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      Descripción de la implantación y grado de desarrollo de tecnología de comunicación e informática de los equipos de Atención Primaria en los servicios autonómicos de salud en España Translated title: Description of the implementation and degree of development of primary care telecommunication and information technology in regional health services in Spain


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          RESUMEN Objetivo: Describir la situación, percepciones y opiniones de los profesionales sanitarios de Atención Primaria (AP) respecto a los sistemas de telecomunicación y telemedicina de este ámbito, así como determinar su grado de satisfacción. Método: Estudio descriptivo observacional transversal realizado en profesionales sanitarios de Atención Primaria mediante un cuestionario autocumplimentado con variables sociodemográficas, características laborales, opiniones y percepciones sobre desarrollo informático, sistemas de información, accesibilidad telemática, seguridad para pacientes y el grado de satisfacción de los profesionales respecto al desarrollo informático. Resultados: Los resultados muestran que se puede acceder a informes de alta hospitalaria y urgencias en el 89,2% (intervalo de confianza [IC] 95%: 86,4-92,0) y 87,2% (IC 95%: 84,2-90,2) de casos, respectivamente. Existe opción de teleconsulta con hospitalaria según un 95,1% de encuestados. Un 38,9% indicó disponer de alertas de recepción de informes de hospital, y el 73,3%, tener accesibilidad telemática para sus pacientes. El 34,8% señaló que no había ninguna mejora en general en las vías de comunicación, y el 51,7% y tampoco veía mejoras en los recursos tecnológicos en general tras la pandemia. Un 13,0% manifestó estar muy insatisfecho y el 27,3% dijo estar insatisfecho con el nivel de desarrollo informático en sistemas de telemedicina y telecomunicación en la AP de su área sanitaria. Conclusiones: La mayoría de los equipos de Atención Primaria de los Servicios Autonómicos disponen de historia clínica compartida con el hospital, mientras que solo una parte cuenta con sistemas de alertas de recepción de informar del ámbito hospitalario. El obligado cambio de la asistencia sanitaria no ha mejorado sustancialmente los recursos tecnológicos tras la pandemia y existe un considerable grado de insatisfacción de los profesionales.

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          ABSTRACT Objective: To report Primary Care healthcare professionals’ circumstances, insight and points of view in regard to telecommunication systems and telemedicine as well as determine their degree of satisfaction. Method: Descriptive, observational, transversal study performed on primary healthcare professionals by means of a self-completion questionnaire with socio-demographic variables, job characteristics, views and perceptions in regard to IT development, information systems, online accessibility, patient safety and the degree of satisfaction of healthcare professionals with IT development. Results: The results showed that it is possible to access discharge reports from hospitalized patients and from the accident and emergency department in 89.2% (95%CI: 86.4-92.0) and 87.2% (95%CI: 84.2-90.2) of cases, respectively. According to 95.1% of people polled, there is an option for remote consultation with hospital care. A total of 38.9% of survey respondents pointed out that they receive e-notifications of hospital reports and 73.3% claimed to have online access to their patients’ information. A total of 34.8% and 51.7% of clinicians stated that, in general, there was no improvement in communication channels or technological resources after the pandemic, respectively. A total of 13.0% of respondents expressed that they are very unsatisfied and 27.3% unsatisfied with IT development in primary healthcare telemedicine systems and telecommunication in their health area. Conclusion: Most Primary Care healthcare teams in regional health services have access to medical histories shared with hospitals. However, just some of them have electronic notification systems for hospital reports. The mandatory change in healthcare has not substantially improved technological resources after the pandemic and there is a considerable level of dissatisfaction among professionals.

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          What is e-health?

          Introduction Everybody talks about e-health these days, but few people have come up with a clear definition of this comparatively new term. Barely in use before 1999, this term now seems to serve as a general "buzzword," used to characterize not only "Internet medicine", but also virtually everything related to computers and medicine. The term was apparently first used by industry leaders and marketing people rather than academics. They created and used this term in line with other "e-words" such as e-commerce, e-business, e-solutions, and so on, in an attempt to convey the promises, principles, excitement (and hype) around e-commerce (electronic commerce) to the health arena, and to give an account of the new possibilities the Internet is opening up to the area of health care. Intel, for example, referred to e-health as "a concerted effort undertaken by leaders in health care and hi-tech industries to fully harness the benefits available through convergence of the Internet and health care." Because the Internet created new opportunities and challenges to the traditional health care information technology industry, the use of a new term to address these issues seemed appropriate. These "new" challenges for the health care information technology industry were mainly (1) the capability of consumers to interact with their systems online (B2C = "business to consumer"); (2) improved possibilities for institution-to-institution transmissions of data (B2B = "business to business"); (3) new possibilities for peer-to-peer communication of consumers (C2C = "consumer to consumer"). So, how can we define e-health in the academic environment? One JMIR Editorial Board member feels that the term should remain in the realm of the business and marketing sector and should be avoided in scientific medical literature and discourse. However, the term has already entered the scientific literature (today, 76 Medline-indexed articles contain the term "e-health" in the title or abstract). What remains to be done is - in good scholarly tradition - to define as well as possible what we are talking about. However, as another member of the Editorial Board noted, "stamping a definition on something like e-health is somewhat like stamping a definition on 'the Internet': It is defined how it is used - the definition cannot be pinned down, as it is a dynamic environment, constantly moving." It seems quite clear that e-health encompasses more than a mere technological development. I would define the term and concept as follows: e-health is an emerging field in the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the Internet and related technologies. In a broader sense, the term characterizes not only a technical development, but also a state-of-mind, a way of thinking, an attitude, and a commitment for networked, global thinking, to improve health care locally, regionally, and worldwide by using information and communication technology. This definition hopefully is broad enough to apply to a dynamic environment such as the Internet and at the same time acknowledges that e-health encompasses more than just "Internet and Medicine". As such, the "e" in e-health does not only stand for "electronic," but implies a number of other "e's," which together perhaps best characterize what e-health is all about (or what it should be). Last, but not least, all of these have been (or will be) issues addressed in articles published in the Journal of Medical Internet Research. The 10 e's in "e-health" Efficiency - one of the promises of e-health is to increase efficiency in health care, thereby decreasing costs. One possible way of decreasing costs would be by avoiding duplicative or unnecessary diagnostic or therapeutic interventions, through enhanced communication possibilities between health care establishments, and through patient involvement. Enhancing quality of care - increasing efficiency involves not only reducing costs, but at the same time improving quality. E-health may enhance the quality of health care for example by allowing comparisons between different providers, involving consumers as additional power for quality assurance, and directing patient streams to the best quality providers. Evidence based - e-health interventions should be evidence-based in a sense that their effectiveness and efficiency should not be assumed but proven by rigorous scientific evaluation. Much work still has to be done in this area. Empowerment of consumers and patients - by making the knowledge bases of medicine and personal electronic records accessible to consumers over the Internet, e-health opens new avenues for patient-centered medicine, and enables evidence-based patient choice. Encouragement of a new relationship between the patient and health professional, towards a true partnership, where decisions are made in a shared manner. Education of physicians through online sources (continuing medical education) and consumers (health education, tailored preventive information for consumers) Enabling information exchange and communication in a standardized way between health care establishments. Extending the scope of health care beyond its conventional boundaries. This is meant in both a geographical sense as well as in a conceptual sense. e-health enables consumers to easily obtain health services online from global providers. These services can range from simple advice to more complex interventions or products such a pharmaceuticals. Ethics - e-health involves new forms of patient-physician interaction and poses new challenges and threats to ethical issues such as online professional practice, informed consent, privacy and equity issues. Equity - to make health care more equitable is one of the promises of e-health, but at the same time there is a considerable threat that e-health may deepen the gap between the "haves" and "have-nots". People, who do not have the money, skills, and access to computers and networks, cannot use computers effectively. As a result, these patient populations (which would actually benefit the most from health information) are those who are the least likely to benefit from advances in information technology, unless political measures ensure equitable access for all. The digital divide currently runs between rural vs. urban populations, rich vs. poor, young vs. old, male vs. female people, and between neglected/rare vs. common diseases. In addition to these 10 essential e's, e-health should also be easy-to-use, entertaining (no-one will use something that is boring!) and exciting - and it should definitely exist! We invite other views on the definition of e-health and hope that over time the journal will be filled with articles which together elucidate the realm of e-health. Gunther Eysenbach Editor, Journal of Medical Internet Research
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            Factors that influence the implementation of e-health: a systematic review of systematic reviews (an update)

            Background There is a significant potential for e-health to deliver cost-effective, quality health care, and spending on e-health systems by governments and healthcare systems is increasing worldwide. However, there remains a tension between the use of e-health in this way and implementation. Furthermore, the large body of reviews in the e-health implementation field, often based on one particular technology, setting or health condition make it difficult to access a comprehensive and comprehensible summary of available evidence to help plan and undertake implementation. This review provides an update and re-analysis of a systematic review of the e-health implementation literature culminating in a set of accessible and usable recommendations for anyone involved or interested in the implementation of e-health. Methods MEDLINE, EMBASE, CINAHL, PsycINFO and The Cochrane Library were searched for studies published between 2009 and 2014. Studies were included if they were systematic reviews of the implementation of e-health. Data from included studies were synthesised using the principles of meta-ethnography, and categorisation of the data was informed by the Consolidated Framework for Implementation Research (CFIR). Results Forty-four reviews mainly from North America and Europe were included. A range of e-health technologies including electronic medical records and clinical decision support systems were represented. Healthcare settings included primary care, secondary care and home care. Factors important for implementation were identified at the levels of the following: the individual e-health technology, the outer setting, the inner setting and the individual health professionals as well as the process of implementation. Conclusion This systematic review of reviews provides a synthesis of the literature that both acknowledges the multi-level complexity of e-health implementation and provides an accessible and useful guide for those planning implementation. New interpretations of a large amount of data across e-health systems and healthcare settings have been generated and synthesised into a set of useable recommendations for practice. This review provides a further empirical test of the CFIR and identifies areas where additional research is necessary. Trial registration PROSPERO, CRD42015017661 Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0510-7) contains supplementary material, which is available to authorized users.
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              Interactive telemedicine: effects on professional practice and health care outcomes.

              Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care.

                Author and article information

                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Española de Medicina de Familia y Comunitaria (Barcelona, Cataluña, Spain )
                : 14
                : 2
                : 71-80
                [14] orgnamesemFYC orgdiv1Sección de Investigación
                [12] orgnamesemFYC orgdiv1Grupo de Trabajo de Diabetes
                [2] Barcelona orgnameCentro de Atención Nutricional Infantil Antímano Venezuela
                [7] orgnamesemFYC orgdiv1Grupo de Innovación Tecnológica y Sistemas de Información
                [10] orgnamesemFYC orgdiv1Grupo de Trabajo de Medicina Basada en la Evidencia
                [3] orgnameServicio Aragonés de Salud orgdiv1Centro de Salud Universitas, Sector Zaragoza-III
                [9] orgnamesemFYC orgdiv1Grupo de Trabajo de Seguridad del Paciente
                [5] Valencia orgnameUniversitat de Valencia orgdiv1INCLIVA orgdiv2Hospital Clínico Universitario Valencia Spain
                [13] orgnameUniversidad de Castilla-La Mancha orgdiv1Facultad de Medicina Spain
                [8] orgnamesemFYC orgdiv1Junta Permanente
                [6] orgnameServicio de Salud de Castilla-La Mancha orgdiv1Gerencia de Atención Integrada de Albacete orgdiv2Centro de Salud Zona VIII de Albacete España
                [11] Valencia orgnameUniversitat de Valencia Spain
                [4] San Sebastián orgnameOsakidetza orgdiv1OSI Donostia orgdiv2Centro de Salud de Alza
                [1] orgnameServicio Andaluz de Salud orgdiv1Servicio de Coordinación de Sistemas de Información orgdiv2Servicio de Urgencias Área de Gestión Sanitaria Norte de Huelva
                S1699-695X2021000200006 S1699-695X(21)01400200006

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                : 03 June 2021
                : 24 May 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 10

                SciELO Spain


                Primary Health Care,e-salud,Satisfaction,Health services management,E-health,satisfacción,gestión de servicios sanitarios,Atención Primaria de Salud


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