Health Information Systems (HIS) are becoming crucial for health providers, not only for keeping Electronic Health Records (EHR) but also because of the features they provide that can be lifesaving, thanks to the advances in Information Technology (IT). These advancements have led to increasing demands for additional features to these systems to improve their intelligence, reliability, and availability. All these features may be provisioned through the use of cloud computing in HIS. This study arrives at three dimensions pertinent to adoption of cloud computing in HIS through extensive interviews with experts, professional expertise and knowledge of one of the authors working in this area, and review of academic and practitioner literature. These dimensions are financial performance and cost; IT operational excellence and DevOps; and security, governance, and compliance. Challenges and drivers in each of these dimensions are detailed and operationalized to arrive at a model for HIS adoption. This proposed model detailed in this study can be employed by executive management of health organizations, especially senior clinical management positions like Chief Technology Officers (CTOs), Chief Information Officers (CIOs), and IT managers to make an informed decision on adoption of cloud computing for HIS. Use of cloud computing to support operational and financial excellence of healthcare organizations has already made some headway in the industry, and its use in HIS would be a natural next step. However, due to the mission′s critical nature and sensitivity of information stored in HIS, the move may need to be evaluated in a holistic fashion that can be aided by the proposed dimensions and the model. The study also identifies some issues and directions for future research for cloud computing adoption in the context of HIS.
Objective: Anterior odontoid screw fixation for type II odontoid fracture is the ideal management option. However in the context of unavailability of an O-arm or neuro-navigation and poor images from the available C-arm may be an obstacle to ideal trajectory and placement of the odontoid screw. We herein detail our surgical technique so as to ensure a correct trajectory and subsequent good fusion in Type II odontoid fractures. This may be advantageous in clinical set ups lacking state of the art facilities.
Methods and Results: In this cohort study we included 15 consecutive patients who underwent anterior odontoid screw placement. We routinely dissect the longus colli to completely visualize the entire width of C3 body. We then perform a median C2-C3 disectomy followed by creating a gutter in the superior end of C3 body. We then guide the Kirchsner (K) wire purchasing adequate anterior cortex of C2. Rest of the procedure follows the similar steps as described for odontoid screw placement. We achieved 100% correct trajectory and screw placement in our study. There were no instances of screw break out, pull out or nonunion. There was one patient mortality following myocardial infarction in our study.
Conclusion: Preoperative imaging details, proper patient positioning, meticulous dissection, thorough anatomical knowledge and few added surgical nuances are the cornerstones in ideal odontoid screw placement. This may be pivotal in managing patients in developing nations having rudimentary neurosurgical set up.
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