make this data more usable, and to extract more value from it. I specifically discuss the use of natural language processing to transform clinical documentation into structured data for this purpose.
An AI-based Decision Platform built using unified data model, incorporating systems biology topics for unit analysis using semi-supervised learning models
NLP (Natural Language Processing) shows a great deal of potential for many applications in the healthcare industry. This document shares 6 promising use cases for NLP to manage Epilepsy treatment effectively.
Medical Informatics: Computational Analytics in HealthcareNUS-ISS
Presented by Dr Liu Nan, Senior Research Scientist and Principal Investigator, Singapore General Hospital at ISS Seminar: How Analytics is Transforming Healthcare on 31 Oct 2014.
Leveraging Analytics to Identify High Risk PatientsCitiusTech
A predictive analytics platform can help healthcare providers identify which patients and team members could be at the highest risk for severe illness / hospitalization.
What you need to know about Meaningful Use 2 & interoperabilityCompliancy Group
Does this describe you?
·You are constantly challenged to stay abreast of the latest information on EHR integration and HIE interoperability, Meaningful Use stages, the Direct Project, clinician and patient portals, just to name a few.
·You walk a fine line between adopting health information technology for the good it can bring patient outcomes…….and for the good incentive dollars it can mean to your organization.
·You play a key role in ensuring your organization can attest for meaningful use.
Join Andy Nieto, Health IT Strategist at DataMotion where he’ll explain the key role that interoperability plays in Meaningful Use Stage 2 attestation including:
- What does interoperability really mean
- Why you can’t ignore interoperability
- How to achieve interoperability and make it meaningful
- What you need in order to attest
Intelligent, Interoperable, Relevance and Value Enrichment in Universal, Ubiq...ijceronline
Electronic Health Records(EHR) are electronically maintained, linked, collections of allied, patientrelated healthcare information collected during past encounters. They incorporate patient demographic information, encounter details, laboratory reports, prescription notes, past medical records, and other medical data. EHR creation is designed to support the future diagnosis, treatment, and decision making in patient care. However, since EHR technology is a burgeoning science, many facets lie under-used or under-utilized.Current implementations are confined to national boundaries managed by individual National Health Systems (NHS). Consolidated, universally interoperable EHR schemes are still a thing for the future; a migratory patient may not have his national EHR available in distant territories. Further, the examination of operational factors unearthed more inadequacies. Interoperability-related issues include the limiting network bandwidth causing inordinate delays, diverse local storage schemes at the various NHS clusters, the related requirement for synchronous vocabulary-related translation mechanisms at the various NHScontrolled boundaries causing inordinate delays, and the related security and access issues. These issues arise from the requirement for synchronous, query-messaging nature of information access and exchange. This paper articulates a novel, sound, and secure methodology for achieving true International Interoperability and uniform efficiency in ubiquitous Electronic Health Record systems.Utilizing intelligent machine learning processes, required query-messaging information is meaningfully aggregated enhancing the relevancy, access speed, and value-derivation from the given data.Asynchronous learning excludes the need for high available network bandwidth, upload and download delays associated with current synchronous database/cloud systems.Indeed, this overarching solution ensures seamless synchronous operation and high-end international interoperability, and would work in any ubiquitous EHR environment.
Mining Health Examination Records A Graph Based Approachijtsrd
EHR Electronic Health Records collects data on yearly basis and it is used in many countries for healthcare.HER Health Examination Records collects the data on regular basis and identifies the participants at risk that is important for early warning and prevention.the fundamental challenge is for learning classification model for risk prediction with unlabelled data and live data string that established the majority of the collected dataset.the unlabelled data string describes the participants in health examintions whose health conditions can be vary from healthy to highly risky or very ill.in this paper, we propose a graph based,semisupervised learning algorithm called SHG health semi supervised heterogenous graph on Health for risk prediction and assessment to classify a progressively developing condition with the majority of the data unlabelled. An efficient iterative algorithm is designed and developed to proof the convergence is given.extensive experiments based on both real health examination dataset and live datasets to show effectiveness of our method. Jayashri A. Sonawane | Dr. Swati A. Bhavsar ""Mining Health Examination Records - A Graph Based Approach"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd22810.pdf
Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/22810/mining-health-examination-records---a-graph-based-approach/jayashri-a-sonawane
Understand what healthcare analytics is.
Identify the 5-stage Analytics Program Lifecycle (APL).
Understand how data analytics can be used in healthcare.
Check it on Experfy: https://www.experfy.com/training/courses/introduction-to-healthcare-analytics.
Here are a few tips on selling from David Ogilvy and other experts. Can you sell?
Enter the Search for the World's Greatest Salesperson. Deadline May 16, 2010 at youtube.com/ogilvy
See download link below.
Here is a free compilation of all the freebies you might need for your presentations, or other creative projects, including fonts, colors, icons and more.
Download link: https://www.dropbox.com/s/ziy3976c8qxn51y/The%20Ultimate%20Freebies%20Guide%20for%20Presentations.pdf
This presentation was created 100% in PowerPoint by my presentation design agency Slides. We are based in Spain (Europe) but have clients worldwide.
Drop me an email and we will discuss your project.
Medical Informatics: Computational Analytics in HealthcareNUS-ISS
Presented by Dr Liu Nan, Senior Research Scientist and Principal Investigator, Singapore General Hospital at ISS Seminar: How Analytics is Transforming Healthcare on 31 Oct 2014.
Leveraging Analytics to Identify High Risk PatientsCitiusTech
A predictive analytics platform can help healthcare providers identify which patients and team members could be at the highest risk for severe illness / hospitalization.
What you need to know about Meaningful Use 2 & interoperabilityCompliancy Group
Does this describe you?
·You are constantly challenged to stay abreast of the latest information on EHR integration and HIE interoperability, Meaningful Use stages, the Direct Project, clinician and patient portals, just to name a few.
·You walk a fine line between adopting health information technology for the good it can bring patient outcomes…….and for the good incentive dollars it can mean to your organization.
·You play a key role in ensuring your organization can attest for meaningful use.
Join Andy Nieto, Health IT Strategist at DataMotion where he’ll explain the key role that interoperability plays in Meaningful Use Stage 2 attestation including:
- What does interoperability really mean
- Why you can’t ignore interoperability
- How to achieve interoperability and make it meaningful
- What you need in order to attest
Intelligent, Interoperable, Relevance and Value Enrichment in Universal, Ubiq...ijceronline
Electronic Health Records(EHR) are electronically maintained, linked, collections of allied, patientrelated healthcare information collected during past encounters. They incorporate patient demographic information, encounter details, laboratory reports, prescription notes, past medical records, and other medical data. EHR creation is designed to support the future diagnosis, treatment, and decision making in patient care. However, since EHR technology is a burgeoning science, many facets lie under-used or under-utilized.Current implementations are confined to national boundaries managed by individual National Health Systems (NHS). Consolidated, universally interoperable EHR schemes are still a thing for the future; a migratory patient may not have his national EHR available in distant territories. Further, the examination of operational factors unearthed more inadequacies. Interoperability-related issues include the limiting network bandwidth causing inordinate delays, diverse local storage schemes at the various NHS clusters, the related requirement for synchronous vocabulary-related translation mechanisms at the various NHScontrolled boundaries causing inordinate delays, and the related security and access issues. These issues arise from the requirement for synchronous, query-messaging nature of information access and exchange. This paper articulates a novel, sound, and secure methodology for achieving true International Interoperability and uniform efficiency in ubiquitous Electronic Health Record systems.Utilizing intelligent machine learning processes, required query-messaging information is meaningfully aggregated enhancing the relevancy, access speed, and value-derivation from the given data.Asynchronous learning excludes the need for high available network bandwidth, upload and download delays associated with current synchronous database/cloud systems.Indeed, this overarching solution ensures seamless synchronous operation and high-end international interoperability, and would work in any ubiquitous EHR environment.
Mining Health Examination Records A Graph Based Approachijtsrd
EHR Electronic Health Records collects data on yearly basis and it is used in many countries for healthcare.HER Health Examination Records collects the data on regular basis and identifies the participants at risk that is important for early warning and prevention.the fundamental challenge is for learning classification model for risk prediction with unlabelled data and live data string that established the majority of the collected dataset.the unlabelled data string describes the participants in health examintions whose health conditions can be vary from healthy to highly risky or very ill.in this paper, we propose a graph based,semisupervised learning algorithm called SHG health semi supervised heterogenous graph on Health for risk prediction and assessment to classify a progressively developing condition with the majority of the data unlabelled. An efficient iterative algorithm is designed and developed to proof the convergence is given.extensive experiments based on both real health examination dataset and live datasets to show effectiveness of our method. Jayashri A. Sonawane | Dr. Swati A. Bhavsar ""Mining Health Examination Records - A Graph Based Approach"" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-3 | Issue-3 , April 2019, URL: https://www.ijtsrd.com/papers/ijtsrd22810.pdf
Paper URL: https://www.ijtsrd.com/engineering/computer-engineering/22810/mining-health-examination-records---a-graph-based-approach/jayashri-a-sonawane
Understand what healthcare analytics is.
Identify the 5-stage Analytics Program Lifecycle (APL).
Understand how data analytics can be used in healthcare.
Check it on Experfy: https://www.experfy.com/training/courses/introduction-to-healthcare-analytics.
Here are a few tips on selling from David Ogilvy and other experts. Can you sell?
Enter the Search for the World's Greatest Salesperson. Deadline May 16, 2010 at youtube.com/ogilvy
See download link below.
Here is a free compilation of all the freebies you might need for your presentations, or other creative projects, including fonts, colors, icons and more.
Download link: https://www.dropbox.com/s/ziy3976c8qxn51y/The%20Ultimate%20Freebies%20Guide%20for%20Presentations.pdf
This presentation was created 100% in PowerPoint by my presentation design agency Slides. We are based in Spain (Europe) but have clients worldwide.
Drop me an email and we will discuss your project.
These are the slides I will be using for an executive workshop in Mexico on the topic of "Competitive Advantage through Business Model Design and Innovation"
You and I have wasted enough time on PowerPoint Presentations. It's a necessary evil, but there are much better ways to approach it. Based off a talk I gave @ APTS. Enjoy!
This is the first SlideShare adaption of Timothy E. Johansson's 100 Growth Hacks in 100 Days. The growth hacks that's included in the slide are 1 to 10. Timothy is the front-end developer at UserApp (www.userapp.io).
Three business basics to always remember! People don't care about your brand. They care about what you can do for them. Back to basics... Give people what they want, do it consistently and do it better than your competition.
Did you know that Tuesdays at 11am is one of the worst possible times to send your email campaigns? Stop relying on guesswork and hunches to drive your email marketing--you might be shooting yourself in the foot. Learn How to Tweak Your Email Messaging to Generate More Leads!
View full presentation here: http://www.hubspot.com/the-science-of-email-marketing/
Your welcome email (or lack thereof) sets the tone for the email marketing relationship you have with your subscribers—make sure it's sending the right message!
Most sales pitches suck. Why? Because they are all about you instead of focusing on the client and their needs. Here is what you can do to change and make them better. Be a Blue Lobster and stand out.
17 Copywriting Do's and Don'ts: How To Write Persuasive ContentHenneke Duistermaat
You studied several copywriting books.
And read blog post after blog post about writing.
But writing your own web copy?
It’s a struggle.
You know the grammar is fine.
But the copy sounds bland. Perhaps even a little too salesy.
You read, and re-read your copy. You can’t quite put your finger on it. What’s wrong? How can you improve it? And persuade more people to buy?
Today I’ve assembled 17 examples of yucky copy. And I tell you exactly what’s wrong, and how to improve it.
Enjoy
The eBooks you create have the potential to become an important pillar in your content marketing mix.
Do it right and these high-converting "lead magnets" can continue to work for your content marketing machine long after the average blog post has ran out of steam.
But first, we need to move past the assumption that great eBooks are merely written and start building them with all the right parts!
10 Disruptive Quotes for EntrepreneursGuy Kawasaki
People think that innovation happens by sitting around with your buddies and letting magical ideas pop into your head. Or, your customers tell you exactly what they need, and you just have to build it.
Dream on. Innovation is a hard, messy process with no shortcuts. It starts with making something that you’d like to use and that might make people’s lives better. Then you have to get the word out that your product or service exists.
Follow #VirginDisruptors to join the conversation with Richard Branson and Guy Kawasaki as they talk about whether entrepreneurs have lost the will to innovate.
The Live Google+ Hangout with Richard Branson will be live streamed on Friday, May 9 at 9:30 am PT/12:30 pm PT with a live audience as well. It’s sure to generate a thoughtful conversation and innovative thinking. RSVP on the Google+ event to get a reminder. http://bit.ly/1mgP0b6
Are you leveraging social proof to optimally boost leads and sales? Checkout out these tricks for harnessing current and past customer success (testimonials, star ratings, customer action shots, etc.) to drive more conversions.
You'll learn:
- What kinds of social proof aid conversion (and why)
- Common conversion-killing social proof cases to avoid
- When and where social proof matters on a landing page
- How to score/grade the quality of your social proof
- What elements make a highly persuasive testimonial (and how to get them)
BONUS: Learn my "CRAVENS" methodology -- a simple scorecard for measuring the quality of social proof to effectively persuade conversion. CRAVENS = Credible, Relevant, Attractive, Visual, Enumerated, Nearby [anxiety points], Specific.
Note: A "craven" is a chicken, quitter, scaredy cat, etc. The CRAVENS model focuses on leveraging social proof to strategically reduce anxiety (i.e. scaredy cat, abandonment tendencies) and in turn boost conversion. Get ready for some actionable social proof tips and some epic LOL cat slides! #RememberTheCravens (scaredy cats!)
>> Presented Aug 26, 2014 for an Unbounce Webinar.
Short link: http://j.mp/socialproofcrowebinar
BlaBlaCar is a long distance car sharing community, connecting drivers with empty seats and people looking for a ride. Our website and mobile apps allow drivers to publish a planned journey. Passengers can then search available offers, and get in touch with the driver of their choice.
We provide a range of features to create a secure, reliable, trust-based community and easy connections between drivers and passengers. For instance, members specify how chatty they are on the scale “Bla”, “BlaBla” and “BlaBlaBla”, hence the name BlaBlaCar. Members rate one another after travelling together, allowing them to build trusted reputations in the community, and contact details are verified.
BlaBlaCar is currently used by more than 500,000 people every month across Europe. The community, already numbering 2.5 million members, has been growing rapidly since 2009, in great part due to rising fuel costs and expensive rail fares.
http://www.blablacar.com
https://www.wrike.com/blog/08/27/2014/Crowdfunding-Sites-Infographic - In the last few years, the crowdfunding scene has exploded. It's not just about Kickstarter and IndieGoGo anymore. Now there are hundreds of platforms to choose from, with more popping up every day. But which crowdfunding site is best for your startup, small business, or charitable cause?
In this infographic, we cover 26 Top Crowdfunding Sites with all the essential details so you can choose wisely.
More info here on the blog: https://www.wrike.com/blog/08/27/2014/Crowdfunding-Sites-Infographic
How to Pitch B2B? Do you have an awesome product? Doing the same old sales presentation? Improve your pitch by following these 9 steps and win more business.
Go Viral on the Social Web: The Definitive How-To guide!XPLAIN
Creating a Viral Content success story has no recipe. It has a lot of variables, not all of which can be controlled by a Brand. However, this deck offers you the ideal How-To approach in creating tasteful, inspired Content that will help your message stand out from the information noise on Social Web and make people eager to share it around.
PERFORMANCE MEASURES USING ELECTRONIC HEALTH RECORDS .docxkarlhennesey
PERFORMANCE MEASURES
USING ELECTRONIC HEALTH RECORDS:
FIVE CASE STUDIES
Jinnet Briggs Fowles, Elizabeth A. Kind, and Shadi Awwad
Park Nicollet Institute
Jonathan P. Weiner and Kitty S. Chan
Johns Hopkins Bloomberg School of Public Health
Patricia J. Coon, Billings Clinic; James T. Krizak and Lynne Dancha, HealthPartners;
Nancy Jarvis, Park Nicollet Health Services; Dean F. Sittig and Brian L. Hazlehurst,
Kaiser Permanente of the Northwest; and Mark J. Selna, Geisinger Health System
May 2008
ABSTRACT: This report examines the experiences of five provider organizations in developing,
testing, and implementing quality-of-care indicators, based on data collected from their electronic
health record (EHR) systems. HealthPartners used the EHR to compile blood pressure
measurements, Park Nicollet Health Services developed a composite measure for care of people
with diabetes, Billings Clinic tested an automatic alert on potential interactions between
antibiotics and the anticoagulant warfarin, Kaiser Permanente used a natural-language processing
tool for counseling about tobacco use, and Geisinger Health System explored ways of reconciling
Problem Lists and provider-visit notes regarding high-impact chronic-disease diagnoses.
Common themes emerged from these case studies. They included challenges—of ensuring the
validity and reliability of data, efficient workflow, and staff support—but the providers’ successes
in implementing their respective EHR-based quality measures demonstrated that such measures
are adaptable to different EHR systems, amenable to improvement, and worth pursuing.
Support for this research was provided by The Commonwealth Fund and The Robert Wood
Johnson Foundation, with additional support from the Agency for Healthcare Research and Quality.
The views presented here are those of the authors and do not necessarily reflect those of the two
sponsors or their directors, officers, or staff. This document and other Commonwealth Fund
publications are available online at www.commonwealthfund.org. To learn more about new publications
when they become available, visit the Fund’s Web site and register to receive e-mail alerts.
Commonwealth Fund pub. no. 1132.
http://www.commonwealthfund.org/
http://www.commonwealthfund.org/
http://www.commonwealthfund.org/myprofile/myprofile_edit.htm
CONTENTS
List of Figures and Tables.................................................................................................. iv
About the Authors................................................................................................................v
Executive Summary ........................................................................................................... vi
Introduction..........................................................................................................................1
Case Study #1 Using the EHR to Compile Blood Pressure Measurements ...
The Perception of Emergency Medical Staff on the Use of Electronic Patient Cl...ijtsrd
Background The electronic recording of patient information in ambulance services has provided healthcare professionals with the ability to send patient data to their GP or other relevant services electronically. It is critical to comprehend how paramedics view and adjust to electronic platforms as technology continues to advance. Objective To identify the facilitators and barriers EMS staff encounter when using e PCR. To explore the overall perception of EMS staff towards the utilization of e PCR in EMS settings. Method Four databases were searched including PubMed, Scopus, Medline and Science Direct. Result All 11 publications were evaluated for qualitative data and the publication was found to be of fair or good quality. Studies investigating the perception of staff found mixed perceptions. The search generated a total of 1365 potential articles. After the initial screening process, 229 duplicate records were removed Out of the remaining 1136 papers, 1079 were excluded as they did not meet the selection criteria the title, abstract, and keywords. Of the remaining 57 papers, a full text screening eliminated 46 for the study design quantitative studies n=22 , no perception of staff documented n=19 and no full text available n=5 . Thus, 11 papers that met the inclusion criteria were selected for final analysis. The risk of bias was quantified using CASP. A qualitative synthesis was conducted and three major themes emerged Facilitators, Barriers and overall perception of staff. Conclusion This systematic review found that EMS staff hold complex and diverse views on e PCR systems. While several facilitators and barriers impact e PCR adoption, it has been found that e PCR has the potential to enhance documentation, communication, data driven decision making and finally the ability to improve overall patient care quality. To ensure successful adoption, addressing technical issues, data security and training requirements and organisational barriers is important. Reshma Joe | Jomin George "The Perception of Emergency Medical Staff on the Use of Electronic Patient Clinical Records Systems in Emergency Medical Service: A Systematic Review" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd62365.pdf Paper Url: https://www.ijtsrd.com/medicine/other/62365/the-perception-of-emergency-medical-staff-on-the-use-of-electronic-patient-clinical-records-systems-in-emergency-medical-service-a-systematic-review/reshma-joe
Electronic health records | Data collection systems | Data collection and ana...Pubrica
Implementing precise data management systems ensures the secure and effective movement of sensitive healthcare data. However, medical practitioners neglected their critical role in medical data processing. As a result, implementing high-quality electronic health record (EHR) software in health care is critical for reducing medical mistakes. As a result, the purpose of this study is to highlight the roles of EHR in promoting quality healthcare service provision.
The new Pandemic Preparedness Citizen's Guide, edited by Sarah Booth, Kelsey Hills-Evans & Scott Teesdale to incorporate information around the recent COVID-19 pandemic.
Disease Reporting Hotline Launches to Stop Outbreaks in Cambodia InSTEDD
To improve disease reporting in Cambodia, the iLab Southeast Asia, in partnership with the Cambodian CDC and Skoll Global Threats Fund, launched a free to the public disease hotline built with InSTEDD's interactive voice response tool, Verboice.
Cambodia is in a 'hot zone region', susceptible to deadly disease spread. Timely reports from Health Centers across the country are critical to stopping outbreaks.
Mobile technologies landscape and opportunity for civil society organizations...InSTEDD
Channe talks about how mobile technologies can help Civil Society Organizations (CSOs) do more with less. Channe will tackle practical issues like how to get started and their process of design and implementation. Channe will walk you through several exciting projects, including mobile technologies in labor rights and health care and the use of mobile phone as a data collection tool.
When: 3:30 - 5:00pm. Friday 7th February 2014
Where: Himawari Hotel, Phnom Penh
Organized by: Development Innovations
https://www.eventbrite.com/e/mobile-technologies-landscape-and-opportunity-for-csos-in-cambodia-tickets-10444502789
The iLab Southeast Asia presented at BarCamp Phnom Penh 2012 on how to use Google's Map Maker application. The iLab SEA team trained participants on how to add and edit locations, draw streets, rivers, and other important landmarks on the Google map.
"Technology with a Purpose" - Eduardo Jezierski speaks at Ignite Health Foo 2...InSTEDD
InSTEDD's Chief Technology Officer, Eduardo Jezierski, speaks at the 2012 Ignite Health Foo event. Ignite is a geek event in over 100 cities worldwide. At the events Ignite presenters share their personal and professional passions, using 20 slides that auto-advance every 15 seconds for a total of just five minutes.
The event was put on by O'Reilly Media, in order to help spread the knowledge of technology innovators around the world.
Caricia Catalani presents at the International AIDS Conference 2012. Over 40,000 delegates from around the world attended this conference in Washington, DC, which highlighted cutting edge science and strategies for an AIDS-free generation.
With a worldwide penetration rate of over 85%, the mobile phone has become one of the most transformative tools in human history. As mobile communication technologies become less expensive, faster, and more accessible, the ability of people, communities and institutions to share information and knowledge will continue to skyrocket. Specifically for Global Health, the use of mobile communication and network technologies for delivery of health care (mHealth) holds great promise for the future. In low resource settings, community health workers (CHWs) provide a backbone for the delivery of health care services. Often isolated and without significant formal education or training, CHWs can be seen as key connectors between their communities and the formal health care system. In the hands of CHWs, mHealth tools may facilitate effective task shifting; by expanding the pool of human resources, increasing the productivity of health systems, and lowering the cost of services. The reported experience with mHealth suggest a wide range of opportunities exist to improve ease, speed, completeness and accuracy of the work of CHWs. The outcomes associated with these sort of new capabilities can be expected to result in ongoing improvements in performance on key national health indicators. The presentation will examine the state of the art and science-- by describing a systematic review of the literature and citing examples in action -- and provide recommendations focused on the design and development of mHealth tools for use by CHWs to strengthen Global Health interventions.
Speaker Bio:
Dennis M. Israelski, M.D
www.instedd.org/team
Presentation by Channe Suy of the iLab Southeast Asia speaking at TEDxPhnom Penh. To see the video of this presentation, please go here: http://instedd.org/blog/from-the-ted-prize-to-tedxphnom-penh/
This is the presentation that InSTEDD CEO, Dennis M Israelski, MD, gave during the Rio 2.0 Demo Alley Conference. For a more detailed description, please go to: http://instedd.org/blog/rio-2-0-demo-ally/
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
2. sician order entry systems have been shown to ibility of all studies identified in our search. A
reduce medical errors,15 but they can also in- second reviewer confirmed all relevant articles
crease error rates if not well designed and and retrieved full-text articles. Supplementary
implemented.16 methods of finding evaluations included a review
of article reference lists, informatics conference
proceedings, information provided by primary
Study Data And Methods study authors, requesting submissions from
STUDIES ELIGIBLE FOR REVIEW In our survey of stud- other researchers and implementers, and
ies for review, we included any qualitative or searching the RHINO Literature Database20 and
quantitative evaluation of information technol- other recent reviews.7,21–23
ogy affecting health care in developing coun- DATA ABSTRACTION AND SYNTHESIS We extracted
tries. We did not include telemedicine because data according to recurring themes, defined be-
other recent reviews exist.9,17 Developing countries low.We summarized these findings using tabular
were defined as those in the Emerging and De- techniques and descriptive statistics. Reported
veloping Economies List in the International analyses were too disparate to be pooled in a
Monetary Fund’s World Economic Outlook Report. meta-analysis.
Evaluations were excluded if (1) data complete- The systems described in the articles were
ness of the system was the only outcome, (2) the placed into one of eight categories correspond-
evaluation method was not described, (3) the ing to the typical applications used in developing
article only described the feasibility or technical countries. The order of these categories does not
evaluation of a system, (4) the evaluation was on infer any priority:
attitudes toward or knowledge of e-health (not (1) Electronic health record: an electronic rec-
an actual system), or (5) it was only an educa- ord of health-related information on an indivi-
tional tool.18,19 In the case of the Uganda Health dual that can be created, managed, or consulted
Information Network, we report on the e-health by clinicians or staff. In literature, the term elec-
component of the system. If an article did not tronic medical record is used interchangeably and
have an abstract, we attempted to find the article is used as a synonym in this paper.
through the Harvard or Massachusetts Institute (2) Laboratory information management sys-
of Technology (MIT) library systems. tem: a system for laboratory-specific activities or
FINDING RELEVANT STUDIES We conducted a for reporting results to administrators and
worldwide review of the literature and requested health care personnel.
submissions from researchers and those imple- (3) Pharmacy information system: any system
menting e-health in developing countries. Lit- used to order, dispense, or track medications or
erature searches were completed through Octo- medication orders including computerized or-
ber 2009 without language restrictions through der entry systems.
MEDLINE, EMBASE, Science Citation Index (4) Patient registration or scheduling system:
(Web of Science), Social Sciences Citation Index, any system used to monitor and manage the
the Cochrane Library, and the Latin American movement of patients through multistep proc-
and Caribbean Health Science Literature Data- esses or to maintain a census.24 An example is
base (LILACS). To find reports not in scientific admissions-discharge-transfer systems.
journals or conferences, we also used Google (5) Monitoring, evaluation, and patient track-
Scholar. For MEDLINE and EMBASE searches, ing system: any system used for aggregate report-
terms were derived from the MeSH database and ing of information, program monitoring, and
EMTREE tool, respectively. We searched for tracking of patients’ status. Examples include
more than forty commonly used terms to de- district health information systems or health
scribe e-health applications, found the broadest management information systems.
term within each tool that maintained its con- (6) Clinical decision support system: system
text, and then used that term for the search to designed to improve clinical decision making, in
ensure that we included all possible studies. which characteristics of individual patients are
Among the terms used in the final strategies were matched to a computerized knowledge base and
medical informatics applications, reminder system, software algorithms generate patient-specific
geographic information system, hospital informa- recommendations.25
tion systems, outcome and process assessment (7) Patient reminder system: a system used to
(Health Care), evaluation studies, attitude, costs prompt patients to perform a specific action—for
and cost analysis, developing countries, poverty, example, take medications or attend the clinic.
Africa, Latin America, eastern Europe, and central (8) Research/data collection system: any sys-
or southeastern Asia (complete strategies are tem used for collecting data from different loca-
available from the authors on request). An initial tions or for storing, managing, or reporting on
reviewer read the abstracts to evaluate the elig- data used for research purposes.
F E B R UA RY 2 0 1 0 29 : 2 HE A LT H A FFA IRS 245
3. POLICIES & POTENTIAL
Evaluations were classified into two major and abstracts, we found 126 articles that ap-
categories—qualitative and quantitative—as peared relevant. An additional five articles were
shown in Exhibit 1. Qualitative evaluations were identified by hand-searching bibliographies of
those where users gave opinions regarding a eligible articles and prior reviews. Of these,
system. These could be through questionnaires, forty-five fulfilled the inclusion criteria after full
focus groups, or interviews. (This definition is review of their abstracts. They are listed by type
different from the one proposed by Anselm of system and evaluation in Exhibit 1 and are
Strauss and Juliet Corbin of “any type of research categorized by systems in Appendix Exhi-
that produces findings not arrived at by statisti- bits 2a–5a.32 We included an evaluation from
cal procedures or other means of quantifica- the U.S. Indian Health Service, although it is
tion.”)26 Quantitative evaluations were those not in a developing country, because socioeco-
whose outcomes were data quality, administra- nomic and infrastructure conditions among the
tive changes, patient care, or economic assess- population treated are similar to those in devel-
ment. Evaluation designs were grouped accord- oping countries. If a system had multiple evalua-
ing to the definition by Charles Friedman and tions, only those with different outcomes are
Jeremy Wyatt:27(1) descriptive (uncontrolled) listed. If they had the same outcome, we took
study; (2) historically controlled (before-after) the one with the largest sample size. There were
study; (3) case-control (retrospective) study; two articles reporting an evaluation that did not
(4) prospective self-controls (subjects perform- occur because of a failed system implementa-
ing the same action in both systems; this cate- tion.33,34 These are not part of the results, but
gory was added by the authors); (5) simultaneous we considered them relevant to list because ar-
nonrandomized controls; (6) simultaneous ran- ticles on unsuccessful systems are not commonly
domized controls; and (7) externally and intern- published.
ally controlled before-after study. Two cost stud- Fifteen articles performed qualitative evalua-
ies and two studies modeling future medication tions, and forty performed quantitative evalua-
requirements were categorized as self-controls tions. If an evaluation performed both types, it
because they compared the impact of the system was counted in both categories. Two qualitative
against the same situation without the system. evaluations and sixteen quantitative performed
As a result of the inherent limitation of perform- statistical analysis. Of all evaluations, two
ing a case-control, descriptive, or qualitative (13 percent) of the qualitative and seven (18 per-
study without statistics, we do not comment cent) of the quantitative were performed by an
on the limitations of these studies. outside evaluator. The number of evaluations
has more than tripled comparing periods before
and after 2002.
Study Results ELECTRONIC HEALTH RECORDS Because EHRs are
Searches retrieved 2,043 citations. Five articles the core clinical application, they usually encom-
were excluded because they did not have ab- pass a variety of functionalities, which makes
stracts and full-text versions were not avail- their implementations complex35 and prone to
able.28–31 After the initial screening of article titles failure.36 This complexity provides an additional
EXHIBIT 1
Number Of Articles Included In Analysis, By E-Health Category And Evaluation Type
Quantitative
E-health category Qualitative Descriptive studies Controlled studies
Electronic health record 5 1 5
Laboratory information management systems 0 1 2
Pharmacy information systems 4 2 3
Patient registration or scheduling systems 1 0 2
Monitoring, evaluation, and patient tracking systems 0 2 4
Clinical decision support systems 1 0 3
Patient reminder systems 0 1 3
Research/data collection systems 5 1 11
Total 15 8 32
SOURCE Authors’ analysis. NOTES The articles (n ¼ 45) are classified by e-health category and by type of evaluation. If an article had both
qualitative and quantitative studies or multiple types of systems, it was counted in both categories. Details about the evaluated
projects are in Appendix Exhibits 2a–5a, available online as in Note 32.
246 HEA LT H AF FA IR S F E B R UA RY 2 0 1 0 29:2
4. challenge in their evaluation. Most evaluations in training and technical support and the need to
found provided insight into possible impacts of maintain a parallel paper system.
these systems, but had limited scientific rigor, as MONITORING , EVALUATION , AND PATIENT TRACKING
seen in Appendix Exhibit 2a.32,27 SYSTEMS Evaluations of systems to track and
The Indian Health Service’s Vista system was monitor patients’ status are limited to two
the most complete system we reviewed, and its case-control studies performed by the same or-
rigorous qualitative evaluation showed that a ganization in Haiti (Appendix Exhibit 4a).32
majority of clinicians viewed its implementation Both of these studies suggest that an electronic
positively and hence used it more. The Mosoriot system can effectively alert staff of patients who
Medical Record System evaluation in Kenya pro- have “fallen through the cracks” and prevent
vides data on the impact that an EHR can have on rates of patients lost to follow-up, which were
improving staff productivity and reducing pa- found to be as high as 76 percent (after two
tient wait times. All other evaluations were qual- years) as reported in some HIV programs.3
itative and provided insights into EHRs’ ability Two randomized controlled trials looked at
to improve staff satisfaction, providing higher- the effect of Global Positioning Systems (GPS)
quality data to relevant personnel and ultimately in finding households once a patient has been
improving patient care. identified. An evaluation from South Africa
LABORATORY INFORMATION MANAGEMENT SYSTEMS showed that GPS reduced the time to find a
There were only three evaluations of laboratory household by 20–50 percent, whereas one from
information management systems, all quantita- Nicaragua showed no difference between the pa-
tive, with only one having a control group (Ap- per and GPS systems. Both the South African and
pendix Exhibit 3a).32 However, they suggest two Nicaraguan systems were tested in similar urban
major benefits that such systems can provide: settings with novice users, so no immediate
(1) decreasing times for communication of re- reason for the difference can be found. Both
sults, and (2) improving the productivity of the studies had small sample sizes (identifying
laboratory. An additional impact, reduction in ten to fifty households) and lacked statistical
errors, has not yet been studied, although there analysis.
are groups currently performing such trials.37 Two evaluations, one descriptive and one cost
PHARMACY INFORMATION SYSTEMS Computerized analysis, looked at monitoring departments
order entry can provide a key incentive for clin- within a hospital in Cambodia and health estab-
ical staff, especially clinicians, to use an informa- lishments nationwide in Tanzania. They suggest
tion system, because such systems can reduce the that electronic systems can help allocate re-
time to order medications (especially repeat or- sources efficiently and improve infection control
ders) and provide easy access to past informa- and can be relatively low cost, respectively. How-
tion. The four qualitative evaluations shown in ever, both evaluations lacked detail on the tasks
Appendix Exhibit 3a32 cite these as their system’s affected, as well as control groups.
main advantages. The two quantitative evalua- CLINICAL DECISION SUPPORT SYSTEM Decision
tions with a control group (Socios en Salud in support systems have received attention for de-
Peru and Hamadan University of Medical veloping countries as a possible solution to the
Sciences in Iran) showed a reduction in errors, lack of trained clinical personnel, especially in
which is a main outcome cited in developed rural areas. The three quantitative evaluations
country studies. An additional benefit from some seen in Appendix Exhibit 4a32 were of high rigor.
pharmacy systems in developing countries is The expert system for mechanically ventilated
their ability to forecast medication requirements newborns showed that nurses performed better
(Socios en Salud in Peru). This is useful if a on a standardized test and felt that they had
country or organization needs to order medica- better judgment after receiving training on the
tions months in advance to get lower prices, system. The evaluation of the personal digital
which is currently the case for drug-resistant assistant (PDA) device to perform the Electronic
TB medications. Integrated Management of Childhood Illness ap-
PATIENT REGISTRATION AND SCHEDULING The two proach in Tanzania showed that more clinical
quantitative evaluations of registration systems, staff completed the electronic questionnaire
seen in Appendix Exhibit 4a,32 showed that fin- compared to the paper booklet. It also showed
gerprint scanners and barcode readers de- that it took the same amount of time (12.5 min-
creased the time to locate records by 74 percent utes) to fill out the questionnaire by either meth-
and 97 percent, respectively. The small sample od. The evaluation of the Early Diagnosis and
size of thirty in these randomized controlled Prevention System in India showed higher satis-
trials was their biggest limitation. In the quali- faction among patients if they were seen by a
tative evaluation of the Baobab system in Mala- computer operator before their clinical visit
wi, users preferred it to paper despite limitations and that there was a large increase in new pa-
F E B R UA RY 2 0 1 0 2 9 :2 HE A LT H A FFA IR S 247
5. POLICIES & POTENTIAL
tients at health centers with the system. compared the PDA system to paper and not to
However, the two studies with simultaneous a gold standard. The study performed by Socios
controls had major limitations. The evaluation of en Salud had a small number of users (n ¼ 4),
the Electronic Integrated Management of Child- and the study performed by the London School of
hood Illness was performed by the developers of Economics was performed seventeen years ago.
the systems, and because the technology was The organizations that implemented the PDA-
new to the users, the novelty rather than its use- based systems in Uganda and South Africa have
fulness could account for the additional comple- experience with hundreds of users and more
teness. In the case of the Early Diagnosis and than a dozen implementations combined, which
Prevention Systems, the increased attendance empirically shows the feasibility of such systems.
and patients’ opinions could have been easily The cost analyses show that these systems are
biased by the presence of the computers, the able to recoup the high initial costs by providing
motivation of computer operators, and the increased efficiency and continuous material
length of time spent with operator, none of costs. The Uganda system showed a cost savings
which were present at control sites. of 91 percent over the paper system. The South
PATIENT REMINDER SYSTEMS The quantitative African analysis calculated that after using the
evaluation of the South African text messaging PDA system for data collection in eight studies of
system (Appendix Exhibit 5a)32 found that after medium scale, it would equal the costs of paper.
the system was implemented, there were higher The PDA system in Peru would pay for expansion
completion rates of TB treatment. However, the to other health districts in three months as a
comparison was made to the city’s TB program result of increased efficiency.
register, for which the data quality was not ver-
ified and the data were different from the source
of the prospective data. A randomized trial in Discussion
Malaysia found that both text messaging and This review shows that with the exception of
mobile phone reminders significantly increased PDA-based data collection, there are still few
attendance (by 21 percent) over the control scientifically rigorous data on the effectiveness
group. Although they both had similar effective- and cost-effectiveness of e-health systems in de-
ness, the text messaging system was half the cost veloping countries. Further, the evaluations
of the mobile phone reminders. This evaluation have mostly been performed by organizations
had no major limitations. connected to academic settings and not by other,
The Malaysian study performed a well- larger recipients of donor funding.When looking
designed cost-effectiveness study showing that at the software systems included in the U.S. Pres-
text messaging, implemented correctly, can be a ident’s Emergency Plan for AIDS Relief (PEP-
cost-effective method to increase clinic atten- FAR) Anti-Retroviral Therapy (ART) Software
dance. This is especially important since both Inventory Report5 and EngenderHealth–Open-
TB and HIV treatments require constant super- Society software tools38 comparison, only three
vision of patients and strict adherence to a daily systems, the Partners in Health—Electronic
regimen of medications. Such systems can help Medical Record/HIV—Electronic Medical Rec-
patients in resource-poor settings who encoun- ord in Kenya, Mosoriot Medical Record System
ter many obstacles that can prevent them from in Kenya, and Vista in the U.S. Indian Health
getting their medications. Service, have had any evaluations performed.
RESEARCH / DATA COLLECTION SYSTEMS Research/ Although a few studies have been commissioned
data collection systems was the group with the by the U.S. Centers for Disease Control and Pre-
largest number and most rigorous evalua- vention (CDC), it is particularly important that
tions (Appendix Exhibit 5a).32 All systems, ex- large funders such as the U.S. Agency for Inter-
cept the Mexican National Institute of Public national Development or PEPFAR include re-
Health’s Audio Computer-Assisted Self-Inter- sources for the evaluation of e-health systems
view (ACASI) system, were on PDAs. Four ran- developed and deployed in developing countries
domized trials showed that the main benefits of and perhaps make them a requirement for con-
PDA-based systems were data qual- tinued funding. This could include
ity similar to paper systems or high- standard designs for studies that
er, less time taken to perform inter- are suitable for resource-poor en-
views, and decreased time to collect vironments, that minimize biases,
data. However, many of the studies and that are easily comparable to
had major limitations. The systems the results from other projects.
from the Universidad Peruana The overall pattern of e-health
Cayetano Heredia and the South evaluations in developed countries
African Medical Research Council reflects an initial focus on qualita-
248 HE A LT H A FFA IRS F E B R UARY 2 0 10 2 9 :2
6. tive and descriptive evaluations, with an increase health and cell phone–based tools, because these
in the number of quantitative and larger evalua- devices are also playing an increasing role in
tions published in the past decade. Developing communication directly with patients.
countries seem to be following this pattern as Evaluations of e-health systems are chal-
well, so in this study we found mostly qualitative lenging and require significant resources in ad-
and descriptive studies but saw an increase in the dition to funds creating and implementing sys-
number of randomized trials performed in the tems. Implementations should have evaluations
past few years. This suggests that as e-health built into the process. This will provide useful
implementations become more robust in devel- feedback to improve the project (formative eval-
oping countries, we can expect more rigorous uations) and will also demonstrate the impact of
studies, such as randomized trials or cost-effec- the system in the long term (summative evalua-
tiveness studies. tions). Evaluations in resource-poor environ-
Initial evaluations suggest that the following ments face many challenges when compared to
functions are of positive impact in developing those in developed countries, such as the physi-
countries: cal environment, power, networking, and avail-
(1) Ability to track patients through the treat- ability of technical staff. Measures of short- and
ment initiation process, monitor adherence, and long-term system usage and data completeness
detect those at risk for loss to follow-up. (2) Tools are important and a necessary prerequisite to a
to decrease communication times of information full evaluation study. Poor data quality is a con-
within and between institutions. (3) Tools to stant problem in health projects, whether they
label or register samples and patients. (4) Ability use paper or electronic systems, so tools that can
to electronically monitor and remind patients of reduce errors as well as benefiting other aspects
health care needs or treatment. (5) Collection of of care are likely to be well received.
clinical or research data using PDA applications. Some benefits of electronic systems are diffi-
(6) Reductions in errors in laboratory and med- cult to quantify. One is the ability to perform
ication data. operational research with greatly reduced costs.
Important findings include the user prefer- During our search we found eight studies that
ence for the Baobab touch-screen system in used electronic databases and probably could
Malawi, one of the only fully electronic point- not have been performed if manual data collec-
of-care systems in use in Africa, which is now tion was required. Another is the impact of emer-
in daily use for more than 35,000 HIV patients. gency communication across large distances,
The benefit shown for patient tracking and such as in the cholera outbreak in India or refu-
reminders is also important, given the loss to gee situations.39 The strongest evidence for ben-
follow-up rate of up to 76 percent for HIV pa- eficial impact of e-health on health care will come
tients in Africa.3 The Malaysian systems that from long-term follow-up of this sort carried out
texted patient reminders showed a significant by independent evaluators.
decrease in missed visits, at a reasonably low
cost, and the On Cue Compliance Service in
South Africa was well liked by users several years Conclusions
after implementation and, perhaps more impor- With the rapid growth of e-health in developing
tant, by an independent evaluation team. These countries, there is clearly an urgent need for
systems can be of high value because intermit- solid evidence of its impact to justify and guide
tent treatment puts patients at grave risk of the investment of resources in such systems.
deterioration and death, as well as causing in- Despite major increases in evaluations in recent
creased drug resistance and further transmis- years, most large e-health implementations have
sion of disease to the wider community. little or no evaluation data. To date, most studies
Tools to store and communicate such data with have been small; focused on process indicators
low error rates have been early successes in de- rather than patient outcomes, or on the attitudes
veloped countries, and the positive evaluations of users and patients; and performed mostly by
described here should drive their use in the de- academic groups. An increased focus on includ-
veloping world. Evaluations of PDAs and mobile ing evaluations as part of e-health implementa-
devices were particularly rigorous, and they con- tions is necessary and should be adopted by or-
vincingly demonstrate that such devices can be ganizations implementing or funding such
very effective in improving data collection time systems. One method is for large funders to in-
and quality. An additional benefit is their light clude resources for evaluations or make them a
weight and lack of printing costs compared to requirement for implementation.
large paper forms, which is crucial in remote Although evaluations of important indicators
areas with poor infrastructure. These results of care are difficult to do well, this review has
are important for the growing field of mobile confirmed that they are feasible even in very
F EB R UARY 2 0 1 0 29:2 H E ALT H AF FAI RS 249
7. POLICIES & POTENTIAL
challenging environments. Initial benefits were medications. Because of the lack of infrastruc-
shown in systems that track patients through ture and backup systems in resource-poor envir-
treatment initiation, monitor adherence, and de- onments, well-designed e-health solutions may
tect those at risk for loss to follow-up; tools to have a much larger impact on quality of care than
decrease information communication times in more developed areas. As e-health becomes
within and between institutions, as well as errors widespread in developing countries, these and
in reporting laboratory data; barcoding for pa- other benefits will need to be identified by more
tient identification cards and laboratory sam- rigorous evaluations that include long-term
ples; handheld devices for collecting and acces- follow-up and are carried out by independent
sing data; and the ordering and management of evaluators. ▪
An initial version of this paper was Chilean company that provides health Veronica Rojas, Adesina Iluyemi,
requested by the Rockefeller Foundation informatics consulting and technology in Mauricio Soto, Waldo Ortega, Chris
for the Making the eHealth Connection Latin America. The authors acknowledge Bailey, Patrick Whitaker, Gerry Douglas,
conference held in Bellagio, Italy, in July those who took the time to provide Natasha Kanagat, Steve Yoon, Zach
2008. This paper was funded by the additional information: Holly Ladd and Landis Lewis, Joel Selanikio, and Neal
Rockefeller Foundation. Joaquin A. Blaya Berhane Gebru from AED-Satellife, Lesh. Finally, the authors thank Claire
is cofounder of eHealth Systems, a Libby Levison, Heather Zornetzer, Mack for her invaluable editing.
NOTES
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ABOUT THE AUTHORS
Africa, and Asia. Blaya, 31, implementing an electronic Institute in the United United Kingdom. He also
who was born in Chile, is a health record for use in States, the Medical completed a fellowship in
Harvard and Massachusetts managing multidrug-resistant Research Council in South clinical decision making and
Institute of Technology TB patients in Peru. He and Africa, and others, have cardiology at MIT and the
(MIT)–trained Ph.D. in health Blaya teamed up to produce developed an “open source,” New England Medical Center.
sciences and technology. a Palm Pilot–based system or nonproprietary, electronic Blaya, who today is a
Fraser, age 47, was born in to collect laboratory results health record system for research fellow at Partners
Scotland and was educated on behalf of these patients. developing countries, called in Health, is also a National
and trained in medicine and In a study published in 2009 OpenMRS. The system is Library of Medicine Fellow
Joaquin A. Blaya cardiology in the United in the International Journal used by more than forty-five at Harvard Medical School.
Kingdom. They met in 2004 of Infectious Diseases, the organizations in twenty- In addition, he recently
when Blaya was at a joint system was shown to three countries and is cofounded a company,
Harvard-MIT program decrease delays in getting available for download at eHealth Systems, which aims
working on his Ph.D. and those results from thirty http://www.openmrs.org. to implement open-source
Fraser became his days to eight days, and to “My focus has been on technologies, including
supervisor. Then, as now, reduce errors in the practical systems that are OpenMRS, in health systems
Fraser was an assistant communication of these useful for doctors and other in Latin America. Having
professor of medicine at tests to clinicians by 59 health care staff,” says emigrated from Chile to
Harvard Medical School and percent. Fraser, who is also an Miami, Florida, twenty-two
director of informatics and Since then, the two have associate physician at the years ago, he plans to move
telemedicine at the worked on implementing a Brigham and Women’s back to Chile in 2010. His
nonprofit organization Web-based system to Hospital in Boston. In five-year goal is for a
Partners in Health, which communicate laboratory addition to his medical majority of public health
Hamish Fraser focuses on providing health results to TB clinicians in degree, he trained in the centers in Chile to use
Coauthors and frequent care for the poor in a more than 220 health development and use of so- OpenMRS and to expand
collaborators Joaquin Blaya number of developing centers throughout Peru. called knowledge-based their use in Nicaragua,
and Hamish Fraser share a countries, including Haiti, Fraser’s group (the systems—computer systems Argentina, Brazil, and other
passion for using e-health Rwanda, and Peru. Electronic Medical Records to diagnose and analyze countries.
technologies to improve Back then, Fraser was Team at Partners in Health), real-world data—at
health care in Latin America, working on developing and with the Regenstrief Edinburgh University in the
F E B R UA RY 2 0 1 0 2 9 :2 HE A LT H A FFA IRS 251
9. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-
50.
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APPENDIX Exhibit 2a Electronic Health Record Evaluations
System or Evaluation
Institution Country Type Outcome
Virginia System costs were US$750 for satellite
Commonwealth communication, and a fixed cost of a satellite
University phone (US$500), and monthly fees. They provided
[1a] Kenya Cost for 2700 patients.
Bhorugram Over 4 years immunizations increased from 45.4%
Rural Case- to 81.9% and 46.1% to 77.7% in DPT and polio
Dispensary control vaccines; antenatal registration increased from
[2a] India study 384 to 705 patients.
Decreased percentages of wrong entries and non-
St. Luke's Case- entries either of weight or height; Increases
Medical Philipp control seen in nutrition support services referrals to
Center [3a] ines study clinical dietitians and dietician productivity.
Kwonsun Staff & Increased staff productivity and satisfaction.
Health Center patient Did not increase staff decision abilities.
[4a] Korea surveys Increased visitors' satisfaction with services.
Advantages: physicians recorded improved
communication (95%); improved quality of care
(85%); accurate entry and retrieval of data
(80%); easy access to data (70%); usable in
physician liability cases (64%); reduced medical
errors (67%); enhanced productivity (59%);
Disadvantages: disease coding is a problem
Sur Hospital Physician (70%); system is time consuming (67% agree); and
[5a] Oman survey too slow (60%).
Advantages: improve clinical documentation,
consistency of health maintenance, access to
patients' data and research opportunities.
Euro Health Staff Disadvantages: negative impact on physician-
Group [6a] Serbia survey patient consultation time.
Advantages: EHR implementation was viewed
positively (66%); improved quality of care
(35%); 34% self-reported that EHRs improved
quality, this was associated with increased
utilization (odds ratio 3.03). IT could improve
quality of care in underserved settings (87%)
Indian Health Physician Disadvantages: decreased quality of patient–
Service [7a] USA survey doctor interaction (39%).
Higher availability of reports at district
Tororo health office compared to paper (79% vs. 100%),
District Before- no difference in quality, majority of staff
Hospital[8a] Uganda after interviewed appreciated system.
Hospital matron noticed a cluster of sexually
transmitted disease and therefore dispatched a
team to investigate. Also noted lack of child
Mosoriot immunizations and dispatched nurses to that
Medical site. Reports that previously took a clerk two
Record System User weeks, now take minutes; allowed the director to
[9a] Kenya opinion reassign two clerks to other duties
Mosoriot Duration of visits dropped from 41 to 31
Medical minutes; providers time with patients dropped
Record System Before- from a third to a sixth of workday; providers
[9a] Kenya after spent two thirds less time interacting with
13. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-50.
other staff and tripled their time spent in
personal activities; clerks spent two thirds
less time interacting with other staff and
almost doubled their time registering patients.
The EMR had higher overall completeness than the
paper system. High workloads, shortage of
Karolinska Random bedside hardware and lack of software features
Institute selection were prominent influential factors in the
[10a] Iran of records quality of documentation.
SOURCE: Authors’ Analysis
NOTES: Evaluations are in increasing order of strength with multiple
evaluations of a single system placed together. References can be found
in Appendix Exhibit 1a
14. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-50.
APPENDIX Exhibit 3a Laboratory Information Management
Systems (LIMS) and Pharmacy Information System Evaluations
System or Evaluation
Institution Country Type Outcome
Laboratory Information Management Systems (LIMS)
Cholera was isolated in 22.6% (7/31) of
samples sent to a central laboratory.
Information was relayed to hospital and
Sanjay Gandhi health authorities, who took strict measures
Post Graduate to improve hygiene at a festival.
Institute of Subsequently, the number of diarrhea cases
Medical during festival decreased and an epidemic was
Sciences [11a] India Descriptive averted.
Case- Productivity indexes showed an increase by
control 41% in number of patients handled and 28% in
Tesilab [12a] Mexico study number of tests processed.
Turn around times for routine samples
Karadeniz decreased from 1 to half day; number of
Technical samples processed increased a factor of 2;
University, Before- annual laboratory revenue increased 4 times,
[13a] Turkey after from 55,000 to 220,000 euro per month.
Pharmacy Information Systems
In 28.2% of medication orders there was
dubious or misleading information
Advantages: ease of data access and
ordering. Disadvantages: repetition of
Universidade de Descriptiv orders from previous days without a review
São Paulo [14a] Brazil e and incorrectly typed information.
Advantages: user-friendly interface;
quickness and clarity of information; ease
of use; reduction of time between drug
Hospital das prescription and administration; believed to
Clínicas da result in a drastic reduction in the risk of
Faculdade de error.
Medicina de Disadvantages: insufficient number of
Ribeirão Preto Staff terminals; system got stuck; technical
[15a] Brazil survey support was unsatisfactory.
Advantages: legibility (37.5%); less time to
order (20.5%); more practical and organized
(8%).
Disadvantages: repetition of previous
prescriptions (34%); typing mistakes (17%);
University of Staff dependence on computers (11%); alterations
São Paulo [16a] Brazil survey made manually (7%)
Over 70% of users preferred system over
paper, felt that it reduced the number of
prescription errors, and knew what to do
when system was down.
Its limitations were with system speed and
functionality in processing prescriptions.
National Satisfaction was more associated with
Healthcare Staff perceived impact on productivity than with
Group [17a] Singapore survey patient care.
Ekbatan Staff Clinician users of the prescribing system
Hospital [18a] Iran interviews were found to mostly rely on their memories
15. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-50.
and be overconfident which could lead to
errors.
Advantages: increased confidentiality,
reduction of medication errors and
educational benefits.
Disadvantages: high cost, social and
cultural barriers, data entry time and
problems with technical support.
Before intervention (Period 1), error rate
was 53%, which did not significantly change
after the implementation of CPOE without
Hamadan decision support (Period 2). However, errors
University of were significantly reduced to 34% after the
Medical Before- decision support was added to the CPOE
Sciences [19a] Iran after (Period 3).
Accuracy of prediction per medication was
Socios En Salud Model vs. 117% over-estimate in 2002, 5% underestimate
[20a] Peru actual use in 2003 and to 2% under-estimate 2004.
Model, For subgroup of 58 patients on
order individualized treatment, model predicted
Socios En Salud placed vs. 99% of actual use, the actual order placed
[21a] Peru actual use was 145% of actual use.
Externally 17.4% error rate fell significantly in the
controlled study group to 3.1% per patient. Error rate
Socios En Salud before- did not differ statistically in control
[22a] Peru after group (8.6% to 6.9%).
SOURCE: Authors’ Analysis
NOTES: Evaluations are in increasing order of strength with multiple
evaluations of a single system placed together. References can be found
in Appendix Exhibit 1a.
16. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-50.
Appendix Exhibit 4a Patient Registration and Scheduling,
Monitoring and Evaluation, and Clinical Decision Support
System Evaluations
System or Evaluation
Institution Country Type Outcome
Patient Registration and Scheduling
Most of the users (70%) expressed a clear
preference for the touch screen over the
paper system. However, every respondent
Baobab Clinical also identified on-going problems that need
Health[23a] Malawi user survey to be addressed.
Sustainable Mean time to locate record with fingerprint
Sciences Simultaneous scan was 7.0 (SD 3.5) seconds, versus 27.3
Institute randomized (SD 7.1) seconds using the traditional
[24a] Nicaragua controls method.
Average time to locate a patient’s chart
Sustainable using traditional methods was 2.9 (SD 2.1)
Sciences Simultaneous minutes, whereas using barcode-based
Institute randomized methods the average was 0.09 minutes, or
[24a] Nicaragua controls 5.5 (SD 1.2) seconds.
Monitoring, Evaluation, and Patient Tracking Systems
Data are invaluable for the short-term
Calmette management of the hospital. SIM helped set
Hospital [25a] Cambodia Descriptive up infection control committee.
Tanzanian Total annual systems cost was US$2,119,941,
Ministry of $0.13 per participant, and $0.06 per
Health [26a] Tanzania Cost capita.
For patients with CD4 counts between 101
and 350, those entered into the system
within 14 days had an odds ratio of 3.2 for
Case-control starting treatment within 14 days compared
HIV-EMR [27a] Haiti study to those without early CD4 entry.
Logged patient follow-up visits allowed
staff to rapidly identify a decline among
patients who had stopped receiving food
supplementation. New strategies were
HIV-EMR2.0 implemented within 3 weeks, and clinic
(OpenMRS) Case-control attendance returned to original level of
[27a] Haiti study over 90%.
University of Time taken to locate ten households was
the Simultaneous reduced by 20% and 50% in each of two
Witwatersrand South randomized communities using the PDA/GPS device
[28a] Africa controls compared to paper.
Sustainable
Sciences Simultaneous
Institute randomized GIS did not significantly decrease the time
[24a] Nicaragua controls necessary to locate a home.
Clinical Decision Support System (CDSS)
Chulalongkorn Nurses perceived they had better judgment
University Before-after and information access, all participants
[29a] Thailand qualitative wanted permanent installation.
Chulalongkorn
University Before-after Mean judgment performance score for case
[29a] Thailand quantitative simulations increased by 42%.
17. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-50.
Electronic
Integrated 84.7% of e-IMCI investigations had IMCI
Management of completed compared to 61% with the chart
Childhood Simultaneous booklet. Amount of time for both IMCI and
Illness (e- nonrandomize e-IMCI sessions averaged 12.5 minutes for
IMCI) [30a] Tanzania d controls the one clinician tested.
Increase of 430 new patient visits per
month at intervention sites, increase from
Early baseline of 18% at intervention sites
Diagnosis and compared with decline of 5% at control
Prevention sites. Intervention was associated with
System (EDPS) Longitudinal significant improvements in Global Patient
[31a] India RCT Assessment of Care Index.
SOURCE: Authors’ Analysis
NOTES: Evaluations are in increasing order of strength with multiple
evaluations of a single system placed together. References can be found
in Appendix Exhibit 1a.
18. Blaya JA, Fraser HSF, Holt B. E-health technologies show promise in developing countries. Health Aff (Millwood). 2010;29(2):243-50.
Appendix Exhibit 5a Patient Reminder and Research/Data
Collection Systems Evaluations
System or Country Evaluation
Institution Type Outcome
Patient Reminder Systems
On Cue
Compliance South Cost of 120 SMS reminders were
[32a] Africa Cost R13.90/patient/month (US$2.43).
Intervention had higher completion rate (10.6
vs. 3%), but similar cure rate (62.3 vs.
66.4%) and treatment success rate (73 vs.
On Cue 69%) compared to data from City of Cape
Compliance South Before- Town's TB Control Program for same clinic in
[32a] Africa after 2003.
It cost RM 0.45 per attendance for text
International messaging reminder as compared with RM 0.82
Medical Cost- per attendance for mobile phone reminder. The
University effectivene ratio of cost per unit attendance of text
Puchong [33a] Malaysia ss messaging versus mobile phone was 0.55.
Attendance rates of control, text messaging
and mobile phone reminder groups were 48.1,
59.0 and 59.6%, respectively. The text
messaging group was significantly higher than
International Simultaneou control group, no difference between text
Medical s messaging and mobile phone group. Text
University randomized messaging reminder system cost less than half
Puchong [33a] Malaysia controls of the mobile phone reminder per attendance.
Research/Data Collection Systems
There were no problems with the PDAs while
Ifakara collected data on 83,346 individuals over
Health seven weeks. Dataset was available within 24
Research & hours. Median time to form completion was 14
Development minutes during training and nine minutes
Centre [34a] Tanzania Descriptive during survey.
87% reported that health content received
Uganda helped them make faster more accurate
Health diagnoses. 86% integrated PDA into other
Information activities. 73% able to solve problems; 68%
Network reported problems with 41% of them being
[35a, 36a] Uganda User survey resolved due to lack of technical support.
System provides up to 91% saving per unit
Uganda spending compared to paper-based HMIS data
Health collection and reporting approaches.
Information Reporting compliance to MOH improved from
Network Cost national average of 63% to 94-100% for
[35a, 36a] Uganda analysis districts using UHIN.
Advantages: time savings (95 percent); the
ability to quickly mobilize or organize
individuals (91 percent); reaches audiences
previously difficult or impossible to reach
UN-Vodafone (74 percent); transmit data more quickly and
Partnership Multiple accurately (67 percent); gather data more
[37a] countries User survey quickly and accurately (59 percent).
Albert Gabon Self- Rate of discrepant entries was 1.7%.