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The economic trend and the health care landscape are rapidly evolving across Asia. Effective real-world data (RWD) for regulatory and clinical decision-making is a crucial milestone associated with this evolution. This necessitates a critical evaluation of RWD generation within distinct nations for the use of various RWD warehouses in the generation of real-world evidence (RWE). In this article, we outline the RWD generation trends for 2 contrasting nation archetypes: "Solo Scholars"-nations with relatively self-sufficient RWD research systems-and "Global Collaborators"-countries largely reliant on international infrastructures for RWD generation. The key trends and patterns in RWD generation, country-specific insights into the predominant databases used in each country to produce RWE, and insights into the broader landscape of RWD database use across these countries are discussed. Conclusively, the data point out the heterogeneous nature of RWD generation practices across 10 different Asian nations and advocate for strategic enhancements in data harmonization. The evidence highlights the imperative for improved database integration and the establishment of standardized protocols and infrastructure for leveraging electronic medical records (EMR) in streamlining RWD acquisition. The clinical data analysis and reporting system of Hong Kong is an excellent example of a successful EMR system that showcases the capacity of integrated robust EMR platforms to consolidate and produce diverse RWE. This, in turn, can potentially reduce the necessity for reliance on numerous condition-specific local and global registries or limited and largely unavailable medical insurance or claims databases in most Asian nations. Linking health technology assessment processes with open data initiatives such as the Observational Medical Outcomes Partnership Common Data Model and the Observational Health Data Sciences and Informatics could enable the leveraging of global data resources to inform local decision-making. Advancing such initiatives is crucial for reinforcing health care frameworks in resource-limited settings and advancing toward cohesive, evidence-driven health care policy and improved patient outcomes in the region.

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Resumen Los procesos de digitalización del siglo XX extendieron el uso de Tecnologías de Información y Comunicación al campo de la salud. El artículo aborda la Historia Clínica Electrónica a partir de las críticas y debilidades señaladas por especialistas en Clínica Médica, Medicina General y/o de Familia del Área Metropolitana de Buenos Aires, Argentina. El diseño metodológico cualitativo incluyó 43 entrevistas realizadas entre junio de 2019 y marzo de 2020. El andamiaje teórico interpretativo articula tres campos: Comunicación y Salud; Biomedicina, Biopolítica y Tecnologías de Información y Comunicación; Subjetividad, Derechos y Género. Los principales resultados conciernen a cambios en las relaciones médico-paciente, registro y uso de datos, implicancias sobre los derechos y las subjetividades, potencialidades y problemáticas de la informatización en salud en un contexto de precaria infraestructura, desafíos en la regulación y desigualdades estructurales.(AU)

Abstract Digitalization has extended the use of information and communications technologies in the field of health. This article addresses electronic medical records drawing on the criticisms and weaknesses highlighted by clinical specialists, general practitioners, and family doctors working in the metropolitan region of Buenos Aires, Argentina. The qualitative research design included 43 interviews conducted between June 2019 and March 2020. We developed an interpretive framework structured around three categories: communications and health; biomedicine, biopolitics and information and communication technologies; subjectivity, rights and gender. The main results refer to: changes in doctor-patient relations; data recording and usage; implications for rights and subjectivities; potential and challenges of health informatization in a context of precarious infrastructure; and regulatory challenges and structural inequalities.(AU)

Resumo Os processos de digitalização do século XX estenderam o uso das Tecnologias da Informação e Comunicação ao campo da saúde. O artigo aborda o Registro Médico Eletrônico a partir das críticas e fragilidades apontadas por especialistas em Clínica Médica, Medicina Geral e / ou Família da Área Metropolitana de Buenos Aires, Argentina. O desenho metodológico qualitativo incluiu 43 entrevistas realizadas entre junho de 2019 e março de 2020. O referencial teórico interpretativo articula três campos: Comunicação e Saúde; Biomedicina, Biopolítica e Tecnologias de Informação e Comunicação; Subjetividade, Direitos e Gênero. Os principais resultados referem-se a mudanças nas relações médico-paciente, registro e uso de dados, implicações em direitos e subjetividades, potencialidades e problemas de informatização em saúde em um contexto de infraestrutura precária, desafios na regulação e desigualdades estruturais.(AU)

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BACKGROUND: In this study, we determine the feasibility of using electronic medical record (EMR) data to determine obesity prevalence at the census tract level in El Paso County, Texas, located on the U.S.-Mexico border. METHODS: 2012-2018 Body Mass Index (BMI kg/m2) data from a large university clinic system in was geocoded and aggregated to a census tract level. After cleaning and removing duplicate EMR and unusable data, 143,524 patient records were successful geocoded. Maps were created to assess representativeness of EMR data across census tracts, within El Paso County. Additionally, maps were created to display the distribution of obesity across the same geography. RESULTS: EMR data represented all but one El Paso census tract. Representation ranged from 0.7% to 34.9%. Greatest representation were among census tracts in and around clinics. The mean EMR data BMI (kg/m2) was 30.1, this is approximately 6% less than the 36.0% estimated for El Paso County using the Behavioral Risk Factor Surveillance Study (BRFSS) estimate. At the census tract level, obesity prevalence ranged from 26.6 to 57.6%. The highest obesity prevalence were in areas that tended to be less affluent, with a higher concentration of immigrants, poverty and Latino ethnic concentration. CONCLUSIONS: EMR data use for obesity surveillance is feasible in El Paso County, Texas, a U.S.-Mexico border community. Findings indicate substantial obesity prevalence variation between census tracts within El Paso County that may be associated with population distributions related to socioeconomics.

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BACKGROUND: With the rapid adoption of electronic medical records (EMRs), there is an ever-increasing opportunity to collect data and extract knowledge from EMRs to support patient-centered stroke management. OBJECTIVE: This study aims to compare the effectiveness of state-of-the-art automatic text classification methods in classifying data to support the prediction of clinical patient outcomes and the extraction of patient characteristics from EMRs. METHODS: Our study addressed the computational problems of information extraction and automatic text classification. We identified essential tasks to be considered in an ischemic stroke value-based program. The 30 selected tasks were classified (manually labeled by specialists) according to the following value agenda: tier 1 (achieved health care status), tier 2 (recovery process), care related (clinical management and risk scores), and baseline characteristics. The analyzed data set was retrospectively extracted from the EMRs of patients with stroke from a private Brazilian hospital between 2018 and 2019. A total of 44,206 sentences from free-text medical records in Portuguese were used to train and develop 10 supervised computational machine learning methods, including state-of-the-art neural and nonneural methods, along with ontological rules. As an experimental protocol, we used a 5-fold cross-validation procedure repeated 6 times, along with subject-wise sampling. A heatmap was used to display comparative result analyses according to the best algorithmic effectiveness (F1 score), supported by statistical significance tests. A feature importance analysis was conducted to provide insights into the results. RESULTS: The top-performing models were support vector machines trained with lexical and semantic textual features, showing the importance of dealing with noise in EMR textual representations. The support vector machine models produced statistically superior results in 71% (17/24) of tasks, with an F1 score >80% regarding care-related tasks (patient treatment location, fall risk, thrombolytic therapy, and pressure ulcer risk), the process of recovery (ability to feed orally or ambulate and communicate), health care status achieved (mortality), and baseline characteristics (diabetes, obesity, dyslipidemia, and smoking status). Neural methods were largely outperformed by more traditional nonneural methods, given the characteristics of the data set. Ontological rules were also effective in tasks such as baseline characteristics (alcoholism, atrial fibrillation, and coronary artery disease) and the Rankin scale. The complementarity in effectiveness among models suggests that a combination of models could enhance the results and cover more tasks in the future. CONCLUSIONS: Advances in information technology capacity are essential for scalability and agility in measuring health status outcomes. This study allowed us to measure effectiveness and identify opportunities for automating the classification of outcomes of specific tasks related to clinical conditions of stroke victims, and thus ultimately assess the possibility of proactively using these machine learning techniques in real-world situations.

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The current information systems for the registration and control of electronic medical records (EMR) present a series of problems in terms of the fragmentation, security, and privacy of medical information, since each health institution, laboratory, doctor, etc. has its own database and manages its own information, without the intervention of patients. This situation does not favor effective treatment and prevention of diseases for the population, due to potential information loss, misinformation, or data leaks related to a patient, which in turn may imply a direct risk for the individual and high public health costs for governments. One of the proposed solutions to this problem has been the creation of electronic medical record (EMR) systems using blockchain networks; however, most of them do not take into account the occurrence of connectivity failures, such as those found in various developing countries, which can lead to failures in the integrity of the system data. To address these problems, HealthyBlock is presented in this paper as an architecture based on blockchain networks, which proposes a unified electronic medical record system that considers different clinical providers, with resilience in data integrity during connectivity failure and with usability, security, and privacy characteristics. On the basis of the HealthyBlock architecture, a prototype was implemented for the care of patients in a network of hospitals. The results of the evaluation showed high efficiency in keeping the EMRs of patients unified, updated, and secure, regardless of the network clinical provider they consult.

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By the implementation of the EMR in the Primary Care Centers of the City of Buenos Aires, it has been claimed that there is a need to obtain systematic and accurate information about the assessment that patients have about such incorporation. A qualitative research has been carried out in order to answer this query.

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Through the development of a dashboard with participative methodology we present a centralized strategy to analyze and visualize EMRs data for the management of 15 public hospitals from Buenos Aires City. This approach could constitute an efficient option for public health systems from developing countries.

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Abstract Electronic medical records have been touted as a solution to many of the shortcomings of health care systems. The aim of this essay is to review pertinent literature and present examples and recommendations from several decades of experience in the use of medical records in primary health care, in ways that can help primary care doctors to organize their work processes to improve patient care. Considerable problems have been noted to result from a lack of interoperability and standardization of interfaces among these systems, impairing the effective collaboration and information exchange in the care of complex patients. It is extremely important that regional and national health policies be established to assure standardization and interoperability of systems. Lack of interoperability contributes to the fragmentation of the information environment. The electronic medical record (EMR) is a disruptive technology that can revolutionize the way we care for patients. The EMR has been shown to improve quality and reliability in the delivery of healthcare services when appropriately implemented. Careful attention to the impact of the EMR on clinical workflows, in order to take full advantage of the potential of the EMR to improve patient care, is the key lesson from our experience in the deployment and use of these systems.

Resumo Os registros médicos eletrônicos (RME) têm sido apontados como uma solução para muitas das deficiências dos sistemas de saúde. O objetivo deste ensaio é revisar a literatura pertinente e apresentar exemplos e recomendações de várias décadas de experiência no uso de registros médicos na atenção primária à saúde, de maneira a ajudá-los na organização de seus processos de trabalho para melhorar o atendimento ao paciente. Observou-se que problemas consideráveis resultam da falta de interoperabilidade e padronização de interfaces entre esses sistemas, prejudicando a colaboração efetiva e a troca de informações no atendimento a pacientes complexos. É extremamente importante que políticas regionais e nacionais de saúde sejam estabelecidas para garantir a padronização e interoperabilidade dos sistemas. A falta de interoperabilidade contribui para a fragmentação do ambiente de informações. O prontuário eletrônico (RME) é uma tecnologia disruptiva que pode revolucionar a maneira como cuidamos dos pacientes. Foi demonstrado que o RME melhora a qualidade e a confiabilidade na prestação de serviços de saúde quando implementada adequadamente. Uma atenção cuidadosa ao impacto do RME nos fluxos de trabalho clínicos, a fim de aproveitar ao máximo o potencial do RME para melhorar o atendimento ao paciente, é a principal lição de nossa experiência na implantação e uso desses sistemas.

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Resumen Objetivo: La implementación de las guías de práctica clínica está limitada por la falta de herramientas que faciliten los procesos de auditoría y retroalimentación a los profesionales de salud. Este estudio evalúa la herramienta automatizada (EXEMED), diseñada para valorar la adherencia a las guías de práctica clínica a partir de la información consignada en las historias clínicas electrónicas. Métodos: En un grupo de 35 pacientes hospitalizados entre enero y marzo de 2016 se evaluó la adherencia a cinco recomendaciones contenidas en las guías de práctica clínica de falla cardiaca del Hospital Universitario San Ignacio. Se utilizó la herramienta automatizada EXEMED y se evaluó la validez de la misma comparando los resultados con la valoración realizada por una junta médica independiente. Se determinó concordancia entre los dos métodos usando el coeficiente kappa. Resultados: La adherencia a las diferentes recomendaciones osciló entre 0% para la determinación del perímetro abdominal al ingreso, hasta 97% para el uso de betabloqueadores al egreso. La proporción de acuerdo entre los dos métodos de evaluación estuvo por encima del 90% para todas las recomendaciones. El kappa para las diferentes recomendaciones fue de 0,78 (IC 95% 0,62-0,95) y 0,64 (0,48-0,80). El tiempo de evaluación se redujo de veinte a dos minutos por paciente con el uso de la herramienta EXEMED. Conclusiones: EXEMED es una herramienta válida y eficiente en la evaluación de la adherencia a las guías de práctica clínica. Se requieren nuevos estudios para evaluar el impacto de su uso asociado a retroalimentación a los clínicos, en la evolución a largo plazo de los pacientes con falla cardiaca.

Abstract Objective: The implementation of clinical practice guidelines is limited due to the lack of tools to carry out audits and provide feedback to the health professionals. In this study, an evaluation is performed using the automated (EXEMED) tool in order to assess the adherence to clinical practice guidelines from the information entered in the electronic health records. Methods: The adherence to 5 recommendations contained in the heart failure clinical practice guidelines was evaluated in a group of 35 patients admitted to the Hospital Universitario San Ignacio between January 2016 and March 2016. The automated EXEMED tool was used to assess this, by comparing the results obtained with the evaluation carried out by an independent medical committee. The kappa coefficient was used to determine the agreement between the two methods. Results: The adherence to the different recommendations varied between 0%, for the determination of the abdominal circumference, up to 97%, for the use of beta-blockers at discharge. Percentage agreement between the two evaluation methods was above 90% for all the recommendations. The kappa for the different recommendations was 0.78 (95% CI; 0.62-0.95) and 0.64 (0.48-0.80). The evaluation time was reduced from 20 minutes to 2 minutes with the use of the EXEMED tool. Conclusions: EXEMED is a valid and effective tool in the evaluation of adherence to clinical practice guidelines. Further studies are required to assess the impact of its used associated with feedback to the clinicians, in the long-term outcomes of patients with heart failure.

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BACKGROUND: The use of stress ulcer prophylaxis (SUP) has risen in recent years, even in patients without a clear indication for therapy. AIM: To evaluate the efficacy of an electronic medical record (EMR)-based alarm to improve appropriate SUP use in hospitalized patients. METHODS: We conducted an uncontrolled before-after study comparing SUP prescription in intensive care unit (ICU) patients and non-ICU patients, before and after the implementation of an EMR-based alarm that provided the correct indications for SUP. RESULTS: 1627 patients in the pre-intervention and 1513 patients in the post-intervention cohorts were included. The EMR-based alarm improved appropriate (49.6% vs. 66.6%, p<0.001) and reduced inappropriate SUP use (50.4% vs. 33.3%, p<0.001) in ICU patients only. These differences were related to the optimization of SUP in low risk patients. There was no difference in overt gastrointestinal bleeding between the two cohorts. Unjustified costs related to SUP were reduced by a third after EMR-based alarm use. CONCLUSIONS: The use of an EMR-based alarm improved appropriate and reduced inappropriate use of SUP in ICU patients. This benefit was limited to optimization in low risk patients and associated with a decrease in SUP costs.

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RESUMO Este estudo objetivou analisar as características sociodemográficas e clínicas de idosos, vítimas de trauma, atendidos em uma unidade de pronto atendimento de um hospital de ensino. Método descritivo, com abordagem quantitativa, realizado em um serviço de referência em urgência e emergência, por meio de análise de 2113 prontuários eletrônicos referentes aos anos de 2014 e 2015. Para análise estatística utilizou-se Qui-quadrado, T Student e do coeficiente de correlação de Spearman, com nível de significância de 5%. A maioria dos idosos com idade entre 60 e 80 anos, do sexo feminino, com ensino fundamental incompleto, casado, cor branca e profissão do lar. As principais especialidades médica foram ortopedia/traumatologia e cirurgia geral e os diagnósticos mais frequentes foram traumas não especificados, seguidos de fraturas de extremidades e do fêmur. O desfecho clínico predominante foi a internação hospitalar em setor específico de ortopedia e traumatologia. Houve associação entre as variáveis tipos de traumas com a idade de cada idoso e entre os tipos de trauma e sexo, com predomínio do sexo feminino entre todos. Portanto, a enfermagem deve intervir na prevenção de trauma em idosos, com atenção especial às mulheres de idade avançada.

RESUMEN Este estudio analizou las características sociodemográficas y clínicas de adultos mayores víctimas de trauma, atendidos en la unidad de emergencias de un hospital escuela. Método descriptivo con abordaje cuantitativa realizado en un servicio de referencia en emergencias, por medio del análisis de 2.113 registros médicos electrónicos referentes a los años de 2014 y 2015. Para análisis estadístico se utilizó el test del qui-cuadrado, el test t-Student y el coeficiente de correlación de Spearman, con un nivel de significancia del 5%. La edad de la mayoría de los adultos mayores era de 60 a 80 años, del sexo femenino, con enseñanza primaria incompleta, casadas, de raza blanca y amas de casa. Las principales especialidades médicas fueron ortopedia/traumatología y cirugía general. Los diagnósticos más frecuentes fueron traumas no especificados, seguidos de fracturas de las extremidades y del fémur. El desenlace clínico predominante fue la internación hospitalaria en sector específico de ortopedia y traumatología. Hubo asociación entre los tipos de traumas con la edad de cada adulto mayor y entre los tipos de trauma con sexo, predominando el sexo femenino. Por lo tanto, la enfermería debe intervenir en la prevención de traumas en adultos mayores, con atención especial a las mujeres de edad avanzada.

ABSTRACT This study analyzed the sociodemographic and clinical characteristics of older adult victims of trauma cared for in the emergency care unit of a teaching hospital. Method descriptive study with a quantitative approach performed in a reference emergency service, through the assessment of 2,113 electronic medical records of 2014 and 2015. The Chi-square test, Student t-test, and Spearman's correlation coefficients with 5% significance level were used for the statistical analysis. The majority of the older adults were female, aged between 60 and 80 years, white, with incomplete primary education, married, and housewives. The main medical specialties were orthopedics/traumatology and general surgery, and the most frequent diagnoses were unspecified traumas, followed by upper-and lower-limb fractures and femoral fractures. The prevalent clinical outcome was hospitalization in a specific sector of orthopedics and traumatology. There was an association between the types of trauma and the age of each older adult, and between the types of trauma and sex, with prevalence of female older adults. Therefore, nursing should intervene in the prevention of trauma in older adults with special attention to old aged women.

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Objetivo. Conocer las características de las historias clínicas electrónicas en Bogotá y verificar los aspectos que se pueden mejorar para que esta se enfoque en Atención Primaria Integral en Salud (APIS).Metodología. Se hizo investigación en dos fases: 1) hermenéutica, para conocer las perspectivas de autores que escribieron sobre historia clínica electrónica en Bogotá y Colombia; y 2) de campo, mediante la aplicación de entrevistas, grupos focales y entrevistas, para obtener las perspectivas de los usuarios de la historia clínica electrónica en Bogotá y de decisores sobre la misma. El análisis se hizo en ATLAS ti 7.5.Resultados. Se identificaron 7 artículos referidos a la historia clínica en Bo-gotá y a nivel nacional, que describen algunas características de la historia clínica electrónica y encontramos en Colombia 25 normas que se refieren al tema. Ninguno de estos artículos o normas consideró específicamente la APIS. En fase de campo, se analizaron cinco categorías deductivas (primer contacto, continuidad, integralidad, coordinación, inclusión de factores determinantes de salud) y 11 categorías inductivas (facilidad de uso, capa-citación, tiempo-facilidad de la consulta, interoperabilidad, trazabilidad y sistema de información, entre otras).Conclusiones. La literatura científica acerca de la historia clínica electró-nica en Bogotá y Colombia es escasa y no especifica temas de la APIS. Se encuentran múltiples modelos de historia clínica electrónica en Bogotá y los usuarios describen sus diversas utilidades que dependen del software utilizado. En general, los entrevistados consideran importante la inclusión de los factores determinantes de la salud y se requieren esfuerzos para llegar a un consenso sobre datos mínimos de la dicha historia que faciliten la interoperabilidad, así como para establecer criterios de facilidad de uso que faciliten el trabajo del prestador primario.

Objective. Getting acquainted with the characteristics of elec-tronic medical records in Bogotá and seeking for improvement of such aspects that could hinder its interrelatedness with Pri-mary Health Care.Methodology. Research was conducted in two stages. On the first stage, a hermeneutical approach was implemented so as to become acquainted with the authors of documents pertaining to electronic medical records in Bogotá as well as Colombia. On the second stage, field work was conducted. Focus group and interviews were used to secure the perspective of electro-nic medical records users and decision makers. Data analysis was implemented with ATLAS ti 7.5.Results. Seven articles referred to electronic medical records in Bogotá as well as other places nationwide were found. Twenty-five regulations pertaining to the electronic medical records were found. None of the above provided specific information on primary health care. During the field work stage of the pre-sent research five deductive categories were analyzed: first contact, continuity, integrality, coordination and health deter-minant factors inclusion. Deductive categories for this study are as follow: user friendliness, training, time of the consulta-tion, interoperability and traceability.Conclusions. Scientific literature about electronic medical re-cords in Bogotá and nationwide is scant and unspecific to pri-mary health care issues. Multiple models for electronic medical records are listed and their users describe their effectiveness on the software implemented. Generally speaking, the inter-viewees deem it important to include health determinant fac-tors. Consensus on minimum data required is needed to ease interoperability as well as coming up with criteria to improve friendliness for primary care workers.

Objetivo. Conheçer as características das histórias clínicas ele-trônicas nesta cidade e verificar para aspectos que consigan ser melhorados na busca da atenção primária da saúde.Metodología. Foi feita en días fases. A primera hermenéuti-ca, para conheçer as perspectivas documentais e a segunda, de campo, mediante entrevistas quis se conheçer o olhar dos usuários dos serviços de saúde, mesmo cómo aquele de quem organiza e pode decidir acima desses serviços.Resultados. Foram identificados 7 artigos se referindo ao caso de Bogotá e 25 normas envolvidas con este assunto no país. Nenhuno desses artigos considera a APIS. Da aproximação empírica foram analizadas 5 categorías deductivas: primeiro contato, continuidade, integralidade, coordenação, inclusão de factores dos determinantes sociais da saúde e 11 categorías indutivas: facilidades de uso, capacitação, tiempo de consulta, sistema de informação entre otras.Conclusões. A literatura científica que visa analizar as histórias clínicas eletrônicas en Bogotá e Colômbia é muito escasa e não trata o asunto da APIS, embora expliquem os vários modelos que existem. En general, os usuários consideram importante a inclussão de dados sobre os determinantes sociais na histórica clínica que facilitem a abordagem profissional dos casos.IntroducciónCon el advenimiento de la modernidad y la tecnifica-ción subsecuente, así como con la globalización de la información, surgió la posibilidad a nivel mundial de facilitar la implementación y el uso de los sistemas de información en salud, apoyándose en las tecnolo-gías de la información y la comunicación(1). Con los registros de salud electrónicos, como la historia clíni-ca electrónica, se pueden obtener datos estadísticos de la población que generan información útil para las políticas de salud pública. Existe el reto de que esta información sea acorde con la concepción de la APIS, que sea integral desde una concepción biopsicosocial y que integre a los factores determinantes de la salud.Colombia, como país creciente en población y en la exploración continua hacia la mejora de la calidad de vida de sus ciudadanos, no es ajeno a esta necesidad y busca la implementación de la APIS. En el país, se ha documentado la falta de sistemas de información adecuados, capaces de suministrar datos actualizados sobre el estado de salud de la población, lo cual con-tribuye a la segmentación del sistema de salud y a pro-blemas de calidad en la atención(2).La especialidad de Medicina Familiar busca promover la atención primaria en salud, como una forma de dar atención integral, eficaz, eficiente y segura. Desde este Keywords: electronic medical record, first contact, continuity, integrality, coordination, inclusion social health determinants.Palavras Chave: história clínica eletrônica, primeiro contato, continuidade, integralidade, coordenação, inclusão determinantes sociais.

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Introducción Actualmente con la Política de Atención Integral en Salud y el Modelo Integral de Atención en Salud (MIAS) que busca una visión integral del riesgo y enfoque diferencial con base en las Rutas Integrales de Atención en Salud (RIAS) es necesario contar con una HCE que permita la integralidad y la calidad en la prestación de los servicios, optimización de los recursos y resultados clínicos eficaces y costo efectivos para el sistema de salud Colombiano.Objetivo. Consolidar el conjunto mínimo de datos de una historia clínica electrónica en APIS enfocada en determinantes de la saludMetodología. Estudio de alcance exploratorio, de carácter cualitativo do-cumental. Se tomaron como documentos base de revisión los trabajos de tesis académica, las directrices de las Rutas Integrales de Atención en Sa-lud (RIAS), los Catálogos del Ministerio de Salud y Protección Social y la propuesta del grupo de asesores de la línea de investigación de salud fa-miliar y atención primaria. Se elaboró un análisis documental que parte de la definición de categorías según los componentes de una historia clínica y se llevó a cabo una validación con la triangulación de la información y asesoría de expertos.Resultados. Se desarrolla el contenido de la historia clínica, los cuales contienen datos relevantes enfocados en atención primaria y determinan-tes de la salud, que conforman el conjunto mínimo de datos como base para la creación de una HCE en aras de consolidar un sistema de informa-ción interoperable, eficiente, y usable para profesionales de la salud.Conclusiones. Esta revisión genera conocimiento valioso para la imple-mentación de modelos integrales de HCE en atención primaria y provee temas a discutir para próximas investigaciones.

Overview. The enactment of Colombian Comprehensive Health Policy and the Comprehensive Health Care Model seek a tho-rough understanding of risk. It is therefore necessary to imple-ment an electronic medical record that allows for quality in health services provision, resource optimization and outcome efficacy within the Colombian healthcare system.Objective. Consolidating minimum required data set for an electronic medical record focused on primary care and health determinants.Methodology. An exploratory qualitative study was conducted and documents such as academic dissertations and handbooks produced by the Colombian Ministry of Health regarding pro-ceedings pertaining to primary health and family health re-search were reviewed. A documentary analysis on the com-ponents of an electronic medical record was implemented. Further validation was conducted through data triangulation and expert advice.Results. The content of the electronic medical record is develo-ped. Such relevant data are focused on primary care and health determinants which are the minimum required as a baseline to co-me up with an electronic medical record that consolidates an effi-cient, interoperable and user-friendly health information system.Conclusions. This documentary review reveals valuable knowled-ge for the implementation of integrated models of electronic me-dical record in primary care.

Introdução. Atualmente com a política de atenção integral em saúde e o modelo integral de atenção en saúde, MIAS, à procu-ra de uma abordagem que some a visão integral do risco com o enfoque diferencial, baseado nas rotas integrais de atenção, precisa de uma HCE que garanta bons serviços, otimização de recursos e resultados clínicos eficazes e costo-efetivos para o sistema de saúde nacional.Objetivo. Consolidar o conjunto mínimo de dados de una histó-ria clínica eletrônica em APIS focada nos determinantes sociais da saúde.Metodologia. O estudo é de caráter explotarório, qualitativo e documental. Foram considerados trabalhando de teses acadê-micas, diretrizes das Rotas Integrais, catálogos dos Ministério de Saúde e Proteção Social e propostas do grupo de pesquisa em saúde familiar e atenção primária. Realizou-se análisis do-cumental e definição de categorías segundo os conteúdos de uma história clínica, validada com ajuda de especialistas.Resultados. Foram desenvolvidos la conteúdos das históricas clínicas com aspectos próprios dos deteminantes sociais e atençæo primária, cómo base para a criação de uma HCE que busque consolidar un sistema de informação interoperável.Conclusões. Esta revisão aporta elementos Chávez para a im-plenentação de modelos Integrais de saúde.

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BACKGROUND: Electronic health (eHealth) interventions may improve the quality of care by providing timely, accessible information about one patient or an entire population. Electronic patient care information forms the nucleus of computerized health information systems. However, interoperability among systems depends on the adoption of information standards. Additionally, investing in technology systems requires cost-effectiveness studies to ensure the sustainability of processes for stakeholders. OBJECTIVE: The objective of this study was to assess cost-effectiveness of the use of electronically available inpatient data systems, health information exchange, or standards to support interoperability among systems. METHODS: An overview of systematic reviews was conducted, assessing the MEDLINE, Cochrane Library, LILACS, and IEEE Library databases to identify relevant studies published through February 2016. The search was supplemented by citations from the selected papers. The primary outcome sought the cost-effectiveness, and the secondary outcome was the impact on quality of care. Independent reviewers selected studies, and disagreement was resolved by consensus. The quality of the included studies was evaluated using a measurement tool to assess systematic reviews (AMSTAR). RESULTS: The primary search identified 286 papers, and two papers were manually included. A total of 211 were systematic reviews. From the 20 studies that were selected after screening the title and abstract, 14 were deemed ineligible, and six met the inclusion criteria. The interventions did not show a measurable effect on cost-effectiveness. Despite the limited number of studies, the heterogeneity of electronic systems reported, and the types of intervention in hospital routines, it was possible to identify some preliminary benefits in quality of care. Hospital information systems, along with information sharing, had the potential to improve clinical practice by reducing staff errors or incidents, improving automated harm detection, monitoring infections more effectively, and enhancing the continuity of care during physician handoffs. CONCLUSIONS: This review identified some benefits in the quality of care but did not provide evidence that the implementation of eHealth interventions had a measurable impact on cost-effectiveness in hospital settings. However, further evidence is needed to infer the impact of standards adoption or interoperability in cost benefits of health care; this in turn requires further research.

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BACKGROUND: The implementation of electronic medical records (EMR) is becoming increasingly common. Error and data loss reduction, patient-care efficiency increase, decision-making assistance and facilitation of event surveillance, are some of the many processes that EMRs help improve. In addition, they show a lot of promise in terms of data collection to facilitate observational epidemiological studies and their use for this purpose has increased significantly over the recent years. Even though the quantity and availability of the data are clearly improved thanks to EMRs, still, the problem of the quality of the data remains. This is especially important when attempting to determine if an event has actually occurred or not. We sought to assess the sensitivity, specificity, and agreement level of a codes-based algorithm for the detection of clinically relevant cardiovascular (CaVD) and cerebrovascular (CeVD) disease cases, using data from EMRs. METHODS: Three family physicians from the research group selected clinically relevant CaVD and CeVD terms from the international classification of primary care, Second Edition (ICPC-2), the ICD 10 version 2015 and SNOMED-CT 2015 Edition. These terms included both signs, symptoms, diagnoses and procedures associated with CaVD and CeVD. Terms not related to symptoms, signs, diagnoses or procedures of CaVD or CeVD and also those describing incidental findings without clinical relevance were excluded. The algorithm yielded a positive result if the patient had at least one of the selected terms in their medical records, as long as it was not recorded as an error. Else, if no terms were found, the patient was classified as negative. This algorithm was applied to a randomly selected sample of the active patients within the hospital's HMO by 1/1/2005 that were 40-79 years old, had at least one year of seniority in the HMO and at least one clinical encounter. Thus, patients were classified into four groups: (1) Negative patients (2) Patients with CaVD but without CeVD; (3) Patients with CeVD but without disease CaVD; (4) Patients with both diseases. To facilitate the validation process, a stratified sample was taken so that each of the groups represented approximately 25% of the sample. Manual chart review was used as the gold standard for assessing the algorithm's performance. One-third of the patients were assigned randomly to each reviewer (Cohen's kappa 0.91). Both coded and un-coded (free text) sections of the EMR were reviewed. This was done from the first present clinical note in the patients chart to the last one registered prior to 1/1/2005. RESULTS: The performance of the algorithm was compared against manual chart review. It yielded high sensitivity (0.99, 95% CI 0.938-0.9971) and acceptable specificity (0.86, 95% CI 0.818-0.895) for detecting cases of CaVD and CeVD combined. A qualitative analysis of the false positives and false negatives was performed. CONCLUSIONS: We developed a simple algorithm, using only standardized and non-standardized coded terms within an EMR that can properly detect clinically relevant events and symptoms of CaVD and CeVD. We believe that combining it with an analysis of the free text using an NLP approach would yield even better results.

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PURPOSE: To evaluate the satisfaction and expectations of patients and physicians before and after the implementation of an electronic health record (EHR) in the outpatient clinic of a university hospital. METHODS: We conducted 389 interviews with patients and 151 with physicians before and after the implementation of a commercial EHR at the internal medicine clinic of Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HC-FMUSP), Brazil. The physicians were identified by their connection to the outpatient clinic and categorized by their years since graduation: residents and preceptors (with 10 years or less of graduation) or assistants (with more than 10 years of graduation). The answers to the questionnaire given by the physicians were classified as favorable or against the use of EHR, before and after the implementation of this system in this clinic, receiving 1 or 0 points, respectively. The sum of these points generated a multiple regression score to determine which factors contribute to the acceptance of EHR by physicians. We also did a third survey, after the EHR was routinely established in the outpatient clinic. RESULTS: The degree of patient satisfaction was the same before and after implementation, with more than 90% positive evaluations. They noted the use of the computer during the consultation and valued such use. Resident (younger) physicians had more positive expectations than assistants (older physicians) before EHR implementation. This optimism was reduced after implementation. In the third evaluation the use of EHR was higher among resident physicians. Resident physicians perceived and valued the EHR more and used it more. In 28 of the 57 questions on performance of clinical tasks, resident physicians found it easier to use EHR than assistant physicians with significant differences (p<0.05). When questioned specifically about EHR satisfaction, resident physicians responded "good" and "excellent" to a greater extent than assistant physicians (p=0.002). CONCLUSIONS: Our results reinforce the idea that the EHR introduction in a clinical setting should be preceded by careful planning to improve physician's adherence to the use of EHR. Patients do not seem to notice much difference to the quality of the consultation done using paper or EHR. It became clear after the third evaluation with the physicians that the younger (residents and some preceptors) perceived the advantages of the EHR more than the older physicians. Resident physicians use the EHR more and are more satisfied with it.

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BACKGROUND: Electronic medical records (EMR) are more used in university hospitals, but the use of EMR by medical students at the workplace is still a challenge, because the conflict of interest between medical accountability for hospitals and quality of medical education programs for students. Therefore, this study investigates the use of EMR from the perspective of medical school deans and students, and determines their perceptions and concerns about consequences of restricted use of EMR by students on quality of education and patient care. METHODS: We administered a large-scale survey about the existence of EMR, existing policies, students' use for learning, and consequences on patient care to 42 deans and 789 Residency Physician Applicants in a private university in Colombia. Data from 26 deans and 442 former graduated students were compared with independent t tests and chi square tests. RESULTS: Only half of medical schools had learning programs and policies about the use of EMR by students. Deans did not realize that students have less access to EMR than to paper-based MR. Perceptions of non-curricular learning opportunities how to write in (E)MR were significantly different between deans and students. Limiting students use of EMR has negative consequences on medical education, according to both deans and students, while deans worried significantly more about impact on patient care than students. Billing issues and liability aspects were their major concerns. CONCLUSIONS: There is a need for a clear policy and educational program on the use of EMR by students. Discrepancies between the planned curriculum by deans and the real clinical learning environment as experienced by students indicate suboptimal learning opportunities for students. Creating powerful workplace-learning experiences and resolving concerns on students use of EMR has to be resolved in a constructive collaboration way between the involved stakeholders, including also EMR designers and hospital administrators. We recommend intense supervision of students' work in EMR to take full advantage of the technological advances of EMR at the modern clinical site, both for patient care and for medical education.

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Introducción: en un paciente bajo ventilación mecánica con resistencia aumentada de la vía aérea, la duración de la fase espiratoria es insuficiente para exhalar todo el volumen inspirado. Para mantener la oxigenación y reducir el trabajo de los músculos respiratorios, es común aplicar una presión positiva al final de la espiración (PEEP), que reduce la colapsabilidad del tejido, compensando el aumento de la resistencia. Diversos estudios han demostrado la utilidad de la electromiografía de superficie (EMGS) para cuantificar el trabajo respiratorio. Objetivo: evaluar el efecto de la PEEP en la actividad muscular respiratoria mediante EMGS en individuos sanos bajo ventilación mecánica no invasiva. Metodología: estudio de la actividad muscular en 10 hombres voluntarios sanos ventilados de manera no invasiva con variaciones de la PEEP desde 0 hasta 5 cm H2O en pasos de 1 cm H2O, cada 30 segundos. Resultados: los biopotenciales del diafragma y el esternocleidomastoideo permitieron detectar diferentes respuestas ante el estímulo incremental: 1) aumento del trabajo de los dos músculos durante la inspiración y la espiración; 2) aumento de la actividad en solo uno de los músculos; 3) aumento del trabajo muscular exclusivamente durante la espiración. Conclusión: en individuos ventilados de forma no invasiva, la EMGS relaciona cuantitativamente el nivel de PEEP con el cambio en la actividad del diafragma y el esternocleidomastoideo.

Introduction: In a mechanically ventilated patient with increased airway resistance, the expiratory time span is insufficient to exhale all the inspired volume. In order to maintain oxygenation and to reduce the workload of respiratory muscles, it is common to apply an extrinsic positive end-expiratory pressure (PEEP) that reduces tissue collapsibility, counterbalancing the increased resistance. Several studies have shown the usefulness of surface electromyography (sEMG) to quantify the work of breathing (WOB), particularly in patients with obstructive diseases. Objective: To assess the effect of incremental PEEP in the respiratory muscle activity through sEMG in healthy volunteers noninvasively ventilated. Methods: Study of muscle activity in 10 healthy male volunteers, noninvasively ventilated for 20 minutes. The extrinsic PEEP was applied from 0 to 5 cm H2O in steps of 1 cm H2O at 30 seconds intervals. Results: The bio-potentials of diaphragm and sternocleidomastoid muscles revealed different breathing patterns in response to incremental PEEP: 1) increase in the workload of both muscles during inspiration and expiration; 2) increase in the workload of only one muscle; 3) a remarkable increase in muscle activity only in expiration. Conclusion: In noninvasively ventilated volunteers, sEMG quantitatively relates the PEEP level with changes in sternocleidomastoid and diaphragm activity.

Introdução: Num paciente sob ventilação mecânica com resistência aumentada da via aérea, a duração da fase respiratória é insuficiente para exalar todo o volume inspirado. Para manter a oxigenação e reduzir o trabalho dos músculos respiratórios, é comum aplicar uma pressão positiva no final da respiração (PEEP), que reduz a colapsabilidade do tecido, compensando o aumento da resistência. Diversos estudos demostraram a utilidade da eletromiografia de superfície (EMGS) para quantificar o trabalho respiratório. Objetivo: avaliar o efeito da PEEP na atividade muscular respiratória mediante EMGS em indivíduos saudáveis sob ventilação mecânica não invasiva. Metodologia: estudo da atividade muscular em 10 homens voluntários saudáveis ventilados de maneira não invasiva com variações da PEEP desde 0 até 5 cm H2O em passos de 1 cm H2O, cada 30 segundos. Resultados: os biopotenciais do diafragma e o esternocleidomastoideo permitiram detectar diferentes respostas ante o estímulo incremental: 1) aumento do trabalho dos dois músculos durante a inspiração e a espiração; 2) aumento da atividade em só um dos músculos; 3) aumento do trabalho muscular exclusivamente durante a espiração. Conclusão: em indivíduos ventilados de forma não invasiva, a EMGS relaciona quantitativamente o nível de PEEP com o câmbio na atividade do diafragma e oesternocleidomastoideo.

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La investigación biomédica enfocada a la preservación de la salud y manejo de la enfermedad requiere hoy del trabajo articulado bidireccional entre básicos y clínicos, lo cual ha generado una nueva tendencia, denominada investigación traslacional. Este tipo de investigación se fundamenta en poder brindar una atención en salud oportuna, pertinente, eficaz y personalizada, para lo cual se requieren muestras biológicas e información clínica asociada, garantizando a su vez seguridad, calidad y confidencialidad para los donantes. Promover la investigación traslacional y la aplicación de los avances del conocimiento y de la tecnología derivados de la investigación y la innovación, requiere del apoyo de infraestructuras de fácil acceso que faciliten la rápida demostración experimental de una hipótesis o la comprobación de un modelo simulado previamente. Dentro de las diversas plataformas biomédicas y de salud existentes, los Biobancos, en sus diferentes modalidades, se constituyen en una de las más atractivas plataformas a la hora de contribuir a establecer puentes entre la investigación básica y clínica, con la práctica asistencial. La necesidad de contar con muestras biológicas humanas de alta calidad y, al mismo tiempo, la obligación de preservar los derechos de los donantes, ha elevado la gestión de los Biobancos a la categoría de disciplina científico-técnica, con una complejidad particular que involucra múltiples aspectos entre los cuales se incluyen aspectos científicos, técnicos, éticos, jurídicos y sociales. Esta serie de artículos, que serán publicados en los diferentes números de la revista durante el 2016, tienen como objetivo hacer una revisión crítica de los aspectos más relevantes en torno a la gestión de los Biobancos con fines de investigación y proponer una serie de guías de manejo del material biológico humano a conservar las cuales se han desarrollado en el marco del Programa Cardiecol.

Biomedical research aimed at the preservation of health and disease management requires nowadays a bidirectional and articulated collaboration between basic and clinical work, which has generated a new trend called translational research. This type of research is based on the ability to provide timely, relevant, effective and personalized healthcare, for which biological samples, and associated clinical information are required, while ensuring safety, quality and confidentiality for donors. In order to promote translational research and the application of the advances in knowledge and technology from research and innovation, the support of accessible infrastructure is required to facilitate the rapid experimental demonstration of an hypothesis or testing a previously simulated model. Among the diverse biomedical and healthcare existing platforms, the Biobanks, in their various forms constitute one of the most attractive platforms contributing to establish bridges between the basic and clinical research with the clinical practice. The need for human biological samples of high quality, and at the same time, the obligation to preserve the rights of donors, has raised the Biobanks' management to the scientific and technical category, with the added particular complexity of involving multiple aspects including scientific, ethical, legal, and social factors. This series of articles that will be published in different issues of the magazine in 2016, aims to make a critical review of the most relevant aspects regarding the management of Biobanks for research, and to propose a series of guidelines for the management of human biological material as developed by the program Cardiecol.

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Esta pesquisa objetivou investigar a existência e a acessibilidade ao prontuário eletrônico na atenção primária à saúde. Trata-se de estudo quantitativo, descritivo e exploratório, realizado em Montes Claros - Minas Gerais, Brasil. Os dados foram coletados entre nos meses de outubro de 2010 ea março de 2011. A análise foi realizada por meio do Statistical Package for The Social Science PASW® 17.0. Foram entrevistados médicos, enfermeiros e cirurgiõães-dentistas de Equipes de Saúde da Família (ESF). Este trabalho foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Estadual de Montes Claros, parecer consubstanciado nº 2011/2010. Os resultados demonstraram a inexistência do prontuário eletrônico.

This study investigated the existence and accessibility to electronic medical records in health care. This is a quantitative, descriptive and exploratory study, held in Montes Claros - Minas Gerais, Brazil. Data were collected from October 2010 to March 2011. The analysis was performed using the Statistical Software Statistical Package for Social Science The PASW ® 17.0. We interviewed doctors, nurses and dentists of Family Health Teams. This study was approved by the Ethics Committee in Research of Montes Claros State University, the consolidated nº.2011/2010. The results showed the lack of electronic medical records.

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