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This chapter proposes an optimized innovative information technology as a means for achieving operational functionalities of real-time portable electronic health records, system interoperability, longitudinal health-risks research cohort and surveillance of adverse events infrastructure, and clinical, genome regions – disease and interventional prevention infrastructure. In application to the Dod-VA (Department of Defense and Veteran's Administration) health information systems, the proposed modernization can be carried out as an “add-on” expansion (estimated at $288 million in constant dollars) or as a “stand-alone” innovative information technology system (estimated at $489.7 million), and either solution will prototype an infrastructure for nation-wide health information systems interoperability, portable real-time electronic health records (EHRs), adverse events surveillance, and interventional prevention based on targeted single nucleotide polymorphisms (SNPs) discovery.

This qualitative case study aims to identify and analyse the factors influencing the implementation and effectiveness of electronic health record systems (EHRS) in primary health-care (PHC) facilities in Tanzania. This study aims to explore ways to optimize the use of EHRS for better health-care service delivery.

The study uses a qualitative case study design. Data were collected through interviews and focus groups conducted with health-care workers and information and communication technology officers at the PHC facilities in Tanzania. Purposive sampling and data source triangulation were used to address potential biases and limitations associated with the study’s small sample size.

This study identifies several key findings related to the implementation and effectiveness of EHRS in Tanzanian PHC facilities. The primary obstacles include inadequate technical infrastructure, poor internet connectivity and insufficient financial resources. The study suggests a comprehensive strategy for improving EHRS, emphasizing patient and health-care professional involvement in system design, investments in technical infrastructure and connectivity, data quality and accuracy and ongoing technical support and training.

This research contributes to the existing body of knowledge by offering a nuanced understanding of the Tanzanian health-care context. It emphasizes the need for tailored solutions and strategies specific to the region’s challenges and opportunities. The study’s originality lies in its focus on EHRS in the Tanzanian context, providing valuable insights for future initiatives. A key policy implication underscores the importance of a supportive regulatory framework, dedicated resources and consistent stakeholder communication for successful EHRS implementation.

This paper is based on a study done to investigate patient safety in two of the largest hospitals in the Maldives, and part of that study was on challenges faced by nurses in using electronic health records (EHRs) to enhance patient safety. Patient safety is a vital component of an established patient safety culture (PSC).

This study was conducted among nurses who also work as patient safety champions/link nurses from hospitals in Central Malé area, in the Maldives, by using focus group discussions. A purposive sampling technique was adopted, and five nurses from each hospital participated in the discussion.

Key findings included poor usability of EHRs; importance of training to use EHRs; and importance of information sharing.

The implications for positive social change include establishing an EHR, which has the capacity to collaborate with the National Health Information Network while providing access to every patient in the Maldives.

EHR systems can help in collaboration among health-care professionals resulting in better patient outcomes which can contribute to establishing a PSC. Most of the patient documentation is done as paperwork in this clinical area; EHRs can contribute to minimizing paperwork and contributing quality time for better patient care. Establishing an EHR which has the capacity to collaborate with the national health information network while providing access to every patient in the Maldives.

Establishing an EHR which has the capacity to collaborate with the national health information network while providing access to every patient in the Maldives.

Nurses are the bridge between patients and clinicians during patient care and therefore require as much information as possible to improve patient outcomes. While the EHRs in these two hospitals were electronic patient records (EPRs) developed by staff within the hospitals for their own use, the findings from such a bottom-up approach to develop and use EPRs can be relevant, to ensure patient safety targets of EHRs are met.

The purpose of this paper is to investigate the elements that health care personnel in Thailand believe are necessary for successful adoption of electronic medical record (EMR) systems.

Initial qualitative in-depth interviews with physicians to adapt key elements from the literature to the Thai context. The 12 elements identified included things related to managing the implementation and to IT expertise. The nationwide survey was supported by the Ministry of Public Health and returned 1,069 usable questionnaires (response rate 42 percent) from a range of medical personnel.

The key elements clearly separated into a managerial dimension and an IT dimension. All were considered fairly important, but managerial expertise was more critical. In particular, there should be clear EMR project goals and scope, adequate budget allocation, clinical staff must be involved in implementation, and the IT should facilitate good electronic communication.

Thailand is representative of middle-income developing countries, but there is no guarantee findings can be generalized. National policies differ, as do economic structures of health care industries. The focus is on management at the organizational level, but future research must also examine macro-level issues, as well as gain more depth into thinking of individual health care personnel.

Technical issues of EMR implementation are certainly important. However, it is clear actual adoption and use of the system also depends very heavily on managerial issues.

Most research on EMR implementation has been in developed countries, and has often focussed more on technical issues rather than examining managerial issues closely. Health IT is also critical in developing economies, and management of health IT implementation must be well understood.

Electronic health records (EHR) can enable collection and use of data for achieving better health both at the patient and population health levels. The World Health Organization's (WHO) draft 2019 four-year global digital health strategy aims to “improve health for everyone, everywhere by accelerating the adoption of appropriate digital health” and EHRs are key to achieving better health goals. Despite the fact that EHRs can help to achieve better health, there is lack of evidence explaining national and sub-national EHR development in the limited resource settings.

We conducted a landscape study to describe the EHR development and use in the low- and middle-income countries for achieving better health. We reviewed literature from four scientific databases and analyzed gray literature identified in consultation with 17 international experts.

The findings of this literature review are presented in three subsections. The first two subsections describe key stakeholders for development of national and sub-national EHR and health information architecture which includes status of ehealth foundations, EHR, and sub-systems in the country. The third subsection presents and discusses key challenges related to sustainability of national and sub-national EHRs. The findings in these three subsections are further explored through examples of health information flow in Uganda, and electronic medical record/EHR implementation in Sierra Leone and Malawi. These examples briefly describe stakeholders, information architecture, and sustainability challenges.

This paper fills an important research gap and clearly explains the urgent research need to build context-specific EHR development models to enable use of data for better health.

Information and communication technologies can transform how services can be and are delivered as has already happened in other arenas, such as civil aviation, financial services and retailing. Most modern health care is heavily dependent on e-health, including record keeping, targeted information sharing and digital diagnostic and imaging techniques. However, there remains little scientific knowledge base for optimal system content and function in primary health care, particularly for children. Models of Child Health Appraised (MOCHA) aimed to establish the current e-health situation in children’s primary care services. Electronic health records (EHRs) are in regular use in much of northern and western Europe and in some newer European Union Member States, but other countries lag behind. MOCHA investigated the use of unique identifiers, the use of case-based public health EHRs and the capability of record linkage, linkage of information with school health data and monitoring of social media influences, such as health websites and health apps. A widespread lack of standards underlined a lack of research enquiry into this issue in terms of children’s health data and health knowledge. Health websites and apps are a growing area of healthcare delivery, but there is a worrying lack of safeguards in place. The challenge for policy-makers and practitioners is to be aware and to lead on the innovative harnessing of new technologies, while protecting child users against new harms.

The purpose of this paper is to validate and measure the overall evaluation of electronic health record (EHR) and identify the factors that influence the health information systems (HIS) assessment in Brazil.

From February to May 2020, this study surveyed 262 doctors and nurses who work in hospitals and use the EHR in their workplace. This study validated the National Usability-focused HIS Scale (NuHISS) to measure usability in the Brazilian context.

The results showed adequate validity and reliability, validating the NuHISS in the Brazilian context. The survey showed that 38.9% of users rated the system as high quality. Technical quality, ease of use and benefits explained 43.5% of the user’s overall system evaluation.

This study validated the items that measure usability of health-care systems and identified that not all usability items impact the overall evaluation of the EHR.

NuHISS can be a valuable tool to measure HIS usability for doctors and nurses and monitor health systems’ long-term usability among health professionals. The results suggest dissatisfaction with the usability of HIS systems, specifically the EHR in hospital units. For this reason, those responsible for health systems must observe usability. This tool enables usability monitoring to highlight information system deficiencies for public managers. Furthermore, the government can create and develop actions to improve the existing tools to support health professionals.

From the scale validation, public managers could monitor and develop actions to foster the system’s usability, especially the system’s technical qualities – the factor that impacted the overall system evaluation.

To the best of the authors’ knowledge, this study is the first to validate the usability scale of EHR systems in Brazil. The results showed dissatisfaction with HIS and identified the factors that most influence the system evaluation.

Information systems (IS) research in general and health IS studies, in particular, are prone to a positivity bias – largely focusing on upside gains rather than the potential misuse practices. This paper aims to explore failures in health IS use and shortcomings in data privacy and cybersecurity and to provide an explanatory model for health record misuse.

This research is based on four data sets that we collected through a longitudinal project studying digital health (implementation, use and evaluation), interviews with experts (cybersecurity and digital health) and healthcare stakeholders (health professionals and managers). We applied qualitative analysis to explain health records misuse from a sociotechnical perspective.

We propose a contextualized model of “health records misuse” with two overarching dimensions: data misfit and improper data processing. We explain sub-categories of data misfit: availability misfit, meaning misfit and place misfit, as well as sub-categories of improper data processing: improper interaction and improper use-related actions. Our findings demonstrate how health records misuse can emerge in sociotechnical health systems and impact health service delivery and patient safety.

Through contextualizing system misuse in healthcare, this research advances the understanding of ineffective use and failures in health data protection practices. Our proposed theoretical model provides explanations for unique patterns of IS misuse in healthcare, where data protection failures are consequential for healthcare organizations and patient safety.

This study aims to investigate the adoption and use of electronic health record systems (EHRS) in Tanzanian public primary healthcare institutions. The study’s objectives include understanding the factors that affect EHRS adoption, identifying implementation challenges and evaluating the effect of EHRS usage on healthcare delivery. By addressing these research goals, the study aims to contribute insightful information on the current level of EHRS adoption in Tanzanian primary healthcare facilities and contribute to developing strategies to improve EHRS deployment and healthcare in the nation.

This study combined quantitative and qualitative data using a mixed-methods methodology. Both data types were collected and analysed concurrently using a concurrent triangulation approach. The study aimed to comprehend the variables that affect the adoption and use of EHRS in Tanzanian public primary healthcare institutions. Eleven regions spanning various geographic locations and urban–rural dynamics were chosen as research sites. A survey of 122 healthcare employees was conducted with a sample of 31 healthcare facilities. The questionnaire had closed-ended and open-ended questions to gather quantitative and qualitative data. Descriptive statistics and thematic analysis were used in data analysis. Throughout the investigation, ethical standards and confidentiality precautions were observed.

Several factors affect the adoption and use of EHRS. Perceived usefulness and use, support and training, interoperability, data security and privacy, business culture and leadership are all factors. Inadequate infrastructure, power interruptions, duplication of effort and a lack of data analytic expertise were among the difficulties. Among the effects were improvements in data management, service delivery and coordination, productivity and efficiency, medical supply inventory control, billing and revenue collection.

This study, which complements earlier research that has concentrated chiefly on specialised healthcare settings, gives new insights by investigating the adoption and utilisation of EHRS, especially in primary healthcare institutions. The findings give policymakers and healthcare professionals in Tanzania and other nations vital information to help them decide whether to embrace and use EHRS in primary healthcare.