Centre of Health Informatics, Health and Hospital Management, Institute of Business Management, Karachi, Pakistan.
Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The Medical School, The University of Edinburgh, Edinburgh, UK.
Inform Health Soc Care. 2020;45(2):130-150. doi: 10.1080/17538157.2019.1582053. Epub 2019 Mar 28.
: Ready access to reliable data is essential to support decision-making in patient care planning and delivery. Health information exchange (HIE), which is fundamental to achieve this, is currently limited in many low- and middle-income countries (LMICs), reflecting the lack of prioritization of this issue and the many barriers to its successful implementation.: We sought to explore and understand stakeholders' perspectives on the context of and deployment strategies for HIE in Pakistan.Method: Data collection comprised interviews with purposefully selected groups of stakeholders across Pakistan, field notes, and a critical review of key national and international policy documents.: We identified reports of small pockets of effective HIE existing mainly in private hospitals, but in a patchy and fragmented form overall. Many problems were attributed to the absence of effective HIE, these ranging from 'delays in retrieving records' to contributing to 'the increase in antibiotic resistance'. The mindset of policymakers, poor infrastructure, lack of finance, training and data interoperability, and health-care providers' resistance to recording consultations due to poor documentation skills and concerns about liability considerations were highlighted as major barriers to HIE. Sharing regional health information with international organizations was perceived by some participants to increase the risk of regional espionage. A clear government policy directive for evidence-based decision-making, constant supply of electricity, training, widespread adoption of common data standards and public pressure to adopt mobile technology frameworks were identified as potential facilitators of HIE.: HIE can be achieved with the support of the federal and provincial governments coupled with financial and technical backing from international donor organizations. The transition to HIE is likely to be very dependent on improving governance capabilities and bolstering the informatics skill-base in Pakistan and indeed many other LMICs.
: 可靠数据的便捷获取对于支持患者护理规划和提供决策至关重要。健康信息交换（HIE）是实现这一目标的基础，但在许多中低收入国家（LMICs）受到限制，这反映出该问题未被优先重视，以及其成功实施面临诸多障碍。: 我们旨在探讨和了解利益相关者对巴基斯坦 HIE 背景和部署策略的看法。: 方法：数据收集包括在巴基斯坦有针对性地选择利益相关者群体进行访谈、现场记录和对国家和国际关键政策文件的批判性审查。: 我们发现有报道称，HIE 在私人医院中存在一些有效的小范围应用，但总体上呈现零散和不完整的形式。许多问题归因于缺乏有效的 HIE，这些问题包括“检索记录的延迟”和“导致抗生素耐药性增加”。政策制定者的思维模式、基础设施差、缺乏资金、培训和数据互操作性，以及医疗保健提供者因记录咨询的文档技能差和对责任考虑的担忧而不愿意记录咨询，这些都被认为是 HIE 的主要障碍。一些参与者认为，与国际组织共享区域健康信息会增加区域间谍活动的风险。明确的政府基于证据的决策政策指令、持续的电力供应、培训、广泛采用通用数据标准以及采用移动技术框架的公众压力，被认为是 HIE 的潜在促进因素。: HIE 可以在联邦和省政府的支持下实现，同时还需要国际捐助组织提供财务和技术支持。向 HIE 的过渡可能非常依赖于改善治理能力和增强巴基斯坦乃至许多其他 LMIC 的信息学技能基础。
