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This chapter more clearly identifies the distinction between Electronic Health Record (EHR) and Electronic Medical Record (EMR), and states their value in obtaining individual-level data. Synthetic medical records may be used as a surrogate for EHR data in order to ensure digital data privacy is maintained during the development of the LHS. Synthea is an open-source simulation tool available through GitHub.¹ Extensive descriptive analysis of synthesized data is provided as a foundation for the analysis in Chapter 7.

Recently, interest and necessity for cloud-based hospital information systems (HISs) have emerged as an appropriate alternative for revitalizing medical information exchange between hospitals, analyzing “big data” medical information and developing the use of new medical technologies. The purpose of this paper is to investigate factors that affect the switching of information systems in existing on-premise environments into cloud-based HISs.

A research model was developed using the push–pull–mooring model based on migration theory. The research model was analyzed using confirmatory factor analysis and path analysis using partial least squares structural equation modeling.

The results of this study showed that low compatibility, perceived value, low cost and inertia influenced the intention to switch to cloud-based HISs; low flexibility and low compatibility influenced dissatisfaction; and low cost, ease of maintenance and ease of managing indicators influenced perceived value.

This study is expected to be used as the basis for developing a research model in subsequent studies to analyze the transition to new innovative technologies. Also, in practice, it is expected to contribute to the activation of cloud computing environments in hospitals.

Today, e-government (electronic government) applications have extended to the frontiers of health-care delivery. E-Nabız contains personal health records of health services received, whether public or private. The use of the application by patients and physicians has provided efficiency and cost advantages. The success of e-Nabız depends on the level of technology acceptance of health-care service providers and recipients. While there is a large research literature on the technology acceptance of service recipients in health-care services, there is a limited number of studies on physicians providing services. This study aims to determine the level of influence of trust and privacy variables in addition to performance expectancy, effort expectancy, social influence and facilitating factors in the unified theory of acceptance and use of technology (UTAUT) model on the intention and behavior of using e-Nabız application.

The population of the study consisted of general practitioners and specialist physicians actively working in any health facility in Turkey. Data were collected cross-sectionally from 236 physicians on a voluntary basis through a questionnaire. The response rate of data collection was calculated as 47.20%. Data were collected cross-sectionally from 236 physicians through a questionnaire. Descriptive statistics, correlation analysis and structural equation modeling were used to analyze the data.

The study found that performance expectancy, effort expectancy, trust and perceived privacy had a significant effect on physicians’ behavioral intentions to adopt the e-Nabız system. In addition, facilitating conditions and behavioral intention were determinants of usage behavior (p < 0.05). However, no significant relationship was found between social influence and behavioral intention (p > 0.05).

This study confirms that the UTAUT model provides an appropriate framework for predicting factors influencing physicians’ behaviors and intention to use e-Nabız. In addition, the empirical findings show that trust and perceived privacy, which are additionally considered in the model, are also influential.

This study aims to review and understand the state of records management practices in Malawi, focusing on both public and private sector organisations.

The hermeneutic framework underpinned a qualitative review of the study phenomenon. The inclusion and exclusion criterion for the literature was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis methodology. Fifteen documents met the eligibility criteria and informed the study findings. The literature comprised of journal articles, dissertations at both master and doctoral levels, and conference papers.

The study found that records are created, captured and maintained both in print and electronic formats. It also confirmed that different types of organisations (public, private, academia and civil society) recognise the need for proper records management practices. However, effective and efficient records management is besieged by numerous obstacles, including lack of funding, absence of records management policy, standards and procedures at both institutional and national levels, poor records classification systems and a lack of top management support. Most importantly, the review shows that the majority of studies in Malawi have focused on academia, with little attention to other equally fundamental areas such as agriculture, trade, tourism, transport and energy. Thus, this situation calls for more empirical studies of records management practices in those sectors.

To the best of the authors’ knowledge, this is the first kind of review to be done at a national level, so the findings provide significant insights for policymakers and research practitioners on records management research trends to date in Malawi.

The purpose of this study is to examine the state of research into adoption of machine learning systems within the health sector, to identify themes that have been studied and observe the important gaps in the literature that can inform a research agenda going forward.

A systematic literature strategy was utilized to identify and analyze scientific papers between 2012 and 2022. A total of 28 articles were identified and reviewed.

The outcomes reveal that while advances in machine learning have the potential to improve service access and delivery, there have been sporadic growth of literature in this area which is perhaps surprising given the immense potential of machine learning within the health sector. The findings further reveal that themes such as recordkeeping, drugs development and streamlining of treatment have primarily been focused on by the majority of authors in this area.

The search was limited to journal articles published in English, resulting in the exclusion of studies disseminated through alternative channels, such as conferences, and those published in languages other than English. Considering that scholars in developing nations may encounter less difficulty in disseminating their work through alternative channels and that numerous emerging nations employ languages other than English, it is plausible that certain research has been overlooked in the present investigation.

This review provides insights into future research avenues for theory, content and context on adoption of machine learning within the health sector.

Taking a business lens of telehealth, this article aims to review and provide a state-of-the-art overview of telehealth research.

This research conducts a systematic literature review using the scientific procedures and rationales for systematic literature reviews (SPAR-4-SLR) protocol and a collection of bibliometric analytical techniques (i.e. performance analysis, keyword co-occurrence, keyword clustering and content analysis).

Using performance analysis, this article unpacks the publication trend and the top contributing journals, authors, institutions and regions of telehealth research. Using keyword co-occurrence and keyword clustering, this article reveals 10 major themes underpinning the intellectual structure of telehealth research: design and development of personal health record systems, health information technology (HIT) for public health management, perceived service quality among mobile health (m-health) users, paradoxes of virtual care versus in-person visits, Internet of things (IoT) in healthcare, guidelines for e-health practices and services, telemonitoring of life-threatening diseases, change management strategy for telehealth adoption, knowledge management of innovations in telehealth and technology management of telemedicine services. The article proposes directions for future research that can enrich our understanding of telehealth services.

This article offers a seminal state-of-the-art overview of the performance and intellectual structure of telehealth research from a business perspective.

This study intends to improve the quality of venous thromboembolism (VTE) prophylaxis practices including proper VTE risk assessment and the appropriate prophylaxis measures for surgical urology patients.

The authors applied the Six-Sigma define, measure, analyze, improve and control (DMAIC) improvement methodology in a pre–post interventional study that involved all adult patients above 18 years old indicated and scheduled for urology surgical interventions including endoscopic urological surgeries in a urology specialized 60-bed hospital. The pre-intervention sample included all patients meeting the inclusion criteria over a period of six months. Post-intervention sample included all patients meeting the inclusion criteria over a period of six months. The improvement areas included both the VTE risk assessment as well as the VTE prophylaxis prescription.

DMAIC methodology has achieved a substantial sustained improvement in surgical urology VTE prophylaxis practices with an average of 70% on both levels; VTE risk assessment practices and VTE prophylaxis prescribing practices were statistically significant. The post-intervention results also showed a statistically controlled process with no special cause variations. Based on the study results, the Six-Sigma DMAIC methodology can be considered of high value when applied in healthcare clinical practice improvement projects.

The project study includes some pitfalls that can be addressed as follows: 1. The lack of VTE rate incidence tracking. This limitation can be partly refuted when the authors conduct a literature review and explore that the VTE prophylaxis effectiveness had been proven with sufficient evidence to an extent that pushed several scientific societies to develop their own guidelines to support VTE prophylaxis. (Algattas et al., 2018). 2. Another limitation of this study can be that it handled only surgical patients and more specifically surgical urology patients. Of course, VTE prophylaxis is a crucial life-threatening problem not only for the surgical admitted patients but also for all the medical admitted patients either in hospital wards or ICUs. However, the prediction that surgical patients especially surgical urology patients are more prone to VTE development risk as they have -in several cases-two or three main additive risk factors which are age, procedure duration and malignancy in elderly men. (Tikkinen et al., 2014). So, the authors consider the study project to be a prototype that hopefully can be utilized for future study projects that will manage both other surgical specialty patients and medical patients on the national level and can track accurately and effectively report the VTE incidence rates.

Several recommendations can be extracted from the research project that is summarized in the following points: Paying focused attention to continuous healthcare quality improvement initiatives and projects as a main approach for healthcare improvement especially for the public health-related problems. This might be achieved through periodic region-specific or specialty-specific focus groups from which public health problems could be addressed and prioritized to be considered as a part of country healthcare campaigns regarding cost-utility and feasibility studies. The adoption of a system thinking approach in dealing with the improvement strategies; all efforts and resources are to be employed to achieve a common objective. This includes the generation of a national-wide electronic health information system that can aid in healthcare resource allocation and direct the healthcare efforts towards the most important, high-priority public health problems. Electronic national-wide health record is really an effort, and resources consuming activity, but actually, it's worth exerting efforts, and its valuable outcomes may be seen several years later. 3. Development of unified national specialized VTE prophylaxis pathways to standardize the patient-specific VTE prophylaxis plans. Standardization of healthcare pathways enables healthcare professionals to follow an evidence-based practice which will be reflected on the improvement of healthcare quality level, cost-effectiveness enhancement, and timely patient care on all levels especially in high critical areas like ER and ICU. 4. Incorporation of VTE prophylaxis costs in the universal health insurance diagnosis-related group (DRG) insurance packages and service pricing. Universal health insurance is a nationwide strategy that is aiming to cover all Egypt residents by the year 2030. Universal health insurance is being following the DRG reimbursement policy that is thought to control all the healthcare-associated costs so, the VTE prophylaxis costs shall be added as the main cost item to encourage all healthcare facilities to follow an evidence-based VTE prophylaxis pathway taking into consideration the high-risk patient categories who will definitely represent a high-cost burden on the long run if they suffer a VTE event.

DMAIC improvement methodology applications in healthcare are still relatively limited, especially on the clinical level. The study can be considered one of a kind in Egypt dealing with a comprehensive DMAIC methodology application on the clinical level.

The purpose of the study is to measure the performance of Indian hospitals, both operationally and financially, by using hospital KPI's. The assessment is predominantly done by linking it to the existing Lean practices in Indian hospitals.

An empirical study based on cross-sectional survey of hospital managers and specialists in various private healthcare facilities across India was conducted to validate the proposed Lean framework. From an extensive literature survey, the authors identified quality, delivery, efficiency, accessibility and patient centeredness to be the main operational performance (OP) indicators for hospitals. Business or financial performance was measured based on parameters which are average revenue per occupied bed (ARPOB), earnings before interest, tax, depreciation and amortization (EBITDA) and operating revenue. Confirmatory Factor Analysis (CFA) was carried out using a specialized technique, called Structural Equation Modelling(SEM) and an explicit factor structure was hypothesized.

Management commitment towards Lean in hospitals is statistically proven to have impacted operational and financial performance. However, leanness in technology and business processes showed no statistical significance on either operational or financial performance parameters. Hospital stakeholders showed statistical significance on though it had no impact on the financial performance. Results obtained from the statistical analysis indicate a positive impact of hospital Lean practices on timely delivery of services and improved service quality. Efficiency, accessibility of services and patient centered behavior in hospital operations could not be statistically proven to have impacted the financial performance.

Effectiveness of Lean management (LM) principles in improving hospital operations is largely dependent on patient centered behavior. Empowered employees who are trained to add value from a customer view point, make hospital operations safe and improved. Properly trained and communicated employees who are committed to quality improvements can make a positive impact on patients' quality of life and thus positively impact the society. The study lists ways to attain the required outcomes.

This paper is among the very few that has attempted to suggest ways to link implementation of Lean practices more effectively in Indian hospitals to improve hospital performance at operational and financial levels.

The purpose of this paper is to inform or alert readers to the extensive use and ready availability of genetic information that poses varying degrees of social and legal danger. The eugenics movement of the 1920s and the general acceptance of genetic essentialism provide context for considering contemporary examples of the problem.

This paper takes an argumentative approach, supporting proposals with ideas from historical and current research literature.

The limits of data protection, extensive use of direct-to-consumer genetic testing and use of genetic information in white nationalist circles portend a resurgence of eugenic beliefs from a century ago.

Research-based recommendations may help to avoid extreme consequences by encouraging people to make informed decisions about the use of genetic information.

The paper counterposes contemporary understanding of genetic testing and data accessibility with the much older ideology of eugenics, leading to concerns about how white nationalists might further their aims with 21st century technology.