DEVELOPING AN ELECTRONIC PALLIATIVE CARE COORDINATION SYSTEM (EPACCS) WITHIN A LARGE CITY WITH MULTIPLE CLINICAL IT SYSTEMS

The implementation of clinical IT systems is resource-demanding and difficult. In this paper we show how laboratory-based usability tests can be used as a last checkpoint before a system is rolled out, and share lessons learnt on how to conduct such tests in order to obtain valid results. The recommendations are based on experiences from two usability tests of a new medication module conducted in the spring 2008, where two nurses and two physicians simulated a pre round meeting, ward round, and administration of medication in a usability lab furnished as a hospital ward. The results show that details around the test situation are important for testing of implementation ready clinical IT systems. Patient cases must be adapted to the clinical specialties of the test participants, the patient data in the system must be complete, and persons holding the roles as patients have to understand the patient histories and the medical problem.

Hospital characteristics that facilitate IT adoption have been described by the literature extensively, however with controversial results. The aim of this study therefore is to draw a set of the most important variables from previous studies and include them in a combined analysis for testing their contribution as single factors and their interactions. Total number of IT systems installed and number of clinical IT systems in the hospital were used as criterion variables. Data from a national survey of German hospitals served as basis. Based on a stepwise multiple regression analysis four variables were identified to significantly explain the degree of IT adoption (60% explained variance): 1) hospital size, 2) IT department, 3) reference customer and 4) ownership (private vs. public). Our results replicate previous findings with regard to hospital size and ownership. In addition our study emphasizes the importance of a reliable internal structure for IT projects (existence of an IT department) and the culture of testing and installing most recent IT products (being a reference customer). None of the interactions between factors was significant.

BackgroundThere is a need for greater understanding of the epidemiology of primary care patient safety in order to generate solutions to prevent future harm.AimTo estimate the rate of failures in processing actions requested in hospital discharge summaries, and to determine factors associated with these failures.Design and settingThe authors undertook a retrospective records review. The study population was emergency admissions for patients aged ≥75 years, drawn from 10 practices in three areas of England.MethodOne GP researcher reviewed the records for 300 patients after hospital discharge to determine the rate of compliance with actions requested in the discharge summary, and to estimate the rate of associated harm from non-compliance. In cases where GPs documented decision-making contrary to what was requested, these instances did not constitute failures. Data were also collected on time taken to process discharge communications.ResultsThere were failures in processing actions requested in 46% (112/246) of discharge summaries (95% confidence interval [CI] = 39 to 52%). Medications changes were not made in 17% (124/750) of requests (95% CI = 14 to 19%). Tests were not completed for 26% of requests (95% CI = 16 to 35%), and 27% of requested follow-ups were not arranged (95% CI = 20 to 33%). The harm rate associated with these failures was 8%. Increased risk of failure to process test requests was significantly associated with the type of clinical IT system, and male patients.ConclusionFailures occurred in the processing of requested actions in almost half of all discharge summaries, and with all types of action requested. Associated harms were uncommon and most were of moderate severity.

Chapter 14 - Nurse Education in the Digital Age—A Perspective From the United Kingdom

Today’s operating rooms consist of numerous medical devices, clinical IT systems and systems for computer assisted surgery. The majority of these systems comes from different vendors and has different user interface designs and interaction schemes. This diversity introduces a high risk of accidental misuse, which is critical in the surgical domain. The proposed framework integrates user interfaces of heterogeneous components into one central control console using a uniform screen design and interaction scheme. To accomplish this, the standards Universal Remote Console (URC) and Device Profiles for Web Services (DPWS) have been combined and integrated. The prototype results are demonstrated in the ICCAS integrated operating room.

BackgroundThere has been a resurgence of Artificial Intelligence (AI) on a global scale in recent times, resulting in the development of cutting-edge AI solutions within hospitals. However, this has also led to the creation of isolated AI solutions that are not integrated into clinical IT. To tackle this issue, a clinical Artificial Intelligence (AI) platform that handles the entire development cycle of clinical AI models and is integrated into clinical IT is required. This research investigates the integration of a clinical AI platform into the clinical IT infrastructure. This is demonstrated by outlining the stages of the AI model development cycle within the clinical IT infrastructure, illustrating the interaction between different IT system landscapes within the hospital with BPMN diagrams.MethodsInitially, a thorough analysis of the requirements is conducted to refine the necessary aspects of the clinical AI platform with consideration of the individual aspects of clinical IT. Subsequently, processes representing the entire development cycle of an AI model are identified. To facilitate the architecture of the AI platform, BPMN diagrams of all the identified processes are created. Clinical use cases are used to evaluate the processes using the FEDS framework.ResultsOur BPMN process diagrams cover the entire development cycle of a clinical AI model within the clinical IT. The processes involved are Data Selection, Data Annotation, On-site Training and Testing, and Inference, with distinctions between (Semi-Automated) Batch Inference and Real-Time Inference. Three clinical use cases were assessed to evaluate the processes and demonstrate that this approach covers a wide range of clinical AI use cases.ConclusionsThe evaluations were executed successfully, which indicate the comprehensive nature of our approach. The results have shown that different clinical AI use cases are covered by the BPMN diagrams. Our clinical AI platform is ideally suited for the local development of AI models within clinical IT. This approach provides a basis for further developments, e.g., enabling the training and deployment of an AI model across multiple sites or the integration of security- and privacy-related aspects.

E-health Information Management according Types of DRGs and ICD Classification Systems: Greek Perspectives and Initiatives

BackgroundThe End of Life (EoL) Strategy (2008) recommends a care pathway approach for commissioning and delivering integrated EoL health and social care (H&SC) services. The historical development and redesign of...

The aim of the paper is to present the research analysis and author’s practical experiences in implementing modern IT solutions. These solutions concern, in particular building and implementing the Integrated Multilevel IT Systems for Logistics, Finance and HR operating in the defense and security services. The detailed research was also on possibility of implementing systems for product coding, electronic shopping and distance learning. Implementing modern IT solutions should improve performance in logistics, finance and HR in defense and security services. The implementation of these solutions in both areas at the same time will be the most effective approach to manage the assets in the most effective way. Implemented IT solutions support rational planning, collecting, storing and using assets. Logistics management should be integrated with finances and Human resources, which facilitates delivery of necessary assets in tight quantity, quality, place and time for competitive price. This will influence achieving set aims (fulfilling tasks) in time of peace, crisis and war. Presented solutions set general directions for informatization and involve implementation of the latest technologies (software, applications, hardware, and computer networks) and IT security. As the result the Integrated Multilevel IT Systems for Logistics, Finance and HR should be built. This system with applied planning, analytical and evaluation applications operates in real time and facilitate information exchange with systems of national economy, NATO and EU. The base of Integrated Multilevel IT Systems for Logistics, Finance and HR is the reliable coding and identification system for all assets used and in stock. With the coding system it is possible to organize electronic shopping which help prevent corruption. The distance learning (e-learning) is another effective solution for logistics, finance and HR. Presented possibilities of implementing new IT solutions for logistics, finance and HR are not the only possibilities new IT solutions offer. The presented ones should serve as an inspiration for decision-makers to further actions, theoretical research and practical steps. The conducted research proved that new IT solutions influence better performance of logistics, finance and HR for defense and security services. It should also be indicated that implementation of new solutions for defense and security services is long organizational and intellectual process. It needs financial means, well prepared experts at single organizational levels where these solutions are being implemented.

The study investigated the quality of end-of-life care in hospitals settings and the utility of bereaved relatives’ views for improving care. It was conducted over ten years utilizing a multi-phased mixed methods design. In Ireland, 30,000 people die each year. Two thirds die in hospital settings. Yet prior to the initiation of this study in 2007, there was little research examining bereaved relatives’ perspectives of the quality of end-of-life care in hospital settings. There was a gap in the research comparing quality between acute and community hospitals. The first phase of the study (Part A) began in 2007. It compared the quality of end-of-life care, rated retrospectively by bereaved relatives, between two acute and two community hospitals. It examined the importance of hospital type (acute versus community) in comparison to patient and family factors, in influencing bereaved relatives’ perception of two outcomes measures (a) unmet needs for specific domains of end-of-life care and (b) satisfaction with care. The study design formed a cross sectional retrospective postal survey. Of 374 relatives contacted, 142 opted to consent to receive the questionnaire. Then 118 (Acute Hospitals =50, Community Hospitals = 68) relatives returned questionnaires. The study response rate was 31.6%. The Part A survey formed part of the early work of the Hospice Friendly Hospitals (HFH) Programme. This was a nationwide initiative, implemented over three phases between 2007 and 2015, concerned with improving the quality of end-of-life care for patients and their families. As the HFH Programme progressed there was an observed shift in approaches to measuring quality of end-of-life care. In addition to research approaches, bereaved relatives’ views were now being collated using quality improvement and assurance approaches. Yet no reflective account existed of the pragmatic value of collating their views for making improvements in care, nor of the relative utility of the different paradigms outlined. Therefore in 2014, the second phase of this study (Part B) explored healthcare professionals’ and other stakeholders’ views of the potential of bereaved relatives’ feedback to inform positive change in the care of dying patients and their families, at individual, organisational and national level of the hospital system of care. In Part B of the study, 11 stakeholders were interviewed who had experience considering or collecting bereaved relatives’ views. These included End-of-Life Co-ordinators, Researchers &amp; Academics, National Advocacy workers and National Level Health Service Managers/Regulators. Interpretive Phenomenological Analysis (IPA) was used to explore participants’ views and experiences. Findings from Part A &amp; B of the study were integrated in order to inform the overall programmatic aim associated with the study – the improvement of end-of-life care in acute and community hospitals. Part A respondents positively rated the quality of care in the hospitals. There were few unmet <em>patient needs</em> overall but in comparison, a preponderance of unmet <em>family needs</em> for emotional support and information. Part A respondents did not distinguish between the quality of end-of-life care in acute and community hospitals, though co-ordination of care and patient needs for help with feelings of anxiety and sadness formed an exception to this. Rather than setting of care, the importance of family preparedness for the death, of patient awareness of dying and of the family being informed that their relative was likely to die soon were highlighted. Part B participants identified both positive and nuanced perceptions of the utility of the views of bereaved relatives for informing change. Societal norms (a reluctance to talk about death and dying and, to challenge the over-medicalisation of dying) were seen as barriers to improvement. These norms, inherent in research models which exclude dying patients, were seen to mitigate against positive change in the care of dying patients and their families. In particular, to mitigate against care in relation to preparedness for dying and communication around death and dying in general. Among the research recommendations were the exploration of research models that would support preparedness for dying and a societal opening of conversations about dying.

Few cancer physicians routinely provide bereavement follow-up in clinical practice. The purpose of this study was to identify the prevalence of impaired mental health among the bereaved spouses over several years and explore the indicators for early detection of high-risk spouses during end-of life (EOL) care. A cross-sectional mail survey was conducted for the bereaved spouses of patients who had died at the National Cancer Center Hospital of Japan. Bereaved spouses with potential psychiatric disorders were identified by the cut-off score of the 28-item General Health Questionnaire. Associated factors of potential psychiatric disorders were explored by logistic regression analysis. A total of 821 spouses experiencing bereavement from 7 months to 7 years returned the questionnaires. Overall mean prevalence of potential psychiatric disorders was 44% (360/821). Bereaved spouses 'under 55 years' (71%) or '2 years after bereavement' (59%) revealed a significantly higher prevalence (p < 0.01). Associated factors during EOL care were several characteristics such as 'spouses' history of psychiatric disorder (odds ratio (OR) = 3.19), 'patients' with stomach cancer (OR = 1.87), and 'patients' using psychiatric consultation services (OR = 1.52) as well as spouses' dissatisfaction with EOL care such as 'physicians' treatment of physical symptoms' (OR = 3.44) and 'time spent communicating with patients' (OR = 1.55). Nearly half the bereaved spouses showed potential psychiatric disorders even 7 years after bereavement. Patients' psychological distress, spouses' history of psychiatric disorder, and dissatisfaction with EOL care were indicators of high-risk spouses.

Information Technology has had significant impact on the society and has touched all aspects of our lives. So far, computers and expensive devices have fueled this growth. The challenge now is to take this success of IT to its next level where IT services can be accessed by masses. Masses here mean the people who (a) are not yet IT literate and/or (b) do not have the purchase power to use the current IT delivery mechanisms (PC centric model) and/or (c) do not find current IT solutions and services relevant to their life or business. Interestingly, a huge portion of the world's population falls in this category. To enable the IT access to such masses, this workshop focuses on easy-to-use and affordable, yet powerful, user interfaces that can be used by this population.

The article concerns the analysis of elements building the reliability of IT solutions used in the organizations (system reliability, usage reliability, information reliability and support service reliability) and their influence on IT performance in conditions of the crisis, which calls for social-distancing and forces employees to work remotely, putting IT performance at the centre of attention for organizations seeking ways to survive the crisis. The article aims at verifying the IT Reliability Model under such conditions and identifies which elements building the reliability of IT solutions may contribute to ensuring IT performance. The empirical study is performed among 115 organizations operating in Italy during the COVID-19 epidemic crisis in March 2020 (during the lockdown and peak of the epidemic). The results are compared with a previous study performed among 349 organizations from Poland and 288 organizations operating in Switzerland operating under normal conditions in January 2019. The obtained results confirmed that there are major differences in the strength and significance of the influence of four elements building IT reliability on IT performance among employees from organizations working under normal conditions and conditions of epidemical crisis. The usage reliability and support service reliability were proven to become key factors influencing IT performance under such critical conditions.Implications for Central European audience: Central Europe was hit by the COVID-19 pandemic, and most of the organizations experienced problems with their functioning due to the need to establish new ways of working in a world of social distancing rules. Information technology became an especially important factor allowing them to remain continuity. Therefore, the analysis of factors influencing its performance during the crisis may help contemporary organizations in Central Europe to overcome the crisis caused by the sudden need to relay, more than ever, on information technology.

The entry of the Russian economy into the 6th technical and technological structure is a matter that affects ensuring the national security of the state and its transition with the help of artificial intelligence to the creation of new developments and increasing the efficiency of work in many areas of the agro-industrial complex (AIC). This will ensure a transition to a qualitatively new level of management of the global economy. Issues related to the growing role of implementing effective IT technologies in agricultural enterprises and the need for timely recognition and use of the opportunities for continuous improvement of business processes are considered. The analysis of the effectiveness of the implementation of IT solutions, including the necessary resource base for this, was carried out as part of the investment of IT projects. A formula is presented for analyzing the cost-effectiveness of implementing integrated IT systems in food industry enterprises with the need to assess the total costs of an IT system for the entire life cycle (development, implementation, commissioning and development, and decommissioning costs). The introduction of information and communication technologies in food production will reduce the production costs of agricultural enterprises, as well as focus on factors of time, quality and surveillance, since the introduction of a suitable IT system will speed up the optimization of organizational and analytical processes. Significant cost savings and long-term productivity gains are key concepts that form the basis of enterprise success in a modern market economy. The necessity of developing a new integrated methodology is substantiated, allowing to take into account separately the development of software and hardware for digital transformation of enterprises and separately calculate the surplus value from the introduction and use of IT solutions in food production enterprises.

The purpose of this study is to determine underlying constructs that predict customer satisfaction during business process reengineering, with focus on organisation strategic goals and information technology as key enabler. Literature review leads to development of a structural equation model (SEM) illustrating links between strategic goals, information technology compounded of behaviour/performance of the utilised IT solution, customer perceived ease of use and attitude, as well as customer satisfaction. The model was tested using survey data from a sample of 236 students who used a new service as result of the process reengineering project. The strategic goals were significantly correlated with both utilised IT solutions and customer satisfaction, while IT solutions had direct effect on customer perceived ease of use and attitude towards the introduced change and utilised technology. Customer attitude also influenced customer satisfaction, while customer perceived ease of use of the IT solution failed to predict their satisfaction.