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Purpose – The purpose of this article is to investigate one core research question: How can health information technology (HIT) be assessed in a national health care system context?

Design/methodology – We examine this question by taking a systematic approach within a national care system, in which the purpose of HIT is to contribute to a common national health care system's goal: to promote population health in an efficient way. Based on this approach we first develop a framework and our criteria of assessment, and then using Taiwan as a case study, demonstrate how one can apply this framework to assess a national system's HIT. The five criteria we developed are how well does the HIT (1) provide accessible and accurate public health and health care information to the population; (2) collect and provide population health and health care data for government and researchers to analyze population health and processes and outcomes of health care services; (3) provide accessible and timely information that helps to improve provision of cost-effective health care at an institutional level and promotes system-wide efficiency; (4) minimize transaction and administrative costs of the health care system; and (5) establish channels for population participation in governance while also protecting individual privacy.

Findings – The results indicate that Taiwan has high levels of achievement in two criteria while falling short in the other three. Major lessons we learned from this study are that HIT exists to serve a health care system, and the national health care system context dictates how one assesses its HIT.

Originality/value – There is a large body of literature published on the implementation of HIT and its impact on the quality and cost of health care delivery. The vast majority of the literature, however, is focused on a micro institutional level such as a hospital or a bit higher up, on an HMO or health insurance firm. Few have gone further to evaluate the implementation of HIT and its impact on a national health care system. The lack of such research motivated this study. The major contributions of this study are (i) to develop a framework that follows systems thinking principles and (ii) propose a process through which a nation can identify its objectives for HIT and systematically assess its national HIT system. Using Taiwan's national health care system as a case study, this paper demonstrated how it can be done.

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.

To consider how information and information systems can be used to support improving patient flow in acute hospitals (a key target for the National Health Service in England), and the potential role of the National Programme for Information Technology currently being developed.

The literature plus past and present research, teaching and consulting experience with all levels of the National Health Service is drawn on to consider information provision and requirements.

The National Programme for Information Technology specifies many features designed to support improving patient flows, though timescales for implementation are longer than those for the pledged flow improvements, and operational use of this type of information system has been problematic in the National Health Service.

The work is limited to the National Health Service and information systems in use and planned for it. The National Health Service access targets, flow improvement initiatives and the National Programme for Information Technology apply primarily to England.

Some bed/flow management information systems currently in use incorporate tools and capabilities in advance of what is outlined in the National Programme for Information Technology, and some rare cases of culture changes in information system use have been achieved. One should learn from these to inform development and implementation of National Programme systems. These existing information systems and approaches may also be useful to hospitals considering systems prior to implementation of the National Programme for Information Technology.

There has been very little consideration of the use of operational information and information systems for bed/flow management in the literature. Development and implementation of National Programme for Information Technology systems should build from an understanding of the practice and context of bed/flow management.

Recent studies indicated that the level of adoption of health data standards in healthcare organisations remains frustratingly low worldwide although health data standards have been perceived to be an essential tool for interoperability barriers within health information systems. The relevant literature still lacks significant studies concerning the issues of the adoption process of health data standards in healthcare organisations, and in particular those in developing nation. In addressing this gap in knowledge, the purpose of this paper is to investigate the adoption decision of health data standards in tertiary healthcare organisations in Saudi Arabia, and to develop a technology-organisation-environment list that contains the critical factors influencing their adoption.

A multiple-case study methodology was conducted in Saudi Arabia and different data collection methods were used included semi-structured interviews with different decision makers at various levels and departments of the subject organisations, and documents analysis to identify critical factors to the adoption decision of health data standards.

The findings demonstrated a list of key factors from different aspects impacting the adoption decision of health data standards in the subject organisations. The technological factors are complexity and compatibility of health data standards, IT infrastructure, switching costs, market uncertainties, systems integration and enhancing the use of advanced systems. The main organisational factors are the lack of adequate policies and procedures and information management plan, resistance to change, data analysis and accreditation. The core environmental factors are the lack of national regulator and data exchange plan, national healthcare system and the shortage of professionals.

The results from the qualitative data were difficult to generalise to other populations. For example, the structure of the health sector varies from country to country as each health sector has its own characteristics that affect and are affected by national circumstances. In order to provide a more grounded theory resulting from a qualitative study, further examination by conducting quantitative studies is required. In addition, the TOE approach does not take into account the sociotechnical issues and further research is required in this area.

The investigation into the adoption decision of health data standards in tertiary healthcare organisations in Saudi Arabia has led to the development of a technology-organisation-environment list that contains the critical factors influencing their adoption. The research outcome has addressed the gap in knowledge of the adoption of health data standards in healthcare organisations. It also provides the decision maker, and in particular those in developing nations, with better understanding of the adoption process of those standards to better judge and to develop suitable strategy of adoption interventions.

Although recent studies indicated that the level of adoption of health data standards in healthcare organisations remains frustratingly low, the prior studies related to health data standards missed out on the exploration of the adoption decision of different types of health data standards in healthcare organisations and the critical factors influencing their adoption. Research on health data standards adoption based out of a developing country such as Saudi Arabia can also potentially provide several new insights on standards practices.

The purpose of this paper is to explore the challenges of transforming South Africa’s health sector through the country’s eHealth Strategy and particularly one of its key components, the implementation of an integrated Electronic Document and Records Management System (EDRMS).

The study conducted an extensive review of literature and used it as a basis to analyse the challenges as well as opportunities in South Africa’s transformation path within its health sector based on the nation’s eHealth Strategy.

South Africa’s health sector faces three main transformation challenges: inequity, legacy of fragmentation and a service delivery structure biased towards curative rather than preventive services. Health information systems provide a solid platform for improving efficiency but, within South Africa, these systems have been highly heterogeneous. A recent study showed the country had more than 40 individual health information systems scattered in all provinces, with over 50 per cent not adhering to any national or international standards and more than 25 per cent being stand-alone applications that shared information neither locally nor externally. The eHealth Strategy offers a robust platform to start addressing the legacy of fragmentation and lack of interoperability. However, it also raises a few other concerns, including the use of different terminology such as Electronic Medical Record (EMR) interchangeable with Electronic Health Record (EHR), or EDRMS parallel with Electronic Content Management (ECM). In addition, there is the opportunity to explore the use of the maturity model concept in the EDRMS implementation experiences within South Africa.

This paper demonstrated the complex nature of the legacy of fragmentation in South Africa’s health information systems and explored three aspects relating to terminology as well as maturity models that should be considered in the country’s future eHealth Strategy.

In a technological age where and how does the health sector fit in? Have hospitals and other health agencies that are updated technologically also advanced in other areas of service and operation?

Discusses the national health information system in Brazil which, until very recently, consisted of two main structures of health services with a dichotomy between curative and preventive health care acting in a vertical manner. The autonomy of health authorities and specialized structures created numerous independent health information systems with different methods of data collection. Although the issues of decentralization and a unified health system had been agreed on in 1963, they had not been implemented until the new health policy reform was lunched in 1988. The reform was based on the strengthening of primary health care at national level and accelerating decentralization of health systems. However, in spite of strong political will the new health managers at local level are lacking essential information, data and instruments that only a decentralized health management information system can provide. Based on a study conducted in the Ceara State of the north east of Brazil, explores how the present health information system can support the process of decentralization.

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.

This paper aims to report some findings of a study that investigated health information systems (HISs) in Namibia with a view of establishing the nature of these systems and coming up with recommendations on how these could be enhanced.

This study applied a mixed methods research approach, using interviews and survey questionnaire to collect data. Survey data were analysed for descriptive statistics using SPSS and data from interviews were analysed applying content analysis for data analysis.

The findings of this study indicate fragmented HISs resulting in duplication of diagnosis, tests and treatment. The findings show that there were errors in capturing data into the systems, which could compromise the reliability of the data and compromise service delivery.

This study was limited to two (Khomas and Oshana) of the fourteen regions in Namibia; therefore, further studies could look at other regions, as the study findings cannot be generalised to the entire country.

The findings and recommendations, particularly those relating to the public health sector, could inform policies and procedures, especially those relating to the patient health passport (card), and the way health information is shared within and across health sectors.

This study focused on health information sharing, whereas a previous study on HISs concentrated on quality of healthcare.

SatelLife is an international not‐for‐profit organisation, which began as an initiative of the group known as International Physicians for the Prevention of Nuclear War (IPPNW), recipient of the 1985 Nobel Peace Prize. Based in Cambridge, Massachusetts, SatelLife aims to promote the use of micro‐satellite technology to serve the health communication and information needs of countries in the developing world SatelLife administers HealthNet, which uses a ‘store and forward’ satellite in a pole‐to‐pole orbit, HealthSat, in order to facilitate the transmission of messages and information between the ground stations over which it passes. The system is relatively cheap to install and is independent of the notoriously unreliable communications infrastructures of Third World countries, relying as it does on radio rather than telephone links between each ground station and the satellite. HealthNet is specifically designed to facilitate the exchange of information among health professionals in the developing world and to link them with their colleagues in First World countries. Essentially an e‐mail system, HealthNet has been installed in several northern African countries as well as Cuba, However, HealthNet is also used to facilitate the distribution of an electronic newsletter among African medical librarians. Although South Africa is technologically far more advanced than the rest of Africa, problems still arise in terms of the transmission of essential health statistics and data that is now required for demographic and healthcare planning in terms of the ANC's new health policy. Accordingly, a pilot study linking three of the more under‐developed regions in South Africa has recently been established under the coordination of a national manager. In South Africa, the system will be known as HealthLink, as HealthNet already exists as a trademark in this country. This paper aims to describe the background leading to the establishment of HealthLink, as well as its current status in the improvement of electronic healthcare information delivery in South Africa