Indoor Morbidity and Mortality Record (IMMR) forms the back bone of data in the evaluation of the health status of a nation. In Sri Lanka it is also an integral part of the health information system which supports management of healthcare, monitoring of disease patterns and evaluation of treatment and prevention. Although the paper based system of IMMR in place has served this purpose over the years to a level of satisfaction, it has increasingly become obsolete with practical and logistical barriers. This has rendered it almost a daunting task to keep up with the expected levels of timeliness, accuracy and relevancy as is required. It has become ever more evident in the recent past with the volatility of disease patterns on the rise and the role of disease surveillance becoming a "life-saver" in current epidemics. In the quest for solutions, healthcare digitisation along with a web-based IMMR, as explored in this instance, proved to be a promising tool and a shift in the right direction. The system introduced will pave the way for the concept of "enter once-use many times" of all data inputs plus the almost unimaginable ways of analysis and presentations. With almost real-time information at hand and extrapolations of such, the digital healthcare information system would inevitably become the "crystal ball" for prediction of the future health needs and disease patterns.
Objectives To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. Methods Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE ‘Guideline Quality Checklist’, and mapping of the supporting evidence. Results Fifteen guidelines were identified: asthma ( n=7) and type 1 diabetes mellitus ( n=7), CF ( n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration ( n=15), chronic condition self-management education ( n= 17), clinicians’ skills ( n= 4); personalized action plans ( n=3), problem-solving ( n=2); and the assessment of children’s chronic condition self-management needs ( n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool ( n=2), and adolescence ( n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines’ recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. Discussion Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.
Objective: To present insights on training challenges arising during the development and implementation of one of Sri Lanka's first national ehealth initiatives: the national electronic hospital separation record system.Methods and procedures: This system aims to improve the reporting of separation diagnosis in public hospitals and was developed through an Agile software methodology. Initially users at 7 hospitals were engaged in the system design and iteratively trained in system use. Subsequently the national roll-out began with a further 8 hospitals trained in the system by October 2012. More than 150 hospitals are expected to have the system in place by January 1 st 2014 and nation-wide implementation is expected to complete by 2017. Analysis of training challenges is based on data from both the first 7 hospitals and the second 8 hospitals. It is anticipated insights presented will support an improved national roll-out of the system Results: Training approaches and user training requirements varied considerably between users involved in the initial development and the users to whom the developed system was subsequently introduced. Significantly, the system changed medical workflow such that the project had to extend
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