背景:在过去十年中,社区卫生信息系统变得越来越复杂和以证据为基础,它们现在是许多低收入和中等收入国家中使用最广泛的卫生信息系统。本研究旨在就社区卫生信息系统(CHISs)的关键功能和互操作性优先事项达成共识。
方法:在系统选择的CHIS专家小组中进行了Delphi研究。这个令人印象深刻的专家库代表了一系列全球领先的卫生机构,性别和区域平衡以及其专业领域的多样性。通过五轮迭代调查和后续访谈,专家们达成了高度共识。我们通过与10位社区卫生工作者(CHW)领导人进行的一系列焦点小组讨论补充了Delphi研究结果。
结果:今天的CHIS有望适应广泛的本地背景要求,并支持和改善护理服务。一旦与单个角色类型(CHW)关联,这些系统现在预计会吸引其他最终用户,包括患者,supervisors,临床医生和数据管理者。在30项世卫组织分类的医疗服务提供者数字卫生干预措施中,专家认为23人(77%)对CHISs很重要。病例管理和护理协调功能占当今CHIS预期核心功能的三分之一以上(37个中的14个,38%),比例高于任何其他类别。互操作性的最高优先级用例包括CHIS到健康管理信息系统的每月报告和CHIS到电子病历转介。
结论:今天的CHISs有望功能丰富,为了支持社区卫生系统中的一系列用户角色,并高度适应当地的上下文需求。未来的互操作性努力,如一般的CHISs,预计不仅要有效地移动数据,而且要以可衡量地改善护理的方式加强社区卫生系统。
BACKGROUND: Information systems for community health have become increasingly sophisticated and evidence-based in the last decade and they are now the most widely used health information systems in many low-income and middle-income countries. This study aimed to establish
consensus regarding key features and interoperability priorities for community health information systems (CHISs).
METHODS: A Delphi study was conducted among a systematically selected panel of CHIS experts. This impressive pool of experts represented a range of leading global health institutions, with gender and regional balance as well as diversity in their areas of expertise. Through five rounds of iterative surveys and follow-up interviews, the experts established a high degree of
consensus. We supplemented the Delphi study findings with a series of focus group discussions with 10 community health worker (CHW) leaders.
RESULTS: CHISs today are expected to adapt to a wide range of local contextual requirements and to support and improve care delivery. While once associated with a single role type (CHWs), these systems are now expected to engage other end users, including patients, supervisors, clinicians and data managers. Of 30 WHO-classified digital health interventions for care providers, experts identified 23 (77%) as being important for CHISs. Case management and care coordination features accounted for more than one-third (14 of 37, 38%) of the core features expected of CHISs today, a higher proportion than any other category. The highest priority use cases for interoperability include CHIS to health management information system monthly reporting and CHIS to electronic medical record referrals.
CONCLUSIONS: CHISs today are expected to be feature-rich, to support a range of user roles in community health systems, and to be highly adaptable to local contextual requirements. Future interoperability efforts, such as CHISs in general, are expected not only to move data efficiently but to strengthen community health systems in ways that measurably improve care.