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  • Küçük Resim
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    A two-stage diagnosis strategy for COVID-19 and similar pandemics
    (Türkiye Klinikleri, 2021) Koçak, Mehmet; Cece, Sinem; Türkay, Tuğçe
    Objective: Coronavirus disease-2019 (COVID-19) outbreak emerged in Wuhan-China in December-2019, and has covered the world by rapidly becoming a pandemic, infecting >4.5 million by mid-May 2020, killing >300,000 globally, and >90 million people tested. Several rapid test kits based on antibody response have been developed but the reverse transcriptionpolymerase chain reaction (RT-PCR) approach for its superior sensitivity and specificity. As rapid detection of the virus is vital, we propose a two-stage testing framework that utilizes antibodydiagnostic kits and refers to RT-PCR only when a decision cannot be made. Material and Methods: In this study, using the Bayes formula and independent tests assumption, we developed several “repeat-testing” strategies to increase the overall sensitivity and specificity of both tests. We compared the false negatives, false positive, burden on the testing centres, and predicted cost among strategies. Results: We have shown that it is possible to increase the diagnostic capabilities of poor tests, “repeat” testing strategies. The primary advantage of such approaches is the faster diagnosis of cases, which allows for timely isolation, quarantine, and affiliation work. Also such strategies reduce the burden on the RT-PCR testing laboratories, thus, allowing them to focus their efforts to individuals that are more difficult to diagnose. The cost-comparison we conducted also suggests that this proposed is more cost-effective. Conclusion: The two-stage diagnostic strategy for COVID-19 is more efficient regarding pandemic management as it provides the testing results more quickly for the majority of suspected cases, allowing for timely isolation and affiliation work, and more cost-effective, reducing the burden on the healthcare system.
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    Analysis of the effect of digital hospital efforts on paper savings in inpatient procedures and on the duration of nursing care services
    (2024) Volkan, Esra; Köse, İlker; Cece, Sinem; Elmas, Özge
    Background: This study has two primary objectives. Firstly, it aims to measure the time savings achieved through the digitization of paper forms filled out by nurses in the inpatient care process. Secondly, it seeks to reveal the financial savings resulting from reduced paper consumption due to the digitalization. The Health Information Management System Society (HIMSS)—Electronic Medical Record Adaption Model (EMRAM), which makes stage-based (0–7) evaluations, serves as a tool to measure the rate of technology utilization in public hospitals in Turkey. The study is based on the HIMSS EMRAM criteria for 2018. Bahçelievler State Hospital, a public hospital in Turkey, was chosen as the research facility. In 2017, it was accredited as Stage 6 with HIMSS EMRAM. However, not all its wards have been digitalized. Initially, pilot selected wards were digitized. Therefore, digital and non-digital wards serve together. In this context, 4 wards were randomly selected and time, paper and toner savings before and after digitalization were measured. Method: A table was created in Microsoft Excel,listing the forms used by nurses in inpatient care and the time required to fill them out.The time spent for filling paper-based forms and digital-based forms was measured in randomly selected wards. Result: The analysis showed that digital forms saved more time, paper and toner. For example, filling out the patient history form took 45?min when using paper, compared to 12?min in digital environment. Approximately 27% time savings are achieved only for the patient history form. The total time savings delivered by digitalization for 1,153 inpatients during the year were found as 117 care days, and the savings on total paper consumption was 41.289 pages. For 1,153 inpatients throughout the year, the total time savings from digitalization was 117 care days and the total paper consumption savings was 41,289 pages. In addition, in 4 wards with a total bed capacity of 25, annual paper savings of $1,705.86 and toner savings of $283,736 were achieved. Discussion: This study reveals the benefits of digitalisation in hospitals for nurses. It saves the time that nurses allocate for filling out paper forms with digitalised forms. Thus, it is a good practice example in terms of using the time allocated for form filling for patient care.When we extend this study to Turkey in general, it can be considered that the time savings achieved by nurses by digitizing inpatient forms varies between 10.8% and 13%. The number of nurses working in public hospitals in Turkey is approximately 160,000. Assuming that 60% of the nurses work in the inpatient ward, it is understood that the annual savings achieved by digitizing the forms corresponds to a range of 398–559 nursing hours. 2024 Volkan, Köse, Cece and Elmas.
  • Küçük Resim
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    Basic electronic health record (EHR) adoption in **Türkiye is nearly complete but challenges persist
    (BioMed Central Ltd, 2023) Köse, İlker; Cece, Sinem; Yener, Songül; Seyhan, Senanur; Özge Elmas, Beytiye; Rayner, John; Birinci, Şuayip; Ülgü, Mustafa Mahir; Zehir, Esra; Gündoğdu, Berrin
    Background: The digitalization studies in public hospitals in Türkiye started with the Health Transformation Program in 2003. As digitalization was accomplished, the policymakers needed to measure hospitals’ electronic health record (EHR) usage and adoptions. The ministry of health has been measuring the dissemination of meaningful usage and adoption of EHR since 2013 using Electronic Medical Record Adoption Model (EMRAM). The first published study about this analysis covered the surveys applied between 2013 and 2017. The results showed that 63.1% of all hospitals in Türkiye had at least basic EHR functions, and 36% had comprehensive EHR functions. Measuring the countrywide EHR adoption level is becoming popular in the world. This study aims to measure adoption levels of EHR in public hospitals in Türkiye, indicate the change to the previous study, and make a benchmark with other countries measuring national EHR adoption levels. The research question of this study is to reveal whether there has been a change in the adoption level of EHR in the three years since 2018 in Türkiye. Also, make a benchmark with other countries such as the US, Japan, and China in country-wide EHR adoption in 2021. Methods: In 2021, 717 public hospitals actively operating in Türkiye completed the EMRAM survey. The survey results, deals with five topics (General Stage Status, Information Technology Security, Electronic Health Record/Clinical Data Repository, Clinical Documentation, Closed-Loop Management), was reviewed by the authors. Survey data were compared according to hospital type (Specialty Hospitals, General Hospitals, Teaching and Research Hospitals) in terms of general stage status. The data obtained from the survey results were analyzed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured. Results: We found that 33.7% of public hospitals in Türkiye have only basic EHR functions, and 66.3% have extensive EHR functions, which yields that all hospitals (100%) have at least basic EHR functions. That means remarkable progress from the previous study covering 2013 and 2017. This level also indicates that Türkiye has slightly better adoption from the US (96%) and much better than China (85.3%) and Korea (58.1%). Conclusions: Although there has been outstanding (50%) progress since 2017 in Turkish public hospitals, it seems there is still a long way to disseminate comprehensive EHR functions, such as closed-loop medication administration, clinical decision support systems, patient engagement, etc. Measuring the stage of EHR adoption at regular intervals and on analytical scales is an effective management tool for policymakers. The bottom-up adoption approach established for adopting and managing EHR functions in the US has also yielded successful results in Türkiye.
  • Küçük Resim
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    Comparative analysis of joint commission international and healthcare information and management systems - electronic medical record adoption model measurement models using text mining
    (Association of Nurse Managers, 2022) Cece, Sinem; Köse, İlker
    Introduction: Health service quality refers to all efforts to prevent a negative outcome in the health status of individuals. For this reason, measuring and evaluating the quality of health services is important to increase the quality of services provided. Aim: In this study, Joint Commission International’s (JCI) accepted indicator-based health service quality measurement model and the Healthcare Information and Management Systems Society’s (HIMSS)-Electronic Medical Record Adoption Model (EMRAM) are discussed. Method: This research used the bag-of-words model (BoW), a text mining method. Result: As a result of the analysis, the similarity of keywords (as unigrams) used in all of the guides was found to be approximately 33%, the bigram similarity was 6% and the trigram similarity was 3%. Conclusion: The fact that the similarity between the two models is not higher can be explained by the fact that, unlike JCI, the HIMSS EMRAM model handles the quality of health services with a digitalization axis. Text mining opens up new research areas as a method for comparing quality standards with new and interesting results.
  • Küçük Resim
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    The effect of digitalization of nursing forms in ICUs on time and cost
    (BMC, 2023) Yılmaztürk, Nevin; Köse, İlker; Cece, Sinem
    ObjectiveIntensive Care Units are one of the areas with the lowest digitization rate. This study aims to measure the effect of digitizing medical records kept in paper forms in ICUs on time-saving and paper consumption. In our study, care forms in ICUs were transferred to digital media. In our research, care forms in ICUs were transferred to digital media.MethodsThe time required to fill out the nursing care forms on paper and digital media was measured, the change in paper and printer costs was determined, and the results were compared. Two volunteer nurses working in the ICU of a university hospital in Istanbul measured the time it took to fill out the forms of patients on paper. Then, a future projection was made using digital form data of 5,420 care days of 428 patients hospitalized between October 2017 and September 2018. Only anonymous data of patients hospitalized in the general ICU were used, and other untempered were not included in the study.ResultsWhen the forms were filled in digitally by the nurses, one nurse per patient per day saved 56.82 min (3.95% per day).DiscussionHealth care services are provided in hospitals in Turkey with 28,353 adult intensive care beds and an occupancy rate of 68%. Based on the occupancy rate of 68%, the number of full beds is 19,280. When 56.82 min are saved per bed from the forms filled by the nurses, 760.71 care days are dedicated. Considering the salary of 1,428.67 US dollars per nurse, the savings to be achieved are estimated to be 13,040,804.8 US dollars per year.
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    Türkiye'de sağlık hizmet kalitesi için kullanılan ölçeklerin karşılaştırmalı analizi yapılarak post-modern işletme yönetimi yaklaşımlarına uygun ve özgün bir sağlıkta kalite ölçüm modelinin geliştirilmesi
    (İstanbul Medipol Üniversitesi, Sosyal Bilimler Enstitüsü, 2022) Cece, Sinem; Köse, İlker
    Kalite standartları; sağlık hizmetlerinin dinamik yapısının yönetilmesini, belirsizliklerin azaltılmasını ve hataların önlenmesini sağlayan bir unsurdur. Çünkü kalite; ölçme, değerlendirme ve sürekli iyileştirme esaslarına bağlıdır. Kalite kavramı, kalite yönetim modelleri, kalite ölçüm modelleri ve kalite iyileştirme araçlarını içermektedir. Bu kapsamda hastayı merkeze alan, hasta güvenliğini amaçlayan ve hizmetlerin kalitesini sürekli iyileştirerek yaşam kalitesini ve sunulan hizmet kalitesini iyileştirmeyi hedefleyen bir hizmet anlayışı ortaya konulmaya çalışılmaktadır. Türkiye'de sağlık hizmet kalitesinin ölçümünde kullanılan ulusal ve uluslararası modeller bulunmaktadır. Bu modeller, vaka bazlı ve gösterge bazlı olarak iki gruba ayrılmaktadır. Bu çalışmada Türkiye'de yaygın olarak kullanılmakta olan gösterge bazlı (SKS-Hastane Versiyon 6, HIMSS-EMRAM Preparatory Guide 2020, JCI Accreditation Standards for Hospitals, 6th Edition) kalite ölçüm modelleri ele alınmıştır. Bu tezin amacı, gösterge bazlı olan sağlıkta kalite ölçüm modelleri arasında yer alan Joint Comission International (JCI), Sağlıkta Kalite Standartları (SKS) ve Health Information Management System Society-Electronic Medical Record Adaptation Model (HIMSS-EMRAM) modellerinin kavram, süreç ve kriterlerinin karşılaştırmalı olarak analiz edilmesi ve bu modellerin post-modern işletme yönetimi yaklaşımını kapsamalarını sağlayacak şekilde özgün ve yeni standartlarla genişletilmesidir. Standartlar geliştirilirken Delphi Tekniği, Metin Madenciliği, Doküman İncelemesi ve İstatiksel Yöntem (SPSS) yöntemleri kullanılmıştır. Elde edilen sonuçlar ile, SKS-Hastane Versiyon 6, HIMSS-EMRAM Preparatory Guide 2020, JCI Accreditation Standards for Hospitals, 6th Edition dokümanları ele alınarak post-modern işletme yönetimi yaklaşımlarını kapsayacak şekilde özgün bir standart seti öneri olarak literatüre sunulmuştur. Ayrıca literatürde bu üç modeli kapsayan ve bu modelleri post-modern yönetim yaklaşımlarını da kapsayacak şekilde ele alan ve standart seti öneresinde bulunan bir çalışmaya rastlanılmaması literatüre olan katkısını da ortaya koymaktadır.