Health informatics in the cloud pdf

The high frequency of studies conducted on the implementation of cloud-based health information systems revealed health industry interest in the application of this technology. Security was a subject discussed in most studies due to health information sensitivity.

In this investigation, some mechanisms and solutions were discussed concerning the mentioned systems, which would provide a suitable area for future scientific research on this issue. In all, an estimated district users were given two and a half days of training, starting in September and continuing until March The same week as the system was officially launched in April, an administrators training was held for the appointed district administrators.

This was meant as refresher training, with focus on the administrative functions of the system. It was also used as an opportunity to get all districts started on the system from day one. After the rollout, additional trainings were held for district and regional directors and managers, as well as for managers at the national level.

An important additional purpose of the trainings was to get feedback from the end-users on the system. No pilot phase was planned, and the trainings were therefore the only opportunity for a large scale testing. Many issues were identified and resolved this way, leading to important improvements in the system. In Kenya, the implementation team found that the mobile network coverage was good enough even in rural areas for users to get online using mobile modems.

An assessment in Ghana indicated that a similar online approach would be possible. This allowed the team of implementers in Ghana to quickly get started on the customisation, and at the same time it meant that getting support from the HISP team abroad was easy. GHS wanted to move the system to a server within Ghana before it was rolled out. A donor had provided a server to be used, however, the government did not have a location with the required infrastructure to host it.

It was therefore decided to locate this server with a private hosting company in Accra. At the time of rollout, there was no capacity within GHS to configure and maintain the sever, and a member of the HISP network therefore did the initial setup.

He has continued to perform the regular maintenance up till this date. GHS wants to develop capacity to take over this role, and has requested training on server maintenance from HISP in early An important aspect of hosting is backup and plans for disaster recovery and hardware failure.

Plans for disaster recovery and hardware failure situations are not yet ready. Discussion Customisation of DHIMS2 started in early , and it took only about a year for the system to be rolled out nationally. The use of a central national server, accessible for users over the Internet, has been essential in making this possible.

Comparing the current system to the previous, many of the major improvements are direct results of the system being online. In this section, we discuss the consequences of using an online system, as well as looking at the lessons learned in the key areas of garnering support for integration and capacity building.

Figure 1. If a computer fails, another can be used without requiring any installation. With the previous system, software and databases were installed on computers in all regional and district offices, and government hospital, adding up to several hundred installations that needed to be maintained.

Computer failure meant that the system needed to be reinstalled, and could lead to data loss unless a proper backup system was in place locally. One of the most complex technical tasks performed in districts and regions was the merging or compilation of databases. Over time, minor metadata differences developed between the different databases, making the merging process difficult or impossible.

And because data is no longer transferred via email of physical media, the risk of computers being infected by virus and potentially loosing data is reduced. While using the system has been simplified in the periphery, a more complex central server must now be maintained. Competency in server maintenance is required to administer the system at the central level, something that has proven to be a challenge.

For example, GHS needs to develop procedures of what to do in the event of hardware failure, something that is avoided when using a public provider. Complexity has been moved from the end users in the periphery to the server at the central level, which is a typical property of cloud computing [14]. This merging process often caused delays: regions would either have to wait for the last district to send their database before they could compile a regional database, or send incomplete data to the national level.

Similarly, the national database was not ready until the last region had reported. This does not guarantee that no data is delayed, but it means that data is available for all users once it has been entered in the system. DHIMS2 also improves access to information. Previously, each region or district only had one or two users that knew the software and had access to the system. Only Health Information Officers where trained in use of the software, they typically had the database on their computer, and they where often reluctant to share date.

Firstly, any user registered on the system can log in on any computer with internet access and get the information needed. Secondly, more people have been trained to use the system. Data access is key for a HIS. Key points are illustrated throughout by actual examples of open source and commercial health IT products and services.

While written with practitioners and students entering the field of clinical informatics in mind, the book eschews technical terminology and is easily accessible by the lay reader not proficient in clinical medicine or information technology. It is organized into eight chapters.

I highly recommend the book for those seeking a sophisticated primer. Skip to main content Skip to table of contents. Advertisement Hide. This service is more advanced with JavaScript available. Health Informatics in the Cloud.

Figure 3. Acknowledgments Funding Sources: Drs. Contributor Information Claire F. References 1. Institute of Medicine. Crossing the Quality Chasm. Institute for Healthcare Improvement. Berwick D. Health Aff Millwood ; 28 :w— Wachter RM. Hersh W. A stimulus to define informatics and health information technology. What is the quality of surgery-related information on the internet? Lessons learned from a standardized evaluation of 10 common operations. J Am Coll Surg. A comparison of world wide web resources for identifying medical information.

Acad Radiol. Medication errors among adults and children with cancer in the outpatient setting. J Clin Oncol. Medication safety in the ambulatory chemotherapy setting. Certification Commission for Health Information Technology. Principles of safe practice using an oncology EHR system for chemotherapy ordering, preparation, and administration, Part 1 of 2. J Oncol Pract. Schwappach DL, Wernli M. Healthcare system approaches for cancer patient communication. J Health Commun.

Fam Med. Centers for Medicare and Medicaid Services. What it takes: Characteristics of the ideal personal health record. Health Aff Millwood ; 28 — A vision for patient-centered health information systems.

The anxious wait: Assessing the impact of patient accessible EHRs for breast cancer patients. An Internet-based patient-provider communication system: randomized controlled trial. J Med Internet Res. Patient web services integrated with a shared medical record: patient use and satisfaction. J Am Med Inform Assoc. Tang PC, Lansky D. The missing link: bridging the patient-provider health information gap. Health Aff Millwood ; 24 — Web-based care management in patients with poorly controlled diabetes.

Diabetes Care. Communication plays a critical role in web-based monitoring. J Diabetes Sci Technol. Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. Implement Sci. Doctor-patient relationship as motivation and outcome: examining uses of an Interactive Cancer Communication System.

Int J Med Inform. Electronic surveillance of testicular cancer: understanding patient perspectives on access to electronic medical records. Measuring quality of life in routine oncology practice improves communication and patient well-being: a randomized controlled trial. Adverse symptom event reporting by patients vs clinicians: relationships with clinical outcomes. J Natl Cancer Inst. Use of health-related quality-of-life assessments in daily clinical oncology nursing practice: a community hospital-based intervention study.

Randomized trial of coordinated psychosocial interventions based on patient self-assessments versus standard care to improve the psychosocial functioning of patients with cancer. Role of a medical social worker in improving quality of life for patients with advanced cancer with a structured multidisciplinary intervention. J Psychosoc Oncol. PatientViewpoint: a website for patient-reported outcomes assessment.

Qual Life Res. Electronic collection of health-related quality of life data: validity, time benefits, and patient preference. Response rate and completeness of questionnaires: a randomized study of Internet versus paper-and-pencil versions. The application of computer touch-screen technology in screening for psychosocial distress in an ambulatory oncology setting.

Eur J Cancer Care Engl ; 11 — Relevant content for a patient-reported outcomes questionnaire for use in oncology clinical practice: Putting doctors and patients on the same page. The clinical value of quality of life assessment in oncology practice-a qualitative study of patient and physician views. Long-term toxicity monitoring via electronic patient-reported outcomes in patients receiving chemotherapy.