EDITORIAL
Information technology challenges in a public hospital during the COVID-19 pandemic
Read
993
Timeswas read the article
334
Total PDF
659
Total HTML
Share statistics
array:24 [ "pii" => "S1807593222001351" "issn" => "18075932" "doi" => "10.6061/clinics/2021/e2648" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "135" "copyright" => "CLINICS" "copyrightAnyo" => "2021" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by/4.0/" "subdocumento" => "edi" "cita" => "Clinics. 2021;76C:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S1807593222001363" "issn" => "18075932" "doi" => "10.6061/clinics/2021/e2652" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "136" "copyright" => "CLINICS" "documento" => "simple-article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by/4.0/" "subdocumento" => "edi" "cita" => "Clinics. 2021;76C:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:8 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>" "titulo" => "Relationship between the coronavirus disease 2019 pandemic and immobilization syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pérola Grinberg Plapler, Daniel Rubio de Souza, Helena Hideko Seguchi Kaziyama, Linamara Rizzo Battistella, Tarcisio Eloy Pessoa de Barros-Filho" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Pérola Grinberg" "apellidos" => "Plapler" ] 1 => array:2 [ "nombre" => "Daniel Rubio de" "apellidos" => "Souza" ] 2 => array:2 [ "nombre" => "Helena Hideko Seguchi" "apellidos" => "Kaziyama" ] 3 => array:2 [ "nombre" => "Linamara Rizzo" "apellidos" => "Battistella" ] 4 => array:2 [ "nombre" => "Tarcisio Eloy Pessoa de" "apellidos" => "Barros-Filho" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222001363?idApp=UINPBA00004N" "url" => "/18075932/000000760000000C/v1_202211191031/S1807593222001363/v1_202211191031/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S180759322200134X" "issn" => "18075932" "doi" => "10.6061/clinics/2021/e2643" "estado" => "S300" "fechaPublicacion" => "2021-01-01" "aid" => "134" "copyright" => "CLINICS" "documento" => "article" "crossmark" => 0 "licencia" => "https://creativecommons.org/licenses/by/4.0/" "subdocumento" => "fla" "cita" => "Clinics. 2021;76C:" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">ORIGINAL ARTICLE</span>" "titulo" => "Increased Serum Interleukin-6 and Tumor Necrosis Factor Alpha Levels in Fabry Disease: Correlation with Disease Burden" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 522 "Ancho" => 750 "Tamanyo" => 39776 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Serum cytokine levels in FD patients <span class="elsevierStyleItalic">versus</span> those in the control subjects.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Nilton Salles Rosa, Judith Campos de Barros Bento, Valéria de Falco Caparbo, Rosa Maria Rodrigues Pereira" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Nilton Salles" "apellidos" => "Rosa" "sufijo" => "Neto" ] 1 => array:2 [ "nombre" => "Judith Campos de Barros" "apellidos" => "Bento" ] 2 => array:2 [ "nombre" => "Valéria de Falco" "apellidos" => "Caparbo" ] 3 => array:2 [ "nombre" => "Rosa Maria Rodrigues" "apellidos" => "Pereira" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S180759322200134X?idApp=UINPBA00004N" "url" => "/18075932/000000760000000C/v1_202211191031/S180759322200134X/v1_202211191031/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">EDITORIAL</span>" "titulo" => "Information technology challenges in a public hospital during the COVID-19 pandemic" "tieneTextoCompleto" => true "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jorge Futoshi Yamamoto, Izabel Oliva Marcílio de Souza, Leila Suemi Harima Letaif, Vilson Cobello-Júnior" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Jorge Futoshi" "apellidos" => "Yamamoto" "email" => array:1 [ 0 => "insilicium@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Izabel Oliva Marcílio de" "apellidos" => "Souza" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Leila Suemi Harima" "apellidos" => "Letaif" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">II</span>" "identificador" => "aff2" ] ] ] 3 => array:3 [ "nombre" => "Vilson" "apellidos" => "Cobello-Júnior" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">I</span>" "identificador" => "aff1" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Nucleo Especializado de Tecnologia de Informacao (NETI), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "I" "identificador" => "aff1" ] 1 => array:3 [ "entidad" => "Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR" "etiqueta" => "II" "identificador" => "aff2" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 383 "Ancho" => 607 "Tamanyo" => 21108 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Rescheduled medical consultations (2020) via the application.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="para10" class="elsevierStylePara elsevierViewall">In the past few decades, academic healthcare centers have positively impacted medical care quality by establishing well-structured information technology (IT) departments to address medical and research issues globally (<a class="elsevierStyleCrossRef" href="#bib1">1</a>,<a class="elsevierStyleCrossRef" href="#bib3">3</a>). However, information technology is not a panacea to solve all problems concerning healthcare; many aspects of applying IT need to be assessed, such as safety, organization, and environment (<a class="elsevierStyleCrossRef" href="#bib6">6</a>). Nevertheless, IT possesses great potential for creatively resolving and answering the challenges that risky situations pose to society.</p><p id="para20" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic is an extraordinary challenge since, unlike the Spanish flu pandemic in 1918, which took approximately a year to spread worldwide, its infection disseminated in a few weeks (<a class="elsevierStyleCrossRef" href="#bib5">5</a>). COVID-19, an acute viral infection caused by the novel coronavirus (SARS-CoV-2), was initially detected in Wuhan, China, in December 2019. Due to the virus’s high transmissibility and the severity of the disease, the World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern under the International Health Regulations (2005) (<a class="elsevierStyleCrossRef" href="#bib8">8</a>).</p><p id="para30" class="elsevierStylePara elsevierViewall">Healthcare systems around the world utilized various resources, such as science and technology, in preparation to handle the COVID-19 pandemic. Fortunately, several digital technologies that assisted in tackling COVID-19 infections were mature enough at the start of 2020 to be applied to the field of medicine. Ting et al. (<a class="elsevierStyleCrossRef" href="#bib12">12</a>) divided these digital technologies into four groups: Internet of Things (IoT), big data analytics, artificial intelligence (AI), and blockchain technology.</p><p id="para40" class="elsevierStylePara elsevierViewall">The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP)—the most extensive university-affiliated hospital in São Paulo City, Brazil—played an essential role in diagnosing and treating the highly complex COVID-19 cases. Since the end of March 2020, the hospital has reserved one of its largest buildings—with 500 beds and 300 adult intensive care unit (ICU) beds—to treat COVID-19 patients exclusively. Furthermore, all of the hospital's sectors were utilized to deal with COVID-19 patients.</p><p id="para50" class="elsevierStylePara elsevierViewall">According to Ting et al. (<a class="elsevierStyleCrossRef" href="#bib12">12</a>), the HCFMUSP utilized two of the aforementioned four digital technology groups, namely IoT and AI, in addition to telemedicine. Several departments were integral to effectively applying these resources: the IT department, Núcleo Especializado de Tecnologia de Informação (NETI), which manages the central administration systems and electronic health records; the Clinical Engineering Department, which provides and maintains the highly technological facilities and operational services at the hospital; the Clinical Director's Office, which promotes the development of health actions and services, supports professional training, and strives for comprehensive patient care; and lastly, the Crisis Management Committee, which was mobilized to assist with strategic planning (<a class="elsevierStyleCrossRef" href="#bib7">7</a>,<a class="elsevierStyleCrossRef" href="#bib11">11</a>,<a class="elsevierStyleCrossRef" href="#bib13">13</a>).</p><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">TECHNOLOGIES APPLIED AT THE HOSPITAL</span><p id="para60" class="elsevierStylePara elsevierViewall">Among their various statements, the WHO<span class="elsevierStyleSup">1</span> proposed the adoption of certain preventive measures against the virus, such as social distancing and staying at home (shelter-in-place). Consequently, traditional medical consultations were deemed risk factors.</p><p id="para70" class="elsevierStylePara elsevierViewall">Technological resources that allowed for remote medical practice were used to solve this problem. Keesara et al. (<a class="elsevierStyleCrossRef" href="#bib5">5</a>) commented that digital technologies have existed for decades, but that they did not exhibit extensive infiltration in the market due to heavy regulations, high costs, and shortages in technical support.</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">NETWORK INFRASTRUCTURE</span><p id="para80" class="elsevierStylePara elsevierViewall">Virtually all digital technologies require a network connection. Therefore, the existing network infrastructure at the hospital came under intense scrutiny. Consequently, to support the implementation of digital technology, investments to combat the COVID-19 pandemic had to be diverted to expenses concerning network communication and electrical infrastructures.</p><p id="para90" class="elsevierStylePara elsevierViewall">Fortunately, the hospital had installed a metropolitan network backbone meant to provide fast and reliable access to several available information systems in 2018. In turn, each institute should provide a local network infrastructure to connect to the main backbone. However, due to the space reserved for COVID-19 patients, the network needed to be reinforced, mainly with a focus on wireless access. In a joint effort with several sponsors, the hospital managed to set up a network on an emergency basis to supply the necessary connections.</p></span><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESCHEDULING MEDICAL APPOINTMENT</span><p id="para100" class="elsevierStylePara elsevierViewall">Using digital technologies was critical in facilitating communication with those patients and families who were long-term clients of large health systems (<a class="elsevierStyleCrossRef" href="#bib10">10</a>). Assigning the largest hospital building exclusively for COVID-19 patients, in combination with the social distancing and shelter-in-place protocols, necessitated extensive alterations to the scheduled consultations. All of the existing consultations scheduled for the first half of 2020 needed to be swiftly changed.</p><p id="para110" class="elsevierStylePara elsevierViewall">The NETI developed an application utilizing voice recognition technology that listed scheduled patients' consultations and phone numbers. The application screened patients that were available for phone calls, and subsequently connected them with a physician to reschedule. We found that, for cultural reasons, most patients preferred direct conversations with their physicians; confidence in automatic voice services is lacking, especially among low-income patients. Therefore, it is crucial to engage patients directly during the rescheduling process.</p><p id="para120" class="elsevierStylePara elsevierViewall">Between April 1<span class="elsevierStyleSup">st</span> and July 15<span class="elsevierStyleSup">th</span>, 66,259 rescheduling activities were facilitated through the application (<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>).</p><elsevierMultimedia ident="fig1"></elsevierMultimedia></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">BED MAPPING</span><p id="para130" class="elsevierStylePara elsevierViewall">Unfortunately, the planning and management concerning bed capacities had to be evaluated within an environment of uncertainty, variability, and limited resources (<a class="elsevierStyleCrossRef" href="#bib4">4</a>). With regard to the COVID-19 pandemic, above factors seem incredibly unfavorable.</p><p id="para140" class="elsevierStylePara elsevierViewall">The hospital reserved 500 beds and 300 ICU beds to accommodate the COVID-19 patients. Although the hospital already possessed a bed mapping web system, it was necessary to adapt it for this situation. The web system displays a dashboard panel which allow staff to monitor the occupied beds. Initially, the panel displayed limited data, such as patient identification; however, after the modifications made by NETI, the dashboards provided extensive information on the patients.</p><p id="para150" class="elsevierStylePara elsevierViewall">Between March 30<span class="elsevierStyleSup">th</span> and August 11<span class="elsevierStyleSup">th</span>, 2020, the average number of patients admitted daily was approximately 30.3, with a maximum of 56. Given this data, the need for bed mapping became apparent; moreover, we had to account for and control an aggravating factor: nosocomial infections occurred due to COVID-19's high virulence. For example, after a patient was discharged, the bed that they had occupied had to immediately undergo a sterilization process.</p></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle50">SUPPORT FOR CLINICAL STAFF</span><p id="para160" class="elsevierStylePara elsevierViewall">Due to the high virulence of COVID-19, all medical teams must continuously assess their health and look for any symptoms. Similarly, other hospital employees who were not in direct contact with patients also needed to be vigilant of their symptoms.</p><p id="para170" class="elsevierStylePara elsevierViewall">The Centro de Atendimento ao Colaborador (CEAC)—the hospital medical employee center—has been altered to deal solely with suspected COVID-19 cases since March 2020. To prevent the hospital team from dealing with crowding situations related medical support, NETI created an application that monitors the number of people in line for medical care. The center's concierge counts the number of people and records these values in the system. If the number is high, people can postpone their medical support visit until the number goes down. Additionally, the system calculates the expected waiting time based on the registered flux of people.</p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">TELEPRESENCE</span><p id="para180" class="elsevierStylePara elsevierViewall">All COVID-19 patients were strictly isolated inside the hospital. To avoid further contagion, their relatives and friends were forbidden from coming to the hospital and, subsequently, faced difficulties in getting news from their loved ones. Considering the complications of face-to-face communication during this pandemic, the HCFMUSP incorporated telepresence communication into its work routine, with the aim of bringing patients and the healthcare team closer to their families.</p><p id="para190" class="elsevierStylePara elsevierViewall">Additionally, with the adoption of remotely controlled robots, cross-contagion among the assistance teams as well as the amount of required personal protective equipment can be substantially reduced. Technically, the robot is only an adapted Apple iPad mounted on a remote-controlled propulsion system. The improvements made concerning the wireless network structure proved essential to these robots; they communicate through Wi-Fi.</p><p id="para200" class="elsevierStylePara elsevierViewall">Although telemedicine refers to relatively old technology (<a class="elsevierStyleCrossRef" href="#bib9">9</a>), the Federal Ministry of Health has only started regulating its practice under emergency conditions this year. The HCFMUSP established a telemedicine network to support clinical decisions for care patients and train several public hospitals connected to its network (<a class="elsevierStyleCrossRef" href="#bib2">2</a>). Expert intensive care physicians from the HCFMUSP remotely trained frontline healthcare professionals through the telemedicine network.</p></span><span id="cesec70" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">AI AND IMAGE ANALYSIS</span><p id="para210" class="elsevierStylePara elsevierViewall">The hospital's Instituto de Radiologia (Radiology Institute) launched an important initiative for developing deep learning algorithms that analyze X-ray and computerized tomography (CT) images. The project, named RadVid-19, resulted from a partnership with private companies.</p><p id="para220" class="elsevierStylePara elsevierViewall">The RadVid-19<span class="elsevierStyleSup">2</span> project aims to provide specialized support to hospitals in all regions of the country through AI analysis reports. Additionally, it offers a second opinion channel for interpreting CT and X-ray examinations of patients with positive or suspected diagnoses of COVID-19. The examinations and data obtained during the analyses will also aid the construction of a database concerning positive cases, which can support studies and research to combat the pandemic.</p></span><span id="cesec80" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">CONCLUSION</span><p id="para230" class="elsevierStylePara elsevierViewall">The COVID-19 pandemic brought the medical activities that take place inside a hospital under scrutiny. Drastic changes had to be made since even the face-to-face interaction between clinical staff and patients became hazardous due to the risk of contagion.</p><p id="para240" class="elsevierStylePara elsevierViewall">According to the examples above, IT hospital groups support the fight against the COVID-19 pandemic to a great extent. Combating the pandemic through the support of technological resources has made numerous contributions to medical treatments, many of which the hospital will thoroughly incorporate.</p></span><span id="cesec90" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">AUTHOR CONTRIBUTIONS</span><p id="para250" class="elsevierStylePara elsevierViewall">Ragazzo L contributed in article's conception, researcher, manuscript development and accountability. Puech-Leao P and de Luccia N contributed in critical revision and approval of the manuscript. Wolosker N contributed in article's conception and critical review. Saes G contributed in researcher and critical revision. Ritti-Dias RM and Kamikava DY contributed in researcher and statistical analysis. Kanikava D participated as researcher. Zerati AE contributed in article's conception, critical review and approval of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "cesec10" "titulo" => "TECHNOLOGIES APPLIED AT THE HOSPITAL" ] 1 => array:2 [ "identificador" => "cesec20" "titulo" => "NETWORK INFRASTRUCTURE" ] 2 => array:2 [ "identificador" => "cesec30" "titulo" => "RESCHEDULING MEDICAL APPOINTMENT" ] 3 => array:2 [ "identificador" => "cesec40" "titulo" => "BED MAPPING" ] 4 => array:2 [ "identificador" => "cesec50" "titulo" => "SUPPORT FOR CLINICAL STAFF" ] 5 => array:2 [ "identificador" => "cesec60" "titulo" => "TELEPRESENCE" ] 6 => array:2 [ "identificador" => "cesec70" "titulo" => "AI AND IMAGE ANALYSIS" ] 7 => array:2 [ "identificador" => "cesec80" "titulo" => "CONCLUSION" ] 8 => array:2 [ "identificador" => "cesec90" "titulo" => "AUTHOR CONTRIBUTIONS" ] 9 => array:2 [ "identificador" => "xack636768" "titulo" => "ACKNOWLEDGMENTS" ] 10 => array:1 [ "titulo" => "REFERENCES" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-12-16" "fechaAceptado" => "2021-01-04" "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara" id="cenpara10">No potential conflict of interest was reported.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig1" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 383 "Ancho" => 607 "Tamanyo" => 21108 ] ] "descripcion" => array:1 [ "en" => "<p id="spara10" class="elsevierStyleSimplePara elsevierViewall">Rescheduled medical consultations (2020) via the application.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec10" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The benefits of health information technology: a review of the recent literature shows predominantly positive results" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ MB Buntin \n \t\t\t\t\t\t\t\t """ 1 => """ MF Burke \n \t\t\t\t\t\t\t\t """ 2 => """ MC Hoaglin \n \t\t\t\t\t\t\t\t """ 3 => """ D Blumenthal \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Health Affairs (Millwood)" "fecha" => "2011" "volumen" => "30" "numero" => "3" "paginaInicial" => "464" "paginaFinal" => "471" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://doi.org/10.1377/hlthaff.2011.0178" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Use of telemedicine to combat the COVID-19 pandemic in Brazil" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => """ CRR Carvalho \n \t\t\t\t\t\t\t\t """ 1 => """ PG Scudeller \n \t\t\t\t\t\t\t\t """ 2 => """ G Rabello \n \t\t\t\t\t\t\t\t """ 3 => """ MA Gutierrez \n \t\t\t\t\t\t\t\t """ 4 => """ FB Jatene \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clinics (Sao Paulo)" "fecha" => "2020" "volumen" => "75" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://doi.org/10.6061/clinics/2020/e2217" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Systematic review: impact of health information technology on quality, efficiency, and costs of medical care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ B Chaudhry \n \t\t\t\t\t\t\t\t """ 1 => """ J Wang \n \t\t\t\t\t\t\t\t """ 2 => """ S Wu \n \t\t\t\t\t\t\t\t """ 3 => """ M Maglione \n \t\t\t\t\t\t\t\t """ 4 => """ W Mojica \n \t\t\t\t\t\t\t\t """ 5 => """ E Roth \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.7326/0003-4819-144-10-200605160-00125" "Revista" => array:7 [ "tituloSerie" => "Ann Intern Med" "fecha" => "2006" "volumen" => "144" "numero" => "10" "paginaInicial" => "742" "paginaFinal" => "752" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16702590" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.7326/0003-4819-144-10-200605160-00125" "WWW" => array:1 [ "link" => "https://doi.org/10.7326/0003-4819-144-10-200605160-00125" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Modelling for the planning and management of bed capacities in hospitals" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => """ PR Harper \n \t\t\t\t\t\t\t\t """ 1 => """ AK Shahani \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Journal of the Operational Research Society" "fecha" => "2002" "volumen" => "53" "numero" => "1" "paginaInicial" => "11" "paginaFinal" => "18" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://doi.org/10.1057/palgrave/jors/2601278" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Covid-19 and Health Care’s Digital Revolution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ S Keesara \n \t\t\t\t\t\t\t\t """ 1 => """ A Jonas \n \t\t\t\t\t\t\t\t """ 2 => """ K Schulman \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1056/NEJMp2005835" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2020" "volumen" => "382" "numero" => "23" "paginaInicial" => "e82" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32240581" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1056/NEJMp2005835" "WWW" => array:1 [ "link" => "https://doi.org/10.1056/NEJMp2005835" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Problems with health information technology and their effects on care delivery and patient outcomes: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ MO Kim \n \t\t\t\t\t\t\t\t """ 1 => """ E Coiera \n \t\t\t\t\t\t\t\t """ 2 => """ F Magrabi \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1093/jamia/ocw154" "Revista" => array:7 [ "tituloSerie" => "J Am Med Inform Assoc" "fecha" => "2017" "volumen" => "24" "numero" => "2" "paginaInicial" => "246" "paginaFinal" => "250" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28011595" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1093/jamia/ocw154" "WWW" => array:1 [ "link" => "https://doi.org/10.1093/jamia/ocw154" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiologic Surveillance in an academic hospital during the COVID-19 pandemic in Sao Paulo, Brazil: the key role of epidemiologic engagement in operational processes" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ I Marcilio \n \t\t\t\t\t\t\t\t """ 1 => """ A Miethke-Morais \n \t\t\t\t\t\t\t\t """ 2 => """ L Harima \n \t\t\t\t\t\t\t\t """ 3 => """ AC Montal \n \t\t\t\t\t\t\t\t """ 4 => """ B Perondi \n \t\t\t\t\t\t\t\t """ 5 => """ JRCM Ayres \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clinics (Sao Paulo)" "fecha" => "2020" "volumen" => "75" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://doi.org/10.6061/clinics/2020/e2166" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Covid-19 strategic preparedness and response plan - operational planning guidelines to support country preparedness and response" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => """ WHO \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "Available from: https://www.who.int/docs/default-source/coronaviruse/covid-19-sprp-operational-planning-guidelines-to-support-country-preparedness-and-response-(22may20).pdf" "fecha" => "2020" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Using telemedicine to improve health care in distant areas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => """ J Preston \n \t\t\t\t\t\t\t\t """ 1 => """ FW Brown \n \t\t\t\t\t\t\t\t """ 2 => """ B Hartley \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1176/ps.43.1.25" "Revista" => array:7 [ "tituloSerie" => "Hosp Community Psychiatry" "fecha" => "1992" "volumen" => "43" "numero" => "1" "paginaInicial" => "25" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1544643" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1176/ps.43.1.25" "WWW" => array:1 [ "link" => "https://doi.org/10.1176/ps.43.1.25" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and economic strategies in outpatient medical care during the COVID-19 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ DA Provenzano \n \t\t\t\t\t\t\t\t """ 1 => """ BT Sitzman \n \t\t\t\t\t\t\t\t """ 2 => """ SA Florentino \n \t\t\t\t\t\t\t\t """ 3 => """ GA Buterbaugh \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1136/rapm-2020-101640" "Revista" => array:7 [ "tituloSerie" => "Reg Anesth Pain Med" "fecha" => "2020" "volumen" => "45" "numero" => "8" "paginaInicial" => "579" "paginaFinal" => "585" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32475827" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1136/rapm-2020-101640" "WWW" => array:1 [ "link" => "https://doi.org/10.1136/rapm-2020-101640" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rapid response to COVID-19: health informatics support for outbreak management in an academic health system" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ JJ Reeves \n \t\t\t\t\t\t\t\t """ 1 => """ HM Hollandsworth \n \t\t\t\t\t\t\t\t """ 2 => """ FJ Torriani \n \t\t\t\t\t\t\t\t """ 3 => """ R Taplitz \n \t\t\t\t\t\t\t\t """ 4 => """ S Abeles \n \t\t\t\t\t\t\t\t """ 5 => """ M Tai-Seale \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1093/jamia/ocaa037" "Revista" => array:7 [ "tituloSerie" => "J Am Med Inform Assoc" "fecha" => "2020" "volumen" => "27" "numero" => "6" "paginaInicial" => "853" "paginaFinal" => "859" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32208481" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1093/jamia/ocaa037" "WWW" => array:1 [ "link" => "https://doi.org/10.1093/jamia/ocaa037" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Digital technology and COVID-19" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => """ DSW Ting \n \t\t\t\t\t\t\t\t """ 1 => """ L Carin \n \t\t\t\t\t\t\t\t """ 2 => """ V Dzau \n \t\t\t\t\t\t\t\t """ 3 => """ TY Wong \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1038/s41591-020-0824-5" "Revista" => array:7 [ "tituloSerie" => "Nat Med" "fecha" => "2020" "volumen" => "26" "numero" => "4" "paginaInicial" => "459" "paginaFinal" => "461" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32284618" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1038/s41591-020-0824-5" "WWW" => array:1 [ "link" => "https://doi.org/10.1038/s41591-020-0824-5" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospital preparedness for mass critical care during SARS-CoV-2 pandemic" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => """ T Wurmb \n \t\t\t\t\t\t\t\t """ 1 => """ K Scholtes \n \t\t\t\t\t\t\t\t """ 2 => """ F Kolibay \n \t\t\t\t\t\t\t\t """ 3 => """ N Schorscher \n \t\t\t\t\t\t\t\t """ 4 => """ G Ertl \n \t\t\t\t\t\t\t\t """ 5 => """ R Ernestus \n \t\t\t\t\t\t\t\t """ ] ] ] ] ] "host" => array:2 [ 0 => array:2 [ "doi" => "10.1186/s13054-020-03104-0" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2020" "volumen" => "24" "numero" => "1" "paginaInicial" => "386" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32605581" "web" => "Medline" ] ] ] ] 1 => array:2 [ "doi" => "10.1186/s13054-020-03104-0" "WWW" => array:1 [ "link" => "https://doi.org/10.1186/s13054-020-03104-0" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack636768" "titulo" => "ACKNOWLEDGMENTS" "texto" => "<p id="para260" class="elsevierStylePara elsevierViewall">We wish to gratefully acknowledge Antonio José Rodrigues Pereira, the CEO of HCFMUSP; Prof Dr Eloisa Maria Silva Dutra de Oliveira Bonfá, our Clinical Director; Djavan Nonato and Gisele Pereira from the corporate IT team for their partnership during this journey; and Geraldo Busatto Filho (LIM-21 HCFMUSP) for his comments and support for the summary of projects.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/18075932/000000760000000C/v1_202211191031/S1807593222001351/v1_202211191031/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/18075932/000000760000000C/v1_202211191031/S1807593222001351/v1_202211191031/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1807593222001351?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 36 | 19 | 55 |
| 2024 September | 34 | 16 | 50 |
| 2024 August | 52 | 14 | 66 |
| 2024 July | 47 | 26 | 73 |
| 2024 June | 28 | 6 | 34 |
| 2024 May | 46 | 14 | 60 |
| 2024 April | 33 | 18 | 51 |
| 2024 March | 18 | 11 | 29 |
| 2024 February | 26 | 17 | 43 |
| 2024 January | 18 | 14 | 32 |
| 2023 December | 13 | 25 | 38 |
| 2023 November | 17 | 32 | 49 |
| 2023 October | 21 | 29 | 50 |
| 2023 September | 18 | 26 | 44 |
| 2023 August | 26 | 5 | 31 |
| 2023 July | 13 | 22 | 35 |
| 2023 June | 17 | 7 | 24 |
| 2023 May | 26 | 8 | 34 |
| 2023 April | 47 | 8 | 55 |
| 2023 March | 45 | 1 | 46 |
| 2023 February | 24 | 9 | 33 |
| 2023 January | 15 | 2 | 17 |
| 2022 December | 27 | 1 | 28 |
| 2022 November | 8 | 3 | 11 |
Show all